Local Health Network Consumer and Health Advisory Councils Transforming Health Consumer Engagement Forum Northern Adelaide Local Health Network - Lessons learnt to date & what’s ahead for 2017 Adj. Associate Professor Vanessa Owen Executive Director •Nursing & Midwifery •Clinical Governance Service •Outpatient Departments

NALHN Self Sufficiency Population growth in Adelaide’s Northern catchment and the anticipated related increase in service needs has led to the refocus of the LMH to become the major adult tertiary hospital for the north. People who are currently treated within their Local Health Network: CALHN – 88% SALHN – 87% NALHN – 54%. Goal is to increase NALHN’s self sufficiency across the majority of services Transferring services from CALHN to NALHN is intended to assist LHM to increase its capability to meet the needs of its local population and help patients living in the North and North-East to receive their care closer to home. Following discussions with senior clinicians, a number of services were identified for potential transfer from CALHN to NALHN as part of the reconfiguration of services outlined in Transforming Health. The transfer will also enable the Lyell McEwin Hospital to develop into the major adult tertiary hospital for the north as planned, supported by Modbury Hospital as a centre for elective surgery, rehabilitation and sub-acute services.

Intra NALHN Service Move Significant work has taken place across NALHN to unlock existing capacity within the hospitals by improving the effectiveness and efficiency of care provided. On 15 March, 2016, the Northern Adelaide Local Health Network (NALHN) carried out the first of its service moves by relocating medical and cardiology inpatient and orthopaedic emergency and multi-day activity from Modbury Hospital to the LMH. On 3 May, 2016, the second phase of the service moves occurred with the remainder of emergency and multi-day surgical activity transferred from Modbury Hospital to Lyell McEwin Hospital. On 31 May, 2016, the third and final phase of the service moves occurred which saw the consolidation of the 4 remaining Critical Care beds, and associated activity from Ward 1 West at Modbury Hospital to Intensive Care at LMH. LMH will continue to undertake complex multiday and emergency surgery and ensure comprehensive, quality care is delivered to north and north eastern residents.

Intra NALHN Service Move MODBURY Other initiatives aimed at delivering more care to more people closer to their homes are progressively being implemented and include: The new purpose built rehabilitation centre at Modbury Hospital which will include a hydrotherapy pool, gym and therapy spaces. Ward areas being redeveloped The expanded one stop breast service commenced on Friday 29 April, 2016 and continues to grow. Gastroenterology outpatients expanded at Modbury Hospital from July 2016.

Modbury Hospital Construction of the Rehabilitation Centre at Modbury Hospital is taking shape. The centre's roof and roof plan have been installed, along with electrical and pool solar panels. Pool tiling was completed in early September and the has now been filled Work on the southern link way, which connects the rehabilitation building to the main hospital is well underway. In September patients were moved from 3West in to the refurbished 3East, to allow the full refurbishment of 3West to begin. The new rehabilitation centre includes a gym, hydrotherapy pool, making it easier for people in the north and north eastern suburbs to access retaliations close to home. New Link way under construction Eastern Entry of New Rehabilitation Building Therapy Garden under construction

Modbury to LMH Activity Movements Modbury Hospital Lyell McEwin Hospital Ward 3 East - 24 beds (General Medicine) Ward 1B - 24 beds Ward 2 East -24 beds (General medical Multi-Day Surgery) Ward 2B, 2E and 2FX -12 beds Ward 3 West A – 4 beds (Cardiology) /Medical Cardiology - beds AMU 2 Total 38 beds relocated to LMH

Outcomes ED, Inpatient and Day surgery ED representations within 48 hours LMH ED visits readmitted within 48 hours decreased from 4.4% to 3.98% ModH ED visits readmitted within 48 hours decreased from 3.94% to 3.54% NALHN ED visits readmitted within 48 hours decreased from 4.23% to 3.82% Inpatient readmission (adult) within 28 days MH inpatient readmission rate decreased from 9.43% to 9.16% ModH inpatient readmission rate decreased from 7.57% to 6.1% NALHN inpatient readmission rate decreased from 8.86% to 8.35% Day Surgery Rate

Surgical Service Improvements Data Source: NALHN Case mix Elective Surgery - Funded Activity Report These improvements are a reflection of the ongoing work of the NALHN Transforming Health Surgical Initiatives implemented through the following work streams: Orthopaedic Pathways Surgical Pathways Acute Surgical Unit Operating Theatre Utilisation Same Day & 23hour Procedures

Mental Health Service Improvements Data Source: NALHN ED Data Repository Mental Health ED average visit time continues to be within 350-500 minutes within Mod & LMH respectively. The NALHN Transforming Health Mental Health initiatives continue to support the delivery of patient care through the following work streams: Emergency Department Pathways Community Mental Health Reform

CALHN/NALHN Service Moves Extensive planning has been undertaken to prepare for the service moves. Concurrent to the planning for the service moves, a number of system-wide resources have been developed for application to any future service move. Development of methodologies and data sources to model the transfer of inpatient, outpatient and ED activity Development of principles for the implementation of service activity moves Development of financial principles associated with the service activity moves Development of criteria to assess clinical and financial viability of activity Agreement on type and volume of activity and associated funding to transfer for this phase of the project

CALHN to NALHN transfers commence The transfer of some CALHN staff working in a number of specialities to support these transfers of activity to NALHN began on October 2016 . CALHN staff who have transferred to NALHN to support the care of orthopaedics, renal and vascular specialties. It is expected staff within other specialties and support functions will transfer in a phased approach, with all moves planned to be complete by the end of February 2017, including the transfer of: ENT Urology Breast Endocrine Upper GI Cardiology Stroke Medical Oncology Haematology Endocrinology

Lessons Learnt… Early engagement with stakeholders, especially clinical leads and consumers which enabled key stakeholders to have ownership with accountability during the change processes. Clear objectives with measurable outcomes. Investigate and engage with other hospitals to understand what has worked and how this can be implemented into current practices across our network. Trial new processes allowing opportunities for review and develop prior to embedding into current practices Agreement principles, including a strong focus on the patient Well-structured project planning and management

Lessons Learnt……… Consumer Advisory Council – INVALUABLE Keep talking to people Manage your own good news stories Media is negative and never report accurately Remember why you began – to improve patient outcomes and care Change is difficult – people don’t like change even if think the results will benefit