Excellence in Leadership

Excellence in

Leadership

This category is looking at management practice and operational improvement and innovation in: Management culture, open communication, accountability, management development, professional standards and diversity of workforce; and operational protocols, work practices. (Related to how service delivery is provided). Previous submissions looked at accountability in leadership, enhancing opportunities for junior managers, taking the lead in occupational violence, and increased health outcomes for ATSI people. Each service is encouraged to analyze the programs they have implemented that pave the way in leadership for future generations of paramedics.

Sponsored by

Excellence in Leadership Improving Equity

St John New Zealand

Team: Dave Richards, Dan Spearing, Aroha Brett and Dumindri Amerasinghe This project aims to combine our theoretical framework with practical strategies to initiate organisational change; leading to equitable outcomes for all patients regardless of ethnicity, socioeconomic background and demographic. Part of this project is accepting that our systems are biased and that we need to take responsibility for the things that we are able to control and influence. Furthermore, this project places an impetus on Maori health equity. Not only do Maori have significant disparities in terms of health inequity but Hato Hone St John are determined to move towards an organisation that is aligned to the principles of te Tiriti o Waitangi. The project builds tools and initiatives to better enable informed decisions to drive equity improvement across Ambulance Operations, with a focus on Maori, Pasifika and patients in lower socio-economic areas. These patient cohorts have been shown to have worse health outcomes and lower life expectancy. With this work we endeavour to weave health equity initiatives throughout our patient journey to ensure equitable access to ambulance services and cater for the holistic health needs of our communities.

Hato Hone St John is committed to providing an equitable ambulance service. To achieve this we have developed tools to identify inequities and support decisions to remedy them. This includes an Equity Scorecard, PowerBI Equity Dashboard, regular equity reporting and incorporating demographics in our simulation tool to apply an equity lens across resource planning. In addition, our Te Aka strategy (St John’s overarching Maori strategy) and Waka Manaaki Plan (delivering the key outcomes of Te Aka Strategy in an ambulance context) provide a framework to ensure Ambulance Operations effectively navigates through our journey of becoming aligned to te Tiriti o Waitangi, ultimately improving Maori health equity. We have already made decisions based on this equity framework, including locating additional resources in areas with high Pasifika populations and changing the priority of stations in patient centred deployment plans to improve access and response times to Pasifika patients. With our simulation tool now incorporating demographics, an equity lens will be applied to all future resource planning decisions. Once we address these initial equity access issues, we will focus on equity in the quality of service we provide. With a focus on skill mix, ethnicity and the cultural competency of our workforce.

Excellence in Leadership Patient flow - Delta to Omicron and beyond

NSW Ambulance

Team: David Dutton, Tony Gately and Wayne McKenna

As experienced across the broader health system, NSW Ambulance (NSWA) was presented with a range of pressures during the respective Delta and Omicron COVID-19 outbreaks.

During the 2021 Delta outbreak, NSWA transported more than 200 suspected or confirmed COVID-19 patients daily. This increased during Omicron outbreak, to an average of 270 per day. Paired with record breaking daily Triple Zero call volume peaking at 5,120 on 1 January 2022, NSWA has maintained emergency response capacity and the provision of high-quality care to the communities served, through a broad range of operational strategies, under the NSWA COVID-19 response.

Surging the NSWA workforce from frontline paramedics to control centre staff, implementing innovative IT driven dashboards and platforms, enhancing coordination with state partners and advancing new models of care and procedures, NSWA has demonstrated excellence in leadership through a broad range of strategic, agile and proactive strategies implemented across the organisation. As an integral part of the NSW Health System, NSWA provides essential mobile health services and high quality clinical, rescue and retrieval services to the people of NSW with emergency and medical health needs.

With impacts from the global pandemic felt across the organisation, from a record demand for ambulance services through to staff furloughed from COVID-19 exposure or infection, the aim of NSWA response was to ensure the priority of the organisation to protect its people and ensure emergency response capacity. With the ongoing need to adapt to changing Public Health Orders and emerging variants and public health advice, NSWA has provided clear direction, through management procedures and concepts of operations and policy.

