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Issue 43 January 2016
The Hospital Alliance for Research Collaboration
In the news
Tapping into the patient experience
Avoiding adverse events
Physicians in focus

Designs on improved patient care

HARC scholar Estelle Marque

HARC scholar Estelle Marque is confident that adopting a new way of thinking can help solve challenges in healthcare delivery, and ensure better outcomes for patients, carers and staff.

read more

Shining a spotlight on adverse events

Welcome to the first HARC e-Bulletin for 2016, covering the latest news, research and reports from December last year and this month.

In this Bulletin, we look at new research on avoiding adverse events in healthcare, including a study that reveals off-label prescribing is linked to a high rate of adverse events. Another study shows that printed handover notes on patients are out of date after just three hours, increasing the risk of errors.

Meanwhile, in our news section, we cover the latest data on preventable hospitalisation in Australia, with a report showing that people living in some parts of the country are nine times more likely than others to be admitted to hospital for a condition that could have been treated more effectively in the community.

In our profile, we meet 2015 HARC scholar Estelle Marque, a course manager with the Agency for Clinical Innovation (ACI) Centre for Healthcare Redesign, who is researching how a new way of thinking can solve challenges in healthcare delivery.

Please forward this edition of the Bulletin to colleagues who may be interested in joining the HARC Network. We'd love to hear your feedback or suggestions at:

Megan Howe

Editor, HARC e-Bulletin

Preventable hospitalisation varies widely: report

People living in some areas of Australia are nine times more likely than others to be admitted to hospital for conditions that could have been treated more effectively in the community, according to a new report.

The National Health Performance Authority’s second report on potentially preventable hospitalisations, released in December, reveals that 6% of all hospital admissions and 8% of all bed days in 2013‒14 were for 22 conditions for which hospitalisation was deemed preventable.

The report focuses on a subset of five conditions: chronic obstructive pulmonary disorder (COPD), diabetes complications, heart failure, cellulitis and kidney and urinary tract infections, which contributed to almost half of potentially preventable hospitalisations and almost two-thirds of bed days for such admissions nationally.

Rates of potentially preventable hospitalisations varied greatly across local areas, the report showed, even after adjusting for differences in the age of residents ‒ ranging from 1406 potentially preventable hospitalisations per 100,000 people in Pennant Hills-Epping (NSW) to 12,705 per 100,000 in Barkly (NT).

Reducing potentially preventable hospitalisations is a focus for the 31 Primary Health Networks established in mid-2015, according to the report, which shows wide variations in hospitalisations for each of the five conditions across PHNs. For example, for COPD, there were 112 hospitalisations per 100,000 people in Northern Sydney compared with 600 per 100,000 in the NT.

Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said the report showed older people, those from regional and remote areas and people of lower socioeconomic status had more potentially preventable hospitalisations than others.

“The figures show both the importance of primary care in easing the burden on our hospital system, and the opportunity for Primary Health Networks to identify and respond to regional need by commissioning well-targeted health services,” she said.

Government MBS review targets “obsolete” items

The Federal Government’s ongoing review of the Medical Benefits Schedule has recommended that 23 “obsolete” items be cut from the MBS across areas including diagnostic imaging, ENT surgery and gastroenterology.

The first tranche of recommendations from the taskforce commissioned to review all 5700 MBS items were released in late December.

There was clinical consensus that 23 items were obsolete and no longer represented clinical best-practice, according to a taskforce report, which calls for their immediate removal from the MBS. They include seven diagnostic imaging items, nine ENT (ear, nose and throat) surgery items, five gastroenterology items, one obstetric item and one thoracic medicine items.

In total, the 23 items were claimed 52,500 times in 2014‒15, costing $6.8 million in Medicare benefits.

The report outlines reasons why each item should be removed, ranging from there being more clinically appropriate or efficient technologies and procedures already listed on the MBS through to patient safety, unnecessary doubling-up of item claims and decreasing usage.

For example, it recommends removal of the item for direct examination of the supraglottic, glottic and subglottic regions of the larynx (item 41846), which was claimed 36,719 times in 2014-15 at a cost of $5.5 million. The procedure was “no longer part of contemporary clinical practice” and had been replaced by newer technologies, with its use concentrated among a minority of providers in certain geographic areas, the report stated.

