Eastern Health Quality Account 2018-19

Page 1

GREAT CARE, EVERYWHERE, EVERY TIME

QUALITY ACCOUNT 2018-19


Welcome to the 2018-19 Eastern Health Quality Account

W

elcome to the Eastern Health Quality Account for 2019; our annual publication showcasing performance in a number of key clinical areas as well as demonstrating our commitment to providing safe, high-quality health care.

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A snapshot of 2018- 19 Our performance

1,350,629

episodes of patient care up 1.7% or 23,161

169,465 emergency department

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presentations

up 0.3% – that’s one person every 3.1 minutes

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4870 babies born

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up 1.5% – one baby every 108 minutes X

50,037 ambulance arrivals Adjunct Professor David Plunkett Chief Executive Eastern Health

Dr Peter Dohrmann Chair Quality and Safety Committee

02 Great care, everywhere, every time

to our three emergency departments – up by 4.8% – that’s one ambulance every 10.5 minutes. Average 83% of patients transferred to hospital within 40 minutes of arrival


CONTENTS 02 Welcome to the 2018-19 Eastern Health Quality Account 02 A snapshot of 2018-19

40,350 operations

a record 18,022 of these were elective surgeries

282,690 specialist clinic

appointments

up 6.6% or 17,583 more appointments

4179 people

admitted to our mental health inpatient units and 271,055 occasions of service provided by mental health community services

17 Improved visibility of performance and clinical risks for better patient outcomes

04 About Eastern Health

18 A serious approach to infection prevention and control

06 SECTION 1

19 Fighting flu to help prevent its spread

Consumer, carer and community participation

06 Participation in the Victorian Healthcare Experience Survey (VHES) 08 Partnering with our consumers

20 Advancing care for mums and babies 22 Caring for our more vulnerable community members 24 Escalating patient care efficiently

11 Supporting people with disabilities

26 Personalised care in mental health

12 Eastern Health speaks your language

20 SECTION 3

14 SECTION 2

Quality and safety

14 Listening and responding to feedback 16 Our culture of patient safety continues to shine 16 Fully accredited healthcare services

Comprehensive care

28 Taking action on community health feedback 30 At Eastern Health we welcome your feedback 30 Patients First 31 Eastern Health

Our staff Over

85

different nationalities Speak

30

different languages Born in over

100

different countries Eastern Health Quality Account 2018-19

03


About Eastern Health Established in 0333, Eastern Health plays a key role in the provision of public health services in Melbourne’s eastern and outer eastern suburbs. We work with community healthcare providers suchas general practitioners, community health services and a2liated healthcare agencies. Geographically, Eastern Health covers the municipalities of Boroondara, n K ox, Manningham, Maroondah, Whitehorse and Yarra Ranges. Further, Eastern Health’s Statewide Services cater for consumers right across Australia. Eastern Health is one of Melbourne’s largest metropolitan public health services. We provide a range of emergency, surgical, medical and general healthcare services, including maternity, palliative care, mental health, drug and alcohol, residential care, community health and statewide specialist services to people and communities that are diverse in culture, age, socio-economic status, sexual orientation, gender identity and healthcare needs.

Eastern Health Catchments

Buxton

Glenburn

Woods Point

Kinglake

L}o] E vHoRS] P]u ˙Ruv C S }v˙Ruv C

Marysville Narbethong

Steel Creek

Cambarville

Matlock

Chum Creek Healesville Hospital and Yarra Valley Health

Yarra Glen

Reefton Kangaroo Ground Eltham Templestowe

Warrandyte

Wandin Kew

Box Hill Hospital Glen Iris

Peter James Centre

Mulgrave

Toorongo

Warburton

Yarra Ranges Health Woori Yallock

Maroondah Hospital Hoddles Creek Wantirna Health

Olinda

Angliss Hospital Rowville

Powelltown Emerald

Lysterfield

Gembrook Upper Beaconsfield Garfield

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Eastern Health acknowledges the traditional owners of the land upon which our health service is built, the Wurundjeri People, part of the Kulin Nation, and pay our respects to their Elders, past, present and emerging. 04 Great care, everywhere, every time


OUR VISION

OUR MISSION

OUR VALUES

Great care, everywhere, every time

Together we care, learn, discover and innovate

Patients First Kindness Respect Excellence Agility Humility

Caring for 788,260 people

Our values reflect our understanding that health care is about people caring for people. The way we work together in healthcare teams and with patients, their families, carers and our communities, requires us to be kind, respectful, agile and humble, and to strive for excellence in all that we do. As we live these values each day, our work environments are characterised by respectful and supportive relationships between staff and with our patients and their families. These values represent and describe the very heart of our organisation and what we stand for.

Eastern Health Organisational Profile Larger sites

Services located across 2816 square kilometres – the largest geographical area of any metropolitan health service in Victoria

Angliss Hospital Box Hill Hospital Healesville Hospital and Yarra Valley Health Maroondah Hospital Peter James Centre Statewide Services – Richmond • Spectrum

1507* beds – 7 hospitals and 3 emergency departments

• Turning Point Wantirna Health Yarra Ranges Health (Lilydale)

Corporate functions Annual operating budget of

$1.1 billion

Information, Technology and Capital Projects Finance, Procurement and Corporate Services Fundraising, Legal Services and Corporate Governance People and Culture

We have 9962 employees, 70 per cent of whom live within the community we serve A

Learning and Teaching Quality, Planning and Innovation Research

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Eastern Health Quality Account 2018-19

05


SECTION 1

CONSUMER, CARER AND COMMUNITY PARTICIPATION

PARTICIPATION IN THE VICTORIAN HEALTHCARE EXPERIENCE SURVEY (VHES)

T

he VHES patient experience survey is one way we receive feedback from our patients on their experiences at Eastern Health.

