Transcript Slide 1

Service Planning SA
Presentation to the National Service
Planners conference
Service planning in a reform environment
> Reforming health plan released in 2007
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Challenges: workforce; changing health profiles;
unsustainable demand, new technology, outdated
infrastructure building and their design.
Aims – rebalance system components, redesign service
models, build new infrastructure, improve ICT
infrastructure
> Approach to all planning work
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Organic approach to planning
 Solutions that meets clinician, consumer
need/expectations as well as achieving the targets
and challenges
 Dynamic, situational, iterative, flexible
 Evidence based/best practice
 Reforming approach – not about more of the same
 Focused and targeted on specific areas
Integrated approach – active engagement of health
planners, clinicians, consumers, peak bodies
 Achieving change in health culture – bringing people
along on the planning journey
 Health planners includes dept/regions
Service planning in a reform environment…
> Planning tools
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New model of care
Planning principles
Networks & Senate
Consumer/clinical
HCA
> Outcomes
• Reducing rate of growth in demand
• Achieve the health infrastructure that supports the
new model of care
• Change in culture across clinicians and community
to be active in new health paradigms
• Achieve workforce reforms eg. establish advance
practice roles (eg NP)
System Reform/Health Care Plan
GP Plus Strategy
GP Plus Health
Care Centres
Statewide
Service Plans
General Hospital
Country General Hospital
Establishment
Clinical Networks
COAG
System Service
Redesign
Acute Operations
Major Hospital
Model of Care Components
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Future patient needs
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Contemporary clinical practice
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ambulatory options
care management
direct admissions
multiple access points
manage patients by acuity
grouping patients with like needs, not by clinical speciality,
patient journeys articulated by critical clinical decision making
points
managed exits
better identification of patients - known patient (planned and
unplanned occasions of care) and unknown patient (unplanned)
Advances in functional design for optimal healing
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Older, multiple chronic conditions
separate out elective/emergency surgery
Advances in technology
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distributive imaging/interventional imaging
ICT - clinical support
Statewide Service Plans
> SA reform context is fundamental to aims to be
achieved:
• Reflect the imperatives in the HCP and
comprehensive reform program
• Integrated with other related service plans
• Active engagement and participation in the service
planning process by clinicians and consumers eg
Networks & Senate/HCA
> An iterative process required to achieve final
service model (12-18 months)
> Evidence based/grounded in good practice
> Consensus view – not an imposed solution
> Final plans a blend of strategic direction and
operational elements
Examples of practice change
achieved by collaborative approaches
> Rapid activation systems:
• ST Elevation Myocardial Infarction (STEMI) protocol
- reported 45 mins from ambulance call to
angiography suite
• Hospital pre notification stroke protocol
> Arthroscopy Review and Assessment Clinics
(ARAC) - reducing the requirement for orthopaedics
OPD attendances and surgery
> 24/7 Perinatal Consultant Advice Line – improved
patient safety particularly for country regions
> Older people rapid assessment teams in EDs
> Increase role of cancer MDTs in planning of care
‘Collaborative corridors’ in GP Plus centres
(community allergy services)
Outcomes/impacts of planning
reform
> Shifting ambulatory sensitive illness out of
hospitals into primary care
> Achieving reduced rate of growth in
demand
> Managing services across multiple care
sites
> Acknowledgment of achievements by
clinical sector
positive commentary: culture change
achievement
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“I feel it is important to acknowledge that the work coming from SA is
very much a State Government supported and sponsored initiative
without which the 60 page document that will be released shortly would
not have been produced. It also points towards a template for
engagement with state and federal governments when it comes to
advocating for stroke. In our case our state government responded
positively to a rather negative report about stroke services in SA based
on the NSF audit. They appointed a pro-active stroke chair of the stroke
clinical network who in turn has been able to engage in a bilateral
conversation with the Department of Health to deal with key workforce
gaps based upon a year long stroke service activity report compiled by
2 very passionate stroke advocates. But at the end of the day we also
have to acknowledge a debt of gratitude to key members of the
executive of the Department of Health who are advocates for and also
monitor the implementation of the SA stroke plan and have a close
working relationship with our state chair…
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This type of cooperation between government, a service
network and clinicians should be something that we
should aim for on a national level.”
From a stroke physician
Reducing rate of growth in demand
Since the Health Care Plan was
implemented, using the GP Plus Service
Funds to effect change, the growth in
metropolitan inpatient separations has
reduced steadily from 2007-08 to 2009-10
The Health Care Plan set a target to reduce
growth to 2 per cent per annum; in 2009-10
growth in inpatient services was 1.8 per cent.
Metropolitan Sameday and Multiday Inpatient Separations % change from previous
year
5%
4%
3%
2%
1%
0%
2005/06
2006/07
2007/08
2008/09
2009/10