Building Healthy Communities

BENDIGO HEALTH QUALITY ACCOUNT 2016 – 2017

Building Healthy Communities

BENDIGO HEALTH QUALITY ACCOUNT 2016 – 2017

Welcome

Welcome to the Bendigo Health Quality of Care report for the 2016-17 year.

It has been a big year for us as so many years of hard work came to fruition with the completion of our brand new hospital. On 24 January 2017 we moved in and began a new chapter in health care delivery for the region.

This was the culmination of around a decade of lobbying, planning, designing and training for the modern state of the art hospital the Loddon Mallee region needed and deserved. The substantial effort of our staff did result in a move of all patients from old locations into the new Hospital on the 24th of January without any incidents or poor clinical outcomes – a remarkable achievement and one that was very ably supported by our volunteers, patient transport partners, Exemplar Health and associates.

The opening of the new hospital has already led to an increase in demand for our services and we are working hard to reduce waiting lists, offer a more diverse range of services, and improve access whilst maintaining high standards of care.

The passion our staff have for the community and their patients never ceases to amaze me and this translates into numerous quality improvements. Even with the workload resulting from the new hospital, which involved hours of training and preparation, our staff continue to work hard to improve our services. This report contains a number of examples of this and I would like to take this opportunity to thank our staff and volunteers for their hard work and dedication.

Another group who deserve special recognition are all our community and consumer representatives who provide us with a consumer voice and give their time and expertise in various ways throughout the organisation. We are grateful for and learn from their contributions.

Peter Faulkner
Acting CEO

Welcome

Welcome to the Bendigo Health Quality of Care report for the 2016-17 year.

It has been a big year for us as so many years of hard work came to fruition with the completion of our brand new hospital. On 24 January 2017 we moved in and began a new chapter in health care delivery for the region.

This was the culmination of around a decade of lobbying, planning, designing and training for the modern state of the art hospital the Loddon Mallee region needed and deserved. The substantial effort of our staff did result in a move of all patients from old locations into the new Hospital on the 24th of January without any incidents or poor clinical outcomes – a remarkable achievement and one that was very ably supported by our volunteers, patient transport partners, Exemplar Health and associates.

The opening of the new hospital has already led to an increase in demand for our services and we are working hard to reduce waiting lists, offer a more diverse range of services, and improve access whilst maintaining high standards of care.

The passion our staff have for the community and their patients never ceases to amaze me and this translates into numerous quality improvements. Even with the workload resulting from the new hospital, which involved hours of training and preparation, our staff continue to work hard to improve our services. This report contains a number of examples of this and I would like to take this opportunity to thank our staff and volunteers for their hard work and dedication.

Another group who deserve special recognition are all our community and consumer representatives who provide us with a consumer voice and give their time and expertise in various ways throughout the organisation. We are grateful for and learn from their contributions.

Peter Faulkner
Acting CEO

Community use of the new facility1

Figures for the last quarter of the 2016-2017 financial year confirm that we are seeing more patients than ever before. The results show that we have risen to the challenge.

11,885

patients were admitted in the 2017 quarter compared to 10,336 last year.

12,779

people were seen in emergency between April and June 2017 compared to 12,299 in the same period in 2016.

Our time to treat reduced from 28 to 21 minutes

and we treated 100% of the 114 ‘category 1’ emergency patients (patients who must be seen within 2 minutes of arrival) between April and June 2017.

The elective surgery waiting list reduced from 1700 to 1340

during the past three months.

Our community and health

The following statistics provide a glimpse into who we are and what our health and wellbeing is like.

POPULATION

316,4872 is the total population of the Loddon Mallee Region.

49% are female, and
51% are male

2.3%

are people of Aboriginal and Torres Strait Islander origin, the highest percentage in the State.

9.2%

are people born overseas, the lowest percentage in the State

4.8%

are people who speak a language other than English at home

The region has 142.8 new settler arrivals per 100,000 population. 31.6% of these are humanitarian new settler arrivals3.

In Loddon Mallee4:

The percentage of low income families with children is the highest in the state.

The percentage of people with food insecurity is the highest in the state.

The percentage of people who do not meet dietary guidelines for either fruit or vegetable consumption is the highest in the state.

The percentage of breast cancer screening participation is the highest in the state.

The percentage of people receiving prescriptions is the highest in the state.

The rate of Home and Community Care (HACC) clients aged 65 years and over per 1,000 target population is the highest in the state.

The percentage of children attending 3.5 year old maternal and child health checks is the highest in the state.

HEALTH AND WELLBEING

DISABILITY

6,546 people or 5.9% of the population in the City of Greater Bendigo in 2016, reported needing help in their day-to-day lives due to disability5. In Campaspe Shire it was 6.4% of the population6, Gannawarra 6.5%7, Loddon 7.4%8, Macedon Ranges 4.1%9 and Mount Alexander 5.0%10.

HOW WE PERCEIVE OUR HEALTH

In 2011-12, 18 out of 21 Victorian LGAs in the Murray Primary Health Network catchment had a higher proportion of population that assessed their health as fair or poor. Five out of six Local Government Areas (LGAs) in the Central Victorian Region recorded rates of fair or poor self-assessed health that were higher than the Victorian Figure11.

CHRONIC ILLNESS

Of adults with a doctor-diagnosed chronic disease: 27.0% had depression; 20.6% arthritis; 5.3% Osteoporosis; 8.6% cancer; 2.9% stroke; and 7.2% heart disease12.

FACTORS CONTRIBUTING TO ILL HEALTH

Diabetes

 

Victoria-wide, the prevalence of type 2 diabetes increased with age, being highest in people 55 years or older13. In the Loddon Mallee region, 4.6% of males have type 2 diabetes, and 6.0% of females14.

Smoking

 

In the Loddon Mallee region, 20.6% of adults are current smokers, 25.2% are ex-smokers and 53.6% are non-smokers. This compares to Victorian figures of 18.5%, 26.3% and 54.8% respectively15.

Diabetes

 

Victoria-wide, the prevalence of type 2 diabetes increased with age, being highest in people 55 years or older13. In the Loddon Mallee region, 4.6% of males have type 2 diabetes, and 6.0% of females14.

Smoking

 

In the Loddon Mallee region, 20.6% of adults are current smokers, 25.2% are ex-smokers and 53.6% are non-smokers. This compares to Victorian figures of 18.5%, 26.3% and 54.8% respectively15.

Overweight and obesity

 

In 2015, 37.2%of Victorian men and 23.4 per cent of women were pre-obese while 20.1% of men and 18.1% of women were obese. A significantly higher proportion of adults who lived in rural Victoria were obese compared with their metropolitan counterparts16.

 

25.9% of females and 39.1% of males are overweight in City of Greater Bendigo. In Central Victoria, the figures are 25.0% of females and 44.7% of males. Victorian-wide, 24.6% of females are overweight, and 40.6% of males. Both our City of Bendigo and regional percentages of females who are overweight are higher than the State average. For males, our regional figure exceeds the State average by 4.1%17.

About this report

The Quality Account is Bendigo Health’s report to the community. It outlines our work, details our performance in the area of safe and high quality care, and provides information about our efforts to improve how we work with and for our patients and communities.

Bendigo Health’s Quality Account is published online in an interactive format. We have incorporated visual and audio-visual content and have given greater emphasis in this year’s report to the direct voices and experiences of consumers, carers and staff.

We recognise the benefit of online access and have continued with this approach for 2016-2017. The report can be read on devices such as tablets and smartphones. Additionally, printable downloads and brochures are in waiting rooms, wards, clinics, cafeterias and staff rooms across the Bendigo Health sites. We also distribute it through our community partners, such as GP practices, community health centres and aged care facilities.

We would like to hear what you think of the 2017 Quality Account, and welcome feedback including suggestions about improvements to this report.

About this report

The Quality Account is Bendigo Health’s report to the community. It outlines our work, details our performance in the area of safe and high quality care, and provides information about our efforts to improve how we work with and for our patients and communities.

Bendigo Health’s Quality Account is published online in an interactive format. We have incorporated visual and audio-visual content and have given greater emphasis in this year’s report to the direct voices and experiences of consumers, carers and staff.

We recognise the benefit of online access and have continued with this approach for 2016-2017. The report can be read on devices such as tablets and smartphones. Additionally, printable downloads and brochures are in waiting rooms, wards, clinics, cafeterias and staff rooms across the Bendigo Health sites. We also distribute it through our community partners, such as GP practices, community health centres and aged care facilities.

We would like to hear what you think of the 2017 Quality Account, and welcome feedback including suggestions about improvements to this report.

Working Together

Working Together

Community Advisory Committee

Community Advisory Committee members are being listened to, it’s a valued committee … we have developed trust.”
Community Advisory Committee member, 2017

The Community Advisory Committee (CAC) is a sub-committee of the Bendigo Health Board of Directors. Its role is to ensure the views of consumers and communities are taken into account at all levels of health service delivery, planning and policy development. The CAC supports Bendigo Health to develop links with consumers and the community and advocates to the Board of Directors on behalf of the community, consumers and carers.

Key areas of the CAC’s work for 2016 – 2017 have been input into the move to the new Hospital (wayfinding and signage), participation in development of the Bendigo Health Strategic Plan 2018 – 2023 and representing CAC on 8 other committees and reference groups, including the Strategic Planning Committee, the Population Health Committee and the Quality Care Council.

Members

Membership of the CAC for 2016-2017 has included the following people:

Marg O’Rourke
Board of Directors

Marilyn Beaumont
Board of Directors

Daniel O’Brien
Community member

Gabby Gamble
Community member

Heather McNeill
Community member – outgoing

Jeff Bray
Community member

Jodie Rasmussen
Community member – outgoing

Kathleen Pleasants
Community member

Mark Boyd-Graham
Community member

Matthew Gromadzki
Community member

Penny Bolton
Community member

Rex Fisher
Community member

Robyn Tickner
Community member

Ruth Harris
Community member

Sally Fraser
Community member

The following staff members have been nominated to support the CAC functions: Ms Liz Hamilton (Executive Director Healthy Communities and Continuing Care), Ms Kir Larwill (Consumer Participation Support Officer) and Ms Sue Lawrance (Minutes).

Members

Membership of the CAC for 2016-2017 has included the following people:

Marg O’Rourke
Board of Directors

Marilyn Beaumont
Board of Directors

Daniel O’Brien
Community member

Gabby Gamble
Community member

Heather McNeill
Community member – outgoing

Jeff Bray
Community member

Jodie Rasmussen
Community member – outgoing

Kathleen Pleasants
Community member

Mark Boyd-Graham
Community member

Matthew Gromadzki
Community member

Penny Bolton
Community member

Rex Fisher
Community member

Robyn Tickner
Community member

Ruth Harris
Community member

Sally Fraser
Community member

The following staff members have been nominated to support the CAC functions: Ms Liz Hamilton (Executive Director Healthy Communities and Continuing Care), Ms Kir Larwill (Consumer Participation Support Officer) and Ms Sue Lawrance (Minutes).

What I value about being a consumer on an advisory committee is the validation of the value of what personal, lived experiences have to offer the sector. The acknowledgement that although we may have felt dis-empowered or ‘lesser than’ in the past, there is now a recognition that consumers can play an integral role in service development and ongoing consumer-focused practices.”
Community Advisory Committee member, 2017

In focus

Connecting community and hospital

Supporting diversity at Bendigo Health
With cultural awareness, it’s about doing little things all the time … it doesn’t need to be a big program …”
Gabby
Gabby Gamble, a member of the Indigenous community, has been a volunteer at Bendigo Health for two years. She is also a member of Bendigo Health’s Community Advisory Committee (CAC). This year Gabby has been recognised for the work she does, and her valuable contribution to supporting and promoting diversity across the organisation. Gabby is the winner of the 2017 Minister for Health Volunteer Awards “Outstanding Achievement by a Volunteer – Supporting Diversity”.

Reflecting on her two roles at Bendigo Health, and their combined value for the community, the organisation and herself, Gabby speaks about being able to “quietly demonstrate and raise awareness about cultural sensitivity”.

As a volunteer, talking to and supporting people coming to the Hospital, Gabby’s experience is one of connecting and building trust with people. She sees the volunteer role as being particularly well-placed in this way:

“Being a volunteer has enabled me to be a presence within the Hospital and the community … Volunteers are afforded a certain amount of trust by staff and users of the Hospital … people see us as ‘fuzzy’, softer, more neutral … [they] open up”.

Working with people in this way, Gabby is conscious of the need to “be available”, and of the potential to share information and “empower individuals to respond to their own health needs”:

“You have to put your own story on the backburner and be empathetic to the people you work with … It’s all about communication and developing and maintaining trust … being honest, objective … not having an individual opinion”.

This “grassroots” work also means that Gabby hears about people’s experiences of Bendigo Health, particularly those of Indigenous people. In this way, the combination of volunteer and CAC member roles is, in Gabby’s words, “amazing”. It enables her to hear about what’s working and what suggestions people have to make changes, and to convey this through the CAC and other channels. Her approach (whether one to one with a patient or in a committee setting) is positive and collaborative, one she describes as: “We’ve identified this, so how are we going to fix it? … and a big thank-you for letting us know!”. As much as possible, she ends all her conversations “on a note of ‘what’s good?’”.

For Gabby, the advantages of being available to community and organisation in this way are considerable. Conveying patient and community perceptions – being “a conduit between community and hospital” – means that Bendigo Health “can be aware if there are any problems brewing” and work to change practice, systems, or the service environment for the better. She has seen changes happen as a result of issues raised and is able to feed that back to community. In the time that she has worked in both CAC and volunteer roles, Gabby believes that feedback from the Indigenous community, through various channels, has had real influence:

“It has changed over the time I’ve been [here], looking at feedback from the Indigenous community … I have experienced change as a result of issues being raised …”.

And, like all volunteer roles, there’s a lot in it for the volunteer: the affirmation of doing valuable work for others; and what that work can open up for the volunteer, both personally and professionally. Gabby’s experience is no exception:

Reflecting on her two roles at Bendigo Health, and their combined value for the community, the organisation and herself, Gabby speaks about being able to “quietly demonstrate and raise awareness about cultural sensitivity”.

As a volunteer, talking to and supporting people coming to the Hospital, Gabby’s experience is one of connecting and building trust with people. She sees the volunteer role as being particularly well-placed in this way:

“Being a volunteer has enabled me to be a presence within the Hospital and the community … Volunteers are afforded a certain amount of trust by staff and users of the Hospital … people see us as ‘fuzzy’, softer, more neutral … [they] open up”.

Working with people in this way, Gabby is conscious of the need to “be available”, and of the potential to share information and “empower individuals to respond to their own health needs”:

“You have to put your own story on the backburner and be empathetic to the people you work with … It’s all about communication and developing and maintaining trust … being honest, objective … not having an individual opinion”.

This “grassroots” work also means that Gabby hears about people’s experiences of Bendigo Health, particularly those of Indigenous people. In this way, the combination of volunteer and CAC member roles is, in Gabby’s words, “amazing”. It enables her to hear about what’s working and what suggestions people have to make changes, and to convey this through the CAC and other channels. Her approach (whether one to one with a patient or in a committee setting) is positive and collaborative, one she describes as: “We’ve identified this, so how are we going to fix it? … and a big thank-you for letting us know!”. As much as possible, she ends all her conversations “on a note of ‘what’s good?’”.

For Gabby, the advantages of being available to community and organisation in this way are considerable. Conveying patient and community perceptions – being “a conduit between community and hospital” – means that Bendigo Health “can be aware if there are any problems brewing” and work to change practice, systems, or the service environment for the better. She has seen changes happen as a result of issues raised and is able to feed that back to community. In the time that she has worked in both CAC and volunteer roles, Gabby believes that feedback from the Indigenous community, through various channels, has had real influence:

“It has changed over the time I’ve been [here], looking at feedback from the Indigenous community … I have experienced change as a result of issues being raised …”.

And, like all volunteer roles, there’s a lot in it for the volunteer: the affirmation of doing valuable work for others; and what that work can open up for the volunteer, both personally and professionally. Gabby’s experience is no exception:

I’ve valued the whole experience … the inclusiveness, the support, the gentle push towards taking opportunities within the hospital or the community”
Gabby

Committees and Reference Groups

There’s good representation of consumers, and a good mix of management from different levels … so it’s a good place to give feedback … People at the top of the chain can’t always be fully aware of what goes on down the line.”
Consumer member of the Acute Services Reference Group

Throughout Bendigo Health there are many ways in which the consumer voice influences service development and improvement. In addition to the CAC, various committees and reference groups provide an avenue for Bendigo Health to hear the perspectives, ideas and experiences of the patients and community we work for, and to draw on their expertise in developing, evaluating and planning services.

Groups and Committees across the organisation of which the majority of members are consumers (indicated by *), or where there is consumer representation, include:

Aboriginal Advisory Committee

Acute Services Reference Group*

Advance Care Planning Working Party

Bendigo Healthy 4U

Clinical Handover Working Party

Deteriorating Patients Committee

Diversity Committee

Mental Health Consumer Participation Group* (Auspiced by Golden City Support Services)

Primary Care and Population Health Advisory Committee

Quality Care Council

Rehabilitation Services Consumer Reference Group*

Specialist Clinics Steering Committee

Strategic Planning Committee

Stroke Reference Group

Volunteer Services Reference Group

Throughout Bendigo Health there are many ways in which the consumer voice influences service development and improvement. In addition to the CAC, various committees and reference groups provide an avenue for Bendigo Health to hear the perspectives, ideas and experiences of the patients and community we work for, and to draw on their expertise in developing, evaluating and planning services.

Groups and Committees across the organisation of which the majority of members are consumers (indicated by *), or where there is consumer representation, include:

Aboriginal Advisory Committee

Acute Services Reference Group*

Advance Care Planning Working Party

Bendigo Healthy 4U

Clinical Handover Working Party

Deteriorating Patients Committee

Diversity Committee

Mental Health Consumer Participation Group* (Auspiced by Golden City Support Services)

Primary Care and Population Health Advisory Committee

Quality Care Council

Rehabilitation Services Consumer Reference Group*

Specialist Clinics Steering Committee

Strategic Planning Committee

Stroke Reference Group

Volunteer Services Reference Group

In Focus

Testing our assumptions

What’s so valuable about the group is that it gives us an opportunity to test our assumptions, and they are often wrong”
Wendy Millar, Subacute Ambulatory Care Services Manager

The Rehabilitation Services Consumer Reference Group is a forum for the views and perspectives of consumers to influence the way rehabilitation services are planned and delivered. This includes involvement in evaluating services and highlighting areas that need to be improved or prioritised.

“The value for organisations working with committees and reference groups is that … it enables the exposure of high level, strategic decision-makers to the day-to-day challenges of the average, everyday person who is or will be accessing their services.”

-Jeff Bray, member Community Advisory Committee and Consumer Participation Group member

When the Group participated in a discussion about a Bendigo Health Project – called the Inpatient Rehabilitation Enriched Environment Project – the exchange was lively and valuable. After hearing about the purpose of the Project, the Group members were asked to give general ideas and feedback and, specifically, to test-run an on-admission “activities checklist” developed as part of the Project. Discussion included Reference Group members suggesting:

  • A name-change for the Project to make it more meaningful;
  • Prioritising conversation above a written checklist when trying to find out about a person’s interests and what activities they might like to do to as part of their recovery;
  • Using the checklist in a sensitive and discretionary way, particular in situations where a person’s injury or disability may mean that things they once loved doing seem out of their reach, and being asked to read through a checklist of limitless possibilities could be distressing or confronting;
  • Making specific resources available to people while they are rehabilitation inpatients, so that they can choose what they want to do, and when.

The Reference Group’s suggestions were taken up in a number of ways. The Project now uses the title “Enriching your rehabilitation experience” for patient handouts. The checklist will only be used when required rather than as a routine part of the rehabilitation admission process, and the parts of the list that required people to list all the things they currently do has been removed. The project is looking at bedside satchels containing puzzle books, jigsaws and pedometers, iPads and new games and books being available on Wards. In addition, the introduction of movie nights, support groups and a shared whiteboard for people looking to connect with other rehabilitation patients are being explored.

Having access to the expertise of the Group was “truly appreciated” by the Project staff, and their exchange with the Group enabled many crucial improvements.

The Rehabilitation Services Consumer Reference Group is a forum for the views and perspectives of consumers to influence the way rehabilitation services are planned and delivered. This includes involvement in evaluating services and highlighting areas that need to be improved or prioritised.

“The value for organisations working with committees and reference groups is that … it enables the exposure of high level, strategic decision-makers to the day-to-day challenges of the average, everyday person who is or will be accessing their services.”

-Jeff Bray, member Community Advisory Committee and Consumer Participation Group member

When the Group participated in a discussion about a Bendigo Health Project – called the Inpatient Rehabilitation Enriched Environment Project – the exchange was lively and valuable. After hearing about the purpose of the Project, the Group members were asked to give general ideas and feedback and, specifically, to test-run an on-admission “activities checklist” developed as part of the Project. Discussion included Reference Group members suggesting:

  • A name-change for the Project to make it more meaningful;
  • Prioritising conversation above a written checklist when trying to find out about a person’s interests and what activities they might like to do to as part of their recovery;
  • Using the checklist in a sensitive and discretionary way, particular in situations where a person’s injury or disability may mean that things they once loved doing seem out of their reach, and being asked to read through a checklist of limitless possibilities could be distressing or confronting;
  • Making specific resources available to people while they are rehabilitation inpatients, so that they can choose what they want to do, and when.

The Reference Group’s suggestions were taken up in a number of ways. The Project now uses the title “Enriching your rehabilitation experience” for patient handouts. The checklist will only be used when required rather than as a routine part of the rehabilitation admission process, and the parts of the list that required people to list all the things they currently do has been removed. The project is looking at bedside satchels containing puzzle books, jigsaws and pedometers, iPads and new games and books being available on Wards. In addition, the introduction of movie nights, support groups and a shared whiteboard for people looking to connect with other rehabilitation patients are being explored.

Having access to the expertise of the Group was “truly appreciated” by the Project staff, and their exchange with the Group enabled many crucial improvements.

Volunteering

We know it’s doing us good!
Why are all the people in the red shirts so nice?”
Little boy in Medical Imaging

In the past 3 years volunteers have given more than 78,000 hours of service – an average of 26,000 hours a year. This contributes enormously to patients’ experience of Bendigo Health, and to our capacity to provide the best care we can for our community. In the first half of 2017:

  • 14,511 patients were assisted by our ‘meet and greet’ volunteers (particularly valuable to those coming to the new hospital for the first time);
  • Volunteers made contact with 8,933 patients in Emergency, checking in with them about estimated waiting times and what to expect, assisting with information, and providing a reassuring presence;
  • 1,725 clients had contact with volunteers providing support in Hospice; and
  • Volunteers in the “Volunteer Express” program assisted 498 people with transport to and from Bendigo Health.
“It’s great having volunteers in the clinics adding a personal touch … [we are] able to see when people need assistance … [we are] learning the art of reading people’s demeanour to provide the right type of assistance.”

– Volunteer

Volunteering also strengthens community health. A National 12-month study on volunteerism showed that the benefits to individual health and community connectedness are huge. 96% of volunteers say that volunteering enriches their sense of purpose in life. 94% say that volunteering improves their mood, 76% that volunteering has made them feel healthier, and 95% that their volunteer work helps to make their community a better place.

In the past 3 years volunteers have given more than 78,000 hours of service – an average of 26,000 hours a year. This contributes enormously to patients’ experience of Bendigo Health, and to our capacity to provide the best care we can for our community. In the first half of 2017:

  • 14,511 patients were assisted by our ‘meet and greet’ volunteers (particularly valuable to those coming to the new hospital for the first time);
  • Volunteers made contact with 8,933 patients in Emergency, checking in with them about estimated waiting times and what to expect, assisting with information, and providing a reassuring presence;
  • 1,725 clients had contact with volunteers providing support in Hospice; and
  • Volunteers in the “Volunteer Express” program assisted 498 people with transport to and from Bendigo Health.
“It’s great having volunteers in the clinics adding a personal touch … [we are] able to see when people need assistance … [we are] learning the art of reading people’s demeanour to provide the right type of assistance.”

