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Annual Report 2017-2018

Contents 03

Mission, Vision and Values

04 Chairmanâ€™s and CEOâ€™s Report 05

Highlights

06 Nursing and Clinical Services 09

Measuring our Performance

Finance and Administration

People, Organisational Development and Safety

Information Systems Engineering and Support Services

Current Research and Ethics Projects

Medical Education

Foundation

Financial Report

Organisational Structure

Board of Governors

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Medical and Surgical Excellence

St Andrew’s is a 230 bed private surgical hospital overlooking Adelaide’s south-eastern parklands. It houses 11 state-of-the-art operating theatre suites, 3 procedural suites, a 28 bed cardiac unit, an 18-bed critical care unit and emergency service. Not to mention a new procedural suite complete with DOSA (Day of Surgery Admission), an angiography suite and arguably South Australia’s most comprehensive private cancer-care facility.

In addition to these facilities, we believe that we have some of the best people in South Australia working for St Andrew’s. This belief is supported by the team’s numerous national quality and clinical excellence awards.

Mission

Vision

Values

Medical and Surgical Excellence.

St Andrew’s will be known as the best private hospital in Australia, with a culture where relationships matter.

We Care, We Create, We Deliver.

We will achieve this by creating an environment that promotes: • quality healthcare supported by exemplary customer service, • best-practice patient care and support, • partnerships with patients, carers, consumers and medical specialists that facilitate a service responsive to their needs, • a positive culture based on teamwork that allows us to attract and retain the best staff, • sound business and financial practices to maintain a stable base for future growth, • a strong affiliation with the Uniting Church and its agencies, • innovation and creativity in all our pursuits, • the use of up-to-date facilities and equipment

Stephen Walker

David Whitbread

Chairman’s and CEO’s Report

It is a pleasure to present you with our Annual Report for 2017/18 and as you will see it has been another exciting and successful year for St Andrew’s. The highlight of course would have to be the completion of our Eastern Clinical Development (ECD) in January 2018. The considerable effort that went into the design and the extensive consultation of key stakeholders has resulted in not only a fabulous building but one that is highly functional. The ECD includes a Procedural Suite (3 x endoscopy rooms, 2 x angiography rooms, 2 x operating theatres and a 35 bed recovery unit), a 28 bed cardiac ward, 200 bay car park and a gymnasium. The feedback from patients, staff and our visiting medical specialists has been wonderful. In fact, the ECD project received a high commendation at the European Healthcare Design Awards (held in London) and also won a SA Master Builders Award. Our architects (wiltshire + swain), builder (Mossop) and all of our consultants and project managers should feel very proud of what has been created. The biggest accolades however must go to our staff who helped every step of the way and had to work through some challenging times during the construction process. In particular I would like to acknowledge Peter Cooper, Maged Shenouda and Anne Sherlock who were all critical in ensuring a successful outcome. The formal opening of the ECD was held on Thursday 31 May and was officiated by His Excellency, The Governor of South Australia, the Honourable Hieu Van Le AC and Mrs Le. This lovely event was also attended by the Hon Stephen Wade, Minister for Health and Wellbeing and Mr Chris Picton, Shadow Minister for Health and Wellbeing as well as current and past Board members. The building works have continued however and as I write this we are

opening our new CSSD (Central Sterile Services Department). The new CSSD which is conveniently located adjacent our main operating theatre complex is bright and spacious with state of the art sterilising equipment and is fully compliant with the new Australian Standards AS4187. In addition to all of our major building works we have installed/upgraded patient rooms and a significant amount of engineering plant and equipment. The centrepiece of the engineering works has been the installation of our Tri Generation plant, this sophisticated plant consists of a gas engine that generates our base load electrical power requirements and the waste heat from this process is used for heating water and to operate our absorption chilling unit. The result is a highly efficient plant that provides security in energy supply and reduces our impact on carbon footprint! The above accomplishments alone demonstrate our commitment to having a well presented, highly functional and efficient hospital that is well regarded by all. Whilst the capital works are important it does not distract us from our core function of caring for our patients which is by far our highest priority and proudest achievement. Our activity increased by approximately 6% this past year with more than 30,000 patients being admitted to St Andrew’s. We are now the largest independent private hospital in Australia with over 230 beds providing an extensive range of clinical specialties. The additional capacity in ECD has enabled us to expand our ENT, gynaecology, plastics and orthopaedic operating lists as well as our endoscopic service. We have continued to expand our robotic surgery and are now nearing 600 robotic procedures a year which sees us as one of the busiest robotic centres in the country. St Andrew’s has always provided a comprehensive cancer service that includes our beautiful chemotherapy suite located at our Medical Centre, the radiotherapy service provided by Genesis Care and of course our surgical specialties. We undertake a significant amount of urological cancers, breast cancer (supported by our breast care nurses

and breast centre) and colorectal cancers (supported by our stoma nurses). Our new angiography suites have seen an increase in both vascular and cardiology procedures and we are one of only three Hospitals in South Australia accredited to undertake TAVI procedures (transcatheter aortic valve implantation). Our dedicated cardiac surgery operating theatre has also seen an increase in activity and more recently we have introduced minimally invasive cardiac procedures. All of our clinical services are extremely well supported by our experienced ICU and Emergency teams, physicians and state of the art imaging from Dr Jones and Partners. Providing these clinical services is one thing but achieving excellent patient outcomes is another. As you will see in the report, our performance in a range of clinical indicators is excellent and together with the outstanding feedback from a number of independent patient satisfaction surveys is what we are really proud of. Our ability to attract and retain dedicated, skilled staff and visiting medical specialists is what sets us apart. The efficient and effective provision of healthcare is widely discussed in the media, the wider community and by our policy makers. It is and will continue to be a challenge as we move forward in the face of increasing technology, fiscal constraints, community expectations and an ageing population. We are proud of how we are confronting these challenges and believe St Andrew’s will continue to be a private hospital of choice for the community of South Australia and beyond. We would like to thank all of our dedicated nursing staff and medical specialists, our non nursing and administrative staff, volunteers, our board and foundation, all of whom have worked very hard throughout another outstanding year for St Andrew’s.