In diagnostic imaging, invasive tests to diagnose blood clots in the lower leg or gall bladder problems had now been replaced by non-invasive ultrasound technology, the report states.

Federal Health Minister Sussan Ley said the recommendations were “not by any means a comprehensive or complete list of the final findings about the final makeup of the MBS” and the taskforce was seeking further views on the 23 items before final decisions were made.

The recommendations are open for public consultation until 8 February 2016.

Cosmetic surgery industry under spotlight in NSW

The NSW Government is considering tightening regulation of the cosmetic surgery industry, following several cases of patients being rushed to hospital after experiencing complications while undergoing procedures at clinics.

NSW Health Minister Jillian Skinner, releasing a new discussion paper on regulation of the industry, said cosmetic surgery could be performed by a range of medical practitioners from specialist plastic surgeons to GPs. While practitioners were subject to the standards set by the Medical Board of Australia, several recent cases had raised concerns about the regulation of the facilities in which procedures were performed.

“NSW Health is considering whether further legislation of the cosmetic industry is required,” she said.

Currently, cosmetic surgery facilities only need to be licensed under the Private Health Facilities Act if patients are administered general, epidural or major regional anaesthetic or sedation, resulting in more than conscious sedation.

The discussion paper, which is open for consultation until 29 January, looks at whether there should be a new class of cosmetic surgery required to be licensed and, if so, how that class would be defined and what standards should apply.

ACI investing in future leaders

More than 450 frontline health workers from a range of NSW metropolitan, rural and state-wide health services have now graduated from the Agency for Clinical Innovation (ACI) Centre for Healthcare Redesign, aimed at improving healthcare delivery.

Thirty-four graduates from 10 Local Health Districts and Speciality Health Networks were awarded a diploma of project management by NSW Health Minister Jillian Skinner at a ceremony in Sydney in December, after showcasing the results of their projects to fellow school graduates, senior sponsors, redesign leaders and NSW Health staff.

The program provides professional development opportunities for clinical and non-clinical staff leading priority projects in patient care improvement or innovation. ACI Chief Executive Dr Nigel Lyons said the program builds skills and confidence and will help improve the way healthcare is delivered.

"Increasing the capability of healthcare staff to partner and lead local healthcare innovation, service redesign and improvement in their own workplaces, benefits patients right across NSW,” he said.

Read our profile on HARC scholar and ACI Healthcare Redesign course manager Estelle Marque.


Audio recordings of consults a useful patient aid

Conducting an audio recording of outpatient consultations, which patients can listen to later at home, can be a useful information aid, a new study shows.

In the study, 2784 Danish patients attending outpatient clinics in paediatrics, orthopaedics, internal medicine and urology had their consultations with doctors recorded. 

One in five adult patients and 18% of parents said they replayed the consults due to difficulties remembering or understanding information from the consultation.  
Many patients replayed recordings

The recordings were made using digital audio recording technology via a wireless telephone, and patients were able to replay them later using any telephone, by entering a social security number and PIN code.

Of the 2784 recorded consultations, 31% were replayed by the patient, a relative or a combination of the two within 90 days of the consultation. A further 19 recordings were replayed later, the study found.

One in three recordings from the adult outpatient clinics and one in five paediatric recordings were replayed later.

Findings in the International Journal for Quality in Health Care showed that the majority of patients had no difficulty in replaying their consultation.

One in five adult patients and 18% of parents said they replayed the consults due to difficulties remembering or understanding information from the consultation. A further 15% of adult patients and 30% of parents replayed the consultation in order to share it with relatives.

While the authors suggested further research was needed on the feasibility of offering audio recordings in paediatric clinics, they said the technology was worth considering in time-pressured adult clinics.

“DAR [Digital Audio Recordings] could become a resource in outpatient clinics, where there is limited time for interaction with the health professional and increasing pressure for patients to become active participants,” they wrote.

