The Health Roundtable

The Health Roundtable Our Mission The Health Roundtable Limited has operated as a non-profit collaborative organisation since our inception in 1995. We exist to: Provide opportunities for health executives to learn how to achieve Best Practice in their organisations. Collect, analyse and publish information comparing organisations and identifying ways to improve operational practices. Promote interstate and international collaboration and networking amongst health organisation executives. Our Members Membership of The Health Roundtable is open to health services across Australia and New Zealand, subject to approval by the Board of Directors. Each member organisation nominates its most senior operational executive to serve as a Personal Member of The Health Roundtable. Personal Members elect a Board of Directors to provide overall governance. They meet regularly to shape the agenda and review progress. The Board s Audit & Risk Committee reviews operational and financial performance on a monthly basis. The Health Roundtable receives no direct government funding. All activities are supported by annual membership dues, subscription fees and corporate sponsorships. Sharing Information Data provided to The Health Roundtable are freely shared amongst participating members, but are not disclosed to outside organisations. However, general insights and methodologies are openly available to the public through our website: www.healthroundtable.org The Health Roundtable Honour Code In order to maintain frank discussion in our meetings, all our members agree to abide by The Health Roundtable Honour Code which requires that: Members shall not criticize the performance of other member hospitals, or use any of the information to the detriment of a fellow member. Members consent to the use of their data for research purposes, provided that it is fully de-identified as to patient, provider, health service, and jurisdiction. Members agree not to distribute Health Roundtable data or reports identifying any member to nonmembers without the unanimous consent of all those identified, unless required by law. The Health Roundtable Limited 40 Port Jackson Road Terrigal NSW 2260 Australia Tel: +61 2 8041 1421 New Zealand (09) 889-2551 www.healthroundtable.org ABN 71 071 387 436 i The Health Roundtable Limited Annual Report 2015

Table Of Contents Page General Manager s Report 2 Directors Report 3 Core Activities, Data Collections and Reports 12 Special Roundtables and Workshops 22 Improvement Groups 27 Financial Statements 41 Independent Auditor s Report 48 The Health Roundtable Limited Annual Report 2015 1

General Manager s Report 2015 was a significant year for The Health Roundtable (The Roundtable) for many reasons. The year commenced with a special Annual General Meeting that recognised the 20 th anniversary of the establishment of The Roundtable. Over the last twenty years, the membership of The Roundtable has grown from the initial seven member hospitals to reach a total of 87 health services which includes 152 hospitals throughout Australia and New Zealand. This is the largest and longest running clinical benchmarking and innovation sharing group in the Southern Hemisphere. Despite its growth, The Roundtable continues to consistently deliver on its original mission goals of i) providing opportunities for health executives to learn how to achieve Best Practice in their organisations; ii) collect, analyse and publish information comparing organisations and identifying ways to improve operational practices; and iii) promoting interstate and international collaboration and networking amongst health organisation executives. At the start of 2015, I was appointed General Manager of The Roundtable following David Dean s retirement from the position. David led the development of The Roundtable for all of its first twenty years of existence. Whilst David retired from the role of General Manager, he still supports The Roundtable as the Managing Director of Chappell Dean Pty Limited, the company that has provided all of the technical support to The Roundtable. In mid-2015, I undertook a SWOT analysis of The Roundtable for the Board of Directors. That analysis noted that whilst members were happy with the various reports, workshops and educational programs being provided, there was a desire for a number of improvements. All of the suggested improvements were noted, and The Roundtable started an implementation of new and upgraded initiatives. All of the improvement activities will be implemented by the middle of 2016. Examples of some of the improvements included the appointment of additional managers to provide more frequent on-site presentations to member hospitals. Other examples relate to substantially upgrading and revising significant reports especially the maternity services and mortality reports. There will also be greater liaison activities with key stakeholders and supporters of The Roundtable activities. In particular, The Roundtable will commence work with relevant community based entities that continue the care of patients once they leave hospital. Discussions have already commenced to consider possible data analysis with Primary Health Organisations. As well as the new initiatives, The Roundtable continued to run educational workshops that showcase innovations in health service quality and safety. The 2015 innovations workshop s included over 280 innovations that have been implemented by hospitals around Australasia and New Zealand. To ensure that all members of The Roundtable can better appreciate the innovation that is occurring to improve patient care and safety, short video recordings of the best innovation presentations provided at each workshop will be uploaded to the HRT website. During 2016, there will also be increased showcasing of innovations by The Roundtable client managers when they conduct hospital briefing sessions. As we all appreciate, the journey to continue improving the quality, effectiveness and efficiency of health services is never ending. It is thus extremely pleasing to acknowledge the commitment of all of The Roundtable members who not only continue to share their innovations (and the lessons learnt from failures) but also their willingness to provide ongoing encouragement and support for other hospitals. After 20 years, The Roundtable can not only positively reflect on all of its activities that have helped hospitals improve patient care, but also feel confident that its three foundation mission goals will continue to assist improving services in Australian and New Zealand hospitals for at least another 20 years. Finally, I would like to acknowledge the work and support of two important groups that ensure the services provided by The Roundtable continue to grow each year both in number and quality. The first group is the dedicated staff and consultants of Chappell Dean Pty Limited who work tirelessly behind the scenes to ensure the professional delivery of all of The Roundtable data analysis, report preparation, technical support and educational programs for member hospitals. The second group is the Board of Directors, ably led by Assoc. Prof Andrew Way. The personal members who serve on the Board voluntarily give of their time to provide the strategic leadership and standard setting that is essential in helping The Roundtable remain as the leading clinical benchmarking and innovation sharing entity in Australasia. Dr John Menzies 2 The Health Roundtable Limited Annual Report 2015

Directors Report THE HEALTH ROUNDTABLE LIMITED ABN 71 071 387 436 DIRECTORS FINANCIAL REPORT FOR 2015 Your directors submit the financial accounts of the Company for the calendar year ending 31 December 2015. Members of the board of Directors as of 29 February 2016 were: Andrew Way, President Ron Dunham Margot Mains Frank Daly, Vice President Naomi Dwyer Phillip Balmer Kim Hill John Menzies, General Manager Geraldine Carlton Nigel Millar Jim Story, Company Secretary Principal Activities The principal activities of the Company during the financial year were to: Provide opportunities for health executives to learn how to achieve best practice in their organisations. Collect, analyse and publish information comparing organisations and identifying ways to improve operational practices. Promote interstate and international collaboration and networking among health organisation executives The Roundtable focuses on sharing innovations in patient care amongst its members, so that they can treat additional patients and continue to improve the quality of patient care. Membership 2015 The Constitution of The Roundtable delineates separate roles for Organisational and Personal members. Health service providers are eligible for Organisational Membership. Personal Membership is offered to a senior executive within each Organisational Member. Voting rights on issues affecting the operation of The Roundtable are vested in Personal Members only. During 2015 there were some organisational realignments and executive personnel changes. We welcomed new members; Liverpool Hospital NSW, UnitingCare Health, Qld and Bairnsdale Regional Health Service Victoria. In Queensland, Lady Cliento is the new Childrens Health Service facility. Organisational and Personal Members of The Roundtable as of February 2016 are listed on page six below. Associate Membership Under the Constitution, Associate Individual and Organisational Membership can be offered to a wide range of organisations and individuals, subject to approval of the Board of Directors, listed on the next page. Associate Membership status provides the opportunity to participate in selected activities as authorised by the Board of Directors. There are no Organisational Associate Members at this time. The individual Associate Members of The Roundtable as of the date of this report are: David Dean Jennifer Williams Colin MacArthur Bill Kricker Linda Sorrell Karen Roach Pat Martin Kathryn Cook Kaye Challinger Kerry Stubbs Adrian Nowitzke Andrew Bernard Michael Szwarcbord Mary Bonner Michael Walsh John O Donnell The Health Roundtable Limited Annual Report 2015 3

