HCCA AGM 2012 President’s Report

Adele with HCCA staff Nicole and Heather

This year is my fourth and final year as President of the Health Care Consumers’ Association (HCCA) of the ACT.  During the past four years, our organisation has made a significant impact by providing respected, informed and strong consumer input to influence the development of quality health services in the ACT.

I am proud that we continue to consolidate our position as the peak body representing health consumers in the region.  The strength of our membership and our committed and passionate consumer representatives are pivotal to the achievements of HCCA and I sincerely thank them and all our members for their active involvement, keen interest and support.

 

I would like to begin by reflecting on some of the significant changes and achievements HCCA has seen over these past four years. 

  

In 2009, HCCA moved from the Community Centre in Pearce to ACT Sports House in Hackett. This increased office space for staff and gave us much needed, and indeed, much used, rooms for training and meetings.

Since that move, HCCA staff numbers have almost doubled.  This is due to an increase in funding, but also to the larger number of part-time staff.  We have gone from a staff of 7 in 2008 to 12 staff members today.

HCCA’s active participation on committees within the ACT has increased from 58 committees in 2008 to 93 committees as at 30 June 2012. 

Increased funding to employ staff to ensure that consumers have input into the Health Infrastructure Program.

We have established two Consumer Reference Groups for ehealth and Cancer Services. These groups are convened monthly and bring together consumers and staff from the Heath Directorate and other organisations together to work through issues. I would like to thank Russell McGowan and Sally Saunders for their work in convening these groups.

These Reference Groups play a very important role in providing consumer input into development of health policies and we are considering establishing other groups around Primary Health Care and Aged Care.

We have entered into a new partnership with the University of Canberra to work on a number of research projects and are also working with the Uni in supporting ways to increase clinical placements of students in aged care.

We continue to hold a Health Issues Group every two months, providing fora for discussion about a variety of topical health issues.

The demand for consumer input on policies continues to increase. During this financial year, we completed 18 submissions, compared with 11 in the previous period.

Health literacy is the cornerstone of consumer empowerment and plays a significant role in delivering better health outcomes for individuals and the broader community.  The HCCA Health Literacy Program develops the expertise of health consumers to actively engage with health care systems and health professionals to make informed decisions about their own and their family’s health.

From a financial perspective, I am pleased to report that HCCA continues to operate within a sound financial base.  Equity is currently $141,614 as we enter the final year of our three year funding round with Health Directorate.  This equity has allowed us to introduce a consumer scholarship program and undertake the review of the Consumer Representatives Program.

I firmly believe the strength of our membership and the significance of our combined voice has cemented our excellent reputation today as the peak advocacy organisation for health care consumers in the ACT, which will enable us to deliver quality input to these important policies.

I sincerely thank all of our consumer representatives and members for their active involvement, their empowering support and their engaged interest. 

I thank my fellow Executive Committee Members for their commitment, energy and vision over the past year and, on behalf of all our members and the Executive Committee, I deeply thank our outstanding Executive Director, Darlene Cox, and her very capable and professional team for all their hard work during this challenging and productive year.

My thanks to Marion Reilly, who is leaving the Executive Committee after 13 years; I am delighted she will continue her active involvement with HCCA and I hope she continues her recovery from her recent illness.

And my thanks to Russell McGowan for his truly valuable contribution, over many years, as a member of the Executive Committee, where he has served as President for 10 years, Vice President and member.  He is stepping down from the Committee at the end of this term, but I know he will maintain his close association with HCCA.    

While I step down from the position of President I will continue to be an active member of the HCCA to advance consumer interests in our health system.

I have been honoured to hold the position of President for 3 years and I thank you all for your support to me personally, during that time.

Adele Stevens

Health Care Consumers' Association President 2008 - 2012

HCCA Annual General Meeting 2012

HCCA’s Annual General Meeting was held on Thursday 15 November at 5:00pm in the Drawing Room at University House. It was a magnificent event with a very strong turnout and I would like to thank to all attendees for their time and participation.

Ngunnawal Elder, Aunty Agnes Shea welcomes us all to Country

Professor Sharon Friel from the Australian National University gave a very informative and captivating speech about how public policy can reduce health inequalities experienced in our community. Professor Friel’s speech and presentation can be viewed on our website.

Professor Sharon Friel

Adele Stevens gave her last report as president. Adele has been the president of Health Care Consumers’ Association for four years and we have greatly appreciated her significant commitment to the organisation. Adele’s full report is available in the Annual Report and the speech she gave at the AGM will be posted to our blog.