The survey includes specialised questions for: ovR]o]vvU]vo]vP vlP]v ovR]ouPv˙uv 'vU]vo]vPvlP]v ovR]o]o]o]v] 'vU]vo]vPvlP]v uv]˙}vu o}uuv]˙RoRo]v ouov] ~}RovvvuPv˙

06 Great care, everywhere, every time

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Overall, how would you rate the care you received while in hospital 100 95 90 85 80

Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- JanMar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 2019 Eastern Health Performance Target

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Transitions of care indicator 95 85 75 65 55

Jul-Sep 2015

Jan-Mar 2016

Jul-Sep 2016

Jan-Mar 2017

Jul-Sep 2017

Jan-Mar 2018

Jul-Sep 2018

Jan-Mar 2019

Sufficient information about managing health and care at home (Q 69) Consideration of family or home situation when planning discharge (Q 70) Adequate arrangements made by the hospital for any services needed (Q 71) GP given all the necessary information about treatment or advice received in hospital (Q 72) Transition Indicator Target

To improve our performance in these areas, Eastern Health has three projects underway.

1

We have made the time of medical rounds visible to families and visitors on each ward, to enable our patients’ families and carers to participate in the rounds and ask questions if needed

2

Our Nurse Unit Managers touch base with patients daily to hear about and try to resolve any concerns and feedback

3

We are working towards having at least 80 per cent of discharge summaries provided to the patient and the general practitioner within 48 hours of discharge.

Eastern Health Quality Account 2018-19

07


PARTNERING WITH OUR CONSUMERS

F

or our community to be able to experience great care, everywhere, every time, Eastern Health strives to maintain our focus on achieving excellence in health care by delivering great patient outcomes, great patient experiences and harm-free care.

08 Great care, everywhere, every time

u O r commitment to ap rtnering iw th

80 consumers

222

participation activities


SAFER CARE VICTORIA AND INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) DELIRIUM COLLABORATIVE PROJECT Consumer representative, Peter Michell, is part of the Cognition, Mobility and Continence Expert Advisory Committee. His insight, based on lived experience, has made him a significant contributor to the Safer Care Victoria IHI Delirium Collaborative Project. The aim of this initiative is to improve the identification and management of patients with delirium on Ward 6.1 at Box Hill Hospital, including how we engage families and carers in this process. PRv]vPo}o}]vP vvP`˙}(vPP]vPX WRvo˙RSF}P MN} _G}`W}R] }uo`]RvvR] }vu]]}v}R``]RR]u }(}u}vP}uuv]}v`v }v(vUR]o}}vv +Uvouo˙Ro}}] '(}R}v]vR}]oW `R]R]]uov]vPu}} }v[]v]]o(v} `v]o}}}]o˙X PR]v]`}vR `}]vR]}v}( R]}X Ao}(R]}iU`R (}vvvo]lo˙} RR]]`u}v]o˙`]R }vuvURRv +uuX

Improving medication lists Outcomes In the words of our consumer representative:

We need a single point “of face to face contact for carers. ” We need user-friendly “education resources. ” We need to involve carers “in huddles and meetings. ” need to make sure the “onlyWesource of information flow is not from a confused patient to an uninformed loved one.

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These were the outcomes of this focus group:

You said

We did

Medications on the list are not in any order which is confusing. Please order them alphabetically by generic name

Medications are now sorted alphabetically (as of August 2019)

Consumers want to know what each medication is for before reading the instructions. Place the ‘Purpose’ column before ‘Direction’

The ‘Purpose’ section is now located before ‘Direction’

Eastern Health Quality Account 2018-19 09


THE IMPORTANCE OF CONSUMER PARTICIPATION Our Consumer Information Committee includes six consumers along with staff from allied health, language services and consumer participation departments. This committee was created to review patient information across Eastern Health. }v B RoRo]˙]v]oU R]}uu]'Ro} v]v(}u}vo}uv P]o]vU`R]Rvo+} }]]uo].}uuv]}v }vU}}RoR o]˙vR] v}(}vu`R} } ]X

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Feedback from our consumers

Participation in the Rapid “Improvement Event has helped me understand the challenges on the groundX

The effort and attention is “welcoming and supportive.

I feel listened to and engaged. Where a contribution is not taken up, the relevance is well explained – usually this is a lack of medical knowledge and the suggestion is outside the operating principles.

Feedback from staff

Consumer participation is an “integral part of our continued

growth as an organisation, and their presence in committee meetings is invaluable. As the support person for the consumer on our committee, I pay particular attention to avoid jargon, acronyms and complex, technical terms in the committee papers where possible and define any that are unavoidable. We discuss the papers prior to the committee meeting, and I then answer any questions and provide a debrief after the meeting.

Snapshot of Eastern Health Consumer Participation as at June 2019

4% Community Advisory Committee 8% Expert Advisory Committees 5% Quality and Safety Committees 3% Consumer Information Committee 21% Other committees 11% Working groups 2% Projects 5% Rapid improvement events 27% Events and celebrations 14% Disability Action Plan consultation 10 Great care, everywhere, every time

At Eastern Health, we continue to support consumer participation by: Providing orientation, support and education to our consumer representatives at all times and build their capacity Showing appreciation by verbal recognition, personalised letters of thanks for their time, ideas, knowledge and other resources they provide Keeping our consumers up to date via our Consumer Forum, regular emails and phone communications Ensuring we close the feedback loop by providing outcomes of participation Continuing to evaluate the impact of all activities from consumer participation with a view to acting on the evaluation findings as part of our quality improvement cycles.