Directors Report Officers Andrew Way Director Chief Executive. Attended 6/6 meetings Alfred Health, Vic Feb 2012, Casual vacancy appointment March 2012, Elected March 2014 Elected Treasurer March 2015 Elected President Frank Daly, Chief Executive. Attended 3/6 meetings South Metro AHS, WA July 2012, Casual vacancy appointment March 2013, Elected March 2014, Elected Vice President Max Alexander, Chief Executive. Attended 6/6 meetings Southern NSW LHD March 2013, Elected March 2015 Elected Treasurer Directors Ron Dunham, Chief Executive, Attended 6/6 meetings Lakes DHB New Zealand Feb 2012, Casual vacancy appointment March 2012, Elected Feb 2014-15 President Phillip Balmer, Chief Operating Officer, Attended 5/6 meetings Bay of Plenty DHB, NZ July 2012, Casual vacancy appointment March 2013, Elected Margot Mains, Chief Executive. Attended 3/6 meetings Northern Adelaide LHN, SA Feb 2012, Casual vacancy appointment March 2012, Elected March 2014, Re-elected John O Donnell, Chief Executive Attended 3/4 meetings Mater Health Services Brisbane, Qld. March 2008, Elected March 2008, April 2009, President March 2010, Re-elected March 2013, Re-elected Kim Hill, Executive Medical Director. Attended 6/6 meetings Western Sydney LHD, NSW August 2013, Casual vacancy appointment March 2014, Elected Director Geraldine Carlton, Executive Director. Attended 6/6 meetings Rockingham General Hospital, WA March 2014, Elected Naomi Dwyer, Chief Executive. Attended 2/6 Women s & Children s Hospital Adelaide November 2014, Casual vacancy appointment Nigel Millar, Chief Medical Officer. Attended 2/3 meetings Canterbury DHB, New Zealand 2015 Casual vacancy appointment David Ashbridge, Chief Executive. Attended 0/2 meetings Barwon Health, Victoria July 2012, Casual vacancy appointment March 2013, Elected Director 2015 President of The Health Roundtable John Menzies, General Manager March 2015 Appointed Jim Story, Company Secretary February 2015, Appointed Audit and Risk Committee Andrew Way, Member April 2014 Current Ron Dunham, Member July 2012 Current Margot Mains, Member November 2012 Current Andrew Way (Max Alexander, Chairman until Dec 2015 ) Southern NSW LHD External Members of the Audit and Risk Committee The Board expresses its appreciation to its external members serving on the Board s Audit and Risk Committee for their input to the governance of The Roundtable during 2015: Colin Holland, General Manager Finance and Performance, South Metropolitan Health Service, WA Natalie McDonald, Executive Director, Finance, Western Sydney LHD, NSW Director Resignations 2015 David Ashbridge Chief Executive Barwon Health, Victoria 27 March, 2015, Resigned John O Donnell, Chief Executive Mater Health Services Brisbane, Qld 24 July 2015, Resigned Max Alexander, Chief Executive Southern NSW LHD December 2015, Resigned 4 The Health Roundtable Limited Annual Report 2015

Directors Report Operating Results The Health Roundtable continued to operate on a sound financial basis in 2015, with income exceeding expenses. The organisation had 87 member health services during the year with 152 facilities providing data for comparative analysis. The organisation recorded a surplus of $69,562 for the financial year. The accumulated surplus increased to $868,172 as of the end of the financial year. The Roundtable makes no provision for income tax, as the company is exempt from income taxation as a not-for-profit charitable organisation. Almost all expenses are matched against member subscription revenue under an outsourcing contract with Chappell Dean Pty Limited. Administration and discretionary expenses are offset against corporate sponsorship and interest earnings. The overall financial strategy of the Board is to build a small surplus to cover monthly fluctuations in income and expenses. As at December 2015, the surplus represents about 8 weeks of running costs for the organisation. Directors Indemnification During or since the end of the financial year, the Company has paid premiums in respect of a contract insuring all directors and officers of The Roundtable Limited, including external members of the Audit & Risk Committee against certain liabilities incurred in that capacity. Disclosure of the nature of the liability covered by the insurance, and premiums paid is subject to confidentiality requirements under the contract of insurance. Meetings of the Audit & Risk Committee The Board s Audit & Risk Committee has responsibility for reviewing the organisation's Risk Register, for reviewing the performance of the organisation and has delegated authority from the Board for disbursement of funds. This committee includes two external members with extensive financial expertise, Colin Holland and Natalie McDonald. The committee reviewed status reports and approved expenditures through email resolutions on a monthly basis during the year. Board Expenses Board expenses for 2015 were $55,718 for external consultancies, and for reimbursement for travel and accommodation expenses to attend Board meetings or Board approved external meetings. Directors Benefits No director has received or become entitled to receive, during or since the financial year, a benefit because of a contract made by the company with: a director, a firm of which a director is a member or an entity in which a director has a substantial financial interest. Proceedings on behalf of the Company No person has applied for leave of Court to bring proceedings on behalf of the Company or intervene in any proceedings to which the Company is a party for the purpose of taking responsibility on behalf of the company for all or any part of those proceedings. The Company was not a party to any such proceedings during the year. The Health Roundtable Limited Annual Report 2015 5

Directors Report Alfred Health Austin Health Victoria Ballarat Health Services Bairnsdale Regional Health Barwon Health Bendigo Health Cabrini Health Eastern Health Melbourne Health Mercy Public Hospitals Monash Health North East Health Northern Health Royal Children's Hospital South West Healthcare St Vincent s Health West Gippsland Healthcare Western Health South Australia Central Adelaide Northern Adelaide Southern Adelaide Womens & Childrens Health Adelaide Tasmania Tasmanian Health Org -Southern Tasmanian Health Org Northwest Australian Capital Territory Calvary ACT Canberra Hospital Northern Territory Personal Member Andrew Way Brendan Murphy Andrew Kinnersley Therese Tierney Paul Cohen John Mulder Michael Walsh Alan Lilly Peter Bradford Linda Mellors Andrew Stripp Margaret Bennett Siva Sivarajah Christine Kilpatrick John Krygger Susan O Neill Dan Weeks Alex Cockram Personal Member David Panter Margot Mains Belinda Moyes Naomi Dwyer Personal Member Craig Watson Annette Pantle Personal Member Karen Edwards Ian Thompson Personal Member NT Top End Louise Oriti to Dec 2015 New Zealand Personal Member Auckland DHB Bay of Plenty DHB Canterbury DHB Capital and Coast DHB Counties Manukau DHB Hawkes Bay DHB Hutt Valley DHB Lakes DHB Mid Central DHB Nelson Marlborough DHB Northland DHB South Canterbury DHB Southern DHB Tairawhiti DHB Taranaki DHB Waikato DHB Waitemata DHB Whanganui DHB Sue Waters Phil Cammish Nigel Millar Debbie Chin Phillip Balmer Kate Coley Carolyn Cooper Ron Dunham Murray Georgel Chris Fleming Nick Chamberlain Nigel Trainor Lexie O'Shea Jim Green Rosemary Clements Jan Adams Dale Bramley Julie Patterson Queensland Cairns & Hinterland HHS Children s Health Qld Central Queensland HHS Darling Downs HHS Gold Coast HHS Mackay HHS Mater Health Service, Brisbane Metro North HHS Caboolture Redcliffe Hospital Royal Brisbane & Women s The Prince Charles Metro South HHS Logan Princess Alexandra QE II Jubilee Redland Metro South Addictions & Mental Health Sunshine Coast HHS Townsville Hospital HHS UnitingCare Health West Moreton HHS Wide Bay HHS New South Wales Calvary Mater Newcastle Central Coast LHD Illawarra Shoalhaven LHD John Hunter Hospital Liverpool Hospital Mid North Coast LHD Murrumbidgee LHD Nepean Blue Mountains LHD Royal North Shore & Ryde South East Sydney LHD St George & Sutherland Prince of Wales Network St Vincent s Hospital Personal Member Julie Hartley-Jones Fionnagh Dougan Len Richards Peter Gilles Ron Calvert Clare Douglas Shane Kelly Peter Tesar Lexie Spehr Judy Graves Luke Shorten Brett Bricknell Stephen Ayre Mike Kerin Rosalind Crawford David Crompton Kevin Hegarty Kieran Keyes Terence Seymour Sue McKee Adrian Pennington Greg Flint Personal Member Matt Hanrahan Margot Mains Michael DiRienzo Robynne Cooke Kathleen Ryan Jill Ludford Kevin Hedge Andrew Montague Cath Whitehurst Jon Roberts Brett Gardiner Southern NSW LHD Max Alexander to Dec 2105 Western NSW LHD Western Sydney LHD Western Australia Child&Adolescent Health Service Scott McLachlan Kim Hill Personal Member Philip Aylward WA Country Health -Bunbury* Jeff Moffet South Metro AHS Armadale Hospital Chris Bone Fiona Stanley Hospital Robyn Lawrence Fremantle Hospital* David Blythe to Dec 2015 Royal Perth Hospital Aresh Anwar Rockingham General Hospital Geraldine Carlton North Metro AHS Victor Cheng St John of God* New 2016 Updated February 2016. * not currently subscribed 6 The Health Roundtable Limited Annual Report 2015

Directors Report In 2015, The Health Roundtable enjoyed the support of the organisations listed below. The Roundtable welcomes sponsor organisations to participate in its activities to learn more about the issues facing health services, provided that no perceived conflict of interest is identified by any member, and that sponsors abide by the Honour Code. Funds received from sponsorship are used to defray administrative expenses and to fund awards for innovative practices amongst members. Roche Products Pty Limited (Australia) is part of the International F. Hoffmann-La Roche Group worldwide. Roche has grown from a small drug laboratory into one of the world's leading research-based healthcare companies and is known for many innovative contributions to medicine. Arranged in two operative divisions, our global mission today and tomorrow is to create exceptional added value in healthcare. These two units are: Pharmaceuticals and Diagnostics. Novartis is caring and curing. We are committed to research and development and since 2007 Novartis has invested 20% of its net pharmaceutical sales globally in R&D in Australia we invest around $AUD 30 million annually. Our dedication to research drives innovation and we have one of the strongest pipelines in the industry. In Australia, the Novartis Group comprises of Pharmaceuticals, Alcon, Sandoz, Consumer Health, Animal Health and Vaccines & Diagnostics. To find out more about who Novartis is, visit www.novartis.com.au Free up more time for treating patients and improve the accuracy of your professional time reporting by using the Activity BarCoding (ABC) System. The ABC System replaces paper diaries and data entry typing tasks with a portable barcode reader that instantly records the barcode label of the patient you are seeing plus codes for your key activities with the patient, as you deliver your service. It then takes just a couple of minutes to upload and review all your activity for the day. The system was designed from the ground up for busy health care professionals, with extensive management reports for you, your patients and referring departments. For more information, please check www.activitybarcoding.com The Health Roundtable Limited Annual Report 2015 7

