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Improvements Achieved through Priority Initiatives

The initiatives described below are selection of the actions undertaken across Hunter New England Health District during the 2022-2023 financial year. The projects represent different clinical areas and functions of the health service, including health promotion, improving efficiency in emergency mental health triage, complex care coordination for children, supporting our clinicians, and ensuring our services are delivered in a culturally safe manner.

Mental Health First Responder (MHFR) Program

Mental Health First Responder (MHFR) Program

The Mental Health First Responder (MHFR) program partners with emergency services to provide care to people where there is some uncertainty about the urgency of care required. The program uses iPads to connect emergency services with specialized mental health triage services. The recommendations provided by the triage service may include:

*           Transportation to hospital for assessment

*           Follow up with community mental health

*           Support via General Practitioner or other community-based supports

People referred through MHFR are connected to appropriate community mental health support. This reduces unnecessary transport and emergency department visits. The program has been very successful with 85% of people referred being able to safely remain in their own homes. This has led to better patient experience by keeping patients at home where possible. It has also decreased the pressure on Police, Ambulance and Emergency Department resources.

Clinicians have provided early access, reassurance, and guidance. This has played a vital role in helping consumers understand how to seek further mental health assistance. The program has also reduced travel time and resource use for emergency services.

Positive feedback from the clinicians reinforces the effectiveness of MHFR for e.g.:

“As this was the first time I had used the system, I was not sure how long I would have to wait to speak with the clinician, in the end it gave the patient early access to a clinician who ended up providing both additional information to the patient but also reassured the patient. Will definitely utilise the resource in the future” – NSW Ambulance

“Patient was having mental health issues but was not in contact with a mental health professional. The call with the First Responder helped the patient understand how to get help with his mental health” – NSW Police

MHFR's success has prompted its expansion across rural and regional areas in HNELHD. This will provide broader access to mental health triage for people in contact with emergency services. By using technology, targeted training, and collaboration with consumers, MHFR has demonstrated its potential to positively change mental health care delivery and provide better support to those in need. To date, MHFR offers access to triage for 53 Police stations and 38 Ambulance stations using 144 MHFR iPads.

HNEkids Compass Project: Connecting and Coordinating Care for Children with Medical Complexity

HNEkids Compass Project: Connecting and Coordinating Care for Children with Medical Complexity

Children with complex and chronic health needs make up only 1% of the paediatric population, but account for more than 30% of health service costs. These children are known as Children with Medical Complexity (CMC). CMC may have numerous chronic health problems affecting different organ systems.  As a result, CMC need frequent access to many health services and care from a diverse team of professionals. Parents/Carers of CMC often experience the overwhelming task of navigating multiple healthcare teams and services to coordinate care for their children. These families experience significant interruptions to school, work, and family life, with families from rural areas facing additional challenges associated with significant travel distances and costs.

“Most days I am in total fear of what to do and who to contact. I don’t know who to trust or who will help me. The healthcare system seems so complicated, and I feel completely incompetent” - parent of CMC

The HNEkids Compass project aims to improve care coordination for CMC and their families. The project is funded by the Ministry of Health Paediatric Priority Fund until June 2024. To achieve this aim, the project team undertook a co-design approach. This meant that over 150 families and staff attended and contributed at workshops held across the district. A further 31 interviews and over 100 informal consultations were undertaken to better understand the experiences and needs of both families and staff.

As a result, the HNEkids Complex Care Coordination Service was developed and a Paediatric Complex Care Coordinator has now been permanently funded by the district (not just until June 2024), based on consumer and staff feedback and identified need. The HNEkids Complex Care Coordination Service began accepting referrals in June 2023.

The HNEkids Complex Care Coordination Service incorporates the following: 

  • An intensive dose of care coordination delivered over 6 months, supported by the dedicated Paediatric Complex Care Coordinator.
  • A HNE staff network that connects existing paediatric roles across subspecialty teams, outpatient clinics, and locations across the district. Once the families’ goals are met and they no longer require intensive care coordination, an identified member of the network becomes the main point of contact for the family.
  • A family-centred approach to enhance care. This includes:
  • Conducting routine screening for unmet family psychosocial needs
  • Providing suitable support and making referrals as needed
  • Identifying goals
  • Providing coaching

Over the 12-month pilot period (June 2023-May 2024), the HNEkids Compass project team will actively monitor and improve the model of care to make sure it works well and can be sustained. The experiences of CMC, their families, and the staff involved in the service will play a crucial role in determining the most effective way to integrate this work into regular practice.

