1. Local Health Network Consumer and Health Advisory Councils Transforming Health Consumer Engagement Forum Northern Adelaide Local Health Network - Lessons learnt to date & what’s ahead for 2017
Adj. Associate Professor Vanessa Owen
Executive Director
•Nursing & Midwifery
•Clinical Governance Service
•Outpatient Departments

2. NALHN Self Sufficiency
Population growth in Adelaide’s Northern catchment and the anticipated related increase in service needs has led to the refocus of the LMH to become the major adult tertiary hospital for the north.
People who are currently treated within their Local Health Network:
CALHN – 88%
SALHN – 87%
NALHN – 54%.
Goal is to increase NALHN’s self sufficiency across the majority of services
Transferring services from CALHN to NALHN is intended to assist LHM to increase its capability to meet the needs of its local population and help patients living in the North and North-East to receive their care closer to home.
Following discussions with senior clinicians, a number of services were identified for potential transfer from CALHN to NALHN as part of the reconfiguration of services outlined in Transforming Health.
The transfer will also enable the Lyell McEwin Hospital to develop into the major adult tertiary hospital for the north as planned, supported by Modbury Hospital as a centre for elective surgery, rehabilitation and sub-acute services.

3. Intra NALHN Service Move
Significant work has taken place across NALHN to unlock existing capacity within the hospitals by improving the effectiveness and efficiency of care provided.
On 15 March, 2016, the Northern Adelaide Local Health Network (NALHN) carried out the first of its service moves by relocating medical and cardiology inpatient and orthopaedic emergency and multi-day activity from Modbury Hospital to the LMH.
On 3 May, 2016, the second phase of the service moves occurred with the remainder of emergency and multi-day surgical activity transferred from Modbury Hospital to Lyell McEwin Hospital.
On 31 May, 2016, the third and final phase of the service moves occurred which saw the consolidation of the 4 remaining Critical Care beds, and associated activity from Ward 1 West at Modbury Hospital to Intensive Care at LMH.
LMH will continue to undertake complex multiday and emergency surgery and ensure comprehensive, quality care is delivered to north and north eastern residents.

4. Intra NALHN Service Move
MODBURY
Other initiatives aimed at delivering more care to more people closer to their homes are progressively being implemented and include:
The new purpose built rehabilitation centre at Modbury Hospital which will include a hydrotherapy pool, gym and therapy spaces.
Ward areas being redeveloped
The expanded one stop breast service commenced on Friday 29 April, 2016 and continues to grow.
Gastroenterology outpatients expanded at Modbury Hospital from July 2016.

5. Modbury Hospital
Construction of the Rehabilitation Centre at Modbury Hospital is taking shape. The centre's roof and roof plan have been installed, along with electrical and pool solar panels. Pool tiling was completed in early September and the has now been filled
Work on the southern link way, which connects the rehabilitation building to the main hospital is well underway.
In September patients were moved from 3West in to the refurbished 3East, to allow the full refurbishment of 3West to begin.
The new rehabilitation centre includes a gym, hydrotherapy pool, making it easier for people in the north and north eastern suburbs to access retaliations close to home.
New Link way under construction
Eastern Entry of New Rehabilitation Building
Therapy Garden under construction

6. Modbury to LMH Activity Movements
Modbury Hospital
Lyell McEwin Hospital
Ward 3 East beds
(General Medicine)
Ward 1B beds
Ward 2 East -24 beds
(General medical Multi-Day Surgery)
Ward 2B, 2E and 2FX -12 beds
Ward 3 West A – 4 beds
(Cardiology)
/Medical Cardiology - beds AMU 2
Total 38 beds relocated to LMH

7. Outcomes ED, Inpatient and Day surgery
ED representations within 48 hours
LMH ED visits readmitted within 48 hours decreased from 4.4% to 3.98%
ModH ED visits readmitted within 48 hours decreased from 3.94% to 3.54%
NALHN ED visits readmitted within 48 hours decreased from 4.23% to 3.82%
Inpatient readmission (adult) within 28 days
MH inpatient readmission rate decreased from 9.43% to 9.16%
ModH inpatient readmission rate decreased from 7.57% to 6.1%
NALHN inpatient readmission rate decreased from 8.86% to 8.35%
Day Surgery Rate

8. Surgical Service Improvements
Data Source: NALHN Case mix Elective Surgery - Funded Activity Report
These improvements are a reflection of the ongoing work of the NALHN Transforming Health Surgical Initiatives implemented through the following work streams:
Orthopaedic Pathways
Surgical Pathways
Acute Surgical Unit
Operating Theatre Utilisation
Same Day & 23hour Procedures

9. Mental Health Service Improvements
Data Source: NALHN ED Data Repository
Mental Health ED average visit time continues to be within minutes within Mod & LMH respectively.
The NALHN Transforming Health Mental Health initiatives continue to support the delivery of patient care through the following work streams:
Emergency Department Pathways
Community Mental Health Reform

10. CALHN/NALHN Service Moves
Extensive planning has been undertaken to prepare for the service moves. Concurrent to the planning for the service moves, a number of system-wide resources have been developed for application to any future service move.
Development of methodologies and data sources to model the transfer of inpatient, outpatient and ED activity
Development of principles for the implementation of service activity moves
Development of financial principles associated with the service activity moves
Development of criteria to assess clinical and financial viability of activity
Agreement on type and volume of activity and associated funding to transfer for this phase of the project

11. CALHN to NALHN transfers commence
The transfer of some CALHN staff working in a number of specialities to support these transfers of activity to NALHN began on October CALHN staff who have transferred to NALHN to support the care of orthopaedics, renal and vascular specialties.
It is expected staff within other specialties and support functions will transfer in a phased approach, with all moves planned to be complete by the end of February 2017, including the transfer of:
ENT
Urology
Breast Endocrine
Upper GI
Cardiology
Stroke
Medical Oncology
Haematology
Endocrinology

12. Lessons Learnt…
Early engagement with stakeholders, especially clinical leads and consumers which enabled key stakeholders to have ownership with accountability during the change processes.
Clear objectives with measurable outcomes.
Investigate and engage with other hospitals to understand what has worked and how this can be implemented into current practices across our network.
Trial new processes allowing opportunities for review and develop prior to embedding into current practices
Agreement principles, including a strong focus on the patient
Well-structured project planning and management

13. Lessons Learnt……… Consumer Advisory Council – INVALUABLE
Keep talking to people
Manage your own good news stories
Media is negative and never report accurately
Remember why you began – to improve patient outcomes and care
Change is difficult – people don’t like change even if think the results will benefit