Download 2013-2018 Strategic plan refresh - Royal Victorian Eye and Ear

2013-2018 Strategic plan refresh
Background paper- January 2016
Background paper to inform discussions and consultations on the strategic plan refresh
Introduction
The Royal Victorian Eye and Ear Hospital (The Eye and Ear) is a world class specialist
hospital in eye, ear, nose and throat (ENT) care, and is the largest public provider of
ophthalmology and ENT services in Victoria. As Australia’s only specialist eye, ear, nose
and throat hospital, the Eye and Ear has been providing care for the senses for 150
years.
The Eye and Ear has over 50 different outpatient clinics for the diagnosis, monitoring and
treatment of vision and hearing loss and provides a 24 hour emergency eye and ear,
nose, and throat service.
In 2014–15 the Eye and Ear cared for over 250,000 patients, with over 200,000
outpatients and over 40,000 emergency patients and over 14,000 inpatients.
The hospital provides medical, nursing and allied health training, with all Victorian
Ophthalmologist trained through the hospital. In collaboration with Universities and
research partners, the Eye and Ear undertakes world leading research.
A major redevelopment is currently underway to create a modern internal structure. The
redevelopment will be completed in 2018 and provides an excellent opportunity to
continue to build the hospitals capacity to provide safe, effective and efficient, patient
centred care into the future.
The hospitals current strategic plan was developed in 2013 and expires in 2018. Many of
the key actions, aims and objectives have been complete or are near completion and a
strategic plan refresh is required to ensure the hospital continues to work towards the
identified strategic goals.
The refresh process will not alter the identified strategic imperatives, but will update the
objectives and outcomes focusing on the next three years (2016-18), and will continue
reflect our Vision, Mission and Values.
Vision
Improving quality of life through caring for the senses
Mission
We aspire to be the world’s leading eye and ear health service by:
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Excelling in specialist services
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Integrating teaching and research with clinical services
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Leading workforce capability
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Partnering with consumers and community
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Building a sustainable future
Values
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Integrity
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Care
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Teamwork
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Excellence
Strategic imperative 1
Excel in innovative specialist Eye and Ear health services
Achievements
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Clinic established to provide specialist treatment for balance disorders
Cochlear services expansion with regional support services
Telehealth Eye connect device trialed- providing timely access to emergency
assessment for acute eye issues in rural settings
Australian Commission on safety and quality in health care national standards
achieved
New model of care implement for ocular trauma patients
New model of care for glaucoma patients based on risk stratification
Drivers and Data
System drivers
 Demand for care is growing faster than funding
 Increasing focus on service system integration, partnership & collaboration with
community based care playing a growing role in health care delivery.
 Not all Victorians have equal access to appropriate and timely healthcare or get
the same benefits. Compounding this, people with the same health care needs
can be treated very differently, with different outcomes, depending on where
they are treated (Health 2040). As a result there is growing pressure to reduce
variation in healthcare through use of protocol drive care.
 Address barriers to consistent outcomes for all Victorians. E.g. Aboriginal Health,
socio-economic disadvantage, mental health, disability etc.
 Optimally manage demand to ensure a balance between timely treatment for the
most urgent conditions, accessible highly specialist care and high throughput/
demand services.
 Ongoing financial constraints
 Need to harness the opportunity provided by telehealth and technology
Data
The Hospital provides a significant percentage of Eye and Ear care across the state
o 46% of Elective ophthalmology surgery in Victoria (with 40% of total
cataract surgeries)
o 12% of Elective ENT surgeries in Victoria
o 16% of ED presentations related to eyes, ear, nose and throat.
 75% of patients attend from the north west metro area and 10% from
regional/rural areas
Questions to consider
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What steps can we take to ensure consistent, equitable, safe, patient centred
care across the state?
What other opportunities do we have to partner with other organisations to better
manage demand and redirect care appropriately to the community?
How can we continue to build and embed our statewide role?
What top five things should the hospital be best known for?
What should we be doing more of and less of?
How can the hospital support consistency of health care outcomes and care
delivery?
Strategic imperative 2
Integrate teaching and research with ophthalmology and ENT
clinical services
Achievements
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Mandatory training matrix developed in line with National Standards
E-learning system implemented for mandatory and non-mandatory training
packages
New governance structure supporting teaching and training
Research strategy developed
Partnership agreement signed with research partners
Fundraising on track for new education centre
Signed partnership agreements in place with research partners and membership
of the Melbourne Academic Centre for Health
The Hospital is the parent hospital for training of 100% of the state’s
Ophthalmologists
Drivers and Data
System drivers
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Research funding shrinking in the context of a highly competitive market
Growing focus on research that can be readily transferred to practice
Promotion of simulation teaching methodology- implications for future teaching
and training
Online teaching and training development ensuring flexibility and accessibility
Consumers playing a larger role in teaching, training and research
Trend to better integrate teaching activities across professional disciplines
Question to consider
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How can we build greater collaboration between teaching and our research
partners?
What can we do to optimise the opportunity provided by the redevelopment to
build research and teaching?
How can we continue to promote translational research?
How can we align resources to further integrate teaching and training services,
reducing professional silos?
How can we streamline research education activities across the precinct
What opportunities exist to better integrate teaching activities across disciplines
at the Eye and Ear.
