Thursday, April 24, 2014

Wifi at Canberra Hospital

Update from ACT Heatlh:

ACT Health is continuing the implementation of a wireless (Wi-Fi) internet facility for our healthcare consumers and their visitors. This will allow people to use their own Wi-Fi enabled devices to browse the internet and keep up to date with their e-mails.

Currently, free Wi-Fi is available within Paediatrics, Ward 12B (Rehabilitation), Oncology, Central Outpatients, Emergency Department and Renal Services. These areas were selected to participate in a trial of public internet access, which commenced in mid-2013.

Over the next month, public internet access will be implemented at community health centres in Belconnen, Gungahlin and Tuggeranong; and within additional areas of the Canberra Hospital, including: Buildings 1, 3, 7, 8, 11 and 12. In addition, discussions will be undertaken with business areas located in Buildings 2, 10, 19 and 25 to identify suitable areas for the location of public Wi-Fi hotspots.

The public internet facility builds on the existing wireless network (TUTD), which enables staff to access the ACT Health network using ACT Government laptops and authorised iPads/iPhones which have been secured using the Mobile Iron mobile device management app. Also available on the Canberra Hospital Campus is the ANU wireless network, which provides access for ANU students and staff.

Public internet access is filtered for appropriateness, and access is capped to avoid excessive cost to Government. Service levels are designed primarily for browsing the internet and accessing e-mails.

Wednesday, April 23, 2014

Health Pathways for the ACT

On Monday 7 April I attended a joint workshop with ACT Health an ACT Medicare Local on Health Pathways. Eleanor Kerdo and Katrina, a consumer representative with HCCA, also participated.

Leanne Wells (CEO, ACT Medicare Local) formally opened the workshop and provided a brief  introduction of healthpathways, stating that it is an important collaboration between ACT Health and ACTML. Health pathways is a powerful platform to improve services and outcomes for consumers and they see it as an opportunity to develop pathways that put the patient at the centre of care and aspects of the system that need to be improved and enhanced. 

Rosemary O’Donnell (Executive Director Division of Medicine, ACT Health)  reflected on initial introduction to healthpathways as an exciting opportunity. She sees that this is a framework to enhance the patient journey through the system so that it is as seamless as possible. Rosemary commented that there is a large volume of medical services, including people living with chronic disease, and see that there are opportunities for improvement.

Ian Anderson – Streamliners NZ – Canterbury Health System, was the facilitator for the day. 

The idea of HealthPathways grew out of necessity in Christchurch, NZ. Christchurch is similar to Canberra: urban population of 400,000 people, one major tertiary hospital, catchment of 500,000.
In 2006 the Canterbury District Health Board introduced a new approach to working on problems. This involved new language and terminology, and collaborative approach across the system. By 2010 the new approach was starting to reveal results and improvements which resulted in better outcomes for patients. In 2011 Hunter New England asked about their work and they adopted aspects of their ways of working. They have shared their experience with other Australian districts. There are now 12 entities (Medicare Locals and & Local Hospital Networks) in Australia using elements of Health Pathways and six entities in NZ. In total about 10 million patients across Australia and NZ are part of this.

Three main themes:
  • The environment and creating fertile ground for collaboration and service improvement
  • The detail of service improvement, running work groups and getting change
  • The pathways: these are enablers of service change. They reduce variation in the system and improve outcomes
Ultimately this is all about improving services. In order to achieve sustainable change you need all three of these elements. Thee Canterbury story is a classic demonstration of what is possible when managers have a vision and trust clinicians to be involved in bringing about change.

There was a presentation from Carolyn Gullery, the General Manager of Planning and Funding for Canterbury health system, who was one of the prime drivers of change. This was the presentation she made at the ACI in 2013. (20 min video). It is not online but there is a long video (over an hour) online.

Gullery describes the burning platform, with 1 in 5 people over the age of 65, and by 2020 this will grow to be 1 in 3. There is growing demand, with increased admissions to hospital and increased waiting times. If there was not change there would be a need for many more GPs, another tertiary hospital, another 6000 people in the workforce, and another 2000 nursing home beds. Obviously unachievable and not sustainable.

Graphic of Canterbury health system: Connected system, shared vision. One of the elements that appeals to me is that the work was based on a premise that you shouldn’t be in a hospital if you don’t need to be there. A key measure is not to waste people’s time, both patients and clinical staff. At the core of their work is the belief that most people do the right thing if the system enables them.

A collaborative way of working and it was led by clinicians. They had to bring about a big change. They could not wait for incremental change. 

The full story of the transformation as well as the journey they took is available online on the Kings Fund website.

Executive Director

Friday, April 4, 2014

ACT Dental Health Forum 28 March 2014

On the 28th of March HCCA hosted a Dental Health Forum.
Yelin , Loretta Bettiens and the DHP team
This was presented by Loretta Betteins, Director Dental Health Programs (DHP) and her team.
 Loretta, provided an overview of the public dental program which involves at combination of dentists, dental therapists, prothetists and technicians who make dentures. More recently this expanded to include the oral health and hygienist role. The DHP is a very busy service, taking 4000 phone calls per week making this one of the busiest phone lines in the ACT Government.
Since the last dental forum held 3 years ago, staff numbers have increased from around 90 to 120 people, allowing the DHP to address previously long waiting times and unmet needs of the ACT community.

