Healthcare Week 2017

Western Sydney Local Health District was in the spotlight at Healthcare Week 2017 (8-9 March), with our redevelopment projects on show.

The event program included presentations by Danny O’Connor, chief executive of Western Sydney Local Health District (WSLHD) and Peter Rophail, director of operational design at Blacktown and Mount Druitt hospitals.

 

The event was an opportunity for Danny and Peter to discuss WSLHD redevelopments with members of the healthcare and government sector.

Their presentations demonstrated the significant work undertaken by WSLHD, particularly in relation to consumer and community partnerships and engagement and significant transformation of patient-centred care and experience through digital technologies.

Danny O’Connor highlighted the importance of our digital capability as our hospitals grow.

“In western Sydney, we must ensure that our digital health capability matches our world-class physical capital renewal, and recognise that the experience of healthcare in the decade 2020-2030 will be very, very different to the experience of healthcare today,” he said.

The conference was attended by more than 4000 members of the healthcare industry.

Attendees included hospital managers and executives, clinicians, GPs, government and administrative staff, architects, hospital construction companies and suppliers of healthcare goods and services.

The Westmead Redevelopment team also ran a booth at the annual Healthcare Week conference at the new International Convention Centre in Sydney.

 

Find out more about the conference at: www.austhealthweek.com.au.

Audio of Danny O’Connor’s presentation can be downloaded here: https://drive.google.com/open?id=0B1lr-YvDLqAtXzlYa0hYOVNxM0E.

 

You can also view Danny’s speech notes below.

Healthcare Week presentation – By Danny O’Connor, WSLHD chief executive

When Westmead Hospital opened in 1978 there was no internet, no electronic medical record, no smart phones or other mobile devices. But there was air conditioning!!!!!

Digital technology has already transformed human life and society and there is increasing evidence it is changing the way our brains work.

Digital technology is also transforming healthcare – but with some way to go

So what do we want from a transforming experience of healthcare. I’ll make some suggestions, none of which are novel

1. A consumer who is health literate – that is they have a very good understanding of the health products and services relevant to their needs and wants
2. High quality information for consumers about health products and services including performance metrics
3. A health services system which maximises consumer choice
4. An optimal healthcare experience irrespective of place
5. A single patient view with each person’s medical history, available to anyone relevant to their healthcare
6. A healthcare system where consumption is linked to best value for money and optimal outcomes

These characteristics of a transforming experience of healthcare are foundational to three themes shaping our thinking about the Westmead redevelopment and other changes underway in my organisation

1. consumer centric health service design
2. Information technology changing healthcare
3. Hospitals that are wholly connected to a health services system

It’s an irony that Australia has one of the best performing healthcare systems in the world, in terms of health outcomes and costs, and yet so much of the experience of healthcare is inconvenient, disjointed, slow and confusing. It’s hard to know which doctor to see, or which hospital to go to get the best care, or even appropriate and safe care

It is not original thinking to suggest that one factor central to achieving a positive transformation of healthcare is a significantly better informed consumer

The Competition Policy Review by Ian Harper and others made some interesting comments about healthcare.  One of the things they said was – for many people, the word “consumer” sounds out of place in a discussion of healthcare. And indeed some of the woes of our health system arise precisely from our effort to keep commerce away from medicine. We thought we were protecting the autonomy of doctors and the privacy of patients, but in effect we have created a system that too often rewards waste and failure – I would add, and in some cases supports appalling self-interest.

Harper goes on – We need to turn this around and create a healthcare market that rewards success and penalizes failure, where no one benefits unless the patient benefits. The Harper panel recommended that user choice, informed by good information, should be a significant influence on service delivery transformation. It said ‘initiatives that allow consumers to effectively use their own information…have the potential to assist consumers to make better choices and drive competition’

This agenda to transform the experience and delivery of healthcare is gathering momentum.