Crossing the Border: Collaborating to close the gap

Crossing the border: Collaborating to close the gap.

Boggabilla Community Health Centre (BCHC) is in a small community with a large Indigenous population.  BCHC has partnered with Goondiwindi Medical Centre (GMC) to improve access to healthcare by collaborating across borders and offering a shared care service that is provided in a culturally safe manner.

Several initiatives have emerged from the collaboration based on gaps, improving patient care:

  1. Annual school visits for children's health checks.
  2. Yearly 715 health check that helps identify whether someone is at risk of illnesses or chronic conditions.
  3. General Practitioner (GP) clinic operating two days a week.
  4. Collaboration with mental health services and specialists.
  5. Breast screening bus.
  6. Cardiopulmonary Resuscitation (CPR) education days.
  7. Podiatry and audiology visits.

Engagement from the community has increased since the introduction of the clinic, resulting in more presentations.  There were 6,740 face-to-face individual appointments in 2018 and 14,426 in 2022. This represents a 114% increase in productivity for individual appointments alone. This does not include the increase in telehealth, case conferencing, or telephone consultations. This has also led to fewer hospital admissions and less reported visits to town from local ambulance services.

Transport issues have also been reduced as healthcare is now provided within walking distance of patients' homes and other service delivery modes have been utilised to reduce the need for travel (e.g., telehealth services).

The clinic offers flexible appointments (drop-in services) as well as wound dressings, immunization, mental health, pathology collection, specialist care, and GP care. Staff members are also available to assist patients in navigating their care. This includes providing support for patients receiving treatment away from the community.

The collaboration between BCHC and GMC has improved healthcare access in the community. It has resulted in reduced ambulance transfers and hospital admissions, increased engagement and interaction from the community, improved communication between healthcare providers, and enhanced productivity of the clinic. The services offered and the commitment to closing the gap have made the clinic a vital part of the community.

Hospital HealthPathways - Supporting our clinicians

Hospital HealthPathways – Supporting our clinicians.

HNE Hospital HealthPathways (HHP) are online clinical pathways that aim to provide quick, easy access to best practice clinical guidance and support for HNELHD clinicians.  They include referral information, discharge criteria and patient support services. The original target audience included junior medical officers (JMO) as well as our transient workforce (e.g., locums) to support wellbeing, however they are now used by all clinicians. HNELHD was the first HHP site outside of Canterbury New Zealand to implement the program.

The first phase of the project was to implement and localise HHPs at John Hunter and John Hunter Children’s Hospitals. This was followed by development of an innovative multi-facility version of HHP, a Service Directory (linking local referral processes to the patient journey) and LHD wide implementation. HHPs were embedded as part of the Policy Procedure Guideline Framework and supported by a Clinical Editor (CE).

The HHP team has worked collaboratively with clinicians and managers from across the LHD to develop HHPs.  The team also partners with the Primary Health Network (PHN) to align both Community HealthPathways (CHP) and HHP’s (as appropriate) and with an external vendor.  The approach used has supported efficiency, innovation, and continuity of care throughout the health system.

To date 96 HHPs and 148 referral pages have been developed.  Usage and engagement data shows that HHPs have received 252,825 page views in the last 2 years, which have increased more than 50% in the last financial year. The top HHPs viewed map to common diagnosis and procedures in HNELHD, showing they are meeting clinical need.

Outcomes from JMO surveys carried out in 2023 indicated that 60% of them would be very/extremely likely to use HHPs daily.  Feedback from clinicians show that they value HHPs:

Reduces stress and workload when on after-hours by providing senior advice at my fingertips. The layout is succinct and mirrors the assessment framework…’ -JMO

‘…Most helpful, especially the link to arrange referrals as it makes it much easier to figure out how to do it in different hospitals!’-RMO.

The team have learned that strong engagement with clinicians and managers; the role of the CE and collaboration with community partners is essential.  A well embedded governance and approval process also supported credibility and engagement.

HNE Leading the way for Nurse Practitioners

HNE leading the way for Nurse Practitioners

The development of the Emergency Nurse Practitioner (ENP) workforce aims to improve healthcare access and outcomes and address recommendations from the Rural and Regional Health Inquiry. These recommendations are outlined in the health outcomes and access to health and hospital services in rural, regional, and remote New South Wales report (2022).

Nurse Practitioners play a crucial role in improving access to treatment and safe care.  They are often respected senior clinical decision-makers, providing high-quality, safe, and effective care.  Nurse Practitioners have shown their capability to manage care across various health systems. They provide culturally safe and patient-focused care as primary providers or within care teams.