Directors Report 2015 Annual General Meeting and 20th Anniversary Celebrations The Health Roundtable Annual General Meeting and Executive Workshop were held in Sydney on Friday, 27 March. The theme was Looking Forward: The Next 20 Years. All presentations and video are available on The Roundtable Website www.healthroundtable.org In 1995, the Roundtable members agreed on 10 patient service aspirational goals that have guided many of our discussions over the last 20 years. Many have been reached and surpassed, whilst others such as readmissions continue to elude us. In 2015 it s time to take stock and update these goals and set new goals that reflect National and International health aspirations. Recognising that health care is now being more influenced by global trends and adoption of new technologies, invited local and international speakers helped provide insight on how aspirational goals could be achieved. Joshua Tepper from Canada, Who will deliver care in 2035? Mario Bozzo from the UK, What facilities to meet patient needs? Richard Ashby from Australia, How to pay for care in 2035? Nigel Millar from New Zealand What care will our citizens expect in 2035? Ontario s Quality Improvement Plans: Shining the spotlight on good ideas! The Health Roundtable sponsors a number of international health leaders each year to share insights with members. In addition to joining in the 20 year celebrations; Joshua Tepper, President and Chief Executive Officer of Health Quality Ontario, led a full day workshop to share Ontario s experience with Quality Improvement Plans (QIPs). These were implemented 4 years ago in the hospital sector and over the course of the last few years extended to: primary care organizations; long-term care homes and community care access centres over 1000 Health Care Provider Groups! QIPs play a pivotal role in improving the quality of care that is delivered in Ontario. They allow organizations to formalize their quality improvement activities, articulate their goals, and identify concrete ways of achieving their goals. In this workshop Joshua shared Key Observations highlighting activities that have been linked to positive gains for seven priority indicators. By shining a spotlight on the ideas that have been most effective, we in Australasia can also learn from the Ontario experience. 8 The Health Roundtable Limited Annual Report 2015

Directors Report 2015 Research Collaboration The Health Roundtable inpatient episode data base is one of the largest non-governmental collections of hospital operational activity in the world, adding over 5 million records per year from 152 hospital facilities across Australia and New Zealand. The database has a wealth of de-identified diagnosis, procedure and demographic data linked to hospital stays and provides a mechanism to track episodes of the same patient over time for many member organisations. Extracts from the database are available to researchers who agree to abide by the conditions set out by the Board in its academic research policy, these were updated in 2015 and are available on the website. University Healthsystem Consortium Merged into Vizient The Health Roundtable is an international member of the University Healthsystem Consortium www.uhc.edu that offers all Health Roundtable member organisations and their staff free access to an online library of materials regarding health care practices in the USA. The merger in 2015 does not affect member access https://www.vizientinc.com International Hospital Federation The Health Roundtable became an associate member of the IHF in 2013 and is participating in a new global special interest group of academic medical centres comparing practices and solutions. The Health Roundtable Limited Annual Report 2015 9

Directors Report The Health Roundtable is a virtual organisation without bricks and mortar or staff. The Board of Directors has negotiated a contract with an external management firm, Chappell Dean Pty Limited, led by Dr David Dean, to manage the operations of the organisation. Chappell Dean provides a network of employees and independent contractors to help you improve the effectiveness and efficiency of patient care. Under the contract, Dr John Menzies is seconded to serve as General Manager. During the year, Chappell Dean Pty Limited provided the following team members to support the operations of The Roundtable: Chappell Dean Staff David Dean, Managing Director Aditya Mothukuri, Data Analyst Alireza Radman, Systems Administrator Aman Dayal, Chief Information Officer Christine Eko, Systems Analyst Cheryl Duffy, Operations Manager Karen Murdoch-Hollies, Project Officer Kate Tynan, Project Manager Kavitha George, Systems Analyst Lohit Salaria, Systems Analyst Margaret Colville, Data Analyst Margaret Dean, Accounts Manager Mariette Reefman, Administrator Mercedeh Edrisi, Systems Analyst Nick Mitchell, Systems Analyst Paul White, Relationship Manager Rachel Plumbe, A-HED Manager Rebecca Tian, Data Analyst Salma Bergum, Data Analyst Sarah Brandt, Clinical Consultant Shwetha Naga, Data Analyst Siavash Adibi, Systems Analyst Chappell Dean Contractors* John Menzies, General Manager Alex Carrasco, Relationship Manager Bernie Mullin, Relationship Manager Bill Kricker, Senior Mentor Bindy Steuart, Report Production Brian Dolan, Clinical Consultant Chris Cunningham, Project Manager Chris O Gorman, Relationship Manager Gail Prileszky, Relationship Manager Ian Tebbutt, Database Architect John Menzies, General Manager Matt Stewart, Project Manager Mark Limber, Relationship Manager Michael Blatchford, Relationship Manager Nicholas Smeaton, Website Designer Pam O Nions, Relationship Manager Peter Reeves, Operational Consultant Pieter Walker, Project Manager Rohan Cattell, Project Manager Wojciech Korczynski, Relationship Manager Raj Behal, Patient Safety Consultant *Individuals provided through various contracting organisations 10 The Health Roundtable Limited Annual Report 2015

Directors Report The financial statements in this annual report of the Directors are signed in accordance with a resolution of the Board of Directors The Health Roundtable Ltd. I, John Menzies, General Manager of The Health Roundtable Limited, declare that in my opinion: 1. The financial records of The Health Roundtable Limited for the financial year have been properly maintained. 2. The financial statement and the notes for the financial year comply with the accounting standards; 3. The financial statements and notes for the financial year give a true and fair view; and Andrew Way, Director and President Date 18 February 2016 4. Any other matters that are prescribed by the regulations for the purposes of this paragraph in relation to the financial statements and the notes for the financial year are satisfied. Yours sincerely, Date 18 February 2016 Geraldine Carlton, Director Date 18 February 2016 Dr John Menzies MBBS MHP FRACMA AFACHSM General Manager Health Roundtable The Health Roundtable 40 Port Jackson Road Terrigal NSW 2260 Tel: (02) 4385 5894 Fax: (02) 4384 7078 www.healthroundtable.org ABN 71 071 387 436 After Balance Events Since the close of the financial year in December 2015, no matters or circumstances have arisen which may significantly affect the operations of the Company, the results of those operations, or the state of affairs of the Company in subsequent financial years. The Health Roundtable Limited Annual Report 2015 11

Overview of 2015 Activities We work with members to improve patient care by helping them answer three key questions: Where is our performance below that of our peers? How do the exemplar performers achieve their results? How can we improve practice in our health service? Our membership in 2015 included 87 health services from every state and territory of Australia and all District Health Boards in New Zealand, including both public and non-profit private facilities. Each member provides operational data on inpatient, outpatient, and emergency presentations which we collate, analyse and compare to identify variation. We provide customised reports for each member to compare them to peer organisations and to highlight those with better results. We then encourage the members to contact the exemplars directly or through our various meetings to find out if the results are due to improved coding and counting, or to improved clinical practice. This section provides a snapshot of the key activities, which are recorded in far more detail on our website www.healthroundtable.org Core Activities for All Member Organisations The Health Roundtable provided five core membership services in 2015 for all members to help them identify performance improvement opportunities: 1. In-Hospital Mortality Reports 2. Key Performance Indicator Reports 3. Inpatient Care Reports 4. Emergency Presentation Reports 5. Innovation Workshops and Awards Continuous Improvement Services We offered specialised services to individual members, including on-site executive and clinical unit briefings, operational planning support, ad hoc data analysis, and staff climate surveys. Two are highlighted in this report are Continuous Improvement Services Stranded Patient and Lean Healthcare Training Programs. 12 The Health Roundtable Limited Annual Report 2015

