Value-based health care - ISSUE 64 / August 2021 Patients first The courage to measure outcomes Transforming the health system for sustainability ...
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Patients first
The courage to
measure outcomes
Value-based
Transforming the
health system for
sustainability
health care
The official magazine of the
Australian Healthcare and Hospitals Association
ISSUE 64 / August 2021
PRINT POST APPROVED PP :100009739
Contents
ISSUE 64 / August 2021
Articles
09. The 2021 Value-Based Health Care Conference
12. Transforming the health system for sustainability
24
14. M
anaging the long term health consequences
of COVID-19 in Australia
18. Patients First
21. The Courage to Measure Outcomes: A Patient’s Perspective
32
24. Smile Squad recognised as school dental innovator
28. Leading Better Value Care
32. Beyond COVID-19
36. V
alues aligned organisational culture as the foundation
for workforce wellnessIs it a pipe dream?
Super that’s good for the planet 40. R
esuscitating respect—the heartbeat of workplace
psychosocial safety
and for your pocket. 46. B
uilding a robotic surgery program at Macquarie
52
University Hospital
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making sure the world you retire into is a better one. 56. Small gains translate into big differences
60. Improving the quality of healthcare?
From the AHHA desk
Cover: Photo by Moses Vega on Unsplash
04. Chief Executive update
06. AHHA in the news 56
Change your super 62. Become an AHHA member
Change the future 64. More about the AHHA
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CHIEF EXECUTIVE UPDATE
The value of
JOHN GREGG
Chief Executive
value-based
AHHA
health care in a
post COVID world
Welcome to the value-based health care themed COVID-19 continues to challenge the healthcare
issue of The Health Advocate. Having recently sector and also provides opportunities for us
joined the AHHA, I am eager to continue advancing to reflect on how VBHC principles may assist
value-based health care in Australia. support services redesign delivery and assistance
Value-based health care is the key to moving to our consumers. AHHA’s Deeble Institute for
health care investments from volume to value, Health Policy Research recently published a
focusing on the health outcome for the consumers brief which examines how value-based health
of healthcare services. Broadly speaking, it is care offers a path to managing the long-term
GraphicStock
about achieving the outcomes that matter to health consequences of COVID-19 in Australia
health consumers at a cost that is acceptable to (see page 15).
consumers and the health system. It is a concept The COVID-19 pandemic has highlighted the
that has been evolving for many years globally, importance of health literacy and how our
and we are now seeing some activity and system health systems need to provide avenues for our “Value-based health care is the key to moving health care
transformation taking place here in Australia as communities to feel more confident in their own investments from volume to value, focusing on the health
health services and systems adopt the principles health decision making, including options and risks outcome for the consumers of healthcare services.”
of value-based health care. with vaccinations. The focus that value-based
In May, AHHA and the Continuous Improvement health care has brought to understanding the
in Care Cancer Project facilitated the inaugural outcomes that matter to patients is noteworthy,
Value-Based Health Care Conference. This but we must also continue to work to support sustainability concepts, exploring the opportunity as we pursue our shared vision of a healthy
conference showcased and celebrated national and improvements in health literacy and provide the for value-based health care transformation to Australia supported by the best possible
international value-based health care in practice. opportunity for consumers to take an active role guide consideration of climate change and its healthcare system. ha
In this issue you can read a wrap up of the in their own health care. impacts on health and health care (see page 12).
To learn more about AHHA’s value-based health
conference as well as several feature articles from One of the drivers behind uptake of value- The principles of value-based health care offer
care work, visit the Australian Centre for Value-
keynote presenters at the Conference, including based health care concepts is a focus on moving the opportunity to reorient our health system to
Based Health at valuebasedcareaustralia.com.au.
Elizabeth Teisberg and Julie McCrossin and outlines the health sector to a more sustainable footing. provide all Australians with effective, accessible,
of services and projects that were recipients of Sustainability in this context is often thought of equitable and outcomes-focused health care
the inaugural Value-Based Health Care Innovation in terms of funding, but a recent Deeble health delivered in a sustainable manner.
and Collaboration awards. policy brief has considered broader environmental I look forward to working with AHHA members
4 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 5
FROM THE AHHA DESK
HAVE YOUR SAY...
