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HEALTH MATTERS Victorian Healthcare Association ISSUE 1

[

MAY 2013

] www.vha.org.au

Governance and risk in healthcare Finding opportunities in risk Clinical governance analytics Gender balance on boards Leadership and quality of care

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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This issue… 3 4 5 6 8 10 12 13 14 15 16 18 19

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Getting women on board

CHAIRMAN’S MESSAGE New online tool for board development CHIEF EXECUTIVE’S MESSAGE Balancing risk and return in governance GOVERNANCE AND RISK Finding the hidden opportunities in risk GENDER AND GOVERNANCE Getting women on board encourages best practice LAW REFORM Not-for-profit reform: the implications for mergers, restructures and raising revenue QUALITY OF CARE Lessons from the Stafford hospital crisis: how governance impacts on patient care INFORMATION MANAGEMENT Active analytics for clinical governance PLANNING AND HEALTH Designing communities around better health EXECUTIVE RECRUITING Managing financial risk by hiring for success Local telehealth project wins international award THE VHA CELEBRATES 75 YEARS SINCE INCORPORATION PUBLIC PRIVATE PARTNERSHIPS Advancing the discussion on private sector partnerships Lawyers named among best in Australia

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How governance impacts patient care

For editorial content please contact: SARA BYERS Media and Communications Manager The Victorian Healthcare Association Level 6, 136 Exhibition Street Melbourne, Victoria 3000 Australia Telephone: +61 3 9094 7777 Facsimile: +61 3 9094 7788 Email: vha@vha.org.au www.vha.org.au The VHA would like to thank member agencies and supporters for supplying many of the photos included in this edition. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior permission from The Victorian Healthcare Association and inquiries concerning reproduction and rights should be addressed to the editor. © The Victorian Healthcare Association Ltd 2011.

The Victorian Healthcare Association (VHA) is the major peak body representing the interests of the public healthcare sector in Victoria. Our members are public hospitals, rural and regional health services, community health services and aged care facilities. Established since 1938, the VHA promotes the improvement of health outcomes for all Victorians, from the perspective of its members.

This publication is printed using eco-clean print processes by Southern Colour (Vic) ISO9001 / ISO14001 & AS/NZS 4801


ANTHONY GRAHAM VHA CHAIRMAN

Chairman’s Message

“The ACHG’s governance and resource manuals contain model policies, templates and fact sheets to guide board practice across the key areas addressed in the evaluation.”

New online tool for board development Ensuring effective board performance is an important leadership role of any board chair. Regular board evaluation is necessary to allow the board to reflect on and continually improve its governance. While the scope of a board evaluation can vary, most boards undertake annual selfassessment. Periodically, they may also wish to undertake a more comprehensive board evaluation that includes facilitated board interviews, focus groups, peer reviews and evaluation of committees. The Australian Centre for Healthcare Governance (ACHG) – the governance research and consulting arm of the VHA – is launching a new online evaluation and development tool for this purpose. This resource has been developed in response to an identified need for accessible and affordable online learning for directors and boards. The online resource builds on the board selfassessment tool that was previously available through ACHG, and provides important additional features for directors through five interlinked resources: • • • • •

board self evaluation capability assessment action plan governance manual resources manual

These additional features aim to guide the action of boards in implementing the key findings of their self-evaluation. After completion of the board self-evaluation by all directors, a capabilities assessment

provides boards with an immediate summary of outcomes across key governance areas. Their performance is rated as ‘early development’, ‘developing’ or ‘mature’. An accompanying action plan provides recommendations for further board development, which are linked to relevant sections of the governance and resource manuals. The ACHG’s governance and resource manuals contain model policies, templates and fact sheets to guide board practice across the key areas addressed in the evaluation. The tool enables trending of board evaluation results over time and provides a sector-wide benchmarking service for organisations that complete the evaluation within a specified timeframe. The benchmarking provides useful information for boards in comparing their results, and enables the identification of sector-wide director development needs that inform VHA’s advocacy work and ACHG board development activities. In further enhancing the development of our health service boards, the ACHG is offering a program of board roundtables, providing an environment in which directors can confidentially share their experiences on a range of topics, including strategic planning and board/chief executive relationships. I commend both the online governance resource and the roundtable program to all health service directors as essential components of their ongoing training and development.

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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Chief Executive’s Message

Balancing risk and return in governance

TREVOR CARR VHA CHIEF EXECUTIVE

professional, skills-based boards is now well recognised within the healthcare sector as a necessary part of the solution.

In financial investment circles, the concept of risk and return is fundamental to decisions that underpin where money is invested – how much risk do you take for a particular return? Tracking error, standard deviation, and predictive modelling based on historical performance data all influence the final decision. But what does the risk and return equation look like for the delivery of healthcare services? Victorian hospitals have followed a devolved governance model for about 80 years. Our community health services are companies limited by guarantee with an even higher level of governance responsibility. This means that health service boards, in executing their clinical governance responsibilities, must apply a risk and return lens to the service models they endorse. But how does this happen in practice? Health service boards do not have the same definitive tool set for decision-making that financial investors do. In addition, healthcare boards are under constant pressure to balance the demand for services that meet community needs with the financial capacity to deliver these services. In a system that is perpetually rationed, this tension is ever-present. So how is this tension between community expectation and real capacity to be managed? I believe the shift towards

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This does not imply that all boards should be remunerated, although the VHA supports self-determination on this question. Moreover, professional boards must recognise that their responsibility is first and foremost to make decisions that benefit the organisation, as opposed to decisions that satisfy some other pressure. Boards must apply the risk and return lens in governing, to ensure that service quality meets the objective assessment of an external accreditation agent (and the most recognised and quoted external accreditation agent is often the front page of the newspaper circulating in their community!) Boards must be satisfied that the organisation is characterised by reasonable risk in the context of service standards and sustainability, and a reasonable response to efficiency. This often happens in an environment of data deprivation, so how do boards apply the risk and return lens in a manner that assures sound decision making? Boards must have a balanced overview of the essential elements that contribute to quality services and outcomes. Boards require data that addresses: Appropriate workforce • register with the Australian Health Practitioner Regulation Agency (AHPRA) • define clinical competency • monitor staff satisfaction, through internal and external surveys. Low satisfaction or high absenteeism may be symptomatic of concern about clinical services. Patient experience and outcomes • standardised mortality data • infection and pressure ulcer rates • readmission rates • key processes, such as waiting lists and discharge processes • patient satisfaction, with particular attention to clinical satisfaction

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

Safety • monitor rate-based measures of common errors, such as medication and falls • assess responsiveness to manage adverse outcomes • observe any medico-legal patterns. In Australia’s largest ever medicolegal study, Melbourne University researchers have found that three per cent of doctors account for half of all complaints to health service commissions across Australia.1

