REFORMS AFFECTING CORPORATE

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ACHSE PRESENTATION 1 December 2006

• REFORMS AFFECTING CORPORATE FINANCE
• An Area Health
• Service Perspective

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Australian Health Context

• Health is Australias biggest industry - 9 GDP.
  
• The success of Medicare

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WHO is responsible for WHAT?

• Federal Government?
• State Government?
• Private providers?
• Health Insurance?
• Medicare?

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Economics of Health

• new high cost drugs,
• new expensive technologies and
• an increased supply driven market

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Future

• We should expect an entirely different looking
  system.
• current systems and delivery models will be
  unsustainable

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Planning Better Health Reforms - 2004

• resulted in the abolition of HS Boards,
• the amalgamation of AHS and
• the creation of new corporate service entities of
  Health Support and Health Technology.

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IPART Recommendations

• 67 create Health Shared Services Corporation
  (i.e Health Support).
• 73 create Increased Uniformity of IT and
  Management (ie SIM/HT)

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Principles of Shared Services

• role clarification
• more efficient and effective delivery of
  corporate and system support services. recognised
  the lack of clear responsibility and
  accountability in the system
• appropriate plans and performance KPIs are
  developed for those entities and that these are
  effectively integrated with overall HS priorities

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Other IPART Recommendations

• the need for wider national structural reform
  both in C/W and State funding
• future demand for health care services would be
  driven by demographics, morbidity and the
  existing culture in the health system and in
  society

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Other IPART Recommendations

• recognised the lack of clear responsibility and
  accountability in the system
• service delivery reform.

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Proven Model for SWAHS

• Western Sydney Area Health Service experience of
  its Clinical Stream model.
• A critical requirement for the successful
  development of a Clinical stream structure is
  leadership

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CARE First
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CARE First

• Aims and Objectives
• Provide accessible and appropriate clinical
  services
• Design safe, effective and innovative models of
  care
• Invest in services that are value for money
• Advocate a culturally appropriate model of
  service and community participation
• Promote a culture of knowledge through teaching
  and research
• Develop a highly skilled workforce

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CAREFirst

• clinical leadership
• hospitals as gateways to quality care
• appropriateness of service models
• appropriate roles for each of our facilities

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SWAHS Approach

• ORT (Organizational Reform Taskforce)
• These were documented into a proposed plan (ORT
  plan) for each major clinical and corporate
  service within the new AHS and were presented to
  the Administrator and an executive group

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SWAHS Reform

• extensive consultation between key stakeholders
  in the planning process
• fast-track the new organizations progress and
• mitigate change risk.

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Communications Strategies

• inform and educate staff about the new
  arrangements associated with the
  amalgamation/restructure from pre-transition,
  transition and post implementation

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ORT - SPORT

• SPORT- Service Performance and Organizational
  reform Taskforce.

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Outcomes of ORTs

• The ORT plans served to
• clearer accountabilities
• role delineation
• Reduce the duplication of effort and double
  handling of issues and
• Promote Cost efficiency in the management and
  provision of services
• Develop the foundation stone for the extension of
  clinical streaming structure to the new
  organization through re-defined Clinical Networks

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Clinical Networks Responsibilities

• Applying the SWAHS Care First vision, the primary
  responsibilities of each Clinical Network were
  defined to
• Plan and implement the Network component of the
  SWAHS Clinical Service Plan (CSP).
• Plan the strategic application of the Areas
  capital and recurrent allocation to assist in the
  achievement of the SWAHS CSP which incorporates
  key National, State and SWAHS priorities.

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Clinical Networks Responsibilities(contd)

• Manage services across the continuum and
  effectively network these services and
  facilities and
• Maintain and improve on the Areas sound record
  in financial performance
• Performance measurement and reporting
• Focus on achievement and improvement

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Clinical Clusters

• There are four Clinical Clusters which each
  encompass several networks as follows
• Western (St Marys Portland)
• Central (Blacktown/Mt Druitt/Hawkesbury)
• Eastern (Westmead Auburn)
• Integrated (Primary Community Health)

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Clusters their networks

• Western (Nepean Lithgow)
• Surgery
• Cancer Services
• Womens Adolescent and Childrens Health

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Clusters their networks

• Central (Blacktown Hawkesbury)
• Aged Chronic Continuing care
• Allied Health
• Acute Intervention Medicine
• Research

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Clusters their networks

• Eastern (Auburn Westmead)
• Cardiac Services
• Access Patient Logistics (incorp Emergency and
  Critical care)
• Oral Health

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Clusters their networks

• Integrated
• Primary Community Health
• Mental Health
• Drug and Alcohol

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.
Clusters their networks

• Imaging and Pathology
• Clinical Networks but operate as Business Units
  in a Clinical Support and Technology Cluster.
• Education is a network headed by a Clinical
  Director within Workforce

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SWAHS
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Directorate of Clinical Governance

• Coordinates Clinical Risk management/quality
  activities
• Includes Patient Safety Officers Client Liaison
  Officers
• operates the Areas Governance Support Unit.

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Directorate of Nursing and Midwifery Services

• Responsible for professional and workforce issues
  affecting Nurses
• Disaster Planning and coordination
• specified supra Area clinically related services
• ADON works closely with the DCO in relation to
  service facilitation

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Directorate of Corporate Financial Services

• Corporate and Finance-related functions
• Delivers services through Cluster Managers of
  Corporate Services (Food and Hotel services etc)
  and/or centrally managed in-house or
  contract-managed services for Finance, Risk
  management, Asset management, IT and clinical
  support services e.g. Imaging and Pathology
  business units Biomedical etc.

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Directorate of Workforce and Organizational
Development

• Area-wide services Medical Administration, HR,
  Industrial, Staff Development, Web-Multi media
  and Public affairs and the SPORT unit.

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Directorate of Service Development and Population
Heath

• Service, capital, corporate and strategic
  planning.
• Population health, Health promotion, public
  health
• Interagency liaison,
• Area Wide information management
• Performance Management Unit that incorporates
  performance reporting and business information

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Funding

• SWAHS CSP and priorities for capital and
  recurrent investment (incl access to growth
  funds) have been framed according to this.
• Episode funding principles.

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KPIs

• Dashboard Approach for KPIs SAP almost real
  time
• Regular (monthly) reports on its budget
  performance
• Periodic reports on overall benchmark
  performance.
• Clinical Costing engine Urgently needed.

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Conclusion

• Appropriate quality service provision continuum
  across the Area Health Service
• Realignment /redesign of business processes to
  support health care delivery

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Bernard Deady Executive Director, Corporate
Financial Services Sydney West Area Health Service