Strategic imperative 3
Lead workforce capability building for Eye and Ear health
services
Achievements
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Workforce strategy published
Nursing professional development plan progressed and evaluated
Allied Health Credentialing Committee developed
Team based models of care implemented in Glaucoma
Leadership and change capability framework developed
Aboriginal employment plan implemented
Drivers and data
System drivers
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Growing focus on leadership skills and behaviors, recognising the importance of
quality leadership at all levels to improve the quality of patient care
Ageing workforce
Highly fractional senior medical workforce
Workforce gaps- difficulty attracting and retaining highly skilled workforce
Growing need for changing skills and role flexibility in existing workforce –aligned
with changing need of the community (increase in multiple and complex health
care needs)
New technologies influencing the way we work
Move toward enhancing inter-professional teamwork
Balance demand for high quality generalist care and specialism
Data
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Average age of register nurse at the hospital is 48 and fractional specialist is 50,
10% workforce is over 60
Questions to consider
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How can we build capability to lead staff through the planned changes including
change in physical environment, models of care and service improvement?
How can we develop and retain our talent and improve job satisfaction?
How can we develop skills and competencies of current workforce to better meet
the needs of patients?
Which roles would an advanced or extended scope of practice better support
innovative models of care, improved efficiency and optimise patient outcomes?
How can we continue to support workplace health and wellbeing?
What steps can we take to better align our workforce with future demand?
What are our current critical workforce issues?
Strategic imperative 4
Partner with our consumers, communities and other
organisations to deliver improved eye and ear health
Achievements
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Comprehensive framework supporting consumer participation and volunteers.
Two fold increase in registered consumers with consumer involvement in service
improvement, working groups, committees and focus groups
Partnering with consumers and community plan 2016-19 launched
Aboriginal art work purchased and displayed, memorandum of understanding
signed with St Vincent’s Hospital supporting capacity building for Aboriginal
Health services. Funding secured healthy ears outreach service.
Glaucoma model of care developed in partnership with Australian College
Optometry
Habilitation partnership established for Cochlear services
Drivers & Data
System drivers
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Increasing demand for consumer directed care, fueled by increased community
expectations and evidence of improved outcomes
Growing role of primary and community care in service system with a focus on
system integration, partnership and smooth care transitions.
Development of patient centre outcome measures of healthcare effectiveness and
efficiency
Data
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The Eye and Ear provides care to a diverse range of patients with 17592
interpreter services provided in 2014-15, with 88 languages requested. The top
five language constitute 59% of the demand for interpreting (Greek, mandarin,
Vietnamese, Cantonese and Italian)
93% of patients rated overall experience as good or very good
Access to services, including; wait times for new, review appointments and waits
during Hospital attendance, is the most common area of concern accounting for
47% of all complaints
90% ED discharges and 69% inpatient discharges result in a letter to the GP
Questions to consider
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How can we build our capacity to provide patient and family centred care?
What can we do to continue to improve the patient experience?
How can we build relationships hard to reach and high risk communities to gather
feedback and optimise care outcomes?
How can we build our skills knowledge and understanding of our diverse patient
cohorts?
What teaching/ training could be undertaken to continue to build skills in
partnering with consumers?
How can we improve our communication with primary care providers?
Strategic imperative 5
Build a sustainable future
Achievements
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New models of care implemented for Acute Ophthalmology and Surgical
Ophthalmology resulting in a significant increase in surgical conversion rates
Clinical services plan developed
Digital Health Record including on line pathology implemented
Business intelligence tool expanded
Successfully undertaken decanting, process review and troubleshooting
supporting the redevelopment
Significant improvement in performance measures for the ED
Review referral criteria, waitlist validation project and other initiatives have
reduced the total patients waiting for a new appointment
Electronic medical record (EMR) strategy refreshed (for 2015-18)
Drivers & data
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Exponentially growing demand for health care services predicted for Eye and ear
conditions:
o Hearing loss predicted to increase by 50% by 2050
o By 2030 it is predicted that the number of people with Age related
Macular degeneration will increased by 70% (to around 1.77 million)
o By 2025 over 3 million Australians (currently 1 million) will have diabeteswith an estimated 15% developing Diabetic retinopathy
o By 2023 cataract operations will have doubled from 2003 rates
o By 2030 it is predicted that the number of Australians with Glaucoma will
increase by 202-213%
Demand for services currently outweigh supply and this pressure will grow
o Discharge rates for outpatients is 29% for Eye patients and 15% for ENT
o There are 13,915 patients overdue for a review appointment for eyes and
4017 overdue for ENT
o Overall surgical conversion rate for outpatient’s clinics is 6% eyes and 5%
ears. With the following surgical clinics conversion rate being: SOS 55%,
Otology 7%, Rhinology 17%, Head and Neck 12% and Acute Glaucoma
9%
Redevelopment and change agenda
Challenges & opportunities
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How can we use our data (internal and external) to improve efficiency and
sustainability?
How can we optimise the opportunity provided by redevelopment in terms of
improving efficiency and sustainability?
What further steps can we take to improve the safety and consistency of service
provision and effectively manage risk?
Are there any new or potential funding sources available to support service
provision?
What further opportunities does technology provide to improve efficiency and
sustainability?
How can the Electronic Medical Records support our clinical services planning and
delivery?