Annual Report 2012–13 The Alfred 55 Commercial Road Melbourne Vic. 3004 Telephone: (03) 9076 2000 Facsimile: (03) 9076 2222 Caulfield Hospital 260 Kooyong Road Caulfield Vic. 3162 Telephone: (03) 9076 6000 Facsimile: (03) 9076 6434 Sandringham Hospital A n 193 Bluff Road n u Sandringham Vic. 3191 a l Telephone: (03) 9076 1000 R e Facsimile: (03) 9598 1539 p o r t 2 0 www.alfredhealth.org.au 1 2 Leading care – 1 3 ABN 27 318 956 319 CGoonveternntasnce Our vision About Alfred Health 1 Chairman and Chief Trusted to deliver outstanding care Executive’s Review 3 Our mission Employees 6 Highest-quality clinical practice: Delivering Quality Care 9 > Delivered in partnership with patients, carers, the community Performance 13 and other healthcare providers; Research through Partnership 19 > Enabled through innovation, research and education. Projects 22 Our values Community Support 23 Integrity Governance 25 We engage others in a respectful, fair and ethical manner, Disclosure Index 34 fulfilling our commitments as professionals and employees. We ensure the highest degree of dignity, equity, honesty Financial Statements 35 and trust. Notes to the Financial Statements 42 Accountability We show pride, enthusiasm and dedication in everything that we do. We ensure quality patient care and use resources appropriately. We accept professional responsibility for all our decisions and actions. Collaboration We consult and collaborate with others and respect the diverse knowledge and skills of our partners; working as a team we ensure the best inter-professional patient care. Knowledge We create opportunities for education and are committed to continuous development. We enable everyone to make knowledge-based decisions. About this report This annual report outlines the operational and financial performance for Alfred Health from 1 July 2012 to 30 June 2013. It covers the activities at Alfred Health’s three locations – The Alfred, Caulfield Hospital and Sandringham Hospital. The relevant Minister for the reporting period was the Minister for Health and the Minister for Ageing, the Hon. David Davis MP. Alfred Health is a metropolitan health service established under section 181 of the Health Services Act 1988 (Vic) in June 2000. Established as Bayside Health, the name was changed to Alfred Health from 10 September About the cover: 2008, by order of the Governor in Council. Alfred Health’s Emergency and Trauma Centre is one of the most advanced and recognised in the world, treating more than 6,500 trauma patients in 2012–13. This report is available on line at: www.alfredhealth.org.au/publications Team members (L–R), Dr Sean Arendse, Nurse Tim Phillips and Nurse Rosie Perkins are captured at work. About Alfred Health 96,372 6,568 11,124 episodes of trAumA pAtients elective surgeries inpAtient cAre treAted performed 92,197 450+ emergency depArtment Alfred HeAltH presentAtions volunteers (admitted and non-admitted) Alfred Health is a leading major metropolitan health primary and secondary catchment service, serving more than 680,000 people living in and key campuses Melbourne’s bayside and inner southeast area. We strive to provide the best possible health outcomes for our patients and community by integrating clinical practice with research and education. Melbourne – Remainder Melb – We provide the most comprehensive range of specialist Melb – S’bank inner medical and surgical services in Victoria. – D’lands Port Phillip – West While best known as one of Australia’s busiest trauma The Stonnington centres and home to the largest and most advanced intensive Alfred – Prahran Stonnington care unit in the region, Alfred Health provides a range of – Malvern specialist statewide services to the people of Victoria. Port Phillip – St Kilda Caulfield These services include Cystic Fibrosis, Heart and Lung Hospital Transplantation, Adult Burns, Clinical Haematology Unit Glen Eira – Caulfield and Haemophilia, Malignant Haematology and Stem Cell Bayside – Transplantation, Sexual Health, Victorian HIV/AIDS, Brighton Glen Eira – South Hyperbaric Medicine, Victorian Melanoma, Rehabilitation and Psychiatric Intensive Care. Bayside – South Alfred Health services are provided from three locations: Sandringham The Alfred, Caulfield Hospital and Sandringham Hospital. Hospital Kingston – North The Alfred is a major tertiary