Wolderslund M, Kofoed P-E, Holst R, Ammentorp J. Patients’ use of digital audio recordings in four different outpatient clinics. International Journal for Quality in Health Care. 2015;27(6):465‒71


Patients told about ED wait times are more satisfied

Patient are more satisfied with their care in emergency departments (EDs) if they are told at triage how long they are likely to wait for a bed, a study suggests.

The US study involved 1209 adult patients attending the ED: 322 were told at triage how long they were likely to wait for an ED bed, and 887 were not given any estimate of waiting time. All filled out a patient satisfaction questionnaire on discharge.

The expected wait time was estimated using a model based on time of day, day of the week and triage levels.

“The main goal of the intervention was to improve communications of delays and managing the patients’ perceptions of wait time without affecting clinical care and/or reducing operational inefficiencies,” they wrote.

The communication of delays didn’t result in improved patient satisfaction for the “satisfied with wait time in triage” and “informed about delays” questions on the patient satisfaction survey, the study found. However, it was associated with the overall rating of the ED visit question.

Patients who received no communication about delays were between 1.42 and 5.48 times more likely to rate the three satisfaction questions lower than “very good”, according to findings in the Patient Experience Journal.

Nearly 15% more patients who were told about delays rated satisfaction questions as “very good” than those who didn’t receive wait time information. They were also less likely to give a “very poor/poor” satisfaction rating than patients given no information about delays.

“This indicates that patients are more likely to accept longer wait times provided their expectations are managed via communications,” the authors wrote.

They called for further research into more effective ways to manage patient expectations and into compliance with such initiatives through staff training, incentives, standardisation of processes and technological developments.

Shah s, Patel A, Rumoro DP, Hohmann S, Fullam F. Managing patient expectations at emergency department triage. Patient Experience Journal. 2015;2(2):31‒44


Push for better tools to measure patient experience

Research is needed about new ways to measure patient experience that can capture real-time data and feed it back to frontline clinicians, according to the authors of a review of tools used to measure patients’ hospital experiences.

Health professionals worldwide were broadening their focus to include the experiences of patients and their families as a means of assessing the quality of patient-centred care, the Australian researchers said.

They conducted a literature review to identify instruments specifically designed to measure inpatient hospital experiences, which identified 17 studies and 13 relevant instruments, including the Australian-developed Patient Evaluation of Emotional Care during Hospitalisation (PEECH) survey.

All the instruments they identified were survey-based and provided predominantly quantitative data. Five of the surveys were designed to collect information during the patient’s hospital stay, but most were completed by patients after they were discharged.

Writing in the Patient Experience Journal, the researchers said the literature search found no validated instruments that were designed to capture qualitative data.

However, they suggested that developing more detailed surveys was not the solution to obtaining richer data.

“While surveys tend to have positive response rates, length of survey can actually be a deterrent to complete thereby impacting response and value of information,” they wrote.

Rather, they suggested patients needed to be involved in the development of a survey that could collect data while the patient was still in hospital, with a corresponding feedback process to healthcare staff.

“Ideally such an instrument could be designed using a participatory research methodology, whereby patients, friends, family and healthcare clinicians are equal co-developers,” they wrote.

Edwards KJ, Walker K, Duff, J. Instruments to measure the inpatient hospital experience: a literature review. Patient Experience Journal. 2015;2(2):77‒85


Printed handover notes outdated in just three hours, study shows

The common hospital practice of using printed patient handover documents has been thrown into question by a study that shows the information on such documents becomes inaccurate and outdated very quickly.

The US study analysed a sample of 100 adult patient records over a single 24-hour period at an academic medical centre to determine the ‘half-life’ of the printed handoff documents – or the time at which half the patients would be expected to have inaccurate information on such a document.

They looked at changes in the patient orders on such documents such as those related to medication, diet, code status and patient location.

The half-life of the printed document on the 12-hour night shift was just six hours, they found.

“A typical resident getting sign-out on 20 patients overnight could safely assume that the data for 10 of them would be inaccurate or outdated within six hours, and that it would be inaccurate on another two by the morning,” the authors wrote in BMJ Quality and Safety.

On the day shift, inaccuracies accumulated even more quickly, with the half-life of documents found to be just 3.3 hours.