“Boards must be satisfied that the organisation is characterised by reasonable risk in the context of service standards and sustainability, and a reasonable response to efficiency.” Health services operate in a constrained environment, with restrictions coming from the Health Services Act 1988, from funding deliverables, and from community demand. The flexibility for boards to develop strategy is limited in such an environment. It is important in this context for boards to accept that no organisation can be all things to all people. Partnerships with others will help to fill the skills gaps. Effective partnerships should be pursued when the risk and return lens indicates such a need. Reference 1

Bismark M, Gurrin L, Spittal M, Studdert D, Ward M Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia, BMJ Quality and Safety in Healthcare, April 2013 http://qualitysafety.bmj.com/content/early/2013/02/22/ bmjqs-2012-001691.full.pdf


Governance and Risk

Boards should view risk as an opportunity instead of a problem, according to Conscious Governance Managing Director Steven Bowman. “In the end, risks are all hidden opportunities if only you’re willing to see them,” Mr Bowman says. “One of the challenges in today’s financial climate is that boards view risk as something to be avoided, rather than saying ‘OK, what are the risks we face and how can we actually turn them to our strategic advantage?’

Finding the hidden opportunities in risk The vision statement should: • • • •

be used to focus the directors on their purpose be reflected in reports and recommendations to the board be used to map against the organisation’s programs and activities be linked to the organisation’s outcomes

“Reports to the board should not be about how busy everyone has been. They should be about how the organisation is actually striving towards achieving the vision,” Mr Bowman says.

For example, a board that identifies a risk like over-reliance on one funding source might decide to manage that source more effectively while seeking opportunities to diversify into other sources. Mr Bowman believes that viewing risk as an opportunity focuses organisations on growth and innovation, while viewing risk as a hazard focuses them on protection and compliance. “The whole notion of governance has been highjacked over the past 20 years. It has been focused on compliance, fiduciary responsibility and risk. “The board is not there just to make sure the organisation complies. The board is there to add value to the organisation – to make the choices that create the future for the communities they serve. Boards can provide huge insight. They are not simply there because the law says so.” Mr Bowman views the vision statement as the board’s single biggest strategic tool and says it should appear on board agendas to remind directors of why they are sitting around the table. “The vision statement encapsulates the true spirit of the organisation – what it should always stand for, no matter what,” he explains. “The chair of the board should truly understand the vision, and know the top four or five key intents of the statement, while the CEO can use the vision statement to help shape the organisation’s culture.”

“Recommendations going to the board should demonstrate how certain actions will meet core elements of the vision. “The key document that assists us to ascertain whether we’re actually making a difference is the strategic plan. The board should be interested in what has been achieved against the strategic plan.” Mr Bowman describes the annual report as the organisation’s key accountability document, which should be aligned to the vision. “Unfortunately, it is often a public relations document about how busy the organisation has been. But it should be about showing how your organisation is living the vision and outlining your achievements against key strategies.”

TIPS ON MANAGING RISK

Do – ask stakeholders what risks they see the organisation facing – obtain views from all board members, key staff, external auditors, risk managers, organisation members or clients, and funding bodies.

Do – use that information to agree on the organisation’s top four risks (those with a high potential to occur, a high impact if they do, and poor controls).

Do – set up a risk management committee to rank those risks according to their potential to occur and the likely impact they would have.

Do – ask similar overseas organisations if they’d be willing to share their risk register.

Don’t – view risk only as financial risk (also consider things like reputation risk, strategic risk, uncertainty risk).

Don’t – make risk management a staff operational function. Many organisations fall into the trap of asking staff to identify risks, when it is a strategic function of the board.

“The whole notion of governance has been highjacked over the past 20 years. It has been focused on compliance, fiduciary responsibility and risk.”

For further information visit www.conscious-governance.com

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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CLAIRE BRAUND EXECUTIVE DIRECTOR WOMEN ON BOARDS

Gender and Governance

With so much focus nowadays on improving the gender balance on boards, it’s important to understand the benefits a board appointment can bring to your career and business. There are several major reasons why being a director will benefit your career: •

Joining a not-for-profit board indicates to management or your clients that you are interested and engaged in your community at a leadership level. A directorship might be the one thing on your curriculum vitae that makes you stand out when applying for a new role. You can build market and industry knowledge and networks through exposure to a diverse range of issues from the perspective of a director. It may be where your next client or job comes from. It builds your capacity to develop career and leadership skills that you may not be able to develop in your day-to-day job. If you need to take a career break at any stage, a directorship can give you continuity on your CV. It helps you to maintain professional contacts and could provide you with the confidence to re-enter the workforce more easily after a significant break. Directorships improve career resilience and provide strategic understanding of workforce dynamics. It gives you the chance to explore the idea of a post-executive board career.

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Getting women on board encourages best practice Having a woman in the boardroom makes good business sense for the organisation, too. Research tells us that the dynamics of the discussion in the boardroom and the quality of decision-making when women are present is different. The range of issues canvassed increases and includes usefully different perspectives from female board members. Boards with women are also more likely to follow best practice in terms of board evaluations, codes of conduct, conflict of interest guidelines and looking more closely at executive remuneration arrangements. Finding a board appointment that suits your interests, skills and geography takes patience, determination and effort. You need to make a plan and stick to it – you can’t just sit around waiting for opportunities to present themselves to you. With women being a minority when it comes to board positions, it is up to you to take control of your professional future and make sure that you are progressing wisely

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

down the right path towards your goals. It is important to step away from the day-today grind of work and spend quality time reflecting on your board aspirations and developing plans for your future. Take time to write a board CV and make your aspirations known to those in your personal and professional network. It’s important to be clear on the type of role you are looking for and what skills and networks you are able to bring to the table. You need to view strategic networking for yourself as a key component of your board journey. It is a great way to meet new people, find out about organisations, build your contacts and create a name for yourself. You should also think about a group of people who may be able to help you achieve your goals. Make a list of six people of influence, make contact and keep in touch with them. Join an organisation that specialises in helping people achieve their board


Gender reporting prompts rise in female directors ambitions. These organisations often list board vacancies, so be sure to scan them frequently and apply for roles. Be strategic in your networking and professional development. If you can see a need on a board, build a business case to fill that need – with yourself. If you have little or no board experience, look at smaller not-for-profits or industry and professional association committees, and government bodies that select by professional expertise. If you have some experience, there are many small and medium enterprises (SMEs) whose boards value having directors that are successful SME operators, because they understand the challenges of a smaller company. There’s a board position waiting for you. Claire Braund will present at the ACHG conference on May 16.

