Revised Proposed Structure for SALHN Network Clinical Leadership

1. Southern Adelaide Local Health NetworkClinical Leadership Structures Summary of Feedback and Revised Proposed Structure June 2015

2. Purpose This presentation provides an overview of the feedback received and details of the implementation process of the proposed SALHN Network Clinical Division organisational structure.

3. Background • The South Australian public health system (SA Health) has undergone significant structural change over the last several years, as part of ongoing National and State Health reforms. • Historically structures and governance were designed and implemented at a hospital/site level. • SALHN continues to consider moving governance and organisational structures from site to a Network focus, which also supports National Accreditation requirements. • The changes are designed to improve the management of operational requirements, improve local decision making and maintain appropriate levels of timely, safe and quality care, efficiency and cost effectiveness across the Network. • Whilst there may be some local differences, the adoption of clinical streams and Co-Directors is consistent with overseas, interstate and other LHNs.

4. Consultation Background • Proposal to amend the current SALHN structure distributed to stakeholders in July 2014. • As part of the consultation process meetings were held with union representatives and staff, and CEO Bulletin published advising of the proposal. • Staff were informed of the proposal by way of meetings held with them at the Divisional Management level. • Feedback on the proposed model commenced 7 July and concluded 28 July. • All stakeholders whether in scope or out of scope were consulted. • Mental Health and Allied Health have review processes occurring concurrently within their respective divisions and are out of scope of this review. • Due to Transforming Health Reforms being consulted at the time the SALHN Clinical Leadership Structures were put on hold to ensure future structures supported the reforms post consultation.

5. Proposed SALHN Organisational Structure in July 2014 • It was proposed that there will be four (4) Network Clinical Divisions, with the functions of the former Division of Emergency and Perioperative Medicine realigned within those: • Women's & Children’s • Surgery and Perioperative Medicine • Medicine, Cardiac & Critical Care • Rehabilitation, Aged Care, Intermediate Care • Proposed that leadership of the Network Clinical Divisions will be by way of a partnership between the existing Clinical Director positions and a joint head of division (Co-Director Operations).

6. Previously proposed SALHN Organisational Structure – Continued • The Clinical Director and Co-Director Operations will be jointly responsible for: • managing the human and material resources • quality of service provided • recruitment, appointment, retention and coordination of the development of all staff • establishing policies, goals and objectives of the Division. • Two Co-Director Operations classification models proposed: • Multi Class - Award Roles and classification (e.g. Nursing / Scientific Officer / Allied Health) • Executive Roles and Classification • The Co-Director Operations is a new role. Therewill be a merit based process for the appointment of the Co-Director of Operations role. • The Nursing Director at Noarlunga Hospital and the Nursing Director for Surgery (FMC) will not be retained positions. HR Principles will be applied consistent with the SA Health (Health Care Act) HR Manual.

7. Previous Proposed Organisational Chart

8. Feedback Received A total of 29 responses from stakeholders was received following the consultation paper being released. These included responses from: Individuals Group responses from clinical divisions Employee Representatives/Unions Key Themes: Strong support for the adoption of clinical leadership structures Clarity was sought around structure below the Medical and Nursing Structures outlined. Some feedback on what structures within the clinical divisions should look like at the next level. Clarity sought over where some units were captured within the clinical divisions.

9. General Feedback • A Director of Nursing position is required at each individual site in SALHN. • Significant feedback from Primary Health Care and Transition Services, highlighting that more consideration was required to consider whether it should be within the Rehabilitation and Aged Care. Support to rename Intermediate Care. • Would employees need to relocate? • All Nursing Directors should be consistently classified across the network which would require a SALHN wide portfolio and approach. • Information required as to future for Noarlunga Hospital as the proposal appears not to provide a vision which creates uncertainty for staff. • Further information and clarity required in respect to site management, in particular how the Deputy COO and the DON role at RGH will be built into the governance. • Surgical division currently has an Operations Manager but other divisions do not; request consideration to be given to including like positons in other Divisions. • Role clarity between the Operations Manager role in Surgical Division and the proposed Co-Director Operations role and questions around the reporting line for the Operations Manager.