Overview of 2015 Activities Major Roundtable Workshops 2015 The Health Roundtable held six special workshops to address emerging issues of interest to our members. 1. Special Roundtable: Reducing Unplanned Readmissions 2. Special Roundtable: Improving Hospital in the Home 3. Special Roundtable: Improving Care for Patients with Hip Fracture 4. Special Workshop: Joshua Tepper, Ontario s Quality Improvement Plans 5. Special Workshop: Hospitals and PHNs. The New Force in the Management of Chronic Conditions 6. Special Workshop: Raj Behal, Stanford, Journey to a High Performance Organisation Optional Improvement Groups 2015 The Health Roundtable offered a wide selection of ongoing improvement group programs to identify innovative practices at other health services and get help from peers to improve services: 1. Imaging Improvement Group Workshop 2. Financial performance Review Workshop 3. Paediatric Improvement Group Workshop 4. Maternity Improvement Group Workshop 5. End-of-Life Care Improvement Group Workshop 6. Mental Health Improvement Group Workshop 7. Medication Improvement Group Workshop 8. Nursing Improvement Group Workshop 9. Surgical Journey Improvement Group Workshop 10. Patient Safety Improvement Group Workshop 11. Allied Health Improvement Group Workshop 12. Health Roundtable Innovation Awards 13. Sub-acute Services Improvement Group Workshop 14. NSW Chapter Workshop 15. NZ Chapter Workshop Open Sharing of Information Amongst Members We recognise that some members may not have the time or staff to participate actively in all our activities. The Roundtable has a policy of openly sharing reports and information with all members to encourage the spread of innovation more quickly. All Health Roundtable data reports (excluding detailed mortality reports), meeting materials, and presentations are available to all staff of all member organisations in the member section of the website. Usage of the information is subject to our Honour Code which prohibits the use of the information to the detriment of another member, or the external disclosure of the information without the consent of those who contributed the data. The Health Roundtable Limited Annual Report 2015 13

Core Activities: Health Roundtable Data Collections The Health Roundtable collects and analyses a wide range of data provided by its member organisations to identify differences in performance to alert them to potential opportunities for further improvement. The following pages summarise the breadth and depth of the reports available to members to help them identify where their results are below that of their peers. During 2015, The Roundtable team of analysts collaborated with staff from member organisations to analyse large amounts of data, including: 5.7 million inpatient records representing over 15 million bed days. Patients aged 80 or more represent about 13% of the population, but required 21% of bed days. Approximately 9% of patients had an additional hospital-acquired condition during their episode. These patients used 35% of all bed days. The total cost of the episodes using the Australian national weighted activity unit value was over $25.8 billion Australian dollars. 6.2 million emergency department presentations, of whom 32% were formally admitted to hospital. Across Australia and New Zealand, 69% of those presenting to ED left within 4 hours and 85% left within 6 hours. 9.3 million Allied Health records detailing approximately 4.8 million hours of professional time to service 424,517 individuals as outpatients and 433,302 individuals as inpatients. Summary reports from these analyses were provided to the participants in each improvement group to enable them to compare results with each other. In addition, over 9,500 customised narrative reports were produced to provide clinicians at each member facility with details of their clinical performance for key patient groupings compared with their peer organisations in The Roundtable. All reports are stored in an online library on The Roundtable website and are available for downloading by all staff members of every member organisation. The Roundtable takes care to ensure that only administrative data about patients is submitted by member organisations, without disclosure of patient-identifying information. 14 The Health Roundtable Limited Annual Report 2015

Core Activities: Reducing Length of Stay Inpatient Briefing Reports The Health Roundtable produces a suite of inpatient briefing reports by DRG family to assist in finding opportunities for improvement. Although focused on length of stay, the reports also provide data on readmission, DOSA rates, patient complexity and complications of care. We also introduced in 2015 an online tool to produce reports by DRG or Principal Diagnosis on demand, comparing their performance to any grouping of member facilities. The Health Roundtable provides customised inpatient briefing reports to assist in finding opportunities for improvement. The reports highlight major differences in patient care using a Relative Stay Index (RSI) to account for differences in patient mix across facilities. They are designed to help members focus on the highest value opportunities to improve patient care. Briefing Charts Inpatient briefing reports include charts on differences in patient length of stay patterns. Departmental Reports Hospitals are organised by Clinical Departments. To make the comparative data more useful, we provide Departmental Reports based on the clinical unit that discharged the patient. Our computer system finds the closest 10 units across The Health Roundtable membership with the most similar Casemix to provide comparative reports. The Health Roundtable Limited Annual Report 2015 15

Percentage of Target Core Activities: Emergency Department Reports Emergency Department Reports Emergency Data Reports are produced every three months to provide trend information for each health service compared to its peers on a variety of key indicators, such as: Percentage discharged within 4 or 6 hours Hourly presentation patterns Monthly volume trends ED admission rates Did not wait rates A key focus for improving patient care is the time taken in Emergency Departments to determine whether the patient should be admitted to a ward or discharged home after treatment in the department. Members provide the details of every ED presentation to allow a comprehensive range of analytics, from time-of-arrival comparisons to duration of stay. The Emergency and Inpatient reports have been customised for Australian and New Zealand members to reflect differing definitions. In Australia, the ED component is separated from inpatient stay, whilst in New Zealand it remains a part of the inpatient episode. The chart below highlights continuing improvements in the number of patients processed with 4 hours. National Emergency Access Target 4 Hour Compliance Hospitals The reports include analysis of differences in ED stay by Urgency Related Group and by diagnosis 16 The Health Roundtable Limited Annual Report 2015

Core Activities: Executive Level Scorecards Key Performance Indicator Reports Key Performance Indicator Reports bring together information derived from inpatient and emergency data, together with selected clinical and workforce measures that are manually entered by hospital staff through our online portal. This provides senior executives an overall Balanced Scorecard: Trend information of performance over time Comparisons with peer hospitals on each indicator Traffic light indicators to identify opportunities in your service at a glance National Standards Reports In 2015 the KPI reports were reformatted to make it easier to see each member s peer ranking on each indicator together with comparisons to the overall 25th and 75th percentiles for The Health Roundtable. Your service is compared with 15 peer hospitals and overall trend over time is also shown on the same page. The Health Roundtable Limited Annual Report 2015 17

Core Activities: Mortality Reports Inpatient Mortality Reports The Health Roundtable produces mortality reports on a quarterly basis for the preceding 12-month period. Services can compare their hospital mortality rates to an expected rate based on about 15 million episodes drawn from over 160 public and private hospitals in a 3-year index period. The process is designed to anticipate the methodologies to be used by government agencies for public reporting. Each organisation receives a report showing its standardised hospital mortality rate (HSMR) compared to other members of The Roundtable. We send alerts to those whose results are unlikely to be due to random variation. Six month rolling HSMR Higher Risk for Weekend Arrivals Internationally, patients face a 10% higher standardised mortality ratio (SMR) if they require treatment on weekends. Overall results across Australia and New Zealand indicate a similar elevated risk for emergency patients arriving on Saturday or Sunday, compared to Tuesday or Wednesday, after taking into account known patient risk factors. 18 The Health Roundtable Limited Annual Report 2015

Core Activities: Innovations Workshops and Awards 2015 Innovation Workshops and Awards 2015 The Health Care system has never been under such intense pressure. New technologies, an ageing population and workforce shortages are combining with the global financial crisis to create a perfect storm for health system leaders. Major improvements in care delivery are urgently needed and The Roundtable is dedicated to spreading innovative practices as quickly as possible. In November 2015, 300 delegates from Health Roundtable Members across Australia and New Zealand were again challenged and motivated by a diverse array of over 190 innovations, our largest workshop ever! The rapid fire poster sessions were designed to provide time to share issues and to create a network of colleagues to assist each other to meet the future demands of health care systems. Improving Patient Care Improving Organisational Performance Meeting Clinical Performance Targets Participants voted on the posters of most relevance to them, with the winners of each of 12 sessions receiving a $1000 prize. In the final plenary session, participants selected one winner from each stream to receive a $5000 prize. All Innovation Posters and video recordings of the keynotes are displayed on the public-facing side of The Roundtable website to encourage the widest possible spread of innovations developed by member organisations. www.healthroundtable.org Keynote Speaker Winning Innovations! Stream One: Improving Patient Care In home specialist Telehealth Paediatric Care Amy Holmes, Sunshine Coast HSS Improving continuity of care with telehealth and support technologies Raj Behal, Chief Quality Officer from Stanford University Hospital shared their journey to pre-eminence starting with placing patient needs at the centre of care and implementing strategies to move from incremental change to orders of magnitude change. Stream Two: Improving Operational Performance Waste Management - Our Story Gavin Johnson, Metro South HHS, Redland Redland hospital achieved a Met with Merit on waste in its accreditation undertaken in March April 2015 under the National Safety and Quality Health Service (NSQHS) Standards Stream Three: Meeting Clinical Performance Targets ipromptu2 Paul Russell, Northern Sydney LHD ipromptu2 is a practical medical device for improving hand hygiene compliance in all clinical settings The Health Roundtable Limited Annual Report 2015 19

Reports Online: Faster Data Exploration A-HED Online Tools Australasian Healthcare Evaluation Data (A-HED ) is an online solution developed in collaboration with University Hospitals Birmingham to enable member organisations and healthcare agencies to find ways to improve patient care by exploring clinical variation. A-HED s interactive and intuitive interface makes it easy for healthcare professionals from the Board to the Ward to review the latest trends on key performance indicators, as well as to drill down to individual patient episodes. The A-HED online system enables any member to compare its performance to other members including a selection of UK hospitals. Trend data is available from 2012 so services can monitor their improvements. The interactive interface has a range of filtering options to select specific diagnoses, procedures, time frames, and clinical units, including a drill down to each member s own individual patient episodes. A-HED incorporates national and international measures of clinical quality and efficiency, adapted by The Roundtable for the Australasian setting. Performance indicators have been established to provide quick updates on Patient Safety, Operational Efficacy, Clinical Quality and Financial Opportunity. Members have the option of providing data on a monthly basis, or to rely on quarterly updates. In 2015 there were 23 hospitals using the system to improve their performance. Hospitals 20 The Health Roundtable Limited Annual Report 2015

