With an ageing population and rising rates of chronic disease, there is increasing pressure on our health system. However, the Victorian Government is tackling this problem head on, through innovative programs designed to build capability and sustained improvement across the state.
In July 2017, Better Care Victoria (BCV) integrated with the administrative office Safer Care Victoria (SCV) in order to provide a greater opportunity to broaden the scope of BCV, and drive further integration of improvement across Victoria.
Through a range of funded initiatives, BCV is supporting and investing in sector-led improvement and innovation projects, partnerships and capability development programs aimed at improving access to, and the quality of, healthcare across Victoria.
The Improvement and Innovation Program
One of BCV’s key initiatives is their Improvement and Innovation Program—previously known as the Redesigning Hospital Care Program (RHCP)—which focuses on both organisational-level and state-wide improvement priorities. Funding is provided to health services to engage a full-time Improvement and Innovation Advisor, a valuable resource to both their home organisations and state-wide initiatives to lead local and system-level improvement.
Natalie Bemrose, Manager of Improvement at Safer Care Victoria, says the program is designed to leverage collective expertise to drive improvements across the health system as a whole.
“Our participating health services have an opportunity to broaden the work that they are already doing to improve healthcare delivery and access,” she says. “This program allows us to really take it to the next level and concentrate efforts on a coordinated approach to system wide improvement and innovation.”
“We have a diverse range of skills and experience, and in bringing these Advisors together we can benefit from their collective expertise. As a group we are stronger, wiser and smarter than the individual and we aim to build a psychologically safe space – where people can come together, to share success and failure, to grow, build relationships and feel supported.”
A collaborative contribution
The program focuses on building a community of practice between health services, in order to scale and embed successful improvement and innovation initiatives, across individual health services and the state health system. As part of the program, participating health services have the opportunity to be involved in continuous professional development and networking events.
Simon Castles—Improvement Facilitator and part of the Improvement team at Peter MacCallum Cancer Centre—says it’s been great to have central support from the Victorian Government, and the opportunity to work with others who are experiencing similar challenges.
“It’s obvious that health services are all tackling the same problems, such as access, patient flow and being able to provide quality health care,” he says. “However, by developing partnerships and collaborating with other services, we’re in a better position to learn about what does and doesn’t work, in terms of improvement strategies.”
Jessica Amy, Redesign Project Officer at Albury Wodonga Health agrees that the networking opportunities have been extremely valuable.
“We have been in close contact with Northeast Health Wangaratta (NHW) for a number of years, due to proximity and have benefited from sharing ideas, site visits, and providing mutual support. But the program provided by BCV has given us many more opportunities to seek out best practice at other health services in our state,” she says.
Tapping into industry expertise
Those participating in the program also have access to mentoring activities, including BCV industry coaches—improvement science specialists, who work with and support health services.
Clinton Cummins, Executive Director Performance Improvement at St Vincent’s Hospital, says the coaches have proven to be an extremely beneficial addition in supporting positive change.
“They all have a fantastic knowledge of what’s required for continuous improvement, so they’re able to help health services head in the right direction. What has been most valuable is they have avoided taking a prescriptive approach, and instead, facilitated the problem-solving process,” he says.
“When we ask the right questions, we find the real problems that need solving. Industry coaches have brought ‘outside thinking’ into our hospital, which has given us the confidence to push ahead with our projects, knowing that we’re on the right track.”
A culture of information-sharing
Simon Craig, System Improvement Specialist and Industry Coach at BCV says that in order to embed continual, sustainable improvements throughout the health system, all health services need to work together to develop a culture of contributing to the state.
“One of the key barriers to state-wide improvements and innovation is that successful improvements are often not scaled to other health services, and information is not always shared with peers,” he says. “There will always be pockets of sharing based on personal relationships, but with BCV’s Improvement and Innovation Program, there is a more structured and coordinated effort to facilitate this sharing of information across the state.”
By focusing on system-level improvements, the Improvement and Innovation Program aims to strengthen the capability of the Victorian health system. It does this by building organisational systems and structures, workforce skills and knowledge, along with culture and behaviours to align with best practice in continuous improvement and innovation.
Already, the program has seen significant benefits for hospitals and health services.
Albury Wodonga Health has seen improvements in efficiency in their food services team and through their perioperative stock reconfiguration program. They have also improved access for patients accessing their midwifery care program.
Similarly, St Vincent’s has seen significant improvements in access to their emergency departments and other medical areas, while over at Peter MacCallum Cancer Centre, the program has raised the profile of improvement and innovation across the hospital.
Ongoing improvements and staff engagement
Bemrose says a great way to measure improvement capability is the Organisational Strategy for Improvement Matrix (OSIM).
"This has been developed to enable health services to assess and monitor their capability to instigate, drive and sustain improvements. Improvement never stops. It’s continuous. There’s always something that we can do better," she says. "This tool is such a valuable way for health services to identify their hotspots they could benefit from focussing on."
Equipping hospitals to identify their own gaps, and come up with strategies to fill them is key in getting staff to work together and be committed to improving their practices.
Amy explains: “I have the opportunity to bring together clinical and non-clinical areas, and help break down the barriers that can get in the way of developing creative solutions to problems. This often provides staff with new challenges and can improve their job satisfaction.”
With state-wide health services aiming to provide high quality patient care, amidst increased demand for services, there are many challenges ahead. And while each health service will have its unique set of challenges, central for all of them is being able to provide high-quality care to every patient every time.
While that’s a big challenge for all health services, Castles believes that developing a culture of continuous improvement will continue to drive more effective and sustainable improvements and innovations.
“Improvement capability needs to be embedded in every staff member in the organisation—whether they are kitchen or admin staff, clinical staff, or heads of departments. When you know it’s your role to keep improving, it’s not good enough to keep doing the same thing, every day,” he says.