Understanding Monash Health s environment Context for developing our 2018-2023 Strategic Plan Working draft September 2017
Introduction Monash Health is a health care, teaching and research institution dedicated to improving the health and wellbeing of our local community and the broader Victorian and Australian community. We are in the final year of our current Monash Health Strategic Plan, providing us with an exciting opportunity to develop our new strategic plan. We are determined to develop and deliver a strategic plan that is meaningful, inspiring, and provides guidance to our staff, and that enhances value for the people that we care for and partner with. Through the development and implementation of our new strategic plan we want you to get involved in shaping the future direction of Monash Health. To set the context, this paper will assist you with gaining a better understanding of: Our health service Our people Our community Our academic partners, our local partners, and our government The external context in which we work. The Monash Health Community Monash Health holds an important place in the Victorian healthcare system, providing health care services for people in Melbourne s southeast across more than 40 sites, including eight hospitals, community-based sites, and residential care facilities.
Monash Health: Who we are and what we provide Our health care services Monash Health provides health care services from pre-birth to end of life. In 2016-17 we delivered more services to our community than ever before: 3.61 MILLION Total episodes of care 75% more episodes of care than in 2011-12. 260,786 Hospital admissions 30% more hospital admissions than in 2011-12 220,914 Emergency Presentations 23% more presentations to our three emergency departments than in 2011-12. 48,480 Surgical Procedures 24% more procedures per year than in 2011-12. Did you know.? 1.20 MILLION Outpatient services 87% more occasions of service provided by outpatient services than in 2011-12. 40,293 Paediatric admissions 34% more admissions of children under age 19 to our children s wards and neonatal units than in 2011-12. 224,460 Mental Health contacts 30% more client contacts than in 2011-12. 10,162 Babies delivered 18% more babies delivered than in 2011-12. Monash Health is the largest health service in Victoria. Our three emergency departments are among the busiest in Victoria. Our maternity service is the largest maternity provider in Victoria. We provide the third busiest paediatric (children s) service in the country. We improve the health of our community through: Prevention Early intervention Community-based treatment and rehabilitation Highly specialised surgical and medical diagnosis, treatment and monitoring services Hospital and community-based mental health services Comprehensive sub-acute and aged care programs Palliative care Research Education and teaching the next generation of healthcare professionals
Monash Health: Who we are and what we provide
Number of Employees Our people Monash Health has a large and diverse workforce of over 17,000 highly-skilled and dedicated people. Our people are our greatest strength, providing excellent care that meets the needs of our diverse community. Further developing our workforce in line with the diversity in our community, and ensuring the safety and wellbeing of our workforce, are two of the most important things Monash Health is working towards. 7,000 6,000 5,000 4,000 3,000 2,000 1,000 Casual Casual Bank Full Time Part Time Sessional Male 283 349 1,738 798 495 Female 792 1,445 3,743 6,189 301 Employment Type Figure 1: Monash Health employment type, December 2016 Male Female All of our people play an important role at Monash Health. Our staff 44% Nursing 15% 10% 9% 9% 9% 3% 2% Administration and Clerical Medical support Hotel and Allied Services Hospital Medical Officers Ancillary Staff (Allied Health) Sessional Clinicians Medical Officers Nursing Medical Support Hotel and Allied Services Sessional Clinicians Administration and Clerical Hospital Medical Officers Ancillary Staff (Allied Health) Medical Officers Figure 2: Monash Health employee numbers by labour category, June 2017 (average monthly FTE for financial year) Our volunteers Monash Health has more than 1000 volunteers who play a vital role in supporting our staff, visitors, patients, families and carers. They provide support in many ways, such as support for philanthropic events, consumer participation activities, patient social support, and administrative activities.
Population Our community: Who we are here for Monash Health provides its services to a large and growing community. From 1998 to 2013, Victoria had the largest population growth of all Australian states and territories and is predicted to grow to over 10 million by 2051 with 8 million individuals residing in Greater Melbourne 1. Our catchment Monash Health provides services primarily to people who are residents of the surrounding areas, however our reach also extends across the state of Victoria, and across Australia, for our more specialist services. Figure 3 below shows the local government areas (LGAs) that comprise our primary, secondary and tertiary catchments. Primary Catchment Secondary Catchment Tertiary Catchment Our population is growing quickly The number of people who reside within the Monash Health primary catchment is expected to increase to 1.36 million people by 2031 (from 1.05 million people in 2016). Cardinia and Casey are by far the local government areas with the largest predicted growth (Figure 4). 400,000 300,000 200,000 100,000 0 2016 2031 Casey (City) Cardinia (Shire) Glen Eira (City) Greater Dandenong (City) Kingston (City) Monash (City) Bayside (City) Frankston (City) Knox (City) Mornington Peninsula (Shire) Bass Coast Baw Baw East Gippsland Latrobe South Gippsland Wellington Figure 3: Monash Health catchments and Local Government Areas Monash Health delivers some quaternary (less common and highly specialised) services to Victoria and the south east of Australia, including pancreas transplantation, intra-uterine foetal surgery, endovascular clot retrieval, gender dysphoria and the Victorian thalassemia service. 1 Victoria in Future 2016 report (Department of Environment, Land & Water) Figure 4: Forecast population growth by Local Government Area The number of people who reside within our secondary and tertiary catchments are also expected to grow to over 2.2million by 2031. Our population is ageing By 2031, the number of people aged 80 years living in our primary catchment area will have increased 70% from 2016 and over 165,000 local community members will be aged 70 years and over; 65,000 more than in 2016. A higher proportion of the population within Kingston and Glen Eira are aged over 65 when compared with the state average.