Stephen Walker Chief Executive Officer

David Whitbread Chairman

Highlights

Completion and opening of the Eastern Clinical Development (ECD). The Governor of South Australia, the Honourable Hieu Van Le AC (and Mrs Le) formally opened the ECD on Thursday 31 May with the Hon Stephen Wade, Minister for Health and Wellbeing and Mr Chris Picton, Shadow Minister for Health and Wellbeing in attendance. The Governor and Mrs Le were taken on a tour of the new development prior to the opening—wiltshire + swain architects, “Highly Commended Award” at the European Healthcare Design Awards for the design of the ECD —Mossop Award, Master Builders SA, Winner, “Excellence in a Commercial/ Industrial Building $20-50M”—Breast Care Team, Finalists, “Excellence in Person Centred Care - Team Award” —What matters to you day—Length of service—Significant capital investment —Medical student placements.

Nursing and Clinical Services SA Health Nursing and Midwifery Excellence Awards The 2018 SA Health Nursing and Midwifery Excellence Awards were held on Friday the 11th of May 2018 at the Adelaide Entertainment Centre. We had two teams nominated for these awards, and were the only private hospital to have nominations this year, which in itself, is a significant achievement.

this team throughout their journey. There is a palpable warmth and comradery at the venue during this event. We were also fortunate to have another group of staff nominated for the award who were responsible for the introduction of the “What Matters to You?” event in 2017. We have participated in this global event over the last 2 years.

Jacquie Wiley, Director Nursing and Clinical Services, and all of the nominees were present on the night and joined together to celebrate the wonderful achievements of all staff at St Andrew’s Hospital. For the third consecutive year, our Breast Care Team were selected as finalists in the “Excellence in Person Centred Care – Team Award”. This is an outstanding achievement, as only three finalists were chosen from nominations across the industry, from private, public, aged care, education, rural and community. We are enormously proud of the service this team of dedicated nurses provide to our patients undergoing breast surgery. They also organise the annual Breast Care Lunch for 250 guests and patients who have been treated in St Andrew’s over the previous 24 months. The Breast Care Team organise the menu, wine, and a range of guest speakers. These consist of professionals who provide clinical or scientific information, individuals who have overcome adversity, and entertainers who provide positive messaging to the group. There is also a lingerie parade, modelled by current and previous patients. This demonstrates the confidence of this outstanding group of women who have often undergone significant body image changes. Those present talk of the confidence and support provided to them by

Nicole’s experience in both the public and private sectors, brings a range of skills and knowledge in the area of peri-operative nursing. She joined the team at a time of change as we approached the opening of the Eastern Clinical Development. Having spent time at St Andrew’s earlier in his career, our new 4th floor Clinical Manager, Simon Dunbar, returned in June. Simon has come to us with a wealth of knowledge in the area of Orthopaedics and has worked at a similar level within the public sector. Simon’s other areas of expertise are change management and education. Heather Grady has recently been awarded the Clinical Manager role in a job share capacity on the 2nd floor. Heather had previously been part of the Leadership Team as a CN on the 2nd floor. I am confident that the high calibre care delivered on the 2nd floor will continue with Heather and Liz Knight leading this team.

Lisa Bilsborough (Breast Care Nurse), Adj. Associate Professor Elizabeth Dabars AM (Branch Secretary, ANMF SA), Amanda Jones (Breast Care Co-ordinator)

Changes to Staff in the Nursing Division Our turnover rate at St Andrew’s continues to be extremely low, well under the 3% mark. This ensures we continue to maintain staff with knowledge of the organisation and the preferences of our medical specialists. During the previous 12 months we have seen changes in some of the leadership positions. Nicole Russell-Higgins joined the Nursing Division in January this year as Associate Director of Nursing, Procedural Areas.

Caroline Guest has moved from Clinical Manager on the 2nd floor to a permanent After Hours Coordinator role. Caroline brings to the role a depth of corporate knowledge and clinical expertise to share with her colleagues.

We have been fortunate to also have current senior staff apply and be successful in the roles of Clinical Nurse: 2nd Floor

Michelle Reynolds Stacey Neindorf

4th Floor

Sarah Hazelager Carly Omand

Angiography Suite Mark Pangilinan

Intensive Care Unit Michelle Mantripp

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International Nurses Day

Cardiothoracic Theatre Shirlene Robertson

Recovery/Anaesthetics Clinical Educators Kathy Humphries Jenny Slade

Recovery and Anaesthetic Coordinators Ashleigh Stacey Dominic Ianniello

Procedural Suite Coordinators Tiffany Heinrich May Kivubiro

Theatre Coordinators Sarah Anderson Lucy Fennell

Breast Care Coordinator Amanda Jones

Pre Admission Coordinator Tricia Fanning

Clinical Placement Coordinator Leanne Batten

CSSD Supervisor Natasha Mitrovic

On Friday 11 May 2018, we celebrated the globally recognised International Nurses Day (which actually fell on Saturday 12 May). Our executive team visited each ward and shift to personally thank the nursing staff for the dedicated and expert care they provide to our patients, delivering delicious cakes from Pat-a-Cake Bakery.