Continuous Improvement Services Continuous Improvement Services The Health Roundtable offers a wide range of specialised services to assist members in planning and implementing improvements. These include: Lean Healthcare Training Stranded Patient Program Operational Planning Modelling Staff and Medical Engagement Surveys On-site briefings Ad Hoc Analyses In 2009, we launched a special Stranded Patient Program to help member organisations identify the issues surrounding medical and surgical patients in hospital for over 21 days. The issues often involved highly complex patients who required treatment from multiple specialties. However, in many cases, coordination of the overall management of these patient was lacking, and the patients become stranded. Our program helps hospital teams develop screening tools to identify patients at risk of stranding, as well as escalation processes to assist patients when length of stay exceeds expectations. In addition, many of our standard reports now highlight potential long-stay patient issues for members. A Stranded Patient Reports provide trend data to track improvements over time. Timaru Hospital NZ embarked on a program to reduce stranded patients in 3 inpatient units by 20% over a period of two years. With coaching from The Roundtable expert team they: Mapped the patient journey to identify blocks in service Displayed visual data to identify potential Stranded Patients Relocated outliers back to the home ward within 48 hours to prevent long stays Education for all clinical staff Improved communication between departments and community services. E.g. wrap around service Improved documentation and input from Allied Health Introduction of the ERAS (enhanced recovery after surgery) programme Sustained a reduction in long stay patients! Why services should manage Long Stay patients No waste, no wait & no harm Prevent poor patient experiences and clinical outcomes Recognition that a patient s time is important Reduce waste and resource costs for organisation while improving high quality patient care The Health Roundtable Limited Annual Report 2015 21

Special Roundtable: Reducing Readmissions Reducing Readmissions Date: 19 & 20 February Location: Sydney Subscribers: 30 hospitals Attendees: 80 delegates What do we know about reducing readmissions: A wicked problem. Internationally and across Australasia Hospital Funders are increasingly paying for outcomes and penalising health services who have high readmission rates for selected conditions. Reducing Unplanned and Avoidable Readmissions - was the special focus for members with the majority actively reviewing their data, undertaking patient level reviews and implementing a wide range of improvement strategies. A common theme for action plans was on creating improved care for patients by improving transitions of care ; enhancing support in the community; and enhancing services for high risk patients, coining the term Very Intensive Patients. For the group, all medical readmissions range from 5.5 12%. However there are subgroups of patients with much higher readmission rates, e.g. COPD patients aged over 65 the average readmission rate is about 18%. Thought Starter Ian Scott, Professor and Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Qld Readmissions are less likely with integrated, multi-component interventions comprising pre- & post-discharge phases spanning transition from hospital to home Innovation Highlight @ The Alfred chronic disease management, centred firmly within the primary care system, is not only an ideal it is achievable! General physicians and general practitioners under one roof Smooth and facilitated transition to a general practitioner of choice Beginning of shared care Informal exchange of patient management strategies in the corridor Formal live case conferencing in the one room, to devise a mutually agreed management plan, with appropriate goal & priority setting Physician, GP, care coordinator, patient, (carer), (case manager) Referrals to in-house allied health, with greater chance of adherence Getting better in the community, closer to home Non-threatening familiar environment 22 The Health Roundtable Limited Annual Report 2015

Special Roundtable: Improving Hospital in The Home Improving Management of Cellulitus At Home! Special Roundtable: Hospital in the Home Date: 21 & 22 May Location: Brisbane Subscribers: 20 hospitals Attendees: 70 delegates Time for a rethink! Are we making the best use of hospital facilities. With new therapeutics, increasing sophistication and use of telehealth and remote monitoring, there are substantial opportunities to provide efficient and safer medical services to patients in their home. Several jurisdictions have implemented targets for Hospital in the Home admissions. Clinical care in the home setting helps patients avoid hospitalacquired complications, enjoy shorter stays and experience greater patient and carer satisfaction. The clinical focus for this workshop was on management opportunities for J64 Cellulitus in HITH currently utilising 150,000 beddays across The Roundtable, and varies markedly between jurisdictions. 50000 40000 30000 20000 10000 0 J64 cellulitus total beddays by State 2013/2014 Total HIH Days Total Non HIH LOS Innovation Highlight@ Alfred Health, Victoria Alfred Health have developed a formally structured approach to respond to HITH patients who call in with symptoms or concerns. Emergent clinical condition to be identified and escalated for appropriate clinical review in a timeframe appropriate for that condition Thought Starter Gideon Caplan, Director of Post-Acute Care Services, and Director of Geriatric Medicine at Prince of Wales Hospital, reviewed the evidence for HITH as a safe and efficient substitute to traditional wards The evidence is mounting for a variety of common conditions that HITH as a substitute to hospital has superior outcomes for patients and benefits for the service. Treatment of cellulitis in HITH is practical, safe, well tolerated and efficacious. Added benefits of HITH include cost savings, increased patient and carer satisfaction, and avoidance of hospital-associated complications such as delirium and functional decline. Innovation Highlight @ Dubbo Health, Western NSW Patients requiring PICC insertion were previously placed on the emergency waiting list resulting in: waits of up to 4 days; insertion related complications; and patient complaints and delays in referral to HITH services. Consequently they have introduced an innovation to have a dedicated PICC insertion team, operating from the Ambulatory Care Outpatient Unit and directly referring on to HITH. In the first 2 years of operation the PICC insertion team has recorded a 95% insertion success rate, zero insertion related infections, 96% of patients receiving insertion within a day, earlier referrals to HITH and a massive saving of up to $3000 per patient. The Health Roundtable Limited Annual Report 2015 23

Special Roundtable: Improving Management of Hip Fracture Special Roundtable: Hip Fracture Date: 20 & 21 August Location: Sydney Subscribers: 18 hospitals Attendees: 70 delegates This special Roundtable facilitated members to share strategies to fulfil Australian and NZ guidelines such as fast track surgical pathways to improved nutrition, pain relief and delirium management. Special reports were provided for the meeting and members completed a premeeting survey on selected aspects of the Australian/NZ guidelines and draft Clinical Care Standards. Improving Management Of Hip Fracture The Australia NZ Hip Fracture Registry issued the Guideline for Hip Fracture Care: Improving Outcomes in Hip Fracture Management of Adults to.. to help professionals providing care for people with a hip fracture to deliver consistent, effective and efficient care. More than 17,000 Australians and almost 4,000 New Zealanders break their hip every year, incurring hospital costs of AU$570 million and $NZ105 million. Health Roundtable data shows that across hospitals there is wide variation in how care is delivered with differences in timely access to operating theatre, length of stay in hospital, transfer to subacute services and readmission to hospital. For patients with fractured femur, the average duration (in hours) in the Emergency Department ranges from 3 hours to 9 hours Thought Starter Jacqueline Close combines a clinical and academic career at the Prince of Wales Hospital and Neuroscience Research Australia. Over the past 15 years she has combined research with clinical practice and provided leadership in relation to ensuring that research is translated into policy, guidelines and everyday practice Innovations Highlights@ Canterbury, NZ Fast track # NOF pathway. Fast-track Pathway - reducing time from ED presentation to Ward admission from 3.5 hrs to 90 minutes Reduced time to surgery Increased access to surgery within 36 hours Reduced wait time for transfer to rehabilitation facility Time to transfer 48 hrs postop A reduction in overall LOS 24 The Health Roundtable Limited Annual Report 2015

Special Workshop: Collaborating with Primary Care Special Workshop: Collaborating with Primary Care Date: 3 & 4 September Location: Melbourne Subscribers: 22 hospitals Attendees: 51 delegates Many members are already working closely with their primary care providers but recognise there is more to be done especially for patients with chronic conditions. The aims of this workshop were to: Identify exemplars in coordination of care for chronic disease Learn how exemplar hospitals are working together with primary care providers Hospitals and Primary Care Partners The New Force in the Management of Chronic Conditions How can hospitals and community based primary care, work together to help patients with Chronic Conditions manage symptoms and maximise quality of life? The increasing prevalence of chronic disease, requires a team approach. Both Primary Health Organisations in New Zealand and some of the new Primary Health Networks in Australia, have expressed a strong interest in collaborating with The Roundtable members to improve quality and appropriateness of care for patients with chronic illness. This special Roundtable was convened to assist members and their associated Primary Care Partners to identify specific local opportunities in chronic disease management to focus on for improvement. Geocoded primary care reports The Roundtable data show how services are currently performing in managing chronic diseases in general, and specifically Heart Failure. Identify how to improve coordination with primary care providers Thought Starter Sally Howe, Director of Business and Service development at Cabrini Health for Sub acute and Community services. Her role supports delivering a suite of scalable and recurrently funded alternatives to acute hospital care. Sally was the program lead in the development of successful Hospital Avoidance Programs at Cabrini aimed at reducing hospital re admissions and emergency room presentations for the chronically ill. Innovation Highlight@ Cabrini Health, Vic Cabrini Health has actively sought partnerships with the primary care community to promote greater cross-sector engagement and to strengthen the provision of person-centred, accessible and integrated care. The initial work has shown a 70% reduction in the number of hospital readmissions among people with heart failure and respiratory conditions through the provision of community based programmes involving education and person-to-person care. The Health Roundtable Limited Annual Report 2015 25