More than 16,000 women are registered with Women on Boards (WOB), an organisation that works to improve gender representation on Australian boards. In 2010, WOB launched the Boardroom Diversity Index – the first comprehensive, publicly available data on women’s participation on the boards of Australian Stock Exchange (ASX) 1-300 companies. Updated annually, the index tracks gender representation in the following sectors: • • • • • • • •

superannuation trustees credit unions health funds state government owned corporations national sporting organisations cooperative research centres research and development corporations parliaments of Australia

After heavy lobbying by Women on Boards and other groups, the ASX Corporate Governance Council announced in December 2009 that gender would become a reporting requirement of listed companies. The announcement prompted a grab for female directors – 59 women were appointed to the boards of ASX 200 companies in 2010, compared to only 11 the year before. Furthermore, the number of ASX200 companies with no female directors dropped from 105 in 2009 to 64 last year.1

“The use of the carrot rather the big stick approach in Australia has raised the issue of whether corporate Australia will simply put enough women on its boards and in senior leadership roles to be seen to be doing the right thing, or if real cultural change will flow,” WOB Executive Director Claire Braund says. 2 In 2011, WOB surveyed 1,080 of its members and found that more than 70 per cent believed the ASX reporting guidelines had increased the number of women on boards.3 The Reibey Institute, an independent notfor-profit research organisation, has found that ASX500 companies with women directors deliver a higher return on equity (ROE) than companies without women on their boards (6.7 per cent higher over three years and 8.7 per cent higher over five years).4

“After heavy lobbying by Women on Boards and other groups, the ASX Corporate Governance Council announced that gender would become a reporting requirement of listed companies.” References 1

http://www.womenonboards.org.au/pubs/bdi/

2

http://www.womenonboards.org.au/pubs/articles/ cb1012-summary.htm

3

But unlike Norway, where companies can be dissolved for not complying with a 40 per cent quota law, there are no penalties for failing to meet the ASX reporting guidelines.

http://www.womenonboards.org.au/pubs/ articles/1112-why-women-are-good-for-business.htm

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http://www.reibeyinstitute.org.au/

For further information visit www.womenonboards.org.au

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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JONATHAN TEH SENIOR ASSOCIATE RUSSELL KENNEDY

SOLOMON MILLER PRINCIPAL RUSSELL KENNEDY

Law Reform

Not-for-profit reform: the imp mergers, restructures and rais Charities and not-for-profit organisations in the healthcare sector face challenging but exciting times. For the first time in decades, substantial legislative and policy reform is in train to support charities and not-for-profit organisations into the future. However, global economic turmoil has put pressure on federal and state government budgets. Even as more funding flows to healthcare, organisations are finding it difficult to maintain funding (let alone attract new funding) and contain rising costs. Financial pressure can also create the impetus to merge and restructure. This article considers how the reforms might affect your plans to survive lean economic times, and describes some practical legal

problems relating to revenue generation, mergers and restructures. MORE REVENUE, OR MORE RISK? A possible response to the economic downturn is to seek additional revenue sources. For example, your organisation might be considering whether to: • • • •

implement business opportunities which could generate a commercial return provide consulting or support services to third parties make better use of existing land and equipment conduct more fundraising to attract philanthropic donations and grants

As explained in the table below, the reforms may adversely affect your ability to pursue these matters. Even if reform issues can be

REVENUE OPPORTUNITY

ISSUES ARISING FROM REFORMS

OTHER LEGAL ISSUES

All opportunities

• Will the business be consistent with the charitable purposes you notified to the ACNC? The ACNC will ask charities for their activities annually to confirm ongoing entitlement to charity registration, and therefore, tax concessions

• Does the legislation that creates your organisation allow you to do this?

• The business opportunity might be taxed as an “unrelated commercial enterprise”. If charity tax concessions are not available (for income and fringe benefits tax) will there be an adequate return?

• Will this affect your obligation to pay property taxes, such as land tax and municipal rates? This is often linked to the use of the property.

Business opportunity (eg a profit-making arm or division)

• Do your governing documents allow you to do this? • Does your insurance cover the activity?

• If the business diverts resources and attention away from your charitable purposes, this could place your ACNC registrations at risk.

• Should the opportunity be undertaken in a taxable subsidiary entity to quarantine liability? Note that charities are less accustomed to working with complex corporate structures.

• Do you have a policy of supporting only organisations with the same charity and DGR registrations?

• Do you have formal agreements in place? What is your liability if things go wrong?

• The provision of consulting or support services (particularly at commercial rates) to non-charities is unlikely to be charitable and might place your ACNC registrations at risk.

• Do your software licences and materials allow use for the benefit of third parties? Your intellectual property rights might be restricted to internal use.

Use of land and equipment (eg leases or sub-leases, casual room hire, equipment hire)

• Will you provide resources to other organisations with the same charity and DGR registrations? Have you checked those registrations are current?

• Will this affect your obligation to pay property taxes (eg land tax, municipal rates)? These are often linked to the use (or the tenant’s use) of the property.

• If your capital resources are being diverted to generating a return, rather than to support your charitable purposes, this could place your ACNC registrations at risk.

• Do you need to register personal property security interests to protect your equipment in case the organisation using the equipment becomes insolvent?

Fundraising

• Do you have state fundraising registrations? Unless the national reforms progress, fundraising registrations are difficult to establish and maintain.

• Do you have the expertise to comply with fundraising legislation? Will the cost outweigh the benefit from fundraising? Should this be left to professional fundraisers or an umbrella fund?

Consulting or support services (eg office support, shared services, secondments or shared staff)

• Do you have a public ancillary fund whose documentation need updating? Do you have processes in place to comply with the public ancillary fund guidelines? • ACNC rules apply to philanthropic funds. These funds will not want to jeopardise their own ACNC registration if your organisation is at risk of losing its registration.

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• Do you have adequate professional liability insurance?

• Do your governing documents require a gift fund to be maintained? • Should a separate foundation or trust be established? • Should the foundation have separate branding?

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au


lications for ing revenue addressed, it is important to consider the additional legal risks. MERGERS AND RESTRUCTURES With constrained budgets, governments are increasingly funding a smaller number of larger organisations (rather than a larger number of smaller organisations). Although this reduces the government’s cost of administering funding, it can compel organisations to: • • •

merge with other organisations restructure, for example, by spinning out a division into another organisation convert from an incorporated association to a company limited by guarantee, for example, where funders decide to fund only the latter wind up and distribute surplus assets to another organisation, for example, if defunded

Even if we put aside the reforms for a moment, mergers and restructures can raise difficult personal, political and professional issues. Some problematic issues include: •

selecting a new name and branding, which gives rise to trade mark, business name and corporate naming issues differences in employment practices and employee conditions, which can give rise to employee disunity the design of the future board, particularly the need to balance the continuity of the ‘transitional board’ with open member elections or a skills-based appointment process charitable trust conditions which affect property or funds, for example, when received under a will contingent or unknown liabilities, which may require legal and financial due diligence differences in charity registration and tax statuses of the merger parties

Mergers and restructures are already difficult to implement, but the Australian Charities and Not-for-profits Commission (ACNC) and incorporated association reforms have changed the landscape for designing a merged or restructured charity’s legal structure.