Our outgoing President thanked Russell McGowan and Marion Reilly for their contribution to the Executive Committee, who have both stepped down from their positions. Although they are no longer on the Executive Committee, I am sure they will continue to be very active members within the organisation.

As part of the organisational business undertaken at the meeting, HCCA elected its new Executive Committee. The Executive Committee for the next year is as follows:

• President: Sue Andrews (term ends 2014) 
•  Vice-President: Adele Stevens (term ends 2014) 
•  Treasurer: Bev McConnell (term ends 2013)
• General Members: Therese Findlay, Sharon Eacott, Caroline Polak Scowcroft, David Lovegrove (term ends 2013), Michelle Banfield and Bill Heins (term ends 2014)

Our new Executive Committee

I look forward to working with the new Committee in the coming year.

Darlene Cox
Executive Director

A visit to the Belconnen Enhanced Community Health Centre

Last week, members of the Community Health Centres Executive Reference Group, including HCCA's Yelin Hung, visited the construction site of the Belconnen Enhanced Community Health Centre. 

Construction is well under way on the new Centre, and the building is going to be huge!  While a lot of work has already been done, there is still certainly a lot left to do.  The Centre's Project team took the Executive Reference Group members through every level of the building, and up to the top floor where you can catch a panoramic view of Belconnen's commercial district. 

There is still a long way to go, and a number of things to do before construction can be completed but time flies and soon June 2013 will be around the corner.  

Yelin doing her best Bob the Builder impression,
minus the tool belt!

Conference Report, PHCRIS

Last July Jenny Berrill and I were endorsed to attend the 3-day Primary Health Care Research conference of 2012 at the Canberra Convention Centre.  About 400 health professionals attended to INFORM, to INFLUENCE and to IMPLEMENT matters of primary health care.  In the opening remarks, the Conference Convener, Dr Christina Hagger, challenged us to maximise knowledge exchange, not only between colleagues who share similar views but also with colleagues who have different views.  In the three days, there were 126 concurrent sessions. Let me tell you about two of the several I attended.

One was titled, “Inter-Professional Collaboration Across Organisational Boundaries Relating to Diabetes”.  In simpler words, perhaps it could have read: “The Need for More Medical Cooperation Across Jurisdictions.”   Optimal diabetes care requires well-coordinated services from a range of medical and allied health professionals.  However, the complex mix of public and private sector primary health services presents challenges to this being achieved.

Two questions have arisen in the study:
•    In what way do health professionals who work in different jurisdictions collaborate?
•    What influences the keenness to collaborate?

The study is finding that a complex mix of organisational and professional factors adversely influence decisions about whether to collaborate with whom and to what level.  It seems that the level of collaboration rarely goes beyond a low level of coordination.  While this works satisfactorily for patients with routine care needs, it works less so for patients with complex needs. Much work seems to be needed before meaningful collaboration can be achieved.

Another session I attended was titled, “Supporting Advanced Nursing and Development and Sustainability in General Practice or SANDS in GP.  The project is funded by the Australian General Practice Network.

Five teams based in Australian primary care organisations are working together to develop a syllabus framework to support advanced nursing.  Each team is focused on one of five organisational levels as follows:

•    Individual nurse,
•    General Practice,
•    Primary Care organisation/Medicare Local
•    Leadership and Management
•    Governance

I was surprised to learn that this research is occurring simply because there is no clear career path for general practice nurses.  What is known is that international evidence shows that GP nurses can achieve good patient outcomes and good levels of satisfaction.  They have shown they are able to fill workforce shortages.  However, while our Federal Government supports the expansion of general practice, initiatives, such as the introduction of practice nurse MBS item numbers, are not based in strong evidence and may restrict the role.  Research is currently being carried out on definitions, training and how assessments are to be made on competencies.

To check on the current situation I emailed the Primary Care Nursing Research Fellow at ANU who was a delightful person to speak with. She has assured me that I will be kept informed of their progress in outlining the framework for this proposed nursing development.  

Roger Killeen
Consumer Representative

Partnering with Consumers

One of the workshops I attended at the Australasian Conference onSafety and Quality in Health Care in Cairns earlier this month focussed on how to help health services to take up the challenge of partnering with consumers to ensure they comply with the ‘Partnering with Consumers’ Standard within the National Safety and Quality Health Service Standards (NSQHSS).

