Statewide SA Retrieval Service

Looking back. Moving forward.

November 2008

Outline

• Background

• Change

• Where we are heading: Governance and leadership Retrieval Coordination Workforce Operations Training Clinical Governance Time lines

Background

> A few drivers of change• Risks

• Coronial recommendations

• Workforce dynamics

• Costs (Financial & other. Overt and hidden)

• Inefficiency, duplication and disintegration

• Benchmark comparisons

• Increasingly complex environments

• Service demand & future challenges

Progress

> Portfolio Executive -12/06> Director commences -10/07> Movement to Operations

Division -12/07> Strategy formation (SCAG)> Workshop -12/07> Discussion paper -2/08> Project plan development> Road show and stakeholder

consultation (ongoing)> Feedback review - 5/08> International visits 5/08> Workshop 2 - 6/08> Movement to CNAHS – 7/08> Governance & leadership> Re-defining model (ongoing)> Implementation

Change…………

‘It is not the strongest of the species that

survive, nor the most intelligent, but the one

most responsive to change’

Charles Darwin

The wind’s of change……….

“The pessimist complains about the wind and builds walls.

The optimist expects it to cease……..one day.

The realist……….builds windmills”

The momentum of change

Change……….

> There will be a single Statewide Retrieval Service for SA.

> This will not be one of or a federation of existing services.

> Current service delivery strengths will be extended.

> We will develop a service for the present but most importantly for the future

> There will be three core components to the new service……..

Core components – SA Retrieval

Retrieval Coordination (Retrieval and transport)

PNPR*Adult Retrieval &Rapid Response

*PNPR = Paediatric, neonatal and perinatal retrieval

GovernanceMinister for Health

SA Health

CNAHS

‘SA Retrieval’ (Name TBC)

Retrieval Clinical Coordination

Adult Retrieval & Rapid Response

Paediatric, Neonatal and Perinatal Retrieval

Leadership> Director, Statewide SA Retrieval Services

• Increasingly operational

> Clinical Directors• Retrieval Coordination• Training and Standards• Paediatric & Neonatal Retrieval

> Nursing • Director (L5)• Operational/Management (L4)

> Paramedical • Team leader

> Project & administrative team• ASO 3 and 6

Retrieval Coordination

> One centre

> One number (+ ‘000’)

> Co-located with SAAS

> Retrieval and transport

Retrieval Coordination

> Multi-agency coordination:• Health (Medical and SAAS) and RFDS

> Best practice models:• National• International• Clinical network integration

> Innovative ideas:• Workforce (Critical Care Nursing)• Process• IT and technology

Asset tracking Teleconference Telemedicine and video streaming Tasking & CAD systems Point of care data entry (Victorian

Ambulance Clinical Inform. System)

> Clinical Governance and audit

Workforce

> The right people (skills, knowledge and attitude)

> Retrieval team:

• Familiarity Each other Equipment Environment

> Clinical> Other

• Safety Team Patient

• Flexibility Across tasks Across platforms

• Redundancy

• Efficiency and effectiveness

• Avoidance of a ‘split system’ within adult service

National Comparisons – Adult Retrieval

STATE TEAM COMPOSITION

NSW

(non-regional)

R: Doctor & SCAT Paramedic

H: Doctor & SCAT Paramedic

F: Doctor & Flight Nurse

Queensland

(major centres)

R: Doctor & IC Paramedic

H: Doctor & IC Paramedic

F: Doctor & RFDS Flight Nurse

Victoria R:MICA Paramedic +/- Doctor

H:MICA Paramedic +/- Doctor

F:MICA Paramedic +/- Doctor

ACT

R: Paramedic + Doctor

H: Paramedic + Doctor

F: N/A

Tasmania

R: N/A

H: Paramedic

F: Doctor & Paramedic

WA

R: N/A

H: Paramedic +/- Doctor

F: Doctor + RFDS Flight Nurse

Northern Territory

R: N/A

H: N/A

F: Doctor + Flight Nurse

South Australia

R: Doctor + Retrieval Nurse

H: Doctor, Retrieval Nurse (IHT) and Paramedic (1°)

F: Doctor, Retrieval Nurse and RFDS Flight Nurse

Adult team flexibilityAcross platforms. Across tasks

Workforce

> Adult & RR (team of 2)• Medical

Consultants Fellows Registrars

• Paramedic/Nursing Dual qualification? ‘Practitioner’ level

> N&P (team of 2)• Medical

Consultants Fellows Registrars

• Nursing ‘Practitioner’ level Neonatal & Paediatric

Relatively small groups performing complicated tasks frequently

Operations

> Dedicated service capacity• Adult (up to 3 teams)• Neonatal & Paediatric (1 team)

> Operational base issues• Interim

Old CHC base• Long term

Joint Emergency Services? Assistance?

> Improve:• Rapid Response capacity• Team development/CRM• ‘Empty leg’ helicopter costs• Service identity

> Allow:• Service expansion

Training

> Post-graduate educational opportunities• Supported• Aiding recruitment and retention

> Harness in-house resources• Personnel, other agencies, experience…..

> Links with developing National programs• JCU

> Actively encourage Research

> Actively encourage innovation

> Standardise safety training

> College re-accreditation

Clinical Governance

> ‘A culture of safety’• Open, multi-agency and

qualitative processes

> Continuous service enhancement

• Closed loop processes• Links with ongoing training• Relevant KPI measures

> Supported training• TeamSTEPPS• CPI program• TRM course

> Alignment with State, National and International quality and safety frameworks

• AIMS

Timelines

July 2008 (Governance and leadership)

January 2009 (Service models)

January 2010 (Implementation)

Stage 1

Stage 2

Stage 3

Rural workforce support/engagement

> Coordination• Point of contact• Advice, transport and/or retrieval• Network integration

> Response• Time• Standardisation

> Training opportunities

> Clinical Governance and audit• Feedback• Q&S• Research

My commitment

> To deliver a…• safe

• rapidly responsive

• innovative

• sustainable

• efficient

• effective

• leading

• patient focussed

• outcome driven

> service for the SA Health Care region

Where we are heading……..

“Leaders who inspire realise there will always be rocks in the road ahead of us.

They will be stumbling blocks or stepping stones; it all depends on how we use them.”