SUPPORTING PEOPLE WITH DISABILITIES IMPROVING OUR FOOD Our consumer representatives participated in a Food Immersion Hour to develop an increased awareness of the processes used to make sure patients receive their preferred meal that is consistent with their dietary requirements. TR]}]v˘]v]vR }}(ovP(}}(}v }vu}vvRo]˙v }]v(}}]U]vo]vP (}}vPX

Positive feedback

When patients have “choices regarding food –

this is something they have power over compared to all the time that things are done to them, i.e. clinical staff would take their blood or do an injection.

Suggestions for improvements

Use TV screens to inform “patients, carers and family

members on ‘Food at Eastern Health’.

– This is already in place at Box Hill Hospital via the Patient Entertainment System.

O

ver the next three years, Eastern Health will continue to focus on providing an inclusive, safe and accessible health service for all; our consumers and their carers, our employees and volunteers, and visitors to all of our sites.

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The Eastern Health disABILITY Action Plan 2019 – 2022 was developed through: Broad consultation including staff workshops and consultation, community consultation forums and Have your say feedback form Data analysis of feedback

from multiple sources

including Leadership

Walkrounds, Victorian Health Incident Management System (VHIMS – Consumer Feedback), Victorian Healthcare Experience Survey, People Matter Survey (staff)

Best practice research.

Eastern Health looks forward to commencing implementation of this plan and working towards achieving the following outcomes: Removing barriers for persons with a disability accessing Eastern Health’s services and facilities Removing barriers for persons with a disability in obtaining and maintaining employment at Eastern Health Eastern Health promoting inclusion and participation in the community for people with a disability Tangible changes in attitudes and practices which discriminate against persons with a disability.

Eastern Health Quality Account 2018-19

11


EASTERN HEALTH SPEAKS YOUR LANGUAGE

C

ultural diversity in the eastern metropolitan region is higher than the Victorian average, with 17 per cent of people born in a country where English is not the primary language spoken. Eastern Health understands the importance of providing patients and their families with an easy way to communicate with our sta%.

In 2018-19: Eastern Health employs an in-house team of NAATI-certi1ed interpreters (National Accreditation Authority for Translators and Interpreters) who deliver interpreting services in languages of the highest demand such as Mandarin, Cantonese and Greek. A part-time and casual pool of additional interpreters supports requests for other languages.

6% (or 10,374)

of Eastern Health patients

required an interpreter

An average of 55 per cent of interpreter services are delivered in-house, with the remainder being provided by an accredited contracted agency. 12

Great care, everywhere, every time

of Eastern Health patients

have a primary language other than English

003

8.7% (or 15,274)

Language services were provided in

81

languages

across Eastern Health


Eastern Health has 24/7 access to telephone interpreters who currently support approximately 20% of overall demand for interpreter services. Ivo]v`]R}P]P}o}(]P]ov(}u}vUvE HoR ]vo˙˘o}]vP]}vouR}}(o]]vP]vvP ]U]vo]vPu}]}]vvPUvov}o} vo}v]}o}v(}]v}}l]vPX Iu}uv`}l]o}ovv}vR}]]o]˙}(o]]vPR ovPPl]oo}(]o]vPo+}]`]Ro}`r]l}uuv]}v ]uvX

The highest numbers of occasions of service across all care settings1 for the top ten languages provided in 2018-19 were:

4159 Mandarin 3033 Cantonese 2018 Greek 630 Italian 368 Vietnamese

441 Hindi 426 Persian (excluding Dari) 326 Macedonian 260 Lao 236 Arabic

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Accessed Language Services by booking type 2018-19 1200 1000 800 600 400 200 0

Jul 2018

Aug 2018

Sep 2018

Oct 2018

Nov 2018

Dec 2018

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

EH in-house bookings

Total number of times our language services were accessed

Agency bookings Telephone bookings

30,000 20,000 10,000

19,416

23,017

25,781

24,487

2015-16

2016-17

2017-18

2018-19

0

Eastern Health Quality Account 2018-19

13


Creating an inclusive and welcow eQuality Wor

SECTION 2

QUALITY AND SAFETY xxx xxx xxx

LISTENING AND RESPONDING TO FEEDBACK

E

astern Health seeks to hear the voice of our consumers in a variety of ways. Feedback is important as it helps us to identify where we are doing well and also identify where there are opportunities for improvement from our consumers’ perspective.

14

Great care, everywhere, every time


The number of complaints and compliments formally received from January 2016 to June 2019 is outlined as follows:

Complaints and Compliments Jan 2016 - June 2019 500 400 300 200 1 00 0

JanMar 2016

AprJun 2016

JulSep 2016

OctDec 2016

JanMar 2017

AprJun 2017

JulSep 2017

OctDec 2017

JanMar 2018

AprJun 2018

JulSept 2018

OctDec 2018

JanMar 2019

Compliments

The patient story

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I recently spent time in the Foetal Maternal Assessment Clinic “ (FMAC), birth suite and post natal ward at Box Hill hospital where

I had concerns for my baby. All the midwifes and doctors I saw were absolutely amazing and so reassuring. The care I received was so thorough. I had a number of different midwifes look after me. Jenny in the FMAC unit, Helene the PM midwife in the delivery suite, Sue the night duty midwife in the delivery suite and Jess the midwife on the post natal ward. They were all so calming and informative and took amazing care of myself and my unborn child. It can be a very daunting experience having to go into hospital and every single midwife was calm and made me feel comfortable. I cannot thank them enough for their excellent care and hard work.