referral teaching hospital. We have a strong commitment to research, undergraduate and postgraduate training for medical, nursing, allied health and other support staff through partnerships with Monash University and La Trobe University. We also have important research and development links with the Baker IDI, the Kingston – South Burnet Institute and Monash University, our partner in the Port Phillip Alfred Medical Research & Education Precinct (AMREP). Bay We are recognised as a national pacesetter, consistently linked to progressive developments in healthcare practice, medical research and teaching. Our focus is on leading Primary catchment (380,000+) clinical service development and implementing new models Secondary catchment (297,000+) that deliver accessible, efficient and quality care for our Source: Adapted from an Australian Bureau of Statistics map patients and community. ALFRED HEALTH ANNUAL REpoRT 2012–13 1 About Alfred Health Statewide services > cystic fibrosis service > sexual Health service > Heart and lung transplant service > victorian Hiv/Aids service > major trauma service > Hyperbaric medicine service > victorian Adult Burns service > victorian melanoma service > clinical Haematology unit and > rehabilitation services Haemophilia services > psychiatric intensive care service > malignant Haematology and stem cell transplantation service clinical services We provide the most comprehensive range of specialist medical and surgical services in Victoria. We offer almost every form of medical treatment across our three locations at The Alfred, Caulfield Hospital and Sandringham Hospital. > cancer services − Head Surgery > renal services > psychiatry − Bone Marrow − Neck Surgery − Nephrology − Adult − Transplantation − Urology − Child > gastrointestinal services − Adolescent − Radiotherapy − Haemodialysis − Gastroenterology − Youth − Oncology − Renal Transplantation − Gastrointestinal Surgery − Aged − Cancer Surgery > specialist medicine − Palliative Care > general medicine > residential Aged care − Clinical Immunology > general surgery − Geriatric Evaluation > cardiothoracic services − Clinical Pharmacology − Breast − Management − Heart and Lung − Dermatology − Endocrine Transplantation − Endocrinology/Diabetes > rehabilitation − Colorectal Surgery − Cardiology − Hyperbaric > community programs − Cardiac Surgery > infectious disease − Infectious Diseases − Melbourne Sexual − Cardiac Rehabilitation treatment services − Rheumatology Health Centre − Respiratory Medicine − HIV/AIDS − Community Medicine > specialist surgery − Alcohol & Drug Services − Thoracic Surgery > neurosciences − Dental Surgery − Carer Support − Adult Cystic Fibrosis − Neurology − Faciomaxillary Surgery Programs > emergency medicine − Neurosurgery − Plastic Surgery − Community Health − Intensive Care > obstetrics & gynaecology − Vascular Surgery − Burns > orthopaedics − Adult Major Trauma > eye and ear, nose & throat 2 Chairman and Chief Executive’s Review Highlights 2012–13 > Timely Quality Care initiative introduced to improve patient experiences > Acquired Brain Injury Unit construction underway at Caulfield Hospital > Monash Partners Academic Health Science Centre launched > Partnership with the Royal Women’s Hospital announced > Accreditation under new national standards achieved 2012–13 saw Alfred Health maintain its status as one of the trusted with care best-performing and most trusted health services in the country as we strove to deliver outstanding care, not only by In June 2013, Alfred Health became the first major meeting the performance targets that govern public health metropolitan health service in Victoria to achieve accreditation service performance, but by exceeding them. under the new National Safety and Quality Health Service Standards (NSQHS). Demand for care remained high across our community. We saw more patients requiring emergency care, accessing This set a new benchmark, not only for ourselves but for outpatient services and benefiting from rehabilitation health services throughout the state. Most importantly, expertise than ever before – all achieved while maintaining it means our patients and local community can be assured the sound operating result of $0.11 million in a climate of that all our services meet the rigorous standards applied financial change. to the delivery of