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‘Rapid actions’: SA Health focus on hospitals shakeup

EXCLUSIVE: Paramedics will be “empowered” to treat patients at home rather than transport them to hospital and a new cabinet committee will be formed to tackle ramping, under a SA Health proposal which already has some workers planning industrial action.

May 01, 2023, updated May 01, 2023
SA Health CEO Dr Robyn Lawrence. Photo: Supplied. Image: Jayde Vandborg/InDaily

SA Health CEO Dr Robyn Lawrence. Photo: Supplied. Image: Jayde Vandborg/InDaily

Documents obtained by InDaily reveal SA Health is planning to implement 27 “rapid actions” to improve patient flow through the public hospital system.

It comes as the department plans to launch a new initiative called “Focus Week” from May 15 to 21, with the model based on a similar program in the United Kingdom called “Perfect Week”.

In an email to SA Health staff on Friday and seen by InDaily, chief executive Dr Robyn Lawrence wrote that Focus Week would help the department figure out how to improve the state’s emergency care system.

“Focus Week will see the Local Health Networks (LHNs), SA Ambulance Service and the Department for Health and Wellbeing work together to make sure our patients get the right care, in the right place, at the right time, 100 per cent of the time,” Lawrence wrote.

“The shared aim is to look at what processes work well, which can be improved and how we can reduce delays.

“Understanding this will help improve the patient experience, safety and staff morale.”

A document marked “official” lists 27 other actions which SA Health is considering implementing – some of which will occur during Focus Week.

One action is titled “Treat no Transport”, with the listed objective being “to strengthen and empower paramedics to treat not transport, if possible”.

Another action is titled “New ramping governance structure”, with the document proposing “the establishment of a sub-committee of Heath Cabinet Committee” comprising Lawrence, Health Minister Chris Picton, the board chairs of the central, northern and southern local health networks and SA Ambulance Service chief executive Rob Elliott.

According to the document, the new governance structure would be “based on (the) success of the WA model”.

Other proposed actions include:

  • Commissioning “interstate expertise” to conduct independent reviews of each emergency department
  • Having senior SA Ambulance Service staff stationed at emergency departments between 11am and 10.30pm every day to manage ambulance ramps
  • Setting a target for 30 per cent of discharges to be complete by 10am and 50 per cent of discharges to be complete by 12 noon
  • Exploring an “incentive structure” within the SA Ambulance Service
  • Ensuring the SA Ambulance Service promotes private emergency department attendance where possible
  • Establishing general medicine teams within the Royal Adelaide Hospital and Flinders Medical Centre emergency departments “based on (the) Gold Coast Model”

The Health Services Union (HSU), which represents allied health staff, criticised the plan, with the union’s SA branch secretary Billy Elrick telling InDaily his members were planning industrial action to coincide with Focus Week.

Elrick said the industrial action would likely include bans on participating in the week and on working overtime – except when it is required for duty of care – as well as displaying HSU campaign material and talking to patients about attraction and retention issues in the allied health workforce.

“The allied health professionals most impacted by the ‘perfect week’ are radiographers, sonographers, occupational therapists, psychologists, social workers, and cardiac physiologists,” he said.

“SA Health is asking an already overstretched allied health workforce to work additional hours and overtime to improve services for their ‘perfect week’.

“This reeks of ivory tower management. It’s worrying to think the same management is responsible for improving ramping and bed block.”

Elrick added that allied health workers were some of the lowest-paid health professionals in Australia, with employees already leaving SA Health “in droves”.

Ambulance Employees Association (AEA) secretary Leah Watkins said she was “reserving judgement” on the Focus Week plan, but welcomed government moves to address ambulance ramping.

“I’m a bit on the fence,” she said.

“If there are initiatives, I don’t know why they are not looking to implement them now outside of a Focus Week.

“However, it is a positive that the government is looking to shake things up a bit.”