The advantages and disadvantages of each legal structure will depend on the future relationship between federal and state regulators, and on how successfully the ACNC eliminates red tape. The compliance burden is currently high during transition to the ACNC, and it remains difficult to tell which legal structures have the least compliance burden. PRACTICAL PROBLEMS WITH GOVERNING DOCUMENTS Under the ACNC regime, clients who are establishing new charities or reviewing their rules have thrown up new and interesting challenges. In our experience, the time and work required to establish a new charity has increased. A detailed knowledge of the pre and post ACNC regimes is needed. We have encountered many governing documents that do not have the required not-for-profit, winding up, gift fund and revocation of deductable gift recipient (DGR) clauses. This creates a major risk, in that the organisation might lose its tax concessions or DGR status. We have seen several instances of governing documents that do not have any statement of purpose. It was common practice for Victorian associations to include this in a separate document. In light of the ACNC and association reforms, these should now be merged into a single document as soon as possible. Many not-for-profit organisations appoint their chief executive officer as the secretary and public officer under the governing rules. However, ACNC forms can only be signed by a director. Fortunately, the ACNC (unlike ASIC) is willing to accept scanned documents! With the future requirement to report annually to the ACNC, charities must ensure that their activities will be consistent with existing charity registrations and tax concessions. Continuing eligibility for tax concessions is fundamental to many organisations, and should be carefully protected.

While the extent of reforms has been dynamic and unprecedented, this article demonstrates how the reforms creep into many strategic decisions that not-for-profit boards are required to make. We encourage you to seek independent advice to deal with the ACNC reforms, and with transactions arising from difficult times. This article is intended as general commentary and should not be regarded as legal advice. Should you require specific advice on the topics discussed, please contact the authors or visit www.rk.com.au

REFORMS COMMENCED • • •

Public ancillary fund (community fundraising) governance reform Victorian incorporated associations – new Act and model rules ACNC – new regulator (does not affect government hospitals, which are not charities)

REFORMS PENDING JULY 2013 • ACNC governance standards (published March 2013) • ACNC financial reporting regulations (currently in draft form) • ACNC external conduct standards (draft not yet available) JANUARY 2014 • A new statutory definition of charity (currently in draft form) JULY 2014 • ACNC 2013-14 annual information statement (currently in draft form) JULY 2015 • Taxing of NFP organisations’ unrelated commercial enterprises (consultations occurred May 2011) TO BE ANNOUNCED • DGRs being required to operate solely in Australia (currently before Parliament) • Overhaul of NFP tax concessions (consultations occurred December 2012) • Charitable fundraising reform (consultations occurred April 2012)

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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DIRECTOR, POLICY & STRATEGY VICTORIAN HEALTHCARE ASSOCIATION

TOM SYMONDSON

Quality of Care

Stafford is in many ways a typical English town, located 50 kilometres north of Birmingham and the same distance east of the Welsh border. It counts among its claims to fame a history as the home of England’s shoe industry and of its largest remaining Tudor wooden-framed house. It is also the site of possibly the worst scandal to hit the National Health Service (NHS) since it was established in 1948.

Lessons from the Stafford Hos how governance impacts on p Across these two inquiries, Francis discovered shocking details of poor care. Elderly patients were left to fend for themselves without their most basic care needs being met, such as access to food and water, and assistance to wash or use the toilet. Cleaning standards fell so far that the rooms of patients infected with the superbug Clostridium Difficile (C.Diff) were not cleaned after being vacated. There were accounts of nurses ignoring the pleas of severely ill patients, and of families being left to watch their relatives decline and die in circumstances that should have been totally avoidable. While these stories were plastered across the British tabloid press, even more disturbing for the medical and political establishment were the incredible failures of leadership and governance at the hospital, the trust and across the broader health sector. Francis reported a culture of fear and disengagement, which prevented staff from speaking up, distanced senior

clinicians from management decisions, and overlooked the concerns of patients and families. He condemned the failure of the Trust’s board to identify quality of care issues, or to even see this as part of its role. He found the board was guilty of a “passive style from which challenge and engagement with the key issues was absent”.2 The executive leadership and the board were so obsessed with targets and financial performance, that they overlooked concerns about quality. In the midst of the crisis, the board decided to push for foundation status, which is only open to high-performing NHS trusts and brings increased freedom from government control. Rather than first solving its problems, the board viewed foundation status as a catalyst for improvement, thereby putting the cart firmly before the horse. The failings of external organisations formed a central pillar of the second Francis inquiry. At the time of the crisis, the local health system consisted of a bewildering array of organisations, including: the

Stafford Hospital, run by the Mid Staffordshire NHS Foundation Trust, first came to the attention of regulators in 2007, following claims that mortality rates were alarmingly high for a hospital of its type and size. It has since been estimated that up to 1200 people died at the hospital between 2005 and 2009 due to sub-standard care.1 Public concerns about the hospital were first raised by local resident Julie Bailey, who launched the grassroots campaign group Cure the NHS following the death of her mother, Bella, there in November 2007. In response to growing public pressure, Labour Prime Minister Gordon Brown announced an inquiry, which was chaired by Robert Francis QC in 2009 and reported its findings in February 2010. Following the Labour Government’s defeat at the 2010 election, new Conservative Prime Minister David Cameron asked Francis to lead a full public inquiry with broader powers including the power to investigate external organisations. Photo (above) sourced from: http://martintideswell.com Photo (below): Alistair Rose 2011

10 The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au


A HOSPITAL IN CRISIS

spital crisis: patient care Foundation Trust; a primary care trust responsible for service commissioning; a strategic health authority responsible for oversight; an ambulance trust; the Healthcare Commission, tasked with national oversight of quality standards; the Department of Health; and local councils responsible for delivery of home and social care. Each one of these organisations failed to identify the enormity of the crisis in Stafford. In fact, the Strategic Health Authority at first sought to defend the hospital from negative publicity after the Healthcare Commission first raised concerns in 2008. Francis condemned the oversight and governance structures of the NHS, which fostered a target-driven culture and a heavy focus on financial accountability. He described the situation as a “failure of the NHS system at every level” .3 While the scale of the crisis in Stafford is unique, the underlying issues provide a salutary warning to anyone involved in health leadership, and a very visible example of what can go wrong when boards

November 2007 – Following the death of her mother Bella at Stafford Hospital, Julie Bailey launches the grassroots campaign ‘Cure the NHS’.