They said 92% of patients had at least one change on their orders within a 24-hour period, with most changes related to medication.

The authors suggested that minimising printing of documents would drive providers to look at information updated in real time, such as medication lists on electronic health records (EHR).

“Easy access to and usage of online handoff reports contained in EHR present a potential solution to this problem,” they concluded.

Rosenbluth G, Jacolbia R, Milev D, Auerbach AD. Half-life of a printed handoff document. BMJ Qual Saf 2015 [Internet] doi:10.1136/bmjqs-2015-004585


Patients’ experiences of adverse events overlooked, review finds

Few studies comprehensively report on patients’ experiences of adverse events, despite an increasing policy focus on enhancing patient engagement in healthcare, a study shows.

The Australian-led review of 33 studies found that patients had a different view of adverse events (AEs) to health professionals, yet data on their experiences was not routinely captured and utilised to develop effective system-wide policies to minimise adverse events.

The frequency of adverse events reported by patients varied widely, but the most common events identified by patients were medication errors and communication breakdowns, the review found.  
Patients can recognise things that go wrong

Patients reported a large number and type of adverse events, according to the study, which the authors said demonstrated that patients were able to recognise things that went wrong in their care.

However, it found patients often defined adverse events more broadly than health professionals’ definition of such events. For example, in one study, nearly half of patient-identified adverse events were described by health professionals as “misunderstandings” and a further 19% were described as “miscommunications” rather than mistakes.

“The studies highlight that an AE from a patient’s perspective is a chain of problems in care, connecting problematic care before an event, the event itself (clinically defined) and ‘care’ (or lack of satisfactory care) in response to the event,” the authors wrote in the International Journal for Quality in Health Care.

The frequency of adverse events reported by patients varied widely, but the most common events identified by patients were medication errors and communication breakdowns, the review found.

The authors said patient involvement was now a core component of health service policy internationally, and the findings suggested patient reporting of adverse safety events could add value to the quality of data that was captured.

“The information from patients is critical to identifying incidents and ultimately to reducing patient harm, but they are not routinely asked to provide these data,” the authors wrote.

Harrison R, Walton M, Manias E, Smith-Merry E, Kelly P, et al. The missing evidence: a systematic review of patients’ experiences of adverse events in healthcare. International Journal for Quality in Health Care 2015 [Internet] doi:


Warning over adverse events linked to off-label prescribing

Researchers have urged caution in prescribing drugs for off-label use, after finding that the practice is associated with a high rate of adverse events, especially when there is a lack of strong scientific evidence to support the off-label use of drugs.

The researchers used electronic health records to analyse adverse drug events (ADEs) in a cohort of 46,000 patients prescribed medications through primary care clinics in Quebec, Canada.

Off-label use ‒ when a drug is prescribed for an indication, a route of administration, or a patient group that is not included in the approved product information document for that drug ‒ was reported in 11.8% (17,847) of the scripts. In four out of five of those cases, the off-label use lacked strong scientific evidence.

Findings in JAMA Internal Medicine showed that physicians discontinued 3484 drug treatments due to adverse drug events, most of which occurred in the first year of treatment.

The overall incidence rate of ADEs was 13.2 per 10,000 person-months, but adverse events were 44% higher for off-label prescribing, compared with on-label prescribing, after adjusting for patient and drug characteristics.

There were 19.7 ADEs per 10,000 person-months for off-label prescribing, compared with 12.5 for on-label prescribing and the rate of adverse events related to off-label scripts for drugs without strong scientific evidence was higher than if the drugs’ usage was evidence-based.

The authors estimated that the mean cost per adverse drug event ranged from $US759 to $1214.

They said doctors and medical organisations should “recognise the enormity of the problem”, and suggested future electronic health records should be designed to enable post-marketing surveillance of treatment indications and outcomes, to help monitor the safety of both on- and off-label uses of drugs.

Eguale T, Buckeridge DL, Verma A, Winslade NE, Benedetti A, et al. Association of off-label drug use and adverse drug events in an adult population. JAMA Intern Med 2015 [Internet] doi:10.1001/jamainternmed.2015.6058


Review reveals high rates of depression among junior doctors

More than one in four physicians-in-training experiences depression or depressive symptoms, according to a review which calls for further research into strategies to prevent mental illness in junior doctors.