The project investigated the possibility of implementing Rural Nurse Practitioners across many sites. Models of care were created to support the implementation of Nurse Practitioner roles. Hospital sites were audited to assess the financial and patient safety benefits of introducing Rural Nurse Practitioners.

Nurse Practitioner working with a Junior Medical Officer

Nurse Practitioners are respected clinical decision-makers, providing quality, safe, and effective care.

The success of the ENP services at existing facilities has led to their replication at eight more hospitals. The Emergency Nurse Practitioners collaborate with various multidisciplinary teams, including local general practitioners, Aboriginal Medical Services, allied health, and virtual medical services.

The project's success has been supported by the Nurse Practitioner Development Facilitator. The Facilitator provides mentorship, guidance, and research translation. This enables the Nurse Practitioner to utilise their full scope of practice. These senior clinical decision-makers have become a valuable resource, complementing healthcare services, and contributing to enhanced patient care.

The project's impact is measured through various indicators. These include:

  • the Australasian Triage Scale (ATS) category
  • waiting times
  • Emergency Treatment Performance (ETP)
  • length of stay
  • patient outcomes
  • patient satisfaction.

As a result of the program the Emergency Nurse Practitioner workforce has grown from 8 in 2022 to 34 in 2023. This represents a remarkable 325% growth in 12 months. HNE has reinforced its leading role within NSW for growing and developing NP’s, having established over 100 NP roles in 2023.

The Nurse Practitioner enhancement has improved healthcare access and experiences for rural areas. Nurse Practitioners have emerged as competent and accountable caregivers, making a substantial positive impact on patient care and outcomes. The integration into healthcare services has been well-received by the community. Continued growth is anticipated and will contribute to sustainable, high-quality care for our communities.

Curing Homesickness for Chronic Respiratory Kids

Curing Homesickness for Chronic Respiratory Kids

Chronic respiratory conditions, like Cystic Fibrosis, require long hospital stays for treatments and exacerbations. This impacts the child's well-being and places strain on their families. Parents often must take time off work and children are separated from their families and friends. To address these challenges, a project was launched at John Hunter Children's Hospital. The aim was to develop a new model of care that empowers families to take control of their child's health and manage their care needs at home.

The model involved home visits and virtual care appointments by a multidisciplinary team to support families at home. Medical staff also conducted virtual appointments to support the family. Families received education and training on administering intravenous antibiotics. This upskilling occurred before transitioning to home care. The model also supported Physiotherapy involvement by telehealth and home visiting while the patient was on home-based treatment.

During the pilot phase, the model demonstrated significant success. It reduced the hospital length of stay for children with chronic respiratory conditions from 2 weeks to one. This not only saved the hospital days of admission for each patient but also freed up available single rooms for other inpatients. Parents and caregivers did not need to take as much time off work, and children could be in their home environment and resume their school activities earlier.

Feedback was positive, with parents appreciating the reduced time away from their families. There was also the added convenience of the child receiving care at home. Health staff initially expressed concerns about safety risks associated with administering IV antibiotics at home, but families were willing to upskill and receive support from the team during home care.

The program highlights the positive effects of shared decision-making and empowering families to manage their child's health at home. It not only reduced hospital stays but also improved the overall quality of life for children and their families. With 2 in 3 children returning to school while receiving treatment. The model also demonstrated the potential to optimise the patient experience and use of hospital resources.

Improving the Patient Experience

Achieving the District’s vision of healthy people now and in the future can only be accomplished in partnership with the people we serve – patients, clients, their families, carers and our wider communities. Consumer representatives are valued members of committees, project teams and advisory groups at many different levels of the organisation.

The District Partnering with Consumers Committee is responsible for implementing tools and resources that support consumer engagement. These include Patient-Reported Experience and Outcome Measures (PREMs and PROMs), and the Health Literacy Ambassador Program.

Deaf Community Consultation and Improvement

Deaf Community Consultation and Improvement

The Deaf community faces significant challenges when accessing healthcare, leading to fear and frustration.

Deaf patients faced difficulties across all healthcare services, including Emergency, Inpatient, Outpatient, Community, and Dental services. These challenges spanned all age groups from birth to end of life.

HNELHD recognises the importance of listening to these concerns. HNELHD has engaged with the Deaf community to understand their unique needs.