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The patient survey Patient experience surveys are used to capture feedback from patients and carers. These are targeted to issues we specifically want to learn about. Our in-house interpreters support our non-English speaking patients to participate in surveys so that we learn from them as well.

Complaints

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From 1 July 2018 to 30 June 2019, Eastern Health received 158 stories. EvPPuv`]RPvO]v]}v] }v`˙vE HoRv o}(}vvvvv˙X

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AprJun 2019

– Story taken from Patient Opinion website, submitted on 20/05/2019

The consumer perspective We actively seek feedback and use what consumers tell us through consumer forums, participation in our governance committees and improvement events to inform service improvement. Consumer forums and improvement events provide an opportunity for consumers to talk about Eastern Health more broadly and are not necessarily about an individual experience. We currently have 80 members of our community on the consumer register.

Eastern Health Quality Account 2018-19

15


OUR CULTURE OF PATIENT SAFETY CONTINUES TO SHINE Eastern Health participates annually in the People Matter Survey, a public sector employee opinion survey. IP]+R}}v]˙}˘ R]]`}vR}`}Ro] }ovuo}˙uv]v]o u}v˙}ooPU uvPvv]}oX

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2019 People Matter Survey results

Patient Safety Questions

2018

2019

Peer average

Recommend friend/family be treated as patient Overall positive response to Patient Safety and Culture Staff encouraged to report patient safety concerns Patient care errors are handled appropriately Suggestions about patient safety are acted upon Culture conducive to learning from errors Management driving for safety centred organisation Trainees are adequately supervised Training of new and existing staff

77%

76%

74%

76%

76%

70%

85% 83% 78% 74%

85% 81% 78% 76%

80% 72% 72% 69%

77%

75%

70%

69% 66%

69% 68%

63% 61%

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Fully accredited healthcare services

E

astern Health is accredited by a wide range of external agencies through measurement against industry standards that apply to the whole of the organisation, or one or more of its services.

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Great care, everywhere, every time

Eastern Health successfully met the accreditation requirements of: Royal Australian College of General Practitioners Australasian Sleep Association (ASA) Standard for Sleep Disorders Services Respiratory Function Assessment Service Standards WPoo˙u}v]}}(}uvvR(v}v}(}˙uv }}ul`}uo˙]vP`]R]v˙vv`}l }`(]}vuv}vR`}]PU ˙`RU˙uX

Aged Care Quality and Safety Commission (ACQSC) Standards, after all four of Eastern Health’s residential aged care facilities received unannounced visits during the year.


E

astern Health is committed to delivering healthcare excellence and this is achieved by a strong clinical governance framework and an organisational culture focused on patient safety.

IMPROVED VISIBILITY OF PERFORMANCE AND CLINICAL RISKS FOR BETTER PATIENT OUTCOMES

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Number of Incidents by degree of harm

Serious harm

1000

Minor harm

Near miss

800 600 400 200 0

Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May 2016 2016 2016 2017 2017 2017 2017 2017 2017 2018 2018 2018 2018 2018 2018 2019 2019 2019

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Number of aggression incidents resulting in minor harm 200 160 120 80 40 0

Jul 2016

Oct 2016

Jan 2017

Apr 2017

Jul 2017

Oct 2017

Jan 2018

Apr 2018

Jul 2018

Oct 2018

Jan 2019

Apr 2019

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Key areas of improvement work to be continued or commenced in 2019-20 include:

1

Reducing hospitalacquired infection related to intravenous cannula and urinary tract infection

2

Consumer information and communication regarding discharge and follow up

3

Further development of clinical leadership and patient safety culture – two areas that are becoming a focus worldwide – through best practice. Eastern Health Quality Account 2018-19

17


A SERIOUS APPROACH TO INFECTION PREVENTION AND CONTROL

A

s part of our commitment to safe, high-quality care at Eastern Health, our staff are very conscious of the need to prevent the spread of infectious diseases. To ensure that we achieve this, Eastern Health continuously monitors and reports on healthcare-associated infections. This allows us to investigate and make any necessary improvements. RoR A r}]]v(}v ~}uuooRv}}}u]o[ ]v(}v]v]v(}vR vo}]vPR]˙ ]vR}]oX SR˙o}}A u] B ~SABUu} }uu}vo˙lv}`vSP}ovRU_ ]]}o}}u]v(}v RvRoRr}]X

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Staphylococcus aureus bacteraemia (SAB) rates at Eastern Health sites No. SABs

Occupied bed days (OBDs)

Rate / 10,000 OBDs

31

353,738

0.88

1965

27,802,504

0.7

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18

Great care, everywhere, every time

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]vo]v Puoou]}v]o˙ ]v}Ro}}u~]XXR}PR]X IvrıRRvv} }(CLABSI]v.vE HoRX O}LA C SI B GRv }}}o]]v}P]vP ]v}vv}(voo]v]vICUX W]u}u]v]vR]o`]R }vP}]vP}vU]v]vPU]vP v]oov}(}v ]v(} vX


FIGHTING FLU TO HELP PREVENT ITS SPREAD

E

astern Health’s iconic Flu Fighter (pictured) returned to be the face of the 2018-19 influenza (flu) vaccination campaign, calling for staff and volunteers across the organisation to roll up their sleeves and get vaccinated to help prevent the spread of flu.

