Integration of Health Services

Hospitals and community health services across Western Australia have undergone a process of integration during the year. Apart from savings through the reduction of duplicated administrative support services, the integration aims to improve the range and effectiveness of services, with closer links across all disciplines.

Changes within the health services resulted in the re-evaluation of many of the senior positions. All of the General Manager positions were revised and a re-selection process carried out with the participation of the Health Service Boards and their communities.

During the year a single Murchison Health Service District Board was formed to represent hospitals in Meekatharra, Cue, Mt Magnet and Sandstone. The change to a single board reflects the integration of hospitals and community health services in each town, and the coordination and joint planning framework now in place. Similar changes are being considered by other Boards.

1997 Patient Evaluation Survey of Hospital Services

The Epidemiology and Analytical Services section conducted a Statewide survey with funding provided by the Health Workforce Reform Division’s Best Practice Quality Management Program. The survey aimed to obtain patient opinion of a variety of hospital services and received a response of more than 60 per cent of patients.

The survey:

1. monitored the performance of hospitals in a number of areas, such as communication and special needs;

2. assisted hospitals in improving their services by letting them know what the clients thought about the services during their hospital stay; and

3. let the hospitals know which services were being provided well.

Initial results included an overall satisfaction rating of 86 out of a possible 100 across the State. This indicator encompassed ratings of 11 areas of concern identified by patients.

Availability of doctors and nursing staff was consistently ranked as the most important aspect of hospital stay, closely followed by care and treatment and environmental aspects, while waiting times ranked as least important.

Waiting list management strategy

The Health Department released a Waiting List Management Strategy in November 1996, to outline how it is addressing the issue of waiting lists for elective surgery. The strategy focuses on reducing the amount of time people are on the waiting list before being admitted to hospital. The intention is to ensure that everyone receives treatment within the appropriate time for their condition.

The major points of the strategy included:

• The injection of $30 million in funding for additional procedures in public hospitals, to be used specifically for patients in the urgent category.
• Establishment of a Wait List Helpline to give patients and doctors information on the average waiting time for general surgical areas and some specific procedures at the teaching hospitals.
• Service plans for each of the major specialties to correct problems in service provision, which may increase waiting times.
• System improvement at public hospitals focussing on increased accountability for performance in areas such as cancellations (by the patients and by the hospital), outpatient waiting times and waiting list auditing procedures.
• Development of guidelines by the Health Department for the classification of urgency categories in 15 major surgical procedures. This was the first work of its type in Australia to ensure patients are treated equitably across the State.
• Establishment of a working group to look at how the strategy could best be implemented - quickly, effectively and in a uniform way in all hospitals.

Successful initiatives during the year included the establishment of the Royal Perth Hospital endoscopy satellite services at Swan District and at Osborne Park Hospitals, to reduce teaching hospital waiting lists and provide care closer to the patient’s home.

Telehealth

The development of Telehealth in Western Australia continued over the year, and was well promoted during the Telehealth Expo in February 1997. The Expo was organised by the Health Department to demonstrate the integrated video, voice, data, and image technologies which support the clinical needs identified in the Department’s Telehealth Strategic Plan.

These technologies included: scalable medical imaging servers; diagnostic workstations with 3-D imaging; digitisers; tele-ultrasonography via telephone; videoconferencing coupled with clinical diagnostic attachments; dermatology digitised images transmitted via Internet; cardiology echocardiograms, nuclear medicine images and coronary angioplasty and angiography images; satellite communications, Internet and training equipment.

King Edward Memorial Hospital’s bone densitometer machine, was bought through community fundraising initiatives. The machine assists with diagnosis and management of osteoporosis.

A video made during the Expo was later shown around country health services and hospitals.

Strategic business plans are being developed which clearly define the benefits of Telehealth.

The Health Department Information Technology network, which links all major metropolitan health facilities and rural hospitals/health centres, continues to be upgraded and expanded.

In September 1996, Perth and Adelaide were accepted as Global Reference Centres for emergency telemedicine consultations. The Health Department leads and coordinates this project.