– Volunteer

Volunteering also strengthens community health. A National 12-month study on volunteerism showed that the benefits to individual health and community connectedness are huge. 96% of volunteers say that volunteering enriches their sense of purpose in life. 94% say that volunteering improves their mood, 76% that volunteering has made them feel healthier, and 95% that their volunteer work helps to make their community a better place.

In Focus

Back on the bike

From patient to volunteer

Peter’s connection to Bendigo Health goes back quite a way. One of his children was born at the Hospital. Since then he has supported his wife through treatment in Cancer Services. Five years ago, Peter found himself having his “first ride in an ambulance” after a car ran into him on his motorbike. He was admitted to the Hospital with a severely injured leg.

The accident was the beginning of a long journey through treatment and recovery that brought enormous change to Peter’s life. His leg had been severely injured in the accident. He went through numerous operations and procedures, with infections taking their toll, and was “in and out of hospital” both here and in Melbourne. Finally, three years ago, Peter’s leg was amputated.

“It’s very limiting having a leg taken off, but it beats the alternative … I didn’t think my body could take more treatment … and I needed to move forward … seven weeks to the day after they cut it off I was back on the bike.”

– Peter

And it seems like he hasn’t stopped! Peter’s experience of rehabilitation, and of learning to live as an amputee, has been profound, and he is determined to use it to help others. He joined Bendigo Health as a volunteer a little over two years ago, encouraged by a patient care volunteer he met while he was in rehabilitation himself. His memories of being an inpatient, and the slow process of recovery, remain fresh (the “need to fill time”) and he draws on them a lot in his work:

“People can be there for months, and they don’t have visitors … it can be too hard for family … I can come back and give something, so I came back to volunteer. I primarily visit amputees … people open up and talk to you, they can relate, they can say things they don’t tell their families.”

– Peter

Peter’s insight and empathy are rare and hugely valuable. Drawing on lived experience he finds that he builds an easy rapport with patients, who seek him out because of the particular understanding he brings. As Peter jokes, it’s an understanding that can’t be manufactured:

“I’m yet to meet a doctor who can tell you what being an amputee feels like!”

For Peter, his role supporting people in similar situations to his own, is a two-way street. Volunteering has been part of rebuilding his life and adjusting to being an amputee:

“It’s therapy for me as well … you can lock yourself away. You’re out of the workforce, and your whole life can become the medical system. I get a buzz out of the volunteer work. You can [help people by] telling them your experiences … and people can be repeat customers!”

Extending this work, Peter has gone on to help set up a local amputee support group with another amputee. Moving forward is exactly what he’s doing – on and off the bike!

Peter’s connection to Bendigo Health goes back quite a way. One of his children was born at the Hospital. Since then he has supported his wife through treatment in Cancer Services. Five years ago, Peter found himself having his “first ride in an ambulance” after a car ran into him on his motorbike. He was admitted to the Hospital with a severely injured leg.

The accident was the beginning of a long journey through treatment and recovery that brought enormous change to Peter’s life. His leg had been severely injured in the accident. He went through numerous operations and procedures, with infections taking their toll, and was “in and out of hospital” both here and in Melbourne. Finally, three years ago, Peter’s leg was amputated.

“It’s very limiting having a leg taken off, but it beats the alternative … I didn’t think my body could take more treatment … and I needed to move forward … seven weeks to the day after they cut it off I was back on the bike.”

– Peter

And it seems like he hasn’t stopped! Peter’s experience of rehabilitation, and of learning to live as an amputee, has been profound, and he is determined to use it to help others. He joined Bendigo Health as a volunteer a little over two years ago, encouraged by a patient care volunteer he met while he was in rehabilitation himself. His memories of being an inpatient, and the slow process of recovery, remain fresh (the “need to fill time”) and he draws on them a lot in his work:

“People can be there for months, and they don’t have visitors … it can be too hard for family … I can come back and give something, so I came back to volunteer. I primarily visit amputees … people open up and talk to you, they can relate, they can say things they don’t tell their families.”

– Peter

Peter’s insight and empathy are rare and hugely valuable. Drawing on lived experience he finds that he builds an easy rapport with patients, who seek him out because of the particular understanding he brings. As Peter jokes, it’s an understanding that can’t be manufactured:

“I’m yet to meet a doctor who can tell you what being an amputee feels like!”

For Peter, his role supporting people in similar situations to his own, is a two-way street. Volunteering has been part of rebuilding his life and adjusting to being an amputee:

“It’s therapy for me as well … you can lock yourself away. You’re out of the workforce, and your whole life can become the medical system. I get a buzz out of the volunteer work. You can [help people by] telling them your experiences … and people can be repeat customers!”

Extending this work, Peter has gone on to help set up a local amputee support group with another amputee. Moving forward is exactly what he’s doing – on and off the bike!

Promoting good health

Bendigo Health’s vision of healthy communities is supported through the work of our Healthy Communities team and stakeholders in the broader community. This work, part of Bendigo Health’s GREATER initiative, uses Collective Impact thinking, an approach that brings organisations together to focus on a common agenda and achieve long-lasting change18. It is complemented by a place-based approach to improving the health of the whole population – working with communities to identify local health issues and what’s behind them, and to co-create a response that community can own and act on together.

Bendigo Health’s vision of healthy communities is supported through the work of our Healthy Communities team and stakeholders in the broader community. This work, part of Bendigo Health’s GREATER initiative, uses Collective Impact thinking, an approach that brings organisations together to focus on a common agenda and achieve long-lasting change18. It is complemented by a place-based approach to improving the health of the whole population – working with communities to identify local health issues and what’s behind them, and to co-create a response that community can own and act on together.

OBESITY


In Australia 1 in 4 (25%) children and almost 2 in 3 (63%) adults are now overweight or obese. These rates are continuing to rise with obesity among adults having almost tripled in the last two decades. Obesity has lifelong impacts on health and wellbeing and is a major risk factor for many diseases such as Type 2 diabetes, cardiovascular disease, musculoskeletal conditions and some cancers. Obesity reduces people’s life expectancy and quality of life and is associated with depression, anxiety and low self-esteem19.

A key focus for GREATER is to encourage the Bendigo region to value health and wellbeing. 9 GREATER Governance Group meetings have been facilitated, with participation of representatives from 23 organisations. GREATER is working with Health Futures Australia to develop a shared strategy for working to reduce obesity in the community.

Early years and primary

Achievement and Smiles 4 Miles Programs

Through the GREATER initiative, 34 early years services and 31 schools located in the City of Greater Bendigo have registered with the State-facilitated Achievement Program. The Program works with services to make progress on major health priorities. They are working on tobacco control, sun protection, safe environments, sexual health and wellbeing, healthy eating and oral health, alcohol and other drug use, mental health and wellbeing. Sally Hicks, Director of Jenny’s Early Learning Centre in Strathfieldsaye, speaks about the work they have done with their community:

“We pride ourselves on supporting children, families and communities … the links we made with communities [through the Program] were incredible … the support we were given from City of Greater Bendigo, Bendigo Health [and other organisations] has only strengthened these relationships”.

Sally reflects on what the benefits of the Program have been for her service and its community.

36 early years services (94% of services, used by over 3300 children in City of Greater Bendigo) are also working with GREATER in the Smiles 4 Miles Program. This involves creating environments that support healthy eating and oral health. 61% of participating services received award status this year.

Winter seedlings for school gardens

In partnership with the Department of Justice, over 20 local primary schools and 24 early years services received winter seedlings for their school gardens. With GREATER assisting with grant applications, a number of local schools received almost $7,000 in grants to support nutrition and garden programs as well as more specialised mental health initiatives. We have also supported primary schools to undertake self-assessment and review their policies. This has enabled teachers to increase their understanding of school health and wellbeing, and to explore how future planning can contribute to better health across the school community.

Language and Literacy program auspice by Communities 4 Children

Book box libraries have been installed and delivered across health services, including Bendigo and District Aboriginal Cooperative (BDAC). These provide access to books and promote reading amongst children in the community. To expand on this, another 40 book box libraries are being built and distributed across the Bendigo Community by Kiwanis Service Club.

The Books for Babies Program continues to provide every baby born at Bendigo Health with a board book and a fridge magnet displaying information about early literacy. This communicates to families that literacy is vital, and that they can play a key role in their child’s early literacy and language development by reading, singing, talking and playing with their child every day.

Early years and primary

Achievement and Smiles 4 Miles Programs

Through the GREATER initiative, 34 early years services and 31 schools located in the City of Greater Bendigo have registered with the State-facilitated Achievement Program. The Program works with services to make progress on major health priorities. They are working on tobacco control, sun protection, safe environments, sexual health and wellbeing, healthy eating and oral health, alcohol and other drug use, mental health and wellbeing. Sally Hicks, Director of Jenny’s Early Learning Centre in Strathfieldsaye, speaks about the work they have done with their community:

“We pride ourselves on supporting children, families and communities … the links we made with communities [through the Program] were incredible … the support we were given from City of Greater Bendigo, Bendigo Health [and other organisations] has only strengthened these relationships”.

Sally reflects on what the benefits of the Program have been for her service and its community.

36 early years services (94% of services, used by over 3300 children in City of Greater Bendigo) are also working with GREATER in the Smiles 4 Miles Program. This involves creating environments that support healthy eating and oral health. 61% of participating services received award status this year.

Winter seedlings for school gardens

In partnership with the Department of Justice, over 20 local primary schools and 24 early years services received winter seedlings for their school gardens. With GREATER assisting with grant applications, a number of local schools received almost $7,000 in grants to support nutrition and garden programs as well as more specialised mental health initiatives. We have also supported primary schools to undertake self-assessment and review their policies. This has enabled teachers to increase their understanding of school health and wellbeing, and to explore how future planning can contribute to better health across the school community.

Language and Literacy program auspice by Communities 4 Children

Book box libraries have been installed and delivered across health services, including Bendigo and District Aboriginal Cooperative (BDAC). These provide access to books and promote reading amongst children in the community. To expand on this, another 40 book box libraries are being built and distributed across the Bendigo Community by Kiwanis Service Club.

The Books for Babies Program continues to provide every baby born at Bendigo Health with a board book and a fridge magnet displaying information about early literacy. This communicates to families that literacy is vital, and that they can play a key role in their child’s early literacy and language development by reading, singing, talking and playing with their child every day.

Healthy Choices for Sports Clubs

In collaboration with the City of Greater Bendigo, GREATER and Sports Focus is working with sporting clubs to support them to meet the healthy choices guidelines policy in their canteens and to increase awareness of these guidelines in the sports community. This has included promoting water as the drink of choice and encouraging a reduction in the consumption of sugary drinks.

Young people taking a lead

The GREATER Youth Ambassador Program, a partnership between the Bendigo Education Council and GREATER, aims to create a health and wellbeing movement in the Bendigo region. The goal is to build youth leadership in health and wellbeing and support them to create supportive environments within their sphere of influence. The Program is open to students in years 9 to 11 who have a passion for being a voice on health and wellbeing for their communities. Nominations have been sought from each secondary school in Greater Bendigo.

PROMOTING SMOKE-FREE


A 37 year old man who had been smoking 1 packet a day for 13 years was assisted by the Supporting Patients to be Smoke Free Program while he was an inpatient. When contacted 3 weeks after being discharged, he was still smoke-free, and very pleased with what he had achieved:
“[I’m] feeling great … very grateful for the support provided in hospital [and my] wife and family are very happy.”

 

The Supporting Patients to be Smoke Free Program encourages and assists patients to quit smoking and manage their nicotine withdrawal. 296 referrals were made to the Program 2016-17. Of these:

155

indicated that their admission to Hospital triggered a quit smoking attempt (55%); and

58

identified as still being smoke free a week or more after being discharged (20%).

The Program has received positive feedback. Patients have talked about the empathy and acknowledgment they felt through the Program, the clear message from staff that “we know it’s going to be hard”, as well as access to support in person and through phone calls when needed. One patient described this support as “turning ‘I can’t do this’ into ‘I can do this’!” Patients have also given feedback about how important it was not to feel judged. In the words of one, “[I] wasn’t treated like a leper”.

A strong response to family violence

The Strengthening hospital responses to family violence (SHRFV) project
Family violence is a significant issue facing our community. Over the past five years reported cases of family violence have increased more than 150 percent in the City of Greater Bendigo, and eight of our ten local government areas in the region have rates of family violence that exceed the state average. Rates of family violence in the City of Greater Bendigo have increased more than 150 per cent in the last five years, exceeding the general increase across the state.20

Family violence is recognised as a significant health issue. People experiencing family violence access emergency departments over a third more than people who have not experienced family violence, and they account for substantial repeat hospital presentations. While hospitals are not family violence specialist services, we know that for many people a health care professional may be the first person that they will talk to about their experience of family violence. Consequently, hospitals are in a unique position to provide a path towards assistance and support. The first response to disclosure of family violence may be pivotal to the person’s safety and support.

“The training is about asking the questions and following through on the health impact of family violence. It’s about staff having the confidence and empathy to ask … reducing fear about the answer and what to do about it”

– Board member

“I feel more confident to ask questions and if I have a feeling that something is not right to ask appropriate follow up questions”

– participant in the training

Bendigo Health is fortunate to have worked in partnership with the Women’s Hospital over the past three years to develop and implement a whole of hospital approach to identifying and responding to family violence. Bendigo Health’s partnership with the Women’s Hospital on the ‘Strengthening hospital responses to family violence’ (SHRFV) project, funded by the State Government, has enabled the development of a service model that is assisting all Victorian hospitals to help those at risk of, or experiencing, family violence.

The SHRFV service model was developed in stage one of the project and has been revised and refined over stage two and three. Bendigo Health has provided mentoring and guidance to implement the model at regional demonstration sites during stage two and has extended this support to an additional fourteen health services across the Loddon Mallee Region during stage three. The Women’s Hospital has provided similar mentoring and guidance to implement the model at an increasing number of metropolitan hospitals.

Family violence is recognised as a significant health issue. People experiencing family violence access emergency departments over a third more than people who have not experienced family violence, and they account for substantial repeat hospital presentations. While hospitals are not family violence specialist services, we know that for many people a health care professional may be the first person that they will talk to about their experience of family violence. Consequently, hospitals are in a unique position to provide a path towards assistance and support. The first response to disclosure of family violence may be pivotal to the person’s safety and support.

“The training is about asking the questions and following through on the health impact of family violence. It’s about staff having the confidence and empathy to ask … reducing fear about the answer and what to do about it”

– Board member

“I feel more confident to ask questions and if I have a feeling that something is not right to ask appropriate follow up questions”

– participant in the training

Bendigo Health is fortunate to have worked in partnership with the Women’s Hospital over the past three years to develop and implement a whole of hospital approach to identifying and responding to family violence. Bendigo Health’s partnership with the Women’s Hospital on the ‘Strengthening hospital responses to family violence’ (SHRFV) project, funded by the State Government, has enabled the development of a service model that is assisting all Victorian hospitals to help those at risk of, or experiencing, family violence.

The SHRFV service model was developed in stage one of the project and has been revised and refined over stage two and three. Bendigo Health has provided mentoring and guidance to implement the model at regional demonstration sites during stage two and has extended this support to an additional fourteen health services across the Loddon Mallee Region during stage three. The Women’s Hospital has provided similar mentoring and guidance to implement the model at an increasing number of metropolitan hospitals.

The next few years will see the SHRFV service model rolled out to all Victorian hospitals and Bendigo Health will take on additional responsibility as the regional sector lead to support all rural and regional hospitals across the state to implement the model. So far we have:

Established strong leadership and momentum in our response to family violence. This includes commitment by the Board and Executive, and governance through an Implementation Team of staff from a range of areas, and varied levels of seniority, across the organisation.

Built a sustainable foundation of policies and procedures. These outline both clinical and workforce responses to identifying and responding sensitively to patients and staff experiencing family violence. They include: Family Violence Assessment and Response Protocol; Response to Family Violence in the Workplace; and a Family Violence Assessment Form.

Shifted organisational culture. Awareness and understanding of family violence as a health issue, for staff and patients, has increased.

Strengthened the capacity and capability of staff. Education and resources have been provided that build skills in sensitive inquiry, and equip staff to identify and respond to people at risk of, or experiencing, family violence. People who have experienced family violence have shared their experience with training participants. Almost 460 Bendigo Health staff have participated in SHRFV training and we have trained almost 200 staff from health services across the region.

Built partnerships and connections with the community and the broader family violence service sector. Working relationships and collaboration have been fostered through Bendigo Health’s participation in initiatives such as White Ribbon Day, Loddon Campaspe Family Violence Advisory Group, DHHS Taskforce 1000, CEO Partnership Group meetings and formalised referral pathways.

Gathered and used evidence. Systems have been developed to ensure that we capture family violence incidents and referrals. This means that the number of patients at risk of or experiencing family violence can be monitored, and the appropriateness of the referrals we make evaluated.

The next few years will see the SHRFV service model rolled out to all Victorian hospitals and Bendigo Health will take on additional responsibility as the regional sector lead to support all rural and regional hospitals across the state to implement the model. So far we have:

Established strong leadership and momentum in our response to family violence. This includes commitment by the Board and Executive, and governance through an Implementation Team of staff from a range of areas, and varied levels of seniority, across the organisation.

Built a sustainable foundation of policies and procedures. These outline both clinical and workforce responses to identifying and responding sensitively to patients and staff experiencing family violence. They include: Family Violence Assessment and Response Protocol; Response to Family Violence in the Workplace; and a Family Violence Assessment Form.

Shifted organisational culture. Awareness and understanding of family violence as a health issue, for staff and patients, has increased.

Strengthened the capacity and capability of staff. Education and resources have been provided that build skills in sensitive inquiry, and equip staff to identify and respond to people at risk of, or experiencing, family violence. People who have experienced family violence have shared their experience with training participants. Almost 460 Bendigo Health staff have participated in SHRFV training and we have trained almost 200 staff from health services across the region.

Built partnerships and connections with the community and the broader family violence service sector. Working relationships and collaboration have been fostered through Bendigo Health’s participation in initiatives such as White Ribbon Day, Loddon Campaspe Family Violence Advisory Group, DHHS Taskforce 1000, CEO Partnership Group meetings and formalised referral pathways.

Gathered and used evidence. Systems have been developed to ensure that we capture family violence incidents and referrals. This means that the number of patients at risk of or experiencing family violence can be monitored, and the appropriateness of the referrals we make evaluated.

Aboriginal health

Bendigo Health (BH) has had a long commitment to providing support and services to the Aboriginal Community. We are proud of the community’s cultural heritage and acknowledge the importance of the traditional owners of the land, the Dja Dja Wurrung people, on which the new facility is built.

The Aboriginal Support space was opened in 2017. Built off the atrium or ‘main street’ of the new hospital, the space has a direct connection to the land on the Drought Street entrance of the building, making it easily accessible and very visible to all who enter the Hospital. Valuing the diversity of our community is of the utmost importance to Bendigo Health and creating an environment and culture where mutual respect is demonstrated is central to ensuring our consumers and staff feel valued and welcome.

The Aboriginal Support area houses the Aboriginal Hospital Liaison Officer. It provides access to resources and information, a comfortable space in which to support Aboriginal patients and their families, and promotes sensitivity of health care providers to Aboriginal and Torres Strait Islanders’ health issues.  It is also a location for team meetings, meetings with Aboriginal controlled organisations, and community gatherings.

An immense amount of detail has been considered in the interior design of the space. The flooring connects to the land, and magazine racks display Aboriginal health promotional information and Aboriginal-specific print media. It has been designed to work as a quiet space for retreat and reflection. A fire pit built into the external landscape design allows for the tradition of smoking ceremonies to take place. There is a small kitchen and eating area, as well as video conferencing facilities to enable connection across the region for meetings, forums, education and support purposes. The space also offers an opportunity for Aboriginal art to be displayed, the artwork serving as a cultural awareness tool for staff and visitors of the hospital.

The Aboriginal Support space was opened in 2017. Built off the atrium or ‘main street’ of the new hospital, the space has a direct connection to the land on the Drought Street entrance of the building, making it easily accessible and very visible to all who enter the Hospital. Valuing the diversity of our community is of the utmost importance to Bendigo Health and creating an environment and culture where mutual respect is demonstrated is central to ensuring our consumers and staff feel valued and welcome.

The Aboriginal Support area houses the Aboriginal Hospital Liaison Officer. It provides access to resources and information, a comfortable space in which to support Aboriginal patients and their families, and promotes sensitivity of health care providers to Aboriginal and Torres Strait Islanders’ health issues.  It is also a location for team meetings, meetings with Aboriginal controlled organisations, and community gatherings.

An immense amount of detail has been considered in the interior design of the space. The flooring connects to the land, and magazine racks display Aboriginal health promotional information and Aboriginal-specific print media. It has been designed to work as a quiet space for retreat and reflection. A fire pit built into the external landscape design allows for the tradition of smoking ceremonies to take place. There is a small kitchen and eating area, as well as video conferencing facilities to enable connection across the region for meetings, forums, education and support purposes. The space also offers an opportunity for Aboriginal art to be displayed, the artwork serving as a cultural awareness tool for staff and visitors of the hospital.

Statistics

As the Table below shows, since 2009 the number of patients feeling safe to identify as Aboriginal and Torres Strait Islander when using BH services has almost doubled.

Still image from training video. View video here.

Health equity

DIVERSITY PLAN

The Bendigo Health Diversity Plan (2016-2019) combines and replaces the Disability Access Plan (2014-2016) and the Cultural Responsiveness Plan (2014-2017). It was developed with staff, services and consumers. The Plan seeks to identify barriers to service access and equity and to put strategies in place to address these from both a consumer and workforce perspective.

It is a working document used to reflect progress and achievements as well as to identify further areas in need of action. It sits alongside the Integrated Aboriginal Health Plan. The plan is accessible for staff on the intranet and to the community via the Bendigo Health website.

LANGUAGE SERVICES

Using interpreters, and ensuring access to interpreting services, is a continued focus at Bendigo Health. The number of people provided with interpreters to support communication with Bendigo Health staff in 2016-2017 has increased by 19% since the previous year21.

DIVERSITY PLAN

The Bendigo Health Diversity Plan (2016-2019) combines and replaces the Disability Access Plan (2014-2016) and the Cultural Responsiveness Plan (2014-2017). It was developed with staff, services and consumers. The Plan seeks to identify barriers to service access and equity and to put strategies in place to address these from both a consumer and workforce perspective.

LANGUAGE SERVICES

Using interpreters, and ensuring access to interpreting services, is a continued focus at Bendigo Health. The number of people provided with interpreters to support communication with Bendigo Health staff in 2016-2017 has increased by 19% since the previous year21.

INTERPRETER USE OVER FOUR CONSECUTIVE YEARS

Year 2013-14 2014-15 2015-16 2016-17
Total 1727 1144 1904 2177

 

This year:

44

departments or services requested interpreter services*

39

languages and dialects were requested for interpreting*

Karen, Dari and Auslan

were the top 3 interpreter requests. Karen was 1300 or 60% of all requests, Dari was 253 or 12% of all requests, and Auslan was 169 or 8% of all requests.

* = highest number on record at Bendigo Health.

GREATER AWARENESS, BETTER COMMUNICATION

We pick up a lot of things incidentally, in everyday life … but that doesn’t happen in the Deaf community, so they miss out on a lot of information”
Kim Muller, Deaf Access Victoria – Loddon Mallee

Deaf Access Loddon Mallee is an information service about hearing loss for people living in the Loddon Mallee region. The team provide up-to-date information for deaf or hard of hearing people, their families and carers, service providers and agencies. Much of this work includes awareness-raising and advocacy.

Using Interpreters supports good communication – open, timely and appropriate, in a way that the person can understand22 – and good health practice. As a health organisation, Bendigo Health is mandated to provide an Auslan interpreter when deaf patients request one. Through Deaf Access Loddon Mallee, we are working to increase awareness amongst staff and community about Deaf culture in general, about language in particular, and about responding effectively to people who are deaf and have Auslan as their first language.