Retirement of Anne Sherlock In April this year, Anne Sherlock celebrated her last day at St Andrew’s after 26 years in the organisation. During this time Anne made a significant contribution to the organisation, both in the nursing division and to the organisation as a whole. Anne started at St Andrew’s in 1992 as an RGN. In 1997, in recognition of her passion and drive, she was appointed a Clinical Nurse in the operating theatres and in 2006 Anne was appointed Clinical Manager for Theatre. During her time as Clinical Manager she was responsible for overseeing enormous change in this area. Clinically she was responsible for the introduction of Cardiothoracic surgery for the scrub/scout team. Her attention to detail served us well, ensuring that patient safety was at the forefront when this specialty commenced.

should or could happen. Matched with a passion for excellence when it came to further developing the organisation. Her attention to detail helped ensure that our end product was of high quality, in all projects she was involved with. Nearly two years ago, Anne took on the role of Clinical Project Coordinator for the Eastern Clinical Development. Her role was to work with the Clinical Managers and ensure that the clinical equipment would meet current and future needs. Anne ensured she was across all aspects of the build, and always pushed for perfection. Working with all stakeholders and contractors Anne earned the respect of all who worked with her. Her project management skills, hard work and focus have been outstanding, significantly contributing to a building that will stand St Andrew’s in good stead for many years to come. We wish Anne well in her retirement and feel very grateful to have had her as part of our team at St Andrew’s.

Anne had a brief time as Clinical Coordinator, overseeing 6th year Adelaide University Medical Students. This aligned perfectly with her passion for education and ensuring the best for our patients. The feedback from the students, both then and now, is that St Andrew’s provides them with an environment that is welcoming and that contributes enormously to their development. As a scrub nurse, Anne was respected for her skill at the table, with an ability to always anticipate what may be ahead and demonstrating a thorough understanding of the anatomy they were working with. Later these skills were translated into project management. Anne was able to plan, have great spatial awareness and vision to see what

Jacquie Wiley (Director Nursing and Clinical Services) and Anne Sherlock (Clinical Project Coordinator)

Quality

Accreditation

St Andrew’s Hospital celebrated “What Matters to You?” day on Tuesday 6 June 2018. The event has become an international movement which asks patients to discuss the things that are important to them.

In November 2017 a self-assessment report was submitted to the Australian Council on Healthcare Standards. It outlined the Hospital’s progress towards meeting the small number of recommendations from the 2016 organisation wide accreditation. The Hospital will undergo a Periodic Review in November 2018. This will involve a review of the Hospital’s performance against the National Safety and Quality Health Service Standards for Governance, Partnering with Consumers, Preventing and Controlling Healthcare Associated Infections, as well as the EQuIPNational mandatory criteria.

On this day, we invited patients across the hospital to write on a handmade leaf about what matters to them. The leaves were then gathered by our staff and volunteers and displayed on a tree in the main reception area for a week. Nurses were asked to reflect on the conversations they had with patients on the day and document this on a reflection tool. Each of the participating clinical areas had a clinical champion available to provide information to staff and patients and help start these important conversations. “What Matters to You?” day also provided us with an opportunity to celebrate all that our teams do every day to ensure our patients receive care that has been tailored to meet their individual needs. Over half of our patients participated on the day and we received valuable feedback with our patients and staff interacting in this meaningful way. The information received was collated and reviewed as part of our commitment to providing the best possible care. Areas identified by patients as being important to them are included in the diagram below. The responses were considered in the development of our strategic plan.

25% Other

Garden, Consider what others don’t have in healthcare, Education, Sleep, Rain, A balcony of fresh air.

18%

Family/Loved onessupport

15% Care

Individual, Prompt, Competent, Safe.

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12%

Communication

Felt listened to, Information, Updates.

14% Staff

Caring, empathetic, professional, friendly.

Environment/ facilities

Décor, Noise, Cleanliness, Equipment.

3% Meals

10% Health

Measuring our Performance Underpinning our commitment to delivering excellence and continuous improvement is the desire and ability to continually measure how well we are performing across the organisation. This performance measurement includes clinical indicator monitoring, clinical and non-clinical audits, independent stakeholder surveys, patient feedback mechanisms and accreditation surveys. Patient feedback continues to be an integral part of informing us on patient safety and quality. In 2017, 58.2% of the 3,536 compliments received were about our staff.

They were recognised for being professional, welcoming, caring, cheerful, friendly, efficient and helpful in the excellent care they provide. The Department of Veterans’ Affairs Annual Patient Satisfaction Summary (2016-17) indicated the hospital’s overall rating remains a very high 9/10, with 80% of patients indicating they would recommend St Andrew’s to family and friends. The hospital’s participation in the ACHS Clinical Indicator Program enables us to benchmark our results against our peers.

In addition, a large number of other performance indicators are monitored internally. Action is taken to address performance indicator results that fall outside expected norms. We have consistently remained a high performer on the benchmarked clinical indicators. The following is a sample of performance indicators that are measured and monitored to further improve patient safety and quality at St Andrew’s Hospital:

Patient feedback These indicators are created from patient feedback that is provided on paper and online via the hospital’s website. The indicators are the rate of compliments, compliments with issues, and complaints. Compliments

Compliments with issues Complaints

29% 70% Average length of stay Over time we have seen a decreasing length of stay (time in hospital) as well as surgeries now being performed as day surgery.

1.77

2017-18

2016-17

1.85

2015-16

1.83

1.0 DAY

2.0 DAYS

Infection Control Indicators Hand hygiene National Benchmark 80.0% A higher rate is a good result. The hospital Hand Hygiene rate is 83.4% and the National Benchmark is 80%. Clinical evidence shows that Hand Hygiene plays a significant role in reducing the Staphylococcus aureus bacteraemia rate.

SAH: 83.4%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0.9%

1.0%

Staphylococcus Aureus Bacteraemia Benchmark 0.8% A lower rate is a good result. The hospital rate for Staphylococcus aureus bacteraemia is 0.54% which is well below the Australian Standard of 0.8%.

