Service Planning SA Presentation to the National Service Planners conference

Service planning in a reform environment >Reforming health plan released in 2007 Challenges: workforce; changing health profiles; unsustainable demand, new technology, outdated infrastructure building and their design. Aims – rebalance system components, redesign service models, build new infrastructure, improve ICT infrastructure >Approach to all planning work Organic approach to planning  Solutions that meets clinician, consumer need/expectations as well as achieving the targets and challenges  Dynamic, situational, iterative, flexible  Evidence based/best practice  Reforming approach – not about more of the same  Focused and targeted on specific areas Integrated approach – active engagement of health planners, clinicians, consumers, peak bodies  Achieving change in health culture – bringing people along on the planning journey  Health planners includes dept/regions

Service planning in a reform environment … >Planning tools New model of care Planning principles Networks & Senate Consumer/clinical HCA >Outcomes Reducing rate of growth in demand Achieve the health infrastructure that supports the new model of care Change in culture across clinicians and community to be active in new health paradigms Achieve workforce reforms eg. establish advance practice roles (eg NP)

System Reform/Health Care Plan GP Plus Strategy GP Plus Health Care Centres General Hospital Statewide Service Plans Country General Hospital Establishment Major Hospital Acute Operations System Service Redesign Clinical Networks COAG

Model of Care Components >Future patient needs Older, multiple chronic conditions >Contemporary clinical practice ambulatory options care management direct admissions multiple access points manage patients by acuity grouping patients with like needs, not by clinical speciality, patient journeys articulated by critical clinical decision making points managed exits better identification of patients - known patient (planned and unplanned occasions of care) and unknown patient (unplanned) >Advances in functional design for optimal healing separate out elective/emergency surgery >Advances in technology distributive imaging/interventional imaging ICT - clinical support

Statewide Service Plans >SA reform context is fundamental to aims to be achieved: Reflect the imperatives in the HCP and comprehensive reform program Integrated with other related service plans Active engagement and participation in the service planning process by clinicians and consumers eg Networks & Senate/HCA >An iterative process required to achieve final service model (12-18 months) >Evidence based/grounded in good practice >Consensus view – not an imposed solution >Final plans a blend of strategic direction and operational elements

Examples of practice change achieved by collaborative approaches >Rapid activation systems: ST Elevation Myocardial Infarction (STEMI) protocol - reported 45 mins from ambulance call to angiography suite Hospital pre notification stroke protocol >Arthroscopy Review and Assessment Clinics (ARAC) - reducing the requirement for orthopaedics OPD attendances and surgery >24/7 Perinatal Consultant Advice Line – improved patient safety particularly for country regions >Older people rapid assessment teams in EDs >Increase role of cancer MDTs in planning of care ‘Collaborative corridors’ in GP Plus centres (community allergy services)

Outcomes/impacts of planning reform >Shifting ambulatory sensitive illness out of hospitals into primary care >Achieving reduced rate of growth in demand >Managing services across multiple care sites >Acknowledgment of achievements by clinical sector

positive commentary: culture change achievement >“I feel it is important to acknowledge that the work coming from SA is very much a State Government supported and sponsored initiative without which the 60 page document that will be released shortly would not have been produced. It also points towards a template for engagement with state and federal governments when it comes to advocating for stroke. In our case our state government responded positively to a rather negative report about stroke services in SA based on the NSF audit. They appointed a pro-active stroke chair of the stroke clinical network who in turn has been able to engage in a bilateral conversation with the Department of Health to deal with key workforce gaps based upon a year long stroke service activity report compiled by 2 very passionate stroke advocates. But at the end of the day we also have to acknowledge a debt of gratitude to key members of the executive of the Department of Health who are advocates for and also monitor the implementation of the SA stroke plan and have a close working relationship with our state chair… >This type of cooperation between government, a service network and clinicians should be something that we should aim for on a national level.” From a stroke physician

Reducing rate of growth in demand Since the Health Care Plan was implemented, using the GP Plus Service Funds to effect change, the growth in metropolitan inpatient separations has reduced steadily from to The Health Care Plan set a target to reduce growth to 2 per cent per annum; in growth in inpatient services was 1.8 per cent.