modern public healthcare. Need remained strong across our trauma program, which Our Patients Come First strategy – the organisational provided specialist care for close to 1,200 critically injured framework supporting consumer, carer and community patients with multiple life-threatening injuries, and more than participation – gained momentum this year and we continued 5,300 less serious traumas. Each arrived by air or road, and to work closely with our Community Advisory Committee with all required urgent medical attention. its ongoing implementation. If 2011–12 was about meeting growing demand for healthcare, commitment to research this year was about innovative service redesign and new models of care. The Monash Partners Academic Health Science Centre took its first steps in 2012–13. In November 2012, we introduced Timely Quality Care (TQC), a team-based initiative to help ensure all patients receive A collaboration between public and private health services timely, high-quality care consistent with their clinical needs. and research institutions, the centre aims to increase the pace and scale of research by linking it directly with clinical While this principle applies to all patients, for those visiting practice. emergency this means prompt and upfront assessment by the most senior doctor available, reducing time spent waiting. Researchers and clinicians are already working across major themes such as cancer and blood diseases, cardiovascular Advancing on more traditional models of triage, the disease and trauma to improve health outcomes. implementation of TQC resulted in three in every four emergency patients being seen, then discharged or admitted We are proud to be a founding member of Monash Partners, within four hours of arrival. With this achievement, Alfred working alongside Baker IDI Heart and Diabetes Institute, Health became one of only a small number of Victorian Cabrini Health, Epworth Healthcare, Burnet Institute, Monash hospitals to achieve the Federal Government’s four-hour Health, Monash University and Prince Henry’s Institute. wait target in 2012–13. ALFRED HEALTH ANNUAL REpoRT 2012–13 3 Chairman and Chief Executive’s Review Our other collective research entity is the Alfred Medical At Sandringham Hospital, the first stage of construction Research and Education Precinct (AMREP), which achieved of the hospital’s new Emergency Department was completed one of its most productive years ever. in June. In 2012–13, AMREP researchers secured more research With more than 30,000 presentations from local residents funding than any year since its formation in 2002. each year, the $6.5 million enhancement ensures the hospital At the same time they increased research publication can provide best-practice emergency care as demand for by almost 17 per cent on the prior year. services increases. Our staff played an important role in this growth, with several As part of the upgrades to Sandringham Hospital, the major and new NHMRC grants secured – across areas maternity ward was re-born through the much anticipated including trauma brain injury, anaesthesia and respiratory $770,000 refurbishment that delivered new en-suite medicine – ensuring research remains embedded in clinical bathrooms for all birth suites, an upgrade of patient practice at Alfred Health. bathrooms and an increase in post-natal beds. One of the most significant research discoveries of the year The redevelopment of maternity paved the way for a new at Alfred Health moved medical science a step closer to partnership with the Royal Women’s Hospital (the Women’s) finding a cure for HIV. that will see the transfer of maternity and gynaecology services to the Women’s. The Alfred made international headlines with news that a cancer drug alters how HIV genes are ‘turned on and off’, Due to take place in October 2013, the partnership between paving the way for further studies to find a cure for the virus. Alfred Health and the Women’s will ensure the long-term provision of a high-quality women’s health service in the When the Transcranial Magnetic Stimulation (TMS) Clinic bayside area. at the Monash Alfred Psychiatry Research Centre (MAPrc) opened in October 2012, it became the first clinic of its kind patient safety in a public hospital in Australia. Patient safety was given another boost with the introduction Pioneered