Local Health Network Consumer and Health Advisory Councils Transforming Health Forum Wednesday 30 November 2016 11am-2.30pm. For more information please contact: Michael Cousins Chief Executive 08 8231 4169 0488 109 124 mcousins@hcasa.asn.au 1
Contents Executive Summary 3 Reccomendations 4 1. Introduction 5 2. Background 6 3. Forum Presentations 7 3. Forum Discussions 10 5. Conclusions 16 Appendix One: Forum program and invitation 17 2
Executive Summary Fifty-eight people attended the Local Health Network Consumer and Health Advisory Councils Transforming Health Consumer Engagement Forum on Wednesday, 30 November 2016. Participants included the Transforming Health Consumer Community Engagement Committee (TH CCEC), consumers and representatives from Local Health Networks (LHN), HCA team and hospital consumer and community Committee members. The overarching theme for the forum was: What do consumers have to look forward to in Transforming Health over 2017? The Transforming Health Consumer and Community Engagement Committee convened the Forum with the purpose of providing information updates on what consumer networks can expect from Transforming Health in 2017 and to share the lessons learned and solutions developed at this point. It was also timely to collaborate with consumers in the early development of the Transforming Health Evaluation Framework, with particular reference to how consumer expectations and perceptions will be captured. HCA also saw this as an opportunity to gauge interest about intent and ways LHN consumer groups could engage in the future. Overall the presentations by SA Health in the first section of the program were informative and provided a snapshot of what health consumers can expect from Transforming Health at the local level in 2017. The expectation and value of including consumers much earlier and continually through this large-scale change process was emphasized by the consumer participants. Many commented on the disappointing level of communication and engagement opportunities with consumers on Transforming Health. There were, however, many consumers who were optimistic about the future and had begun to experience the benefits of this major change. The group discussions in the second part of the program were well regarded and the three topics were well addressed providing insights and strategy for 2017. However, there was comment from a few that they knew little about the TH Evaluation Framework and saw this as an opportunity for engagement in 2017. The evaluation of the Forum indicated the objectives were met and participants welcomed further such events, particularly meeting with consumers from across LHNs in the short term. Participants recommended a review of the program indicating the need for shorter presentation time and more interactive work. The majority of consumer participants indicated they left the event better informed, feeling included, some inspired and others connected. Some related that they need to learn more and remained somewhat confused about what Transforming Health will be in 2017. 3
Recommendations 1. That future forums such as this one are conducted either 3 to 6 monthly with an interactive format. 2. That improvements are made when communicating to consumers and community about the upcoming Transforming Health events and changes. 3. That advice provided by participants about the Transforming Health Evaluation Framework is reported to the established relevant working group. Photo: Local Health Network Consumer and Health Advisory Councils Transforming Health Forum 4
1. Introduction This forum was facilitated by the Transforming Health Consumer and Community Engagement Committee (TH CCEC). At their October meeting it was agreed to hold a Local Health Network Consumer and Health Advisory Council Forum at the Adelaide Pavilion on 30 November 2016, this would replace the usual November committee meeting. The purpose was agreed and Consumer Advisory Council members from each of the LHN s were invited, including the LHN staff members and hospital consumer group representatives. Fifty-eight people attended the forum, which included the TH CCEC, consumers and representatives from Local Health Networks, HCA team and hospital consumer and community members. The overarching theme for the forum was: What do consumers have to look forward to in Transforming Health over 2017? The purpose of the forum included: 1. To update local health networks consumer representatives on Transforming Health and the major activities in 2017 2. Share lessons learned and identify solutions for and between local health networks 3. Inform the consumer components of the Transforming Health evaluation. Photo: Michael Cousins, welcome and acknowledgment of country 5
2. Background The Transforming Health Consumer and Community Engagement Committee TH CCEC is the key mechanism for enhancing consumer and community consultation and engagement in Transforming Health. SA Health committed to working with and through the Health Consumers Alliance (HCA) the Local Health Network of Governing Councils and Consumer Councils, and the Health Advisory Councils to consult with consumers, consumer representatives and communities. HCA as the peak body for health consumers in South Australia was invited by SA Health to convene and chair the Consumer and Community Engagement Committee for Transforming The principles, membership, selection criteria, methods of engagement, priority actions and recommendations to establish the TH CCEC were developed by community participants at a workshop held in May 2015. The purpose of the Committee is to provide SA Health with broad, strategic and representative consumer and community engagement as a consumer and community advisory body for Transforming Health. This Committee also keeps a watching brief on primary health and other aspects of the health system as they become part of the Transforming Health agenda. 6