SAH: 0.54%

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

0.7%

0.8%

Rapid response calls with Cardiopulmonary Arrest Rapid Response Calls are made when concern exists for the patient condition and extra help is required to prevent the patient condition from worsening. Some of the arrests were sudden and there were no early signs which could be acted on prior to the event. All cardiac arrests are reviewed by the clinical team to ensure their are no concerns, identified with lead up care. Benchmark 0.048%

A lower rate is a good result. The rate of Rapid Response calls with Cardiopulmonary Arrest is 0.078% which is slightly higher than the ACHS Private National Average of 0.048%.

SAH: 0.078%

0.00%

0.05%

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0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

0.50%

Total falls The hospital monitors its falls rate in a number of ways. The following graphs indicate the Total Number of Falls, as well as Falls that occur in patients over the age of 65 (over 65 patients are the high-risk group of patients for falling). Benchmark 0.23% A lower rate is a good result for both of these indicators. The rate of falls is 0.18% which is lower than the ACHS Private National Average of 0.23%. This is an outstanding result.

SAH: 0.18%

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

0.50%

0.40%

0.45%

0.50%

Falls in patients over 65 Benchmark 0.38% The rate of falls in patients over the age of 65 is 0.25% which is lower than the ACHS Private National Average of 0.38%. This is an outstanding result.

SAH: 0.25%

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

Finance and Administration Our Finance team continues to work closely with all other areas of the hospital. We provide key support services including billing, payroll, accounts payable, accounting, patient costing and financial reporting. This year, support from the ANZ bank has been instrumental in facilitating the building of the Eastern Clinical Development (ECD). As spending on the project was very close to budget, the total level of financial support from ANZ was as anticipated and we have received favourable interest rates due to current market conditions.

Capital The completion of the ECD was our key achievement for 2017/18, it was both a building construction and equipment expansion project totalling around $50 million. Our Engineering Services Master Plan for 2017/18 focused on refurbishments to the hospital’s major plant and equipment and amounted to just over $2 million. In addition to this new activity, St Andrew’s maintained its annual capital equipment program in support of medical and surgical excellence. Our regular capital expenditure was close to $3 million this year, with major purchases being: • Cusa Excel & Ultrasonic Tissue Ablation System • Anaesthetic Machine • Intra Aortic Balloon Pump • Fluroscan • Olympus Camera Heads • Operating Table Denyer XRT5000 • Cold Cap machine • Transperineal Ultrasound probe • Morcellator instrument set

Administration As construction of the ECD came to a conclusion in early 2018, our Patient Services team spent considerable time to ensure that the new patient admission process would be efficient. We now have three main areas where patients are admitted; the front reception, the procedural suite and the day of surgery admission area. Through effective cooperation between the administration and clinical teams, we have been able to welcome our patients to the hospital and provide a smooth admission process.

Health Information Management With the commencement of our new Health Information Manager at the end of the last financial year, a range of new initiatives and upgrades have been undertaken. These achieve a more effective service and improve the quality and accuracy of our health information. The Clinical Coding Unit workload has been streamlined and automated through the introduction of the 3M Codefinder software. We have commenced a hospitalwide coding and documentation education programme to support clinical and non-clinical staff. An internal auditing schedule has also been established to achieve continuous quality improvement in this area. The refurbishment and reorganisation of the medical record department has resulted in a bright and more spacious environment for staff to work in. This has been achieved along with a review of our offsite record storage requirements, to manage our space constraints and also deliver annual cost savings. St Andrew’s Hospital is now represented on a number of state and national committees. These will support the maintenance of appropriately qualified and skilled health information and coding staff to meet the current and future needs of our profession.

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Supply The supply department has recently begun providing dedicated services within the theatre complex. The supply team, with its collective understanding of material usage and procurement has assisted theatre staff to establish the new procedural area stock imprest. One of our senior supply officers is located on the first level of the hospital, close to both the existing theatres and the new ECD procedural suite. Nurses are now assisted more effectively by supply staff to order, receive and put away medical and surgical supplies, ready for immediate use in theatre.

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People, Organisational Development and Safety

Over the last 12 months the Division has contributed to the achievement of a number of the Hospital’s major projects and strategic goals which has made the year a very busy and exciting one. People Our ability to attract and retain experienced, high quality nursing staff was key in enabling the Hospital to meet new workforce demands with the opening of the Eastern Clinical Development. Despite national skill shortages, and in particular with peri-operative nurses, the Hospital increased its nursing headcount by 22.5%, while maintaining a nursing retention rate above 97%. The Human Resource and Nursing teams pooled their collective ideas to explore innovative ways to secure experienced specialist nurses, and to strengthen the Hospital’s brand in the marketplace. Our Graduate Nurse Program is tailored to meet the projected workforce requirements of the Nursing Division, while providing a dynamic, quality pathway to transition nursing graduates into the workplace in their chosen speciality areas. Of the 2017 graduate nurses, 100% were offered and accepted ongoing employment at St Andrew’s - an outstanding result. As part of St Andrew’s Day celebrations on Thursday 30 November, we were delighted to recognise and celebrate the contribution of 138 staff who had achieved a milestone year of service. This year four staff achieved the milestone of 35 years of service. Jacquie Wiley, Director Nursing and Clinical Services, presented service recognition certificates and badges at presentations held across the day.