by mental health experts at The Alfred, the of an Australian-first enhancement to support more accurate treatment uses a magnetic field to put the symptoms of requesting, collection and labelling of blood samples. depression into remission. This alternative treatment offers hope to the 30 per cent of patients diagnosed with clinical A new software package, called BRIDGE, was developed to depression who do not respond to medical or psychological link the hospital’s patient information system with the existing treatment. laboratory system. In addition to launching Australia’s first TMS Clinic, the With more than 2,000 requests for blood each day, the Minister for Mental Health, Mary Wooldridge, officially opened advancement improves accuracy, with pathology collectors Alfred Health’s new mental health precinct, which includes now armed with portable scanners to electronically the community-based St Kilda Road Clinic and the co-located cross-reference orders for blood with patients. Monash Alfred Psychiatry Research Centre. Antimicrobial stewardship rounds are also continuing to capital projects ensure appropriate and targeted prescription of antibiotics. As antibiotic resistance increases globally, hospitals are Progress on several infrastructure projects was made, with perfectly positioned to take a lead role to address appropriate construction on Caulfield Hospital’s $36 million statewide use of these drugs. rehabilitation service, the Acquired Brain Injury (ABI) Unit, Our multidisciplinary stewardship team reviews patients who commencing in January 2013. fall outside approved indications for antibiotic use and make Opening in 2014, the 42-bed inpatient unit, community recommendations to the treating team such as stopping rehabilitation service, and transitional living service, will antibiotics, changing doses or de-escalating to a narrower house specialist treatment for patients with moderate to spectrum drug. severe acquired brain injury. It will offer care from the early More than 80 per cent of recommendations made by the stages of injury through to rehabilitation and return to the stewardship physicians were adopted during the year. community. 4 Helen Shardey Andrew Way Board Chairman Chief Executive Healthcare awards ceo scorecard: 2012–13 Each year, the Victorian Public Healthcare Awards recognise Emergency Indicators Target Result excellence in public healthcare and, in 2012, Alfred Health was again among the winners. Alfred Hospital Health Leaders Award: The Alfred’s Direct Admission of < 4 Hr in ED (Jul to Dec) 70% 69% Referred Patients to the Acute Medical Unit (DART-AMU) < 4 Hr in ED (Jan to Jun) 75% 75% program received the Secretary’s Award for delivering > 24 Hr in ED 0 0 joined-up healthcare. Attendances N/A 58,823 The DART-AMU model links carer referrals directly to the Triage Seen in Time 80% 73% inpatient unit at The Alfred, providing opportunity for primary Sandringham Hospital care teams and general practitioners to access consultation and advice. In turn, the program allows patients who may < 4 Hr in ED (Jul to Dec) 70% 76% require admission, but not emergency resuscitation, to < 4 Hr in ED (Jan to Jun) 75% 79% bypass the Emergency Department. > 24 Hr in ED 0 0 Attendances N/A 33,374 Health Innovation Award: The innovative ambulatory very-low Triage Seen in Time 80% 81% intensity allogenic stem cell transplantation program was awarded for excellence in quality healthcare for improving outcomes for older patients with blood cancers by using clinical and practice innovations in stem cell transplantation. Elective Indicators Target Result Alfred Hospital Several other Alfred Health teams and programs were highly Cat 1 Admit < 30 Days 100% 100% commended at the awards, including the entries for patient- centred team-based ward rounds, the women’s mental health Cat 2 Admit < 90 Days (Jul to Dec) 75% 84% clinic team at Monash Alfred Psychiatry Research Centre, and Cat 2 Admit < 90 Days (Jan to Jun) 80% 77% advanced practice musculoskeletal physiotherapy services. Cat 3 Admit < 365 Days (Jul to Dec) 93% 99% Cat 3 Admit < 365 Days (Jan to Jun) 94.5% 100% our community HiPs 8 6.4 Alfred Health Alfred Health remains fortunate to have a dedicated community of staff, volunteers, donors and other supporters. Waiting List 3,059 2,319 Sandringham Hospital Our 450-strong volunteer