BALLARAT HEALTH SERVICES STRATEGIC PLAN 2014 2017 Adopted by the Board of Management of Ballarat Health Services, March 2014 Approved by the Minister for Health, November, 2014. 1 P age
CONTENTS Vision Mission and Values.. 3 From the Chair and Board of Management.. 4 Who we are and who we serve.. 5 Beyond the Boundaries.. 7 Achievements from the 2010 2013 Strategic Plan.. 9 Service and Capital Achievement during 2010 2013 Strategic Plan.. 10 period The Service Environment.. 12 Regional Health Status and local health content.. 13 Health Status Indicators.. 15 Health utilization in the Grampians Region. 16 Policy Context.. 17 Visioning the Future Key Challenges.. 18 Alignment with Victorian Health Priority Areas.. 19 List of Appendices.. 24 Appendix 1 : BHS locality map.. 25 Appendix 2: BHS Service Profile.. 26 Appendix 3: Grampians Region (and Associated) Hospital Network.. 27 BHS Strategic Direction 1: Provide Quality Health Care.. 28 BHS Strategic Direction 2: Provide an informed, inclusive and.. 29 positive patient experience BHS Strategic Direction 3: Actively promote partnerships and.. 30 leadership in our region BHS Strategic Direction 4: Achieve and Enhance Sustainability.. 31 BHS Strategic Direction 5: Foster Excellence and Innovation.. 33 References.. 35 2 P age
The Vision of BHS is: Vision, Mission and Values The Vision of BHS is : Excellence in Health Care The Mission of BHS is: To deliver quality care to the communities we service by providing safe, accessible and integrated health services resulting in positive experiences and outcomes. The Values of BHS are: Our services and staff embrace the following: Compassion fair and caring to all those we come into contact with, even during difficult times. We treat others as we would expect to be treated. Integrity behaving in accordance with our professional, ethical and legislative requirements. Using our resources responsibly and transparently, we are honest and trustworthy. We uphold the dignity and rights of ourselves, patients, relatives, carers, colleagues and members of the community. We value the people we work with and their work. Excellence striving to attain the highest standards of service delivery and clinical practice. We achieve this by acknowledging, recognising and promoting innovation, participating in continuous learning, development, training and research. We come to work to make a difference. Collaboration involving staff and services both internally and externally in decision making, sharing our knowledge and experiences to build a better health system. Together we work in partnership with our patients, their families, carers and our colleagues. Accountability understanding our role in providing a safe environment for staff, patients, visitors and members of the community. We take personal responsibility to maintain the necessary skills and competencies required by our roles and encourage others to do the same. We acknowledge that at times errors occur and we are accountable for them. If we make mistakes, we support each other to correct them and be open about them in order to learn and prevent their recurrence. 3 P age
The Chair of the Board and Chief Executive Officer of Ballarat Health Services (BHS) commit the Strategic Plan 2014 2017 to you as a vision, a guide and a challenge. BHS is built on a proud history and now provides services as a leading regional health service with strong links to smaller health services as well as metropolitan health services. Meeting the health needs of the community in a spirit of excellence, inclusion and collaboration is the key driver for BHS. Enhancing service delivery capacity throughout the Region has been demonstrably achieved and remains a high priority. The result for our community is greater access to health care closer to home. As a consequence of the adoption of the 2006 Strategic Services Plan and Model of Care Report, BHS has actively pursued master planning and expansion of facilities. Significantly, several of the key masterplan building projects were in response to regional need to expand and integrate health care, particularly in relation to cancer care. The Ballarat Regional Integrated Cancer Centre (BRICC) is the cornerstone for collaborative cancer care. The delivery of outreach services, the development of local skills and partnerships with health services, primary care providers and consumers will be critical to the development of region wide clinical capability. For the patient, this means delivering the right care in the right place at the right time. BHS also has a focus on expanding non bed based services and has expanded Hospital in the Home (HITH) capacity and is implementing Geriatric Evaluation and Management in the Home (GITH) in addition to building partnerships that increase access to surgical and other clinical services within the Grampians Region. This Strategic Plan is aligned with the Victorian Health Priorities Framework 2012 2022 and Government Rural and Regional Health policy. BHS has an immensely capable workforce. Timed with the rollout of the Australian Commission on Safety and Quality in Health Care, NSQHS Standards and the launch of service wide innovation programs, the Better, Healthier, Safer (BHS) platform is being established to guide and support our staff. The aim is to effectively transform an organisation that, as one team, delivers on the promise of the best health care possible for the community through service expansion, redesign and innovation. The Board of Management in confirming the following five strategic directions in this Plan, presents the strategy upon which our success and provision of services to the community will be measured: Provide quality healthcare Provide an informed, inclusive and positive patient experience Actively promote partnerships and leadership in our region Achieve and enhance sustainability Foster excellence and innovation Andrew Faull Chair, Board of Management Andrew R. Rowe, Chief Executive Officer 4 P age
