Central Adelaide Local Health Network Clinical Directorate Structures Consultation Paper February 2014 Version 2
Document Information and Revision History 1. Version 2. Date 3. Comment 1.0 12 February 2014 Initial draft 2.0 17 February 2014 Final for distribution Release Authorisation File Name Version 2.0 Release Date 17 February 2014 Release Authority 140217 CALHN Clinical Directorate Structure Consultation Paper.doc Chief Operating Officer, Central Adelaide LHN 2
Table of Contents Definitions... 3 Background... 4 Principles... 5 Project Governance... 6 The Proposed Structure... 6 Stage 1 Streams... 6 Stage 2 Units within Streams... 9 Other Clinical Directorates and Services Not in Scope... 9 Process... 9 Heads of Unit... 9 Consultation... 9 Proposed Timeframes... 10 Feedback Questions... 10 Definitions In-scope Directorate Stream Stage One Stage Two Project Sponsor COO CEO HR LHN EDMS SASMOA New RAH SSMS A Clinical Directorate identified as under review for the purpose of this change process. A combination of aligning specialisations or a cluster of aligned services within a Clinical Directorate, reporting directly to a Clinical Service Director e.g. Complex. Level of leadership, responsible for a Stream and reporting directly to a Clinical Service Director. Level of leadership responsible for a Unit within a Stream. Person responsible to the LHN for the success of the change management project. Chief Operating Officer Chief Executive Officer Human Resources Local Health Network Executive Director Medical Services South Australian Salaried Medical Officers Association New Royal Adelaide Hospital Single Service Multiple Site 3
Background Central Adelaide LHN is currently implementing a Single Service, Multiple Site (SSMS) model incorporating direct clinical leadership. SSMS is a network clinical service configuration and delivery strategy developed to ensure sustainable service delivery to meet the vision of the SA Health Care Plan 2007-2016, including preparation for the provision of services related to the implementation of the new Royal Adelaide Hospital (new RAH). This consultation paper outlines the proposed clinical structures for Central Adelaide LHN, to support the SSMS model recognising that more detailed elements of the revised structures will continue to be further defined by the Clinical Service Directors in a top down, staged approach leading up to April 2016. Stage One (1) structure will involve the development and implementation of the first level of the leadership structure across the various Streams (see definitions). Future stages will be informed after appropriate consultation in relation to the implementation plan for the next level of structure. However, it is anticipated that Stage Two (2) structure will involve the development and implementation of the next level of structure identified as those Units under each clinical Stream. It is imperative that partnerships between Allied Health, Nursing and Medical functions are supported and in particular there is an alignment between the nursing and clinical structures, given the crucial partnership between the nursing and clinical leadership functions for the respective Clinical Directorates. It is also imperative that structures and leadership roles consider linkages and interfaces with education and the academic environment. 4
Principles The development of Central Adelaide LHN clinical structures is intended to be underpinned by key principles. These principles will be consistent with those principles utilised in the Nursing Structure wherever possible. The principles will need to form the basis for the consultation process and are recommended to be: 1. Alignment with the Central Adelaide LHN Vision and Values. 2. Embracing the philosophy of a positive practice environment for both patients and clinicians, basing decisions on the best available evidence for patient centred care. 3. Effective operationalisation of the SSMS model and the development of the clinical leadership structures with consideration of the new RAH model of care and flow on effects for other services. 4. Ensuring partnerships with other professional disciplines (Nursing and Allied Health) to work as one team with effective linkages with administrative functions. 5. Optimising clinical workforce capability, by supporting an environment of continuous professional development and enhancing Central Adelaide LHN capabilities as a training and research organisation, supporting the interface with the academic environment. 6. Innovation within the parameters of the relevant industrial agreements to consider and facilitate new roles and expanding services. 7. Enabling transformational leadership allowing for innovation and devotion of appropriate resource to the efficient operations of clinical Units. 8. Centralisation of functions where appropriate to support these principles and the efficiency of the LHN as a whole. 9. Striving to ensure that the working relationship between Central Adelaide LHN, staff and their representative organisations is open and productive. 10. Establishing good governance structures reducing the risk of working in silos and reducing unnecessary duplication. 11. Alignment of work on Central Adelaide LHN wide strategic priorities such as Models of Care, Leadership and Building Workforce Capability. 12. Ensuring cost effectiveness. 5