The systematic review and meta-analysis of 54 studies involving 17,560 physicians-in-training showed that between 20.9% and 43.2% of trainees screened positive for depression or depressive symptoms during residency, depending on the instrument used to measure symptoms.

The overall pooled prevalence of depression or depressive symptoms was 28.8%, according to findings in JAMA.

“Because the development of depression has been linked to a higher risk of future depressive episodes and greater long-term morbidity, these findings may affect the long-term health of resident doctors,” the authors wrote.

They added that depression among residents may also affect patients, with previous research having established associations between physician depression and lower-quality care.

The study found an increase in depressive symptoms among residents over time, and secondary analysis of seven longitudinal studies showed depressive symptoms increased by an average of 15.8% after the start of residency, suggesting that the causes of depression were linked to the residency experience.

The authors said the findings highlighted an “important issue in graduate medical education” and called for further research into effective strategies to prevent and treat depression in medical graduates.

Mata DA, Ramos MA, Bansal N, Khan R, Guille C, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373‒83


Shared patient-physician financial incentives most effective

Offering both patients and doctors financial incentives is an effective strategy to reduce patient cholesterol levels, but paying incentives to either patients or physicians alone has little effect, according to a new study.

The US study involved 340 primary care physicians and 1503 patients at increased risk of cardiovascular disease who were divided into four groups: control group, physician incentives, patient incentives or shared physician-patient incentive.

Those in the physician incentive group were eligible to receive up to $1024 per patient who met LDL-cholesterol goals through use of statin medication, while patients in the patient incentive group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. The doctors and patients in the shared incentive group shared the incentives, while the control group received no incentives tied to outcomes.

After 12 months, only patients in the shared physician-patient incentives group achieved reductions in LDL-C levels that were statistically different from those in the control group, according to findings in JAMA.

Almost half of those in the shared patient and physician incentive group (49%) achieved the cholesterol goal, compared with between 36% and 40% in the other three groups.

“The lack of improvement in LDL-C levels, despite potential physician incentives of up to $1024 per patient, offers the first controlled evidence that adding these incentives to a fee-for-service payment model may not improve medication-related intermediate outcomes,” the authors wrote.

They also highlighted that the use of daily lotteries for patients’ medication adherence had only had a modest effect on cholesterol levels, and that medication adherence remained low in all groups.

Asch DA, Troxel AB, Stewart WF, Sequist TD, Jones JB, et al. Effect of financial incentives to physicians, patients or both on lipid levels. JAMA. 2015;314(18):1926‒34


Engaging clinicians in research has broad benefits: review

Getting clinicians involved in medical research can contribute to improved healthcare performance, according to a review of studies which lends support to a growing number of research networks across healthcare organisations.

The review included 33 papers, with the majority (28 studies) showing positive associations between clinicians’ or organisations’ involvement in research and healthcare performance.

It is reasonable to suggest that when clinicians and healthcare organisations engage in research there is the likelihood of improvement in their healthcare performance, even when that has not been the aim of the research.  
Improvements in processes and outcomes

Improvements were largely in processes of care, but some improved health outcomes were reported.

For example, one study showed that patients treated for unstable angina in US hospitals participating in clinical trials had significantly lower mortality than those treated in non-participating hospitals. Two US studies of patients treated for breast cancer at facilities that were members of cancer research networks found that they were more likely to receive guideline-concordant treatment or be given innovative treatments than those in hospitals that were not network members.

“It is reasonable to suggest that when clinicians and healthcare organisations engage in research there is the likelihood of improvement in their healthcare performance, even when that has not been the aim of the research,” the authors wrote in BMJ Open.

The authors said the findings came as the number of research networks was growing and the contribution of collaborative approaches to research was developing.

They urged further research into the impact of research engagement on healthcare outcomes, “particularly given the pressure to justify research spending in healthcare systems and to encourage its implementation”.