Who we are and who we serve BHS is the largest regional health services and principal referral centre in the Grampians Region Patient catchment boundaries extend from Bacchus Marsh to the South Australian border, an area of more than 48,000 square kilometres. Nearly 250,000 people, or 4.4% of the Victorian population, live in the Grampians region. As the major centre within the region, the City of Ballarat is located approximately 110 kilometres west of Melbourne. Ballarat is at the centre of some of Victoria s most important freight, tourist and commuter transport routes which strengthens its role as a regional service hub. Housing and infrastructure developments in the western corridor of the city are increasing and population estimates indicate an increasing trend for commuting between Ballarat and Melbourne over the next ten years. Established as a single entity public Health Service in 1997, BHS combined the Ballarat Base Hospital, Queen Elizabeth Centre and Grampians Psychiatric Services. BHS maintains a strong commitment to clinical teaching with strong links to the University of Melbourne, Deakin, Australian Catholic and Federation Universities. BHS also maintains a high profile in the residential aged care and community service sector within the region. BHS operates from two major sites, Ballarat Base Hospital site and the Queen Elizabeth Centre. Each site is located close to the central business district with the remaining residential, day centres and community sites located throughout Ballarat. Service locations are detailed in Appendix 1 and the list of services provided are included in Appendix 2. BHS is the major employer within the City of Ballarat with over 3, 800 employees who deliver care to our patients and clients as well as supporting their families and visitors over the acute, residential aged care, sub acute, community and mental health settings. The clinical and corporate team is supported with a growing volunteer community of more than 300 members who are dedicated to assisting patients as vital members of the health care team. 5 P age
The partnership with consumers, families, carers and the community is embedded in our service provision. Consumer participation which informs planning, redesigning service delivery and assessment of health outcomes has been incorporated into all clinical health care streams. Patient and family centred goals to deliver better, healthier and safer health care are supported by the recent system wide expansion of consumer input. BHS is a learning organisation in which the voice of patients and community has shaped the design and delivery of services, the most recent of which is the Ballarat Regional Integrated Cancer Centre. 6 P age
Beyond the Boundaries During the life of this Strategic Plan, BHS plans to expand its flexibility in service configuration according to seasonal, ordinary and extraordinary demand periods and in response to the needs of other smaller health services. BHS regards strong and collaborative links as vital to meeting current and future needs of the population that we serve. Better integration of services locally and at the regional level is fundamental to better meeting the needs of the community. Key reform initiatives across the care continuum are being actively pursued and will build on the clinical service achievements gained in the previous Strategic plan. A number of mutually beneficial and unique collaborative arrangements exist within the region. Operational outcomes will continue to be reviewed in order to assess access and quality along with patient and community satisfaction. Further discussions are to occur to ascertain if the service models can be extended more broadly into the region. BHS and Ballan District Health Care have established a collaboration in the form of sitting two acute public health beds in the Ballan Hospital. This is a significant and unique initiative and provides benefits in terms of capacity building in Ballan. This service development was designed as a new regional service delivery model to bring hospital care closer to home for residents in the Ballan catchment. Strong collaboration and support for the Ballan satellite beds by the Department of Health was a key driver in the establishment and operation of the service model. The potential expansion of partnerships in multidisciplinary ambulatory care, hospital re admission prevention and community programs linkage is in the assessment phase. The opening of the Ballarat Regional Integrated Cancer Centre (BRICC) has improved accessibility to medical oncology and radiotherapy services including the commencement of outreach services in Stawell. Weekly visiting medical oncology services delivered by BHS Medical Oncology is in place at Stawell Regional Health and most recently specialised chemotherapy outreach has been established. This not only means care closer to home for residents of Stawell and surrounding communities but also enhances professional development of clinicians, access to supervision as well as enhanced retention and satisfaction of staff. Commitment to regional education is a key priority that enables BHS to support its leadership and development role. Central to enhanced access to educational information and live interactive sessions, the use of teleconferencing to extend the reach to clinicians throughout the region is a developing platform for BHS. The analysis of regional information technology needs will be foremost in continuing to improve access, speed, flexibility and integration of education with innovative clinical service delivery. The Grampians Palliative Care visiting service is an exemplar on which BHS will seek to expand telemedicine capacity as this has been a patient and family focused link which has enhanced end of life care throughout the region. Telemedicine capacity analysis focused on partnering with local clinicians caring for patients for whom chronic disease has developed or for those at risk of developing chronic disease will be undertaken. Geriatric medicine is another key area in which telemedicine has enhanced access in the outer western part of the region following the introduction of a pilot program. Planning to provide rehabilitation physician access to Horsham and Stawell in 2014 is underway will further develop the rehabilitation and geriatric medicine network within the Grampians Region. 7 P age