3. Forum Presentations Michael Cousins, Chief Executive HCA in his role as chair of the TH CCEC, provided an overview of the program and welcomed everyone. He acknowledged the diversity of backgrounds and roles of participants and the traditional Aboriginal owners of the land on which we meet. The Transforming Health Milestones for 2017 and the Evaluation Framework were addressed by Lynne Cowan, Deputy Chief Executive, Transforming Health SA Health. She noted these anticipated highlights for 2017: Continuing with the valued robust conversations held monthly with the TH CCEC Implementing the TH model of care working groups recommendations Making consumer centred care a focus of continually improving the hospital system Improving the experiences of care by patients such as the reduction in waiting for surgery times for those with fractured femurs, from 150 hours to 15 hours Knowing stroke patients are being treated quicker and recovering better Decommissioning of the Repatriation General Hospital and transfer of all services to FMC and Glenside. Increasing the number of rehabilitation beds in the Hampstead review Increasing the car parking at some sites and exploring better options at others Reviewing the outpatient services by working with general practice on pathways to acute care and working with clinicians on how to work better with general practitioners Partnering with the newly formed TH Aboriginal Expert working group to assess the Aboriginal patient journey Developing the frailty pathway for older people by exploring innovative steps such as passbooks to health services, and geriatricians in emergency departments Realigning the South Australian Ambulance Service thus strengthening their ability to respond to patient s needs. Lynne also talked about the Transforming Health Evaluation working group who have the role of establishing the TH Evaluation Framework. This group is set up under the auspices of the SA Academic Health Science and Translation Centre. The principle role and function of the group is to identify and prioritise TH Evaluation questions and key performance indicators. At the Forum there was an opportunity to inform the development of questions and collection of information for one of the priorities of the Evaluation: Patient/Consumer Experience. David Morris, Chief Operating Officer, Southern Adelaide Local Health Network provided an overview on the main preparations and planning for 2017 which included: Investing $185.5 million in FMC structural improvements for the southern community Building a new and contemporary rooftop Palliative Care Facility at FMC Picking up much of the hospital and service care work done at the Repatriation General Hospital Gaining a new 55 bed rehabilitation centre Aligning staff with the new work load, addressing their preferences where possible 7
Increasing car parking to 1780 and assigning the Wilson car park for consumer use only Focussing in Noarlunga on a community emergency department and dedicated elective day surgery Building a new dedicated veteran s mental health facility at Glenside Developing a 24 hour on call service for acute coronary syndrome at FMC Partnering with consumers for advice on implementing these changes Preparation for the move to the new Royal Adelaide Hospital was addresses by Paul Lambert, Executive Director Central Adelaide LHN and Katherine Stakula, Director of Communications for the new RAH, provided the communications plan for this transition Paul and Katherine s presentations included Advice on progress with the move: no date confirmed at this point Commitment to a proactive approach to the move Knowing there will be a period of ramping down and ramping up the RAH services Keeping staff as informed as possible about the move and its likely impacts Clinical move rehearsals are happening There are enough ambulances, nurses and doctors to undertake the move It will occur over a five-day period and involve road closures, traffic officers, council workers and police Detailed public notices and information will be provided Decommissioning of the old RAH has been raised in the media There will be a need to remove linen, drugs etc. There will be a period of settling into the nrah and unknowns will emerge Will be asking the community for some time to assess and sort this out Opening as soon as it is safe to do so Need consumer advocates to help Executive Director Nursing, Vanessa Owen and Allan Patching, Co-chair consumer Advisory Council Northern Adelaide LHN talked about the lessons learned from the first phase of realignment at NALHN and what s ahead. Vanessa and Allan provided this advice in their overview: Recommended external audits as very useful in providing advice on how hospital services are tracking Needing to continually correct miss-information provided in the media Continuing to promote both the Lyell McEwin and Modbury hospitals will operate emergency departments 24 hour a day 7 days a week Currently the NALHN has seen Mental Health wait times decrease At this point 30 FTE staff have moved to NALHN and more staff will do so Advising all other LHNs to have clear objectives when managing the changes Reinforcing the need to engage others Advocating that the focus must be patient centred 8
Collaborating with consumer advisory committee is an excellent conduit to inform and engage patients and the community Talking to those people who are involved continually Keeping on talking to people Managing your own good news stories Emphasising the hospitals are staffed by highly qualified clinicians Having a vision that the people of the North deserve nothing less Talking to people about how change is difficult Involving people means they understand Consumer experiences and stories are gold Referring to the ACSQHC Standards 2: Partnering with consumers Data is useful however leadership is the most important Referring to the transformation theory Trusting the truth Consumer centred care is what it is all about Questions from participants focussed on these themes: Access for consumers to hospital services is vital Country patient s inclusion in TH is not clear An individual perspective on a poor experience with hospital services Need for earlier consumer partnering and collaboration Observations about the patchy communication Advice about the models of care implantation Photo: Lynne Cowan, Deputy Chief Executive, SA Health 9
