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Meeting Patient Needs

Meeting Patient Needs. Primary & Acute Health – Systems Integration. The Strategic Integration of HARP & Hospital Demand Management Projects. Alison Harle Austin and Repatriation Medical Centre. Allison Harle Demand Management Coordinator Austin & Repatriation Medical Centre.

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Meeting Patient Needs

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  1. Meeting Patient Needs

  2. Primary & Acute Health – Systems Integration

  3. The Strategic Integration of HARP& Hospital Demand Management Projects • Alison Harle • Austin and RepatriationMedical Centre

  4. Allison HarleDemand Management CoordinatorAustin & Repatriation Medical Centre The Strategic Integration of HDM & HARP at the A&RMC

  5. Presentation Overview • Background to HDM • HDM at the A&RMC • Outcomes & Key Lessons • Development of HARP • Integration of HDM and HARP • Future Challenges

  6. HDM Background • Unacceptable numbers of bypass, 12 hour waits, displacement of elective surgery etc. • Pressure and stress in work force • Shortage of aged care beds, with patients backing up in acute beds • Workforce issues, shortage of nurses, especially critical care and emergency nurses • HDM – development of short to medium term projects targeted at predictable areas of demand

  7. Short to Medium Term Aged & Chronic - Care Coordinators, Residential Care Placement Team, Chronic Disease, Functional Maintenance Program, Continence Emergency Department – Aged Care Team, Short Stay Observation Unit, Multidisciplinary Triage, Medical Assessment and Planning Unit Substitution – Ambulatory Care, Medi-hotel, Spinal Admission Prevention, Rehabilitation in the Home Medium to Long Term Clinical Leadership Hospital Primary Care Liaison A&RMC HDM Initiatives

  8. Key to Success • Program Governance • Dedicated Demand Management Coordinator • Constant Analysis of Data and Performance • Program Direction • Project Structure • Change Management • Combination of Short and Medium to Long Term Projects • Clinical Leadership • Hospital Primary Care Liaison

  9. Development of HARP • Community Consultation • Areas of Demand • Analysis of Data • Expectations • Timeframe • Implementation

  10. Integration of HDM & HARP • Where is the connection? • Build on the strengths and lessons from HDM • Program Governance • Dedicated Coordinator • Constant Analysis of Data and Performance • Program Direction • Project Structure

  11. HARP Projects • Chronic Disease Unit (CCF & COAD) • Improving Diabetes Care • Community Link Rapid Response Service

  12. Issues • Project Support • Stakeholder Expectations • Budget Process • Recruitment • Maintaining Motivation • Integration & Sustainability

  13. Future Challenges • Model of Care – Consumer Focused, Sustainable, Integrated • Managing Expectations • Addressing Organisational Weaknesses • Creativity & Innovation • Evaluation • Maintaining Flexibility

  14. Better Communication Between the Hospital & Community Services • Evie Soldatos • Eastern Health

  15. Collaborating on HARP in the East…..better communication between the hospital and communitysectorsEvie.Soldatos@angliss.org.au

  16. Overview • A bit of Eastern collaboration history…. the baseline • The Role of the Clinical Coordinator HARP & HDM • A system for Eastern collaboration • What we’re learning…

  17. Key points… • The reflection on HARP 1 • Collaboration • Who? • How? Structure • In what manner? Processes & principles • What are we learning?

  18. History of Eastern HARP collaboration. • 2002 HARP 1 • Little coordination of effort across the Health Service & Community • Stakeholders internal and external to the Health Service affected • Minimal involvement of the Primary Care Sector • Less than satisfactory outcomes • A clear need for communication to improve

  19. Picking up the pieces… • De briefing – a good ‘vent’… • Identifying the issues, expectations and common ground as a basis for future planning… • Inclusion • Information • Consultation/Contribution • Timing • Feedback

  20. What we did about it… • Established a central point of coordination • Systematically identified and connected with stakeholders • Improved flow of communication • E-mailing Groups, News Flashes, Work Groups • HARP Forum 28 November 2002

  21. Advancing HARP in 2003 • Identifying common concerns, objectives and shared ownership • Establishing trust and building the relationships • Developing and implementing a system for communication and coordination of effort across sectors • Acknowledging and using what we already have

  22. What is the collaboration structure? • A collection of interconnected across sector reference, working groups and operational forums • a vehicle for considering HARP and it’s implications at strategic, coordination and practice levels, and; supporting HARP action. • An evolving ‘species’

  23. Eastern Health Committees Primary Care & Population Health Advisory Committee Community Advisory Committee Hospital Demand (HARP) Reference Group Cohort Reference Groups Older Persons & Mental Health Technical Working Groups Business Systems, Information Management Project Steering Groups, Medication Management

  24. Who are the collaborators? • HARP is a ‘bridge’ between the wider external world… • 3 PCPs; a ‘portal’ with a central strategic and communication role • Key community-based service providers • Care Management providers • Community Health Services • Divisions of General Practice • Local Government • RDNS