AHHA in the news We would like to hear your opinion on these or any other healthcare issues.
Send your comments and article pitches to our media inbox: communications@ahha.asn.au
17 MAY 2021 26 MAY 2021 27 MAY 2021 28 MAY 2021
Long term health Leadership on Three Australian
consequences of COVID-19: environmental issues drives health services honoured
can value-based health care value in healthcare in the Value-Based Health
provide a way forward ‘The severe weather events in recent years have
Care Awards
‘Australia has succeeded in limiting and largely shown us that health systems are at the forefront Dental Health Services Victoria (DHSV), Sydney
controlling the spread of COVID-19 and we must now of responding to the impacts of climate change, Local Health District and Concord Repatriation
New Chief Executive for AHHA shift our focus to responding to the long term health but health systems too have a carbon footprint General Hospital are the three winners honoured
that contributes to climate change and must
The Australian Healthcare and Hospitals Association consequences of COVID,’ says Australian Healthcare in today’s Value-Based Health Care Awards.
and Hospitals Association Chief Executive Adj Prof be addressed,’ says Australian Healthcare and The awards were presented at the inaugural
(AHHA) announced today the appointment of
Alison Verhoeven. Hospitals Association Chief Executive Adj Prof Value-Based Health Care Conference in Perth,
Mr John Gregg as Chief Executive, following the
An issues brief, Managing the long term health Alison Verhoeven. co-hosted by the Australian Healthcare and
retirement of its current Chief Executive, Adjunct
consequences of COVID-19 in Australia, published An issues brief, Transforming the health system Hospitals Association’s Australian Centre for
Professor Alison Verhoeven in June.
today by the Australian Healthcare and Hospital for sustainability: environmental leadership Value-Based Healthcare and the Continuous
‘On behalf of the Board of AHHA, I would like
Association’s (AHHA) Deeble Institute for Health through a value-based health care strategy, Improvement in Care Cancer Project.
to thank Alison Verhoeven who is retiring after
Policy Research examines how a value-based health published today by the Australian Healthcare and ‘Australian health services are leading the way
an outstanding eight years as Chief Executive and
care approach can support Australia’s response to Hospital Association’s (AHHA) Deeble Institute in value-based health care through innovative,
welcome John Gregg,’ AHHA Chair, the Hon Jillian
the long term health consequences of COVID-19. for Health Policy Research examines how a value- inspiring and collaborative projects that are
Skinner, said today.
Deferral of care, workforce burnout and Long based health care approach can support health improving patient outcomes and reducing
‘John comes to AHHA after a distinguished career
COVID are just some of the long term consequences systems to transform for sustainability. costs,’ said Australian Healthcare and Hospitals
in the health and community services sectors in
that present significant challenges for the health The brief provides recommendations for a Association (AHHA) Chief Executive Adj Prof
Australia and internationally, and most recently as
system, according to authors A/Prof Martin Hensher value-based strategic framework that supports Alison Verhoeven. ha
Chief Executive of the North Queensland Primary
et al from the Institute for Health Transformation and the transformation to sustainable models of
Health Network. ha
Deakin Health Economics, Deakin University. ha health care. ha
6 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 7
FROM THE AHHA DESK
AHHA in the news
3 JUNE 2021 14 JUNE 2021
COVID-19 and health inequity: Supporting people with
The 2021
latest Australian research dementia in the community:
The latest issue of the Australian Health Review,
reablement makes a difference
Value-Based Health Care
the academic journal of the Australian Healthcare ‘Most people with dementia live in the community
and Hospitals Association (AHHA), examines and rely on family to provide care that enables them
the various responses and impacts on health to live healthy and independent lives,’ says Adj Prof
organisations during the height of the COVID-19
pandemic in 2020.
A perspectives piece from Nigel Lyons, Cathryn
Alison Verhoeven, Australian Healthcare and Hospitals
Association (AHHA) Chief Executive. ‘Yet despite this,
access to interventions that address the impact of
Conference
Cox and Vanessa Clements from NSW Health dementia on everyday life is limited.’
provides practical insights into the value of clinical An issues brief, Reablement interventions for
leadership and engagement in a time of crisis. community dwelling people living with dementia,
It describes the role of COVID-19 Communities published today by the AHHA’s Deeble Institute for
of Practice, what they have achieved and their Health Policy Research examines how reablement
importance in supporting the ongoing pandemic interventions in dementia care can be adopted in
response in New South Wales. Australia to support people with dementia to live
Dr Rachael Smithson, Elisha Roech and Christina healthy and independent lives.
