Susan Dunn & Hirani Jayasinha ABF Taskforce May 2013

1. ABF Clinical Engagement Susan Dunn & Hirani Jayasinha ABF Taskforce May 2013

2. Why is Clinical Engagement Important? • Understand their operational contribution in ABF • Currently clinical practice is reflected in the costing process which then informs the funding model • Collaboration in addressing unwarranted clinical variation • Identification of appropriate clinical practice • Understand the cost profile of the appropriate clinical cost • Aim is for funding to reflect the cost of appropriate care • Ensure correct funding messages are being heard • Drive improved patient outcomes

3. Key Strategic Approaches Communication Relationships Data Education & Tools

4. Relationships Relationships • Promote a culture of partnership between clinicians, policy makers and administrators with key agencies • Clinical Excellence Commission (CEC) • Agency for Clinical Innovation (ACI) • Bureau of Health Information • Health Education and Training Institute • Local Health Districts (LHDs)/Specialty Health Networks (SHNs)

5. Agency for Clinical Innovation Relationships • ABF Taskforce have engaged with ACI , building relationships with clinical Networks to discuss funding models and build costing models based on best practice. • ACI promotes innovation, by engaging clinicians then designing and implementing new models of care • Clinical Networks • design and support implementation of models of care which spread best practice across the NSW health system • provide expert advice to the NSW Government and Ministry of Health to improve patient care and address inequities in access • Signs of success, • positive feedback and the Tupperware effect

6. Case Study – Renal Dialysis Network • IHPA required Home Delivered Services to be collected at a patient level for each patient administrated service • Unwilling to put this burden of data collection onto clinical staff • Raised issue with key stakeholders in Renal Dialysis Network • Developed a solution framework • Met with Renal Network, Renal Dialysis Network and individual stakeholders to outline issue and to discuss proposed solution • Gained support and commitment to work with the solution • Design phase has now commenced on a reporting solution based on Prescription, census and leave option

7. LHD/SHN Relationships Relationships • LHD/SHN Clinicians , ABF Coordinators, Non admitted staff and SNAP staff • Majority of NSW ABF Workstream Working Groups have clinical co –chairs and clinical membership • Providing input into policy direction and policy support • Improves ability to feedback to IHPA • Identify clinical champions • Provide regular information • Support and focused projects

8. Hunter New England LHD Case Study • Working with clinical groups and junior medical staff on improving clinical documentation • Improved understanding of use of resources and variation in clinical management of patients, including  length of stay and use of diagnostics   • Activity/cost data included in Grand Rounds to emphasise issues with respect to gaining a more holistic view of patient care and discuss better ways of managing frequent repeating patients • Comment from a senior clinician that based on the aggregate cost it would have been better for the patient and system to pay for a full time carer

9. Illawarra Shoalhaven LHD Case Study • Orthopaedics -  identification of prostheses  and comparisons amongst sites has led to further work in standardising implants used and renegotiating the price with the contractors • Costing has been used to identify the costs of readmissions due to surgical infections • Provision of costing data to Grand Rounds to identify costs of long stay patients and discuss impact if treatment was varied or supplied in a different setting • Use of activity and costing data in working with sites and clinicians on clinical pathways for selected DRGs • Reviewing benchmarking reports to compare with peers and exemplar hospitals

10. Relationships Education - Health Education andTraining Institute • Supports and promotes coordinated education and training (clinical and non-clinical) across NSW Health System • Assures workforce competency and the capacity to deliver safe, effective and efficient health care to the people of NSW • Offers an online learning-course on ABF developed in collaboration with ABF Taskforce Education & Tools

11. Education & Tools Education - Other • Documentation – Factsheets, Practical Guide, Casemix Handbook, SNAP Handbook • Tools – NWAU calculators: Acute and ED

12. Data Data • Timely, Accurate, Transparent, Comparative, focused • ABM Business Information System

13. Data – ABM BIS

14. Communication Key to pulling it together:Communication • Site visits • Presentations to clinical groups • Linkage with local ABF Coordinators • Bulletins and factsheets • Handbooks, guidelines • Data timeliness and robustness • Transparency • Open and honest communication

15. Future Initiatives • Establishing NSW Clinical Casemix Advisory Committee –to provide stronger links between NSW Health and LHDs/SHNs • Developing further education materials (publications and online modules) targeted to clinicians • Providing focused analysis of activity, costing and benchmarking data for ACI Clinical Networks • Incompatible ABO renal transplant • Complex foot clinic • ED Benchmarking

16. “What’s in it for me?” • Understanding that best clinical practice and ABF are notmutually exclusive • Quality patient care costs less • Transparency • Timely, accurate, comparative data • Trust • Communication & collaboration