  25. Who are the collaborators? • …and the wider internal world… • Acute Services • Aged Care Rehabilitation & Community Health • Mental Health • Planning and Community Relations • Information, Finance and Corporate programs

  26. What processes underpin collaboration? • Shared vision and opportunity to participate • Guiding Principles • A focus on what we CAN rather than can’t do • Shared commitment • People, community, service system • A culture of consistent communication and action • Frankness, courage & robust debate in the context of respectful relationships

  27. Essentially… • Establishing objectives • Organising • Motivating • Developing people • Communicating • Measurement and analysis (reflecting)

  28. It’s not easy… • An investment • Time, energy, money, systems & tools • Cultural considerations • Language, philosophy, models & perspectives • Recognising skills and specialisation across sector • Politics

  29. What we’re learning…. • Collaboration processes require:- • planning • collective agreement • commitment to application and ‘troubleshooting’ • robust communication across dimensions • time & effort • support • IT’S Definitely NOT the easy path….. But it’s certainly the worthwhile one.

  30. The Future….. • Ongoing reflection on and improvement of structure and processes • Moving increasingly toward shared ownership and problem solving of systems issues • Balancing strategic vs operational needs; supporting the system AND the projects • Checking our language and the meanings we derive from it • A place for everyone

  31. So…. • Create the environment • Relationships ARE important • Have the shared vision & objectives, but bite off chewable chunks; focus on what you CAN agree and do • Have Exit as well as Project champions • Take a ‘systems’ approach • Continuously adjust and improve • Encourage the debate; embrace the “tail twisters” • Try to have some fun! • Enjoy the journey!

  32. “ If possible, try to find a way to come downstairs that doesn’t involve going bump, bump, bump on the back of your head….” • Winnie the Pooh • Pooh’s Little Instruction Book • Inspired by A. A. Milne

  33. HARP: A Vehicle to Transform Relationships and Practice • Phil Cornish • Bayside Health

  34. HARP: A Vehicle for Change Building Relationships Between Providers

  35. Better Care Of Older people • The successful HARP project for Bayside Health and its Partners was a multifaceted integrated model • Components of the model included; • Identified register, shared electronic health care record, targeted strategies, extra resources

  36. Headings • Vision/Passion • Leveraging Existing Relationships • Emphasis on Method not Model • Build on Complementary Initiatives • Principle on Integration and resource shifting

  37. Vision • No ones believes the current model of health care will be sustainable into the future • It is a question of when the model changes rather than if

  38. Leading the Vision • There is no doubt the personal involvement of the Bayside CEO Michael Walsh helped generate a lot of support • The Vision was further refined by the CEO doing a round of sessions with representatives from different agencies across the length of the catchments

  39. Means to an End • Better Care of Older People ( also a Bayside Strategic Direction) saw the project as no end in of itself • It was a way of promoting alternate care models which emphasised community interventions

  40. Life After HARP • It was important in our view to change the nature of the interaction between the sectors • We saw more of the leadership coming from the primary care sector in the future as they were closer to the community

  41. Resultant Model • There is a Joint Steering Committee chaired by the Bayside Health CEO

  42. Membership • CEO’s of two community health services • 2 LGA representatives at a senior level • 2 other Bayside Health Representatives from The Alfred and CGMC • ISEPHIC • Jewish Care • RDNS • GP Division and Bayside Care Options

  43. Leverage Existing Relationships • Would we had to invent the PCP’s? • Strong commitment to the PCP • Primary Care Sector had long history of engagement (Primary Care Alliance)

  44. Other Key Players • Strong Involvement from a range of key staff such as CHS CEO’s • Bayside Health involvement across a number of areas • Bayside Health Representative had cross sector interests both in Primary Care sector and other sectors.

  45. Partnership Statement • The development of successful long term strategic relationships, based on mutual trust, world class and sustainable competitive advantage for all partners; relationships which have a further separate and positive impact outside the partnership. • Lendrum, T. The Strategic Partnering Handbook McGraw-Hill 3rd Ed.

  46. Developing Own Partnering Statement • The group has developed its own partnering statement • Other agreements about personnel and service agreements

  47. Select a Partner Review Internal r’ships Review with partner and share info Analyse Requirements Ensure IFOTA1 requirements Carry out site visits Select and Review partnering Team Members Review skills customer/supplier Review Upstream Technology Network review Develop implement and review strategy/action plan Pp145-149, Lendrum, 1998 Tony’s 12 Steps

  48. Method rather than Model • The group produced a description of both a model but more importantly a description of a method which would allow the project to respond to client need as it was identified • Unitary/integrating model which would be multifaceted

  49. Proposed Model Components • Identified client group of over 70 years multiple admissions or presentations • Shared Electronic Health Care Record • Specialist Team • Provider Resourcing Funds( not brokerage) • 5 sub-programs • 24 hour call centre

  50. Resource Shifting to Primary Care Sector • Bayside Health Representatives stated that Acute Health would not benefit from resource allocation • This has lead Bayside to judge internal proposals against this criteria

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