4. Forum discussions First Discussion Topic: Transforming Health Evaluation: What consumer evaluation questions should be asked? We have been asked to advise the evaluation of Transforming Health. Data will be collected now, and into the future from consumer perspectives and consumer experiences on their engagement with the hospital system as part of their overall health care. Question 1.1 What in Transforming Health is important? What do you think should be measured, assessed and reported on in the evaluation? a) Consumers expectations and perceptions via: Written survey, face to face interviews, phone call survey, focus groups, community forums, workshops and volunteers engaging with consumers (4) b) Consumers encouraged to provided constructive feedback and creating expectation of constructive response, acknowledging and acting on the feedback c) Make sure participants are representative of the demographics of the SA community. Country and regional included, look at carers needs (3) d) Real patient journeys instead of data (4) e) Positive and negative experiences measured f) Communication to CALD non-esl, Aboriginal patients, LGBTIQ. Were your personal, cultural and linguistic needs acknowledged and addressed? g) Accreditation data feedback. Have the improvements from accreditation been made and publicised? h) How well the information is being provided to consumers, for example: health literacy. Check the TH brochures for readability i) Surveys only give part of the picture (3) j) One on one interactions more valuable (3) k) Focus groups are also a good mechanism (3) l) Measures should not be just one dimensional, not just LOS, decrease time in ED (2) m) An effective measure could be is there a care plan in place and was it adhered too? n) Measure outcomes of care from the patient perspective (2) o) Evaluate the post care planning, care planning post discharge, links to primary care, what was the continuity of care like, do you know who you can follow up with? (4) p) Complaints process should be a component of evaluating care q) Were you treated holistically rather than just an illness or the disease you presented with? r) Did you have an opportunity to provide qualitative data by forum, interview, one on one? s) Were your anxiety and or fear acknowledged? Especially for mental health patients. t) Measure the experience in terms of how the patients, carer and significant others recall it. u) Evaluate performance against best care first time every time Was there access to best care v) Evaluate consumer confidence in care provided Numbers note the times this item was raised across groups 10
Question 1.2 What should be asked from a health consumer perspective around the patient journey and consumer experience? a) Follow the consumer journey: compare the actual journey with the designed journey board. b) Try to capture consumers who have experienced pre-and post TH c) Consumers should feel listened to and receive effective answers on any questions asked (3) d) During the health Journey patients may not provide feedback because they are fearful it will be used against them, need to address this issue. Creating safety and confidentiality e) Accessing consumers after their care so they the can reflect on their feedback f) What can be improved in a negative versus a positive experience for affecting the recovery process: in the opinion of the consumer and carer. This should be established when planning the survey tool. g) Are you comfortable all your needs were met? What things did you find helpful? h) Were you satisfied with the level of understanding of your care? Do you feel it was explained to you in a way you understood? i) Do you feel you were treated with respect? Were your family and carers given opportunity to be involved? j) How could you do it better if something unexpected happened? k) Ask consumers what was your understanding and did you have an appointment to ask questions? l) Treated with dignity and respect? m) Impact of TH on service and consumers in the country should be assessed n) Impact of support services need to be assessed o) Using multiple channels to access feedback and across ages, diversity and sensitivity p) Timeliness is paramount q) Are needs being met? r) Focus on what is going wrong as well w) Compare in home options with in patient options and ask what is better? s) Communication and inclusion in decision and care should be proactive and consistent Numbers note the times this item was raised across groups Question 1.3 Any further comments? a) Community gardens are no longer, need to be an initiative of health. b) At what point are we asking consumers about TH? (3) c) Promote positive experiences 11