Special Workshop: Journey to a High Performance Organisation Raj Behal Special Workshop Date: 23 November Location: Parramatta Attendees: 36 delegates Journey to a High Performance Organization Dr Raj Behal, from Stanford University Hospital conducted a special workshop following the Innovations meeting to discuss how significant reductions in cost, length of stay and inpatient mortality were achieved using strategies such as the Lean Care Maps methods. The focus was on six key themes from Stanford s Clinical Excellence Plan and how Stanford is approaching each theme as well as shared data and lessons learnt. 1. Keeping patients safe 2. Improving patient survival 3. Excelling on national measures 4. Preparing for value based healthcare 5. Enhancing recovery, function and quality of life 6. Optimizing system for coordination and service excellence Raj Behal Chief Quality Officer from Stanford University Hospital Why aren't we safe yet? Why do adverse events continue to occur? Key Innovation: 100 point Action Plan Check List! Use this checklist to develop an action plan, guided by the RCA findings. Add up the points for each category addressed in your action plan. An ideal action plan will score 100 points; most real-life actions plans should score 60 or higher. Plans scoring below 30 are unlikely to be effective. Caveat: Improvements can sometimes introduce new failure modes. Selective audits with measures and feedback are important for sustaining change Why do many events recur (especially if we fixed it the first time)? While we can learn from each case, we learn much more from cases in aggregate. Look for patterns and trends Learning is difficult if physicians are not engaged in the review process Type 1 error Deemed not preventable, but potentially preventable: Perhaps we could not have prevented that specific event, but we can reduce the event rate Type 2 error Deemed preventable, but event was a result of complex interacting tightly coupled factors - usually not preventable Understanding how to make sense of data is essential! 26 The Health Roundtable Limited Annual Report 2015

Imaging Improvement Group Imaging Improvement Group Date: 26 & 27 February Location: Brisbane Subscribers: 19 hospitals Attendees: 39 delegates Making the Best Use of a Clinical Imaging Department Money is tight, capacity is limited and the numbers of referrals are moving ever upwards! An analysis of Victorian Hospital presented by Michael Herbert, Victorian Auditor General Department, showed wide variation in costs and equipment utilisation. The Imaging Journey Improvement Group aims to reduce waiting times, reporting delays and unnecessary radiation exposure. Members assist each other by sharing practice insights and innovations to improve the flow of patients through their overall hospital journey. Thought Starter James Nol is a radiobiologist by background and is the Chief Medical Radiation Practitioner at Blacktown & Mt Druitt Hospitals in Western Sydney. James has founded the Imaging Model of the Millennium which comprises Open Access, Evidence Based Imaging, Hybrid Reporting System and an Academic & Training Members provide detailed activity data for each patient encounter for comparative analysis by The Roundtable. This information is merged with inpatient episode data to provide a customised imaging report on each of the different modalities to compare waiting times, service times, time to report completion and exposure to multiple radiological examinations. The report below shows results that indicates low weekend utilisation. Programme. Innovation Highlight@ The Royal Melbourne Imaging Results Notification Tool Improving clinician productivity Reduces delays Improves reliability of image review The Health Roundtable Limited Annual Report 2015 27

Financial Performance Improvement Group Financial Performance Improvement Group Date: 5 & 6 March Location: Brisbane Subscribers: 62 hospitals Attendees: 48 delegates The Clinical Costing Improvement Group enables health services to align detailed costing data with Casemix activity information, bringing together Activity-Based Costing with the emerging Activity-Based Funding reforms. Costing as a Management Tool for Improving Financial Performance The theme of the 2015 Review Meeting was Using Costing as an effective Management Tool to Improve Efficiency and Quality in Health Service Management and Patient Care. More than 60 health service facilities have sent cost data to The Roundtable comprising more than $13 billion of cost from 9.3 million patient inpatient, outpatient, and emergency episodes. Most hospitals reported lower than expected costs for inpatient activity and emergency activity, but higher than expected costs for subacute and outpatient episodes. Overall, the totals were below the expected national efficient price. Congratulations to our members! Our analysis suggests that overall costs for these facilities are below the National Efficient Price for 2013/14. The Roundtable produces an annual, comparative analysis of inpatient costs at the DRG and organisational level, highlighting key differences in costs amongst members. Thought Starter Cost Comparisons by DRG enable members to identify cost outliers James Downie, Executive Director ABF, Independent Hospital Pricing Authority.. The National Efficient price for 2015 16 will be $4,971 per NWAU(15) which is a 3.0% increase on last year when revisions to the 2014-15 NEP are taken into account. New in 2015-16 New Tier 2 Clinics Multi Disciplinary Adjustment 28 The Health Roundtable Limited Annual Report 2015

Paediatric Improvement Group Paediatric Services Improvement Group Date: 12 & 13 March Location: Brisbane Subscribers: 16 hospitals Attendees: 30 delegates This Group was formed in 2014 to bring together health services with large paediatric volumes to address their unique issues, including activity measurement and funding, as well as clinical practice. The Right Care, at the Right Time, at the Right Place This workshop focussed on examining differences in patient care for tonsillectomies among our member hospitals. Members shared improvements to ensure that our children receive the right care at the right place at the right time. Demonstrating the power of good data: A large study at Auckland over nine years showed day stay paediatric tonsillectomy to be a safe procedure: For primary post operative haemorrhage key findings were: 83% of primary post operative haemorrhage occurred in the 4 hour observation period. No child who presented after discharge following day stay surgery required reoperation or blood transfusion. Thought starter Murali Mahadevan, FRACS, MB ChB (NZ), Director of Surgery Starship Children s Hospital, Auckland, New Zealand Issues related to Day stay tonsillectomy Appropriate facility- dedicated day stay!! Paediatric expertise and staff Guidelines and protocols* Patient selection * Parental and care giver attitudes Post operative care of complications Innovation Highlight: Auckland Children's Hospital analysed tonsillectomy outcomes for children over 3 years and concluded same day to be safe with less than 5% of patients converting to overnight admission. Patent satisfaction was high at 80% The Health Roundtable Limited Annual Report 2015 29

Maternity Improvement Group Maternity Improvement Group Date: 30 April & 1 May Location: Brisbane Subscribers: 27 hospitals Attendees: 65 delegates This group aims to identify innovative and effective practices for safe maternity care. Many health services are experiencing rapid growth in maternity services with limited resources and facilities to meet demand. The Group reviews operational and clinical data to look for innovative practice differences and meets annually to discuss trends, report on innovations and share ideas for improvement. Safe Prevention of Primary Caesarean Delivery The special focus of the 2015 meeting was the Safe Prevention of the Primary Caesarean Delivery. Key messages were: Use terminology of promoting normal birth It is possible to reduce the rate The Most successful interventions across the membership multifaceted and multidisciplinary Culture is critical including improving methods of communication e.g. graded assertiveness Fear needs to addressed! Practice should be based on evidence Need the right clinical governance structures Need protected time for quality Focus on what went well as well as what can be improved not necessarily just the adverse outcomes Use reflection sheets Maternity Indicator Reports: Rate of first caesarean section rates varies from 23 37% Thought Starter Aaron B. Caugey, Associate Dean for Women's Health Research & Policy from Oregon Health & Science University Aaron was one of the authors of the American Congress of Obstetricians and Gynaecologists consensus statement on Safe Prevention of Primary Caesarean Delivery Innovation high light @ Womens and Children s Network, Adelaide, SA 3 key priority projects that could lead to Better Systems, Better Care 1.Specifically reducing Length of Stay (LOS) both antenatal/postnatal by improving patient flow around LSCS 2. Changing models of care in relation to induction of labour. 3. Prevention of primary LSCS and reduction of overall LSCS rates. 30 The Health Roundtable Limited Annual Report 2015