Central to this has been the production of an accessible 3-minute training video. Designed to show hospital staff what often happens to Deaf people in a hospital waiting room, not only in Australia but worldwide, the video conveys a clear message about the importance of Auslan interpreters and how to work with one. Drawing on a true story, it provides insight to the barriers faced by deaf patients on a day to day basis as they seek to manage their health in a hospital setting.

“[What’s been valuable] about the video is people suddenly become aware that Auslan is another language … that we use Interpreters not family members … it makes it so much easier for the Deaf community when staff understand this … if you can turn up to Emergency and have staff say ‘I’ll book an interpreter’, that’s half the battle won.”

– Kim Muller

Deaf Access Loddon Mallee is an information service about hearing loss for people living in the Loddon Mallee region. The team provide up-to-date information for deaf or hard of hearing people, their families and carers, service providers and agencies. Much of this work includes awareness-raising and advocacy.

Using Interpreters supports good communication – open, timely and appropriate, in a way that the person can understand22 – and good health practice. As a health organisation, Bendigo Health is mandated to provide an Auslan interpreter when deaf patients request one. Through Deaf Access Loddon Mallee, we are working to increase awareness amongst staff and community about Deaf culture in general, about language in particular, and about responding effectively to people who are deaf and have Auslan as their first language.

Central to this has been the production of an accessible 3-minute training video. Designed to show hospital staff what often happens to Deaf people in a hospital waiting room, not only in Australia but worldwide, the video conveys a clear message about the importance of Auslan interpreters and how to work with one. Drawing on a true story, it provides insight to the barriers faced by deaf patients on a day to day basis as they seek to manage their health in a hospital setting.

“[What’s been valuable] about the video is people suddenly become aware that Auslan is another language … that we use Interpreters not family members … it makes it so much easier for the Deaf community when staff understand this … if you can turn up to Emergency and have staff say ‘I’ll book an interpreter’, that’s half the battle won.”

– Kim Muller

An Advisory Group made up of people from the Deaf community, local interpreters and organisations who work with the Deaf community were involved in the production of the video, and the response so far has been overwhelmingly positive.

There has been a significant increase in the requests for Auslan Interpreters across Bendigo Health, and the impact of the video has gone beyond our organisation: The Interpreter Service, On Call, have it on their website and have used it in education sessions; The Royal Women’s Hospital are including it in their general training on using interpreters; the Human Rights and Equal Opportunity Commission used the video in the launch of Auslan Interpreters in Hospitals Program; and there have been requests for its use from other organisations including Swan Hill Disability & Aged Network and the Department of Health and Human Services (DHHS). DHHS have since recommended the video to the Minister for Health and hospitals in the UK and USA, along with other organisations via Facebook, have asked to use it. In addition, the video was used on Swedish television as part of a panel discussion about access to Sign language interpreters.

And there’s another video in production. This one will focus on teaching staff basic signing so that they can use it in the hospital to greet people, and to communicate basic things such as “I have booked an interpreter”. This, in combination with ongoing in-service sessions with staff, will continue to build the inclusiveness and accessibility of our services to the Deaf community.

An Advisory Group made up of people from the Deaf community, local interpreters and organisations who work with the Deaf community were involved in the production of the video, and the response so far has been overwhelmingly positive.

There has been a significant increase in the requests for Auslan Interpreters across Bendigo Health, and the impact of the video has gone beyond our organisation: The Interpreter Service, On Call, have it on their website and have used it in education sessions; The Royal Women’s Hospital are including it in their general training on using interpreters; the Human Rights and Equal Opportunity Commission used the video in the launch of Auslan Interpreters in Hospitals Program; and there have been requests for its use from other organisations including Swan Hill Disability & Aged Network and the Department of Health and Human Services (DHHS). DHHS have since recommended the video to the Minister for Health and hospitals in the UK and USA, along with other organisations via Facebook, have asked to use it. In addition, the video was used on Swedish television as part of a panel discussion about access to Sign language interpreters.

And there’s another video in production. This one will focus on teaching staff basic signing so that they can use it in the hospital to greet people, and to communicate basic things such as “I have booked an interpreter”. This, in combination with ongoing in-service sessions with staff, will continue to build the inclusiveness and accessibility of our services to the Deaf community.

STATISTICS


Hearing loss affects one in six Australians and this is predicted to increase to one in four by 205023.
Use of Auslan Interpreters increased by 293% from 2014 to 2017, making it the third most requested language of all interpreter requests at Bendigo Health.

Pastoral care

A lot has happened in Pastoral Care this year. Much of it has been about making it easier to find out about and use our service, fostering interfaith care and honouring community connection.

MORE EFFECTIVE REFERRAL

Our referral process has been improved, for people referring themselves, or for those being referred by other organisations or other parts of Bendigo Health. Based on feedback from consumers we have updated the Brochure for Pastoral Care and made information about volunteer Chaplains and how to connect with them available on the Bendigo Health website.

In addition, information about visiting times, end of life care availability, languages spoken and photographs of Chaplains is now on the Intranet for Bendigo Health staff making referrals to Pastoral Care. A guide for staff making these referrals has also been developed. This helps them determine whether the referral is urgent and needs to be made directly to a volunteer Chaplain, or whether it can be responded to by staff Chaplains, who can then visit or contact a specific chaplain to respond.

BETTER CONTINUITY

Changes have been made that enable pastoral care information to be included in health records. The changes foster continuity of care, collaboration and a shared understanding between everyone providing care, both medical and pastoral.

Pastoral care notes are now incorporated into individual medical records via a specific form. This means that staff are aware when a Chaplain has visited, have details of the care provided, and (with appropriate permission) can share this information with the family and with other staff when working together or handing over between shifts. It helps avoid doubling up on conversations, and on referrals. It also fosters a collaborative approach to care.

Whilst ensuring confidentiality is respected, patient information for Chaplains has also been automated. Faith-specific Chaplains now receive direct, daily notification about patients that tells them where patients are in the Hospital, and details of gender and language – enough to enable them to find and make contact with a patient without knowing names or file numbers.

In addition, Chaplains have worked together to come up with a standard process for Chaplain visits. This has been documented and made available to hospital staff and Chaplains.

INCLUSIVE PASTORAL CARE

In the last 4 years there has been significant growth in the Pastoral Care team, enabling us to meet the needs of our diverse community. There are currently 40 accredited volunteer chaplains, including 4 Muslim chaplains, a Sikh chaplain, clergy from major Christian denominations, and chaplains who visit all patients rather than operating from a faith-based list. We have also deepened connections with the Jewish, Hindu, Baha’i and Buddhist communities. Specific orientation has been developed so that representatives who already have a pastoral ministry or represent a minority faith community can be accredited and included in the team.

The Sacred Space, part of the new Hospital, has been designed with an interfaith and broader understanding of spirituality at its foundation. This includes opportunities for experiences such as mindfulness and general inspirational reflections. The community have been involved in donation of Sacred Texts. Bedside screens have a Sacred Space channel available for broadcasting different worship experiences and spiritual material.

MORE EFFECTIVE REFERRAL

Our referral process has been improved, for people referring themselves, or for those being referred by other organisations or other parts of Bendigo Health. Based on feedback from consumers we have updated the Brochure for Pastoral Care and made information about volunteer Chaplains and how to connect with them available on the Bendigo Health website.

In addition, information about visiting times, end of life care availability, languages spoken and photographs of Chaplains is now on the Intranet for Bendigo Health staff making referrals to Pastoral Care. A guide for staff making these referrals has also been developed. This helps them determine whether the referral is urgent and needs to be made directly to a volunteer Chaplain, or whether it can be responded to by staff Chaplains, who can then visit or contact a specific chaplain to respond.

BETTER CONTINUITY

Changes have been made that enable pastoral care information to be included in health records. The changes foster continuity of care, collaboration and a shared understanding between everyone providing care, both medical and pastoral.

Pastoral care notes are now incorporated into individual medical records via a specific form. This means that staff are aware when a Chaplain has visited, have details of the care provided, and (with appropriate permission) can share this information with the family and with other staff when working together or handing over between shifts. It helps avoid doubling up on conversations, and on referrals. It also fosters a collaborative approach to care.

Whilst ensuring confidentiality is respected, patient information for Chaplains has also been automated. Faith-specific Chaplains now receive direct, daily notification about patients that tells them where patients are in the Hospital, and details of gender and language – enough to enable them to find and make contact with a patient without knowing names or file numbers.

In addition, Chaplains have worked together to come up with a standard process for Chaplain visits. This has been documented and made available to hospital staff and Chaplains.

INCLUSIVE PASTORAL CARE

In the last 4 years there has been significant growth in the Pastoral Care team, enabling us to meet the needs of our diverse community. There are currently 40 accredited volunteer chaplains, including 4 Muslim chaplains, a Sikh chaplain, clergy from major Christian denominations, and chaplains who visit all patients rather than operating from a faith-based list. We have also deepened connections with the Jewish, Hindu, Baha’i and Buddhist communities. Specific orientation has been developed so that representatives who already have a pastoral ministry or represent a minority faith community can be accredited and included in the team.

The Sacred Space, part of the new Hospital, has been designed with an interfaith and broader understanding of spirituality at its foundation. This includes opportunities for experiences such as mindfulness and general inspirational reflections. The community have been involved in donation of Sacred Texts. Bedside screens have a Sacred Space channel available for broadcasting different worship experiences and spiritual material.

In Focus

Honouring personal connections

Hospitals are not just bricks and mortar. Buildings are defined by people’s experience of them, and the significance they have for different moments in their lives. Community members and staff reported experiencing significant emotions on seeing old hospital buildings demolished to make way for the new. On the 8th of June, a Reflection Ceremony was held for the Bendigo Hospital Lucan Street Campus. Karen Lunney, Manager, Pastoral Care Services, describes the Ceremony, how it came about, and what it meant to her.

“At the time of the move, there were many people who expressed grief and loss about leaving the old buildings. They played a significant part in people’s lives – staff and members of the community who experienced birth and death within the walls. I had thought about doing something then, but the focus at the time was on the positive experience of the move into the brand new hospital, and there was no appropriate time for saying farewell.

When the buildings started to come down, there were a lot of people watching and taking photos and not just those who were interested in the mechanics of the machinery! So, we used this milestone as an opportunity for people to express those emotions around leaving the buildings. Human beings need ritual, so I created a ritual that would hopefully cover the myriad of feelings that people had in moving from the old site and seeing the buildings be demolished. People have significant ties to this site, memories of the buildings that witnessed many beginnings and endings and significant moments.

“It’s great to know that we have the opportunity to listen to people’s stories and provide emotional support.”

We used four symbols throughout the ceremony. Just like we use a cake and candles to celebrate a birthday, we had stones, feathers, seeds, and leaves. These were to represent people’s different emotions and experiences – of things that weigh us down, lift us up, cycles, birth, death and the like. After the symbols were explained, we used a moving piece of music and people came forward to place their choice of symbol or symbols on the focus space, which was created around the new bench above the plaque. It was very moving.

Bob Cameron, Chair of Bendigo Health Board of Directors, gave a great speech that shared some of the history of the buildings, and that was really appreciated. Also, it was touching that a week or so after the ceremony I had a chance to meet with someone who wanted to see where the plaque was. She shared her stories of loss and grief. After she left, another community member came over and asked about the plaque and was pleased to get a copy of the service too. It’s great to know that we have the opportunity to listen to people’s stories and provide emotional support.”

“At the time of the move, there were many people who expressed grief and loss about leaving the old buildings. They played a significant part in people’s lives – staff and members of the community who experienced birth and death within the walls. I had thought about doing something then, but the focus at the time was on the positive experience of the move into the brand new hospital, and there was no appropriate time for saying farewell.

When the buildings started to come down, there were a lot of people watching and taking photos and not just those who were interested in the mechanics of the machinery! So, we used this milestone as an opportunity for people to express those emotions around leaving the buildings. Human beings need ritual, so I created a ritual that would hopefully cover the myriad of feelings that people had in moving from the old site and seeing the buildings be demolished. People have significant ties to this site, memories of the buildings that witnessed many beginnings and endings and significant moments.

“It’s great to know that we have the opportunity to listen to people’s stories and provide emotional support.”

We used four symbols throughout the ceremony. Just like we use a cake and candles to celebrate a birthday, we had stones, feathers, seeds, and leaves. These were to represent people’s different emotions and experiences – of things that weigh us down, lift us up, cycles, birth, death and the like. After the symbols were explained, we used a moving piece of music and people came forward to place their choice of symbol or symbols on the focus space, which was created around the new bench above the plaque. It was very moving.

Bob Cameron, Chair of Bendigo Health Board of Directors, gave a great speech that shared some of the history of the buildings, and that was really appreciated. Also, it was touching that a week or so after the ceremony I had a chance to meet with someone who wanted to see where the plaque was. She shared her stories of loss and grief. After she left, another community member came over and asked about the plaque and was pleased to get a copy of the service too. It’s great to know that we have the opportunity to listen to people’s stories and provide emotional support.”

Directing your own care

I’m a very independent person. When you are facing a terminal illness your independence can be taken away from you … sometimes people have ignored me and spoken to my husband. I stop them when they do this … let them know I need things to be channelled to me. We work as a team, but they need to talk to me directly. Patients need to be part of the process.”
Patient using Cancer Services

Person centred care is treatment and care provided by a health service that places the person at the centre of their own care, and treats them in the way they want to be treated. This means:

  • Respecting the person’s wishes, concerns, dignity, values and views, and providing care in a way that reflects this;
  • Providing the right information, in a way that works for the person, so that they can make informed choices about their care; and
  • Planning the person’s care with them, in accordance with their goals.

This year saw the production of a person-centred care i-learning video available to staff across Bendigo Health, as well as a growth in the use of patient stories in Board, Community Advisory Committee, Executive and Business Unit Managers meetings as a way to connect discussion to the experience of patients and encourage reflective practice at all levels.

Person centred care is treatment and care provided by a health service that places the person at the centre of their own care, and treats them in the way they want to be treated. This means:

  • Respecting the person’s wishes, concerns, dignity, values and views, and providing care in a way that reflects this;
  • Providing the right information, in a way that works for the person, so that they can make informed choices about their care; and
  • Planning the person’s care with them, in accordance with their goals.

This year saw the production of a person-centred care i-learning video available to staff across Bendigo Health, as well as a growth in the use of patient stories in Board, Community Advisory Committee, Executive and Business Unit Managers meetings as a way to connect discussion to the experience of patients and encourage reflective practice at all levels.

“Consumer centred care and partnerships with consumers have been associated with decreased readmission ratios, decreased healthcare acquired infection rates, reduced length of stay, and improved adherence to treatment regimens.”24

How person-centred are we?

Our third annual ‘Person Centred Care’ (PCC) survey was administered across Bendigo Health in April 2016. In summary, the majority of the respondents (both staff and patients) felt positive about Bendigo Health’s services and the ways in which consumers were involved in their own care.

82% of staff surveyed

felt that care plans are ‘always’ or ‘usually’ structured around the goals of the patient.

88% of patients surveyed

felt that their opinions as patients were ‘always’ (60%) or ‘usually’ (28%) considered equally important to those of treating staff. 

77% of patients surveyed

‘always’ or ‘usually’ felt comfortable to question or challenge the advice given about their care.

56% of respondents

responded that staff ‘Always’ gave them and their carers adequate time to talk to them, whilst 25% felt that this ‘Usually’ occurred and a further 7% felt that this sometimes occurred. Although this year’s positive response of 81% is lower than the 2014 baseline (89%), it is an improvement from 2015 (79%).

Over half of respondents

felt that staff ‘Always’ made an effort to find out what is important to them about health, 23% felt that this ‘usually’ occurred, and a further 6% felt this ‘sometimes’ occurred. This result is similar to 2015 (74%), however remains low compared to 2014 results (89%).

The Victorian Health Experience Survey (VHES) asks patients questions about their healthcare experience.  In the January to March quarter of 2017, 65% of adult inpatients responded positively to whether they were “definitely involved as much as I wanted to be in decisions about my care and treatment”25.

“To me, person-centred care is about … involving the patient and carers in decision making processes … I think that it’s very important to remember that our patients are people, like you and I, and not just a medical case … not just ‘a case of diabetes’, but an actual person with their own beliefs and values.”

– Anna Jennings, Pharmacist, person-centred care i-learning video

Ongoing work to improve the extent to which our care is consistently focussed on and directed by patients includes our use of the STUDER Framework which, among other things, involves:

  • ‘patient rounding’, where staff leaders talk directly with patients and families in the wards, hearing about their expectations and experiences and managing staff and care processes accordingly; and
  • AIDET training, where staff are trained to use a structured communication tool that promotes engagement between staff, patients and families.

 

The Victorian Health Experience Survey (VHES) asks patients questions about their healthcare experience.  In the January to March quarter of 2017, 65% of adult inpatients responded positively to whether they were “definitely involved as much as I wanted to be in decisions about my care and treatment”.25

“To me, person-centred care is about … involving the patient and carers in decision making processes … I think that it’s very important to remember that our patients are people, like you and I, and not just a medical case … not just ‘a case of diabetes’, but an actual person with their own beliefs and values.”

– Anna Jennings, Pharmacist, person-centred care i-learning video

Ongoing work to improve the extent to which our care is consistently focussed on and directed by patients includes our use of the STUDER Framework which, among other things, involves:

  • ‘patient rounding’, where staff leaders talk directly with patients and families in the wards, hearing about their expectations and experiences and managing staff and care processes accordingly; and
  • AIDET training, where staff are trained to use a structured communication tool that promotes engagement between staff, patients and families.

 

Safe, inclusive support

Moving towards a service that is welcoming and provides a safe space for families with members who have diverse gender and sexuality starts with a recognition that the experience of people in this community is different and their needs are often not met by the culture of ‘we treat everyone the same’.
We know that mental health for LGBTI individuals is an issue … they are more vulnerable, and we have a significant number of young people in our service who are at very different stages of gender questioning and diverse sexual orientation.”
Sharon Millist, Occupational Therapist/Senior Clinician, Child and Adolescent Mental Health Services

Work to make Child and Adolescent Mental Health Services (CAMHS) safer and more inclusive for Lesbian, Gay, Bi-sexual, Transgender and Intersex (LGBTI) young people was re-energised in 2015. It began with one staff member’s first meeting with a family where the young person was at the beginning of identifying as male, and transitioning from female to male. Registering their contact with the service, there seemed to be no space for recording gender identity accurately or respectfully, and this lead to further exploration about what was in place at CAMHS to ensure the service was accessible and welcoming.

“When I tried to get some guidance with this I couldn’t find anything … It started me as a clinician and as a person on a very sharp learning curve.”

– Sharon Millist

Since this experience, various changes have been made. This year, examples of improvements made to practice, resources and the service environment, include:

  • Giving one staff person the gender and sexuality “portfolio” ensuring that there’s energy, leadership and accountability in the work being done. Work is happening on two fronts: communicating to people using the service that CAMHS is a safe space, and creating that safe environment; Supporting clinicians in their work with this population.
  • Changing the client information form to include more options under ‘gender’.
  • Developing a ‘safe zone’ poster and displaying that, alongside the Rainbow Families poster26, in the waiting room.
  • Making booklets and pamphlets with information about services available in the waiting room.
  • Providing an electronic resources folder for clinicians, families and policy developers.
  • Purposeful deep listening to the lived experience of people who identify as LGBTI including patients, family members and colleagues.
  • Educating ourselves about the use of pronouns and the process of transition for a person who identifies differently to their assigned birth gender.
  • Broader consideration of families’ support needs across the full diversity of parenting and caring arrangements.
  • Understanding that issues of gender and sexuality are important but only part of the whole person, neither minimising nor over-emphasising these issues.

The work of the project continues to further emphasise gender and sexuality awareness in staff orientation, to build on the collection of LGBTI practice and information resources, and to work out how to evaluate what’s been achieved since the conversation began.

Work to make Child and Adolescent Mental Health Services (CAMHS) safer and more inclusive for Lesbian, Gay, Bi-sexual, Transgender and Intersex (LGBTI) young people was re-energised in 2015. It began with one staff member’s first meeting with a family where the young person was at the beginning of identifying as male, and transitioning from female to male. Registering their contact with the service, there seemed to be no space for recording gender identity accurately or respectfully, and this lead to further exploration about what was in place at CAMHS to ensure the service was accessible and welcoming.

“When I tried to get some guidance with this I couldn’t find anything … It started me as a clinician and as a person on a very sharp learning curve.”

– Sharon Millist

Since this experience, various changes have been made. This year, examples of improvements made to practice, resources and the service environment, include:

  • Giving one staff person the gender and sexuality “portfolio” ensuring that there’s energy, leadership and accountability in the work being done. Work is happening on two fronts: communicating to people using the service that CAMHS is a safe space, and creating that safe environment; Supporting clinicians in their work with this population.
  • Changing the client information form to include more options under ‘gender’.
  • Developing a ‘safe zone’ poster and displaying that, alongside the Rainbow Families poster26, in the waiting room.
  • Making booklets and pamphlets with information about services available in the waiting room.
  • Providing an electronic resources folder for clinicians, families and policy developers.
  • Purposeful deep listening to the lived experience of people who identify as LGBTI including patients, family members and colleagues.
  • Educating ourselves about the use of pronouns and the process of transition for a person who identifies differently to their assigned birth gender.
  • Broader consideration of families’ support needs across the full diversity of parenting and caring arrangements.
  • Understanding that issues of gender and sexuality are important but only part of the whole person, neither minimising nor over-emphasising these issues.

The work of the project continues to further emphasise gender and sexuality awareness in staff orientation, to build on the collection of LGBTI practice and information resources, and to work out how to evaluate what’s been achieved since the conversation began.

Chatting about change is how I would describe it … Speaking at meetings, using the right language because language is important, and highlighting that as an organisation there’s still room to improve.”
Sharon Millist

A welcoming approach

Changes in Bendigo Health Community Dental Services to increase accessibility for newly arrived communities continue to yield good results.
  • Three Dental Assistants who are part of the Karen community were employed by the service this year.
  • In conjunction with Central Victoria Group Training (CVGT), the service is currently training four dental assistants from the Karen community
  • Specific language interpreter clinics were set up in 2016 for the Afghan and Karen communities. The clinics continue to provide a more comfortable and culturally inclusive environment for those using them.
  • Translating appointment letters has had great benefits, firstly in communicating with clients and providing dental health information in a way that can be understood, and secondly in reducing the clinics’ “fail to attend” rates with Afghan and Karen patients.

And, with the interpreters’ help, staff have been teaching themselves basic Karen and Dari greetings, to help Karen and Afghan people feel welcome. Their efforts have not gone unnoticed:

  • Three Dental Assistants who are part of the Karen community were employed by the service this year.
  • In conjunction with Central Victoria Group Training (CVGT), the service is currently training four dental assistants from the Karen community
  • Specific language interpreter Clinics were set up in 2016 for the Afghan and Karen communities. The clinics continue to provide a more comfortable and culturally inclusive environment for those using them.
  • Translating appointment letters has had great benefits, firstly in communicating with clients and providing dental health information in a way that can be understood, and secondly in reducing the clinics “fail to attend” rates with Afghan and Karen patients.

And, with the interpreters’ help, staff have been teaching themselves basic Karen and Dari greetings, to help Karen and Afghan people feel welcome. Their efforts have not gone unnoticed:

I … would like to give your team some feedback from our Settlement team with the system you’ve adopted for your clinics. We are in awe of how you’ve transformed the way you work with our refugee clients. You’ve created a system that seems to be working really well for both our clients and us, so thank you. I wish more service providers could adopt whatever method you are using.”
Case Manager Humanitarian Settlement Services, Bendigo Community Health Services

Statistics

Community Dental Services treat 200-300 patients per day and receive between 100 and 200 phone calls per day.

In 2016-2017, 315 refugee patients attended Community Dental Services for the first time, compared to 243 the previous year.

12 asylum seeker patients attended for the first time, compared to 10 in 2015-2016.

Overall “fail to attend” rates have dropped from 11.3% in July 2016 to 7.6% in June 2017.