Eastern Health’s resident superhero, Flu Fighter, represents our dedication to fighting influenza, and is used in posters and other advertising materials around our sites to promote the campaign.

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84% The DHHS target for healthcare worker influenza vaccination

G A ]v}v(}RoR`}l ]R]PRo˙+`˙} R]l}(+}u]vP]v( `]RGXTR]]v˙v}}vo˙(} v}v}(+]oovUo}} ]l}(vu]]}v}vX

T}(Rv(v UvE HoR}R v]v+]vR]PRr]l o]v]o}}]]v(}u}v vPP}v}vR}`}} RuovR]v]vP R˘l}(G}vX

˙B Rv}(Jo˙UvE HoR R]æv+]v}vU ˘]vPR}Pv]}voP ˙RV]}]vuv D }

SP˙vovv]vP(}ırG }v`]oov.(}uo}v }(Rrıu]Pvv`]oo Rv}( FoF]PRX

(Ho

R

85% Eastern Health's healthcare worker vaccination rate

Eastern Health Staff Influenza Vaccination Rates 2010-2018 100% 80% 60% 40% 20% 0%

38%

43%

51%

59%

65%

71%

79%

78%

85%

2010

2011

2012

2013

2014

2015

2016

2017

2018

Organisation-wide Influenza vaccine coverage, 2019 season flu campaign

Row labels Category A/B Staff* Category C Staff* Grand Total

No response Vaccinated 396 227 623

5326 2243 7569

Declined Grand Total Decline rate 383 300 683

6105 2770 8875

6% 11% 8%

Vax rate Ignore rate 87% 81% 85%

6% 8% 7%

P}˙ C AlB+Rv}vUP}˙+ C }v}

Example high risk areas – ED and ICU - Influenza vaccine coverage, 2019 season flu campaign

Row labels Emergency Department Intensive Care Unit

No response Vaccinated 34 9

542 201

Declined Grand Total Decline rate 27 9

603 219

4% 4%

Vax rate Ignore rate 90% 92%

Eastern Health Quality Account 2018-19

6% 4% 19


ADVANCING CARE FOR MUMS AND BABIES

W

ith 4870 babies born at Box Hill and Angliss hospitals in 2018-19, Eastern Health maternity services provided care across the eastern region, including Lilydale and Healesville. We continue to develop innovative approaches and work alongside Safer Care Victoria in order to provide new mothers and their babies with the best of care.

20 Great care, everywhere, every time


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P}~APGAR

S]Pv].v`}l]o}v`˙}]u} Rvu}(]`R}Rv}R R]P}`R}vo(}]R~ (}oP}`R]}vXo˙ E }v]vP Pvv˙]u}}}u(}]X Wvv`vu]Pv}ul u}Rvv`}(R]u}v }(Pouuv}(R]˙[P}`R R}PR}RPvv˙X vE HoRR}v}v]}v (}+P]vPR]u}v}(vl]vP P}`RuuvooP}(Pvv˙U ]vPP}`RRvv]]vP} `RvP}`R]}v]]v

.X

SR}( }vA UPoUG]uUA]˙UvR]}vUR]uvRl˙RUuo}vUv}R]Pv} ](˘u]o}uPv˙]vX

A healthy relationship with Safer Care Victoria Safer Care Victoria provides all health services with an annual report of the Victorian Perinatal Services Performance Indicators (PSPI) which allows us to review our data and to identify areas that can be improved. vE HoR]o}}v}( RoR]]vP]v RS(V]}] C }Pu SS(˙B }oo} C _U]u ]vPR}(}]o oo]R˙v]vRv˘ ˙XAo}(R]]v]U uv]˙vvE HoR `]oo˘]v(}}R }]vPoo]RX vE HoR}vv}`}l]v }viv}v`]RS(V]}] C }}vv}}]R }]oRoR}}u(}`}uv v]]v}}uuv]˙X

Rate of singleton full-term babies (without congential abnormalities) considered in poor condition shortly after birth 2.5%

Angliss

2.0% 1.0%

Box Hill

0.5%

Statewide Average

0%

2016-2017

2017-2018

(}u D V]}]vP]voP(}uvS]Iv]}r

Rate of singleton babies with severe foetal growth restriction delivered at 40 weeks or more gestation 50% 40%

Angliss

30%

Box Hill

20%

Statewide Average

10% 0%

2016-2017

2017-2018

(}u D V]}]vP]voP(}uvS]Iv]}r

Eastern Health Quality Account 2018-19

21


CARING FOR OUR MORE VULNERABLE COMMUNITY MEMBERS

E

astern Health has four fullyaccredited residential aged care facilities with a total of 120 beds. With an emphasis on promoting resident independence and choice, each provides a comfortable, home-like environment. Our facilities

Edward Street Nursing Home (ESNH) ]}ro}}vRAvPo]H}]o ]]vUFvGoo˙U}]]vP ]v]]o]}]vX Monda Lodge Hostel (ML) ]o}]vHo]oov}+ «vP(}]v`R} ]vvvR}}}] }u}`]RR]vX Mooroolbark Residential Aged Care Facility (MB) ]R]PRr]o] ˙R}P]]v]vPR}u]vR }(M}}}}olX Northside Residential Aged Care Facility (NS)]o}R]PRr ]o]˙R}P]]v]vP R}uv]o}RP JuCv]vB`}}X 22 Great care, everywhere, every time

Since July 2006, Public Sector Residential Aged Care Services (PSRACS) in Victoria have participated in the collection, reporting and benchmarking of data for a set of quality of care performance indicators measured by rate per 1000 bed days. The indicators are designed to assist in monitoring and improving care provided to PSRACS residents in the following areas:

of falls and 1 Prevalence fall-related fractures 2 Prevalence of pressure injuries of use of physical 3 Prevalence restraint of resident 4 Prevalence polypharmacy (nine or more medications)

of unplanned 5 Prevalence weight loss (greater than 3kg

in a month or weight loss over three consecutive months).