BHS as part of a collaborative team, has continued to increase clinical education opportunities in the region through the daily scheduling of Simvan, a mobile clinical training vehicle available to visit health services throughout the region so that clinical competencies can be assessed and further developed. Simvan has proved to be a vital regional educational service providing the opportunity for local clinicians to further develop skills and review their performance in clinical scenario settings. 8 P age
Achievements from the 2010 2013 Strategic Plan Grampians Breastscreen facility established ensuring timely access for women in the region Radiology procedures increased by 16% with greater capacity and reduced waiting time Interventional radiology procedures increased by 12% and additional procedures provided through the cardiovascular service Funding success from the Hospitals and Health Fund to construct a new Dental Clinic at Phoenix College Surgical Services collaboration to reduce waiting times and improve access to surgery closer to home through multiple partnerships in the region with St John Of God Ballarat Hospital, Ballarat Day Procedure Unit, Hepburn Health and Stawell Regional Health. Review and redesign of the Diabetic Service including an expansion of an ambulatory care model Chemotherapy Day Unit redesign creating increased capacity and staff satisfaction Education on line portal established for Emergency Department education Two Acute public beds established in Ballan enabling additional capacity Establishment of a fortnightly visiting program to four community based palliative care services by the Grampians Palliative Care Team Bridging the Care initiative in BHS Residential Aged Care facilities through implementation of Advance Care Directives High Risk Maternity Clinic established Cardiac pathways implemented Development of a stroke pathway Risk assessment tools developed for the Acute Adult Mental Health Unit Child and Youth Mental Health Service Redesign project successfully established with exceptional results achieved and recurrent funding allocated by the Minister for Mental Health Ongoing collaboration with Ballarat and District Aboriginal Co Operative to enhance aboriginal health status consistent with the Closing the Gap initiative. 9 P age
Service and Capital Achievements during 2010 2013 Strategic Plan period BRICC Opened on 13 March, 2013 Multidisciplinary care a key component Cancer specific allied health services provided Partnership with Austin Health for delivery of radiation oncology services established Haematology service commenced Clinical team and multi agency case conferencing integration Wellness Centre opened McGrath Breast Care Nurses relocated to the BRICC Partnership in Care Coordination role developed Supportive Care screening established Additional research and clinical trials established Volunteer roles expanded in BRICC The journey for patients and families touched by cancer is made easier Tremendous community pride in BRICC Cardiovascular Suite (CVS) Service model maximizes interventional procedures cardiac and interventional radiology Door to balloon time for Percutaneous Cardiac Intervention within 90 mins increased from 43% 75% Reduced death and disability Rigorous care pathway established with incoming critical cardiac patient alert implemented Regional framework for acute cardiac syndrome developed aimed at standardizing care for patients presenting at regional facilities Collaboration with Ambulance Victoria, Ambulance Retrieval Victoria and regional partners Cardiac clinical research trials underway 10 P age
Infrastructure projects Emergency Department redevelopment including Short Stay Unit and Fast Track area completed Deakin Health School refurbished Mental Health Adult Acute Unit redeveloped Special Care Nursery redeveloped Midwifery outpatients clinic expanded 11 P age
The Service Environment The regional environment in which BHS operates, impacts and shapes the future direction of the Health Service in terms of service development and the innovative ways in which those services are delivered. Recent opportunities to access additional funding to reduce surgical waiting lists have proved to be effective with new surgical networks being set up within the region for low acuity surgical procedures while the high acuity surgical care will continue at BHS. Community benefits for this approach are evident in the Grampians region and BHS aims to analyse where future capacity exists to expand access to surgery. The context of National and State Health Reform along with sustainability in general has led BHS to continue carefully reviewing existing service arrangements against changes to funding criteria specified by Activity Based Funding and the diminishing financial viability associated with Residential Aged Care Services. BHS has developed a very high profile in the region for both residential aged care and home based or community provided care packages. Consequently, the way in which BHS responds to these challenges will require careful consideration. With regard to acute and sub acute health care, BHS has a significant reach into the community having developed strong collaboration with St John of God Ballarat Hospital, Ballarat Day Procedure Centre, Ballarat Community Health, Ballarat & District Aboriginal Co Operative and the regional health services. Established and new partnerships to shape services in response to regional health indicators will continue to be developed. Episodic acute and transitional sub acute to aged care residential models of care are examples of the flexibility in service mix that BHS continues to develop. While early intervention is an established approach at BHS, health promotion activities continue to be developed. Strongly linked to long term initiatives relating to partnering with primary health care, BHS is widening its scope in relation to how improvements in health literacy can be achieved and sustained. Hospital readmission and post acute care models now have a strong health independence and educative focus. BHS sees this as an important strategy to help patients manage their health proactively. The learnings from these health independence programs will be monitored and expanded where appropriate. Demographics: The Grampians Local Government Areas (LGAs) are listed in Table 1 BHS has an additional referral demographic profile that is not captured in the region specific tables. Residents of the township of Maryborough within the Central Goldfields LGA have historically tended to access a level of health care from BHS. The following table summarises the local health status context for the Grampians Region compared to Victoria 12 P age