In 2016-2017, 315 refugee patients attended Community Dental Services for the first time, compared to 243 the previous year.

12 asylum seeker patients attended for the first time, compared to 10 in 2015-2016.

Overall “fail to attend” rates have dropped from 11.3% in July 2016 to 7.6% in June 2017.

The Dental Service runs Outreach Clinics at schools, Aged Care facilities and Supported Residential Services (SRSs) to improve the region’s Oral Health. Some weeks the clinic will screen 200-plus children.

Better access to outpatient rehabilitation

Working with people who have communication disabilities
We’ve been thinking about consumers and how we can improve services for minority or disadvantaged populations [such as] people who are losing or who have lost the capacity to speak.”
Physiotherapist

After realising that more could be done to ensure that the Outpatient Rehabilitation Service (OPRS) is accessible and responsive to people with communication disabilities, staff decided to make some changes. In collaboration with Scope, a disability support organisation, they put their service and their practice under scrutiny.

Using Scope’s expertise, an audit was carried out that looked at whether communication was as good as it could be for people with a communication disability. They looked at accessibility from the moment the person entered the service, and whether communication resources and support were readily available if needed. The audit involved:

  • “mystery clients” with a communication disability coming into the service and reporting on how they experienced the environment, their interactions with staff, and what they thought should be improved;
  • “mystery callers” using National Relay Service to evaluate the service’s capacity to use the Relay Service, often relied on by people who experience communication or hearing difficulties; and
  • Bendigo Health Speech Pathologists, particularly those working in OPRS, providing their expertise to ensure that all forms of communication were considered.

As a result, a number of changes have been made:

  • The availability of support for people with communication disabilities has been made more obvious, with visible and recognisable signs and resources in the waiting areas so that people feel welcomed and get a clear message that they can ask for communication support;
  • Communication resources are now kept centrally, visible and readily accessible to staff working with clients, so that they have strategies and aids to assist communication; and
  • Staff are undertaking training in working with people who experience communication difficulties.

Having seen the positive effect of these improvements, the Outpatient Rehabilitation service is now sharing their learning and resources with other areas of the Hospital such as the Continence Clinic, a service often supporting children with a communication disability.

After realising that more could be done to ensure that the Outpatient Rehabilitation Service (OPRS) is accessible and responsive to people with communication disabilities, staff decided to make some changes. In collaboration with Scope, a disability support organisation, they put their service and their practice under scrutiny.

Using Scope’s expertise, an audit was carried out that looked at whether communication was as good as it could be for people with a communication disability. They looked at accessibility from the moment the person entered the service, and whether communication resources and support were readily available if needed. The audit involved:

  • “mystery clients” with a communication disability coming into the service and reporting on how they experienced the environment, their interactions with staff, and what they thought should be improved;
  • “mystery callers” using National Relay Service to evaluate the service’s capacity to use the Relay Service, often relied on by people who experience communication or hearing difficulties; and
  • Bendigo Health Speech Pathologists, particularly those working in OPRS, providing their expertise to ensure that all forms of communication were considered.

As a result, a number of changes have been made:

  • The availability of support for people with communication disabilities has been made more obvious, with visible and recognisable signs and resources in the waiting areas so that people feel welcomed and get a clear message that they can ask for communication support;
  • Communication resources are now kept centrally, visible and readily accessible to staff working with clients, so that they have strategies and aids to assist communication; and
  • Staff are undertaking training in working with people who experience communication difficulties.

Having seen the positive effect of these improvements, the Outpatient Rehabilitation service is now sharing their learning and resources with other areas of the Hospital such as the Continence Clinic, a service often supporting children with a communication disability.

Connecting with the Karen community

After experiencing an increase in the number of Karen people attending the Eaglehawk and Mercy Street Rehabilitation services, staff noticed that more could be done to welcome and support them as clients, and to increase their own awareness and confidence in working with people from a different cultural background:

“Many staff are feeling like this is a new experience … Some have not had a great deal of experience working with people from different cultural backgrounds … and they don’t necessarily have experience working with interpreters.”

– Justine O’Bree, Physiotherapist

Systems are in place for booking interpreters prior to appointments, and ensuring that Karen clients are made aware of these bookings in advance. The Charter of Healthcare Rights has been translated into Karen, and appointment letters are also translated into Karen language. Written and video resources about how to work with interpreters are made readily available to staff.

However, there was still a need to strengthen how staff welcomed and worked with Karen clients on arrival at the service, and throughout their rehabilitation care. With the collaboration of Dental Service staff, who have made improvements in the accessibility of their clinics to the Karen community, Rehabilitation staff have undertaken awareness training. This included learning Karen greetings and pronunciation, discussing differences in ways of communicating, and hearing about the experiences and culture of the Karen community.

Connecting with the Karen community

After experiencing an increase in the number of Karen people attending the Eaglehawk and Mercy Street Rehabilitation services, staff noticed that more could be done to welcome and support them as clients, and to increase their own awareness and confidence in working with people from a different cultural background:

“Many staff are feeling like this is a new experience … Some have not had a great deal of experience working with people from different cultural backgrounds … and they don’t necessarily have experience working with interpreters.”

– Justine O’Bree, Physiotherapist

Systems are in place for booking interpreters prior to appointments, and ensuring that Karen clients are made aware of these bookings in advance. The Charter of Healthcare Rights has been translated into Karen, and appointment letters are also translated into Karen language. Written and video resources about how to work with interpreters are made readily available to staff.

However, there was still a need to strengthen how staff welcomed and worked with Karen clients on arrival at the service, and throughout their rehabilitation care. With the collaboration of Dental Service staff, who have made improvements in the accessibility of their clinics to the Karen community, Rehabilitation staff have undertaken awareness training. This included learning Karen greetings and pronunciation, discussing differences in ways of communicating, and hearing about the experiences and culture of the Karen community.

Welcoming people in their language helps them to feel more welcome … and sometimes gives them a bit of a giggle as well!”
Clinical Coordinator, Community Dental Service

Telehealth to the home

Telehealth and associated advancements in technology open up numerous opportunities for providing health services, particularly specialist health services that are not readily available in rural and remote areas. Mental Health support is one such service. Telehealth will provide savings to patients, carers and clinicians, reducing travel and ensuring services are delivered when they’re needed. A challenge for Psychiatric Services is providing Telehealth to the home safely and appropriately, ensuring confidentiality and informed choice by consumers. Providing this challenge is met, the new technology offers significant benefits to our patients and their carers. It’s an exciting development.”
Manager Rural North Community Mental Health Teams

For people living in small and remote communities, access to mental health support can be difficult. Telehealth has been introduced at Bendigo Health with the aim of increasing this access. A new technology, similar to Skype, it enables support to be provided at a distance. Where the situation is right, patients and carers can consult with practitioners without leaving their homes. This is one family’s experience.

In Focus

Reducing the stress

Liz and her husband support their adult daughter Sue who lives with a mild intellectual disability, anxiety and depression. The family live in a small town some distance from mental health services.

Over the last 6 years, having experienced a psychotic episode, Sue has relied on regular psychiatric support and treatment. Part of this is to have appointments for ECT every three weeks and, in the interim, have review sessions with a psychiatrist.

Coming to Bendigo for treatment involves staying the night.

“[If we didn’t do this] we would have to get up at 5 a.m. and we would be flat out getting out the door … so when we have the ECT treatment, we stay in Bendigo the night before, which makes it much less stressful.” 

– Liz

Whilst this makes it an easier morning heading to the Hospital, at a pace that means the family can work together to minimize Sue’s anxiety, there are money and time costs. Going to Bendigo is a 250 km round trip, and public transport doesn’t meet their needs:

“We’re ageing parents, so how long can we keep driving? Sue doesn’t drive and there’s no direct public transport that could get you there and back in a day.”

– Liz

Having the appointments face to face, whether in Echuca or Bendigo, is another trip (130km return) on top of these overnight visits. The opportunity for Sue to have the consultations with the Psychiatrist remotely, via Telehealth, has been very welcome, reducing the number of trips the family have to do by half.

So far, it has been a success. Liz’s worries that the Telehealth session would be anxiety-provoking for Sue, and that it would be difficult for the Psychiatrist to pick up on Sue’s emotional state via screen, was quickly allayed:

“The Psychiatrist picked up on it straight away, which was great … they can observe like its face to face …. And Sue coped with [the online session] extremely well, even though she was stressed … not having to get in the car and go to Echuca was great, and less stressful for Sue.”

– Liz

Liz appreciates “the convenience of it all” for everyone involved, while at the same time being aware that Telehealth “doesn’t replace seeing your medical professional in person every now and then”, and that this is always something that’s available to Sue.

Over the last 6 years, having experienced a psychotic episode, Sue has relied on regular psychiatric support and treatment. Part of this is to have appointments for ECT every three weeks and, in the interim, have review sessions with a psychiatrist.

Coming to Bendigo for treatment involves staying the night.

“[If we didn’t do this] we would have to get up at 5 a.m. and we would be flat out getting out the door … so when we have the ECT treatment, we stay in Bendigo the night before, which makes it much less stressful.” 

– Liz

Whilst this makes it an easier morning heading to the Hospital, at a pace that means the family can work together to minimize Sue’s anxiety, there are money and time costs. Going to Bendigo is a 250 km round trip, and public transport doesn’t meet their needs:

“We’re ageing parents, so how long can we keep driving? Sue doesn’t drive and there’s no direct public transport that could get you there and back in a day.”

– Liz

Having the appointments face to face, whether in Echuca or Bendigo, is another trip (130km return) on top of these overnight visits. The opportunity for Sue to have the consultations with the Psychiatrist remotely, via Telehealth, has been very welcome, reducing the number of trips the family have to do by half.

So far, it has been a success. Liz’s worries that the Telehealth session would be anxiety-provoking for Sue, and that it would be difficult for the Psychiatrist to pick up on Sue’s emotional state via screen, was quickly allayed:

“The Psychiatrist picked up on it straight away, which was great … they can observe like its face to face …. And Sue coped with [the online session] extremely well, even though she was stressed … not having to get in the car and go to Echuca was great, and less stressful for Sue.”

– Liz

Liz appreciates “the convenience of it all” for everyone involved, while at the same time being aware that Telehealth “doesn’t replace seeing your medical professional in person every now and then”, and that this is always something that’s available to Sue.

“It’s a good use of technology. It makes sense economically. They don’t need to find a room to see you in … It’s just a phone call and can be changed quite quickly … and I only have to ring if I need face to face backup. That’s a security for me.”

Connecting with carers

The more information carers have, the more empowered they are … And they get to know others and feel less isolated.”
Fiona Smethurst, Carer Consultant

Carer Consultants play a vital role supporting families and carers of people using psychiatric services at Bendigo Health. As peer workers with lived experience as carers, the Carer Consultants’ expertise has been invaluable to Family and Carer initiatives at Bendigo Health. Since starting six years ago, with one position focused on improving practice with carers and families and enhancing policy and education within the service, there are now two positions. This means there is capacity to provide direct support to carers.

Over the last year, the roles have expanded to include having an active presence in the inpatient units and community teams. The Carer Consultants work alongside staff so that:

  • contact can be made with family and carers in the early stages of a person being admitted to Hospital (particularly when it’s their first experience of admission) as well as later, when family and carers can be referred by community teams;
  • a knowledgeable presence can promote awareness of the needs and experiences of families and carers;
  • everyone involved (consumers, family, carers, carer consultants, clinical and community staff) can work as a team to provide care and referrals to other supports and services.

These changes were made after feedback from families that communication between different roles in the service could be better, and that in the busy environment of the ward, it could be a challenge for family and carers to get the support and attention they needed.

According to Fiona Smethurst, Carer Consultant, this “peer to peer work” is “critical”. It involves going to the acute ward, finding out family and carers’ names, phoning them, offering support, meeting them in the community if they wish, or simply making a connection in case the carer chooses to seek support further down the track.

The role also involves advocating with doctors or other clinicians and promoting family meetings. With Carer Consultants as part of the team, there can be a better awareness of the situation at home and of the needs of family and carers. This is of great benefit in planning for the person to leave hospital and be supported in the community. Also, family and carers can be connected with others who share similar experiences, including having the opportunity to come to information and education sessions.

According to Fiona, this peer to peer “personalised approach” is invaluable. It might not lead a family member or carer to ask for support straight away, but it plants a seed, and lets them know that support is possible. The initial contact can be validating and supportive in itself.

“It often happens that a carer comes to a workshop, like mental health first aid, realises there are others in the same boat, makes contact to talk further, and then takes up a referral for support, such as counselling through Carers Victoria”

– Fiona Smethurst, Carer Consultant

At an organisational level, the Consultants continue to represent the voice of carers on Committees, including Senior Management, Quality and Risk and Diversity, as well as the Family and Carer Support Engagement Committee, which is a body that brings together people who work closely with family and carers in the organisation. They also provide the Carers’ perspective in Graduate Nurse Education forums and education for clinical staff.

Bendigo Health continues to look for ways to improve carers’ experience and strengthen collaboration. According to Cathy Spencer, Carer Consultant:

“We are working to increase ways that family and carers can have greater influence … and ways that we can be more inclusive in how we work.”

– Cathy Spencer, Carer Consultant

This includes boosting the participation of carers in patient, family and carer feedback surveys that happen when someone is discharged. Along with this, the Consultants will continue to promote inclusion of families when a person is admitted to Hospital or using our community based services, and to provide support and referral for carers from that point on.

Quality & Safety

Quality & Safety

Your experience

The experience of people using Bendigo health services is monitored through:

Day to day conversations between healthcare staff and patients.

Feedback from consumers that comes through formal and informal complaints.

Patient-centred care surveys, carried out annually.

Day to day conversations between healthcare staff and patients.

Feedback from consumers that comes through formal and informal complaints.

Patient-centred care surveys, carried out annually.

Focus group discussions and phone calls to patients once they have left hospital.

The Victorian Health Experience Survey (VHES), an independent state-wide survey that asks people how they felt about their experience with a public hospital, such as Bendigo Health.

Victorian Health Experience Survey

Victorian Health Experience Survey (VHES) is a valuable source of information about our health services and how patients experience them. The survey results tell us whether the care we provide is effective from the patient’s point of view. They enable us to monitor the quality of our services and identify areas that need improvement.
I was treated efficiently, kindly, and quickly. My family were given clear instructions on how to treat me medically on discharge and were given every courtesy to make them comfortable while they were with me.”
Patient in Adult Emergency27

The following table shows the percentage of Bendigo Health patients who rated their overall experience as ‘good’ or ‘very good’.

July – Sept 2016 Oct – Dec 2016 Jan – Mar 2017
Bendigo Health 96% 88.6% 84%
Same quarter previous year (BH) 87% 95.1% 88%
Statewide 92% 91% 91%

The figures show a decline in positive overall experience of our services. In identifying ways to turn this around, there are some aspects of practice and care that have particular influence on a patient’s overall experience of Bendigo Health. For example, we know from the VHES data that:

    • If an adult inpatient feels that they have received sufficient information from doctors and nurses about managing their health and care at home, they are more likely to report a positive experience overall.28

    • A person is four times more likely to have a good overall healthcare experience when they feel listened to and understood.29

    • In Maternity, if a patient feels that staff help within a reasonable time all of the time (when needed), they are more likely to have a positive experience overall.30

Responding to the VHES analysis above, action to improve experience for patients include:

  1. Work to improve discharge summaries (see “Improving discharge care”) and changing the way home assessments are done in preventing falls (see “Reducing the risk of falls”);
  2. New approaches being taken through the peer support and carer consultant roles in mental health (see “Connecting with Carers” and “Peer Support”), and through a project to improve the experiences of people with a disability using our services (see “Enhancing access and support”); and
  3. Making lactation information, support and advice more accessible and responsive to women while they are still in Hospital (see “Caring for women and babies”).

We have also made improvements to the way VHES results are communicated and made available to people across the organisation. An accessible newsletter-style summary of each quarters’ results is sent to the Board, committees, reference groups, Communications and Marketing, education roles and Business Unit Managers. The summary includes verbatim comments from survey participants, as well as related information and resources such as links to consumer-focussed videos.

The figures show a decline in positive overall experience of our services. In identifying ways to turn this around, there are some aspects of practice and care that have particular influence on a patient’s overall experience of Bendigo Health. For example, we know from the VHES data that:

    • If an adult inpatient feels that they have received sufficient information from doctors and nurses about managing their health and care at home, they are more likely to report a positive experience overall.28

    • A person is four times more likely to have a good overall healthcare experience when they feel listened to and understood.29

    • In Maternity, if a patient feels that staff help within a reasonable time all of the time (when needed), they are more likely to have a positive experience overall.30

Responding to the VHES analysis above, action to improve experience for patients include:

  1. Work to improve discharge summaries (see “Improving discharge care”) and changing the way home assessments are done in preventing falls (see “Reducing the risk of falls”);
  2. New approaches being taken through the peer support and carer consultant roles in mental health (see “Connecting with Carers” and “Peer Support”), and through a project to improve the experiences of people with a disability using our services (see “Enhancing access and support”); and
  3. Making lactation information, support and advice more accessible and responsive to women while they are still in Hospital (see “Caring for women and babies”).

We have also made improvements to the way VHES results are communicated and made available to people across the organisation. An accessible newsletter-style summary of each quarters’ results is sent to the Board, committees, reference groups, Communications and Marketing, education roles and Business Unit Managers. The summary includes verbatim comments from survey participants, as well as related information and resources such as links to consumer-focussed videos.

Responding to feedback

The approach taken to complaints at Bendigo Health is designed to provide opportunity for the consumer or carer to express their concerns, to have those concerns heard by the people involved in their care, and to be part of discussions and decisions about what will be done to resolve the complaint. The process is about restoring the relationship between the person and the service, rebuilding their trust in the service, fostering mutual understanding, and encouraging the organisation to learn from the patient’s experience and make relevant changes.

We have supported staff in recognising the importance of a restorative approach in the way we receive and resolve complaints and feedback.  It’s important that a restorative approach is taken at every stage of resolving a complaint: In the initial engagement of Clinical Directors and Nurse Unit Managers, and in planning family meetings, open disclosures and resolution meetings.

The restorative approach focuses on actively acknowledging Bendigo Health’s relationship with consumers and seeking to repair any damage to that relationship that may have occurred through their experience with the service. Most often, a consumer’s sense of trust or confidence in the organisation is compromised through a negative or poor experience. In voicing complaints, consumers often report that they have not felt respected, cared for, or valued. A restorative approach provides an opportunity to articulate that we:

  • value our relationship with our consumers;
  • are committed to rebuilding trust and confidence; and
  • will take the steps to do so.    

Systems improvements may occur through the complaints process, however, unless attention is given to repairing the relationship with the consumer then the full benefits of resolution are compromised.  A restorative approach is relevant to quality and safety because if a consumer’s relationship with their health service is positive, then they are more likely to engage and be active in their care during future admissions, supporting safety and better outcomes. 

We have supported staff in recognising the importance of a restorative approach in the way we receive and resolve complaints and feedback.  It’s important that a restorative approach is taken at every stage of resolving a complaint: In the initial engagement of Clinical Directors and Nurse Unit Managers, and in planning family meetings, open disclosures and resolution meetings.

The restorative approach focuses on actively acknowledging Bendigo Health’s relationship with consumers and seeking to repair any damage to that relationship that may have occurred through their experience with the service. Most often, a consumer’s sense of trust or confidence in the organisation is compromised through a negative or poor experience. In voicing complaints, consumers often report that they have not felt respected, cared for, or valued. A restorative approach provides an opportunity to articulate that we:

  • value our relationship with our consumers;
  • are committed to rebuilding trust and confidence; and
  • will take the steps to do so.    

Systems improvements may occur through the complaints process, however, unless attention is given to repairing the relationship with the consumer then the full benefits of resolution are compromised.  A restorative approach is relevant to quality and safety because if a consumer’s relationship with their health service is positive, then they are more likely to engage and be active in their care during future admissions, supporting safety and better outcomes. 

In Focus

Seeing one another’s perspective

“[What was valuable was] seeing one another’s perspective, which doesn’t always happen … she helped me understand her perspective, and she trusted that I took her experience seriously, [and that] we don’t want to make the same mistake again”
Senior practitioner

An experience with Emergency and then Psychiatric triage left Sarah, a supporting grandmother, feeling judged and worried for her granddaughter’s safety. She felt that the seriousness and risk of her granddaughter’s situation had not been appreciated or adequately responded to. Her confidence in Bendigo Health’s care was badly shaken, and she decided to make a formal complaint.

What followed turned that experience around. A senior practitioner responded to the complaint in a detailed and thoughtful letter. He was able to do this without too much delay:

“It was a complaint that I was able to respond to quickly and I think that helps, so things don’t build up … I was able to [investigate what had happened] and could get back to her promptly”.

The response was, and felt like, an apology – a genuine acknowledgment of the anxiety and fear Sarah had felt about her granddaughter’s treatment. The letter was specific and detailed, providing meaningful answers about what happened, and what didn’t happen, and the shortcomings and constraints behind this. It also outlined what action had been taken in response to the issues raised by the complaint: the Electronic Medical Record now in place; discussion with the staff concerned about ways of ensuring prompt follow up in high risk situations; and the (re-)introduction of business cards so that information about follow-up services and contacts can be handed to patients in a professional and clear format.

Soon after the letter was sent, the practitioner received a phone call from Sarah. Understandably, he took the call with some unease: “When she rang, I thought ‘here we go …’ ”. But, alongside fearing that what he was about to hear would be negative, was an awareness that:

“Everyone knows that things go wrong, and mistakes happen … people mostly just don’t want the same mistake to happen to someone else … there is a generosity of spirit in many of the responses we get”.

Sarah had in fact rung to thank him for his response. For the practitioner, being thanked was very heartening. Asked about what this meant, and what he saw as the value of the process, he said:

[The value was in] coming to understand [Sarah’s] perspective … understanding that for her it was about more than just the service at the time … it was also about her experience of suicide in the past, with her own children … so there was all that overlay. It was helpful for me to understand how that impacted on how she experienced things [now] … [The process] enabled [Sarah] to understand the reasons behind what we did, and me to understand where she was coming from”.

In Focus

Making things right

After an upsetting experience in the Children’s Ward, where an Intravenous (IV) drip became dislodged, a parent expressed their concerns to staff. Immediate action was taken to relieve the child and respond to the concerns.

Subsequently, the Nurse Unit Manager spoke at length with the family about their experience and what improvements might be made as a result. At Ward and team levels, the Manager raised the family’s experience for discussion and reflection during morning rounds. She also convened a “think tank” of team members to brainstorm ideas about the barriers to regular checking of drips, and what could be done to prevent similar situations happening in future. This lead to sharing expertise about different ways to secure IV sites on children to enable easy and regular checking and the development and introduction of a new form to prompt and record the checking of IV lines.

Having also contacted the Patient Feedback Coordinator, the family’s experience was taken up through the complaints process. This enabled further review at Department level. The complaint and the response were discussed at both the Paediatric Services Meeting and the Morbidity and Mortality Meeting, looking at system issues, prevention strategies, and questions of person-centred care raised by the experience.

The Nurse Unit Manager was then able to contact the family again to let them know about the action that had been taken as a result of their complaint. The family expressed their thanks for the thought and work that had been put into the response, and were glad to hear back from the Hospital about what had been done.

Subsequently, the Nurse Unit Manager spoke at length with the family about their experience and what improvements might be made as a result. At Ward and team levels, the Manager raised the family’s experience for discussion and reflection during morning rounds. She also convened a “think tank” of team members to brainstorm ideas about the barriers to regular checking of drips, and what could be done to prevent similar situations happening in future. This lead to sharing expertise about different ways to secure IV sites on children to enable easy and regular checking and the development and introduction of a new form to prompt and record the checking of IV lines.

Having also contacted the Patient Feedback Coordinator, the family’s experience was taken up through the complaints process. This enabled further review at Department level. The complaint and the response were discussed at both the Paediatric Services Meeting and the Morbidity and Mortality Meeting, looking at system issues, prevention strategies, and questions of person-centred care raised by the experience.