Organisational Development St Andrew’s commitment to professional development and organisational learning is reflected in the depth and quality of the education and training programs our people participate in. We are proud of our clinical education program which provides comprehensive, relevant and practical education for our nurses. Our goal is to deliver contemporary, evidence-based clinical education and professional development. Face-to-face seminars and workshops, augmented with the convenience of online courses, have enabled staff to engage with, and learn from, visiting medical specialists, industry experts and senior staff and improve their clinical nursing practice. Evaluation of our education has consistently evidenced high levels of participant engagement and positive clinical learning. We believe this in turn supports our primary objective of achieving better patient outcomes and the best possible patient care. Nurses are also encouraged, and financially supported, to attend external seminars and conferences, to participate in the St Andrew’s Foundation clinical scholarship program and to undertake further tertiary study. St Andrew’s has continued to partner with the University of South Australia to develop our current and future leaders across all divisions of the Hospital.

Four recipients of the St Andrew’s Hospital Foundation scholarships completed the University’s 12-month Leadership Development Program in 2017. The Hospital also delivered customised in-house modules from the Program for the clinical and non-clinical management team. Participation in the Program has boosted managers’ knowledge and confidence to lead teams, work collectively, navigate change and contribute to the development of organisational strategy.

WHS and Injury Management As a self-insured employer, St Andrew’s seeks out opportunities to engage with the sector locally and nationally to benchmark our performance. These forums provide an opportunity to discuss health, safety, injury management and wellbeing issues and solutions and to identify opportunities for improvement across the Hospital. The emphasis on a robust, Hospitalwide safety culture has driven projects in higher-risk work areas to engage staff, enhance communication and better understand local work health and safety concerns and priorities. In April 2018 the Hospital welcomed Carly Leaker to the new position of Injury/Claims Manager. This specialist position was created to ensure we achieve our claims management performance indicators and maintain excellent return to work outcomes if there is a work related injury.

Information Systems The 2017-2018 financial year proved to be a challenging year. We have broadened the scope of our support offerings, providing local IT services for state-of-the-art medical equipment IT installations. These include Endobase, Tegris, syngo Dynamics, Haemo Dynamics, Intellivue, Careview and Telemetry systems. New internal communication devices have been rolled out across the hospital using both new and existing IT Wi-Fi infrastructure. Planning for the NBN switch over is mostly complete with just a small number of analogue devices remaining. The Hospital’s network reach has been used in many new and different ways.

The Internet of Things (IoT) devices are being connected to allow for remote management and control in areas ranging from security to engineering plant. Information systems were aligned and configured to the requirements of the new and expanded clinical services included as part of the Eastern Clinical Development. The Trakcare system availability Key Performance Indicator measure remains at an exceptional level. There were more users, more devices resulting in many more service requests.

The goal of keeping abreast of the available technology and maintaining currency has been achieved. The core server technology has been completely refreshed and expanded upon to allow for a planned continued growth in IT services delivery. There is a focus of “knowing your business” and careful planning of information systems capabilities to assist in this area. We look forward to working towards significant progress throughout the coming year.

Engineering and Support Services What a great year! There was the delivery of the Eastern Clinical Development with its new Cardiac Unit, Procedural Suite, Car park and Gym. In addition the hospital has also installed a new chiller plant, diesel generators, refurbished lift controls, and the new Tri-generation Plant. 2017/18 has been an exciting whirlwind of activity for Engineering and Support Services.

We are currently engaged in a steep learning curve of familiarising ourselves with all the new plant and associated controls that are all designed to serve this Hospital’s needs in the short term, and position St Andrew’s in an enviable position for the foreseeable future. Engineering and Support Services consists of: • Maintenance Department • Capital Works Projects • Dietary Services • Bio-Medical Services Department • Cleaning Services • Security Services • Property Services (Leases)

Engineering This department is kept extremely busy in providing preventative and corrective maintenance services to the Hospital and related off-site facilities.

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Capital Works In addition to the routine maintenance and repairs, we have completed significant capital works. These include the replacement of a significant portion of our hydraulics infrastructure and the modernisation of some of our patient bedrooms and en-suites.

Dietary Services The Dietary Services Department continued to retain our HACCP accreditation and has done so since March 2006, one of the few Hospitals in Australia to achieve this. This high standard of meal service is provided on a “paddock to plate” basis. Our meals are all freshly cooked and designed by dietitians to support patients’ needs such as modified textures and special dietary foods (gluten-free, lactose-free, low potassium, low fibre, high protein and modified consistencies).

Biomedical Engineering Services The Biomedical Engineering Services Department is staffed by three qualified and experienced Biomedical Engineers. Maged Shenouda, Colin Hill and, this year Paul Wood, have continued to provide an excellent standard of service to the Hospital. They provide technical support to the new and exciting technologies being employed in the St Andrew’s theatres. In particular, our Biomedical Engineers have provided support to every cardiac procedure performed in St Andrew’s for the entire year. In addition to providing services to St Andrew’s, we extend our service provision to clientele outside the Hospital. Tasks provided by the department during the year include: • preventative Maintenance • corrective Maintenance • external work

Cleaning Services ISS Healthcare Services has continued to provide a high level of cleaning services to St Andrew’s. We have recently celebrated our 4th year of association. In addition to the provision of the cleaning services, (which includes making beds in all ward areas), ISS also carry out the specialised services for our theatres to comply with vancomycin-resistant enterococci (VRE) and methicillin/ multi-resistant staphylococcus aurea (MRSA) cleaning schedules. We continue to work with our major contracting service providers to create innovative ways to improve the quality of services to the Hospital.

