Laureen Hines – CARU Queensland Health
Moira Goodwin – Silver Chain
Rebecca Bell – Blue Care
The Road To The
Horizon
The Road To The Horizon Growth outstripping supply
Major health care reform
HHS are statutory authorities
National and state funding reform
National targets (NEAT and NEST)
New Beginnings
New Beginnings Need to:
Work smarter, not harder
Look at redesign and reform practice
Partner to deliver innovative models of care Department –The Blueprint for better healthcare in
Queensland Four principal themes:
• Health services focused on patients and people. • Empowering the community and our health workforce. • Providing Queenslanders with value in health services. • Investing, innovating and planning for the future.
Light On The Horizon
Light On The Horizon Hospital In The Home (HITH)
provides care in a patient’s permanent or temporary residence
acute conditions requiring clinical governance,
monitoring and/or input otherwise require treatment in the traditional inpatient hospital bed.
focused exclusively on acute admitted care substitution.
HITH has been identified as an opportunity to
Support patients with greater choice in their care,
improve access to health services,
equal or better patient care outcomes,
improve efficiencies in service delivery.
To underline the importance the state budget allocated $28 million (over four years).
Mode of delivery is via Public Private Partnerships
Horizon Scan
Horizon Scan Consult with interstate colleagues
Consult with MDT stakeholder group Clinical HHS
Departmental
Property
Contestability
Two stage procurement process (geographical diversity, ability to deliver, DRG, scalability and quality)
Contract development (Safety and Quality and governance included)
View of Success
View of Success
Blue Care – Metro South and Townsville
Silver Chain – Metro North and Sunshine Coast
The Silver Chain Group comprises of Silver Chain in Western Australia, New South Wales and Queensland and Royal District Nursing Service (RDNS) in South Australia. Together, we are one of the largest in-home health and care providers in Australia.
Silver Chain and our partners RSL Care and Telstra Health will support patients to plan their care and recovery, providing the patient with the option to receive their health care needs, as appropriate, in their own home.
The Silver Chain led team is professionally trained to deliver to our patients quality services and coordination of their care requirements.
Silver Chain Hospital in the Home HITH PPP QLD
Presented by Moira Goodwin Silver Chain State Manager, Queensland March, 2014
Blue Care NFP operating for more than 60
years
Leading service provider in residential aged care, community care and retirement living
Operates more than 260 centres in 80 communities across Queensland and northern New South Wales
Hospital in the Home partnering with Medibank Health Solutions
Design example
QLD PPP Joint HITH Governance
QLD State HITH
Joint Governance Committee
HHS HITH
Joint Governance Committee
HHS HITH Committee
HHS HITH Working Groups
Provider Board
Executive Governance Committee
Provider Clinical Management
Committee and Medical and Quality
Safety Committee
HHS Board
Executive Governance Committee
Learnings Adjustment Advice Action
Contestability PPP contract implementation
Consider PPP contract management logistics
Contract management relationship building between key Queensland Health and provider to collaboratively implement contract focussing on service sustainability. Ongoing governance and support required - provides platform for escalation of issues.
Clarify HITH need
Understand HHS view of their HITH access problem
Localise HITH model effectiveness to the HHS and to each of the referring Hospitals. Collaborative approach.
Engagement with HHS
Consider PPP impact and workflow changes to implement PPP HITH model
HHS and provider alignment of continuous workflows with collaboration to co-design incorporation of PPP as a component of HHS service delivery
Learnings Adjustment Advice Action
Leadership commitment to PPP contract implementation
Clarification of HHS goals to utilise HITH Tier 1 PPP funding
Collectively agree on implementation communication and joint communication messages to commit to effective uptake of available funding. Change management implementation
Increasing choice in options for acute care delivery.
Multi mode engagement, communication and marketing strategy.
Localise strategy to each hospital to increase acceptance of accessible and responsive options for safe care delivery via HITH model.
Engagement with HHS for HITH design.
Design value target problem DRGs and co-design protocols and pathways.
DRGs simple and complex where appropriate. Clinical Review Committee advice and agreement on protocols and pathways.
Learnings Adjustment Advice Action
Cultural shift enabling acceptance of PPP
Repeated communication from HHS/hospital executive to all levels regarding PPP.
Collaborative working between existing service staff and new service staff. Shared understanding of ownership and changes required. Medical safety and quality.
Messages to be communicated to all involved
Communication and relationships are key. Gain understanding of local processes as starting point
Work with key champions to enable local discussions and trust. Ensure processes are agreed on and clearly understood and regularly reviewed.
Local PPP governance oversight
Relevant representatives to reach process agreement early to enhance referrals.
Messages to be shared through a variety of communication and education options with clear referral processes and minimum documentation.
Learnings
Adjustment Advice Action
Gain trust from referring medical officers and nurses
Understand the requirements of potential referring doctors and nurses
Simplify referral processes Minimum referral documentation Flexibility in medical oversight: provide medical oversight and allow retention of medical oversight Flexibility around DRGs – patient safety first approach
True hospital substitution
Provision of 24 hour acute care
Acute care nursing Flexible 24 hour customer centre Web-based interactive real time care plan forum, includes clinical photography. Mobile devices Video conferencing Medication and diagnostics
Learnings
Adjustment Advice Action
Workforce design alignment to local HITH model requirements
Workforce learning and development processes and competency achievement shared with HHS.
Collaborate with HHS to build confidence in skills, knowledge and capacity to deliver agreed referred care requirements.
Introducing options of Medical Governance.
Direct engagement with HHS referring doctors to confirm governance requirements.
Localise medical governance options including internal HHS Medical Governance and co-design an option VMO HHS credentialed Medical Governance.
Evaluate value of safe and quality PPP HITH service.
Consider evaluation capability requirements at EOI stage.
Multi internal coordination of data linkages to produce reports and complete formative and substantive evaluation.
Learnings
Adjustment Advice Action
Information management system design alignment to HHS
Early identification and analysis of patient information management systems and potential IT interface issues
Work with key IT and system analysts to establish dual IT required modifications and enhancements to enable effective planning for HITH implementation
Collaborative approach to documentation development
Documentation design to meet requirements of all parties.
Identify key contributors to documentation development – policy, access, clinical, safety, pt. information, etc. Streamline referral pathway and minimise duplicate information handling.
Learnings Adjustment Advice Action
Quality and safety
PPP HITH provision should align with hospital quality and safety standards.
Clinical incidents are reported to a risk management system. Clinical risk management plans focus on patient journey from admission to discharge. Clinical review committee Antibiotics/antimicrobial stewardship. Utilisation of Q-ADDS. Reporting against quality performance indicators within PPP contract drives quality of HITH service delivery, eg. pt satisfaction.
Bright Future
Bright Future
HITH Activity 1st Feb-21 Jan
Hospital Health Staff
Questions?
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