Regional Health Status and Local Health Context Data Source: 2012 Regional Health Status profiles, Grampians Region, Department of Health Ballarat LGA Regional Victoria Primary care Type presentations to emergency per 1000 242.2 173.4 112.3 population ALOS public hospital inpatients (days) 3.03 3.05 2.9 Emergency department presentations per 1,000 population 414.1 304.9 249.9 Registered mental health clients per 1,000 population 17.0 15.4 11.0 Drug and alcohol clients per 1,000 population 6.3 6.7 5.3 Asthma admission rate ratio 1.04 0.87 1.0 Aged and Disability Characteristics: Disabled persons per 1,000 population 203.0 207.7 188.9 Persons aged 75 and over and living alone 2.9% 2.8% 2.18% Age Pension recipients per 1,000 eligible population 701.0 666.4 651.1 Disability support Pension recipients per 75.6 71.6 51.2 1,000 eligible population HACC clients aged 0 69 per 1,000 eligible population 163.5 378.3 196.9 HACC clients aged 70 and over per 1,000 eligible population 319.7 378.2 339.5 Social, Economic and Multicultural Indicators: Index of Relative Socio Economic Disadvantage 983 986 1010 Aboriginal or Torres Strait Islander 1.0% 1.2% 0.6% New settler arrivals per 100,000 population 172.2 527.3 Unemployment rate 8.0% 7.1% 5.5% Individual weekly income less than $400 per week 49.6% 46% 45.8% Household income less than $650 per week 37.0% 37% 30.6% Table 1: Current and projected resident population, 2011 and 2021, Grampians LGAs LGA 2011 2021 % change Ararat 11,297 13,151 16.4% Ballarat 95,007 113,475 19.4% Golden Plains 18,917 22,915 21.1% Hepburn 14,506 16,838 16.1% Hindmarsh 5,870 5,826 0.7% Horsham 19, 540 21,568 10.5% Moorabool 28,600 36,531 27.7% Northern Grampians 11,942 12,267 2.7% Pyrenees 6,727 7,433 10.5% West Wimmera 4,289 4,404 2.7% Yarriambiack 7,153 7,251 1.4% GRAMPIANS 223, 848 261,679 16.9% VICTORIA 5, 534,526 6,500,653 17.5% 13 P age
Table 2: Projected percentage population by age group, 2011 and 2021 Grampians LGAs Age in years 0 14 15 24 25 44 45 64 65 84 85 + GRAMPIANS 2011 19.2% 13.3% 24.1% 27.3% 14.0% 2.1% VICTORIA 2011 18.2% 13.9% 29.1% 24.8% 12.1% 1.9% GRAMPIANS 2021 18.4% 11.8% 23.8% 25.5% 18.0% 2.6% VICTORIA 2021 18.0% 12.4% 29.0% 23.9% 14.5% 2.2% Characteristics of the Grampians Region population trends compared to Victoria as a whole are as follows : o Ballarat LGA has marginally higher population growth o Golden Plains and Moorabool have a significantly higher population growth o Most growth is projected in the Moorabool corridor. Projections indicating population decline in outer Horsham and West Wimmera is likely to have strategic implications requiring the development of flexible service hubs. State wide challenges 2011 2021: o The increasingly older age characteristic of Victoria s population drives much of the recent health reform. The projected likelihood of chronic disease and frailty means that partnership models between primary health, public acute, community and aged care services will be important. Health workforce reorientation, targeted health promotion and community education will also need to be strategic factors as the areas of health education and promotion are aimed at reducing avoidable poorer health outcomes. o The merging of Federal and State funding has driven a new approach to data management as changes in funding types, shadowing of funding, predictive modeling and forecasting became essential. o An additional link to the Barwon South Western Region may occur through BHS as a provider of services once the pilot phase of the National Disability Insurance Scheme is assessed. The reach of service provision may therefore need to take a Barwon directed slant as the initial service mapping undertaken. This will have implications for the BHS administered State Wide Equipment Program 14 P age
Health Status Indicators Challenges presented by the status indicators in the Grampians Region include: o Life expectancy is not as high as the State average o More people smoke o Obesity levels are higher as are asthma admissions o Higher drug and alcohol dependency rates o Higher risk factors for unexpected injury or accident and higher suicide rates o Higher than average rates of cardiovascular disease o Higher total malignant cancers diagnosed o Relative disadvantage experienced by Aboriginal and Torres Strait Islander members of our community o Higher rates of chronic respiratory disorders o More older members of our community need assistance with core activities o Higher numbers of people have a severe to profound level of disability o A higher percentage of over 75 year olds in the Grampians Region live alone o Those in receipt of the Disability Support Pension in the region is significantly higher Health Status: Source: 2012 Regional health Status profiles Grampians Ballarat LGA Regional Victoria Male life expectancy 77.7 79.1 80.3 Female life expectancy 82.7 83.6 84.4 Percentage of persons reporting fair or poor health 19.5% 18.8% 18.3% Percentage of persons 18+ who are current smokers 23.6% 20.9% 19.1% Percentage of persons overweight or obese 50% 52.1% 48.6% Percentage of persons reporting asthma 15.4% 13.4% 10.7% This data clearly indicates the need for all health services in the region to work collaboratively to improve health status. BHS achievements in the previous three year period have seen a number of important service developments in cardiac care, cancer care, along with major investments in community based programs and non bed based models of care. BHS intends to continue service development promoting early intervention and chronic disease management in multidisciplinary settings. BHS is developing an implementation plan as a Health Promoting Hospital and will continue to use its Primary Care and Population Health Committee to bring health services together so that a community response to obesity and the management of poor nutrition continues. 15 P age