Meanwhile, a separate study published in JAMA in which researchers reviewed the literature on educating physicians to deliver high-value, cost-conscious care outlined three key factors: 

• Knowledge transmission ‒ for example, teaching trainees how to judge medical value and gain insight into patients’ personal values
• Reflective practice, such as providing feedback or asking reflective questions regarding aspects such as prescribing to give trainees insight into their past and current behaviour
• Creation of a supportive environment with a culture of high-value, cost-conscious care.

Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open. 2015;5:e009415 doi:10.1136/bmjopen-2015-009415

Stammen LA, Stalmeijer RE, Paternotte E, Oudkerk Pool A, Driessen EW, et al. Training physicians to provide high-value, cost-conscious care: a systematic review. JAMA. 2015;314(22):2384‒400


Good news on golden staph

Both the number of cases and the rates of Staphylococcus aureus bacteraemia, or golden staph, have fallen in Australian public hospitals over the past four years, new data shows.

A report by the Australian Institute of Health and Welfare shows that between 2010‒11 and 2014‒15, the number of cases of the infection reported in public hospitals decreased by 21%, and the national rate of infections fell from 1.10 cases to 0.77 cases per 10,000 days of patient care. All states and territories recorded rates below the national benchmark of 2.0 cases per 10,000 days of patient care, with rates ranging from 0.66 per 10,000 days of patient care in the Northern Territory, to 0.84 in the ACT.

Download report

Reducing avoidable presentations to emergency

This report details the outcomes of an Australian Primary Health Care Research Institute project that aimed to identify strategies to reduce avoidable GP-type presentations by older patients to hospital EDs, through appropriate redirection to primary and community health services.

The study found that 15% of ED visits by older people in the inner east Melbourne region were avoidable GP-type presentations. Researchers conducted a rapid review, patient interviews and stakeholder workshops and outline key areas for intervention, including increasing patients’ access to primary care services during and after working hours and increasing awareness of alternatives to the ED.

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Models of care for complex patients

This “issue brief” from the US-based Commonwealth Fund analyses expert reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. The authors report that successful models have several common attributes including: targeting patients likely to benefit from the intervention; comprehensively assessing patients’ risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care and facilitating transitions from the hospital and referrals to community resources.

However, it finds the evidence of impact of such models is modest and few have been widely adopted in practice because of barriers, such as a lack of supportive financial incentives.

Download report

Demand on ED increasing in NSW: report

Emergency departments at NSW public hospitals faced an increase in demand over the winter months, with an average of 1600 more patients seeking care each week compared with the same time the previous year, the Bureau of Health Information Hospital Quarterly report for July to September 2015 shows.

The average time patients spent in the ED was two hours and 52 minutes ‒ three minutes longer than the same quarter in 2014. There were nearly 475,000 hospital admissions during the quarter, the highest number ever reported by BHI, while elective surgeries decreased by 3% on the same time the previous year.

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Spending on pharmaceuticals slows

This Australian Institute of Health and Welfare report on the nation’s health expenditure 2013‒14 shows that spending on pharmaceuticals has slowed over the past three years, despite a steady increase in the number of prescriptions dispensed. In 2013‒14, $58.8 billion was spent on hospitals, $54.7 billion on primary care and $32 billion on other goods and services (including prescriptions). A further $9.1 billion was spent on capital expenditure.

The amount the Australian Government spent per person on health averaged $2725, which was $653 more in real terms than in 2003‒04, and a $30 increase in real terms on the previous year.

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NSW ED performance improves, but ambulance response time worsens

This report from the NSW Auditor-General shows that NSW Health, on average, met emergency department triage response time targets across all categories in 2014‒15. However, it failed to achieve its target of 81% of patients being admitted, transferred or discharged within four hours of presenting at the ED.

The report states that average ambulance response time for potentially life-threatening cases was 11.2 minutes, the highest level in five years. And it states that health entities are not effectively managing employee annual leave balances, with more than one-third of the workforce having excessive leave balances.

Download report

Estelle Marque  

Estelle Marque

2015 HARC Scholar 
Centre for Healthcare Redesign course manager
Agency for Clinical Innovation (ACI)

Designs on improved patient care

HARC scholar Estelle Marque is confident that adopting a new way of thinking can help solve challenges in healthcare delivery, and ultimately ensure better outcomes for patients, carers and staff.