are not effective. It emphasises the need for strong governance, for boards to challenge managers to deliver strong outcomes, and to ensure that striving for a strategic focus does not lead to disengagement from critical issues. The success of Julie Bailey and Cure the NHS in bringing the situation at Stafford to national prominence also highlights the power of a co-ordinated consumer campaign to force action. Finally, and perhaps most importantly, Stafford has underlined the responsibility of the health system as a whole, from front line staff to the government and minister, for ensuring not just financial sustainability but patient safety and quality of care. References 1

‘Investigation into Mid Staffordshire NHS Foundation Trust’, Healthcare Commission, March 2009

2

‘Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009’, The Stationery Office, February 2010

3

‘Chairman’s statement’, The Mid Staffordshire NHS Foundation Trust Public Inquiry, 6 February 2013

February 2008 – Mid Staffordshire NHS Trust, which runs Stafford Hospital, is awarded foundation status, giving it increased freedom from government control. May 2008 – The Healthcare Commission opens the first inquiry into Stafford Hospital, following unusually high death rates. March 2009 – The Healthcare Commission report reveals a litany of failings, including a lack of staff on wards, dire levels of cleanliness and poor patient nutrition. Shortly before the report is published, the trust Chair resigns and the CEO is suspended on full pay. May 2009 – Martin Yeates, CEO of the Trust, resigns amid media reports that he has received a £400,000 payout and a £1 million pension. July 2009 – The Labour Government announces an independent inquiry led by Robert Francis QC, but not the full public inquiry demanded by Cure the NHS. February 2010 – The first Francis report has 18 recommendations and finds that “unimaginable distress and suffering” have been caused to patients and their families. May 2010 – The Labour Party loses government and the Conservative and Liberal Democrat parties form the UK’s first coalition government since 1945. Both parties had committed to a public enquiry while in opposition. June 2010 – New Prime Minister, David Cameron, announces that Robert Francis QC will lead a full public inquiry. December 2011 – The public inquiry ends, having cost over £10 million and received more than one million pages of evidence.

Robert Francis QC. Photo: EPA (sourced from: http://illustrateduk.com)

February 2013 – The second Francis report has 290 recommendations and concludes that patients “were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety”. Prime Minister David Cameron apologises in the House of Commons, saying that the trust board has “overwhelming responsibility” for the hospital’s failings.

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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LINDSAY KILEY MARKETING DIRECTOR INTERSYSTEMS

Information Management

What do your executive dashboards look like? Do they provide insights for clinical and corporate governance? What actions can your information systems trigger in relation to key metrics? And how do they support connected care initiatives, such as personally controlled electronic health records (PCEHRs) and the governance issues they create? Correct me if I’m wrong, but that is not how most board members and senior executives of healthcare organisations currently receive and act on information. And that, I submit, is something that has to change. IT systems already support a wide range of administrative and clinical tasks. Administrative systems streamline many activities and support fiscal governance, while clinical systems offer advanced functionality and support quality of care objectives. But they generally have limited support for clinical governance, which requires real-time visibility of operations across the organisation.

Active analytics for clinical governance Clinical governance, in particular, requires ongoing analysis of current information across the organisation for early risk identification, triggers for timely intervention, and real-time tracking of key performance indicators. Dashboards, for example, can monitor time to treatment against government-mandated guidelines, and analysis of current data can be used to pinpoint and resolve bottlenecks. Hospital readmission rates – which averaged 20 per cent in a recent US survey – can be monitored and analytics used to drill down into any data spikes to identify possible causes and take appropriate and timely action. Many healthcare providers are now moving beyond capturing and sharing data, into the breakthrough realm of real-time analysis and deep understanding that drives actions to achieve better financial and clinical outcomes. Some of our forward-thinking clients, like the Royal District Nursing Service and Mater Health Services in Queensland, have deployed a strategic healthcare informatics platform that integrates existing systems around a unified data set with the tools to both analyse data and act on it in real time. This also gives them the agility to adapt to changing requirements, something Mater Health Services has demonstrated as a lead site for PCEHRs. Others have standardised on an enterprisewide healthcare information system that

The problem is that existing systems are not good at talking to one another. They have also created countless discrete islands of information. Despite the trend to try to consolidate or integrate IT systems, few organisations can access and analyse all of their data in one place, in real time. This makes it almost impossible to create executive dashboards like those now commonly used in other industries, such as financial services.

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integrates with existing systems to create a unified data set for real-time analysis. For example, medication management having both a single information repository and shared program logic allows doctors, pharmacists and nurses to work more collaboratively. This reduces medication errors, overheads for data entry, unnecessary communications and stock wastage. In addition to supporting good governance, analysis, understanding and data-driven action provide measurable benefits to demonstrate a return on investment (ROI) on new technology. Dr. Karanvir Singh discovered this as Head of Medical Informatics for Sir Ganga Ram Hospital in India: “Essentially, analytics is what provides the ROI on healthcare information system investment. “Our first tangible ROI was when we analysed the various patient treatment packages offered by the hospital. “Another ROI was identifying workflow bottlenecks and streamlining processes as a result. All this was possible because decision-makers could get data within minutes or hours, which used to take weeks or months to deliver.” Is that the sort of valuable information your board and executives would like to be able to see and act on? InterSystems is a healthcare informatics specialist provider. For further information visit www.intersystems.com


BRIAN HARATSIS CEO MACROPLAN AUSTRALIA

Planning and Health

During the 20th century, unbelievable advances were made in medical science, enabling our society to dramatically reduce – and in many cases eradicate – diseases that had plagued humankind for centuries, dramatically increasing life expectancy around the world. There will be similar changes in the 21st century, with increased life spans and consumption-led lifestyles combining to bring new challenges and a major shift in the health profile. We can diagnose many causes of sickness but what are the main causes of health? How do we maintain our health, our independence and quality of life into old age? How do we reduce the burden of cost on our health care system and aged care globally, through the prevention of chronic disease? It is clear that medical science alone will not provide solutions to these huge questions – there needs to be collaboration across all disciplines. Scientific research is only part of the process of preventing the onset of chronic disease. How we plan our built environment and the way we design our communities provides a context for civil society, and has a huge influence on our lifestyles and health. We need more endeavours in the planning of our physical environment to reduce its direct impacts on people’s health and wellbeing, and to facilitate how we lead healthier lifestyles.

Designing communities around better health Planning cities and towns around walking, cycling, work/home relationships, commuting habits and recreation needs must be at the forefront of preventative health measures. Healthcare will not present itself as a single silo, but will be intricately linked into the way we live and go about our business, recreation and travel. Sixty years ago, 75 per cent of the population was within walking distance of a local grocery store. Today this figure is under 15 per cent. This simple example illustrates the relationship between city design and health issues. Demographic shifts, population growth and increased affluence are forecast to accelerate future demand for new medical centres, hospitals and health precincts, which are significant generators of transport activity and are critical anchors for future mixed-use centres.

