CHI has multiple projects under its umbrella to ensure the delivery of safe, effective, equitable and patient-centred care to the community. CHI is helping to address some of the fundamental safety and patient flow issues felt across all health services worldwide.
Gold Coast Health (GCH), in conjunction with the Gold Coast Primary Health Network (GCPHN), have formed the Integrated Care Alliance (ICA) and are working to create an integrated, coordinated, seamless and streamlined world-class health system on the Gold Coast that strengthens the link between primary, secondary and tertiary care services to ensure a truly person-centred approach to service delivery.
Emphasising the voice of consumers and engaging stakeholders across all sectors via a strong clinically driven process supported by Design Thinking, the formation of the ICA is based on shared governance and collaborative and coordinated work streams between GCH and GCPHN.
The ICA will improve the coordination of care to ensure consumers receive the right care in the right place at the right time by the right person. Access to services will be improved by providing better care closer to home in community-based hubs. In doing so, capacity in the tertiary service will become available to meet increasing volumes of patients requiring acute inpatient care.
During the past 12 months, a number of care pathways were examined and redesigned following extensive clinical and consumer engagement, incorporating evidence and examples of good practice. This ensures that initiatives and processes employed reflect those of high-performing healthcare organisations and exemplar health care systems – as well as reflecting the needs of the local population and stakeholder input.
The Mental Health project proposes to expand, integrate and redesign Mental Health crisis services and adapt a Crisis Now model for the GCH. The principles and practices will introduce core elements for transforming crisis services including focus on recovery orientation, providing trauma-informed care, using multi-disciplinary staff, having a commitment to zero suicide and maintaining strong safety focus for consumers and staff whilst consolidating external agency collaboration. The Crisis Now for the GCH will be made up of four main elements:
- 24/7 Crisis call centres, coordinating in real time
- 24/7 mobile crisis teams
- Short term (23 hour) crisis stabilisation facility
- Access to a range of community-based services and Short Stay inpatient beds.
This project is intended to act as a proof of concept for the rest of Queensland.
In aligning with inpatient initiatives to improve a patient’s journey the Frailty Project is aimed to develop a system that supports the acute care of frail patients in the community and residential aged care facilities, the identification and frontline assessment of frail patients in Emergency Departments and streamlining the in-patient journey.
Care planning and community-based education will assist to support frail patients, their families and carers, Clinicians and General Practitioners across the Gold Coast community.
CHI is supporting two clinical departments at Gold Coast Health to take on more delegated accountability through a shared governance model. This is a ‘proof of concept’ that will be extended to other departments if it is deemed to be successful.
Shared governance – or earned autonomy – involves decentralising decision-making and empowering those delivering services to take greater responsibility over their ways of working. Senior staff in those two clinical departments have greater delegated authority to decide how their budget is spent and to make staffing and other HR decisions. These senior staff are then held to account through a series of key performance indicators captured in a Memorandum of Understanding with the health service executive.
Participating staff and teams will continually measure themselves against five core capabilities, that have been adapted from the current health system framework:
- Safety and quality
- People and culture
- Finance and assets
- Strategy and planning
They are supported by greater visibility of performance data through a dedicated information system – capturing HR, finance and patient outcome data. Initiatives are underway to improve team dynamics, business practices, waitlist management, reporting relationships and formats, and the integration of this information system as a reporting tool.
If the proof-of-concept is successful, barriers to success will be identified and lessons learned will be tracked enabling the team to start to strengthen a mutual understanding of what is required to devolve accountability, what the KPIs and indicators of success are and how they will be measured.
The volume and complexity of the demand currently presenting to the emergency departments at Gold Coast Health has been the catalyst to developing strategies to manage patient waiting times and congestion across the whole clinical system.
We are exploring new ways to demonstrate health system demand and improve the patient journey. Evolving interventions are in place aimed at improving the way patient flow is managed in the Emergency Department, proactively managing discharges in inpatient units and escalating decision-making for patients with the most complex care needs to ensure they can safely and confidently return home as soon as clinically possible.
The full range of interventions are being closely monitored and evaluated. Existing evidence and examples of good practice from other health services have been considered and used where appropriate.
Gold Coast Health is the major provider of ambulatory care services to people on the Gold Coast. In the 16/17 financial year, the service provided 312,458 specialist outpatient appointments and performed 16,154 elective surgery procedures (source: GCH Health Analytics). Despite this activity, there is a significant challenge with ensuring ongoing access to outpatient clinics.
There are many contributing factors that have impacted on this position, including a capacity deficit for new appointments, a growing review cohort and an absence of waiting list / clinic management policies and processes.
This is a complex problem affecting many public healthcare providers. Significant improvements in technology, surgical procedures, and pharmaceutical regimes have resulted in improved health outcomes, however have a perceived dependency on tertiary services for ongoing treatment. As new people are diagnosed and the population continues to age, the patient population will continue to increase.
This project has been commissioned to create and execute a strategy to improve and sustain access for patients. This has involved a full review of bookings and referrals processes and the operational management of outpatients (including policies and procedures). In addition, the specialties with the highest performance risk to GCH have been closely scrutinised to understand current issues and work in conjunction with the clinical specialties to develop and implement solutions that are sustainable for the service in the long term.