Excellence in Leadership Clinical Hub Program

SA Ambulance Service

Team: Kate Clarke

SAAS has undertaken a significant body of work in the last two and a half years to navigate more low-acuity patients to non-ED care pathways and collaborate with other health services to design, develop and implement new pathways.

All of this is underpinned by a commitment to: • Maintaining the patient’s connection to their existing care providers, so the patient’s own GP and existing service providers are the first options considered by

SAAS crews.

• Connecting patients to services that can provide ongoing care, e.g., geriatrician and community-based mental health services.

• Providing more timely access to the appropriate level of care and services closer to home, e.g., by arranging Priority Care Centre referrals instead of ED presentations.

• Easing pressure on the hospital system by avoiding unnecessary ED presentations.

• Keeping on-road ambulance resources available for medical emergencies, e.g., using telehealth paramedics to provide clinical assessment via telephone and arranging alternative transport including taxis. • Remaining collaborative and integrated within SA

Health as a partner, ensuring patients are connected and supported within the system. SA Ambulance Service is successfully diverting low acuity patients away from hospital EDs, connecting them to more appropriate care through: • Integration of 15 non-ED pathways into the SAAS service delivery model in the last three years.

• Clinical Telephone Assessment paramedics who use telehealth to assess patients sooner.

• Health Navigators who arrange patient referrals to alternate pathways.

SAAS has consistently diverted more than 20% of patients from EDs since mid-2021, and some weeks the ED avoidance is nearly 30%.

Of note, unlike a number of other ambulance jurisdictions, SAAS includes all low acuity workload in its transport data, including interfacility transfers, which is not comparable to other ambulance jurisdictions. With this service delivery model and data set, a hospital avoidance rate of 20-30% is significantly high.

Excellence in Leadership National Safety and Quality Health Service (NSQHS) Standards Program

SA Ambulance Service

Team: Graeme Rayson

In December 2021, SAAS was awarded accreditation for the second time, sending a clear and powerful message to the community and ambulance sector that SAAS is committed to safe, quality patient care.

In 2013, the National Safety and Quality Health Service (NSQHS) Standards were introduced by the Australian Commission on Safety and Quality in Health Care to assist health service organisations with their delivery of safe and high-quality care. Implementing the NSQHS Standards is mandatory for all hospitals and day procedure services across Australia, but this mandate currently does not apply to ambulance services. SA Ambulance Service (SAAS) was first awarded NSQHS Standards accreditation in January 2018 and, by doing so, became the first Australian ambulance service to achieve this recognition. The latest accreditation was significantly different to the first and a significant undertaking. The main objectives of the NSQHS Standards project were for SAAS to, firstly, implement the NSQHS Standards across the organisation and, secondly, achieve accreditation in the NSQHS Standards. Both objectives have been accomplished, consequently, the project has been an ongoing success. Accreditation in the NSQHS Standards is a milestone event and validates the professional attention to detail which has characterised SAAS’s approach to the accreditation program and, specifically, to the quality of care provided to our patients. With accreditation recently received, we recognise the need to continuously review and improve our systems and processes to ensure patient care in South Australia is optimised.

SAAS is using 2022 to transition the program to a sustainable ‘business as usual’ model. Integrating a revised NSQHS Standards committee structure into the organisation’s existing governance framework, a decision approved by the organisation’s executive leadership team (ELT).

The most obvious outcome of success is the fact that SAAS has been externally assessed and successfully achieved accreditation twice in the NSQHS Standards - and is the first ambulance service in Australia to do so.

Accreditation has assisted SAAS in:

• Implementing tools to improve performance, outcomes and quality assurance.

• Building a more efficient organisation with increased capability.

• Building an improved culture of quality. • Reducing risk. • Providing the South Australian community with confidence that SAAS services are continuously being improved.

Excellence in Leadership Double Crewing Project

St John New Zealand

Team: Susanne Doddrell and Dave Richards

In the 2016/17 financial year, only 91.2% of ambulance responses at scene were double crewed, meaning that over 35,000 ambulance responses a year had only one crew member.