End of Life Care Improvement Group End of Life Care Improvement Group Date: 28 & 29 May Location: Brisbane Subscribers: 32 hospitals Attendees: 85 delegates More people are dying in hospitals, yet a recent survey in Australia found that over 70% of people wanted to die at home. Unfortunately, less than 20% achieve that goal. The group aims to identify ways to improve patient care in the last 100 days of life. Thought Starters Cross Sector Engagement This fourth annual workshop on Improving End of Life Care theme was Engaging across the patient journey with other specialties and sectors. The survey results showed how many hospitals are engaging in improving end of life care through a wide range of activities from developing organisation wide strategies and supporting patients to complete advance care plans. There is varying penetration for many activities apart from symptom management in the last days of life and the challenge moving forward is for members to engage across sectors and to mainstream end of life care into the acute hospital setting. Innovation Highlight In Australia, the proportion of people dying in residential aged care facilities (RACFs) has steadily increased over the last two decades. In addition, people entering residential care are increasingly frail, often highly dependent and with complex comorbidities The PA Toolkit is a collection of resources developed to assist RACF staff implement a palliative approach Liz Reymond, MBBS [Hons], FRACGP, FAChPM, PhD. A End of Life success story: the National rollout of the PA Toolkit for RACFs Within the group median beddays in last 6 months varied from 4.6 days to 13 days. Bill Lukin, Deputy Director Department of Emergency Medicine at Royal Brisbane and Women s Hospital and a Fellow in Palliative Medicine the doctor s responsibility is to ask patients and families about the care they d like to receive. Innovation Highlight@ Toowoomba Hospital, Qld Simple things can make a difference. Raising awareness of the need for Advance Care Planning discussions improved referrals to Palliative care unit by 100%. Education packs included: SPICT tool for prompting staff to consider ACP information booklets for patients and families about ACP, Pre-printed referral to Advance Care Planning Clinic to see the Palliative Care team The Health Roundtable Limited Annual Report 2015 31

Mental Health Improvement Group Mental Health Improvement Group Date: 18 & 19 June Location: Sydney Subscribers: 32 hospitals Attendees: 60 delegates This group reviews both inpatient and community mental health data to identify innovative practices. Data are organised for three major client groupings: Child & Adolescent, Adult and Aged (over 65). Improving Functional Outcomes The special focus of the 2015 meeting is Improving quality of life for people who live with mental illness including improving functional outcomes and physical health. Thought starter presentations from Frances Dark on Challenges with improving functional outcomes for people living with severe mental illness and Dr Jackie Curtis on It s about Time: Implementing real world service change to reduce cardio metabolic risk in psychosis. In 2015 the mental health data specification was updated and processes for auditing the linkage between the community and inpatient datasets improved. Reports have been revised to include trend data for the hospital and the overall group Trend MH patients transferred from ED within 4 hours The Group follows national KPI definitions for Australia and New Zealand to the extent possible and is working collaboratively to develop metrics for community outcomes using HoNOSCA scores. Thought Starters Jackie Curtis Clinical Director, Youth Mental Health Senior Staff Specialist in Psychiatry, South East Sydney Local Health District Promoting the physical health issues in youth with psychosis. She has co-led the development of the Healthy Active Lives HeAL Frances Dark, Director Rehabilitation, Metro South Health Service Youth Mental Health. Strategies for valuing and promoting good mental health and well being Innovation Highlight@Cumberland Hospital, Western Sydney LHD, NSW The Sensory Garden, revitalising lives and reducing incidents in a mental health setting. Two years post implementation has demonstrated sustained reductions in Aggressive acts, staff and patient injuries, seclusions, AWL and Restraints. Additional benefits: Extra space; Area for families to visit and Ownership of the garden by consumers, carers and treating team. 32 The Health Roundtable Limited Annual Report 2015

Nursing Improvement Group Nursing Improvement Group Date: 6 & 7 August Location: Sydney Subscribers: 52 hospitals Attendees: 91 delegates Patient Safety At Nights and Weekends The theme of the meeting explored how different nursing workforce skill mix and rostering patterns, at night and on weekends, contribute to the safety of patients. The analysis looked to identify particular times of the day or day of the week that have higher incidences of in hospital falls or cardiac and respiratory arrests. The purpose of the group is to enable Nursing Leaders to improve patient outcomes and ensure a stable and productive nursing workforce. Participants in the group share the latest confidential comparative reports identifying differences on key workforce and patient safety indicators: Pressure injuries Falls UTIs Nursing turnover Nursing sick leave Group members compare their patient outcomes with staffing levels and workforce practices, as well as compare notes on new initiatives to improve patient care. The Roundtable publishes comprehensive Nursing Reports including Needleman Care Indicators. Across the group above, the % of falls ranged from 0 to 1.3%. Falls can vary by time of day and patterns are particular to an individual hospital. The graph below shows wide variation across the group for timing and rate of falls with the patterns being particular to each facility. The key message is that services monitor falls by time of day to detect patterns in their organisation if any. Thought starter Martin Keogh, Clinical Service Director for Emergency and Acute Medicine at Alfred Health. Alfred Health s Timely Quality Care initiative has focused the organisation s energy on using the NEAT target as an opportunity to transform their patient care delivery models, including how patients are cared for after hours. Innovation Highlight@Redland Hospital, Qld Implementation of a Nursing Team Model showing dividends! Decreases in falls with harm and medication incidents. Plus positive staff feedback shows closer bonds with colleagues, improved understanding of roles, senior staff increasing supervision of juniors and overall improved team cohesiveness The Health Roundtable Limited Annual Report 2015 33

New Zealand Chapter Workshop New Zealand Chapter Date: 22 & 23 September Location: Auckland Subscribers: 18 hospitals Attendees: 45 delegates The NZ Chapter meets once per year in New Zealand to help members improve patient care by identifying differences in performance by sharing good practice ideas. We collaborate with the NZ Health Quality & Safety Commission to focus on highpriority national topics. Improving Patient Safety in New Zealand The Roundtable provided a special version of the Patient Safety Report for the NZ members. The Report contains a draft set of indicators adapted by The Roundtable from the AHRQ (Agency Healthcare Research Quality) and the Victorian Patient Safety Indicators. These measures are for screening purposes only to identify potential areas for improvement they are subject to surveillance bias e.g. organisations with high rates may be better at clinical documentation and clinical coding than those with low rates. However, these are still important given they are likely to underestimate the incidence of some important measures of harm to patients Services with a ratio above 1 have a difference between weekend and weekday SMR Thought Starter Innovation Highlight@Southern DHB 6,000 Bed-days campaign Using A3 problem solving to save 6,700 beddays and $1million Bed-days saved: 6,719, with 691 more patients admitted Savings against budget for the wards involved: $1,065,448 Sir David Dalton s presentation challenged members to achieve the highest standards of quality and patient safety for patients receiving care within NZ hospitals. Sir David drew on his experience at The Salford Royal NHS Foundation Trust where he has been Chief Executive for 12 years. His team has set a clear ambition to be the safest organisation in the NHS and has adopted a disciplined approach of applied improvement science coupled with deep staff involvement. These savings were in areas like treatment disposables, laundry, cleaning and hotel services Savings against 2013/14 Actuals: $250,152 Readmission rates in Internal Medicine dropped from 16.9% to 10.4% 34 The Health Roundtable Limited Annual Report 2015

Surgical Journey Improvement Group Surgical Journey Improvement Group Date: 8 & 9 October Location: Melbourne Subscribers: 36 hospitals Attendees: 80 delegates Members of the group benchmark performance with peer health services on a variety of key indicators such as: Session utilisation rates Procedure time per case Theatre cancellation rates Return-to-theatre Late starts and Early finishes Standardising and Managing Theatre Costs Some of the best innovators showed that it is possible to reduce orthopaedic prosthesis costs by getting surgeon agreement, and that a 23- hour ward can reduce wait lists and decrease LOS without additional bed stock. There is ~40% variation in theatre productivity across facilities based on revenue per hour of operating on elective patients. The group examine key steps in the patient s journey from pre-admission and ED through to recovery and discharge. An extensive series of reports is prepared for the group highlighting benchmarking opportunities to improve patient care Thought Starter Stephen Duckett, Grattan Institute Report: Questionable care: what to do about things which shouldn t be done? Challenging hospitals to think about: Tabling the Grattan report for discussion with the relevant clinical governance group: How robust are your clinical governance processes? Is appropriateness of care being systematically monitored? What are the accountability mechanisms for clinical choices? Innovation highlight@the Mater, Qld Standardising Prosthetics a local review revealed various types of prostheses used with great variation in costs (Range between $6K and $20K per case) Outcomes: and lessons 30% reduction in costs over 2 years Engagement of clinician leaders, management, finance Broad tender Focus on more than just costs, look at- Support, Education and Outcomes The Health Roundtable Limited Annual Report 2015 35

Patient Safety Improvement Group Patient Safety Improvement Group Date: 22 & 23 October Location: Sydney Subscribers: 46 hospitals Attendees: 87 delegates The Patient Safety Improvement Group meets annually to compare practices and process indicators. A key objective is to spread innovative practices to quickly reduce adverse events throughout Australia and New Zealand. Continuing Improvements: Patient Safety at Night and Weekends The theme for the 2015 Patient Safety Improvement Group was a continuation of Improving patient safety at night and on the weekends. Members shared innovations in a variety of relevant areas including supervision and support for staff afterhours, reconfiguring roles and responsibilities (such as pharmacists) to improve safety and simple initiatives such as an automated phone reminder at 3pm each day to junior doctors on charting key medications. Special SMR reports for member illustrate the issues of excess mortality The Roundtable has developed the Safer Patient Care checklist of key process indicators that are associated with safer care. Each year, member organisations are requested to assess their performance in comparison to mortality and adverse events. The chart below shows the improved change in reporting Fully Implemented for ten members between 2012 and 2015. Thought Starters Innovation Highlight@Westmead Hospital, NSW Always ASC initiative Active Supervision by Consultants. This innovation was to increase the clinical oversight provided by Senior Medical Staff oncall to the Junior Medical Staff on duty after hours. An agreed set of triggers for timely call to Consultant improved consultant involvement from 33-77% and was cost neutral Sarah Gilham, Programme Delivery Lead 7 Day Services, NHS Improving Quality spoke on the challenges and opportunities to deliver 7 day services and Phil Duncan, Head of Programmes Patient Safety, NHS Improving Quality spoke on the challenges of delivering SAFE 7 day services. 36 The Health Roundtable Limited Annual Report 2015