The Multicultural and Refugee Health Service first engaged with the Deaf communities. The engagement sessions adopted a different approach, conducting them in Auslan to create a Deaf-friendly environment. These sessions were led collaboratively by Chief Executive Officer from Deaf Australia. The sessions enabled the health service to identify changes that could lead to positive outcomes for the Deaf community. Many of these outcomes were long-standing requests, indicating the urgent need for change.

The engagement sessions emphasised stories from Deaf patients. Many highlighted the urgent need for a focus on improving their experiences within the healthcare system. Deaf Patient Experience videos were created to share these first-hand stories. The purpose is to raise awareness among HNE Health staff about the challenges faced by Deaf patients.

One of the most significant changes made was to provide Deaf patients with access to a personal Auslan Interpreter, empowering them to choose their preferred interpreter whenever possible. A comprehensive list of all Auslan interpreters working within HNE Health has been compiled. All Auslan interpreters have their qualifications and headshots visible on our intranet page. This way, Deaf patients can have an informed experience when interacting with healthcare providers.

Implementation is focussed on a whole of service basis as opposed to a single facility or unit. Resources developed provide valuable learning for HNE staff improve care to Deaf patients.

Additional resources include:

  • Creating a Deaf accessible Internet page
  • Delivering Deaf led training days and partnering sessions
  • Partnering and building strong relationships with local Deaf community and Deaf service providers.

Our mission is to lead the way in delivering responsive and inclusive care for Deaf patients. By promoting awareness, empowering patients, and fostering a Deaf-friendly environment, we are striving to enhance healthcare access, outcomes, and consumer satisfaction.

Building Beautiful Memories - NICU Palliative Care

Building Beautiful Memories – NICU Palliative Care

Despite improvements in neonatal medicine, aggressive medical interventions may not be the best option for some babies. In these instances, families are counselled and offered the option of an end-of-life care pathway for their baby. End of life care focuses on keeping the baby comfortable in the last days of life, while supporting the parents in taking care of their baby and creating lifelong memories as a family.

The John Hunter Children's Hospital Neonatal Intensive Care Unit (NICU) Palliative Care Room was designed to create a home-like, private, and culturally sensitive space for families to build positive and lasting memories with their baby before and after death. The design process involved collaboration with clinicians from both the NICU and the Paediatric Palliative Care Service along with input from Aboriginal community representatives, ensuring cultural sensitivity.

To reflect the needs and experiences of families, the room features warm earthy colour tones and textures in furnishings and bedding. Three beautifully framed images of local landscapes, connected to Aboriginal song lines were included following feedback from Aboriginal community representatives. Additionally, a unique artwork titled "Maria Yapung Spirit Journey" symbolises the spirit journey of little ones into the arms of Biami, providing a sense of belonging and uniqueness to the room entry.

The project has led to systemic change within the NICU, with consistent use of the Palliative Care Room by all families with a baby who is dying or who has died in NICU. The design also incorporates environmental sustainability with LED lighting and 5-star rated electrical appliances.

Improved patient outcomes include empowering families to direct the end-of-life process over a timeframe of their choice. The room allows for the delivery of intensive care services while enabling families to transition to a period of memory-making and family togetherness without discontinuing life-sustaining treatment. Families have expressed profound appreciation for the opportunity to cuddle and bond with their baby, creating meaningful memories during a difficult time.

The Palliative Care Room is a culturally sensitive space for the 20% of families attending the NICU who identify as Aboriginal. Aboriginal community feedback played a crucial role in the design, fostering a process of connection, grieving, and healing for families experiencing perinatal and neonatal death.

The purposeful design of the NICU Palliative Care Room at John Hunter Children's Hospital has brought significant improvements to patient outcomes and emotional wellbeing for families facing difficult circumstances. The culturally sensitive approach ensures that families can create cherished memories and receive support during a challenging time in a home-like and welcoming environment.

A Workplace Culture that Drives Safe and Quality Care

The Clinical Excellence Commission (CEC) Applied Safety & Quality Program commenced within HNELHD in 2022. The program provides staff with a framework to develop their capability to lead and engage others in local safety and quality improvements. The program was trialled with a cohort of 8 participants who were recruited to be the future teaching faculty for the program. They were given the responsibility of participating, evaluating, and facilitating the content whilst completing a quality improvement project of their own. The material and content for the program were incomplete and still in development by the CEC. Despite these obstacles HNE were the first in the state to successfully graduate a class which was acknowledged by the CE of the CEC, Adjunct Professor Michael C. Nicholl, a true testament, and recognition of the value of this first cohort.