Falls and falls with fracture

Physical restraint

S+(}uR}(R(}]vo(]o]`}l o}o˙`]Roo]RoR+vRvE HoR Fooo]v]o C R]lMvP}vRP](} (oou]v]u]}v]voXAoo]v]v. (oor]l(}]]o]˙}R]}}v v}vro]}lXFo}}rooU]uvu}}v v}uvo}]vo}]u}R(˙ }(Rv]}vuvv}]vX

R]voP(]o]`]R]vvE HoR do not use physical restraint.AoURR been no instances of physical restraint.

Polypharmacy (use of nine or more medications)

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8.1

8 6 4 2 0

5.13 0.08

0.14

2017-2018

2018-2019 Falls

Fall-related fractures

4.37

4.01

2 0

2017-2018

2018-2019

Residents using nine or more medications

Unplanned weight loss Iv(}u}v}R(v˙}(vovv`]PRo} vv]}R}PRu}vRo˙]}(`]PR }(}oo]vXR]v]v.]vP]l }(`]PRo}(}vvE HoR]vv RR}o}P]Uv}vo]ov]o} `R]Rv]vo]˙ouvUuov v]v(v˙}(`]PRu}v]}]vPX

vE HoR]v(}]vi] }vu]]}v}}(]o]vRv]`}v PoU}vP}]vP]`R]ov}X 0.3

0.21 0.16

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0.03 2017-2018

8 4

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0

10 6

Pressure injuries

0.2

P}o˙Ru˙]oo˙.vR}(.} u}PU]vo]vP]U}rRr}vv }uouv˙u]]vXP}o˙Ru˙]vo RoR}vvu}vPRoo˙XT}uvPR]l }]`]R}o˙Ru˙UvE HoRP ]v[Pvo}v~GP}vPo u]}v]`XTR]o}v]}vou]}v ]`}v˙v]vvvRu]`R]R] (}`}R]v[GP(}o}vXW}l]vP `]R]v[GPvRu]}v]`Ru]U vE HoR(]o]Rvo}R] }v]vR]v]v}(]vl]vPv]v} u}u]}vX

6

2018-2019 Pressure Injuries Stage 1 Pressure Injuries Stage 2 Pressure Injuries Stage 3 Pressure Injuries Stage 4

4 2

1.02

1.09

0.76

0.78

0

2017-2018

2018-2019

Unstageable pressure injury

Unplanned weight loss (over 3 consecutive months)

Presumed deep tissue injury1

Significant weight loss (>3kg)

F oorR]lvl]vvo}]v`R]RR˘v}(uP`]R]vRov}v.u]}˙o}PR ~`R]}˙oo}`}R~ol}lX Eastern Health Quality Account 2018-19

23


ESCALATING PATIENT CARE EFFECTIVELY

F

amily members and carers are in an ideal position to identify early, and often subtle, signs of clinical deterioration. This is due to: Fu]o]]˙`]RRvU `R]RRoRu}o˙ RvP]vR]}}}R ]Pv}(]oov TRu}v}(u(u]o] }}Lvv`]R v`R]o]vR}]oU vo]vPRu}]Pv }(o]vX

24 Great care, everywhere, every time

Eastern Health’s three-step escalation process allows patients, families and carers to initiate an escalation of care for their loved one in hospital when they are not doing as well as expected or not improving, or there is concern that the patient’s condition is getting worse.

Step 1:

Step 2:

Step 3:

Patients, families and carers are encouraged to speak to any member of the healthcare team about their concerns. In the majority of situations, concerns will be addressed immediately and no further escalation is required.

Where concerns are not satisfactorily resolved, patients, families and carers are encouraged to speak to the nurse or midwife in charge.

If concerns continue to remain unresolved, patients, families and carers are encouraged to call our dedicated 24/7 Patient Care Hotline at (03) 9975 6789.


Escalating concerns to the Patient Care Hotline When a Patient Care Hotline call is received, details of the concern are considered by the site nursing coordinator who reviews the patient with the nurse in charge. Following this review, the family member or carer is contacted by a member of the healthcare team to advise them of the plan for the patient’s care.