Project Governance The Executive Director, Medical Services (EDMS) has been appointed as Project Sponsor and will be responsible for ensuring the delivery of the change management process through partnership and collaboration with the Clinical Service Directors. Clinical Service Directors will be responsible for the implementation of the structure, in accordance with Human Resources (HR) Principles and Procedures and Implementation Plans, with support from Managers of Business Operations and the Central Adelaide LHN Workforce function. The Strategic Executive will be the governance group to ensure consistent approaches and adherence to the principles. The Proposed Structure Stage 1 Streams The primary focus of this process is the implementation of the first level of the leadership structure, which is identified as those positions reporting directly to the Clinical Service Directors within each of the Directorates and in the larger Directorates is mirrored by the Nursing Structure currently being implemented in the LHN, as depicted in the below charts. Surgical Services Directorate It is proposed that the Surgical Services Directorate top level clinical structure comprises: Clinical Services Director, Surgical Services Orthopaedics Surgical Specialties General Surgery Theatres (Nursing Led) -Chart 1- *NB: Operating Theatres are nursing led and therefore do not have a specific clinical leadership role. 6
Medical Services Directorate It is proposed that the Medical Services Directorate top level clinical structure comprises: Clinical Services Director, Medical Services Acute and Support Services Cardiology Complex Specialty -Chart 2- Critical Care Services Directorate It is proposed that the Critical Care Services Directorate top level clinical structure comprises: Clinical Services Director, Critical Care Anaesthesia Emergency Department Intensive Care Services RAH Trauma -Chart 3- *NB: RAH Trauma is not considered a Stream (see definition) but is a Unit that reports directly to the Clinical Service Director 7
Cancer Services Directorate It is proposed that the Cancer Services Directorate clinical structure comprises: SA Pathology Clinical Services Director Cancer Services Clinical Haematology Oncology Radiation Oncology -Chart 4- *NB: Due to the strong link between Cancer Services and SA Pathology, particularly in the area of Haematology, this structure requires collaboration with SA Pathology. Please note that the streams for Cancer are intended to be implemented over an extended timeframe (i.e. up to 2016) to enable this collaboration to occur. Mental Health Services Directorate It is proposed that the Mental Health Directorate top level clinical structure comprises: Clinical Services Director Mental Health Mental Health Eastern Mental Health Western -Chart 5-8
Stage 2 Units within Streams Proposed Units under each Stream, for each of the in-scope Directorates are depicted in the tables in Attachment 1. These structures will be the subject of separate Directorate implementation plans after the implementation of Stage 1, as described above. The proposed structures are intended to be realigned to reflect the SSMS model and accordingly where the same clinical specialities exist across multiple sites with reporting relationships within that site, they are intended to become one Unit. Other Clinical Directorates and Services Not in Scope In 2010, Renal Services became a single service, which saw the creation of the Central and Northern Adelaide Renal and Transplantation Service (CNARTS), which currently operates across both Central and Northern LHN s and includes a state-wide service with a link to Country and Private. The Renal Services Directorate is not the subject of this restructure and is therefore not in-scope for this change. Also the clinical roles within SA Dental Services, Breast Screen SA, SA Prison Health Service and Donate Life are not the subject of this process, but they may undergo change in line with other imperatives (e.g. Breast Screen SA, as a result of the recommendations from the Digital Mammography System Wide Review). Process It is intended that the lead positions for each Stream will be advertised