‘Delivering a healthy WA’

1. ‘Delivering a healthy WA’

2. “The country is full of good coaches. What it takes to win is a bunch of interested players.” Don Coryell, ex-San Diego Chargers Coach

3. “If you can hear the thunder, it’s too late to build an ark sweetie”

4. The Road to Reform • Nirvana or nonsense? • Finding balance - building bridges • Government returned – mandate • Expectation of community • Capital program • Good days for private health • Costs of care

5. Health Reform Evolution • Functional Review Taskforce • Health Reform Committee formed • Chaired by Prof Mick Reid • Final report released late March 2004 • Health Reform Implementation Taskforce (HRIT) commenced August 2004

6. The Reid Report Provided: • Long-term health care vision • Set out a major plan for health reform • Reconfiguration of health system next 10 to 15 years • 86 recommendations

7. HRIT Work Plan 104 projects Published work plan Outlines project scope and timeframes Clinical Reference groups 3 year timetable Reform Process HRIT Work Plan REID REPORT 86 Recommendations covering 10 themes

8. Delivering a Healthy WA • STRATEGIC DIRECTIONS 2005 • Healthy workforce • Healthy hospitals • Healthy partnerships • Healthy communities • Healthy resources • Healthy leadership HRIT Work Plan REID REPORT 86 Recommendations covering 10 themes

9. WA Health Strategic Directions 2005 • STRATEGIC PLAN • 2005-10 • Safety & Quality • People & Culture • Prevention & Promotion • Sustainable Resourcing & Accountability • Communities • Research & Training • New Hospitals & Infrastructure Renewal • Information Technology • Partnerships • STRATEGIC DIRECTIONS 2005 • Healthy workforce • Healthy hospitals • Healthy partnerships • Healthy communities • Healthy resources • Healthy leadership HRIT Work Plan REID REPORT 86 Recommendations covering 10 themes

10. The Undiscovered Country

11. Delivering a Healthy WA WA HEALTH STRATEGIC PLAN 2005-2010 Healthy Leadership Improving clinical and managerial leadership Healthy Resources Providing sustainable resourcing Managing budgets Accountable for performance Management of assets to deliver the best health benefit Healthy Partnerships Developing stronger participation with: Consumers NGO’s Health Professionals Federal Government Private Sector HealthyCommunities Improving lifestyle, prevention and health promotion Improving equitable and accessible health services Healthy Hospitals Building new tertiary hospitals Upgrading existing hospital stock Providing an efficient and productive health system processes Being innovative in delivery methods New generation information technology Healthy Workforce Recruit, develop & retain Develop knowledge, skills & participation Promote a culture of professionalism, teamwork & accountability

12. Six Strategic Directions • Healthy Workforce • Healthy Hospitals • Healthy Partnerships • Healthy Communities • Healthy Resources • Healthy Leadership

13. Healthy Workforce • Develop and deploy statewide strategic workforce plan • Establish a vibrant & positive culture • Attract & retain the right people to WA Health • Workforce innovation – job design • Strategic Workforce Plan progressing • Allied Health (Advisor) • Workforce needs priority planning system (academic and training institutions) • Identifying new approaches to under-graduate and post-graduate medical training

14. Healthy Hospitals • Debated, agreed and deployed statewide clinical services plan which matches population needs • Reduce demand on traditional hospital services • Capital Infrastructure Plan • Define context for private hospitals • Innovating clinical & admin processes within hospitals • Safety & quality in hospitals • Clinical Services Framework – also impacts on capital program and workforce planning • Fiona Stanley Hospital • Purchase Kaleeya and Galliers Hospitals • Public pathology services reform • Implement hospital pharmacy reform

15. Healthy Partnerships • Establish a framework in which all health providers understand clear role in WA Health • Further encourage private healthcare and its linkages with WA Health • Establish rural / metropolitan links which improve access for rural and remote communities • Engage Commonwealth in service reform • Increase the role of the NGO sector in service provision • Establish closer relationships with central Government agencies • Improve the relationships with academic institutions & learned colleges