Effective promotion of the service Eastern Health communicates information to patients, families and carers about the consumer escalation system in a number of ways, including: ‘Are You Worried’ postcards }]}v}v u]]}v}R` v]oo]v`]vP }}uv}vX P}o}]oo ]vR}.ovPP }RRvvPo]R E }lv˙ v}(vE HoRX

08

PARTNERS IN CARE E FOR YOU HELP US TO CAR PITAL STAY DURING YOUR HOS

PREVEN

TING PR

ESSURE Pressure INJURIES inju or underly ries (bed sor es) for too lon ing tissue, caused are areas of dam g. age by lying or sitting to the skin We can in one pla work tog ce ether to occurring try and . prevent • It is imp a pressu re injury orta avoid lyin nt that you cha g nge you are happy or sitting in the r positio n a special to help you cha one position for regularly and nge pos too mattress long. Sta ition or cushio • Please n as app if needed and pro ff let ropriate. vide as this is the staff know if your bed also a risk ding or . • Eating difficulties, clothing a hea English language is damp If you have any for healthy lthy diet and eter. drinking to book an interpr skin. fluids ofte please ask staff • reter Usi n are imp Interp ng a soa t the Telephone ortant moisturise p free skin was From home contac h 3056. with info d helps keep skin and keeping you Service on 9605 rmation healthy r skin . Ask staff if this on how d free of charge • It is imp to continu . We can provide Services are provide ed language. ortant to you e this at le in your preferr when in keep mo home. information is availab ving as and out (Simplified mu of walking available in often will bed. Sitting out ch as possible, This booklet is both mobility of bed for help you ional Chinese), (Tradit and will meals and (Vietnamese).• Brin Chinese), help you return to your and usual leve se to g Burme retu in comfort rn home. l of (Greek), able, sup stay act ive. portive shoes tha Preventing t will hel p you to achieve a pressure inju ry is our this. goal. Let ’s work together

The Eastern Health Partners in Care brochure `R]R]}]}oo]vv }vu]]}vv]v}} }vuo}v]v(}u}vX

‘Are You Worried’ posters ]o˙]vv o}vPv`]vP }(`U uvv o]v]X

The Eastern Health website `R]R]vo]v(}u}v(}vU (u]o]vv]]oo]v ovPP}RRvEvPo]RX

The consumer escalation system is evaluated every two years through surveys of clinicians, patients, families and carers.

Patient Care Hotline Activations

Between July 2018 and June 2019 there were

48

8 6 4

CALLS

2 0

Jul 2018

Aug 2018

Wantirna

Sep 2018

Oct 2018

Nov 2018

Peter James Centre

Dec 2018

Jan 2019

Feb 2019

Mar 2019

Maroondah Hospital

Apr 2019

May 2019

Box Hill Hospital

Jun 2019

to the Patient Care Hotline. Angliss Hospital

Since the introduction of the consumer escalation system in May 2017, there have been 96 calls to the Patient Care Hotline with the majority of concerns managed by the healthcare team. TRu}}uu}v}v(}oo]vPRPv H}o]v C ]vo}vvP]vPvuvPuvv}uuv]}v]XTRPvH}o]v C R }]v}Rv(}vU(u]o]v}RR]}vvRv}vX

Eastern Health Quality Account 2018-19

25


PERSONALISED CARE IN MENTAL HEALTH

E

astern Health delivers mental health services based on a recovery-focused model of care, through a variety of hospital-based, community and specialist services for children, youth, adults and older people.

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ær

O+}uu]'}}]]vP o]˙]vvv]}vuvR] ((}vU]]}vR] }ooPXIv]}v}}]]vP }vS(`u}o}( U}+R]PRo˙l]oo]v ]v(˙]vPv]Uv˘] vR]}oRvPXTR˙ vlPo]o]]v]vP ]vro}vUR}`}vPP`]R vRoo˙v`Rv} vP}(P]}} ]v]]o]vPu}(]X OC}vuvP C W}l(}]vov`}l`R} R˘]vuvoRoR]oov ]RRuo}}((u]o˙ uuv]oo˙]v ]vR]vv}voo˙

Ivv }voPS}M}oX TR˙`}l]vR]vv v]`]RRo]v]ouv `(}uR]}`v˘]v }vPP}u}ovo }vuvR]} ]v(˙}(R]o](R }u}v}}˙ ]vPvLvu]]}v} ˙R]]]v vv]X

Reducing restrictive interventions IvRuvoRo o]}vv]vR u}]]vv}vX TR]vv}vv }v]ou(}vU R](u]o]v+X

}Pv]

26 Great care, everywhere, every time

R«vPU

Restrictive interventions are only ever used when all other interventions have been explored and where such an intervention is in the best interest of the safety of the patient and those around them. Our inpatient mental health services aim to be below the State target which we achieved in six out of the twelve months of 2018-19.

Definitions (as defined by the Victorian Department of Health and Human Services) Safewards model of care focuses on providing a safer mental health care environment. It is highly effective in reducing conflict and containment and increasing a sense of safety and mutual support for staff and patients. The model is a way of providing personalised care that supports minimum use of restrictive practice. Seclusion means the sole confinement of a person to a room or any other enclosed space from which it is not within the control of the person confined to leave. Bodily restraint means a form of physical or mechanical restraint that prevents a person having free movement of his or her limbs, but does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person’s ability to get off the furniture.