Wicker from Gold Coast University Hospital ‘The 2021 Royal Commission into Aged Care Quality
examined patient and provider experiences of and Safety identified a failure to meet the needs of
virtual care during COVID-19 to provide a way those living with dementia. This is partly due to people
forward to further develop models of virtual care. with dementia and their carers not being provided
The results from their evaluation demonstrated the with the support they need,’ says report author Dr Miia
value and viability of virtual care. ha
Rahja, Research Associate, Flinders University and 2021
Jeff Cheverton Memorial Scholar. ha
24 JUNE 2021
Telehealth funding reforms must prioritise value for patients
In May, the Australian Healthcare and Hospitals Association (AHHA)
‘Telehealth should be supported and continued Research examines how telehealth can be funded to
beyond the immediacy of the pandemic, but achieve improvements in health outcomes in a cost-
and the University of Western Australia’s Continuous Improvement
funding reforms are needed to ensure the extension effective manner. in Care Cancer Project partnered to host the inaugural Value-Based
of telehealth services focuses on delivering The rapid rollout of the telehealth program Health Care (VBHC) Conference in Perth. The conference aimed to
improved health outcomes and value,’ says during the COVID-19 pandemic resulted in increased showcase and celebrate VBHC innovation, initiatives, implementation,
Australian Healthcare and Hospitals Association spending for new MBS items and ICT infrastructures research, and training from all areas of the health care system.
(AHHA) Chief Executive John Gregg. according to the report’s author Michelle Tran, PhD
An issues brief, Towards a sustainable funding candidate, University of Queensland and 2021 Jeff
model for telehealth in Australia, published today Cheverton Memorial Scholar. ha
by the AHHA’s Deeble Institute for Health Policy
8 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 9
CAPABILITY measures a patient’s
“There is not a one-size-fits-all approach to VBHC, and there’s much functional status.
that can be learned from jurisdictions like NSW and Singapore, both COMFORT measure relief from physical
in what they have been able to achieve in a relatively short period and emotional pain.
of transformation and from the frameworks they have established CALM measures the extent to which
through which to progress and evaluate their work.” patients can continue to live their life in
the way they want.
Patients first featured Elizabeth Koff, Secretary of NSW Health, and working in very close partnership with (and
The conference, themed Patients first, started with and Dr Daphne Khoo, Executive Director of the funding) both community services like the justice
a lively keynote session featuring Professor Elizabeth Agency of Care Effectiveness (ACE), Singapore system, public housing, schools, and employment
Teisberg, Executive Director of the Value Institute Ministry of Health. agencies, as well as with health providers in the
for Health and Care at the Dell Medical School, This session highlighted that the approach to primary and acute care sectors.
University of Texas at Austin, and Julie McCrossin, VBHC implementation will vary depending on the Dr Ross Crawford, an orthopaedic surgeon from
a patient advocate. jurisdiction, based on the capabilities and enablers Brisbane, was compelling in his arguments that we
Professor Teisberg’s discussion of patient that are in place, the health outcomes they are must address variation in health care, that to do
outcomes used the Capability, Comfort and Calm seeking to optimise, and the priorities for their this we needed to leverage big data and AI to best
framework, describing this approach as consistent respective governments. understand where efforts should be directed, and
with both patients’ reasons for seeking care There is not a one-size-fits-all approach to that we need to be more agile in testing, adopting
and their experience of it, as well as clinicians’ VBHC, and there’s much that can be learned from and evaluating new technologies like robotics if
professional identities. jurisdictions like NSW and Singapore, both in what we are to provide the best available health care,
Julie McCrossin noted that while her cancer they have been able to achieve in a relatively short achieve the best outcomes and pay the best prices.