Health Utilisation in the Grampians Region BHS Emergency Department presentations are nearly 160% higher per 1,000 population in comparison to State wide levels with the prevalence of primary care type presentations remaining significantly higher than for other regions. The Region continues to have a lower saturation of General Practitioners and this is a significant factor behind this trend. Care pathways and the introduction of pharmacy and allied health care within the Emergency Department are being reviewed to better identify patients at high risk for re presentation and admission, so that a coordinated referral is activated for the patient and their family. Care coordination and multidisciplinary care are available and nurse practitioner resourcing is a recruitment priority given the high primary care type presentation rate. As demonstrated by the health status indicators, admissions at BHS related to oncology, general surgery, orthopaedics, general medicine and cardiology are at higher levels than the State average. The regional Cancer strategy is aimed at continuing to diagnose and enhance early intervention to reduce the morbidity associated with cancer diagnoses. The establishment of the Ballarat Regional Integrated Cancer Centre has facilitated increased research and clinical trial opportunities which BHS is set to maximise in the coming years. While it is acknowledged that the avoidable mortality by cause in the 0 74 year old age group for 2003 2007 indicated that higher rates were evident in the Grampians Region, the greater reach of cancer service provision and growing use of telemedicine, multidisciplinary care and better networks are aimed at having an impact. The collaborative surgical initiative has had a positive impact on patients accessing elective surgery and given a wider focus to region wide capacity. As the regional population ages with high indications for prevalence of chronic disease, the relationship between providers in the region to build models of care becomes imperative. Health literacy improvements, will need continued emphasis. The Dental Clinic being constructed at Phoenix College provides an opportunity for BHS to continue meeting dental health demand, reducing waiting times and improving dental health status. Multidisciplinary care linked to hospital presentations and an analysis of the more prevalent conditions that may be treated in an ambulatory setting continues to be a priority. Through the Hospital Admission Risk Program (HARP) and the BHS relationship with the Grampians Medicare Local, improved chronic disease management models can be further enhanced. 16 P age
Policy Context The period of this Strategic Plan corresponds with a very dynamic period of health reform, growing demand and increasing financial constraints. Public health scope of service may evolve in many new directions with shared care models that see patients being cared for in Ballarat when their clinical acuity indicates and then returned as soon as possible to their local hospital as a matter of course. The issues relating to better, safer, healthier care, closer to home are complex, not least of which is how funding systems will accommodate these arrangements. Shared service arrangements will be more frequently chosen for implementation especially in the community and acute to home sector. The National Disability Insurance Scheme while in its initial phase represents another focus for BHS given the projected demographic profile in the next 10 years. Currently around 35% of our population in receipt of community care packages are aged 65 years or younger, the next decade will see a changed set of needs evolving for those with a disability into potentially higher acuity community assistance packages. With wide experience and service range, BHS will need to make decisions regarding how we might establish care that fits the unique needs of people with disability from both a health care and daily life activity need. The reforms devolve great responsibility for service efficiency to the Hospital Executive to monitor while supporting innovative service flexibility. How well the Health Service operational teams are able to integrate redesign improvements through Better, Healthier, Safer (Productive Ward Series, Perfect List series) will be measured on a regular basis. From a business unit management level, BHS has gained significant expertise through its operation of the State Wide Equipment Program and various procurement arrangements it has negotiated across jurisdictions. This expertise will become increasingly influential in how BHS makes decisions about how to deliver excellent health care that is inclusive, innovative and desired by the patients, families and clients. The Policy context applicable to the Victorian Health system is broadly reflected in the following documents: National Primary Health Care Strategy National Partnerships Agreement on Preventative health (NPAPH) Fourth National Mental Health Plan: An agenda for Collaborative Government Action in Mental Health 2009 2014 Victorian Health Priorities Framework 2012 2022: Rural and Regional Health Plan 2012 2022 Victorian Public Health and Wellbeing Plan 2011 2015 National Reform Agenda 2011 17 P age
Visioning the Future Key Challenges Initiatives to be pursued to meet the key challenges include: Leveraging the gains from current regional partnerships and extending outreach services especially in the areas of cancer care and maternity services. Develop a strategically targeted service expansion plan to locations with the greatest need according to health status and population trends. Establish a regional approach to service planning and development for maternity services The concept of forming a Regional Emergency Consortia will be considered in response to the anticipated increase in critical care transfers especially patients with trauma and patients with cardiac events, ahead of the Helipad becoming operational. Commencement and continuation of significant building programs which will change current service delivery to enhance patient centred care including: o o Relocation of Dental services to a purpose built twenty chair facility incorporating ten teaching chairs. Health promotion from birth