“There needs to be a new mindset around how land use planning deals with health issues, to weave them into the overall fabric of our town centres, shopping strips and malls.” We need to consider the operational focus of health sector planning – which traditionally resulted in stand-alone facilities and precincts with limited capture of crosssectional corroboration economies and transport infrastructure. Land use planning must facilitate a new approach. There needs to be a new mindset around how land use planning deals with health issues, to weave them into the overall fabric of our town centres, shopping strips and malls.

of healthcare. Other needs will be delivered through mixed-use centres located close to transport and centres. Our planning system needs to make this happen. The main street community health model will be complemented by opportunities provided through technology and communication advances. Special advice and care will be available from centres to patients a thousand kilometres away, or in the next suburb. Care will be brought to the patient, rather than the patient visiting single-purpose care facilities. In Australia, the technology revolution offers new care delivery models and opportunities for significant savings and benefits to populations that are often dispersed across broad geographic areas. Australia is at the forefront of an opportunity to demonstrate leadership in the application of scientific research that will build a future society that is healthy, harmonious and economically and culturally progressive. We are considered one of the world’s healthiest nations but we are spending an increasing percentage of our gross domestic product on hospitalisation and acute care, with diminishing returns on the overall health of our population. The challenge for planners in Australia is to help new ideas and initiatives materialise, instead of remaining preoccupied with a regulatory model for providing healthcare products that are becoming redundant to the needs of our community, and are creating cost pressures that diminish our ability to find innovative solutions. Brian Haratsis is a best-selling author and leading economic and strategic advisor in the property sector. His new book Beyond the Fringe is due for release next month. Brian is key note speaker at the ACHG conference being held on May 16-17. For more information visit www.macroplan.com.au

The overly restrictive, single-purpose designation for hospitals and healthcare facilities is redundant and does not take into account the demands of the new health world. In the future, large single-purpose hospitals will focus on the acute care role, rather than trying to deal with every aspect

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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PRINCIPAL & EXECUTIVE DIRECTOR SEARCH & RECRUITMENT HARDYGROUP INTERNATIONAL

JEAN FAGAN

Executive Recruiting

Managing economic risk is an important skill and responsibility of health and public sector leaders. From a workforce perspective, poor retention and the absence of capable and flexible leadership will cost the organisation dearly. Getting it wrong is an avoidable waste of scarce dollars for cash-strapped systems. The cost of a new hire in dollar terms is estimated to be between 30 per cent and 200 per cent of annual salary. We all know the ‘soft’ costs of a poor hire in relation to time, impact on the organisation, damage to reputations, and delays to strategic or critical projects. Impact on the judgment and credibility of the organisation’s leadership, although difficult to quantify in dollar terms, is also high. So how can leadership minimise the risk, and avoid wasting precious dollars that organisations should be directing towards delivering better health and wellbeing to the communities they serve? Whether hiring is done entirely in-house, in partnership with a recruitment firm, or through recruitment process outsourcing (RPO), framing questions that connect with the person behind the interviewee facade is important. By the time senior and executive candidates get to interview, their technical skills and career experience are unlikely to be the real issue. Their careers have progressed to this level because they are smart, articulate and driven by the desire to succeed.

Managing financial risk by hiring for success They have also been on the other side of the interview process and will have been thorough in their preparation and anticipation of questions. They will have plenty of experience to draw on. It is imperative to get behind the candidate ‘front’ and connect with the real person – the way they think, their values and how they are likely to behave in the job. Vision, mission and values are tangible elements of organisational culture, and translating values into specific competencies, asking questions against values and hiring for culture will go a long way to ensuring a successful fit. Mixing carefully-constructed technical and behavioural questions with open-ended questions about your business and how the candidate would deal with a particular scenario will deliver results. Open-ended and left field questions will disclose more, for example ‘what qualities do you admire most in people?’ and ‘how would you turn a $20 million budget deficit in our business to a balanced result?’ CANDIDATE FIT This is about matching knowledge and skills to the requirements of the job. What are their core capabilities? Check out their track record of performance, successes and failures from their CV and get answers prior to short listing. You need to understand what they personally took responsibility for leading and managing, and how well they did it. Check the pattern of where the candidate’s leadership strengths are most comfortably aligned, and how that matches the job needs. For example, does their CV demonstrate a pattern of high-level skills being applied to longer term system improvement, innovative thinking, system or service restructuring, fixing major organisational headaches and moving to the next challenge, or staying to build the workforce and deliver on longer-term vision? What does the job need? Job fit has a strong correlation with job satisfaction, organisational engagement, and early resignation when it goes wrong.

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Structuring questions that elicit the applicant’s ideas on the interconnectedness of the job to the job’s broader context will give you an idea of their fit for the role. It is important to remember that job fit is not just about now, it’s about where you plan for the organisation to be in five years’ time. It is about future strategy and challenge. If you are outsourcing, it is useful to make clear to recruitment consultants the key characteristics that the job demands (such as high visibility and energy, negotiating and influencing, strategy and stakeholder relationships, verbal and written communication skills). ORGANISATIONAL FIT The focus is on personality, values and the needs of candidates and the organisation. The key characteristics are about relationships within the immediate job context. Hire for capabilities to drive success in delivering strategy in current and future organisational contexts. TEAM FIT Recruit individual executive team members who can contribute to strategic directionsetting and whose skills and characteristics build on collective collaboration. These are key to creating and driving vision, mission and culture.


Local telehealth project wins international award FIT WITH THE CEO The rule applies that you never recruit a version of yourself. You recruit to complement your strengths in order to build the collective capability quotient. If you are outsourcing to an external recruiter who doesn’t know you well, make sure you tell them about your style so they understand what characteristics are important to you and those that annoy you. Are you irritated when people are indecisive, or constantly providing another option and taking forever to take action? Do you find judgmental or detached people hard to work with? Do ‘needy’ executives who require frequent recognition annoy you? Knowing the candidate’s Myers-Briggs personality type will give you a clue here. Selection is not about personal chemistry – it is about all these areas of person/job fit. Self-motivated executives are more likely to require all elements of fit to be right. While all this sounds like a lot of effort, if you outsource to a recruitment firm these are the elements you will expect to be covered. If you are doing the recruitment in-house, it is all about short-term effort for long-term gain and responsible financial management.

A Royal District Nursing Service (RDNS) telehealth project, which allows nurses to make ‘virtual visits’ to patients at home, has won an international award for Outstanding ICT Innovation. The Asia Pacific Eldercare Innovation Award was presented at the 2013 Ageing Asia Investment Forum in Singapore. The RDNS ‘Healthy, Happy and at Home’ project was demonstrated via videolink between Singapore’s Senior Minister of State, Mr Chan Chun Sing, and nurse Amanda Murray, who was 6000 kilometres away at the RDNS call centre in Melbourne. Ms Murray responded to the Minister as though he was a real patient, monitoring his ‘medication’ and hypothetically taking his blood pressure. The project has the potential to enable earlier hospital discharge, prevent medicine mismanagement, maximise nursing resources, and help clients remain in their homes for longer.