Darlene and Khalia, getting excited about oral health.

The DHP now operates from 5 community health centres across Canberra.
·         6 Chairs in Gungahlin
·         10 Chairs in Civic

Who can use the services?
·         Child and Youth dental service – all children under 14 in school in the ACT
·         Young people 14 – 18 need a Centrelink card or heath care card
·         Adults who have a  Centrelink card concession or health care card
There is no waiting time for children who need general treatment. Adults who require general treatment, place their name on a waiting list at a community health centre and will be seen within 3-6 months.

Emergency needs

Emergency Services are available for all adults and children out of The Canberra Hospital, People can present to the emergency department after hours, were they are triaged, if deemed to be a high priority i.e facial swelling, infection or trauma to face and mouth they will be seen within 24 hours.  The DHP are looking to increase this capacity of this service through the Emergency Department.

Where are other DHP services delivered?
·         Alexander Maconochie Centre 
      Limited nursing home clinics
·         Some small community groups
·         General anaesthetic work at The Canberra Hospital
·         Calvary Hospital
·         John James Hospital,
·         CC Cares in Stirling
The DHP acknowledged that access to appropriate dental care to people who do not have concession cards but do not have much expendable income is an issue, currently being investigated by the National Oral Health Group. The DHP is also not able to do in-home visits yet and is expanding its reach in nursing homes and residential care communities through the development of the mobile dental clinic.

External funding sources
·         Health Workforce Australia received 500K in 2012 to support dental students. Previously ACT Health did not have a relationship with dental students. Recently the DHP developed a relationship with University of Adelaide dental program, these students do graduate years with the ACT and the program has been very positive with many students returning to work within the DHP in Canberra.
·         The DHP have recently purchased an OPG (Orthopantomogram) machine which is set up Civic. The machine provides a 3D panoramic view of the mouth, teeth and bones of the upper and lower jaws and is similar to a CT Scan in the image that can be created.
·         Federal Budget announcement 2012-3 National Partnership Agreement (NPA) 1 January 2013 over three years.
·         National Oral Health Promotion Plan is being developed – to fund health promotion activities.
·         Child Dental Benefit Schedule voucher system as of 1 January. If a child is receiving Family Tax Benefit Part A or a range of other income support payments they are eligible for this. Private dentist are also participating in this program.

Our wonderful forum participants
What does this mean for the ACT?
From January 2013 the ACT will receive a total of $5.5 million dollars over three years under the NPA plan to reduce public dental waiting lists. At the end of Feb 2014 the ACT has met all the targets set out in the agreement.

Waiting Time
Actual waiting time is currently 2.93 months, compared to February last year where it was 8.49 months. During this time the DHP have removed 2985 clients from the list, and have more than doubled the amount of people they currently see.  Denture waiting list has also seen significant improvements. Wait time is currently 3.06 months compared to 13 months in February of last year.
This data comes from an electronic database, all waiting times are on this database and this is audited annually. Time shown reflects the time from putting your name on the waiting list to when you are sitting in the dental chair.
DHP acknowledges that communication with a transient population like Canberra is difficult and hopes that when The Titanium system will link with ACTPAS and they will be able to update data and improve communication.

Improvements on the way!
·         DHP are looking to improve their informed consent processes. DHP says the electronic client record helps with this and that consent changes being made are consistent with the overarching consent policy from the Canberra Hospital. Using an electronic checklist that the clinician fills in also encourages communication with the consumer to insure they understand, before signing consent forms.
·         DHP have introduced technology that tracks a sterilisation pack of instruments to a particular client to insure safety and quality.
·         DHP have introduced intra-oral cameras that can show clients what teeth are affected, level of decay and conditions on a screen above chair. These images can then be saved on the system.

Mobile Dental Clinic
In the last budget (June 2013) the ACT Government committed 1.6m over 4 years to establish and operate a mobile dental clinic.  This includes $600 thousand to buy the mobile clinic and $250 thousand to run it with a (dentist and dental therapist).
DHP are in the process of developing a model of care for this, involving input from HCCA . Their main focus is providing this service to those living in residential care programs within the ACT, before expanding their scope. They are aiming to see all residents in a two year rolling program.

Partnering with Consumers and Health Literacy
At the forum there were many discussions around the importance of communication with consumers and the development of written materials. DHP was also keen to develop and improve partnerships with consumers about delivery management and policy around these services. HCCA is looking to convene a consumer group about the use of the DHP and is currently in the process of beginning involvement in the development of the mobile dental clinic.
HCCA thanks everyone who attended and Loretta and her team for coming to discuss their program and future consumer involvement.

Eleanor Kerdo
Policy Officer