to adulthood will be built into the dental service and this will serve as a key strategy in the long term public health promotion platform. Utilisation of State Government budget allocation of $46.4M including: - Design, development and commissioning of multi deck car park and helipad - Demolition of Yuille House and interim relocation of service and corporate teams - Development of the New Drummond building replacing Yuille House providing scope for additional beds and operating theatre facilities o o Design development and operationalizing a Mother Baby Unit operated by Mental Health Services Redesign of the Paediatric Ward Implementation of an End of Life pathway will be expanded across the care continuum. Progress the transition of Residential Aged Care Services towards the agreed service profile and facility configuration. As residents remain in their own homes for longer often accessing supportive packages for care, they enter residential care facilities with greater care needs thus requiring services to a higher acuity of care. This transition will need to be informed by consumers, key stakeholders and community groups. Ongoing fiscal responsibility will continue to a priority and promote planning, efficiency and innovation. Bringing the community along with us is an ideal that BHS aspires to, and has application in many areas including: strengthening consumer and volunteer advocacy Addressing the impact of primary care type presentations to the Emergency Department through partnership building, working with General Practice Liaison, leveraging the Nurse Practitioner model, exploring how a multidisciplinary care team might include health self help to reduce this need and the benefits of diversion through a co located General Practice clinic. 18 P age
Alignment with Victorian Health Priority Area Victorian Health Priority Area Developing a system that is responsive to people s needs Ballarat Health Services Strategic Plan Services and resources place the patient at the centre of care Consumer engagement, participation and involvement in care is enhanced Patient involvement and feedback are integrated in service planning to ensure improved ease of access Service models are designed to meet current need and enhanced to meet future need Continued collaboration with private dental providers to meet public dental demand BHS will have an inclusive approach to Person and Family Centred Care A positive and integrated Aged Care Model is developed in close partnership with the community to deliver flexible, responsive care Palliative care pathway is individualized BHS will have a multicultural engagement strategy Improving every Victorian s health status and health experiences Early intervention in health promotion becomes a reality in all areas Paediatric and Adolescent health education is prioritized. Regional demographics underpin service planning Regional Health Services Collaborative is in place Illness prevention is progressed as integral to core business Consumer representation is evident at all levels of BHS operations Ballarat Health Services is positioned as a health promoting hospital. Ballarat Health Services will explore development of a health promotion business unit to maximize funding opportunities 19 P age
Every opportunity, every admission is used to educate patients on good health and wellbeing. Expanding service, workforce and system capacity Ballarat Health Services staff and services model health promotion and illness prevention in as many practical ways as possible Coordinated illness prevention initiatives with academic institutions, researchers, community health and local government are identified and partnerships established Contemporary, patient, family friendly New Drummond building, Mother Baby Unit commences operations with sustainability initiatives fully implemented Ballarat Health Services recruitment, development and retention strategies to ensure high quality sustainable service delivery and capability as per the Workforce Plan adopted by the Board of Management in 2012 and the Clinical Capability Framework for the region 2014 Professional development is progressed across multiple agencies. Form lead clinical group programs by utilizing evidence for clinical engagement and development. Explore and develop contemporary nursing workforce models such as Nurse Practitioner and Advanced practice nurse roles. Further develop clinical networks across specialty areas and in conjunction with Grampians Integrated Cancer Services (GICS) Outreach service development continues in Stawell (oncology Gynaecology Urology), radiation oncology Professional development is progressed across multiple agencies. A leadership and management capability framework is developed Succession planning for emerging clinical and service leader development, opportunity and coaching is enacted. Clinical leadership and partnerships provide staff with the opportunity to plan and implement redesign methodologies, practices and processes to enhance patient care. 20 P age
The engagement with the Better, Healthier, Safer platform begins at the recruitment and orientation stage. Specialist Aged Care workforce is broadened to meet the level of care needed. Volunteer numbers are expanded and roles are enhanced. Increasing the system s financial sustainability and productivity Review of bed configuration and Redesign methodologies is focused on maximising access, efficiency and effectiveness of care across Ballarat Health Services every day A regional approach to patient flow and access continues to be enhanced to enhance patient care and system capacity. Regional referral relationships are enhanced Ballarat Health Services will have progressed capital development planning to ensure sustainability of its aged care service A regional approach to elective surgery management is promoted. Continued service delivery relationship building occurs with Grampians Medical Local. Ballarat Health Services will focus the clinical leadership group on achieving greater patient care efficiency by maximising their understanding of financial and business management. Continued growth in knowledge of activity based funding will enable Ballarat Health Services to better mitigate risk and capitalize on opportunities in the changing environment. Electronic communications technology is maximised to receive referrals region wide. A view of whole of region capacity is enabled for acute, sub acute, aged care and mental health. BHS has access to a number of satellite acute public beds in hospitals in the region. BHS has maximised capacity for technology enabled education for greater regional linkage BHS achieves highest training accreditation for clinical and group training. 21 P age
