The CQI Collaborative dates have changed.

The CQI Collaborative will now be held on 30-31 October 2018 and will be held at the Alice Springs Convention Centre.

The AMSANT Communicare forum/eHealth workshop will be

held after the CQI Collaborative on 1-2 November 2018.

SAVE THESE DATES IN YOUR CALENDAR NOW.

We look forward to working closely with you throughout the year.

Kerry, Louise and Haidee – AMSANT CQI Team

Edition 1 - 2018 In this Communique you

will find:

Page 1 -2: Laynhapuy using Telehealth successfully with people in

the Homelands

Page 3: Sunrise Health Service

Population Health Team – Program Logic

Page 4: CQI in the NT

Edition 1, 2018

1

Laynhapuy using Telehealth successfully

with people in the Homelands

There are many reasons I love working for Laynhapuy Homelands Health team. I love the developingrelationships with people in the homeland communities and the Laynha Health team itself. While not alwaysenjoying it, I appreciate the uncomfortable space between my Napaki world view and living on Yolngu landand working for Yolngu. The people are warm and generous through sharing culture, inclusive in ceremoniesand forgiving when we make mistakes. I enjoy the richness of shared stories and acceptance that developsas relationships become stronger. My biggest struggle is that of ownership. I find it difficultto facilitate Yolngu control over their health and the facilities that enable their health within their own viewof health and wellbeing. I’m not alone in this conflict and realise to offer good health care, not just medicationfor disease prevention, we need to be listening to Yolngu knowledge todevelop meaningful health messages within Yolgnu context. And to hand over the control button.

Laynha Health provides a primary health service to homeland communities. The community clinics aremanaged by community health workers who are responsible in coordinating the medical team, maintainingthe clinic and seeing patients and consulting as they need. Our video conference facility takes a step towardYolngu control of health.

Last year AMSANT set up facilities for videoconferencingin three of the larger Laynha homelands. The facility canbe operated remotely by our healthworkers giving access for people in the remotecommunities to our Laynha office, our medical director inSydney and to specialist services outside North EastArnhem land. Our health workers operate the equipmentindependently. I have participated in videoconferenceswhen visiting the clinics but this week I was able tofacilitate a meeting with a Darwin surgeon and a patientthat was a demonstration of the value of the facility.

A woman diagnosed with duodenal cancer was faced with making the difficult decision about having a hugeoperation that she may not survive or the consequence of the cancer left unchecked. She had travelled toDarwin with her daughter before Christmas and had a clear knowledge of the options for treatment offeredalong with the risks she faced. However there were many unanswered questions and the story was a oneway story – the story she was given rather than the story she and her family had to tell. In Yolngu culture itis appropriate that family other than the patient to make important decisions and this is done through firstfinding out all parts of the story. They needed to hear the story and to tell their part of it.

The clinic room was chocked full of people with other family looking in and listening from outside the windowand overflowing into the storeroom. Prior to the teleconference we discussed what the family wanted toknow. The woman wanted to tell her story about feeling well and believing her and her family had cured thecancer through prayer and strong Yolgnu foods. She wanted to know if the cancer was gone. She also wantedto know if the surgeon was a good man.

Cont. over page

Edition 1, 2018

1

Her husband explained to the surgeon that healingin Yolgnu ways involves special foods and that theyhave strong Christian faith and belief in prayer andthey needed to do that first. The surgeon was ableto respond to requests to repeat the test toconfirm cancer prior to going any further. Heappreciated Yolngu means to make the womanwell and we talked about both ways healing -Napaki and Yolgnu working together. He also tolda straight story. When she asked if she would bealive in five years without the operation he wasclear. Without surgery the lump would grow andblock her food pipe and she would not live for 2years. Thankfully, he had discussed her case withcolleagues and was able to offer smaller surgery with less risks, considering her comorbidities including lungdisease. When asked if she would be alive in five years if she did have surgery, he explained that although hecannot make any promises, he believes she has a good chance with the surgery and that he would only dothe surgery knowing she has a good chance. This straight talking and his ability to listen and incorporatefamily beliefs helped her believe he is a good man. He offered further chance for discussion throughvideoconference.