2023 delivered 19 new participants to the HNELHD Applied Safety and Quality Program across the district from rural, regional, and metropolitan areas. They are employed in differing disciplines and services and are currently working through a more localised and improved program based on evaluation. They are successfully engaged in supporting a very practical application of improvement and patient safety sciences utilising well learnt and practiced facilitation skills underpinned by reflective practices to embed individual development and change.   Feedback from the last workshop reiterated this, “The learning environment allowed for a great impact to truly absorb the content. I have a much fuller knowledge base around Safety and Quality at the point of care” and “This is work that’s applicable to my area and can be utilised to further my effectiveness and productivity”.

Recruitment for the 2024 program will occur from October to November.

The Organisational Development and Learning unit support many of the District's educational and career development requirements.

Learn as you Earn AIN Project

Learn as you Earn AIN project

Learn as you earn Assistant In Nursing (AIN) project partners with TAFE and universities to provide undergraduate medical students with a work-integrated learning model. This allows them to develop essential skills for their future careers in healthcare. The model focuses on promoting and supporting interdisciplinary understanding and collaboration while growing and supporting a skilled workforce to meet the growing needs of healthcare.

The opportunity to adapt this program arose during the COVID surge. This, coupled with evidence from overseas about the benefits of integrating medical students into health systems, created a perfect chance to implement the existing program.

To make this program a reality, TAFE mapped the undergraduate medical program to identify the capabilities medical students could undertake as paid AIN employees. Recognition of Prior Learning (RPL) was used to recognise relevant skills. Further training was provided by TAFE and HNELHD to enhance communication skills and teamwork.

This program targets 2nd-year undergraduate medical students. It offers them a pathway to RPL as a Certificate III in Health Services Assistants (AIN Acute). Students are required to attend three TAFE-led workshops and complete 80 hours of work-integrated learning in HNELHD. After successful completion, participants can work in HNELHD as AINs.

The program received an overwhelming response, with over 39 medical students from the Newcastle area applying to take part. The program's success has resulted in plans for an annual cohort, commencing every December following Year 1. This timing allows workshops and work-integrated learning to be completed before Year 2 and provides support during the Christmas period.

Upon engagement and review of the program, HNELHD's university partner confirmed that this initiative is the first of its kind in Australia. The program's approach to recognising shared skills and knowledge highlights the significance of investing in people. Building a strong workforce capable of delivering quality care with a patient-centered approach.

The success of this program and the interest it generated has paved the way for its expansion. Starting from December 2023, the program will include UNE, TAFE New England, and rural facilities within HNELHD. TAFE NSW's formalisation of the program makes it scalable to all LHDs across NSW and their respective university partners.

Mentoring in Midwifery Program

Mentoring in Midwifery Program

The Mentoring in Midwifery (MiM) Program, developed by The Nursing and Midwifery Office (NaMO) in collaboration with Professor Belinda Dewar and Dr Edel Roddy from Scotland, is a workforce initiative designed to attract and retain midwives. It aims to create a relationship that fosters connection, learning, and growth for midwives and midwifery students.

The program is based on three frameworks: Appreciative Inquiry, Caring Conversations, and Senses Framework. These frameworks promote positive learning cultures, human connection, and continuous learning from day-to-day experiences.

The MiM program consists of three key elements:

  1. MiM Facilitator Development & Support: Workshops and reflective sessions to support MiM Facilitators in their role.
  2. Workshops with Midwife Mentors: Seven workshops over 12 months aligned with the five phases of the Midwifery Mentoring Model.
  3. Mentoring Conversations: Structured conversations focusing on relationship-building and reciprocal learning, also aligned with the five phases of the Midwifery Mentoring Model.

The five phases of the Mentoring Model guide mentor-mentee conversations, with Appreciative Inquiry and Caring Conversations integrated throughout. Creative tools and resources are used to encourage curiosity, deepen inquiry, explore values, and acknowledge emotions.

The MiM Program's evidence base centres on relationship-centred practice to promote learning in the workplace. It aimed to improve the experiences of student midwives and co-create ways to enhance their learning experiences collaboratively.

HNELHD was a part of the pilot program in 2022. Initially 2 facilitators were assigned to support the rollout within the district. During this time multiple mentors were able to be trained in each facility within 10 months.

Since the pilot, 2 additional MiM facilitators have joined the team. This has helped spread mentorship to 57 mentors who support more than 40 mentees. The future of the program lies in the hands of the mentees, with mentees becoming mentors upon successful completion of the program. This ensures that the program and culture continue to grow.