Seclusion

Bodily restraint

IvrıUoovE HoRuvoRoR ]vv]}Po]}v `ooo}`RV]}]vuv D }(HoRvHuvS]P}( æo]}v˙XH}`U }}o]vv]`R ˘]v(}]}}(voo˙R]PR }vuPP]}vU]}ovv ]oov}R˙U`R]RRo ]v]]vRv(}o]}vX

TRP(}uRv]o]v]v}u}Rv]} ˙XvE HoRR]}˘]uo˙R]} ˙}}.]vvuvoRoRv]U `]R}˘]uo˙v}(}]}v}(]v]vPv(} R}}vXI]v}vo(}uoovu}(v}}v (}Rui}]˙}(]v]}XTR]P]]}RSl_]vR oo}`X

Physical restraint per 1000 occupied bed days 100

Iv}}ov]vvv]U `˘]v`}l]vR}( o]}v]v}v}u]v]v]vP(U R]PRro]˙(}uoovu}( }vuXTR]}}(` o}o˙]`vuvP˙} o]v]ou]v}v`]RvE HoR[o]v]oP]o]vX

75 50 25 0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 2018 2018 2018 2018 2018 2019 2019 2019 2019 2019 2019 CYMHS

F}u}o}(æıo]}v]}]vP R]}]v]`Uı]}` oRv(}R}}vXLRv (}R}]}v]}uo(}v vR]`u]v}˘]uo˙ v}(}]}v~v (}urXS}uv˘]v u}Rv}v]}}(o]}v]vPv u]]}vvR}ovu}(]v]]o v+˙o]}v]ıXI]v} vo}Ruoovu}(v }vvP(}Rui}]˙}(o]}v ]}XTR]Rv}uv}v˘o]vU(} Ru}URSl_v}o}`X

Adult

Aged

Mechanical restraint per 1000 occupied bed days 30 20 10 0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 2018 2018 2018 2018 2018 2019 2019 2019 2019 2019 2019 CYMHS

Seclusion rate per 1000 occupied bed days

Aged

Duration of seclusion episodes

30 20 10 0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 2018 2018 2018 2018 2018 2019 2019 2019 2019 2019 2019 CYMHS

Adult

Adult

Aged

Target

Duration 0-1 hours 1-2 hours 2-3 hours 3-4 hours 4-12 hours Total

Number of seclusion episodes 82 (17.8%) 116 (25.2%) 77 (16.7%) 74 (16.1%) 110 (23.9%) 459

Reducing restrictive intervention initiatives vE HoRuvoRoR ]vv]}vvo˙ ]`]vPR}``}]P]v ]vro]v]oP]o]v vu}oU`]RR ]u}vRvo]v]ov}˙ }}u`oo] ]vv}vX}( A (}]voP Iv(˙]vPv[]l}(]]vP o]}v}]vo˙]vR] u]]}vUvvPvP ov}}Rvv +}v]PR]R]PR

]l]}X

R]`]vP}}`]R }}vuv `}l(}}˘o}oo(} }v]vP}]}}( o]}vv]v˘]vP R}uovX

W}l]vP]v vR]} RuPv˙uvv uvoRoRv]}o} }v]vo]v]o}R} }vvuvPuv}( ]lX

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vA uv`]'v˙}v˙]vP`RuvR˙`}oo]l](R˙}uv`oovv}uo}˙uvoRoRuvX Eastern Health Quality Account 2018-19

27


SECTION 3

Creating an inclusive and welcow eQuality Wor

COMPREHENSIVE CARE

TAKING ACTION ON COMMUNITY HEALTH FEEDBACK 28 Great care, everywhere, every time


E

astern Health’s Healesville Hospital and Yarra Valley Health community health service, which also has dedicated facilities in Yarra Junction, participates in a community health, service-specific Victorian Healthcare Experience Survey (VHES).

While results from our most recent survey in 2018 were overwhelmingly positive, the responses highlighted a small number of areas where we could do better. In response to this consumer feedback, the community health team has undertaken several initiatives to address this feedback:

To better communicate the cost of the service to clients, community health team leaders are reviewing the current billing information, systems and processes. Eastern Health will be implementing a new billing system in November 2019 which will assist in simplifying the processes. The leadership group is developing clear guidance for staff and clients as we move over to the new system. To help increase community awareness of the community health service, the counselling team has visited local general practitioners’ (GP) clinics to provide education and “get to know you” sessions. Our clinicians have provided education sessions in a range of settings, including the local library, with the goal of reaching members of the community who are not aware of our services. Our community health team has started a monthly meeting to provide staff with an opportunity to discuss complex clients and/or clients who are presenting to multiple clinicians. In addition, a working group has been established to identify ways to improve the process for staff to document client goals.

C}uuv]˙RoR}vv}]`v ]u}o]v}]XOR}u]vP u}vRRu`]oo}}]v(R }vr]]](}GP}]`}]v (]o].RvUv``]oo}vv`}l]vP o}o˙`]RRP]u˙HoRN`}lv vE HoR[GPL]]}vO8}vo P}}]X Eastern Health Quality Account 2018-19

29


At Eastern Health we welcome your feedback There are a number of ways to provide your feedback For current patients, please speak to the staff member or the person in charge Speak with a member of our team next time you visit Fill in our online feedback form at www.easternhealth.org.au/contact-us/complaints-compliments-and-comments Contact one of our Patient Relations Advisors on 1800 327 837 Patient Relations Advisors are available Monday to Friday from 9am to 3pm Send an email to feedback@easternhealth.org.au Write to us at: The Centre for Patient Experience PO Box 94 Box Hill Vic 3128 Via the Patient Opinion website at www.patientopinion.org.au

PATIENTS FIRST We would like to hear from you

GREAT CARE, EVERYWHERE, EVERY TIME QUALITY ACCOUNT 2018-19

Eastern Health’s Quality Account is produced for consumers in collaboration with consumers and staff across the organisation and is guided by reporting guidelines provided by Safer Care Victoria. Printed copies of this publication are available throughout our facilities and online at www.easternhealth.org.au We would welcome your feedback via email to feedback@easternhealth.org.au or post to The Centre for Patient Experience PO Box 94 Box Hill Vic 3128

30 Great care, everywhere, every time


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Eastern Health Quality Account 2018-19

31



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