group provided thousands of work Cat 1 Admit < 30 Days 100% 100% hours across Alfred Health. This was further supported by Cat 2 Admit < 90 Days (Jul to Dec) 75% 93% the goodwill of tens of thousands of donors whose generosity made a tangible difference to our patients – whether through Cat 2 Admit < 90 Days (Jan to Jun) 80% 95% the support of research or the purchase of additional Cat 3 Admit < 365 Days (Jul to Dec) 93% 100% equipment such as the $4.5 million 3T MRI machine. Cat 3 Admit < 365 Days (Jan to Jun) 94.5% 100% HiPs 8 3.5 A champion of our MRI campaign was Life Governor of The Alfred and Board member of The Alfred Foundation, Tony Charlton, who passed away in December 2012. His long-term support touched all areas of The Alfred and his contribution will be forever remembered. At the end of the reporting period, we farewelled Alfred Health Helen Shardey Board Deputy Chairman, Fiona Bennett, and Board Member Board Chairman Hannah Crawford, and thanked them for their contributions to the health service during their terms. 2012–13 was an important year, equipping us with the processes, facilities and relationships needed to meet growing demands and expectations. As we continue to attract the best Mr Andrew Way staff, engage in the best research and involve our patients Chief Executive in their care, the Victorian community can trust Alfred Health to continue delivering excellence in healthcare. ALFRED HEALTH ANNUAL REpoRT 2012–13 5 Employees 7,741 1,298 1,504 employees new employees stAff pArticipAted in work HeAltH cHecks 533 1.5 $ m employees received sAved in clAims service AwArds over tHree yeArs The year was marked by strong collaboration with staff in redesigning care models, building internal leadership and improving staff safety. redesigning care New e-learning programs were put in place to support professional education and increase accessibility of learning Alfred Health has a strong history of continuous improvement opportunities. These programs included modules on: and innovation, and 2012–13 was no exception. Substantial > safety, quality and patient-centred care work was undertaken to redesign the patient experience to improve care outcomes under the Timely Quality Care (TQC) > manual handling initiative (see page 9). > hand hygiene The Hospital at Night program, part of TQC, demonstrates > falls prevention. Alfred Health’s collaborative approach to work redesign. culture survey 2012 Aiming to transform patient care at night, this program involved the newly formed Junior Medical Officer Leadership A positive, cohesive and healthy culture emerged from the Group, patient representatives and nursing. findings of Alfred Health’s Culture Survey 2012, conducted Throughout the year, over 300 staff were directly included in between September and October 2012. Participation was high, TQC and a further 1,000 influenced the new model of care with more than 3,440 staff (44 per cent of all staff) completing through their feedback and participation. the survey from all sites and most work groups. Key findings were high levels of: education > trust that staff have in front-line management Building employee capability is vital to care excellence. > emotional commitment that staff have to Alfred Health. Many employee groups reported levels of intrinsic job New and emerging leaders along with unit heads were satisfaction well above industry comparison. involved in leadership development activities. This included the first Medical Unit Head Leadership Program. Further The major finding from the Patient Safety Survey 2012 was the developments are planned for 2013–14. improvement in key patient safety domains when compared to levels observed in 2008. Teamwork within and across units During the year, a comprehensive suite of professional uniformly improved, as did the frequency with which benign education programs was delivered across Alfred Health: errors were reported. More than 2,600 clinical staff took part > Nursing Education conducted 204 professional in the survey. development sessions attended by 2,276 participants. > Allied Health delivered 9,642 hours of teaching and training. recruitment > The Medical Education Unit continued to develop a series During the year, 1,298 new employees joined Alfred Health, of innovative programs for junior medical officers, including with over 90 per cent attending the corporate orientation a well-reviewed e-prescribing module. program. Overseas recruitment of health professionals continued to complement our workforce supply and 6 120 100 100 106 108 90 102 80 90 87 80 72 69 60 72 s 69 s m m 60 64 64 Clai 60 Clai 51 51 40 46 45 40 47 46 45 20 20 capacity. In 2012–13, we saw an increase in demand, occupational health and safety with 72 new international recruits holding a 457 visa 0 out of a total of 121 new international recruits. 