Other highlights in this area throughout the year:

• The North-West Mental Health Services telepsychiatry service was installed in Broome, Derby, Karratha, Port Hedland, Kununurra, and Graylands Hospital.
• Western Australia contributed to the development of a Telehealth Issues paper which was submitted to the Australian Health Ministers’ Advisory Council. A National Telehealth Committee was then formed with a number of Working Parties.
• The development of a strategic plan for a Statewide tele-radiology and tele-ultrasound service commenced based on clinical requirements.

The following is planned for the 1997/98 financial year:

• Extension of Telehealth community needs assessment, consultation and planning.
• Stage 1 implementation and evaluation of a satellite-based Telehealth network in a number of rural/remote communities and establishment of a central services hub with links into the Health Department Wide Area Network/Intranet.
• Completion of the State Strategic Plan for Tele-radiology and tele-ultrasound services.

Competitive Tendering and Contracting

The Government’s metropolitan health services have tested the private market for the delivery of non-core services such as catering, cleaning, orderly services, maintenance, gardening and internal audit.

Contracts worth approximately $50 million have been awarded with an expected saving to Government of $6.6 million.

A further $40 million of non-core services underwent market testing, however, the services were retained in-house, as it was not commercially viable to award contracts.

Competitive tendering and contracting will continue to be applied where there is an opportunity for savings improvement or innovation in service delivery through private sector involvement.

Linen service

The sale of Healthcare Linen for $8.75 million was finalised during the year with the new owners taking over on September 16.

The laundry equipment, linen and contracts with the metropolitan public hospitals were sold, and the land and buildings leased to the new owners.

The Health Department benefited from reduced laundry costs and rent from the buildings.

Forty-one employees took voluntary redundancy and 154 employees transferred to the new company, which is continuing to deliver high quality laundry and linen services.

Family and Domestic Violence

In keeping with the principles of the Action Plan on Family and Domestic Violence (1995), the Department released a Health Policy and Implementation Plan to Address Family and Domestic Violence (March 1997). The plan detailed investment and purchasing strategies until 1998/99.

In 1996/97 the Department continued to support health service representatives on regional committees; developed a comprehensive health services training package and plan; worked towards the standardisation of consumer information materials; and aided the development of best practice guidelines and protocols for working with survivors and perpetrators of interpersonal violence.

Government Two-Year Plan for Women 1996-1998

The Department has made substantial progress towards honouring the commitments made in the Government Two-Year Plan for Women 1996-1998 to continue to purchase women’s health services, address the specific health needs of Aboriginal women, develop information resources on maternal health and increase the utilisation of women’s cancer screening services.

There are 13 Women’s Health Centres and six Sexual Assault Referral Centres in WA. These services provide a range of clinical, counselling, crisis intervention, health education and promotion services to women across the State.

In July 1996 the State Evaluation of the National Women’s Health Program concluded that women’s health services were well received by their clients and were used as a specialist referral service by other health professionals. A product of the evaluation was the development of key service programs, outputs, outcomes and performance indicators for women’s health services.

A consultation process to develop best practice standards and safe models of maternity service delivery for women in small country towns was initiated in 1996/97, in keeping with the recommendations of the Select Committee on Intervention in Childbirth Report (1995). Similarly, the Department made efforts towards the development of a ‘Good Birth Guide’ which seeks to inform women about the different models of maternity care available in WA.

In addition, promotions and recruitment strategies were refined to increase participation of women in the BreastScreen WA program. A Statewide recruitment campaign was developed and a General Practitioner Project was implemented, aimed at recruiting unscreened and under-screened women. The participation rate for women (percentage of women screened within 27 months) to the end of June 1997 was 56 per cent. This represents an increase of eight per cent from a participation rate of forty-eight per cent in 1995/1996

The Cervical Cancer Prevention Program encourages women to have bi-annual pap smears. The Cervical Cytology Registry (CCR) is a major component of the Program and provides a reminder service to both women and practitioners when Pap smears and investigations are overdue.

The CCR is now fully operational, and is receiving and processing data from pathology laboratories in WA on a regular basis.

In 1997, the CCR provided the first set of standard reports for all State laboratories and to the Commonwealth in line with the National Quality Assurance Program requirements. The CCR also regularly provides data on screening rates to the various WA health regions.