The Nurse Unit Manager was then able to contact the family again to let them know about the action that had been taken as a result of their complaint. The family expressed their thanks for the thought and work that had been put into the response, and were glad to hear back from the Hospital about what had been done.

Workplace

STAFF SAFETY

We continue to review and revise practices and initiatives to improve the health, wellbeing and safety of our workforce. We have:

  • Reviewed occupational health and safety (OH&S) within our overarching governance and committee structures;
  • Established a high level Executive-lead OH&S committee, along with a review of our Health and Safety Committees and staff representation; and
  • Delivered education and training across all levels of the organisation, developing a values-based culture.

The commissioning of a brand new purpose built facility also brought many improvements for our workforce. Extensive consultation occurred prior to and during the commissioning of the facility to ensure it is as safe as possible for staff, volunteers, patients, clients and their carers and families. Deliberate measures were taken to reduce and prevent violence and aggression towards staff, including increased surveillance and security guard presence.

PATIENT SAFETY AND WORKPLACE CULTURE

The People Matter survey is an employee opinion survey run by the Victorian Public Sector Commission. It asks staff questions about their perceptions of patient safety. In the 2017 survey 67% of respondents indicated Bendigo Health performed positively when delivering patient care. This result is lower than the 2015 result of 87%.

Given the People Matter survey was performed only months after moving into the new facility, it was anticipated that staff perceptions of safe patient care would have shifted. A new facility brings many challenges for the workforce within it as they learn to adapt to new equipment, technology and workflow. Bendigo Health is extremely pleased with the cautious and careful nature of our workforce as they deliver care in a new facility. As confidence in the new facility and surrounds grow we expect staff perceptions of safe patient care will also return to optimal levels.

ABORIGINAL PUBLIC SECTOR EMPLOYMENT

Bendigo Health continues to support Aboriginal people in the workforce. Cadetships and Traineeships were ongoing areas of focus, enabling Bendigo Health to employ and support Aboriginal people to engage with and pursue a career in health. Significant work also took place to create a designated area in the new hospital for the support of Aboriginal people. This space holds a prominent place in the atrium of the health service and is for use by the community and our Aboriginal staff. There is great pride in this achievement and it is hoped that this will further support our efforts to recruit and retain Aboriginal staff.

STAFF SAFETY

We continue to review and revise practices and initiatives to improve the health, wellbeing and safety of our workforce. We have:

  • Reviewed occupational health and safety (OH&S) within our overarching governance and committee structures;
  • Established a high level Executive-lead OH&S committee, along with a review of our Health and Safety Committees and staff representation; and
  • Delivered education and training across all levels of the organisation, developing a values-based culture.

The commissioning of a brand new purpose built facility also brought many improvements for our workforce. Extensive consultation occurred prior to and during the commissioning of the facility to ensure it is as safe as possible for staff, volunteers, patients, clients and their carers and families. Deliberate measures were taken to reduce and prevent violence and aggression towards staff, including increased surveillance and security guard presence.

PATIENT SAFETY AND WORKPLACE CULTURE

The People Matter survey is an employee opinion survey run by the Victorian Public Sector Commission. It asks staff questions about their perceptions of patient safety. In the 2017 survey 67% of respondents indicated Bendigo Health performed positively when delivering patient care. This result is lower than the 2015 result of 87%.

Given the People Matter survey was performed only months after moving into the new facility, it was anticipated that staff perceptions of safe patient care would have shifted. A new facility brings many challenges for the workforce within it as they learn to adapt to new equipment, technology and workflow. Bendigo Health is extremely pleased with the cautious and careful nature of our workforce as they deliver care in a new facility. As confidence in the new facility and surrounds grow we expect staff perceptions of safe patient care will also return to optimal levels.

ABORIGINAL PUBLIC SECTOR EMPLOYMENT

Bendigo Health continues to support Aboriginal people in the workforce. Cadetships and Traineeships were ongoing areas of focus, enabling Bendigo Health to employ and support Aboriginal people to engage with and pursue a career in health. Significant work also took place to create a designated area in the new hospital for the support of Aboriginal people. This space holds a prominent place in the atrium of the health service and is for use by the community and our Aboriginal staff. There is great pride in this achievement and it is hoped that this will further support our efforts to recruit and retain Aboriginal staff.

External reviews

Bendigo Health is accredited by the Australian Council on Healthcare Standards (ACHS) against the National Safety and Quality Health Service Standards (NSQHS). This process provides an opportunity for us to review our quality and safety systems and ensure they meet best practice. In October 2016 Bendigo Health underwent a successful accreditation against Standards 1, 2 and 3 of the NSQHS. This has put the organisation in good stead for our full accreditation survey in October 2017. In preparation for this, we continue to monitor and strengthen our patient safety processes.

A key part of our patient safety program is to expand auditing of our practice and documentation in two areas: the management and prevention of pressure injuries and falls prevention. Audit data has demonstrated significant improvements in practice, leading to better care for our patients. Bedside Handover continues to be implemented throughout the inpatient wards. In some areas this has been expanded to all three nursing shifts each day. To support patient, family and staff communication Patient Communication Boards have been installed near all beds. These boards enable information about care, as well as questions patients or family members may have, to be visibly recorded and followed up on.

The following Table details accreditation processes that have taken place during 2016-2017:

Bendigo Health is accredited by the Australian Council on Healthcare Standards (ACHS) against the National Safety and Quality Health Service Standards (NSQHS). This process provides an opportunity for us to review our quality and safety systems and ensure they meet best practice. In October 2016 Bendigo Health underwent a successful accreditation against Standards 1, 2 and 3 of the NSQHS. This has put the organisation in good stead for our full accreditation survey in October 2017. In preparation for this, we continue to monitor and strengthen our patient safety processes.

A key part of our patient safety program is to expand auditing of our practice and documentation in two areas: the management and prevention of pressure injuries and falls prevention. Audit data has demonstrated significant improvements in practice, leading to better care for our patients. Bedside Handover continues to be implemented throughout the inpatient wards. In some areas this has been expanded to all three nursing shifts each day. To support patient, family and staff communication Patient Communication Boards have been installed near all beds. These boards enable information about care, as well as questions patients or family members may have, to be visibly recorded and followed up on.

The following Table details accreditation processes that have taken place during 2016-2017 (click tab to expand):

Accreditation Processes 2016-17

Accreditation Framework Division Details
National Safety and Quality Health Service Standards (NSQHS)

National Quality Mental Health Service Standards (NSMHS)

Organisation Wide In October 2016 a mid-cycle review was conducted to ensure Bendigo Health met compliance to NSQHS Standards 1, 2 and 3. A full survey of all 10 NSQHS and NSMHS standards will occur in October 2017.
Aged Care Standards Healthy Communities and Continuing Care During 2015, all four of Bendigo Health’s Residential Aged Care facilities were successfully re-accredited against the Aged Care Standards for 3 years. As part of the Aged Care Standards process each facility underwent unannounced audits in 2016. These audits all had successful outcomes.
Human Services Standards Healthy Communities and Continuing Care In February 2016, disability funded programs underwent a 3-day onsite accreditation against the Human Services Standards. These standards will again be assessed in October 2017.
ISO 9001 Corporate Services Division Bendigo Health’s Supply, Payroll and Salary Packaging Departments underwent an accreditation in March 2017. These departments obtained a 3-year full accreditation against the ISO 9001 standard.
Diagnostic Imaging Accreditation Scheme Clinical Support Services Division In 2015, Medical Imaging underwent a successful accreditation against the Diagnostic Imaging Accreditation Scheme. They achieved 4-year accreditation.
Accreditation Framework:

National Safety and Quality Health Service Standards (NSQHS) and National Quality Mental Health Service Standards (NSMHS)

Division
Organisation Wide
Details
In October 2016 a mid-cycle review was conducted to ensure Bendigo Health met compliance to NSQHS Standards 1, 2 and 3. A full survey of all 10 NSQHS and NSMHS standards will occur in October 2017.

Aged Care Standards

Division
Healthy Communities and Continuing Care
Details
During 2015, all four of Bendigo Health’s Residential Aged Care facilities were successfully re-accredited against the Aged Care Standards for 3 years. As part of the Aged Care Standards process each facility underwent unannounced audits in 2016. These audits all had successful outcomes.

Human Services Standards

Division
Healthy Communities and Continuing Care
Details
In February 2016, disability funded programs underwent a 3-day onsite accreditation against the Human Services Standards. These standards will again be assessed in October 2017.

ISO 9001

Division
Corporate Services Division
Details
Bendigo Health’s Supply, Payroll and Salary Packaging Departments underwent an accreditation in March 2017. These departments obtained a 3-year full accreditation against the ISO 9001 standard.

Diagnostic Imaging Accreditation Scheme

Division
Clinical Support Services Division
Details
In 2015, Medical Imaging underwent a successful accreditation against the Diagnostic Imaging Accreditation Scheme. They achieved 4-year accreditation.

Managing clinical risks

The Victorian Health Incident Management System (VHIMS) is the system used for reporting incidents at Bendigo Health (BH). VHIMS is a key feature in our approach to managing clinical risk across the organisation. Reported incidents are used to identify areas of potential clinical risk and opportunities for improvement. Action plans are developed to address these risks, making the organisation safer for our patients. Staff are required to record all incidents and are provided with orientation, training and user guides to assist them with this process.

Results from monitoring of the incident reporting system show growing awareness of the importance of reporting incidents in our efforts to improve patient safety:

A 21% growth

in the number of staff registering to use VHIMS

A 28% growth

in the number of incidents being reported in VHIMS

Significant increase

in the use of the VHIMS Help Desk, from an average of 6 hours per month to around 12 hours per month

An increase of 148%

since 2014 in the number of incidents being entered by Medical staff

There are committees in place across BH to examine incidents and to monitor review processes and action plans. The most severe incidents, rated as severity 1 or 2, are analysed by governance committees made up of a multidisciplinary group of clinicians as well as representatives from Quality and Risk. Recommendations arising from reviews are captured in a database and monitored for completion as well as for their effectiveness in preventing recurrence of similar incidents.

During 2016-2017 there were 185 ‘adverse events’ with a severity rating of either 1 or 2. Three of these were categorised as ‘sentinel events’ – a sentinel event is defined as an incident with a severity rating of 1 and the outcome for the patient was directly related to the incident. In response to these adverse events, to stop them happening again, BH:

  • Evaluated how patients with complex needs are managed to ensure care is coordinated;
  • Introduced an Escalation Policy to guide staff about when and how to seek the advice of senior clinicians;
  • Reviewed how tasks are assigned to nurses during night shift in the Medical Unit to ensure the nurse in charge of the shift is given adequate time to carry out tasks that promote safe care;
  • Redeveloped the Resuscitation Policy to incorporate specific safety requirements of the Cardiac Catheter Laboratory;
  • Devised an action plan within the Psychiatric Services Division to remove barriers to staff using the clinical escalation system appropriately and effectively. This includes staff training and enabling greater access to medical staff on weekends;
  • Developed a Stroke Call protocol to improve timeliness of clinical treatment and, therefore, patient outcomes;
  • Introduced a new training package for endoscope reprocessing staff to ensure their skills are appropriate; and
  • Increased the number of endoscope processing staff to better match demand.

To improve quality and monitoring systems in response to adverse events, our Patient/Client Incident Management Protocol was reviewed and updated. The revised protocol enables staff to be better informed about their obligations in reporting incidents. It also promotes the provision of feedback to staff and patients about the outcome of incident investigations. In addition, we have developed a Recommendations Register to ensure the learnings from incidents are captured and monitored and that the outcomes can be evaluated.

There are committees in place across BH to examine incidents and to monitor review processes and action plans. The most severe incidents, rated as severity 1 or 2, are analysed by governance committees made up of a multidisciplinary group of clinicians as well as representatives from Quality and Risk. Recommendations arising from reviews are captured in a database and monitored for completion as well as for their effectiveness in preventing recurrence of similar incidents.

During 2016-2017 there were 185 ‘adverse events’ with a severity rating of either 1 or 2. Three of these were categorised as ‘sentinel events’ – a sentinel event is defined as an incident with a severity rating of 1 and the outcome for the patient was directly related to the incident. In response to these adverse events, to stop them happening again, BH:

  • Evaluated how patients with complex needs are managed to ensure care is coordinated;
  • Introduced an Escalation Policy to guide staff about when and how to seek the advice of senior clinicians;
  • Reviewed how tasks are assigned to nurses during night shift in the Medical Unit to ensure the nurse in charge of the shift is given adequate time to carry out tasks that promote safe care;
  • Redeveloped the Resuscitation Policy to incorporate specific safety requirements of the Cardiac Catheter Laboratory;
  • Devised an action plan within the Psychiatric Services Division to remove barriers to staff using the clinical escalation system appropriately and effectively. This includes staff training and enabling greater access to medical staff on weekends;
  • Developed a Stroke Call protocol to improve timeliness of clinical treatment and, therefore, patient outcomes;
  • Introduced a new training package for endoscope reprocessing staff to ensure their skills are appropriate; and
  • Increased the number of endoscope processing staff to better match demand.

To improve quality and monitoring systems in response to adverse events, our Patient/Client Incident Management Protocol was reviewed and updated. The revised protocol enables staff to be better informed about their obligations in reporting incidents. It also promotes the provision of feedback to staff and patients about the outcome of incident investigations. In addition, we have developed a Recommendations Register to ensure the learnings from incidents are captured and monitored and that the outcomes can be evaluated.

Preventing infections

Promoting safe practice and reducing risk
The Infection Prevention and Control (IPC) program is responsible for preventing and managing infection by minimising the risk of local transmission. We do this through identifying individuals who are at-risk, taking precautions, and ensuring we comply with safe practices. We also promote best practice in infection control - through policies, education of staff, auditing, feedback from surveillance results, quality improvement activities and regular educational updates.

Ensuring that consumers are included in and informed about their care is essential to reducing infection risks. Brochures providing information on infection control, hand hygiene, and significant infections are widely available across Bendigo Health. IPC information is also available via the Bendigo Health internet site and, to keep staff up to date, via the intranet and noticeboards. In the new Hospital, educative information about hand hygiene is included on screens in waiting areas.

HAND HYGIENE

Bendigo Health (BH) has consistently met the National target rate for hand hygiene since hand hygiene monitoring began (2000). Currently the target is 80%. In the Third quarter of the 2016-2017 year Bendigo Health failed to meet the target, achieving a rate of 75%. An action plan was implemented and in the fourth quarter the target was met, with a rate of 80.1%. Failure to meet the rate was due in part to alcohol-based hand rub not being readily available to staff after the move to the new hospital. Brackets have been installed in more strategic places along with better signage about using hand rub. There was no increase in health care acquired infections during 2016-2017.

  Audit Period *Compliance Required Number of Observations Compliance Achieved
June 2017 2 80% 2,121 80.1%
March 2017 1 80%  1,889 *75.6%
October 2016 3 80%  2,214 81%
June 2016 2 80%  2,290 83%
June 2017
Audit Period 2
*Compliance Req’d 80%
No. of Observations 2,121
Compliance Achieved 80.1%
March 2017
Audit Period 1
*Compliance Req’d 80%
No. of Observations 1,889
Compliance Achieved *75.6%
October 2016
Audit Period 3
*Compliance Req’d 80%
No. of Observations 2,214
Compliance Achieved 81%
June 2016
Audit Period 2
*Compliance Req’d 80%
No. of Observations 2,290
Compliance Achieved 83%

Intensive Care Unit Surveillance

Great care is taken to monitor and reduce the risk to patients of developing healthcare-associated infections, including bloodstream infections. It is believed that a large proportion of these bloodstream infections are associated with the presence of a central vascular catheter (central line). Central Line associated blood stream infections (CLABSI) can be prevented through proper insertion techniques and management of the central line. The use of these techniques is regularly audited by IPC.

Patients receiving mechanical ventilation are at high risk of complications and poor outcomes. Ventilator-associated pneumonia (VAP), sepsis, Acute Respiratory Distress Syndrome (ARDS), pulmonary embolism, barotrauma, and pulmonary oedema are among the complications that can occur in patients receiving mechanical ventilation.

Central Line associated blood stream infections (CLABSI) and Ventilator Related Events (VAE/VAP) are monitored continuously in the Intensive Care unit (ICU). The ICU continue to have no central line associated infections or infections related to artificial ventilation. Best practise interventions are in place in the ICU which require constant observation by staff. ICU also review mortality and morbidity on a weekly basis, enabling robust review of risk for these infections.

Great care is taken to monitor and reduce the risk to patients of developing healthcare-associated infections, including bloodstream infections. It is believed that a large proportion of these bloodstream infections are associated with the presence of a central vascular catheter (central line). Central Line associated blood stream infections (CLABSI) can be prevented through proper insertion techniques and management of the central line. The use of these techniques is regularly audited by IPC.

Patients receiving mechanical ventilation are at high risk of complications and poor outcomes. Ventilator-associated pneumonia (VAP), sepsis, Acute Respiratory Distress Syndrome (ARDS), pulmonary embolism, barotrauma, and pulmonary oedema are among the complications that can occur in patients receiving mechanical ventilation.

Central Line associated blood stream infections (CLABSI) and Ventilator Related Events (VAE/VAP) are monitored continuously in the Intensive Care unit (ICU). The ICU continue to have no central line associated infections or infections related to artificial ventilation. Best practise interventions are in place in the ICU which require constant observation by staff. ICU also review mortality and morbidity on a weekly basis, enabling robust review of risk for these infections.

STAPHYLOCOCCUS AUREUS BACTERAEMIA (SABS)

Bendigo Health remains well within the state benchmark for Staphylococcus aureus blood stream infections (SAB). SAB infection is used as a barometer of Infection Prevention Control practice in health care facilities. It is also used as an indicator of the effectiveness of the Hand Hygiene Program nationally. SAB rates are monitored and reported on a monthly basis to speciality groups within BH as well as to the Department of Health and Human Services (DHHS).

Incidents of Staphylococcus aureus Bacteraemia
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
1 1 0 0 0 1 0 0 1 0 0 1

STAPHYLOCOCCUS AUREUS BACTERAEMIA (SABS)

Bendigo Health remains well within the state benchmark for Staphylococcus aureus blood stream infections (SAB). SAB infection is used as a barometer of Infection Prevention Control practice in health care facilities. It is also used as an indicator of the effectiveness of the Hand Hygiene Program nationally. SAB rates are monitored and reported on a monthly basis to speciality groups within BH as well as to the Department of Health and Human Services (DHHS).

Incidents of Staphylococcus aureus Bacteraemia
Jul 1
Aug 1
Sept 0
Oct 0
Nov 0
Dec 1
Jan 0
Feb 0
Mar 1
Apr 0
May 0
Jun 1

Influenza vaccination

Influenza vaccination is actively promoted to all staff, volunteers, contractors, students on placement, staff members’ immediate family and the wider community. The vaccine is made available via static and mobile clinics across all Bendigo Health services from mid-March through to August-September.

Influenza Vaccination is reported annually to the DHHS. An Influenza immunisation rate of 75% is required to meet the state target for health care workers. The target is set at this rate as this is what is required to prevent an outbreak of Influenza amongst staff and patients. Staff are categorised A, B or C according to their roles and who they work with, and the associated risk of transmission of Influenza from staff to clients.

In 2016 Bendigo Health exceeded the state target with an overall rate of 83% of category A, B and C staff vaccinated against Influenza.

Over 2,500 staff were vaccinated in categories A, B and C. In 2017, 78%, 2,653 category A, B and C staff have received the Influenza vaccination.

Influenza vaccination is actively promoted to all staff, volunteers, contractors, students on placement, staff members’ immediate family and the wider community. The vaccine is made available via static and mobile clinics across all Bendigo Health services from mid-March through to August-September.

Influenza Vaccination is reported annually to the DHHS. An Influenza immunisation rate of 75% is required to meet the state target for health care workers. The target is set at this rate as this is what is required to prevent an outbreak of Influenza amongst staff and patients. Staff are categorised A, B or C according to their roles and who they work with, and the associated risk of transmission of Influenza from staff to clients.

In 2016 Bendigo Health exceeded the state target with an overall rate of 83% of category A, B and C staff vaccinated against Influenza.

Over 2,500 staff were vaccinated in categories A, B and C. In 2017, 78%, 2,653 category A, B and C staff have received the Influenza vaccination.

Medication safety

PHARMACY

The Bendigo Hospital Pharmacy dispenses over 100,000 items per year and manages the medications for approximately 30 Wards and Speciality Units. Reducing medication-related risk and ensuring safe use of medications is a priority in all our pharmacy work.

Medical Officers, pharmacists and nursing staff work closely with the specialised Pharmacy Advisory Committee to ensure that the prescribed medication reaches the patient. This involves three stages – prescribing, dispensing and administration – all of which are carefully checked and monitored. The Pharmacy Department produces a regular ‘Medication Safety’ newsletter specifically focussing on supporting staff to have access to best practise information and to remain highly skilled.

Our last patient survey shows that approximately 90% of patients responded positively to the service and to medication information provided to them on discharge.

MEDICATION CHART SAFETY

The National Inpatient Medication Chart audit was completed in November 2016.31 87 patients participated. Bendigo Health had positive results in the following areas: reduced use of trade names (8.9%); a high proportion of orders with a clear and correct route (92.3%); a high percentage of orders where medications were given at the prescribed time and frequency (95%); and good proportion where the prescriber’s name was clearly documented on orders (76.9%).

Elements of the drug chart shown to have room for improvement included: complete patient identification details (21.8%); complete Venous Thromboembolism (VTE) Risk Assessment (14%); documenting patient weight to inform dosing (32.2%); and correctly ceasing the medication order (4.3%). In response, Check the chart information was provided to staff through the Medication Safety Newsletter, providing instructions and visual demonstrations about safer use of the charts.

CHEMOTHERAPY

This year, a project focussed on improving safety and care for people receiving oral chemotherapy has had good results. The Oncology Department recognised that patients on oral chemotherapy were not routinely given appointments with nursing staff. Regular nursing reviews for patients on oral chemotherapy are important. They help ensure that patients are knowledgeable about their treatment and aware of the risks and symptoms of toxicity, contributing to safer care and better outcomes.

The Project was set up to ensure consistent nursing care for oral chemotherapy patients, and to make sure that care for this group is comparable to what’s provided to patients having chemotherapy intravenously. After researching best practice care for patients on Oral Chemotherapy, the team devised a new approach. A primary component of this was to improve systems so that they reliably identify patients on oral chemotherapy. This has meant that appointments can be automatically scheduled for these patients, and that they are easily distinguishable as a group for monitoring and improvements to care.

Results of these changes include reported reduction in toxicities for patients. The Oncology team are developing an evaluation process, including a patient survey, to continue to monitor the impact.

PHARMACY

The Bendigo Hospital Pharmacy dispenses over 100,000 items per year and manages the medications for approximately 30 Wards and Speciality Units. Reducing medication-related risk and ensuring safe use of medications is a priority in all our pharmacy work.

Medical Officers, pharmacists and nursing staff work closely with the specialised Pharmacy Advisory Committee to ensure that the prescribed medication reaches the patient. This involves three stages – prescribing, dispensing and administration – all of which are carefully checked and monitored. The Pharmacy Department produces a regular ‘Medication Safety’ newsletter specifically focussing on supporting staff to have access to best practise information and to remain highly skilled.

Our last patient survey shows that approximately 90% of patients responded positively to the service and to medication information provided to them on discharge.

MEDICATION CHART SAFETY

The National Inpatient Medication Chart audit was completed in November 2016.31 87 patients participated. Bendigo Health had positive results in the following areas: reduced use of trade names (8.9%); a high proportion of orders with a clear and correct route (92.3%); a high percentage of orders where medications were given at the prescribed time and frequency (95%); and good proportion where the prescriber’s name was clearly documented on orders (76.9%).

Elements of the drug chart shown to have room for improvement included: complete patient identification details (21.8%); complete Venous Thromboembolism (VTE) Risk Assessment (14%); documenting patient weight to inform dosing (32.2%); and correctly ceasing the medication order (4.3%). In response, Check the chart information was provided to staff through the Medication Safety Newsletter, providing instructions and visual demonstrations about safer use of the charts.