The Health Roundtable Safer Patient Care Checklist Organisation-wide Initiatives 1. A standardised multi-disciplinary and multi department morbidity and mortality review occurs at least quarterly in clinical areas. 2. Specific programs are in place to reduce Hospital Acquired Infection, with audit and feedback to clinicians on their antibiotic prescribing practice. 3. All fall locations are mapped to provide visual feedback to ward staff on trends in the number and location of falls in their specific clinical areas. 4. A consistent communication tool is in place for all requests for assistance e.g. SBAR, or ISOBAR. 5. All abnormal critical results from medical imaging and pathology are communicated quickly to the treating team and signed off. 6. Auto-expiring orders are used for every urinary catheter. 7. All patients and their carers are explicitly given the opportunity to be included in the provision of Safe Care e.g. a Daily Plan. 8. Every unit has patient safety goals which are measured, on visual display and discussed at least weekly. 9. All patients receive, in a language they understand, a statement encouraging them to speak up if they notice a staff member failing to wash hands prior to providing care. 10. All nursing handovers are conducted at the patient bedside and include the patient and/or carer in the discussion. Governance Process 1. Patient Safety is the first item on the Executive or Board agenda at every meeting. 2. There are explicit goals for Mortality Rate Reduction which are tracked at least quarterly by the Executive or Board. 3. There are explicit goals for Adverse Event Reduction which are tracked at least quarterly by the Executive or Board. 4. Patient stories relating to clinical incidents are discussed at least quarterly at Board/Executive meetings. 5. Senior Executives participate in Patient Safety Walkabouts at least monthly. Specific Initiatives A1. Ventilator Care Bundles are used and audited at least monthly, including sedative interruption. A2. Central Line Care Bundles are used and audited at least monthly, including the use of checklists for maximal barrier precautions. A3. A documented clinical pathway for Acute MI is used and audited at least monthly. B1. All clinical staff are trained to use a physiological track and trigger system with a graded response strategy and an escalation protocol. C1. Staff audit the level of harm caused by high risk medicines within your hospital at least monthly e.g. Global Trigger Tool. C2. A process is in place for all patients to prevent harm from medication errors between community and hospital using patient held medication cards or electronic communication with primary care providers. C3. All out-of-range INR results (6 or above) are immediately flagged and audited as they occur. D1. Monthly review processes are in place to reduce the rate of surgical site infections through the appropriate use of antibiotics. D2. A Safety Checklist is followed for every operation to improve peri operative communication and teamwork e.g. the WHO Surgical Safety Checklist. D3. A pre-operative case conference is conducted for every high complexity patient to identify contingency actions if difficulties arise. D4. DVT Prophylaxis measures are in place and audited for all surgical patients. E1. All elements of a goal-directed sepsis resuscitation bundle are completed within 6 hours of presentation for ALL patients with severe sepsis or septic shock. E2. All elements of a sepsis management bundle are completed within 24 hours of presentation for ALL patients with severe sepsis or septic shock F1. Advanced care directives are completed prior to medical or surgical intervention for all at risk patients. F2. A member of the palliative care team participates in multi disciplinary team discussions for all patients with advanced disease status prior to invasive procedures. This Checklist provides a way to gauge improvement in patient safety processes. Clear progress is being made year-on-year, particularly on items related to Australian National Standards. The Health Roundtable Limited Annual Report 2015 37

Allied Health Improvement Group Allied Health Improvement Group Date: 29 & 30 October Location: Melbourne Subscribers: 55 hospitals Attendees: 111 delegates In partnership with the Australasian Allied Health Benchmarking Consortium, The Roundtable has been collecting and comparing Allied Health activity data for over 15 years. Members receive individualised comprehensive activity reports for all Allied Health disciplines in the acute, sub acute, outpatient and emergency settings plus more! The data is used to drive change and innovation in staffing and delivery of patient care. Thought Starter Linking Activity and Outcomes This year s Allied Health Benchmarking Workshop theme was Linking Activity to Outcomes The group heard some great low cost innovations such as the Daily Workload Measurement tool used to efficiently reallocate resources to target busy units and the Clinical Redesign enhancing outpatient access using initial Allied consultations to reduce wait times. An extensive suite of Allied reports covers, ED, Inpatient, Subacute and Outpatients. Innovation Highlight@Princess Alexandra Hospital GARB (Green, Amber, Red, Brown) A Daily Workload Measurement Tool. Developing an objective and fair system of measuring workload demand on a given day. Workload allocation surveys were performed across the department with focus on: What constitutes a busy day and What were the factors that contributed to these busy days. These were used to inform the development of a workload measurement system Sharon Mickan Professor of Allied Health, Gold Coast Health, Griffith University, Australia Using research to improve clinical outcomes Knowledge Translation is the effective and timely incorporation of evidencebased information into the practices of health professionals in such a way as to effect optimal outcomes and maximize the potential of the health System 38 The Health Roundtable Limited Annual Report 2015

NSW Chapter Workshop NSW Chapter Workshop Date: 5 November Location: Sydney Subscribers: 10 hospitals Attendees: 36 delegates The current intense focus on Activity Based Funding across Australia and particularly in NSW, prompted establishment of the NSW Chapter in 2012 to improve everyone s readiness for the new system. Chapter Meetings provide the opportunity to share insights with each other, as well as to learn from experts in other jurisdictions on issues including coding, staffing, and financial management practices. Improving Services in NSW The NSW Chapter members shared insights with experts on three key issues: How to improve clinician engagement and reduce errors with new electronic systems How to ensure that our patients are safe whether they arrive during the week or on weekends How to work more closely with government agencies to improve patient care Summary for All NSW Hospitals, HSMR trending down Thought Starter Innovation Highlight@ Calvary Mater, Newcastle, NSW Robert Wachter, author of The Digital Doctor, participated by webcast. Wachter has firsthand experience of implementation of the EMR at University of California, San Francisco, and shared his insights on getting the best value from these new systems. The patient is still at the centre, but more as an icon for another entity clothed in binary garments: the ipatient. The ipatient s blood counts and emanations are tracked and trended like a Dow Jones Index, and pop-up flags remind caregivers to feed or bleed. Red Alert Calendar. Patient flow through the hospital is dependant on many complex sets of relationships between many departments, services and people, and when one resource is affected it slows the whole system down. The dates for recurrent events such as JMO / Registrar term changes were not commonly known, and therefore mitigation plans to improve flow were not in place Aim: To minimise disruption to patient flow and to facilitate patients having access to the care they need, when they need it. To forecast upcoming recurrent disruptions Create a proactive culture by developing risk mitigation strategies Communicate the plan KISS - potential great ideas can fail - so use the simplest IT solution to communicate the calendar ipatients are card-flipped in the bunker, while the real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer. The Health Roundtable Limited Annual Report 2015 39

Sub Acute Services Improvement Group Subacute Services Improvement Group Date: 26 & 27 November Location: Melbourne Subscribers: 19 hospitals Attendees: 53 delegates Benchmarking Quality and Safety Data quality is improving slowly. The issues are the absence of comprehensive SNAP coded data. However the IHPA funding mandate to provide SNAP codes from 1 July 2015 should assist in SNAP data coverage. Sub acute reports are generated for GEM, Maintenance, Palliative, Psychogeriatric and Rehabilitation This Improvement Group was formed in 2015 to share comparative data and experience across all Subacute services as an integral part of the patient journey. The group comprises Rehabilitation, Palliative Care, Geriatric Evaluation & Management (GEM), Psychogeriatric Care, and Maintenance Care services. Thought Starter Len Gray, Professor and Geriatrician,Princess Alexandra Hospital, and Academic affiliation University of Queensland Developing outcome oriented Quality Indicators for common geriatric syndromes and function for the care of older patients in acute care. The Research Collaborative for Quality Care of Older Persons consensus: -Proportion of patients with prolonged length of stay -Discharged with worse levels of mobility compared with pre-admission -Community dwelling patients discharged to long term care Innovation Highlight@Monash Health Implementing the Discharge Passport in Kingston Sub Acute Services A review of discharge information provided to patients in Kingston Sub Acute Services in July 2015 found that there was no information regarding follow up or contact numbers provided to patients discharged home. Changes implemented: Education for team using Discharge Passport Discharge Passport provided to patients discharged home from South 6 Version changes to Passport from patients and staff feedback & suitability for discharge from sub acute services 40 The Health Roundtable Limited Annual Report 2015