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Current Research and Ethics Projects

All research is administered by the Research and Ethics Committee. We adhere to Australian standards in the conduct of all research or projects. St Andrew’s is committed to clinical research and currently supports a number of projects, including: • Collection of data for the Australian Orthopaedic Association National Joint Replacement Registry

• Australian Breast Device Registry • A Clinical Evaluation of the Medtronic Polymer-Free DrugEluting Coronary Stent System in De Novo native Coronary Artery lesions – (Polymer-Free DES Trial)

• The South Australian Audit for the Clinical Management of Advanced Colorectal Cancer

• Magnetic Resonance to Manage Breast Disease

• Bi-National Colorectal Cancer Audit

• Fertility Understanding through registry and Evaluation (FUTuRE Fertility)

• Spine Tango Registry for Spinal Surgery • Application to become an Authorised Prescriber for the Trabecular Metal Glenoid Augment (TMGA) • The South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC): In pursuit of a state-wide population-based cancer registry • The Australian Prostate Cancer BioResource • A prospective MRI evaluation of multifidus structure and composition following percutaneous facet joint denervation in chronic lower back pain

• Fertility SA BioResource

• The couple in the spotlight of fertility treatment. Can couplebased approach improve the standard of care and shared decision making? • Mitral Valve Repair Clinical Trial (MAVERIC Trial) • STREAM Trial: Stimulation Resulting in Embryonic Aneuploidy using Menopur • AMPLATZER™ Amulet™ Left Atrial Appendage Occluder Randomized Controlled Trial • Evolution of prostate MRI and reporting: Audit of MRI vs prostatectomy • The significance of rectal cancer patients with positive lymph node threatening circumferential resection margin (CRM) or positive pelvic sidewall nodes on magnetic resonance imaging (MRI)

• Onyx ONE Study; A Randomized Controlled Trial with Resolute Onyx in One Month DAPT for HighBleeding Risk Patients • Australasian Cardiac Outcomes Registry Ltd TAVI Registry

Medical Education Medical Student Selective Programme 2018 The year 6 Medical Student Selective Programme (MBBS) consists of two semesters. One semester consists of a selective program incorporating Medicine, Primary care, Psychiatry, Surgery and a Student Selected Experience (elective), and the other semester consists of hospital internship placements. The selectives are a 4 x 4 week placement with a community emphasis. St Andrew’s has now been involved in the 6th year selectives program for nine years, offering placements in breast/endocrine, urology and cardiology. A consultant in each of the specialty areas supervises the students. The supervising consultants encourage the students to be exposed to a variety of specialty areas offered at St Andrew’s. This is facilitated by a flexible program, as well as by the co-operation of the medical officers who are willing to be involved with the program. In the previous 12 months Dr Melissa Bochner has supervised ten Breast/ Endocrine students, Dr Peter Sage has supervised the cardiology student and Drs Richard Wells, Andrew Fuller and Raj Singh-Rai have each supervised a urology student. Although the students are assigned to one specialty area, the opportunities to experience a variety of surgical procedures are maximised throughout the rotation. This flexibility is consistently recognised in the feedback statements by students as a positive attribute of the program. All students this year have been able to attend a session in the cardiac theatre and attend the ICU the following morning with the ICU consultants. This year the students have observed robotic procedures as well as participating in surgical

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sessions in Vascular, Plastic, Breast/ Endocrine, Urology, Spinal, Neuro and Orthopaedics, often being able to scrub into procedures. Students have also gained knowledge from Anaesthetists both in assigned sessions and in sessions where they are working with the surgeon. The students are provided with practical sessions to enable them to perfect the technique of scrubbing, gowning and draping. In addition to surgical exposure, students participate in consulting sessions with a variety of consultants, spending time at Adelaide Cardiology where they witness exercise stress Echocardiography, Sleep Studies, CT reporting and are present in the Angiography Suite whilst a variety of procedures are performed, including Angiography, Stenting, Transoesophageal and Electrophysiology studies. Those students in the Breast/Endocrine stream sit in on patient consults to provide an insight into the care of these patients both pre and post operatively. In addition, they spend time with both the breast care nurses and stomal therapy nurses in both the clinical and consult sessions. Adelaide Radiotherapy Centre (ARC) provides a two-day program introducing the students to this specialty area. Dr Jones & Partners (DJP) have also facilitated a session this year with Dr Randell Brown sharing his knowledge with the students. The students were fortunate to gain experience in Oncology with the support of Consultants from both Adelaide Oncology and Haematology and South Terrace Oncology. The second half of the year sees the re-introduction of a pathology session with Clinpath, working with a pathologist looking at specimens through the multiheader microscope.

Rev Peter Morel facilitates a session with all of the students on “delivering bad news”, where he shares his experiences and gives the students practical tips and resources for further reading. Feedback from this session continues to recognise the importance of developing this skill and how this session has benefited and prepared students for their future careers. One student stated that “grief will be a part of any Medico’s career and is poorly taught otherwise”. The feedback received from the students continues to be positive. The following extracts are indicative of the comments received.

“I loved the ability to see so many different procedures; open heart especially was a highlight. [As I’m sure it is for many] but generally just the variety of lists was invaluable for us at this stage, where we’re just trying to feel/soak up as much as we can”. “Ironically, I learnt more about surgery in this rotation than in the public hospitals, the surgeons were extremely friendly and willing to teach”. “Rev Peter Morel’s session was great and really not something we ever get otherwise”. “The organisation of the placements as a whole, actually having surgeons notified beforehand that we will be there, and being introduced to everyone makes such a difference”.