considering the critical nature of these roles to the success of the LHN as a whole, the fact that they are new to the LHN and the broad scope of each Stream. It is intended that the Units within the identified Streams (Stage 2) will be subject to fair and consistent processes and HR Principles and Procedures to fill the leadership roles for Units. This will be the subject of further discussion with key stakeholders. Heads of Unit It is proposed that the title of the lead positions for all levels within the structure (other than the Clinical Service Director roles) will be Head of Unit, and that regardless of the size of the Unit, Heads of Unit will be required to operate across hospital sites, as per the principles of the SSMS model to achieve Central Adelaide LHN s vision to provide a high quality, integrated patient-centered service. Consultation Consistent with the principle of building a positive working relationship between Central Adelaide LHN, staff and their representative organisations consultation will occur through each phase of the development and implementation of the proposed structure. Collaborative dialogue with staff at all levels has been, and will continue to be, encouraged in relation to proposed structures. Staff and representative organisations will continue to be consulted through briefing sessions and regular updates (e.g. electronic communiqués). 9
Proposed Timeframes Action item Consultation Document to be made available to all unions, staff and key stakeholders. Date (Approx.) 18 February 2014 Presentations of proposed structure at staff briefings calendar to be advised; staff communiques; discussions at Directorate meetings; etc. 18 February 2014 to 28 February 2014 Feedback period closes 17 March 2014 Consideration of feedback, further review/refinement of proposed 24 March 2014 structure, as required. Head of Unit roles to be advertised TBA Implementation plans for Stage 2 Units to be developed TBA Implementation complete April 2016 *NB-Timeframes are indicative and subject to change. Feedback Questions In providing feedback please consider the following questions: 1. Do you have any suggestions on how services may better align for Stage 1? 2. What do we need to put in place in order to make the SSMS concept work within and across Units? 3. How do we best support the Clinical Services Director and Nursing Co-Director to be successful in leading and coordinating the Directorate? 4. How do we ensure the structure supports effective partnerships with other professional streams i.e. Nursing/Allied Health/Administrative? 5. This consultation paper focusses on Stage 1 of clinical structure implementation. Do you have any feedback for consideration for the next stage of the proposed structure - Stage 2? 6. What suggestions do you have to minimise unnecessary duplication of services and create efficiencies? 7. Please comment on any barriers the proposed structure may create for the delivery of services. 8. Please provide any further information in relation to the proposed structure for consideration. 10
Attachment 1: INTENDED STRUCTURES (Stage 2) NB: Intended structures are only provided for the purposes of showing current thinking in relation the units that will make up Streams. Separate implementation plans will be consulted and developed for Stage 2 structures and will be led by the Stream Heads of Unit. Therefore the below may be subject to change. Surgical Services Directorate General Surgery Surgical Specialties Orthopaedics Breast / Endocrinology Cardiothoracic Orthopaedics Colorectal Neurosurgery Spinal Upper GI / Hepato- Biliary Burns Urology Gastroenterology Vascular Gynae ENT / Oral Maxillofacial Ophthalmology Plastics / Dermatology / Cranio-Facial -TABLE 1- Medical Services Directorate Acute and Support Services AMU & Short Stay General Clinical Cardiology Clinical Cardiology Complex Complex General Specialty Diabetes & Endocrine Neurology & Geriatric Care Pharmacology Stroke Infectious Disease Rehabilitation Respiratory Clinical Genetics Palliative Care Rheumatology Peri-operative Care Clinical Immunology -TABLE 2-11
Critical Care Services Directorate Anaesthesia Emergency Department (ED) Intensive Care Services RAH Trauma TQEH Anaesthesia RAH ED RAH ICU RAH Anaesthesia TQEH ED RAH Cardio- Thoracic ICU Pain Management TQEH ICU Hyperbaric Cardiac Anaesthesia Acute Pain -TABLE 3- Mental Health Directorate Eastern Mental Health Hallet Glynburn Cedars NW & PICU RAH Mental Health ED (incl PECU) RAH Ward C3 (incl Mental Health Triage) Inpatient Rehabilitation Glenside Consultation Liaison Psychiatry RAH Western Mental Health Port West Cramond House (including ECT) TQEH Mental Health ED Consultation Liaison Psychiatry TQEH Centre for Treatment of Anxiety & Depression -TABLE 4-12