The Commonwealth Productivity Commission late last year released its report into Sectors for Reform, titled Introducing Competition and Informed User Choice into Human Services. The Commission identified six priority services, three are directly related to the business of Western Sydney Health District and the Westmead redevelopment. These services are

1. public hospitals
2. palliative care services
3. public dental services

With respect to public hospitals the Productivity Commission notes that public patients are often given little or no choice about who treats them,  and where. And yet overseas experience indicates that when hospital patients have access to information to compare doctors and hospitals, user choice can lead to improved service quality and costs.  I would add, this too applies to the primary care sector

Around the world there is agreement that healthcare is at least a decade behind many other industries in achieving significant improvements in performance and consumer experience associated with the use of advanced information technology.

Furthermore the Nuffield Trust of the English National Health Service just last year made the observation that “high-profile failures in the implementation of information technology have actually increased the burden on frontline staff and failed to deliver cost reductions”.

Eerily very relevant across Australia. In the past 5 years or so most of the states of Australia have had a least one spectactular, and very costly, failure at ICT health planning and implementation. I have made it my business and that of my team to visit them all and attempt to learn all we can to avoid similar failure.

The Nuffield Trust suggests there are seven great benefits of advanced information technology in healthcare. These are

1. Better clinical care – by clinical information systems helping with  complex decision making
2. More targeted care, through the use real-time patient monitoring and powerful analytics
3. Reducing or eliminating fragmention of care by integrating clinical information
4. Improving access to specialist expertise, for example through telehealth
5. Greater patient involvement in their own healthcare through the use of self-management tools
6. Improved efficiency and productivity via the use of advanced information tools for things like staff rosters and patient flow, matching capacity to demand and so on
7. System improvement and learning through analytics, improvement science, a learning culture

A recent survey found that the average adult spends almost 2 hours a day online on a smartphone. 33% of these people said their smartphone was their preferred search device. But in England only 2% of those surveyed participated in any digital transaction with the NHS – because there was so little useful functionality.

This figure is estimated to be much lower in Australia.

However a further survey of 7,000 patients found that

• 60% would monitor their chronic condition using a mobile app
• 80% would like to view their medical record online
• 90% would use an online GP appointment booking service
• 90% would use a service allowing them to ask a clinician a question

And guess what – most of this functionality exists at Kaiser Permanente, which primarily operates in California – curiously with a patient population similar in size to the population of NSW.

The patient is at its centre of the care experience, surrounded by patientfacing technologies that provide them with opportunities to manage their health and engage with health care providers. These include wearable devices,apps, online clinical consultation and patient portals.

At Kaiser value for money works hand in hand with optimizing clinical outcomes.

Technology enablers of patient centric care include:

• Patient portals and applications that allow them to book appointments, pay bills, access their medical record (or parts thereof), access tailored educational material, provide feedback,  and participate in virtual care consultations.
• Wearables and remote patient monitoring technologies that mean that more care can be delivered at home
• Precision medicine and algorithmic decision support that allows personalized medicine

In NSW we are making progress, but with some way to go.

For example in renal dialysis in western sydney, a digital App provides real-time treatment data for patients and clinicians without the patient leaving home.

Home haemodialysis is a preferred treatment for end stage renal failure because it enables patients to perform their own treatments at home.

With this App, nurses can treat patients in multiple locations without traversing great distances. The App, with clinical support, provies a better experience for the patient, a higher standard of care and at lower costs

Most healthcare is experienced by most people most of the time outside of hospitals – through general practice, community pharmacy; a broad range of community allied health; etc etc. A lot of complicated care occurs in hospitals but to get the maximum clinical and cost benefits out of this care it is critical that this healthcare is fully connected with care received from elsewhere and that all contributors to care know what each other is doing.

Global technology research company Gartner comments on the fundamental changes occurring in the experience of healthcare – so much of which is being driven by digital technology – and this in turn is changing the nature of the relationship between provider and consumer.

For example they estimate that by 2025, 25% of all health care in the US and 15% of all health care in Australia will be delivered virtually.

Excellent examples of connecting hospitals to the rest of the health service system exist including the Integrated Care Project in NSW, of which western Sydney is proud to be a participant and the Commonwealth Health Care Home project, which we are also participating in. But some of the key learnings from projects such as these are the lack of a plan and capability for scale to truly unite the healthsystem. This in no small way is linked to the failure to align policy and investment at the federal and state levels to do so.

