1. Achieving NEAT Forum 2013 “Transforming NEAT Performance: The Executive Role Dr Richard Ashby AM Chief Executive Metro South Health Brisbane, Australia

2. Introduction and Background Metro South Health Health in Metro South 7 Public Hospitals 17 Community Health Centres 1 Residential Aged Care Facility and 2 Special PurposeFacilities Plus 600 General Practices, Allied Health Clinics and Community Pharmacies 5 Private Hospitals >150 NGOs 3856 sq Km 4 Local Government Areas 122 SLAs >1,000,000 Residents 2.1% Indigenous 28% Born Overseas 22% Socially Disadvantaged 12,000 staff $1.85 Billion

3. Metro South Health Metro South activity in 2012-13 186,886 hospital admissions 42,804 operations 713,238 outpatient attendances 249,608 emergency department attendances 464,874 community health occasions of service 8.9 million Medicare services (Commonwealth)

4. The Challenge 2012-13 Metro South Health Governance New Board, Executive Structure, 47 new functions Funding Upfront Productivity Dividend $60m 2012/13 MYEFO cuts ($18.8m) 2013/14 Growth (1.5%) 2013/14; 2014/15 ABF Funding Activity Compound activity growth 3-4% pa, ED growth 6% (Population 2.4%) Time Limited Redundancy Program Mandatory MOHRI Reduction = 650FTE +Complex Services returning Organ and Tissue Transplantation TB Services Public Health

5. Metro South Health Overall Performance Highlights 2012-13 Operating Surplus $19.3m (2010/11 $41m deficit) MOHRI FTE 710 (6.5%) Activity exceeded target by 6260 WAU ($25m) Total productivity dividend >$100m NEAT 52%  73% (PAH 28%  66%) NEST Cat 1 8% Cat 2 3% Cat 3 10%

6. Metro South Health Overall Performance Highlights 2012-13 cont’d Ambulance “bypass” ceased, ramping reduced >50% Emergency Department “DNW’s “reduced 50% Hospital Standardised Mortality Rate <70 all facilities Relative Stay Index <90 all facilities Cost per WAU < National Efficient Price Patient Satisfaction >90% PAH –”best clinical governance system in Australia” (ACHS 2013) (45% “Met with Merit”, No recommendations) Highest research funding ever.

7. Transforming NEAT Performance Princess Alexandra Hospital

8. Wooden spoon Courier Mail 14/12/12 NHPA report 2011-12

9. Metro South Health What was happening at PAH? 840 bed tertiary hospital serving Metro South HHS –Trauma Centre, Cardiac Centre, Transplant Centre, Cancer Centre –40% admission rate with 90% occupancy –56,000 ED presentations at PAH; 50% arrive by ambulance; New ED opened November 2010 –25 acute cubicles and 5 resus bays –Mental Health Assessment Unit –Ambulatory Care, 14 bed Short Stay Ward –In-house Radiology New Medical Assessment and Planning Unit (MAPU) opened February 2011 –30 beds (including Chest Pain Centre)

10. Ramping at Princess Alexandra Hospital Early Initiatives

11. Metro South Health February 2012 – “a seminal moment” Royal Perth Hospital 90% of discharged patients meet NEAT Princess Alexandra Hospital 26% of discharged patients meet NEAT

12. 2012 ED Cultural Change

13. Metro South Health KPMG Its Time Project – Jan-Aug 2012: February 2012: NEAT Forum; Clinical Council March 2012: ED Short Stay Ward process June 2012:ED consultant in Ambulatory Care June 2012:Changes to Mental Health patient processing and rapid transfer to MH waiting area June 2012:Avoidance of unnecessary transit through ED for some admissions

14. Metro South Health Other Interventions NEAT Taskforce; NEAT Clinical Review Improved data and reporting (Daily) Improved patient flow and bed management Logistics Nurses “No bypass” rule (October 2012) Study Tour – Royal Perth, SCG, Alfred etc.

15. Metro South Health Outcomes: PAH: NEAT February 2012 (27.6%)  October 2013 (65%) NEAT Admitted (31%), NEAT Discharged (78%) ED Waiting TimesATS1100% ATS288.8% ATS376.1% ATS488.1% ATS597.7% Patient off stretcher 30 minutes (90%) Did not wait0.9% (2011- 8%)

16. Metro South Health

17. The Challenge: NEAT TargetED Discharge in 4 hours Optimised Admission in 4 hours required 70% (2012)95%26% 77% (2013)95%46% 90% (2015)95%82%

18. Metro South Health

19. Executive Role: Lead Change!! Create “burning platform”. (Reputation, quality, funding) Establish diagnostic and clinical redesign processes – no two hospitals are the same! Establish and empower clinician-led change group (NEAT Taskforce) Focus on largest cohorts with the worst performance Monitor safety Reinforce success!

20. Metro South Health Thank you….. Questions?