The success of this program is due to the time and commitment shown by those involved. Thank you to the many consultants who continue to share their knowledge, the breast care and stomal therapy nurses, nurses from our theatres and Angiography Suites, the ICU team, Rev Peter Morel, the staff from Adelaide Radiotherapy Centre, Adelaide Cardiology, Clinpath, Dr Jones & Partners, Adelaide Oncology and Haematology and South Terrace Oncology who all contribute to developing and running such a diverse and successful placement program. Thank you to all individuals involved, with special thanks to the consultants who continue to support the program: Vinod Aiyappan Michael Berce Melissa Bochner John Bolt Julie Bradley Michael Brown Randell Brown Jim Burnett Georgy Chacko Marianne Chapman Trevor Collinson Rod Cooter James Dickson Patrick Disney Paul Dolan Nick Edwards Darren Foreman Jonathon Fraser Andrew Fuller Phillip Game Tom Jaensch David King Jim Kollias Quoc Lam Clayton Lang Matthew Lawrence Mark Lewis James McLean Bill McLeay Joe Montarello Jamie Morton Nick Murray

Susan Neuhaus Rob Parkyn Richard Pope Peter Sage Luay Samaraie Simon Sandler Maria Santos Samuel Sidharta Varjeet (Bob) Singh Raj Singh-Rai Govindarajan Srinivasan Peter Steele Rob Stuklis Karen Teo Michelle Thomas Charles Tie Fabiano Viana David Walsh David Walters Richard Wells Mary White Rob Whitfield Malcolm Wicks Thuc Nhi Wilson Roger Woods Phil Worley Mike Worthington Stephen Worthley Alex Wurm Glenn Young Rob Young

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St Andrew’s Hospital Foundation

The foundation continues to assist the hospital to achieve its mission of medical and surgical excellence. This year, we have carried out the first of our-three year strategic plan. This involved focussing intensely on how the foundation works with the hospital to create the most impact for our patients. The review also allowed us the opportunity to reflect upon the importance of philanthropy at St Andrew’s and the part it plays in ensuring it remains a premier hospital for South Australian’s, both now and in the future. Through the generosity of our donors, we have provided just over $450,000 in philanthropic support to the hospital during 2017/2018. Project highlights include; • continued and expanded support of nursing and non-nursing staff through our three scholarship programs • purchase of an additional cold cap for the chemotherapy suite • professional development support for our intensive care staff • additional funding for cardiac services • and continued funding for the da Vinci Surgical Robot

The support we have received from our donors, both private and corporate, has been very encouraging and is greatly appreciated. Thank you to everyone who has contributed. Foundation Director Amy Bredon, Foundation Assistant Valerie Turnbull and Coffee Shop Manager John Coates continue to take the foundation to new and exciting heights. Ably led by John, the coffee shop is always a vibrant hub in the main foyer. Our wonderful volunteers are central to creating this warm and welcoming environment. Thank you also to our patient transport volunteers who welcome our patients as they arrive at hospital with a warm St Andrew’s smile.

I would like to thank my colleagues and board members for their time and contribution to the board and team. The hospital continues to support the foundation through its corporate services. Thank you to the hospital staff who provide assistance so willingly. We are proud of our achievements and look forward to what lays ahead in 2018/2019 and beyond. Chris Wright Chairman

Donations We would like to acknowledge the individuals, community groups and service providers who have so generously supported the work of the St Andrewâ€™s Hospital Foundation. Their support enhances the quality of care provided to our patients and their families. Ms Zoi Athanasopoulos Mr John Bishop AO Mr Graham Blacket Mrs Christine Brazier Ms Pamela Buchdahl Mr Brian and Mrs Marion Chapman Mrs Denise Cotterill Ms Maren Cowley Mrs Elisabeth Crilz Mr Rudoph Crilz Mrs Jillian Crouch Ms Suzie Considine Mrs Marlene and Mr Raymond Dixon Professor P Grantley Gill Mr Peter and Mrs Denise Graham Mr Peter and Mrs Ros Griffiths Mr David Gurry Ms Sarah Haas Dr Hugh and Mrs Jo Harley Mr and Mrs Haynes Mr Lou Helley Mr Geoffrey Hennig Ms Viginia Hickey Mr Alex Hubczenko Mr Ronald and Mrs Judy Kelton Mrs Wee Kwee Keng Mr David Klingberg AO and Mrs Margaret Klingberg Mr Peter and Mrs Pamela McKee Mr Michael and Mrs Lesley Madigan Mr Bob Major Dr Peter Malycha AM and Mrs Jennifer Malycha Miss Helen Mickan Dr Neville and Mrs Lynette Minnis Mr Lindsay Oxlad Mr David Sanders Dr Richard Sarre Mr Andrew Scroop Ms Amanda Seaton Mr Jon Skuse Mr David Smith Mr Bruce Spangler Mr Peter Sutherland OAM and Dr Mary Sutherland OAM Mr David and Mrs Fran Taplin

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Mr Erik Tils Mrs Ros Tucker Mr Malcolm Tyrrell Mr Ian and Mrs Rosemary Wallage A/Prof G Young Mrs Mary Walters Mr Kent Wilson Mrs Sah Lan Wong Mr Barry Worrall The Pickard Group The Sterling Foundation Westmead IVF Westmead Fertility Centre

We gratefully acknowledge donations received in memory of the following people who have been in our care. Mr Norman Bellifemine Ms Sandra Edson Mr Raymond McGlashan Mr Barry Sederstrom Mr Dean Tiddy

We gratefully acknowledge the kind contribution of the medical specialists who have participated in the 6th-year medical student clinical placements programme and have kindly donated to the Medical Education Research Fund. Dr V Aiyappan Dr M Berce Dr M Bochner Dr J Bolt Dr J Bradley Dr M Brown Dr R Brown Dr J Burnett Dr G Chacko Dr M Chapman Mr T Collinson Dr P Disney Mr P Dolan Dr N Edwards Mr D Foreman Dr J Fraser Mr P Game Dr T Jaensch Mr D King Mr J Kollias Mr C Lang Mr M Lawrence Mr M Lewis Mr J McLean Mr W McLeay Dr J Montarello Dr J Morton Dr N Murray A/Prof S Neuhaus A/Prof R Parkyn Mr R Pope Dr P Sage Dr L Samaraie Dr S Sandler Dr M Santos Dr S Sidharta Dr V Singh Dr G Srinivasan Dr P Steele Dr R Stuklis Dr K Teo Dr M Thomas Dr C Tie Mr F Viana Dr D Walsh