Regional training consortia is in progress. Research and clinical trials are fostered and capacity within the region is maximized BHS financial performance delivers care within budget parameters. A strategic bequest program is further developed for BHS Joint fundraising initiatives Ballarat Health Services identifies fundraising opportunities to underpin health promotion jointly with Community Health organisations. BHS Residential Aged Care Service operates on an improving financial basis Implementing continuous improvement and innovation Continue to review best practice in Innovative organisations Further integrate Redesign and Improvement Committee priorities with a systematic and measurable approach as part of the Executive Staff Council structure Further develop the key initiatives identified in the Regional Innovation Collaborative: Regional Access and patient flow and Real time data intelligence and Clinical Capability development regionally. Explore the opportunity for regional strategic planning initiatives which maximize regional capacity and service development Increasing accountability and transparency Actively participate in Health Round Table, Dr Foster and other data exchange programs Redesign and Innovation team are key partners in Risk and Quality at BHS Implement and embed open disclosure, transparent systems and processes informed by consumer input Support diversity of staff and build on the culture of collaboration, participation and accountability which is guided by organizational values 22 P age
Utilising e health and communications technology Enhance BHS communications technology and telehealth initiatives and promote a regional approach to inform service planning, delivery and sustainability Incorporate telehealth expansion options and embed telehealth as part of clinical frameworks and business practice at Ballarat Health Services Develop the capacity for mobile technology to enhance responsiveness and service delivery throughout Ballarat Health Services Continue to implement the ICT Strategic Plan and enact and lead regional partnership initiatives, in particular, the Real time data intelligence project Continue to maximise digital patient record potential Continue to improve data security at Ballarat Health Services 23 P age
Appendices Appendix 1 BHS locality map Appendix 2 BHS Service profile Appendix 3 Grampians Region (and Associated) Hospital network 24 P age
Appendix 1 BHS Locality Map = ""!. bca LEARMONTH MILOURA <<! - SHOPPING ' CENTRE ST I;; I;; I;; I
Appendix 2: BHS Service Profile Allied Health Services Dietetics Exercise Therapy Occupational Therapy Physiotherapy Podiatry Prosthetics and Orthotics Psychology Social Work Speech Therapy Community Program including: Aged Care Assessment Service (ACAS) Allied Health Domiciliary Service Commonwealth Carer Respite Centre Carelink Domiciliary Care Direct2Care Hospital Admission Risk Program (HARP) Linkages Central Highlands Coordinated Care Planned Activity Groups Post Acute Care Regional Continence Service Regional Palliative Care Service Rehabilitation in the Home Restorative Care State Wide Equipment Program (SWEP) Transition Care General Medicine Geriatric Medicine Hospital in the Home Intensive Care Unit & MET Team Neonatal Medicine Nephrology Neurology Maternity Services Ophthalmology Otolaryngology (Ear, Nose and Throat Surgery Perioperative Day Procedure Unit Palliative Care Pharmacy Psychiatry Residential Aged Care Safety Link Specialist Clinics (Outpatients) Stroke Management Thoracic Medicine Urology Wound Management Acquired Brain Injury Anaesthetics Ballarat Regional Integrated Cancer Centre (incorporating Ballarat and Austin Radiation Oncology Oncology consulting Clinics Satellite Pharmacy) BreastScreen Cardiology Cardiovascular Service Central Sterile Supply (CSSD) Coronary Care nit Cognitive Impairment and Dementia Management Community Nursing Critical Care Unit Dental Services Diagnostic and Radiology Services: Ultrasound CT Scan Nuclear Medicine MRI EEG ECG Dialysis Emergency Medicine Endocrinology and Diabetes Management Endoscopy Unit Faciomaxillary Surgery Falls and Balance Gastroenterology Gynaecology Infection Control Lymphoedema Services Medical Oncology Mental Health including: Child and Adolescent Mental Health Services Acute Community and Inpatient Services Aged Operating Theatre Suite Orthopaedic Surgery Paediatric Medicine Pain Management Pathology Plastic Surgery Rehabilitation Respite Care Stomal Therapy Thoracic Surgery Vascular Surgery 26 P age
Appendix 3 Grampians Region (and associated) Hospital Networks Hospital Campuses Kaniva 41 km Nhill (WWHS) 43 km Goroke 89 km 39 km Rainbow Jeparit Natimuk Dimboola 34 km 26 km Horsham (WHCG) 30 km Hopetoun 25 km Beulah Warracknabeal (RNH) Murtoa 64 km Minyip Woomelang 49 km 57 km Rupanyip (DmHS) 60 km Birchip 33 km 53 km Donald 62 km 42 km Wycheproof 31 km Charlton 43 km St Arnaud (EWHS) 63 km (to Avoca) RNH - Rural Northwest Health Warracknabeal, Hopetoun, Beulah WWHS - West Wimmera Health Service Nhill, Jeparit, Kavina, Rainbow, Goroke, Natimuk, Cooinda Disability Service Nhill WHCG - Wimmera Health Care Group Horsham, Dimboola DmHS - Dunmunkle Health Service Rupanyup, Minyip, Murtoa EDH - Edenhope District Hospital EWHS - East Wimmera Health Service St. Arnaud, Donald, Birchip, Wycheproof, Charlton SDH - Stawell District Hospital EGHS - East Grampians Health Service Ararat, Willaura B&SHS - Beaufort & Skipton Health Service Beaufort, Skipton BHS - Ballarat Health Services Ballarat, QEGC HHS - Hepburn Health Service Daylesford, Creswick, Clunes, Trentham DjHS - Djerriwarrh Health Service Bacchus Marsh, Melton Ballan District Health & Care (Private) Edenhope 30 km (EDH) Harrow Stawell 33 km (SRH) Elmhurst Avoca Maryborough (MDHS) 67 kms (to Ballarat) Bush Nursing Centres (Harrow, Elmhurst, Lake Bolac, Woomelang) Maryborough District Health Services campuses at Maryborough, Avoca Willaura 50 km Ararat (EGHS) 44 km Beaufort (B&SHS) Clunes Creswick 48 km (SJOG) Ballarat (BHS) Daylesford 45km (HHS) Trentham Ballan 59 km Melton 0 25 50 kilometres Lake Bolac Skipton (B&SHS) Bacchus Marsh (DjHS) 105 km Ballarat to Western General Hospital 98 km Ballarat to Sunshine Hospital 27 P age