A large number of projects were funded throughout the State to increase screening rates. Priority was given to those projects which particularly addressed the needs of women from non-English-speaking backgrounds, women in rural and remote areas, and Aboriginal women.

Improved Hospital Facilities

During the year a number of significant new hospital and health service facilities were completed and began operation:

• The State Government funded a $2.2 million redevelopment of the radiation oncology facilities at Royal Perth Hospital. The new service is provided in partnership with a private practice. The private provider has installed two new linear accelerators.
• Royal Perth Hospital also opened the $1 million redeveloped emergency department, one of the busiest trauma centres in Australia. The new department has 25 patient bays, and new entrances for ambulance, patients and the public.
• The Digital Angiography Unit at the Sir Charles Gairdner Hospital now has two rooms equipped with digital angiography facilities and associated equipment capable of generating clearer images of the heart than ever before.
• The Sleep Study Laboratory at the Princess Margaret Hospital has state-of-the art, fully equipped sleep monitoring units, with an expert consultative service for children with sleeping disorders.
• Albany Regional Hospital opened a new $2 million Emergency Department and CT Scan room.
• Sir Charles Gairdner Hospital unveiled a $1.8 million linear accelerator used to treat patients with cancer, replacing older equipment.
• At Fremantle Hospital, a new $2 million paediatric ward opened in February 1997. More than 64,000 children were hospitalised in Western Australia in 1995/96. Fremantle’s new ward has 29 beds as well as accommodation for parents, and new recreational equipment.
• Also at Fremantle, a new $1.1 million Renal Dialysis Unit opened in March 1997. This eased pressure on units already operating at Sir Charles Gairdner and Royal Perth Hospitals.
• A breast assessment centre was established at Sir Charles Gairdner and Royal Perth Hospitals following extensive consultation with stakeholders, including: health consumers, surgeons and radiologists. The Department’s breast x-ray service, BreastScreen WA, offered diagnostic and counselling services through the new centre.
• King Edward Memorial Hospital unveiled a $100,000 bone densitometer machine, bought through community fundraising initiatives. The machine assists with diagnosis and management of osteoporosis.
• Bunbury Hospital opened its Gastroenterology unit, allowing more access to the operating theatres for surgical cases.
• A new Accident and Emergency Department at Kojonup District Hospital was opened and dedicated to the Kojonup community for their support and service to the Hospital.
• In November 1996 Gnowangerup District Hospital, opened a new palliative care ward. The ward was made possible by the support and contribution of the Gnowangerup community.
• Kalgoorlie-Boulder Regional Hospital officially opened the refurbished Children’s Ward. The ward was named the ‘VARIETY CLUB CHILDREN’S WARD’ following the donation of $500,000 from the proceeds of the 1995 Variety Club of Western Australia "Bash".
• Avon Health Service opened the York Child Health Clinic at the York District Hospital on June 12 1997. The project was funded by the York Shire.
• In April 1997 the Narrogin Community Health Centre was opened. Community Health Services are now located with Mental Health Services in a refurbished building on the Narrogin Regional Hospital campus.
• Premier Richard Court opened the Wagin Medical Centre in May 1997. The Government of Western Australia made a financial contribution to the construction cost of the centre which provides community, immunisation and child health services. Dental and general medical practice surgeries are located in the building.

Improvements to Existing Facilities

Significant building and refurbishment work was completed during the year throughout the Rockingham/Kwinana District Hospital. This work featured the extension and improvement of Emergency Department reception, triage, office and waiting areas, and has provided great benefit to both the patients and staff. Other improvements:

• A $5 million upgrade of the Diagnostic Imaging Unit at Princess Margaret Hospital for Children included a new CT Scanner, a cardiac catheter laboratory and a new fluoroscopy unit. The upgrade was the result of the hospital’s Light the Kite Appeal which raised $750,000 with the balance funded through a special State Government grant.
• The Infant Formula Room at Princess Margaret Hospital was renovated and expanded to provide improved facilities for storing expressed breast milk and for demonstrating the preparation of formulas to carers before they go home from the Hospital.
• Also, Princess Margaret Hospital’s burns unit was upgraded, with a Medicare grant, to include a new outpatients area on the ward and improved facilities for the treatment of young burns patients.
• King Edward Memorial’s radiology services were overhauled during the year. New state-of-the-art X-ray equipment valued at $300,000 was installed. The equipment features many automated functions including automatic exposure which reduces the levels of radiation to which the patient is exposed. In addition the Ultrasound Department received new equipment valued at $280,000.
• The Special Care Nursery at King Edward Memorial was upgraded, including the replacement of ageing ventilators and monitors in the intensive care nursery.
• Major staff accommodation upgrades were completed at Ravensthorpe and Norseman District Hospitals.
• The Minister for Health visited Katanning Health Services in June 1997 to inspect the recently upgraded physiotherapy and occupational therapy departments. The Minister also had the opportunity to inspect the recently completed palliative care ward which was funded by the Katanning community and Kerry Lodge.
• The Albany Safety and Injury Prevention House opened and an injury surveillance database of more than 15,000 injuries in the Great Southern and South West was established.
• Geraldton Health Service, in conjunction with Sir Charles Gairdner Hospital was established as a satellite for home dialysis in June 1997.
• The Bunbury Hospital Redevelopment Project on the South West Health Campus progressed on schedule. Much work is being done in identifying and setting up contracts for clinical and support services on the Campus.
• The Northampton/Kalbarri Health Service saw the completion of much needed renovations and upgrades to Northampton Hospital and Nurses Quarters.

Special Achievements in Client Care

Swan Health Service Primary Health Team was awarded the Jenner 200 Years of Immunisation Health Professionals Certificate of Merit by the Commonwealth Department of Health and Family Services in recognition of improved local immunisation rates.

Kalamunda Health Service also received a Jenner award for providing ADT vaccination to Year 10 students at the local high schools.

Princess Margaret Hospital for Children staff won a major national award for the work of the Multi-Cultural Multi-Faith Committee at the Hospital. The Hospital won a World Conference on Religion and Peace Philia Award for its initiatives in this area. These have included the establishment of a Muslim Salat Room, and the conversion of the previously Christian-only chapel into a multi-faith centre to reflect the differing religious needs of the Hospital’s customers.

Sir Charles Gairdner Hospital has appointed Western Australia’s first Chair in Emergency Medicine in conjunction with the University of Western Australia.

Accreditation

• The Vasse Leeuwin Community Health Service received three years’ accreditation with the Community Health Accreditation and Standards Program (CHASP). This is the first health service in WA to achieve this standard and the presentation of the award was made by the Minister for Health in May 1997.
• The Armadale/Kelmscott Health Service is progressing towards ISO Accreditation and aims to complete the task at the end of 1997.
• Albany Regional Hospital became the first Government Hospital in Western Australia to be accredited by the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program (EQUIP).
• The Australian Council on Healthcare Standards (ACHS) awarded Rockingham/Kwinana Health Service three-year accreditation for its Hospital and Psychiatric Program.
• Bunbury Health Service appointed a Quality Management Officer. Quality Management programs have been established which will lead the Bunbury Health Service into accreditation by the year 2000.
• The East Pilbara Health Service successfully passed a focus survey from ACHS, therefore maintaining continuous accreditation since 1987.

Special Events

King Edward Memorial Hospital celebrated its 80th anniversary with a function led by the Governor’s wife, Mrs Marlena Jeffery.

Fremantle Hospital celebrated its 100th year of service to the people of Western Australia. The Governor of Western Australia welcomed the "first" patient at The Knowle, the original Hospital still used in the grounds of Fremantle Hospital, after a re-enactment through the streets of Fremantle of the "first" patient to arrive at The Knowle 100 years previously.

Armadale/Kelmscott Health Service Hospital Auxiliary held its 50th Anniversary during the year and a celebration was held for over 100 past and present members.

The Whitby Falls Psychiatric Hostel also held its Centenary celebrations during the year.