Although it wasn’t clear what direction the family would take during the videoconference, when I talked tothem that evening in their house, they were happy with working both ways and were keen to go for furthertreatment after another week of Yolgnu healing. She had beside her ground bush plums and berries.

I found that it was easier to pass on her wishes to the surgical team after the teleconference. Rather thannegotiating an often faceless system, having met the consultant nurse on screen, the procedures were easilydiscussed and arranged to create as little uncertainty as possible whilst ensuring the preparation timeneeded. I think the surgical team better appreciated the patient's needs and looked for the best ways tooffer services.

Teleconference has shown itself valuable in other ways. Many family conferences coordinated by the healthworkers with our Sydney based doctor, who is well known and loved through his time spent in Laynhahomelands, have provided valuable stories about complex health management. Three way conversationswith specialist health teams in Darwin enable health care planning to happen in real time. The technology iswell received by people in community.

We have not had long to expand the ways in which this technology canbe used but its easy accessibility to people in community appears toreduce barriers both ways - to help clinicians understand the ways inwhich health decisions are made and to provide community withaccess to expert health care.

Penelope Gibson, RN RM

Edition 1, 2018

3

Sunrise Health Service Population Health Team

– Program Logic

It has been a privilege and a lot of fun working with the SHS Population Health Team over thelast few months to assist them in developing a Program Logic Framework for the work theyare doing. For those who don’t know, a Program Logic helps you to clarify what your short,medium and long term goals are for your team or program area, the specific activities youneed to do to achieve them and to identify the resourcesyou have or will need to help you achieve your goals. Italso helps you to be really clear about who you need toinvolve in the process.

We also learnt a lot of new CQI tools and effective teamworking skills. It is always a pleasure working with teamsof people who are passionate about the work they doand I have thoroughly enjoyed working with thePopulation Health Team at Sunrise. I am looking forwardto the final workshop.

Kerry CopleyTE CQI Program Coordinator

Edition 1, 2018

4

CQI in the NTA Planning Day was held 1 March 2018at Jabiru Health Centre. Usingresources such as Strategic Plans,Operational Plans, PHC Framework anddata from monthly reports,achievements and gaps were discussedand an Action Plan developed. This willbe reviewed three monthly.Gunbalanya and Minjilang have alreadyheld their planning days. WarruwiHealth Centre Planning Day isscheduled in April.Vicki Chamberlain

HiHo, HiHo, it’s off to school we go in Katherine region. February and March busywith training: Point of Care STI, now we can screen for Gonorrhoea and Chlamydiain 45 minutes (that should improve the KPI!) P3 training in AggressionMinimisation, Stryker stretcher and BLS to name but a few sessions. March saw 3of our newly qualified AHP’s attend the About Giving Vaccines course in Katherine.

On the 28th of Feb Kerry travelled to Borroloola at dawn to facilitate a SAT for theteam. There was representation from all the employment streams, which wasfabulous and some honest and robust discussion, reflective of the teams comfortwith each other. The report done, and shows a steady improvement in thefunctionality of the team and system, and that is what we want. Big thanks to Kerryfor facilitating and staff who took care of business at the health centre on the day.

Our only failing from the SAT was no group photo but I did get this snap on the wayhome – Plum Tuckered Out she was!Monica Ostigh

We would like to welcome two new CQI Facilitators to the team. Zoe Evansand Annalise Thompson from Katherine West Health Board who will besharing the CQI role and combining it with their regular Health CentreCoordinator roles. Zoe is the Timber Creek Health Centre Coordinator andAnnalise is at Lajamanu. They will be doing 10 weeks in the CQI role andthen 10 weeks in the HC Coordinator role and rotating.

The photo some of the team Timber creek (KWHB). They are showing theportfolios they use for recalls and follow ups. Each staff member takesresponsibility for 2 portfolios to ensure they stay up to date with all recalls,referrals and appointments. Each month they handover the portfolios to the rest of team to ensureeveryone stays up to date.Zoe Evans