CHEMOTHERAPY

This year, a project focussed on improving safety and care for people receiving oral chemotherapy has had good results. The Oncology Department recognised that patients on oral chemotherapy were not routinely given appointments with nursing staff. Regular nursing reviews for patients on oral chemotherapy are important. They help ensure that patients are knowledgeable about their treatment and aware of the risks and symptoms of toxicity, contributing to safer care and better outcomes.

The Project was set up to ensure consistent nursing care for oral chemotherapy patients, and to make sure that care for this group is comparable to what’s provided to patients having chemotherapy intravenously. After researching best practice care for patients on Oral Chemotherapy, the team devised a new approach. A primary component of this was to improve systems so that they reliably identify patients on oral chemotherapy. This has meant that appointments can be automatically scheduled for these patients, and that they are easily distinguishable as a group for monitoring and improvements to care.

Results of these changes include reported reduction in toxicities for patients. The Oncology team are developing an evaluation process, including a patient survey, to continue to monitor the impact.

Reducing the risk of falls

Involving families and carers early on increases their awareness about falls, and helps us to learn more about their family member so that we can know how best to reduce the risk of them falling.”
Kim Hall, Falls Prevention Coordinator

Preventing people falling, and the injuries that can happen as a result, is part direct care, part awareness, and part systems-improvement. This year there are a number of ways in which we have responded to challenges in this area, and made informed changes.

GETTING THE MESSAGE OUT

On April Falls Day, awareness raising work included ward staff dressing in the falls prevention campaign colour orange, Spotless staff arranging orange food, and falls prevention placemats at meal times on wards and in residential care facilities. An information stand was set up in the Hospital Atrium and many stopped to ask questions and take falls prevention information.

Over April 2017, community allied health staff assisted in getting the word out about preventing falls though community presentations in Bendigo and the wider region. A total of 390 consumers attended these sessions. Inpatient education sessions have also been held, and continue to be scheduled for patients, family members and staff. In these sessions, participants learn about what the risks are and how they can assist to reduce those risks, and complete their “My falls management plan”. Their feedback is that the sessions are helpful, particularly in planning the changes they can make to reduce the risk of having a fall. In the words of one participant: “I liked sharing other people’s experiences and learning how to avoid falls”.

INVOLVING CONSUMERS

“I guess it’s about testing assumptions about what people’s understanding is … We lose track of that as health clinicians.”

– Wendy Millar, Subacute Ambulatory Care Services Manager

To ensure our falls prevention work is shaped by and relevant to consumers and carers, consumers have been involved in designing our information materials and our approach.

Service design

In considering changes to how the Falls Clinic operated, staff discussed their ideas with consumers on the Rehabilitation Consumer Reference Group, seeking feedback about the way the Clinic operated, and what improvements they’d suggest. The Group raised a number of points central to how the service might work better, particularly how home assessments are done. These points included discussion about how home visits can feel like an inspection, both intrusive and scrutinising, with the person not necessarily clear about what’s being assessed, or to what extent they need to ‘tidy up’ for the visit. In addition, the language used in the process was seen to be unclear, alienating and dominated by jargon, and recommendations for changes to the home can come across as directive.

On the basis of this consumer involvement, changes made to improve Falls Prevention processes included using clear and more universal written and spoken language in all falls prevention programs and plans, and changing the approach to risk-assessment to make it more person-centred:

“Rather than assessing the home first, make the assessment with the person while they are an inpatient. Explain what the assessment process might involve, the reason for doing it, why it might include needing to see the person’s home (and what they are looking at there) … and build a connection at the same time.”

– Wendy Millar, Subacute Ambulatory Care Services Manager

Brochure content

A consumer focus group was held to seek ideas on the Falls Prevention brochure design and content. Both were modified on the basis of that feedback, which included reducing the use of jargon and negative language (eg “problem”) and changing the layout to emphasise what’s most important for consumers. Consumers also gave advice about the best way to market and distribute the brochures so that they reach their intended audience. 

Preventing people falling, and the injuries that can happen as a result, is part direct care, part awareness, and part systems-improvement. This year there are a number of ways in which we have responded to challenges in this area, and made informed changes.

GETTING THE MESSAGE OUT

On April Falls Day, awareness raising work included ward staff dressing in the falls prevention campaign colour orange, Spotless staff arranging orange food, and falls prevention placemats at meal times on wards and in residential care facilities. An information stand was set up in the Hospital Atrium and many stopped to ask questions and take falls prevention information.

Over April 2017, community allied health staff assisted in getting the word out about preventing falls though community presentations in Bendigo and the wider region. A total of 390 consumers attended these sessions. Inpatient education sessions have also been held, and continue to be scheduled for patients, family members and staff. In these sessions, participants learn about what the risks are and how they can assist to reduce those risks, and complete their “My falls management plan”. Their feedback is that the sessions are helpful, particularly in planning the changes they can make to reduce the risk of having a fall. In the words of one participant: “I liked sharing other people’s experiences and learning how to avoid falls”.

INVOLVING CONSUMERS

“I guess it’s about testing assumptions about what people’s understanding is … We lose track of that as health clinicians.”

– Wendy Millar, Subacute Ambulatory Care Services Manager

To ensure our falls prevention work is shaped by and relevant to consumers and carers, consumers have been involved in designing our information materials and our approach.

Service design

In considering changes to how the Falls Clinic operated, staff discussed their ideas with consumers on the Rehabilitation Consumer Reference Group, seeking feedback about the way the Clinic operated, and what improvements they’d suggest. The Group raised a number of points central to how the service might work better, particularly how home assessments are done. These points included discussion about how home visits can feel like an inspection, both intrusive and scrutinising, with the person not necessarily clear about what’s being assessed, or to what extent they need to ‘tidy up’ for the visit. In addition, the language used in the process was seen to be unclear, alienating and dominated by jargon, and recommendations for changes to the home can come across as directive.

On the basis of this consumer involvement, changes made to improve Falls Prevention processes included using clear and more universal written and spoken language in all falls prevention programs and plans, and changing the approach to risk-assessment to make it more person-centred:

“Rather than assessing the home first, make the assessment with the person while they are an inpatient. Explain what the assessment process might involve, the reason for doing it, why it might include needing to see the person’s home (and what they are looking at there) … and build a connection at the same time.”

– Wendy Millar, Subacute Ambulatory Care Services Manager

Brochure content

A consumer focus group was held to seek ideas on the Falls Prevention brochure design and content. Both were modified on the basis of that feedback, which included reducing the use of jargon and negative language (eg “problem”) and changing the layout to emphasise what’s most important for consumers. Consumers also gave advice about the best way to market and distribute the brochures so that they reach their intended audience.

BETTER CARE, ENVIRONMENTS AND EQUIPMENT

Falls amongst patients and residents are monitored and reviewed in order to learn what has happened and what might have been prevented. The Falls Prevention Coordinator is now involved in clinical reviews across Bendigo Health. A review takes place if staff request the involvement of the Falls Prevention Coordinator or if someone has more than three falls. The Falls Prevention Coordinator meets with staff to look at where and how prevention processes were followed, what could have been done better, and what strategies could be put in place to prevent future falls. Family members and carers have been involved in these discussions, enabling them to better understand and reinforce falls prevention strategies. Where a problem is identified in any one area of the service, the Falls Prevention Coordinator can work with clinical staff by providing information and advice, or by researching what other organisations do and what equipment they might be using. One example of this is the introduction of position sensors. These enable staff to be aware if a high falls risk patient is moving, perhaps trying to get up.

BETTER CARE, ENVIRONMENTS AND EQUIPMENT

Falls amongst patients and residents are monitored and reviewed in order to learn what has happened and what might have been prevented. The Falls Prevention Coordinator is now involved in clinical reviews across Bendigo Health. A review takes place if staff request the involvement of the Falls Prevention Coordinator or if someone has more than three falls. The Falls Prevention Coordinator meets with staff to look at where and how prevention processes were followed, what could have been done better, and what strategies could be put in place to prevent future falls. Family members and carers have been involved in these discussions, enabling them to better understand and reinforce falls prevention strategies. Where a problem is identified in any one area of the service, the Falls Prevention Coordinator can work with clinical staff by providing information and advice, or by researching what other organisations do and what equipment they might be using. One example of this is the introduction of position sensors. These enable staff to be aware if a high falls risk patient is moving, perhaps trying to get up.

The number of falls for 2016-2017 was 5% lower than 2015-2016.32

Pressure injuries

Pressure injury: a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear [rubbing against the surface of the bed] (National Pressure Ulcer Advisory Panel 2014).

Lying or sitting still for long periods, a common risk for a person who is ill or incapacitated in some way, can cause pressure injuries, also known as pressure ulcers. The prevention and management of pressure injuries is overseen by the Bendigo Health Skin Integrity Committee. Their role is to provide governance, leadership and co-ordination to ensure that we:

  • focus our best efforts on preventing injuries and managing them when they occur; and
  • provide the best possible care and treatment for people with pressure injuries.

Knowing where and what the risk factors are for any individual is essential to preventing and managing pressure injuries. To keep track of how well we are doing, Bendigo Health undertake an annual audit to review our processes for screening and responding to pressure injury risks. The audit assesses how well we are complying with policy, highlights improvement already made and identifies opportunities for further improvement.

Higher rates of screening mean increased likelihood that we detect and respond to risk. Our auditing has shown significant improvements in screening rates over the five years that the audit has been conducted. In 2013, when the audit was first undertaken, screening rates were at 2%. This year, a number of wards were shown to be screening 100% of patients on admission. Organisation-wide, 84% of patients were screened for risk of pressure injury.  Consequently, there has been an increase in the use of pressure-relieving devices.

These improvements are reflected in Bendigo Health’s benchmarking data. This data enables us to compare our performance and the processes we use with those of health services of similar nature and size so that we can evaluate and improve practice. It measures the number of admitted patients who have developed a pressure injury while in hospital. In 2016 Bendigo Health achieved 0.07% less pressure injuries then services of similar size33.

We are continuing to work to do better in how we prevent and manage pressure injuries. A new online education module on assessment and prevention has been developed for Bendigo Health staff. This will be ready to start in the next few months and will inform and support staff to continue to provide the best possible care to patients and residents.

Lying or sitting still for long periods, a common risk for a person who is ill or incapacitated in some way, can cause pressure injuries, also known as pressure ulcers. The prevention and management of pressure injuries is overseen by the Bendigo Health Skin Integrity Committee. Their role is to provide governance, leadership and co-ordination to ensure that we:

  • focus our best efforts on preventing injuries and managing them when they occur; and
  • provide the best possible care and treatment for people with pressure injuries.

Knowing where and what the risk factors are for any individual is essential to preventing and managing pressure injuries. To keep track of how well we are doing, Bendigo Health undertake an annual audit to review our processes for screening and responding to pressure injury risks. The audit assesses how well we are complying with policy, highlights improvement already made and identifies opportunities for further improvement.

Higher rates of screening mean increased likelihood that we detect and respond to risk. Our auditing has shown significant improvements in screening rates over the five years that the audit has been conducted. In 2013, when the audit was first undertaken, screening rates were at 2%. This year, a number of wards were shown to be screening 100% of patients on admission. Organisation-wide, 84% of patients were screened for risk of pressure injury.  Consequently, there has been an increase in the use of pressure-relieving devices.

These improvements are reflected in Bendigo Health’s benchmarking data. This data enables us to compare our performance and the processes we use with those of health services of similar nature and size so that we can evaluate and improve practice. It measures the number of admitted patients who have developed a pressure injury while in hospital. In 2016 Bendigo Health achieved 0.07% less pressure injuries then services of similar size33.

We are continuing to work to do better in how we prevent and manage pressure injuries. A new online education module on assessment and prevention has been developed for Bendigo Health staff. This will be ready to start in the next few months and will inform and support staff to continue to provide the best possible care to patients and residents.

Safe use of blood and blood products

Bendigo Health’s commitment to providing safe blood and blood products remains a high priority. This involves close scrutiny of transfusion processes. Regular monitoring includes:
  • reviewing blood and blood related policies and protocols, ensuring they comply with State and National guidelines;
  • auditing transfusion episodes to confirm that blood components are being appropriately used;
  • measuring wastage rates of blood and blood products to enable waste reduction.

Monitoring our compliance and our practice in these ways helps ensure that our patients have the best possible transfusion outcome, and that we are operating safely and efficiently.

In addition all clinical and support staff involved in any aspect of the transfusion process must successfully complete annual blood component assessments tailored to their position and level of involvement in the transfusion process. All clinical areas where blood or blood products are transfused receive a minimum of two transfusion-related education session per year. Regular newsletters are also produced and distributed either in hard copy or electronically to clinical staff to inform them of any transfusion-related changes or notifications.

There has been one significant and exciting development with our move to the new Bendigo Hospital building. Thanks to contemporary hospital design, we have improved the way we transport blood components from the Pathology Blood Bank to the clinical areas where transfusions occur. Blood is now transported via the pneumatic tube system. This ensures safe, reliable and fast delivery of blood components, which, in critical situations, can be life-saving.

Bendigo Health’s commitment to inform and involve consumers in the transfusion process remains a high priority. Blood and blood product related patient brochures are available in a number of languages on the Bendigo Health website.

“The new pneumatic system has made a huge difference. It has really changed the way we not only send pathology samples but how fast and efficiently we receive blood products. This means we can provide better care for patients whose need for blood products is immediate and critical. The new system has also enabled better communication between the blood bank and the emergency department, making it easier to ensure that blood follows the patient as they move from one part of the Hospital to another.”

– Critical Care Registered Nurse

Safe use of blood and blood products

Bendigo Health’s commitment to providing safe blood and blood products remains a high priority. This involves close scrutiny of transfusion processes. Regular monitoring includes:
  • reviewing blood and blood related policies and protocols, ensuring they comply with State and National guidelines;
  • auditing transfusion episodes to confirm that blood components are being appropriately used;
  • measuring wastage rates of blood and blood products to enable waste reduction.

Monitoring our compliance and our practice in these ways helps ensure that our patients have the best possible transfusion outcome, and that we are operating safely and efficiently.

In addition all clinical and support staff involved in any aspect of the transfusion process must successfully complete annual blood component assessments tailored to their position and level of involvement in the transfusion process. All clinical areas where blood or blood products are transfused receive a minimum of two transfusion-related education session per year. Regular newsletters are also produced and distributed either in hard copy or electronically to clinical staff to inform them of any transfusion-related changes or notifications.

There has been one significant and exciting development with our move to the new Bendigo Hospital building. Thanks to contemporary hospital design, we have improved the way we transport blood components from the Pathology Blood Bank to the clinical areas where transfusions occur. Blood is now transported via the pneumatic tube system. This ensures safe, reliable and fast delivery of blood components, which, in critical situations, can be life-saving.

Bendigo Health’s commitment to inform and involve consumers in the transfusion process remains a high priority. Blood and blood product related patient brochures are available in a number of languages on the Bendigo Health website.

“The new pneumatic system has made a huge difference. It has really changed the way we not only send pathology samples but how fast and efficiently we receive blood products. This means we can provide better care for patients whose need for blood products is immediate and critical. The new system has also enabled better communication between the blood bank and the emergency department, making it easier to ensure that blood follows the patient as they move from one part of the Hospital to another.”

– Critical Care Registered Nurse

Caring for women and babies

“Our baby girl was admitted to the special care unit straight after she was born. We just wanted to say that the care and support that was given by these midwives in this unit was beyond perfect. They not only put in 100% effort into the care for our baby but also [when I] was discharged from the maternity unit they allowed my husband and I to stay in the parents’ room. This was so very generous and made us feel very cared for.”34

We are committed and passionate in our care and support of women before, during and after birth. This includes reflecting on the experience of women in Maternity, and continually examining how we work. Contemporary data has highlighted two areas for improvement in our Maternity Services. Compared with similar health services, Bendigo Health has higher rates of third degree tearing during birth and lower rates of breastfeeding.35 Much is being done to understand patient experience and clinical practice behind these rates, and to improve our work with women in these areas.

MINIMISING PERINEAL INJURY DURING BIRTH

Staff have focused on strengthening perineal care, and on working with birthing women to prevent and manage injury during birth. Hot compresses are used on the perineum while the woman is pushing. To reduce tearing and increase comfort during birth, women are encouraged to birth on their left sides rather than on their backs, and staff are conscious of limiting as much as possible the time that the cervix is fully dilated during birth. Staff have also been supported to increase their skills in episiotomies. Where tears do occur, we recognise the importance of good post-birth care to ensure that women receive the right physical and emotional support.

“We are very keen on reporting tears to ensure that women get good follow up care post birth.”

– Rachel James, Manager Women’s Health

We are committed and passionate in our care and support of women before, during and after birth. This includes reflecting on the experience of women in Maternity, and continually examining how we work. Contemporary data has highlighted two areas for improvement in our Maternity Services. Compared with similar health services, Bendigo Health has higher rates of third degree tearing during birth and lower rates of breastfeeding.35 Much is being done to understand patient experience and clinical practice behind these rates, and to improve our work with women in these areas.

MINIMISING PERINEAL INJURY DURING BIRTH

Staff have focused on strengthening perineal care, and on working with birthing women to prevent and manage injury during birth. Hot compresses are used on the perineum while the woman is pushing. To reduce tearing and increase comfort during birth, women are encouraged to birth on their left sides rather than on their backs, and staff are conscious of limiting as much as possible the time that the cervix is fully dilated during birth. Staff have also been supported to increase their skills in episiotomies. Where tears do occur, we recognise the importance of good post-birth care to ensure that women receive the right physical and emotional support.

“We are very keen on reporting tears to ensure that women get good follow up care post birth.”

– Rachel James, Manager Women’s Health

SUPPORTING WOMEN TO BREASTFEED

Breastfeeding support for women while they are inpatients at Bendigo Health is provided throughout their hospital stay. This includes education, information and focussed support. To increase the rates of breastfeeding amongst women birthing at Bendigo Health we have changed the way we provide breastfeeding services in a number of ways:

  1. The role of lactation consultants has shifted to providing concentrated support to women while they are in hospital rather than after they leave;
  2. Access to lactation consultants has been increased, with lactation consultants available on the ward for women to talk with. This includes a patient clinic where women can seek support and, at the same time, meet and learn from each other;
  3. A parenting group has been formed, focussed, for example, on strategies for settling babies and how to recognise a baby’s cues;
  4. For women with gestational diabetes, tailored education and support is being provided to enable them to understand the possible health implications of diabetes for a newborn, and to support them to make informed choices about breastfeeding;
  5. The policy on treating hypoglycaemia (low blood sugar) in babies has been reviewed. It now reflects and guides our work with women who have diabetes during pregnancy. Specifically, how we educate and support them to express before birth, enabling them to use this supply for their baby’s first feed, and to be aware of the benefits of breastfeeding when diabetes is a factor; and
  6. A monthly Breastfeeding Working Group has been set up so that we can look at the statistics and monitor progress.

SUPPORTING WOMEN TO BREASTFEED

Breastfeeding support for women while they are inpatients at Bendigo Health is provided throughout their hospital stay. This includes education, information and focussed support. To increase the rates of breastfeeding amongst women birthing at Bendigo Health we have changed the way we provide breastfeeding services in a number of ways:

  1. The role of lactation consultants has shifted to providing concentrated support to women while they are in hospital rather than after they leave;
  2. Access to lactation consultants has been increased, with lactation consultants available on the ward for women to talk with. This includes a patient clinic where women can seek support and, at the same time, meet and learn from each other;
  3. A parenting group has been formed, focussed, for example, on strategies for settling babies and how to recognise a baby’s cues;
  4. For women with gestational diabetes, tailored education and support is being provided to enable them to understand the possible health implications of diabetes for a newborn, and to support them to make informed choices about breastfeeding;
  5. The policy on treating hypoglycaemia (low blood sugar) in babies has been reviewed. It now reflects and guides our work with women who have diabetes during pregnancy. Specifically, how we educate and support them to express before birth, enabling them to use this supply for their baby’s first feed, and to be aware of the benefits of breastfeeding when diabetes is a factor; and
  6. A monthly Breastfeeding Working Group has been set up so that we can look at the statistics and monitor progress.

Statistics

As at June 201736

92% of first feeds

for newborns were breastfeeds. This figure had declined by the time women left hospital:

76% of final feeds

before leaving hospital were breastfeeds.

33% was the overall rate

for the use of formula.

26 hours per week

is the amount of hours lactation consultants are now available since restructuring daily work-plans. Prior to the restructure, lactation consultants were available for inpatient consulting 5 hours per week. 

SHORTER WAITS, BETTER ACCESS

Experience suggests that waiting times in women’s clinics need to be reduced. This has been a consistent theme in formal complaints and direct feedback to clinic staff.  To improve, we have:

  • Encouraged staff to check in regularly with people in waiting areas to inform about delays, and when they might expect to be seen;
  • Changed the way clinics are structured so that there are two consultants available, a change that has included employing  additional staff specialists; and
  • Ensured that there is a doctor on duty all the time in the Assessment Clinic, increasing access for women with pregnancy-related issues or routine monitoring, and providing an alternative to seeking support through Emergency.

SHORTER WAITS, BETTER ACCESS

Experience suggests that waiting times in women’s clinics need to be reduced. This has been a consistent theme in formal complaints and direct feedback to clinic staff.  To improve, we have:

  • Encouraged staff to check in regularly with people in waiting areas to inform about delays, and when they might expect to be seen;
  • Changed the way clinics are structured so that there are two consultants available, a change that has included employing  additional staff specialists; and
  • Ensured that there is a doctor on duty all the time in the Assessment Clinic, increasing access for women with pregnancy-related issues or routine monitoring, and providing an alternative to seeking support through Emergency.

In Focus

Words matter

Working together for inclusion
The experience of two women, a same-sex couple participating in a birthing class and hospital tour at Bendigo Health, was largely good. There were, however, a few less positive aspects to their experience that lead to a loss of trust in the care they might receive at Bendigo Health.
[it was] said [in the session] that the room in which birth is taking place should mirror the situation in which conception occurred – natural, intimate, quiet, dark, with minimal people present. This was certainly not our situation, and the assumption that anything other than heterosexual intercourse occurring to bring a child into a family is unnatural was quite unnerving and judgmental. There are many circumstances that people become pregnant and it’s important not to assume about anyone what their personal circumstances are – and even more important still not to make them feel different …”

The feedback was provided in a gentle and productive way through the complaints process at Bendigo Health, giving us the opportunity to reflect on how we might be more inclusive. As a result of the feedback:

  • The Manager of Women’s Health is in contact with a lesbian midwife to provide education to staff and has flagged LGTBI inclusivity as a topic for Maternity’s 2018 study day;
  • The woman providing the feedback has directed us to resources via the website ‘GLHV – Promoting the health and wellbeing of LGBTI Victorians’, and has offered, once settled into life with a new baby, to share her experience and expertise directly with staff; and

Conversations with Bendigo Health’s Diversity Committee and Chair has highlighted opportunities for policy development to ensure inclusion of LGBTI consumers.

Residential Aged Care

Bendigo Health Residential Aged Care Services participate in the Department of Health and Human Services (DHHS) Public Sector Residential Aged Care Services (PSRACS) Quality Indicator program.

This program measures five high risk areas of care important to residents’ health and wellbeing. It provides a set of meaningful and measureable indicators, enabling services to monitor trends in important areas of resident care and safety and benchmark against other residential services. Data is displayed per 1000 bed days to enable facilities of different sizes to be collected and compared.

Below is a summary of our performance in the areas of pressure injuries and falls across the five PSRACS areas over the 2015-2016 and 2016-2017 financial years.

Bendigo Health Residential Aged Care Services participate in the Department of Health and Human Services (DHHS) Public Sector Residential Aged Care Services (PSRACS) Quality Indicator program.

This program measures five high risk areas of care important to residents’ health and wellbeing. It provides a set of meaningful and measureable indicators, enabling services to monitor trends in important areas of resident care and safety and benchmark against other residential services. Data is displayed per 1000 bed days to enable facilities of different sizes to be collected and compared.