A joint initiative with Telstra, Health Tech and La Trobe University, it is a primary platform in the RDNS move towards using high-speed broadband technology to deliver care in the home. The project is supported by the Victorian Government’s Broadband Enabled Innovation Program (BEIP). Over the past two years, it has been tested on about 50 Australian clients who have a computer monitor with an inbuilt camera at home, allowing RDNS nurses to conduct two-way video calls. This gives clients, their families and carers peace of mind that RDNS staff can see whether correct medication is being taken. RDNS Chief Executive, Adjunct Professor Stephen Muggleton, was delighted with the award. “It is a great example of how clever but easy-to-use technology can provide better in-home support for consumers.”

HGI is a specialist in public sector, health and not-forprofit executive recruitment. For more information visit www.hardygroupintl.com

Nurse Amanda Murray makes a ‘virtual visit’ to Senior Minister of State, Mr Chan Chun Sing

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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POLICY ADVISOR VICTORIAN HEALTHCARE ASSOCIATION

CHRIS TEMPLIN

THE VHA CELEBRATES

The VHA’s corporate history started in 1938, although its origins date back to the formation of Victoria’s rural and metropolitan hospital associations 20 years earlier. In May 1918, Victoria’s 40 rural hospitals formed the Country Hospitals’ Association (CHA) and invited metropolitan hospitals to discuss “the formation of a country and metropolitan association for the purpose of promoting the financial and other interests of the whole of the hospitals in the state”. Metropolitan hospital delegates attended the CHA’s inaugural meeting as observers but “were not disposed to take any active part in the formation of an association”.1

75 YE

Group purchasing on behalf of members was the main function of both the CHA and the MHA.

for the fund, which was managed by the AMP Society, but superseded by the Hospitals’ Superannuation Act in 1966.

The CHA spent several months in 1935 and 1936 trying to persuade the MHA to amalgamate to form a single statewide purchasing body. But the MHA was reluctant, and both associations were concerned about losing their individual identities.

The VHA, the MHA and the CHA remained separate associations, acting independently on non-commercial matters until 1974, when new responsibilities outside the VHA’s group purchasing function made amalgamation inevitable.

In March 1937, they reached a compromise and appointed a secretary, William Robinson, to serve both organisations on a salary of £6 per week. A joint executive was also formed to deal with matters of mutual interest to their country and metropolitan members. THE VHA IS FORMED The Victorian Hospitals’ Association VHA) was legally incorporated in October 1938, and an equal number of MHA and CHA representatives were appointed to the board. One of the VHA’s biggest post-war achievements was the establishment of a superannuation scheme for hospital employees. The VHA acted as treasurer

A new Memorandum and Articles were adopted in June 1974 and hospitals could apply for individual membership of the new association. Members were classified into five divisions, according to size and interest rather than geography, to avoid old metropolitancountry hospital rivalries. The divisions were: 1. 2. 3. 4. 5.

teaching hospitals base and larger community hospitals geriatric and rehabilitation institutions district hospitals community health centres

The new VHA was governed by a board of 18 members, who were elected annually from their divisions. It had three basic functions: trading, member services and industrial relations.

At the time, Victoria’s country hospitals ranged from large regional facilities at Bendigo, Ballarat and Geelong to small rural hospitals with daily bed occupancies of eight or 10. Metropolitan hospitals included the Melbourne, the Alfred, the Eye and Ear, the Children’s, the Women’s, the Austin (then known as the Hospital for the Incurables), the Queen Mary Infectious Diseases Hospital at Fairfield, St Vincent’s, the Homeopathic in South Melbourne, and the Queen Victoria. They resisted forming their own association until November 1920, when the establishment of the Charities Board by an Act of Parliament necessitated the formation of the Metropolitan Hospitals’ Association (MHA). Victorian Hospitals Association first honorary board meeting 8th September 1955

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EARS SINCE INCORPORATION By the end of 1974, there were 147 members and 15 associate members. By 1977, the VHA had 185 members, 43 associate members and 150 staff. Its subsidiary company, Cardiac and Surgical Australia, had offices in Melbourne (Mulgrave), Canberra, Sydney and Brisbane, Adelaide and Perth, and recorded an annual turnover of $21 million. The new decade started dramatically, when a huge fire destroyed the VHA’s main warehouse at Mulgrave on 11 January 1980. Fortunately, the administration block was left unscathed and temporary warehouse space was immediately leased, allowing deliveries to be made that week. That year, VHA Chairman L.B. Swinden made a personal appeal to members, foreshadowing “important new responsibilities” in the new decade:

“In the past, the health debate has too often been carried on without inviting the views of the Victorian public hospitals. Our institutions have a uniquely important role in the delivery of health care, and they have a valid and important input to offer when health matters are being discussed. “In the public interest, the opinions of the public hospitals, which are in the first line of contact between the community and its health services, should be firmly stated and made known to all levels of government and the public generally.” The Victorian Hospitals Association changed its name to the Victorian Healthcare Association in July 1996. A Policy and Research Division was established in 1998, reflecting the VHA’s

new advocacy role in Victoria’s changing public health landscape. The same year, members voted to change the Articles of Association and establish a separate trading board to conduct its commercial activities. This enabled the VHA board to focus on health policy and member services, which remain the organisation’s core activities to this day. References 1. Gardiner L Hospitals in Association: A History of the Country and Metropolitan Hospitals Associations 1918-1974, Mount Eagle Publications for the Victorian Hospitals Association (1977).

This is Part I of a commemorative article on the VHA. Part II will appear in the next edition of Health Matters.

“Pressure to contain costs will increase, relationships with government and government agencies will become more critical and, partly because of these factors, public scrutiny of hospitals and the delivery of health care in the community will intensify. “There is a need to add greater strength to the Victorian Hospitals’ Association role as spokesman for public hospitals in this state. This is especially relevant in times when political and public interest in health care and its cost effectiveness is increasing.