16. Healthy Partnerships - cont • 30+ consultative working and advisory groups • Health Consumers’ Council WA • Ambulatory care links with community- based private health providers • Primary Care Practitioner’s Summit • Dialysis services – link with private health providers • Standardised hospital discharge summaries – GPs and hospitals • Medi-hotels forum – all industry • Community Advisory Councils – community and health services • Integrated lifestyle program links – NGO and GP sectors • Palliative care services integrated network - link with private health providers • Rehabilitation opportunity

17. Healthy Communities • Empower communities & individuals to self manage healthcare • Promotion of health & well being • Prevention of ill health • Aboriginal health • Increase non hospital based ambulant care • Foster & support community / consumer buy-in & engagement • Mental Health Strategy 2004-2007 • General Practice engagement (after hours GP clinics at EDs) • Rehabilitation Projects • Women’s and Children’s Health Service • Aboriginal Primary Care Strategy • State Cancer Services • Pathways Home

18. Healthy Resources • Introduce Resource Allocation Model • Establish a 3 - 4 year planning horizon for budgets & resource allocation • Deliver major structural & system efficiencies • Innovation in capital / infrastructure developments/procurement • Legislative overhaul to underpin WA Health • Reconfigured metro Area Health Services • Drive hospital cost efficiencies • Optimise revenue • Role delineation

19. Healthy Leadership • Build shared vision & values • Develop & grow change management skills for all leaders • Establish multi-level leadership development program • Deliver and communicate Strategic Plan • Ensure Governance / transparency / accountability at management level • Focus on capacity building • Improve advocacy • Leading 100 – Emerging Leaders Program • SHEF • State Health Strategic Plan • Medical research strategy (SHRAC)

20. Is Health Reform New? Planning the total health and hospital program in Western Australia the state’s aim should be to keep people out of hospital wherever hospital by overall improvement in public health services and education and by improving and expanding the facilities in the community to provide clinic and home care. The other is that experience throughout the world indicates that wherever hospital beds exist, they tend to be filled. It is axiomatic then that health service planning cannot be centred on how many beds should be built or bought. Health service planning in the first instance must be based on an assessment of the actual health needs of the community, judgement as to which of these can benefit from early intervention and the development and application of risk based strategies and models of care that maximise the preventative element to stop these needs developing to demands on high cost and increasing scarce resources 1975 the Western Australian Parliamentary Public Accounts Committee

21. What are the common aspirations? Promote health Reduce inequities in health status Safe, high quality, evidence based health care Patient centred care Integration (service collaboration, partnerships and coordination) Value for money Financial sustainability Workforce sustainability

22. Common elements A tiered capability framework/role delineation that defines the roles of the hospitals, A structural mechanism to integrate the hospital services with primary care. Establishing Clinical Networks

23. Reform program outputs? Australia’s most advanced hospital Role delineation/service consolidation Safety and sustainability Prevention and promotion Integration Networks

24. Reform program health outcomes ?

25. Everything old is new again? All reform programs have a strong element of commonality All have a project flavour – there are even projects for continuous improvement All have “shiny things” Predominantly technical solutions – centralised policy changes Little adaptive direction except in regard to networks All acknowledge networks as a strategy but treat them as a “black box”

26. ADAPTATION IS NOT A SPECTATOR SPORT!

29. Involving users, carers, staff and the public Process and systems thinking Personal and organisational development Making it a habit: initiating, sustaining and spreading improvement in daily work Discipline of improvement 4 equally important parts of improvement Process People

30. Stop, Think, Do

31. Battery Point – WA Lessons for Tasmania We jump at technical solutions when what is needed is adaptation – behavioural change by those under pressure of predation or extinction We do things when we should just stand there – what is needed is contemplation in action, to step off the dance floor/mosh pit and on to the balcony We put too much effort into defending what we know against uncertainty – enemies that may never materialise and worse – firing shots at potentially useful and powerful allies