Our community: Who we are here for Our community is diverse Well over a third of people living in our primary catchment area were born outside Australia. Our community has inequities We have pockets of disadvantage in all six primary catchment Local Government Areas. Our community is living with more illness Like the rest of Australia, we have an increasing proportion of people with an illness. Our primary catchment is very multicultural, with well over a third of people being born outside Australia. The City of Greater Dandenong is our most diverse LGA, with almost two thirds of residents born overseas. The five most common requests for language services at Monash Health in 2016-17 were Dari (13,827 requests), Mandarin (10,685), Vietnamese (10,461), Greek (8,165), and Khmer (8,088). Aboriginal and/or Torres Strait Islander people account for 0.5% of our community. We acknowledge that there are pockets of disadvantage in all six LGAs within the Monash Health primary catchment. In particular, the people in the City of Dandenong are experiencing significant socio- economic disadvantage and higher unemployment rates compared with other areas in Victoria. We know that these socio-economic characteristics also impact on the healthcare needs of this community. Aboriginal and Torres Strait Islander people have higher rates of chronic diseases and shorter life expectancy than non-indigenous Australians. Increasing rates of illness are being driven by increasing rates of heart disease, cancer and neurological conditions and risk factors such as obesity. People are living with more health conditions than ever before. Chronic disease risk factors are closely linked with poor health. Within our catchment there are LGAs with an increasing burden of disease. For example, 7.6% of the population within Greater Dandenong has type 2 diabetes (compared with the state average of 5.0 %).
Teaching and research Monash Health is a leading teaching and research health service. Together with our academic partners we provide an integrated approach to and are at the forefront of health research, education, training and clinical practice. In partnership with Monash University s School of Clinical Sciences, and Deakin and LaTrobe Universities, we help to train the next generation of Victorian health professionals. Deakin University LaTrobe University Monash University Education and research precinct in the new Monash Children s Hospital An education and research precinct in the new Monash Children s Hospital connects clinical care with teaching and clinical research programs, further consolidating our partnership with Monash University. A state-of-the-art Surgical Simulation Centre, unique in Australia, features a purpose-built operating theatre, paediatric and neonatal ward and procedures rooms to enable medical students to train for real-life emergencies. The centre houses our Monash Children s Hospital Telehealth Service, which provides a direct and live video link from Monash Children s Hospital to regional operating theatres and emergency departments. Our key teaching partners We encourage our doctors, nurses and allied health professionals to hold dual clinical and academic roles, recognising the tremendous benefits to our patients who rely on our well trained and highly skilled health professionals to provide care that is based on cutting-edge clinical research. Monash Health undertakes translational research together with our university partners, and under the auspice of the Monash Health Translation Precinct (integrating the expertise of Monash University, the Hudson Institute of Medical Research and Monash Health), the Monash Partners collaboration, and in numerous Clinical Research Units embedded into clinical services. Research projects Each year, with our research partners, we undertake a range of projects that aim to improve both the delivery of healthcare and the patient experience, along with improving treatment and outcomes for our patients. In 2016-2017: 360 new research projects were approved by the Monash Health Human Research Ethics Committee 1,076 research projects involving patients were underway 344 clinical drug or device trials were being implemented We are active in seeking funding to support our work. Notably, in 2016-17 more than $2 million in funding was awarded to Monash Health and Monash Partners Academic Health Science Centre through commercially sponsored clinical trials and the National Health and Medical Research Council.