L.B. Swinden, VHA Chairman 1979-1983

VHA certificate of incorporation 21st October 1938

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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POLICY ADVISOR VICTORIAN HEALTHCARE ASSOCIATION

ELOISA EVANGELISTA

Public Private Partnerships

If there is a lesson we can learn from the recent federal reduction of $475 million in health funding to Victoria, it may be that health services should start looking beyond public sources for their funding. Although $107 million of this reduction was overturned for this financial year, perhaps the remaining $368 million that Victoria is set to lose over the next three years warrants the exploration of alternate revenue sources to enable health services to meet the needs of their communities. As in many developed countries, Australia has established Public-Private Partnerships (PPPs) as a valuable model for the financing of health infrastructure. But PPPs need not be restricted to infrastructure, and can be expanded to increase capacity, efficiency and quality in emerging market health systems.1 In light of the challenges currently facing the public sector in healthcare finance, management and provision, the discussion of increasing private sector involvement is important and timely. As we progress PPPs in Victoria, we need to envisage how this will look. Will it involve small steps or large-scale service reconfiguration? Recently, Western Australia’s Royal Flying Doctor Service announced it had a commitment from Rio Tinto to fund the Rio Tinto Life Flight aero medical jet service for four years, giving rural and remote WA residents access to urgent healthcare.

Advancing the discussion on private sector partnerships Bupa, a major worldwide health insurance company, has announced its aspiration to manage public hospitals in partnership with governments in Australia by 2020.2 The recently-released ‘Blueprint for better healthcare in Queensland’ outlines the potential for private sector involvement in building new elective surgery centres to clear waiting lists. This will occur through a new Ministerial Health Infrastructure Council, which will act as a portal for private investment in health services and infrastructure. Queensland Health will establish a Contestability Branch to investigate alternative business models for medical equipment, pathology, payroll, and pharmaceuticals, to determine more cost-effective ways to maximise health service outcomes. When appropriately structured and executed, partnering with the private sector may offer advantages. There is potential to address specific cost and investment challenges, to increase efficiency through improved service provision and management, to enhance service quality through substantial investment in infrastructure and medical technology, and to attract and retain a high calibre workforce. A clear definition of what is meant by private sector involvement is imperative, and Australia can learn from the experience of other countries. Health systems that accurately reflect the unique needs of a nation are most likely to improve life expectancy and decrease the rates of disease and infant mortality.3 The United States experience suggests that Australia should be wary about a significant private health sector developing in Australia. In 2009, the US led the world in healthcare spending (17.4 per cent of GDP, compared to a 9.9 per cent OECD average)4 predominately due to the large proportion of private health expenditure. Despite this, globally the US was ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality and 36th for life expectancy.5

18 The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

By contrast, there is increasing reliance on private funding for essential healthcare improvements in South East Asia, where governments spend less than half the OECD average (with the exception of Vietnam and Cambodia).6 If PPPs are to succeed, it is essential that the right frameworks and conditions are set in place by government. Leveraging partnerships with the private sector to address the healthcare challenges faced by government will not be easy, and may not be the most effective or efficient option available.

“When appropriately structured and executed, partnering with the private sector may offer advantages.” Careful consideration of the conditions for success and sustainability are required on a case-by-case basis to assess the risks, costs and benefits.7 Likewise, the private sector will also need to be clear whether it can provide the most appropriate and affordable effective care and ultimately be responsive to the healthcare needs of the consumer. References 1

Pricewaterhouse Coopers (2012) Build and Beyond: Bridging the gap. Meeting the challenges of healthcare development in South East Asia

2

Urban R (2013, January 15) Bupa eyeing foothold in public health The Australian, pp 15-16

3

Pricewaterhouse Coopers (PwC). (2012). Build and Beyond: Bridging the gap. Meeting the challenges of healthcare development in South East Asia

4

OECD (2011) Health at a Glance 2011: OECD Indicators www.oecd.org/health/health-systems/ healthataglance2011.htm

5

Joe D (2009) WHO Statistical Information System (WHOSIS) Geneva: World Health Organization

6

Pricewaterhouse Coopers (2012) Build and Beyond: Bridging the gap. Meeting the challenges of healthcare development in South East Asia

7

Nikolic I A & Maikish H (2006) Public-Private Partnerships and Collaboration in the Health Sector: An Overview with Case Studies from Recent European Experience Washington DC: The International Bank for Reconstruction and Development


Lawyers named among best in Australia Russell Kennedy’s leading expertise in the health and aged care and retirement living sectors has again been recognised by Best Lawyers. Principal Michael Gorton AM has been named the Best Lawyers Melbourne Health and Aged Care Lawyer of the Year for 2013. Best Lawyers is the legal profession’s oldest and most respected peer review publication. It surveys thousands of leading lawyers to confidentially evaluate their professional peers. Only one lawyer in each designated metropolitan area is honoured as the Lawyer of the Year. Mr Gorton is known to many healthcare professionals, and works closely with a large number of hospitals, medical colleges and healthcare professionals,

particularly in the area of constitutions and disciplinary matters.

Board and of the boards of several aged care facilitates.

He is a board member of Australian Health Practitioner Regulation Agency (AHPRA), a board member of Melbourne Health (Royal Melbourne Hospital), Chair of the Victorian Governments Patient Review Panel and the former Chair of the Victorian Assisted Reproduction Treatment Authority.

Russell Kennedy lawyers named in the 2013 Best Lawyers in Australia list are:

Russell Kennedy, which has existed for more than 150 years, is part of the Kennedy Strang Legal Group.

• •

This year, the firm received eight Best Lawyers nominations, including Principal Victor Harcourt as Best Lawyer in Aged Care.

Mr Harcourt heads up Russell Kennedy’s aged care practice and has a Masters in Health and Medical Law. He has been a member of the Dental Practice

• • •

• •

Andrew Chalet, Commercial John Corcoran, Retirement Villages and Senior Living Law Michael Gorton AM, Health and Aged Care Victor Harcourt, Health and Aged Care Wai Hwoon Low, Retirement Villages and Senior Living Law Donna Rayner, Retirement Villages and Senior Living Law Andrew Sherman, Water Rosemary Southgate, Retirement Villages and Senior Living Law

Michael Gorton AM will speak about the legal environment impacting director duties at the ACHG conference on May 16.

The Victorian Healthcare Association Issue 1 [MAY 2013] www.vha.org.au

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An initiative of the Victorian Healthcare Association The ACHG can help you to: • Put in place effective healthcare governance frameworks and processes that equally emphasise corporate and clinical governance responsibilities • Assess board performance and development needs through our online board development and evaluation tool and tailored consultancy services • Develop processes to monitor and redirect organisational performance • Develop a quality and risk management framework that is customised to the activities of your organisation • Develop appropriate quality systems and processes in your organisation • Formulate appropriate strategy to address the population health needs of the community being served • Connect and network with peers, attend knowledge transfer and professional development forums • Keep up to date with research and policy developments

For membership enquiries, or advice about professional services, please contact: Alison Brown Governance Consultant

visit www.healthcaregovernance.org.au

The Australian Centre for Healthcare Governance Level 6, 136 Exhibition Street, Melbourne VIC 3000 03 9094 7777 | achg@healthcaregovernance.org.au

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Health Matters May 2013