‘Partnering with Consumers’ is Standard 2 of the 10 NSQHSS.  It is a particularly important Standard because it provides the framework for active partnership with consumers by health service organisations. It is also one of the most challenging for many health service providers, because it is overarching and applies in conjunction with Standard 1, ‘Governance for Safety and Quality in Health Service Organisations’, in the implementation of all other Standards.

Consumer-centred Care is also the first of three core principles for safe and high-quality care as stated in The Australian Safety and Quality Framework for Health Care. This means providing care that is easy for patients to get when they need it; making sure that health care staff respect and respond to patient choices, needs and values; and forming partnerships between patients, their family, carers and healthcare providers.

The workshop was led by Karen Luxford, Director of Patient Based Care at the Clinical Excellence Commission (CEC) in Sydney, and Nicola Dunbar, Program Manager at the Australian Commission on Safety and Quality in HealthCare with responsibility for a range of program areas, including the deteriorating patient, primary health care, and patient-centred care.

In 2012, the CEC adopted an organisation-wide policy to proactively include principles of patient-centred care within the CEC, to ensure a consistent approach to consumer engagement.

Consumer Advisors were recruited in September 2010 and matched by interest and relevant experience to CEC programs and projects.

Evaluation was through a case-controlled qualitative survey in November 2011.  105 participants were divided into four groups – CEC employees, CEC consumer advisors, CEC working group members and CEC event attendees.  Participants completed a questionnaire anonymously online.

Interestingly, the top three potential barriers identified by participants were as consumer advisors being ‘disregarded as not a health professional’, ‘having an axe to grind’ and ‘lack of clinical knowledge’.

The following headings cover some of the challenges reported by both patients and clinicians.

Communication

Good communication was often found to be lacking. Patients reported not having access to medical staff when things were going wrong; and when the patients knew something was wrong – they were simply not listened to and, if they were in pain, they were just given pain killers to mask the symptoms.

This comment from a consumer, who was told by a nurse that she understood exactly what he was going through after hitting his finger with a hammer, illustrates the point:

‘You can watch someone hit their finger with a hammer a hundred times but until you experience what it’s like yourself you really don’t know what it’s like to hit your finger with a hammer.’

Concept of Consumer

Many clinicians have difficulty with the concept and do not like the term. Some feel there needs to be a focus on the patient and a differentiation of their needs in comparison to family and carer’s needs.  They feel the use of the word ‘consumer’ distorts this.

Concept of Partnership

The concept of partnership refers to a two way relationship characterised by trust and respect and open communication and varies depending on the context. Karen Luxford and Nicola Dunbar acknowledge that this raises the power differentiation between clinicians and patients. The term partnership, as used in a legal concept, refers to sharing responsibility which is not the case with health. The responsibility lies firmly in the hands of the clinicians.

Evidence of the benefits of adopting Patient-Centred Care

In recent years, a number of studies show distinct improvements in hospitals’ uptake of a patient-centred care approach. In one study a comparison was done between two hospital outpatient units - one adopted a patient centred care approach and the other did not; results showed the first had shorter stays and therefore lower costs. Additional positive findings from these studies included significant operational benefits, more satisfied staff, higher staff retention rates, decreased costs, fewer medication errors and adverse events, and improved patient compliance.

Engagement in Governance

It is important to involve consumers who have had direct experience with the health service.  Consumer representatives must be comfortable and briefed so they can speak up at committees. Consumer representatives play a vital role in contributing to quality improvement processes and it is important that they are respected and valued in committee work, otherwise the engagement is tokenistic.

As the only consumers attending the workshop, we drew attention to the role of consumer peak organisations, explaining their important role in support and training.

Unexpected benefits of consumer involvement in governance are that consumers can see the problems more simply and are often solution focused. Standard 2  has been found to be the least met standard because it is seen as being a bit ‘out of the box’. Australia could do well to follow one of the policies in United States health system, where health service providers lose 2% of their Medicare reimbursement if they fail to publish their consumer data.

The Australian health system needs to shift its focus from accreditation to adopting an ongoing process of quality improvement that is responsive to patient needs. Clinical handover, the deteriorating patient, infection control are all part of this process.

How do we measure how we are making a difference

Audit tools currently focus on quantitative data; it is important to think about ways to gather qualitative data.

Conclusion

The need for ‘partnership with consumers’ in governance and care is growing and the role of patients and carers in safety, models of care, program design and review of the organisations performance is key to the establishment of effective partnerships with health service managers and the clinical workforce.

Karen Jameson

HCCA Policy Officer