0 Staff safety and well-being remained priorities during the 06/07 07/08 08/09 09/10 10/11 11/12 12/13 10/y1e1ar, with initia1ti1v/e1s2, such as the M12a/n13ual Handling Strategy, Alfred Health continues to be an employer of choice, Financial year Standard claims contributinFgi ntoa nac 2ia0l pyeearr cent decSrtaenadsaerd icnla simtasndard claims typically attracTtiimnge lhosigt chla-icmasl ibre applicants – both (premium sensitive claims).* Time lost claims national and international – for all roles. Alfred Health workcover claims length of service During the year, 533 Alfred Health employees were 100 recognised for 10, 20, 25, 30, 35, 40, 45 and 50 years of service in presentation ceremonies. 90 80 Headcount 72 full part grand ms 69 time time casual total ai 60 cl of r 51 e The Alfred* 2,795 2,331 658 5,784 mb 40 46 45 Caulfield Hospital 476 675 160 1,311 u N Sandringham Hospital 95 398 153 646 Grand Total 3,366 3,404 971 7741 20 *Includes Alfred Health administrative staff. Standard claims Time lost claims 0 June June labour category current month fte ytd fte 2010–11 2011–12 2012–13 Financial year 2012 2013 2012 2013 Nursing 2,277.6 2,276.9 2,251.2 2,266.8 manual handling Administration and Clerical 852.2 820.3 835.1 830.8 Medical Support 743.8 750.3 746.7 744.0 In 2012–13, the implementation of the three-year Manual Hotel and Allied Services 222.3 219.8 216.1 216.2 Handling Strategy (2010–13) was completed. Main strategic elements included: Medical Officers 175.4 179.8 170.1 177.8 > developing a central manual handling risk register Hospital Medical Officers 457.9 458.8 466.3 459.3 Sessional Clinicians 141.0 128.5 133.8 133.1 > investing $1.1 million in equipment to eliminate/reduce manual handling risks Ancillary Staff (Allied Health) 494.2 493.7 481.3 491.7 > developing tools for managers to help address manual handling risks > independently reviewing manual handling competencies, work design and equipment. Achievements during the strategy’s lifespan included a 17.5 per cent reduction in manual handling claims (representing 28 fewer claims as compared to 2008–10). This equated to a saving in net claims costs of over $1.5 million. Reduced manual handling claims also had a positive impact on the Worker’s Compensation premium, with an estimated reduction of around $1.5 million.* *This information is based on Allianz Insurance data as at 29 June 2013. ALFRED HEALTH ANNUAL REpoRT 2012–13 7 Employees well-being initiatives We recognise that the work environment provided for our employees has a significant influence on their health. Acting on emerging evidence that sedentary work environments can prove harmful, Alfred Health initiated a three-month trial of sit-stand workstations in 2012–13. Around 100 employees participated, using new workstations where they could either sit or stand to use their computers. Results at the end of the trial were encouraging: > sitting time had reduced from 91 per cent to 54 per cent > 87 per cent of participants reported benefits from using the workstation, which included increasing their sense of health and well-being and ability to concentrate, while reducing pain and discomfort as well as feelings of fatigue. Following a high degree of user acceptance for the sit-stand The Emergency Department team at work in Sandringham Hospital workstations, a program is in place to make similar solutions – collaboration in improving patient care was a focus for the year. more widely available across the Alfred Health workforce. Other well-being initiatives that benefited employees as well as patients were: > Work Health Checks, with 1,504 staff taking part > Our Totally Smokefree commitment (see page 10), which continued to make progress > Healthy Choices, which has improved nutrition by offering healthy food and drink options onsite over the past three years (see page 10). 8