Projects and developments To support our ongoing pursuit of excellence in everything we do, we are continuously exploring and pursuing new and innovative ways of working and investing in new and upgraded buildings and technology. Recently completed projects Monash Children s Hospital: The new dedicated 230-bed Monash Children s Hospital with capacity to admit an additional 7,000 children each year. Simulation Centre: A refurbishment and extension of the Simulation Centre at Moorabbin Hospital. The centre is a key tool to assist in teaching and training our nursing, allied health and medical staff. Pakenham Health Centre: The new Pakenham Health Centre provides community-based services including child, family and maternal health, pregnancy care, counselling, rehabilitation, pathology, mental health and outpatient specialist clinics have been co-located to improve accessibility and health outcomes for the local community. The Pakenham Health Centre is managed by Monash Health in partnership with Cardinia Shire Council. Key projects underway Implementation of a new Electronic Medical Record: Monash Health s Electronic Medical Record (EMR) project involves the implementation of a digital clinical patient record keeping system that will provide rapid access to an individual s entire medical history and create a basis for improved decision support and research, in turn resulting in better outcomes for our community. Early in Life Mental Health Service: The new home for Early in Life Mental Health Service (ELMHS) will be within the new Monash Children s Hospital and co-located with the new state-wide Child Inpatient Unit. This project will strengthen mental health services for children and young people. Monash Medical Centre Emergency Department Expansion: Expansion of the emergency department at Monash Medical Centre, including a new dedicated treatment area for children. Casey Hospital Expansion: Expansion of Casey Hospital to provide additional capacity for the growing local community, including additional operating theatres, new intensive care and day beds, and more multi-day beds. Moorabbin Hospital Expansion: Expansion of Moorabbin Hospital to provide additional capacity for the growing local community, including increasing the number of specialist consulting suites, and new Magnetic Resonance Imager (MRI) and Computerised Tomography (CT) machines. Victorian Heart Hospital: This stand-alone cardiac hospital is projected to bring together the world s best in cardiovascular care, research & training. The Victorian Heart Hospital will comprise public and private beds; and cardiac ICU beds.
The broader healthcare system The healthcare industry is evolving rapidly and presents many exciting opportunities and challenges. A paradigm shift towards consumercentric, outcomes-drive, and prevention-focussed healthcare is changing the way we do things now and into the future. Positioning Monash Health to embrace the opportunities, and effectively manage the challenges, will enable us to meet the needs of our community for equitable, accessible, safe, high quality, appropriate and sustainable healthcare service for many years to come. The table below highlights some key areas that we will need to address strategically to achieve this. Funding and financing Increasing expenditure and efficiency focus: Driven by a growing population, medical advancements and new technologies, the mounting costs of delivering health services has led to stronger focus on efficiency at all levels of government. Decline in private health insurance: The reducing proportion of Australians taking up private health insurance is creating an increased reliance on public hospital services. Public Private Partnerships: The Victorian government is increasingly delivering public infrastructure projects using the public private partnerships model, such as that at Casey Hospital. New funding models for enrolled populations: New funding models are shifting away from fee-for-service and activity-based funding are being tested and implemented with the aim of delivering more coordinated and integrated care. Philanthropy: Generous donations improve education, research and clinical care for the benefit of patients, families and carers. Policy directions Consumer expectations Strategic policy directions: Key government strategic policies and guidelines, such as the Health 2040 strategy, will set a broader strategic direction in relation to aspects such as improved access and care; regional planning, stronger governance; and improved safety and quality assurance. Consumer-directed care: New services, such as the National Disability Insurance Scheme and My Aged Care, are designed to give more choice and flexibility to consumers, providing more control over the care and services they receive. As a provider of disability and aged care services, Monash Health will consider how we best deliver coordinated care and services to our patients, families and carers in the community. Increased access to information is changing the way consumers engage with health services: Increasingly, consumers can choose to access services that provide them with personalised and flexible care, and services that empower them to participate in informed, shared decision making. Growing privacy concerns: In an increasingly digital world, organisations holding sensitive information need to be increasingly transparent and build trust with the public about how they store, share and use people s personal information.
The broader healthcare system (cont d) New technology and big data Workforce New technologies are transforming health care, training and research: Technologies such as 3Dprinting, point-of-care diagnostics, genetic sequencing and biosensors have the potential to revolutionise care delivery. Though requiring significant investment, many new technologies have the potential to cut costs and improve patient outcomes and experience. Increasing use of electronic information communications technology: Cloud computing, software and hardware advances will revolutionise the way we share information and communicate with our staff, patients and other service providers. Large scale projects such as the national My Health Record and increasing use of Electronic Medical Records at Monash Health and other services open up new possibilities in the delivery of coordinated and integrated care. Big data as a powerful tool: The opportunities to understand and monitor our community s health using big data and analytics, particularly across organisations and systems, are vast. Cyber security: Increasing cyber security threats, including global-scale viruses and hackers, require increased organisational capabilities to adequately respond. Changing workforce expectations: The modern day workforce is seeking flexible work arrangements, safe and healthy work environments, access to modern technologies and amenities, and advanced learning and development opportunities. We must ensure Monash Health develops both sophisticated workforce models and a work environment that attracts and retains skilled staff across our health service, particularly through the outer suburbs of Melbourne. Safe Patient Care Act 2015: In December 2015 the Safe Patient Care Act came into effect, delivering on the Government s commitment to enshrine in law minimum numbers of nurses and midwives to care for patients. The purpose of the Act is to assist in maintaining the safety of patients in Victorian Public Health Services. Our workforce modelling must adhere to the Act whilst also meeting the changing nature of health and the evolving needs of Victorian patients. Changes in scope of practice: There is growing interest and investment in developing the scope of practice for various health professions. The increasing use of nurse practitioners and advanced practice physiotherapists are two examples of successful extended scope workforce models. Continued investment in developing new workforce models is critical to ensuring a sustainable, efficient, and effective health workforce and maximising patient centred care.