Originally from France, Estelle studied business and management and worked as a management consultant in healthcare before moving to Australia six years ago.

She joined the Redesigning Hospital Care program in Victoria, working at the Wimmera Health Care Group, and in 2012 moved to Sydney and took up the role with ACI’s Centre for Healthcare Redesign.

Since 2007, the Centre has been offering a state-wide Diploma Program which gives NSW health staff the opportunity to build their skills and knowledge so they can successfully implement projects aimed at improving the delivery of healthcare services (see news story).

“Major redesign projects have also been undertaken at state level and have significantly reduced the length of hospital stay, mortality, morbidity and waiting lists for surgery,” she says.

A real-world approach

Health workers learn the redesign methodology to understand how people and processes work and what impact that has in the real world, for example, in a hospital ward or the emergency department, she says. The staff use a range of tools and techniques to rethink the processes by which they carry out tasks, often leading to systemic, innovative change.

“It helps people to really understand complex systems and to have richer input into the design of future services,” she says.

"My job is very satisfying. We support 36 projects a year through the diploma program and see how they deliver better outcomes for patients.”

Estelle says the redesign methodology used by ACI aligns closely with design thinking  ‒ an approach used not only in healthcare but across a wide range of areas. She describes the approach as a human-centred innovation methodology for solving problems and discovering new opportunities.

As part of her HARC scholarship, she spent a month late last year visiting design thinking experts worldwide including Stanford University and the Mayo Clinic in the US, the Design Council in the UK, several centres specialising in design thinking in Denmark, France and Luxembourg.

Over the month-long trip, she gleaned new knowledge about ways of training people in design thinking and how to apply it to different projects.

A hospital by design

She says a highlight of the trip was visiting a team in Denmark building a new hospital using a design-thinking approach. The method has led the team to focus on healing architecture.

The circulation areas are conceived as hybrid spaces to foster a multidisciplinary approach, patients are all accommodated in single rooms and all departments have views outdoors to green space, she says. The design of the hospital is flexible, which will allow changes to respond to evolving population needs.

Estelle returned to Australia with a host of learnings that she hopes will help ACI to further develop its redesign programs.

“I think we can refine our methodology and add more tools or be more flexible in using different tools,” she says. “We can become even more human-centred.”

Youth health forum

This forum, hosted by the Office of Kids and Families and held at Sydney Children’s Hospital Network, Westmead, is themed “Positive psychology and young people”. Program and registration will be available one month prior to the forum and there will be a video conferencing facility.

9 March 2016 Sydney, NSW
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World Indigenous cancer conference 2016
12−14 April 2016 Brisbane, QLD
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Cancer is the second leading cause of death among Indigenous Australians. WICC 2016, hosted by Menzies School of Health Research and held in partnership with the International Agency for Research on Cancer (IARC) has the theme ‘Connecting, communicating and collaborating across the globe”. It will provide opportunities to foster new collaboration, enhance capacity, and share knowledge and information about cancer and Indigenous people internationally.

2016 Patient experience symposium

The 2016 Patient Experience Symposium is designed to showcase expertise and excellence in improving patient experience across NSW Health. The two-day event is expected to attract up to 500 delegates, and will include a presentation by international speaker Leslee Thompson, President and CEO of Kingston General Hospital (KGH) in Canada, who led the organisation through a major transformation to become an award-winning academic health centre.

5−6 May 2016 Sydney, NSW
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CNSA 19th Annual Congress
12‒14 May 2016 Cairns, QLD
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The Cancer Nurses Society Australia 19th Annual Congress is themed Bridging the Gap ‒ distance, culture, workforce & knowledge. Guest speaker will be Professor Margaret Barton-Burke, president of the Oncology Nursing Society from Memorial Sloan Kettering Cancer Center, New York. She will share the latest scientific knowledge from her research and clinical practice.

2016 ADEA NSW branch conference

The 2016 Australian Diabetes Educators Association NSW branch conference, ‘Diabetes: the Pandora’s box – connecting expertise and clinical practice’, will be held at the Parkroyal Parramatta.

4 June 2016 Sydney, NSW
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