Below is a summary of our performance in the areas of pressure injuries and falls across the five PSRACS areas over the 2015-2016 and 2016-2017 financial years.

Pressure injuries

The occurrence of pressure injury incidences is below High Care, State-wide and Loddon Mallee rates. In response to an increase in pressure injuries in 2016, residential services staff have undertaken further training in the identification, prevention and management of pressure injuries.  Residential Services have access to Wound Consultants and Wound Resource Education Nurses who provide up-to-date recommendations about prevention and management of pressure injuries.

Falls

The data demonstrates that, over the past twelve months, falls rates at BH residential services have been lower than overall high-care and overall Loddon-Mallee rates. Activities to reduce falls rates include screening, falls prevention devices and resident education. Please see “Reducing the risk of falls” for more detail.

Restraint use

The data shows that use of restraints in BH residential services is comparable to other high care services over the past financial year. Use of restraints in BH facilities is assessed by the Resident’s GP and reviewed on a regular basis, with the emphasis on minimising the use of restraints whenever possible. Restraints can include bed rails and seat belts and residents are regularly monitored to ensure safety.

Multiple Medications (9 or more)

At Bendigo Health, the rate of residents on multiple medications per 1000 bed days is generally lower than state-wide and Loddon. Regular monitoring, GP and pharmacy review of all residents’ medications occurs across all facilities. The Residential Services Medication Advisory Committee regularly reviews and makes recommendations for improving medication management of all residents. In partnership with the Residential Services Community Pharmacy, the Committee is in the process of undertaking a review of residents on nine or more medications. The review aims to assess medication use and, in consultation with the residents’ GPs, decrease use where it is safe to do so.

Unplanned Weight loss >3kg

Over the last two financial years unplanned weight loss has been just above overall Statewide and overall High Care rates. Residential Services continue to make improvements to reduce unplanned weight loss and to provide a High Energy High Protein diet to assist with weight management. Meal options in general are being reviewed in collaboration with BH dieticians and Spotless (responsible for catering at Bendigo Health). The review is exploring increasing options for residents on soft and pureed diets.

Bendigo Health Residential Aged Care Services participated in the ‘Better Resident Care Together’ project in conjunction with the Department of Health and Human Services (DHHS). The project – Have Your Cake and Eat it too – encouraged choice and provided residents with the opportunity to choose an afternoon tea menu. This project saw weight loss decrease in the residential facility where it was piloted, and is being introduced in the other facilities.

Patient Activated Care Team

Recognising that patients, carers or family members may pick up on things that we may not, Bendigo Health has initiated Patient Activated Care Team (PACT) review. PACT is a patient-activated escalation process. It enables a patient, carer, family member or friend to initiate a medical review if they are concerned about the treatment plan or a deterioration in the person’s condition.

By asking any staff member to make a PACT call, using the Medical Emergency Team (MET) response system, an independent review is carried out by a senior Intensive Care Unit (ICU) doctor, a senior ICU nurse and a medical registrar. The team listen to the concerns and consult with patient and family, examine the patient, and make an independent assessment of the care being provided. They then explain the outcome of their assessment to the patient and their supporters, and to the treating team. This may include identifying alternative treatments or confirming that the current treatment plan is appropriate. All this is documented in a follow up plan and handed over to the treating medical team.

In addition to the PACT brochures already available to inpatients throughout the Hospital, the PACT process is now also promoted via screens in waiting areas throughout the new Hospital. Patients will also be made aware of the PACT system via the patient safety information being develop for the Patient Entertainment Systems.

Recognising that patients, carers or family members may pick up on things that we may not, Bendigo Health has initiated Patient Activated Care Team (PACT) review. PACT is a patient-activated escalation process. It enables a patient, carer, family member or friend to initiate a medical review if they are concerned about the treatment plan or a deterioration in the person’s condition.

By asking any staff member to make a PACT call, using the Medical Emergency Team (MET) response system, an independent review is carried out by a senior Intensive Care Unit (ICU) doctor, a senior ICU nurse and a medical registrar. The team listen to the concerns and consult with patient and family, examine the patient, and make an independent assessment of the care being provided. They then explain the outcome of their assessment to the patient and their supporters, and to the treating team. This may include identifying alternative treatments or confirming that the current treatment plan is appropriate. All this is documented in a follow up plan and handed over to the treating medical team.

In addition to the PACT brochures already available to inpatients throughout the Hospital, the PACT process is now also promoted via screens in waiting areas throughout the new Hospital. Patients will also be made aware of the PACT system via the patient safety information being develop for the Patient Entertainment Systems.

Psychiatric services

Reducing restrictive interventions

Bendigo Health Psychiatric Services (BHPS) continue to work to reduce the use of restrictive interventions: seclusion and bodily restraint. The Reducing Restrictive Intervention (RRI) Co-ordinator works closely with staff, senior management and the Department of Health and Human Services (DHHS) to encourage reflective practice, identify ways to improve care for patients, families and staff, and work towards a service environment where seclusion and restraint are no longer needed.

WHY RESTRICTIVE INTERVENTIONS ARE USED

 

Sometimes, when a patient is admitted for treatment, illness and distress can lead to behaviours that pose a risk to themselves or to others. Under these circumstances, if the risk is considered to be imminent or immediate, restrictive interventions can be used, to ensure safety for all. The decision to use a restrictive intervention is a clinical one, to be taken after other less restrictive options have been considered, tried or ruled out.

Efforts to reduce restrictive interventions emphasise use of sensory modulation rooms and equipment located in each inpatient unit. Staff training, and reviews of the use of restrictive practices, highlight patient and staff safety.

WHEN AND WHY RESTRICTIVE INTERVENTIONS ARE USED

Sometimes, when a patient is admitted for treatment, illness and distress can lead to behaviours that pose a risk to themselves or to others. Under these circumstances, if the risk is considered to be imminent or immediate, restrictive interventions can be used, to ensure safety for all. The decision to use a restrictive intervention is a clinical one, to be taken after other less restrictive options have been considered, tried or ruled out.

Efforts to reduce restrictive interventions emphasise use of sensory modulation rooms and equipment located in each inpatient unit. Staff training, and reviews of the use of restrictive practices, highlight patient and staff safety.

Adult (18-64 yrs) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 7.2 11.2 9.1 5.4 6.8
Statewide 10.4 12.1 12.1 9.9 8.8
 
Aged (65 yrs & older) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 0.3 1.1 0.0 1.3 3.5
Statewide 0.9 1.5 2.0 1.5 2.1
 
Aged (65 yrs & older) mental health service restraint events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 1.2 6.6 3.5 1.3 8.6
Statewide 5.0 5.1 7.5 7.1 8.6
 
Extended Care (18-64 yrs) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 1.5 0.0 2.9 2.9 1.4
Statewide 1.8 1.6 2.3 3.4 2.5
 
Adult (18-64 yrs) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 7.2 11.2 9.1 5.4 6.8
Statewide 10.4 12.1 12.1 9.9 8.8
 
Aged (65 yrs & older) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 0.3 1.1 0.0 1.3 3.5
Statewide 0.9 1.5 2.0 1.5 2.1
 
Aged (65 yrs & older) mental health service restraint events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 1.2 6.6 3.5 1.3 8.6
Statewide 5.0 5.1 7.5 7.1 8.6
 
Extended Care (18-64 yrs) mental health service seclusion events per 1,000 bed days
  Apr-Jun 15 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17
Bendigo Health 1.5 0.0 2.9 2.9 1.4
Statewide 1.8 1.6 2.3 3.4 2.5
 

SAFEWARDS

 

Safewards was introduced to BHPS in 2014. Designed in the United Kingdom, Safewards is a framework to improve staff and patient safety and experience during an admission and to reduce restrictive interventions. It specifically examines events described as conflict (events that threaten staff and patient safety) and containment (things staff do to prevent or reduce harm to staff and patients). The Safewards model includes 10 interventions designed to improve patient and staff experience during an admission and to reduce the risk of conflict and containment events occurring.

Since we began using Safewards, we have continued to work to embed the framework into our everyday clinical practice, training and education. The framework is now the foundation of the Nursing Model of Care for BHPS inpatient services.

SAFEWARDS

Safewards was introduced to BHPS in 2014. Designed in the United Kingdom, Safewards is a framework to improve staff and patient safety and experience during an admission and to reduce restrictive interventions. It specifically examines events described as conflict (events that threaten staff and patient safety) and containment (things staff do to prevent or reduce harm to staff and patients). The Safewards model includes 10 interventions designed to improve patient and staff experience during an admission and to reduce the risk of conflict and containment events occurring.

Since we began using Safewards, we have continued to work to embed the framework into our everyday clinical practice, training and education. The framework is now the foundation of the Nursing Model of Care for BHPS inpatient services.

In Focus

Our Parent Infant Unit

A homely and safe environment
I have lived and worked in Bendigo for nearly 20 years in the field of supporting vulnerable children and their families. When I first came to Bendigo I heard about a ‘mother and baby’ room being opened in the existing adult psychiatric inpatient facility, but this didn’t eventuate. This year with the opening of the new Bendigo Hospital, Bendigo has finally seen not just a room or two for mothers and babies but a whole dedicated unit being opened.”
Monique Rosenbauer, Nurse Unit Manager, Parent Infant Unit
The Parent Infant Unit treats acute mental health disorders in carers whilst supporting the attachment relationship between the infant and their carer. This reflects the significant movement towards recognising the need for specialist mental health services for infants and their carers – mothers, fathers or other carers.

Planning and design of the physical environment for our new Parent Infant Unit began well before the opening of the new Bendigo Hospital and involved a reference group of interested and passionate mental health clinicians. The group visited similar units around the state. They brought back the best aspects of what they had seen to shape the development of a unique space – a space in which to provide the first 24 hour, 7 day a week regional parent infant mental health inpatient unit in Australia. Their main design challenge was to meet the safety and functionality needs of an acute inpatient ward alongside a family’s desire for a homely environment. The result is a 5 bed, 5 cot unit located within the Psychiatry Precinct of Bendigo Hospital. This enables sharing of specialist services as well as a distinct, purpose-built unit with a specific identity, function and space.

The majority of people staying in the Unit are admitted voluntarily. This requires families to recognise and acknowledge their own mental health needs and what an inpatient admission can offer them. There is often some ambivalence or fear associated with the unknown and the stigma of being admitted to a psychiatric unit. Parents who may be admitted are therefore offered the opportunity to come and see the Unit:

“They are always pleasantly surprised. We have not yet had a family visit our unit and not agree to an admission. Patients and their families have been heard to say ‘wow I didn’t expect it to be this nice’, ‘I thought it would be more clinical, more hospital like’, ‘this is like a fancy hotel’, or ‘everything you need is here’ …”

– Monique Rosenbauer

The unit offers large open spaces for safety and social connection as well as smaller more intimate areas for privacy. Partners are welcome to stay and siblings encouraged to visit. 

 

Planning and design of the physical environment for our new Parent Infant Unit began well before the opening of the new Bendigo Hospital and involved a reference group of interested and passionate mental health clinicians. The group visited similar units around the state. They brought back the best aspects of what they had seen to shape the development of a unique space – a space in which to provide the first 24 hour, 7 day a week regional parent infant mental health inpatient unit in Australia. Their main design challenge was to meet the safety and functionality needs of an acute inpatient ward alongside a family’s desire for a homely environment. The result is a 5 bed, 5 cot unit located within the Psychiatry Precinct of Bendigo Hospital. This enables sharing of specialist services as well as a distinct, purpose-built unit with a specific identity, function and space.

The majority of people staying in the Unit are admitted voluntarily. This requires families to recognise and acknowledge their own mental health needs and what an inpatient admission can offer them. There is often some ambivalence or fear associated with the unknown and the stigma of being admitted to a psychiatric unit. Parents who may be admitted are therefore offered the opportunity to come and see the Unit:

“They are always pleasantly surprised. We have not yet had a family visit our unit and not agree to an admission. Patients and their families have been heard to say ‘wow I didn’t expect it to be this nice’, ‘I thought it would be more clinical, more hospital like’, ‘this is like a fancy hotel’, or ‘everything you need is here’ …”

– Monique Rosenbauer

The unit offers large open spaces for safety and social connection as well as smaller more intimate areas for privacy. Partners are welcome to stay and siblings encouraged to visit. 

 

A purpose built unit to meet the needs of families in a World Class hospital in a regional area is something we are very proud of. The physical environment has a profound impact on a family’s ability to remain present and allow the therapeutic processes to improve their mental health and relationships with one another especially their vulnerable infant.”
Monique Rosenbauer

Continuous care

Continuous care

Advance Care Planning

An ongoing conversation
When you’re faced with a crisis situation then all the logic goes out the window and you think with your heart and emotions … So it’s important, come crisis time, that you have it in writing, and they know what you want.”
Rhonda Bell, Care Coordinator, Hospital Admission Risk Program

Advance Care Planning (ACP) allows people to clearly express their values and preferences to inform clinical decision making when they are unable to directly participate. It’s an approach to communication in which a person can discuss goals, values and choices and what they prefer to happen with their care. It puts the person at the centre of care. It involves them, their family (if appropriate), and the clinicians responsible for their care.

Nevertheless, ACP is effective only when it’s well communicated, revised and used when the patient involved is unwell and unable to participate in their own decision-making. As ACP Coordinator Meagan Adams says, “The process of introducing Advance Care Planning isn’t something you just tick off and complete, it’s a process that’s sensitive and takes time”. Whilst making a Plan is important, ensuring that an ACP is current, accessible and visible to the health professionals and healthcare services you are using is vital.

“If you have a Plan, written up in the community, with your GP for example, it has to get to the Hospital before you do.”

– Meagan-Jane Adams

There is a lot happening at community and organisational level to make ACP work well for patients and families at all points in their care. It’s about “giving the community confidence that their wishes will be known when they come to hospital” (Meagan-Jane Adams).

  • Plans are being developed in the community (by patients, with GPs, in other health care services) and emailed in to be included in patient’s Bendigo Health files.
  • Paper-based Plans (made in the community or developed prior to the new Hospital and the new Digital Medical Records) have been scanned and included in electronic records, with an ‘alert’ that automatically tells staff that an ACP exists.
  • Work engaging and educating GPs and practice nurses continues to raise awareness of ACP, and supports them to have ACP conversations with their patients and families.
  • Volunteers give public presentations about ACP and what it involves, as does the Advance Care Planning Coordinator (11 community presentations were given in 2016-2017).

Progress is still to be made. Educating staff about locating and understanding the purpose and legal authority of Advance Care Plans will be a focus for 2017-2018, as will increasing staff skills and confidence in having the conversations. Another area of focus will be working on ways to find out about patient experience of ACP and capture this alongside other feedback and information that’s collected from patients and families.

Advance Care Planning (ACP) allows people to clearly express their values and preferences to inform clinical decision making when they are unable to directly participate. It’s an approach to communication in which a person can discuss goals, values and choices and what they prefer to happen with their care. It puts the person at the centre of care. It involves them, their family (if appropriate), and the clinicians responsible for their care.

Nevertheless, ACP is effective only when it’s well communicated, revised and used when the patient involved is unwell and unable to participate in their own decision-making. As ACP Coordinator Meagan Adams says, “The process of introducing Advance Care Planning isn’t something you just tick off and complete, it’s a process that’s sensitive and takes time”. Whilst making a Plan is important, ensuring that an ACP is current, accessible and visible to the health professionals and healthcare services you are using is vital.

“If you have a Plan, written up in the community, with your GP for example, it has to get to the Hospital before you do.”

– Meagan-Jane Adams

There is a lot happening at community and organisational level to make ACP work well for patients and families at all points in their care. It’s about “giving the community confidence that their wishes will be known when they come to hospital” (Meagan-Jane Adams).

  • Plans are being developed in the community (by patients, with GPs, in other health care services) and emailed in to be included in patient’s Bendigo Health files.
  • Paper-based Plans (made in the community or developed prior to the new Hospital and the new Digital Medical Records) have been scanned and included in electronic records, with an ‘alert’ that automatically tells staff that an ACP exists.
  • Work engaging and educating GPs and practice nurses continues to raise awareness of ACP, and supports them to have ACP conversations with their patients and families.
  • Volunteers give public presentations about ACP and what it involves, as does the Advance Care Planning Coordinator (11 community presentations were given in 2016-2017).

Progress is still to be made. Educating staff about locating and understanding the purpose and legal authority of Advance Care Plans will be a focus for 2017-2018, as will increasing staff skills and confidence in having the conversations. Another area of focus will be working on ways to find out about patient experience of ACP and capture this alongside other feedback and information that’s collected from patients and families.

Statistics

9%

of patients over 75 years old have an ACP in place, up from 6% in 201537. The target is 50%38.

18%

of ‘eligible patients’ (ie. Aged 80 or over, using the HARP program, or living in Residential Aged Care Facilities) admitted to Bendigo Health have ACP documentation39.

25%

of eligible patients within the Hospital Admission Risk Program (HARP) had ACPs in place by June 2017. This is an increase from 16%40.

24 community members

contacted the ACP office directly, had appointments with the ACP Coordinator, and completed Plans now recorded on their Bendigo Health files41.

90 sets of ACP documents

per month require review. The process of scanning ACP documents into the DMR has seen the number of patients with documents needing review increase from an average of 40 sets of documents in 2017. Over the year, 1047 ACP documents have been entered into the DMR42.

In Focus

When the time comes

This is a story about a Plan being tested. You often write a Plan with someone, but until they’re presenting, until it’s tested, you don’t really know whether the Plan works.”
Rhonda Bell, Care Coordinator, HARP

Jim’s health was fragile and failing. With the ongoing support of his wife Lorna, and their daughter, he was living and being cared for at home. His wishes were to stay there, and to be able to go to Church, attend functions and have his friends and family visit. With the support of his GP and Bendigo Health’s Hospital Admission Risk Program (HARP), Jim and his family were able to talk about and document these wishes, and his decisions about his own end of life care: “He had very clear ideas about how he wanted the end of his life to be” (Rhonda Bell).

Conversations about what Jim wanted, and documenting these in his Plan, were ongoing. His Plan was regularly revisited and altered as his circumstances changed, a process that kept his Plan current and relevant and enabled the family and their supporters to advocate:

Jim’s health was fragile and failing. With the ongoing support of his wife Lorna, and their daughter, he was living and being cared for at home. His wishes were to stay there, and to be able to go to Church, attend functions and have his friends and family visit. With the support of his GP and Bendigo Health’s Hospital Admission Risk Program (HARP), Jim and his family were able to talk about and document these wishes, and his decisions about his own end of life care: “He had very clear ideas about how he wanted the end of his life to be” (Rhonda Bell).

Conversations about what Jim wanted, and documenting these in his Plan, were ongoing. His Plan was regularly revisited and altered as his circumstances changed, a process that kept his Plan current and relevant and enabled the family and their supporters to advocate:

Jim had a well-documented Plan, and a good understanding of what that Plan meant. And they stuck by it … they were supported to see that Plan out, not compromise Jim’s wishes.”
Rhonda Bell

This stood the family in good stead when circumstances did change. While still at home, when paramedic support was needed, having a Plan to show and refer to was a great help to everyone:

“There were challenges in his being able to stay at home when the paramedics were called because they told me they should really take him to hospital, but by giving them a copy of the Advance Care Plan to show their manager, they allowed Jim to stay at home after stabilising him with oxygen …”

– Lorna

At a later date, when Jim became extremely unwell, falling and injuring himself badly (suffering a broken femur and bleeding to the brain), he did need to be admitted to Hospital. He was later transferred to Hospice care, and died after 2 ½ weeks.

Throughout this time, Jim’s ACP was put to the test, with the determined backing of his family, his GP, the HARP and ACP staff and hospital clinicians. A thought-through and documented Plan, that everyone had access to, was a huge advantage at crisis time.

“Jim’s wishes were to be pain free, not have surgery. He was aware that his condition meant he was dying with or without surgery … It’s important that people understand they can say ‘no’ to treatment and part of this is having a good plan in place, one that’s supported” (Rhonda Bell).

This was certainly Lorna’s experience:

 “The most valuable thing about having the [Plan] in place, particularly in Jim’s last weeks of treatment was that the family could make decisions regarding Jim’s care. For example the medical team at the Hospital approached us about our wishes as to where Jim could be placed when the Hospital could no longer provide assistance for [him] to recover.  Also we could make decisions about whether the surgeons would operate on Jim’s broken femur …”

– Lorna

 ACP and HARP Coordinators worked hard to support the family throughout, working in particular with the orthopaedic surgeon to uphold Jim’s wishes. Lorna found this support enormously valuable, and attributed it to having the Plan there, something to guide everyone’s response:

“With an Advance Care Plan you are not left on your own. You can have professional expertise and help from people who really care and with the support things run a lot more smoothly.”

– Lorna

Lorna was impressed and moved by the hospice care provided to Jim in his last weeks, the gentle way in which he was tended to and the empathy she experienced from staff. This, and the fact that his wishes had been followed, meant a great deal.

This stood the family in good stead when circumstances did change. While still at home, when paramedic support was needed, having a Plan to show and refer to was a great help to everyone:

“There were challenges in his being able to stay at home when the paramedics were called because they told me they should really take him to hospital, but by giving them a copy of the Advance Care Plan to show their manager, they allowed Jim to stay at home after stabilising him with oxygen …”

– Lorna

At a later date, when Jim became extremely unwell, falling and injuring himself badly (suffering a broken femur and bleeding to the brain), he did need to be admitted to Hospital. He was later transferred to Hospice care, and died after 2 ½ weeks.

Throughout this time, Jim’s ACP was put to the test, with the determined backing of his family, his GP, the HARP and ACP staff and hospital clinicians. A thought-through and documented Plan, that everyone had access to, was a huge advantage at crisis time.

“Jim’s wishes were to be pain free, not have surgery. He was aware that his condition meant he was dying with or without surgery … It’s important that people understand they can say ‘no’ to treatment and part of this is having a good plan in place, one that’s supported” (Rhonda Bell).

This was certainly Lorna’s experience:

 “The most valuable thing about having the [Plan] in place, particularly in Jim’s last weeks of treatment was that the family could make decisions regarding Jim’s care. For example the medical team at the Hospital approached us about our wishes as to where Jim could be placed when the Hospital could no longer provide assistance for [him] to recover.  Also we could make decisions about whether the surgeons would operate on Jim’s broken femur …”

– Lorna

 ACP and HARP Coordinators worked hard to support the family throughout, working in particular with the orthopaedic surgeon to uphold Jim’s wishes. Lorna found this support enormously valuable, and attributed it to having the Plan there, something to guide everyone’s response:

“With an Advance Care Plan you are not left on your own. You can have professional expertise and help from people who really care and with the support things run a lot more smoothly.”

– Lorna

Lorna was impressed and moved by the hospice care provided to Jim in his last weeks, the gentle way in which he was tended to and the empathy she experienced from staff. This, and the fact that his wishes had been followed, meant a great deal.

I have no regrets and can enjoy happy memories of caring for Jim at home as he wished.”
Lorna

Improving Discharge Care

Bendigo Health is committed to improving the quality and safety of care for our patients. By improving communication with local GPs and other health professionals, we are able to better coordinate the continuity of patient care, particularly when a patient moves from the acute hospital to the community setting.

A Discharge Summary is an important clinical and administrative document which summarises key information about a patient’s presentation to hospital, ranging from a brief presentation to the emergency department to a multi-day admission to hospital. Information summarised in this document includes the patient’s final diagnosis, details of any procedures or operations, clinical results (such as blood tests or imaging), medication list (including any changes to medications) and details of follow up plans or further appointments. Good quality discharge summaries are critical to the safe handover of patient information. They are the main communication mechanism between hospitals and primary healthcare providers.

Junior Doctors from Bendigo Health have been working together with a member of the BH Board and local GPs to improve the quality and timeliness of discharge summaries at BH, in order to improve continuity of care and patient experience. An audit completed by Junior Doctors looking at discharge summaries at BH demonstrated that overall, BH produces excellent quality and timely Medical discharge summaries.