Strategic Direction 1: Provide Quality Health Care 1.1 Develop Models of Care and Treatment that are evidence based. Strategies Review service delivery models Develop a Clinical Services Plan following internal and external stakeholder consultation Further develop linkages with existing and new partners to improve integration Enhance home based services by introduction of active measures to reduce length of stay Enhance regional collaboration by better utilization of telehealth and technology Develop regional partnership models of care which emphasises returning patients to local health services during their episode of care Enhance consumer engagement, participation and involvement in care Maximise the use of Health Round Table and all data sources to improve performance against benchmarks Deliverable Outcomes BHS Comprehensive Clinical Services Plan to be developed by December 2014 The patient journey is integrated and improved by more effective referrals to services provided by BHS and other health services in the region Local health services are included in the patient journey so that patients return to their local health service during their care episode more often Consumers and carers are empowered and involved in their care as noted in patient feedback and satisfaction survey results Further develop Cancer and Palliative Care services Develop and implement Models of Care for Maternity, Newborn and Paediatric Care Establish the model of care for a Mother Baby Program comanaged by the Infant and Child Mental Health and Paediatrics Prioritise and implement the recommendations from the review of Diabetes Services (2013) Adult Per Natal Mental Health Services to provide an intensive intervention based program. Cardiac Service continuum Expanded dental capacity 1.2 Continue to reform and enhance Mental Health Services Embed community based mental health service provision Patient centred care is enhanced and integrated in service delivery Further develop links with external service providers Continue to respond to the needs of the Indigenous Community Continue to develop the Horsham based service Continue to embed the reforms achieved through the Child and Youth Mental Health Service Demonstration Project Technology will be used to expand the reach of this program regionally By 2015 Community based mental health services are patient centred and enhanced as measured by attainment of the required targets and the satisfaction of clients and their families Satisfaction feedback from members of the Indigenous community indicate that services have been enhanced Horsham service is staffed to meet service need The Child and Youth Mental Health Service Demonstration Project has implemented the agreed service elements 28 P age
Strategic Direction 2: Provide an informed, inclusive and positive patient experience Strategies Deliverable outcomes 2.1 Adopt a person centred approach which actively involves patients in decision making. By June, 2016, Patient Centred Care is the focus of all service delivery and is demonstrated in patient feedback and satisfaction Appropriate consumer representation is evident at BHS By June 2014, Consumer Advisory Committee will systematically engage with the disability sector to identify and meet their specific needs Patient feedback surveys indicate CALD and Indigenous community members are accessing services appropriately and more frequently as needed Collaborative and innovative service partnerships include outreach models to deliver health services to the most disadvantaged in our community 2.2 Monitor, evaluate and improve Quality and Risk Management By June 2015, Patient feedback surveys and Key Performance Indicators indicate access to services has been improved NEAT and NEST National Reform Targets have been met By December, 2015 redesign initiatives are implemented and service delivery, access and efficiency across BHS is improved to better meet service demand within budgetary allocations An education program is evaluated to ensure that risk management, quality improvement and Redesign processes are included in planning across BHS Open disclosure teaching and training continues to be embedded Patients are informed of their care outcomes including when adverse events occur 2.3 Enhance BHS focus on health promotion and illness prevention Facilitate improved access for Indigenous and disadvantaged community members The needs of CALD groups are included in service planning Outreach programs to address community needs are developed and implemented Engagement with consumers with disability and related groups is developed to ensure responsive service planning BHS will develop strategies to understand socio economic disadvantage in our community and develop collaborative partnerships to address these needs By June, 2016 Illness prevention is incorporated with every patient contact at BHS Priorities are identified and implemented across BHS A framework exists to identify opportunities for BHS staff and services to model health promotion and illness prevention Further enhancement and collaboration with other organizations in the region to promote initiatives to reduce illness and hospital admissions 29 P age
Strategic Direction 3 : Actively Promote partnerships in the region Strategies Deliverable outcomes 3.1 Enhance efficient patient flow and access. Maximise information technology initiatives including portable devices Utilise redesign methodologies to review patient flow systems and processes Review the possible establishment of accountable care units By June, 2016 appropriate telehealth services are implemented and evaluated across BHS Health Round Table and other data sources are reviewed Opportunities to maximize capacity are identified Care coordination systems are developed 30 P age