10. SALHN Clinical Leadership Structure 2015 New positions Modified roles Indicates functions will be standardised into a Network model SALHN CEO Director of Medical Services COO Note: Clinical Directors and Co-Directors will have an operating reporting line to the Chief Operating Officer (COO) Deputy COO Intermediate Care including Aboriginal Health Surgery & Perioperative Medicine Rehab & Aged Care SALHN Nursing Women’s & Children’s Medicine , Critical Care & Emergency Dept Director of Nursing & Midwifery Exec Co-Director Operations Rehab, Aged Care 1.0 FTE New Pos (to be classified) Multi Class *posn will prof report to relevant professional lead Clinical Director Co-Director Operations Surgery New Pos (to be classified) EXE 1.0 FTE Nursing Preference Clinical Director Co-Director of Operations (New Pos to be classified) RN Nursing 0.5 FTE Clinical Director Clinical Director Co-Director Operations Medicine New Pos (to be classified) EXE 1.0 FTE Nursing Preference Corporate Nursing RN5.3 Site based DON RGH/ Medicine stream (classification TBD) Site based DON NH/ Surgery Stream (classification TBD) Manager Operations NIS Nursing Director for W&C 1.0 FTE ND Periop SALHN RN5.3 1.0 FTE ND Med/Cancer Stream SALHN RN5.3 1.0 FTE Infection Control ND Rehab SALHN RN5.3 ND Surgery Stream SALHN RN5.3 1.0 FTE NMER Unit Palliative Care Services RN5.3 1.0 FTE ND ED SALHN RN5.3 ND Critical Care SALHN RN5.3 • Reporting Line Notes: • All Medical Staff will have a professional reporting line to the Director of Medical Services • Medical Heads of Units will report to the Clinical Director and have an operational reporting line to the Co-Director of Operations • All NDs will report professionally to EDONM SALHN. • All NDs in clinical stream will report operationally to Clinical Director and Co-Director Operations. • DONs will have a direct reporting line to EDONM SALHN for site operational management function and nursing responsibilities. • All nursing in Intermediate Care Health will have professional reporting line to the ND for Rehabilitation and Aged Care.

11. Changes made due to feedback • Primary Health will be renamed Intermediate Care. • Intermediate Care will remain reporting to the COO and in due course will be reviewed as a separate exercise and naturally a separate consultation process will occur with any review of Intermediate Care. • Nursing staff in Intermediate Care will have a professional reporting line to the Nursing Director Rehabilitation and Aged Care. • The Operations Manager in Surgery will be retained due to the complexity and volume of work in Surgery with the role of the Co-Director of Surgery. The duties and responsibilities of the Operations Manager of Surgery to be determined with the Clinical Director and in consultation with staff. • Palliative Care will remain under Rehabilitation and Aged Care but will have a closer link with Cancer Services

12. Changes made due to feedback • A Director of Nursing has been retained at each site, with a stream focus. • Co-Director role title will be retained to ensure positions are seen as a joint leadership team. Co-Director role will report to Clinical Director. • Both operationally report to the COO and Clinical Directors will have a direct reporting line to CEO.

13. Clarity to questions posed? • Where do the following services sit? • Pain Unit – Surgery and Perioperative Medicine • Palliative Care - Aged Care and Rehabilitation • Urology – Surgery and Perioperative Medicine • Emergency Department – Division of Medicine, Critical Care and Emergency Department • Hospital @ Home– Corporate Nursing • Aboriginal Health – Intermediate Care • Family Advisory Unit – Women’s and Children’s Division SALHN • Paediatric Services at Noarlunga Hospital– Women’s and Children’s Division SALHN • Nursing Ambulatory Services - Outpatients report to COO and clinics through clinical streams • Noarlunga Private Hospital- Myles Ward – Deputy COO • Radiology – Statewide Services come under CALHN governance • Infection Control– Corporate Nursing • Metropolitan Referral Unit – Statewide service reporting through to Department of Health • Primary Care (early childhood services for children) – Women’s and Children’s Network • FMC Medical Imaging Nurses – should these nurses have a reporting line above CSC level– These are SAMI nurses and have a professional reporting line to Corporate Nursing - Kym Dixon • Is there medical leadership for Palliative Care. Yes through Assoc Prof Craig Whitehead

14. Consideration of comments • Stroke and Neurology to become Clinical Neuroscience. For Medicine to consider. • Infectious Diseases be designated as a Medical Specialty rather than an Ambulatory Service and to include Infectious Diseases, Microbiology, and Infection Control. – No, under SA Pathology governance. • Positions currently funded in Primary Health such as Respiratory nurses, Heart Failure Nurses, Parkinson Disease should report through to Medicine. Yes in future will report to the appropriate division. • Clinical improvement should report not only to DMS but also to COO and CEO. Referred to Executive for consideration, outside of Clinical Leadership Structure. • Nursing Director of ICCU reports by dotted line to the Medical Head of ICCU. – Yes this is already the case. • Trauma Services to sit within Critical Care/Emergency Department. Current leadership structures don’t change sub specialty current reporting lines. • Propose a senior nursing position to oversee Cardiovascular Medicine. This will need to be raised via normal business processes with a Business Change Template.