Second Discussion Topic: Lessons learned in Transforming Health and solutions to be shared. Given the significant changes happening across the metropolitan hospital system: Question 2.1 What have been some of the challenges on Transforming Health? Poor media Public perceptions Involving media to get it right Health Professionals giving negativity about TH People believe all hospitals are equal The message of the benefits of TH has not been communicated to the country community, it is then interpreted as shifting services from community to metro. Change to measuring what is important to consumers Communicating what is better because of TH Right messages to consumers when the media have an agenda The why is not clear to consumers Honesty about the costs Health Professionals fear of being sued GPs not well informed about TH therefore don t champion it Media coverage, correct information needs to be distributed to the community How to continually keep good messaging going: videos, website, hard copy, TV ads, outpatient letters, health sites hospital messaging Media negativity SA Health need to be more proactive with the media More transparency from SA Health Initial reasons for Transforming Health were not clearly articulated Start with questions to the public about what they know about their hospitals Highly skilled change management was absent Consumers trying to be supportive of the process in the face of hostile comments in the media Question 2.2 Are there any lessons learned and solutions to be shared? If consumers were engaged from day one things would have been much better Transforming Health was not a useful title Improving Health might have been better. Needed a change management strategy which was beyond SA Health and clinicians Keep messages simple but clear and honest Country people felt ignored should have focussed more on country patient s access to city services. Proactive transparent messages Early communication consultation with rather than at. Always leave time for interactive sessions so that consumers feel heard 12
Communicate from a consumer s perspective Earlier engagement of consumers, partnering. Comprehensive involvement of consumers and cares Need to filter information Get positive stories out early Don t duplicate methods Should have been named Transforming Hospitals Language of the communications messages need to change to engage the intended audience Question 2.3 How might things be done better in the future? Communication: communication: communication Be repetitious Carers in all discussions Consumers on all committees More engagement of other people in TH, same people doing all the work SA Health could be better at recruiting people Major advertising campaign would help Do consumers know how to access health services know and into the future? Question 2.4 Any further comments? The major issues still unresolved are: Communication, Complaints and Access PATS needs to be better promoted or advertised Aboriginal Patient Journey needs mapping Indigenous health statistics need to be addressed. Photo: Participants discussion 13
Third Discussion Topic: Collaboration between consumer councils and across Local Health Networks Thinking towards 2017 and beyond Transforming Health: Question 3.1 Is there a need for consumer council s/committees and health advisory councils to share information and collaborate? Self-evident -Yes Definite need for collaboration More interactive engagement Needs to be across the entire health environment inclusive of primary care and PHNs Unanimous table input was YES Consumers affected by this change need to have a voice Acknowledge people and consumers move between LHNs Learn from each other is important Yes; support to share information across different groups and LHNs Use SA Health partnering with consumers group to do this and develop broader representation of this group Should be a structure that values, uses and incorporates the consumer voice from the beginning Good for CACs to have regular opportunity from the beginning Question 3.2 What mechanisms, processes and media would you recommend to facilitate information sharing and collaboration? Social media; Local paper; letter drop; public meetings Local pollies; Retirement villages; NGOs; service clubs and open days. Embed the consumer voice in the SA Health bureaucracy (accreditation required) In addition to face to face collaboration webinars are an interactive mechanism which should be incorporated Breakdown the concept of geographical barriers by facilitating collaboration Regular forums facilitated by HCA Opportunities to others who are not members of CAC or CAGs HCA the glue to showcase consumer advocacy and consumer engagement via events CALD consideration community groups community radio Consumer engagement strategy embedded in organisations Include cares in all communicating Upskilling health professionals in communicating with consumers at diverse levels. Good news stories Positive media Visits between LHN sites Shape positive outcomes Newsletter section Seminar annual at first Tour of hospitals TV loop in general Practices Advertise in general media Need regular forums to test new products and support system wide approaches 14
Public forums would share information Mail box drops to ensure information is disseminated particularly for simpler messaging Question 3.3 Who can contribute to support such information sharing and collaboration? Partnering consumers and community in Health committees has a pivotal role in promoting and facilitating collaboration Utilised HACs in country to communicate and inform decisions and provide feedback Local Health Networks and their consumers HCA and LHNs Blog discussion group for consumers Facebook page and social media Network via a consented email list Schools, students of Uni and TAFE SA Health needs to be more contemporary Radio Stations SA Health HCA LHNs Libraries, community centres community groups Focus on CALD and ATSI first. Question 3.4 Any further comments? No comments Photo: Participants discussion 15
5. Conclusion and Evaluation This report and its recommendations will be published on the HCA website together with the available presentations from the forum. The report will also be an agenda item at the January 25 2017 TH CCEC meeting where members will discuss the content and progress the recommendations. An evaluation card was distributed to the participants and up to 40 of the 58 participants responded to most of the questions. Overall the advice was reflective of a valuable and informative forum with suggestions on improvement into the future. The evaluation will also provide the TH CCEC with valuable and practical advice when planning future forums, including content and frequency. 16
Appendix One: Forum Program and Invitation 17
18 Consumers at the heart of health care