Mr D Walters Mr R Wells Dr M White Mr R Whitfield Mr M Wicks Dr T-N Wilson Mr R Woods Mr P Worley Mr M Worthington Prof S Worthley Dr A Wurm A/Prof G Young A/Prof R Young

Financial Report

Statement of Financial Position as at 30 June 2018 2017/18 $,000

2016/17 $,000

25,955

28,387

Non-current assets

124,270

94,396

Total assets

150,225

122,783

23,977

18,719

15,351

595

Total liabilities

39,328

19,314

Net assets

110,897

103,469

Total accumulated funds

110,897

103,469

(Extract from audited accounts)

Current assets

Current liabilities Non-current liabilities

St Andrewâ€™s Hospital Statistics

Auditor 2017/18

2016/17

Occupied bed days

53,683

53,067

Separations

30,396

28,641

1.77 days

1.85 days

12,996

12,896

Day Suite procedures

5,638

5,122

Emergency Department attendances

3,901

4,068

Emergency Department admissions

1,552

1,649

17 minutes

20 minutes

707

662

Average length of stay Theatre procedures

Emergency Department average waiting time Workforce statistics â€“ employees

BDO Chartered Accountants Level 7 420 King William Street ADELAIDE SA 5000

Bankers Commonwealth Bank of Australia 96 King William Street ADELAIDE SA 5000 ANZ 121 King William Street ADELAIDE SA 5000

Solicitors DW Fox Tucker Level 14 100 King William Street ADELAIDE SA 5000 Rossi Legal Level 7 185 Victoria Square ADELAIDE SA 5000

Organisational Structure 17/18 Board of Governors Chief Executive Officer - Stephen Walker Director Nursing and Clinical Services Ms Jacquie Wiley Associate Director Nursing – Wards and Privacy Officer Mr Adrian Saunders Associate Director Nursing – Theatres Ms Nicole Russell-Higgins Clinical Manager Theatre Ms Leandra Spencer Clinical Educator Theatre Ms Kath Reval Clinical Manager Recovery/ Anaesthetics Ms Sharon Blaney Clinical Manager/Procedural Suite Ms Sharon Maslen Clinical Manager – 2nd Floor Ms Liz Knight/Ms Caroline Guest/ Ms Heather Grady Clinical Manager – 3a Ms Karen Shannon Clinical Manager – Cardiac Ward Ms Lisa Walter Clinical Manager – 4th Floor Ms Sarah Schulze (to April 2018)/ Mr Simon Dunbar Clinical Manager – Angiography Suite Ms Joyce Restell Clinical Manager – Critical Care Unit Ms Edel Silke/Ms Kerene Kitschke Clinical Manager – Emergency Service Ms Catherine Turner Clinical Manager – Day Chemotherapy Suite Ms Lisa Mucklow/Ms Lyndee Powell Bookings Manager Ms Viv Gill Quality and Risk Manager Ms Tina Donaldson

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Case Manager Ms Elizabeth Jones Pre Admission Coordinator Ms Annie Filsell/ Ms Tricia Fanning Clinical Educator Recovery/ Anaesthetics Jenny Slade/Kathryn Humphries

Director of Finance Mr Garry Crispin Patient Services Manager Mrs Meredith Staggs Management Accountant Mr David Ormsby Financial Accountant Mr Stuart Campbell Supply Manager Mr John Ioannou Health Information Manager Mrs Lorraine Van Gemert

Director Business Performance and Development Ms Sharon Kendall (to November 2017)

Director of Human Resources Ms Rebecca Wyness HR and Organisational Development Coordinator Ms Alison Sarles Graduate Nurse Coordinator Mrs Kerry Holm WHS Manager Mr Cos Lamberto (to March 2018) Injury/Claims Manager Ms Carly Leaker HR Manager Ms Rachel Stephenson

Director of Engineering And Support Services Mr Peter Cooper Maintenance Controller Mr James Crinson Dietary Services Manager Mr Paul Smith Bio Medical Engineer Mr Maged Shenouda

Director of Medical Services Dr Chris Farmer

(to August 2018)

Director of Information Systems Mr Greg Laing Director of Emergency Service Dr Steven Schueler Director of Critical Care Unit Dr Alex Wurm Director of Foundation Mrs Amy Bredon St Andrew’s Hospital Coffee Shop Manager Mr John Coates Coordinating Chaplain Rev Peter Morel Project Coordinator (ECD) Ms Anne Sherlock

Board of Governors

Rear (L-R): Ms S Furey, Mr J Sweeney, Mr D Whitbread, Mr G Crispin, Prof R Fraser, Rev R Miller, Front (L-R): Ms R Wyness, Dr M Sutherland, Mr T Lambert, Mr S Walker, Dr D Cehic, Ms J Wiley Absent: Dr R Armstrong

Chair

Board Members

Ex Officio Member

Mr D Whitbread BEc, FCA, FAICD

Dr R J Armstrong MAMBA FCPA FCIA

Deputy Chair

Prof R D Fraser AM MBBS MD FRACS FAOrthA

Rev R Miller Min.Dip.; Grad.Dip.Ed. The Moderators Alternate, SA Synod Uniting Church in Australia

Dr M F Sutherland MBBS FFARACS FANZCA

Mr J L Sweeney MBBS FRACS Ms S C Furey LLM (Corp & Commercial) BEc (Acc) GAICD, GDLP, CTA, CA Dr D Cehic MBBS FRACP FCSANZ Mr T Lambert BE (Civil), MEnvSt, GradDip BusMgt

350 South Terrace, Adelaide South Australia 5000 Telephone 08 8408 2111 Facsimile 08 8232 0328 www.stand.org.au

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