Working with technology

The pathology laboratories of Perth’s teaching hospitals were linked by the ULTRA system. The system interfaces with diagnostic equipment, results are relayed to the ULTRA system and are, in turn, relayed to Patient Master Index and Clinical Care.

The system links the departments of Haematology, Biochemistry, Microbiology, Immunology and Cytogenetics and replaces three existing systems. It was the first use of the system in public hospitals in Western Australia.

King Edward Memorial Hospital and Princess Margaret Hospital for Children became the pilot site for the introduction of Oracle Financial System, the first accrual-based accounting system in the WA public health industry.

A new Patient Management Information System (called TOPAS) was introduced at Sir Charles Gairdner Hospital followed by Swan, Kalamunda and Rockingham/Kwinana Health Services.

The system will be deployed in all other metropolitan hospitals during the 1997/98 financial year, and will then be used to manage 240,000 inpatient admissions, and more than 2.3 million occasions of service per year.

Hospital use of the Internet continued to grow. The Avon Health Service established a World Wide Web Site which attracted in excess of 300 visits each month.

Community projects

Community Health Services in Albany were improved with the introduction of a Year 7 measles, mumps and rubella immunisation program, the provision of coordinated health promotion activities by the Community Health Teams, and establishment of a Health Promotions Committee.

A men’s health initiative commenced in the Albany region in May 1997 to focus on ethnic and Aboriginal men’s health issues.

In May 1997 a multi-discipline Diabetic Education Program was introduced in Katanning and this will be provided in Gnowangerup, Kojonup and Tambellup in the future.

The establishment of health promotion committees throughout the Vasse Leeuwin, inclusive of community health, hospital and community representatives, saw the initiation of a number of innovative programs including the Surf Alert - a program developed in consultation with the local surfing community aimed at reducing the surfing related injuries. As a result of this program a surfing code of ethics has been developed and many Shires both within WA and interstate have expressed an interest in picking up the program.

Tambellup Nursing Post organised the delivery of Well Women’s Clinics which were very well attended, particularly by the Noongar community.

A Drug Awareness program for Katanning Senior High School was held in August 1996. This program was run in conjunction with Palmerston Drug Research and Rehabilitation Association, and the target groups were the students, parents and teaching staff.

Care in the Home trial

During the course of the year, Rockingham/Kwinana Health Service has also completed its major trial of Care in the Home, which was a cooperative venture with Access Home Care, a division of the Silver Chain Nursing Association.

This project featured the improved discharge processes and the delivery of care in the patient’s home for a selected number of gynaecology patients. The evaluation of this 1996/97 program has shown it is a great success, not only for the patients, but also for their families, hospital staff, treating specialists and General Practitioners.

Sobering-up centres

During the 1996/97 financial year eight sobering-up centres were operating in Western Australia: Perth, Kalgoorlie, Wiluna, Roeboune, Hedland, Fitzroy Crossing, Halls Creek and Kununurra.

Wiluna’s centre, which achieved outstanding results, including reduced alcohol-related crime, was officially opened by the Minister for Health, Kevin Prince early in June 1997.

Recent figures compare statistics for the year before the opening of the Wiluna Sobering Up Centre, with the first year of its operation. The results showed a 33 per cent reduction in alcohol-related injuries, a 90 per cent reduction in arrests for damage offences, and a 67 per cent reduction in arrests for assaults.

In the twelve months ending June 30, 1997 a total of 15,541 admissions of intoxicated persons were recorded in Wiluna. Of these people, 79 per cent (or 12,274) were admitted to sobering-up centres and 21 per cent (or 3,267) were admitted to police lock-ups in locations where there were no sobering-up services.

These figures demonstrate the success of sobering-up centres in the diversion of intoxicated clients, from police lock-ups, to the safe and caring environment of a shelter. This is consistent with legislative changes introduced in 1989, decriminalising public drunkenness in Western Australia, and the recommendations of the Royal Commission into Aboriginal Deaths in Custody.

Due to the success of the service, other communities throughout Western Australia are now seeking to offer sobering-up shelters. Properties have been acquired and capital work programs are now being undertaken in Derby and Broome for the 1997/98 financial year. Other communities expressing interest include Midland, Wyndham, Geraldton and Carnarvon.