The Double Crewing Project was established to deliver our new service delivery model, adding approximately 375 new staff and allowing St John to deliver on its vision to end the single crewing of emergency ambulances in New Zealand by 2021. During this project 135 stations underwent some form of assessment or change process and new transport-capable first response units for volunteers were introduced. This project demonstrates a successful approach to large change management for ambulance services. At project completion, 99.8% of ambulances are double crewed, essentially eliminating single crewing. The increase in double-crewed responses has also had a positive influence on out-of-hospital cardiac arrest survival to 30 days, which increased from 11.1% to 16.8%. Inequalities have also been addressed, previously only 90% of Maori patients received a double crewed ambulance compared to 95% for non-Maori; only 92% of patients in high deprivation areas received a double crewed ambulance compared to 97% for low deprivation areas. There is now equality and a better ambulance service.

This project aimed to eliminate single crewing of ambulances in New Zealand through the implementation of a new service delivery model (NSDM) and the addition of approximately 375 new staff over four years. The implementation of the NSDM resulted in a steady decrease in single crewing of transporting ambulances, from over 35,000 responses in 2016/17 to almost zero. The goal of the project was that by June 2021, 100% full crewing of transporting ambulances would be realised and that nationally we would see:

• Improved health, safety and wellbeing for our staff, by reducing fatigue, manual handling injuries and associated levels of stress.

• Improved clinical care of our patients by having an ambulance clinician with them enroute to hospital.

• Improved cardiac arrest survival as double crewed ambulances have higher survival rates. • A sustainable volunteer model with volunteer numbers in Ambulance Operations maintained at 3,000 with approximately 1,500 on ambulances and 1,500 on First Response Units.

• A decreased number of ambulances and an increased number of volunteer First Response Units in rural areas.

To increase the utilisation of this equipment by supporting this with a dedicated, non-clinical team focused solely on the supporting and peripheral aspects of major incidents, rather than getting distracted with the provision of prehospital care.

A previous issue impacting major incident support equipment deployment was expertise around equipment and process being held by senior clinicians, that during the incidents, had no capacity to focus on the support process in favour of being directly involved in the treatment and transport of acute patients. The aim was to delineate clinical and support roles, and ensure consistent deployment of MIST resources unimpeded by clinical workload or current personnel availability.

Excellence in Leadership Crisis Leadership – A Leadership Excellence Case Study: The use of intentional leadership and Incident Management Systems to lead an organisation through the COVID-19 pandemic

Queensland Ambulance Service

Team: Craig Emery The rapid emergence of the COVID-19 threat posed significant challenges for all organisations, in particular for those responsible for health care delivery. The potential impacts of the COVID-19 pandemic event were both complex and unpredictable, with the constantly evolving environment presenting a substantial challenge for planning and response. The Queensland Ambulance Service (QAS) leveraged well practiced disaster management prevention, preparation, response, and recovery functions, and combined these with Incident Management System frameworks, project management principles and the commitment to future capability and development to lead the organisation through the COVID-19 pandemic. The QAS made a commitment to ensuring a flexible and innovative approach to planning using crossdisciplinary teams, providing a new standard for ambulance operations in Queensland and in particular, for the planning associated with large scale events or disruptions. The true legacy of COVID-19 for the QAS is the development of the QAS leadership capability development framework and the enhanced collaborative capability that can be extended to other aspects of QAS service delivery. The strategic intent of the QAS response to the COVID-19 Pandemic was to provide appropriate direction to the organisation by maintaining the level of ambulance service capacity required by the Queensland community in an environment where demand is substantially escalated. To this end, the QAS:

1. Delivered an agile and scalable approach to ensure that ambulance service delivery capacity is maintained on a statewide basis;

2. Supported the Whole of Government COVID-19 response through the continued delivery of the QAS

Mission to deliver timely, quality and appropriate, patient focused ambulance services to the Queensland community;

3. Provided leadership across the organisation, identifying opportunities to inform future leadership capability and development frameworks;

4. Consolidated shared alignment, optimal performance management, and a mindset of continuous improvement;

5. Provided improved levels of emotional, strategic and operational intelligence; 6. Enhanced existing disaster management practices to provide holistic oversight of organisational challenges associated with the pandemic response and related demand surge; 7. Established a sustainable command and control structure across the QAS, having regard for the event, including the management arrangements for human resourcing, fleet, critical inventory items, personal protective equipment, Central Pharmacy, and infection control consumables.