15. Consideration of comments • Consideration for aligning Endoscopy with perioperative services – Yes this is the case. • Question around how the nursing and medical structures align – No change to professional reporting line and strengthens operational alignment. • Deputy COO role and DON RGH governance arrangements clarified – Positions are retained, Deputy COO role will support the site management across RGH and Noarlunga. • DON RGH will be retained with a clinical stream focus for Medicine. • Several of the Ambulatory listed services are also in-patient based services and should be listed as Medical Services. No changes proposed to current sub specialty areas. • Pharmacology should be separate to infusions. Under Statewide Services governance. • Cancer should have sub groups of Oncology, Haematology and Radiotherapy – This is to be determined by Clinical Division. • Consideration to be given to Clinical Directors having a presence at across the network in both strategic and operational leadership. Accepted and to be managed by the Clinical Directors.

16. Summary of Impacts of the proposed Clinical Division Structure • Day to day operations of most staff will not be affected • Primary Health Nurses will professionally report to the Nursing Director for Aged Care and Rehabilitation at RGH: • Financial and HR delegations for approvals may change • The Co-Director Operations is a new role and there will be a merit based process for the appointment to Co-Director of Operations role. • Where positions are not retained in the structure (1.8 Nursing Director Roles – Cancer at FMC and Nursing Director at NH), HR Principles will be applied consistent with the SA Health (Health Care Act) HR Manual. • Executive roles will be advertised externally, all other positions will be quarantined to SALHN employees. Employees who have recently been through a full recruitment process for like roles may be considered for direct appointment. • A partnership approach between the Co-Director of Operations and Clinical Directors with an operational reporting line to the Chief Operating Officer. • Professional reporting lines will apply as appropriate to the relevant discipline lead.

17. Consideration of Feedback • SALHN would like to thank everyone who provided feedback, comments and/or suggestions. • The feedback has been reviewed and has been taken into consideration in determining how to progress with the proposed changes. • It is noted that the feedback provided generally supported the proposal to develop Network Clinical Structures and there were a number of good suggestions on how the changes may be implemented. • Many comments made were made by one person and not necessarily representative of a view of many. • While it is acknowledged that some suggestions and/or comments may require further discussion, it is considered that the proposed Network Clinical Division Structure be implemented and consultation commence with stakeholders (staff and employee representatives) on the implementation process.

18. Proposed Implementation Process In response to the feedback given: • Management will implement the 4 clinical divisions • Co-Directors will be established as multi class roles. The divisions of Medicine and Surgery and Women’s and Children’s will have a preference for Nursing and Midwifery qualifications. • The Clinical Leadership Divisions manage local implementation requirements • Implementation is proposed to commence as of 1 July 2015 • Further meetings locally and through the SALHN ILF will be arranged to work through local requirements.

19. Feedback on Revised Proposed Structure Meeting with unions on Friday 29 May 2015. A presentation of the proposed clinical division structure will be made at divisional management meetings – led by CEO/COO and Clinical Directors. Clinical Divisions will ensure communication throughout the division. Management Briefings will be held between 1 June at 10 June for the following: Medicine, Cardiac & Critical Care Women’s & Children's Surgery and Perioperative Medicine Rehab and Aged Care Primary Health Noarlunga Management Corporate Nursing Mental Health Allied Health Feedback from staff sought on proposed model to inform implementation plan and finalise the structure.

20. Feedback on proposed Clinical Divisions Structure (continued) Feedback on the proposed clinical divisional structure can be forwarded to the SALHN Chief Operating Officer. SALHNChiefOperatingOfficer@health.sa.gov.au Feedback on preferred model commences Monday 1 June 2015 until Friday 19 June 2015. Post staff feedback consultation regarding the implementation of the final model will commence. CEO News Bulletin will be issued by 10 June 2015 to all staff advising of feedback process and timeframe, with a link to the summary of feedback and revised clinical leadership structures. Employee Assistance Program support services is available for staff. Line manager and HR support will be available for employees.

21. Questions