The audit also indicated areas for improvement. These improvements are currently underway, including redeveloping the Discharge Summary template to include certain key clinical information and present it in a standardised, clear and easy-to-follow manner for GPs and primary healthcare providers. Another focus is to improve the distribution of Discharge Summaries to GP Practices via electronic methods. This will enable GPs to receive discharge summaries more quickly and efficiently, enhancing patient care beyond discharge.

A Discharge Summary is an important clinical and administrative document which summarises key information about a patient’s presentation to hospital, ranging from a brief presentation to the emergency department to a multi-day admission to hospital. Information summarised in this document includes the patient’s final diagnosis, details of any procedures or operations, clinical results (such as blood tests or imaging), medication list (including any changes to medications) and details of follow up plans or further appointments. Good quality discharge summaries are critical to the safe handover of patient information. They are the main communication mechanism between hospitals and primary healthcare providers.

Junior Doctors from Bendigo Health have been working together with a member of the BH Board and local GPs to improve the quality and timeliness of discharge summaries at BH, in order to improve continuity of care and patient experience. An audit completed by Junior Doctors looking at discharge summaries at BH demonstrated that overall, BH produces excellent quality and timely Medical discharge summaries.

The audit also indicated areas for improvement. These improvements are currently underway, including redeveloping the Discharge Summary template to include certain key clinical information and present it in a standardised, clear and easy-to-follow manner for GPs and primary healthcare providers. Another focus is to improve the distribution of Discharge Summaries to GP Practices via electronic methods. This will enable GPs to receive discharge summaries more quickly and efficiently, enhancing patient care beyond discharge.

Statistics

According to the Victorian Health Experience Survey (VHES) results for Patient Reported Discharge Care, Bendigo Health performed above the State target for a 9 month period43. The target is to have 75% of participants respond very positively to the four discharge questions on the VHES survey:
1

Before leaving hospital did the doctors and nurses give you sufficient information about managing your healthcare at home?

2

Did hospital staff take your family and home situation into account when planning your discharge?

3

Thinking about when you left hospital, were adequate arrangements made by the hospital for any services you needed?

4

If follow-up with your general practitioner was required, was he or she given all the necessary information about the treatment or advice you received while in hospital?

Percentage of respondents rating their discharge experience as very positive:

76%

July – September 2016

77%

October – December 2016

76%

January – March 2017

In Focus

Volunteer express

Support between hospital and home
Andrew has plenty of experience as a volunteer providing transport for people coming to or leaving hospital. After retiring from a professional career, he worked voluntarily providing transport for patients at Broadmeadows Health. Five years ago, after moving to Bendigo, he took up a similar role in Bendigo Health’s “Volunteer Express”. He’s still loving the work.

The Express assists with transport for patients between Bendigo Health sites and accommodation units.  Andrew will often collect patients from the accommodation to hospital for chemotherapy or medical imaging or appointments at our clinics. Often, the people they support have come long distances for treatment, are away from family and home, and may need to stay in Bendigo for a number of weeks. In situations like these, Andrew and other Express volunteers can become a familiar presence for the person while they are staying.

The Volunteer Express also provides transport home for people who don’t have anyone else to assist them when they are discharged. The volunteers’ shifts start in the Discharge Lounge, where bookings have been made in advance for someone to be taken home. Whilst time constraints can be a challenge – “You can be 30-40 minutes with one person, helping them inside, so there’s a limit to how many people you can work with” – the work is satisfying:

“The best thing about the Volunteer Express is that you are directly helping”

– Andrew

One situation was particularly rewarding. Andrew had transported an elderly man home after being in hospital. He “lived in a fairly remote area” and was expecting his wife to greet him when they arrived. What happened, however, was quite different. When there was no answer at the door, they looked through the window to see that the man’s wife was lying on the floor. She had fallen whilst putting wood on the fire, and had been lying there for quite some time. Much to Andrew’s amazement, the 90 year old gentleman climbed through a window to reach her, and let Andrew and the other volunteer in to help. They called an ambulance and supported her until it arrived.

What happened some days later was even more unexpected. When Andrew turned up for his next shift, the person booked to use the Volunteer Express was the very same woman. It’s a rare thing for the Express volunteers to be able to see someone again in the course of their work – to see a situation through and know that the outcome has been good:

Andrew has plenty of experience as a volunteer providing transport for people coming to or leaving hospital. After retiring from a professional career, he worked voluntarily providing transport for patients at Broadmeadows Health. Five years ago, after moving to Bendigo, he took up a similar role in Bendigo Health’s “Volunteer Express”. He’s still loving the work.

The Express assists with transport for patients between Bendigo Health sites and accommodation units.  Andrew will often collect patients from the accommodation to hospital for chemotherapy or medical imaging or appointments at our clinics. Often, the people they support have come long distances for treatment, are away from family and home, and may need to stay in Bendigo for a number of weeks. In situations like these, Andrew and other Express volunteers can become a familiar presence for the person while they are staying.

The Volunteer Express also provides transport home for people who don’t have anyone else to assist them when they are discharged. The volunteers’ shifts start in the Discharge Lounge, where bookings have been made in advance for someone to be taken home. Whilst time constraints can be a challenge – “You can be 30-40 minutes with one person, helping them inside, so there’s a limit to how many people you can work with” – the work is satisfying:

“The best thing about the Volunteer Express is that you are directly helping”

– Andrew

One situation was particularly rewarding. Andrew had transported an elderly man home after being in hospital. He “lived in a fairly remote area” and was expecting his wife to greet him when they arrived. What happened, however, was quite different. When there was no answer at the door, they looked through the window to see that the man’s wife was lying on the floor. She had fallen whilst putting wood on the fire, and had been lying there for quite some time. Much to Andrew’s amazement, the 90 year old gentleman climbed through a window to reach her, and let Andrew and the other volunteer in to help. They called an ambulance and supported her until it arrived.

What happened some days later was even more unexpected. When Andrew turned up for his next shift, the person booked to use the Volunteer Express was the very same woman. It’s a rare thing for the Express volunteers to be able to see someone again in the course of their work – to see a situation through and know that the outcome has been good:

She came to the Departure Lounge on a day we were working … we took her home … it’s so rare that you get a situation where you see a person again, see what happened. You really feel valued, it was such a good outcome.”

Enhancing access and support

Better experiences for people with a disability
For people with a disability who have complex needs, the path through the health care system is not always a smooth one. A Project underway at Bendigo Health – Enhancing access and support for people with a disability and their carers – aims to improve the experiences that people with disabilities and their families have using health services.
We all know waiting rooms are difficult … Sometimes we can go into a quiet room rather than ‘waiting with the masses’, if you like … or if I’m really sensing that [my son] is not tolerating the appointment at all, then we just sit in the car park and wait, and the staff on the desk ring me on my mobile and say ‘we’re ready, you can bring [your son] in’. It’s not really asking people to go far out of their way … Just to think outside the box a bit and then it makes the appointment run smoothly for the health professional, for [my son], and for the carer.”
Mother of a 14yo who has autism and is non-verbal
 “The person who answers the phone [at Reception] is very important … you are the carer explaining to them and you’re wanting them to listen … Can they flag ‘run on time’? … work with the parent, be flexible, listen, communicate … It’s all about the health professional working with me to achieve a positive outcome”

– Mother of a son who has a disability

With the intention of making services more accessible, supporting people better and collaborating with carers, the Project is focussed on two main areas: the Hospital experience; and Primary health care management. Stage 1 has involved working with carers and staff on how to improve the experience of people with a disability who also have complex needs and behaviours to reduce the stress of hospital visits, and minimise anxiety. An educational video has been produced in which carers speak directly about what works, and what doesn’t, sharing their experiences of supporting their loved one in the health system. Care plans – individually called My Hospital Passport – have also been developed for an initial group of people. These Passports:

  • detail the person’s needs, interests and preferred ways of communicating and working with hospital staff;
  • include strategies for making sure that consultations, planned or unplanned admissions to hospital, or plans for leaving hospital go smoothly; and
  • draw on the advice and knowledge of carers, and come with guidelines for staff about how to work with a family to develop the Passports.

The Passports will be kept on a person’s file, with an ‘alert’ in the system to let staff know they are there. With these Passports in place and accessible, the aim is that wherever the carer and their family member make contact with Bendigo Health, their preferences and needs are known.

The families involved have provided feedback on what doing the Passports was like, and suggestions about improving them and their use. The next test is to follow someone with a Passport through the system to see how it works, and whether their experience is positive.

Bendigo Health is also working with Murray Primary Health Network to provide ‘Health Pathways’ for GPs working with a person with a disability, supporting GPs with strategies and referrals, and guiding them in working alongside carers.

 “The person who answers the phone [at Reception] is very important … you are the carer explaining to them and you’re wanting them to listen … Can they flag ‘run on time’? … work with the parent, be flexible, listen, communicate … It’s all about the health professional working with me to achieve a positive outcome”

– Mother of a son who has a disability

With the intention of making services more accessible, supporting people better and collaborating with carers, the Project is focussed on two main areas: the Hospital experience; and Primary health care management. Stage 1 has involved working with carers and staff on how to improve the experience of people with a disability who also have complex needs and behaviours to reduce the stress of hospital visits, and minimise anxiety. An educational video has been produced in which carers speak directly about what works, and what doesn’t, sharing their experiences of supporting their loved one in the health system. Care plans – individually called My Hospital Passport – have also been developed for an initial group of people. These Passports:

  • detail the person’s needs, interests and preferred ways of communicating and working with hospital staff;
  • include strategies for making sure that consultations, planned or unplanned admissions to hospital, or plans for leaving hospital go smoothly; and
  • draw on the advice and knowledge of carers, and come with guidelines for staff about how to work with a family to develop the Passports.

The Passports will be kept on a person’s file, with an ‘alert’ in the system to let staff know they are there. With these Passports in place and accessible, the aim is that wherever the carer and their family member make contact with Bendigo Health, their preferences and needs are known.

The families involved have provided feedback on what doing the Passports was like, and suggestions about improving them and their use. The next test is to follow someone with a Passport through the system to see how it works, and whether their experience is positive.

Bendigo Health is also working with Murray Primary Health Network to provide ‘Health Pathways’ for GPs working with a person with a disability, supporting GPs with strategies and referrals, and guiding them in working alongside carers.

Peer support

Continuity of mental health care
Peer support has helped me do things I used to do, like go back to church for food parcels rather than order pizza for every meal, which is better for my health, James has encouraged me to organise my unit as well as start focusing on my health … I think everyone should have a peer support worker, they care and listen and want to help you be better.”
Consumer

Psychiatric Services at Bendigo Health now includes the Peer Support Program. Three Peer Support Workers have joined the mental health team. Bringing insight and expertise gained through lived experience as consumers, they work in the inpatient units and in the community. This enables them to connect with people while they are inpatients, provide support as they leave hospital, and follow up with them as they embark on their recovery plans. Feedback so far has been positive:

“[It’s been great] having someone to talk to about all the things in my life … [The worker] has talked about lots of things including ways to help my health like quitting smoking and sharing his journey –  that’s been helpful”

– Consumer

The Peer Workers are members of the care teams – patients, families, carers, and clinicians – and have an active role in care and recovery planning. Their contribution to this team and what they offer consumers is unique, and includes:

  • supporting people to develop their recovery goals;
  • modelling personal responsibility, self-awareness, self-belief, self-advocacy and hopefulness; and
  • sharing ideas about ways to achieve recovery goals, drawing on personal experience and a range of coping, self-help and self-management techniques.

There are a number of arrangements in place to support and guide the introduction of Peer Support. An Implementation Group has been established, including the Peer Workers, and Bendigo Health is collaborating with Department of Health and Human Services (DHHS) in the implementation process and in research to evaluate the Program. The mental health Consumer Participation Group receives regular progress reports, and the Peer Workers are part of a local peer hub where peer workers from a range of services can network and share ideas about the Program’s development.

Psychiatric Services at Bendigo Health now includes the Peer Support Program. Three Peer Support Workers have joined the mental health team. Bringing insight and expertise gained through lived experience as consumers, they work in the inpatient units and in the community. This enables them to connect with people while they are inpatients, provide support as they leave hospital, and follow up with them as they embark on their recovery plans. Feedback so far has been positive:

“[It’s been great] having someone to talk to about all the things in my life … [The worker] has talked about lots of things including ways to help my health like quitting smoking and sharing his journey –  that’s been helpful”

– Consumer

The Peer Workers are members of the care teams – patients, families, carers, and clinicians – and have an active role in care and recovery planning. Their contribution to this team and what they offer consumers is unique, and includes:

  • supporting people to develop their recovery goals;
  • modelling personal responsibility, self-awareness, self-belief, self-advocacy and hopefulness; and
  • sharing ideas about ways to achieve recovery goals, drawing on personal experience and a range of coping, self-help and self-management techniques.

There are a number of arrangements in place to support and guide the introduction of Peer Support. An Implementation Group has been established, including the Peer Workers, and Bendigo Health is collaborating with Department of Health and Human Services (DHHS) in the implementation process and in research to evaluate the Program. The mental health Consumer Participation Group receives regular progress reports, and the Peer Workers are part of a local peer hub where peer workers from a range of services can network and share ideas about the Program’s development.

I think the most valuable thing about the program is that our clients are feeling well supported by our peer support workers and are continuing to engage on different levels. Clients are responding really well to having someone who understands their concerns on a different level to clinicians.”
Robin Armstrong, Lead Clinician, Child and Adolescent Mental Health Service [CAMHS]

Palliative care

Making a difference at end of life
Helping to increase everyone’s understanding of palliative care, encouraging us to talk about end of life, is a central part of Palliative Care Services at Bendigo Health.

Palliative Care staff and volunteers coordinated this year’s National Palliative Care Week celebration. Activities included sessions on advanced care planning, an information stand asking “what matters most at the end of your life”, and an afternoon tea for staff and volunteers. The aim was to raise community awareness about palliative care. The theme – you care, your care matters. Palliative care can make a difference – encouraged people to think about palliative care and to discuss their end of life wishes with their loved ones and their health care team.

In addition to increasing community understanding, building clinical awareness and expertise is a central part of BH Integrated Palliative Care Service’s (IPCS) work. Ensuring that palliative support is provided consistently, thoughtfully and well across the health service is essential. This includes equipping healthcare staff to be able to communicate the benefits of palliative care, and to provide that care confidently. It also includes strengthening policies, procedures and systems that ensure the organisation is in a position to support staff in this role.

We continue to provide placements for clinicians as part of the Program of Experience in the Palliative Approach (PEPA). These placements are designed to improve the skills, confidence and expertise of health practitioners who care for people who are dying, and their families – general practitioners, nurses, allied health and Aboriginal health workers. The program has three components:

  1. Supervised clinical placements that build the capacity of the workforce and foster connections between specialist and generalist healthcare professionals.
  2. Workshops to provide an introduction to the palliative approach.
  3. Events to support practitioners after their placements to provide professional development, networking and education.

We look forward this year to being able to be more responsive to the preferences of people we care for. Bendigo Health was successful in our application to the Department of Health and Human Services (DHHS) 2017 Equipment and Infrastructure Grant for community-based palliative care. The grant’s aim is to improve the service’s ability to provide direct home-based end of life care. We are excited about this boost to our capacity to enable people to choose where they are cared for at end of life – in hospice or at home.

Palliative Care staff and volunteers coordinated this year’s National Palliative Care Week celebration. Activities included sessions on advanced care planning, an information stand asking “what matters most at the end of your life”, and an afternoon tea for staff and volunteers. The aim was to raise community awareness about palliative care. The theme – you care, your care matters. Palliative care can make a difference – encouraged people to think about palliative care and to discuss their end of life wishes with their loved ones and their health care team.

In addition to increasing community understanding, building clinical awareness and expertise is a central part of BH Integrated Palliative Care Service’s (IPCS) work. Ensuring that palliative support is provided consistently, thoughtfully and well across the health service is essential. This includes equipping healthcare staff to be able to communicate the benefits of palliative care, and to provide that care confidently. It also includes strengthening policies, procedures and systems that ensure the organisation is in a position to support staff in this role.

We continue to provide placements for clinicians as part of the Program of Experience in the Palliative Approach (PEPA). These placements are designed to improve the skills, confidence and expertise of health practitioners who care for people who are dying, and their families – general practitioners, nurses, allied health and Aboriginal health workers. The program has three components:

  1. Supervised clinical placements that build the capacity of the workforce and foster connections between specialist and generalist healthcare professionals.
  2. Workshops to provide an introduction to the palliative approach.
  3. Events to support practitioners after their placements to provide professional development, networking and education.

We look forward this year to being able to be more responsive to the preferences of people we care for. Bendigo Health was successful in our application to the Department of Health and Human Services (DHHS) 2017 Equipment and Infrastructure Grant for community-based palliative care. The grant’s aim is to improve the service’s ability to provide direct home-based end of life care. We are excited about this boost to our capacity to enable people to choose where they are cared for at end of life – in hospice or at home.

About this report

The Quality Account is Bendigo Health’s report to the community. It outlines our work, details our performance in the area of safe and high quality care, and provides information about our efforts to improve how we work with and for our patients and communities.

Bendigo Health’s Quality Account is published online in an interactive format. We have incorporated visual and audio-visual content and have given greater emphasis in this year’s report to the direct voices and experiences of consumers, carers and staff.

We recognise the benefit of online access and have continued with this approach for 2016-2017. The report can be read on devices such as tablets and smartphones. Additionally, printable downloads and brochures are in waiting rooms, wards, clinics, cafeterias and staff rooms across the Bendigo Health sites. We also distribute it through our community partners, such as GP practices, community health centres and aged care facilities.

We would like to hear what you think of the 2017 Quality Account, and welcome feedback including suggestions about improvements to this report.

About this report

The Quality Account is Bendigo Health’s report to the community. It outlines our work, details our performance in the area of safe and high quality care, and provides information about our efforts to improve how we work with and for our patients and communities.

Bendigo Health’s Quality Account is published online in an interactive format. We have incorporated visual and audio-visual content and have given greater emphasis in this year’s report to the direct voices and experiences of consumers, carers and staff.

We recognise the benefit of online access and have continued with this approach for 2016-2017. The report can be read on devices such as tablets and smartphones. Additionally, printable downloads and brochures are in waiting rooms, wards, clinics, cafeterias and staff rooms across the Bendigo Health sites. We also distribute it through our community partners, such as GP practices, community health centres and aged care facilities.

We would like to hear what you think of the 2017 Quality Account, and welcome feedback including suggestions about improvements to this report.

Acknowledgements

Acknowledgements

People

With thanks to the following people for their part in the development of this year’s Quality Account:

Volunteers and consumers who shared their stories and views, staff across the organisation who provided source material, Community Advisory Committee members, members of the Quality Care Council, Troy Wass and Sarah McAdie of BH Communications and Marketing, BH Quality and Risk team; and Kerry Brown and colleagues at Arteria.

References

[1] April to June quarter Performance Data, Minister for Health.

[2] Department of Health Regional Health Status Profiles 2015 https://www2.health.vic.gov.au/about/publications/data/loddon-mallee-region-2015 accessed 6/9/2017, pp. 3-6.

[3] Department of Health Regional Health Status Profiles 2015 https://www2.health.vic.gov.au/about/publications/data/loddon-mallee-region-2015 accessed 6/9/2017, p. 6.

[4] Department of Health Regional Health Status Profiles 2015 https://www2.health.vic.gov.au/about/publications/data/loddon-mallee-region-2015 accessed 6/9/2017, p. 1.

[5] 2016 Census Data, http://profile.id.com.au/bendigo/assistance accessed 30/07/17.

[6] 2016 Census data, http://profile.id.com.au/campaspe/assistance accessed 30/07/17.

[7] 2016 Census data, http://profile.id.com.au/gannawarra/assistance accessed 30/07/17.

[8] 2016 Census data, http://profile.id.com.au/loddon/assistance accessed 30/07/17.

[9] 2016 Census data, http://profile.id.com.au/macedon-ranges/assistance accessed 30/07/17.

[10] 2016 Census data, http://profile.id.com.au/mount-alexander/assistance accessed 30/07/17.

[11] Social Health Atlas of Australia – Victoria and NSW Local Government Areas, June 2015 release, PHIDU 2015 https://exchange.murrayphn.org.au/central-victoria#subject-53 accessed 30/07/17.

[12] Department of Health and Human Services 2017, Victorian Population Health Survey 2015: Selected survey findings, State of Victoria, Melbourne, Tables 10.8, p.190.

[13] Department of Health and Human Services 2017, Victorian Population Health Survey 2015: Selected survey findings, State of Victoria, Melbourne, Tables 10.2 and 10.3, p.176.

[14] Department of Health and Human Services 2017, Victorian Population Health Survey 2015: Selected survey findings, State of Victoria, Melbourne, Tables 10.2 and 10.3, p.176.

[15] Department of Health and Human Services 2017, Victorian Population Health Survey 2015: Selected survey findings, State of Victoria, Melbourne, Table 2.2, p.35.

[16] Department of Health and Human Services 2017, Victorian Population Health Survey 2015: Selected survey findings, State of Victoria, Melbourne, p.70.

[17] Victorian Population Health Survey 2011-12, Survey Findings, Department of Health 2014,  https://exchange.murrayphn.org.au/central-victoria#subject-36 accessed 30/07/17.

[18] https://collectiveimpactaustralia.com/about/ accessed 30/08/17.

[19] http://reospartners.com/projects/health-futures-australia/ accessed 30/08/17.

[20] http://victorianwomenshealthatlas.net.au/#!/atlas/Violence%20against%20Women/V/Family%20Violence/V_04/Rate%20(per%2010,000)/44/region/WHLM/F/false.

[21] Data collected by BH and reported on 30/6/17.

[22] The Australian Charter of Health Care Rights.

[23] House of Representatives, Standing Committee on Health, Aged Care and Sport, Hearing Health and Wellbeing in Australia, May 2017, Melbourne.

[24] Source: Australian Commission on Safety and Quality in Health Care Partnering with Consumers: Action Guide, Australian Safety and Quality Goals for Health Care. https://www.safetyandquality.gov.au/wp-content/uploads/2012/08/3-Partnering-with-consumers.pdf accessed 2/5/2017.

[25] VHES report January _ march 2017, Adult Inpatients.

[26] Produced by Rainbow Families Council and supported by the City of Darebin. For more information and resources visit www.rainbowfamilies.org.au.

[27] VHES report, Bendigo Health, October – December 2016.

[28] Key Driver Questions for the Adult Impatient Survey, Adult Emergency Department Survey and Maternity Survey provided by Mira Ostojic, Senior Project Officer, Clinical Analytics, Victorian Agency for Health Information (June 2017).

[29] VHES speaker at DHHS-organised VHES forum in Melbourne, November 30, 2016.

[30] Key Driver Questions for the Adult Impatient Survey, Adult Emergency Department Survey and Maternity Survey provided by Mira Ostojic, Senior Project Officer, Clinical Analytics, Victorian Agency for Health Information (June 2017).

[31] Bendigo Health Medication Safety Newsletter Volume 5 Issue 2 June 2017.

[32] VHIMS (Victorian Hospital Incident Management System) and MANAD (incident reporting system for residential).

[33] ACHS Peer Group Comparison, Bendigo Health Care Group, Second Half 2016.

[34] Victorian Health Experience Survey (VHES) data July-September 2016, verbatim comment, Paediatric inpatient).

[35] Women’s Healthcare Australasia, WHABMC Report 2015-2016 (November 2016 figures).

[36] Birthing Outcomes System (BOS), Bendigo Health Patient Records system for maternity inpatients (mothers and babies).

[37] Victorian Admitted Episode Data Set.

[38] Bendigo Health Strategic Plan 2013-2018, 5 year Outcome Measure and Process Indicator.

[39] Annual Report of Bendigo’s Advance Care Planning Program, 2016-2017, p.7.

[40] Annual Report of Bendigo’s Advance Care Planning Program, 2016-2017, p.9.

[41] Annual Report of Bendigo’s Advance Care Planning Program, 2016-2017, p.15.

[42] Annual Report of Bendigo’s Advance Care Planning Program, 2016-2017.

[43] http://performance.health.vic.gov.au/Home/Report.aspx?ReportKey=734, accessed 12/09/2017.