Watkins said the AEA met with SA Health last week to get clarity on the “Treat no Treatment” proposal.

She said ambulance officers already treated some patients at home if it was clinically appropriate, with SA Health now proposing to “redesign” the policy so that it was clearer when and how patients should be diverted away from hospital emergency departments if it is safe to do so.

Lawrence told InDaily this morning that it was “no secret” that the state’s health system experienced a “tough March”, with patients spending a record 3968 hours – the equivalent of 165 days or more than five months – waiting in ambulances ramped outside hospitals due to a shortage of emergency department beds.

She said SA Health was introducing Focus Week in May to figure out how improvements could be made ahead of an expected peak in hospital demand over winter.

“It’s a week where essentially you focus on what is going on around patient flow in your hospital system; from front door to back door, are we doing everything in accordance with our plans and processes for every patient 100 per cent of the time so we’re moving them through the system?” she said.

“There’s no desire for staff to work additional hours as a result of or for Focus Week.

“In fact, that’s not sustainable. That’s not a model we want to see going forward and it wouldn’t help us if we said to everybody: ‘You’ve got to work 10 extra hours this week to make this happen’.

“I can’t say staff won’t work overtime during that week because there could be a whole range of things apart from Focus Week which could cause that – sick leave as an example.

“But, it’s not a requirement or an expectation in any way related to Focus Week.”

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Picton said SA Health was running a Focus Week this year to “help give our clinicians the bandwidth to ensure our system can run as well as possible to meet the needs of our patients”.

“What generally has happened over the past five years is the system gets stressed and then meetings get cancelled at the last minute to deal with the pressure, whereas this is an attempt from SA Health to get ahead of the pressure and allow for system improvements to happen proactively, most of which have been raised by clinicians themselves,” he said.

Meanwhile, Lawrence said a sub-committee of the Health Cabinet Committee had already been established to focus on addressing ambulance ramping.

She said she was not “at liberty to say what goes on” in that sub-committee, as it sat under the Health Cabinet Committee.

“That’s a model which the Minister considered appropriate after some discussions with colleagues in other jurisdictions,” she said.

“The actual governance around the ambulance ramping taskforce remains in place – as I said it now forms part of my executive committee.

“Cabinet has a range of committees and we’ve been reporting to some of them about ramping for as long as I’ve got on in South Australia and this is really to create dedicated time that brings myself and the board chairs together to that meeting on a regular basis.”

Picton said the government had discussions with the Western Australian Government about ramping improvements they had recently achieved.

“One thing they told us that has been useful is a regular meeting they have with the Health Minister, Chairs of Boards and other key people in the system to focus on the issue which has made a difference so we will trial that as an extension of Health Cabinet Committee (which we have had since the election),” he said.

“However, to be frank, it won’t be because of another meeting that will make the difference – it is ground-up solutions listening to our clinicians and by building the additional capacity that our clinicians need.”

New beds, ambulance triage space set to form part of winter demand plan

It comes as SA Health finalises a separate strategy to cope with an expected surge of hospital patients over winter.

A copy of a “Draft Winter Demand and Resilience Plan 2023” SA Health PowerPoint presentation, obtained by InDaily, outlines a number of proposed strategies to increase hospital capacity.

Those strategies include:

  • Appointing a clinical lead to provide advice on projects to improve ambulance ramping
  • Investing in public messaging to reduce the transmission of COVID-19 and other respiratory illnesses
  • Increasing the use of the Child and Adolescent Virtual Care Service
  • Implementing a “fully-staffed dedicated” ambulance triage space in the Lyell McEwin Hospital emergency department
  • Identifying “appropriate spaces” that could be repurposed to deliver additional bed capacity

The draft document also stated new beds had been opened at Flinders Medical Centre in March.

Picton said the winter demand strategy would be released by the end of this week.

“I want to thank our dedicated health workers for their continued hard work to deliver the best care for our community,” he said.

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