The Challenge and Opportunity In Western Sydney

Western Sydney Health District currently has the largest public health capital development program underway in NSW

The NSW government has committed about $2 billion to

• Stage 1 of the redevelopment of the Westmead Precinct
• expansion of Blacktown and Mount Druitt Hospitals
• a new health service at Rouse Hill
• and stage one development of Comberland Hospital

More recently the NSW government has announced a major redevelopment of Nepean Hospital. We must ensure the planning of this redevelopment is linked to the other developments occurring in the west of Sydney in the public and private health sectors.

The society of Western Sydney is changing and the population is growing rapidly. We have over 2.2 million residents now, rising by another one million in the coming decade.

The hospitals at Blacktown and Mt Druitt need expansion in order to respond to rising demand from a rapidly increasing population.

Westmead Hospital and The Childrens Hospital at Westmead also require expansion for the same reason but they also need to work much more closely together for two big reasons

1. because many of the illnesses and diseases that childrens hospitals once treated mostly on their own and with general practice are now also adult diseases due to wonderful advances in medical science.
2. And many of the costly tools to deliver care can be shared, for example diagnistics, pathology, operating theatres and the like

Since 2011 we and our partners have been delivering our capital program part by part.

Over this time, and especially in the past several years we have applied significantly greater sophistication to designing the Digital solutions required to optimize the way our hospitals work, how they connect with other healthcare such as general practice and how they enable the consumer to play a bigger role in their healthcare. This is a broad change management program with consumers in the middle of the design processes

One small but smart example of consumer centric planning is the implementation of the Q-Flow patient check-in system at Blacktown Hospital. Patients can now check in for their outpatient clinics with one swipe of their identity card and the system will then send an SMS alert when it’s time for their appointment. This has ended waiting in waiting rooms and a reduction in the built space of waiting rooms in the hospital.

Another example of consumer enabled healthcare has been the introduction of the TEXT ME program. Literature and consumer experience tells us that a simple SMS can be lifesaving in the fight to prevent heart attacks. The TEXT ME program reminds heart attack survivors about taking their medication, how they can stick to a healthy lifestyle and the importance of getting regular medical check-ups.  People receiving the texts were nearly 1.4 times as likely to exercise, 44 per cent more likely to control their blood pressure and 33 per cent more likely to quit smoking.

Interestingly, an unanticipated result of TEXT ME is that messages have encouraged better medications compliance with other medications in some of the same consumers

Our digital solutions are entirely consistent with the international agenda of transforming healthcare which will see increased democratisation and personalisation of healthcare. Consumer expectations and optimal value for money require an advanced digital information environment. The  Digital Hospital Investment Plan of WSLHD identifies what our change program, with digitial technology at the centre, can achieve in  transforming the experience of healthcare in western Sydney. This includes

1. Activating a Comprehensive electronic health record enabling the delivery of integrated care within the hospital and between the hospital and others such as GPs, public and private hositals.
2. Improving the health literacy of consumers so they can be much more involved in improving services and products
3. Improving the availability of timely and high quality performance data – again with the purpose of driving improvement and also to better support consumer choice
4. Improving business intelligence and data analytics to support clinical decision making, business operations and performance management

science into our business to extract value out of big data lakes to inform medical science and care delivery and also social and commercial levers to improve public health. Our university partners are key this and so too many other public and commercial organisations

The goals of our Digital Hospital Investment Plan are in line with the ICT plans of NSW eHealth, and the National eHealth Program under the stewardship of the Australian Digital Health Agency (ADHA).

But we need to work harder and faster on stronger alignment in the planning and implementation programs between commonwealth and state agencies. This includes harmonizing at least a 5 to 10 year shared funding investment pipeline.

Unifying plans and investment between government agencies and non government organisations such Primary Health Networks will lead to more partnerships with other big commercial businesses who are already big players in the digital health transformation space inlcluding, tertiary education, private health organisations, telecommunications and data technology companies.

The trick here is to recognise that the consumer will not wait for us to get better organized. The tranbsformation is already taking place. Digital health technology, enabled by players other than government agencies will continue to change consumer expectations.

In western Sydney we must ensure that our digital health capability matches our world class physical capital renewal and recognize that the experience of healthcare in the decade 2020-2030 will be very very different to the expeience of healthcare today.