care experience helped restore capability and in period of transformation and from the frameworks In addition to the keynote presentations, the
the longer term, calm, she had had an adverse they have established through which to progress and conference featured over 50 speakers examining
experience in relation to comfort and emotional evaluate their work. topics from measuring what matters to patients, to
pain, particularly during radiation therapy for a Social determinants, changing culture, implementation approaches and
head and neck cancer. funding and variation VBHC enablers. Linking the presentations was a
She talked about strategies to ensure patients The final keynote session examined key themes focus on practical examples, lived experience and
were heard and were included in decision-making including social determinants of health, funding and pragmatic advice.
about their care. Trust and relationships, choice and variation. Joseph Conte, Executive Director of the In this special value-based health care themed
empowerment to participate in decision-making Staten Island Performing Provider System (PPS) in edition of The Health Advocate, we continue to
were strong themes throughout these discussions. New York, spoke about the dramatic improvement shine a light of value-based health care, and we
in health outcomes across a range of programs feature two special articles from Elizabeth Tesiberg
Implementing VBHC in and Julie McCrossin. ha
different jurisdictions supporting very vulnerable patients including
The second keynote session, focused on homeless people, refugees and migrants. The Staten If you’re interested in learning more
implementing VBHC in different jurisdictions, Island PPS is an accountable care organisation, about AHHA’s VBHC work, visit
purchasing social care as well as health care, valuebasedcareaustralia.com.au.
10 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 11
“Currently one of the
Transforming greatest threats to
health care sustainability
is climate change with
the health system
the World Health
Organization declaring
‘climate change the
for sustainability
greatest threat to
global health in the
21st century’.6”
Environmental leadership through a value-based health care strategy
Based Health Care: A Strategic Framework, Academic Medicine. 95
Figure 2: Teisberg et al., (2020). Defining and Implementing Value-
Health services primarily focus on economic
sustainability, or rather, the proper use of available
Figure 1: Simplistic representation of sustainability
financial resources.3 However, ‘the assumption that
(5): 682-685 doi: 10.1097/ACM.0000000000003122
sustainability at the financial and the economic
levels is sufficient, on its own, to enhance the
effectiveness of the health care system and to
overcome the momentous challenges which a
ffect the performance of health care organisations
neglects the wicked nature of sustainability-
related issues’.4
The Sustainable Development Goals represent an
agreed global conceptualisation of sustainability
signifying the indivisible nature of economic, social
and environmental dimensions, with sustainability
only to be achieved when these areas are pursued
Sustainability is most often described as ‘meeting collectively.5 Currently one of the greatest threats to health The Australian Healthcare and Hospitals
the needs of the present without compromising Value based Healthcare (VBHC) is a global care sustainability is climate change with the Association’s (AHHA) Deeble Institute for Health
the ability of future generations to meet their movement which provides a holistic patient centred World Health Organization declaring ‘climate Policy Research published a health policy brief
own needs’.1 Although commonly depicted as three way to support sustainable decision making in change the greatest threat to global health in titled Transforming the health system for
interconnected circles reflecting environment, healthcare. The classic definition of value-based the 21st century’.6 The strategic framework for sustainability: Environmental leadership through a
economy and society, it is also a complex, health care is based on work initially led by VBHC transformation developed by Teisberg et al value-based health care strategy which provides an
multifaceted concept that continually evolves Professors Michael Porter and Elizabeth Teisberg (2020) (Figure 2) provides a framework structure in-depth analysis of the alignment of sustainability
depending on the perspectives of different sectors (2006) who propose that value is the health to support the consideration of climate change and and VBHC and provides series of recommendations
and professions, and their respective expertise outcomes that matter to patients, divided by the its impacts on health care at the patient level and on how policy makers and health leaders can work
and interests.2 costs of delivering those outcomes. within each level of the system. together to implement this holistic approach. >
12 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 13
“The brief also
recommends that strong
leadership is demonstrated
across the health system Deeble Institute for Health Policy Research
through a series of actions,
Managing the long term
including the commitment
to achieve net zero
emissions.”
health consequences of
The brief recommends that environmental For more information about Transforming the
COVID-19 in Australia
sustainability be encompassed in the national vision health system for sustainability: Environmental
Can value-based health care provide a way forward?
and strategy for outcomes-focused, value-based leadership through a value-based health care
health care in Australia. This requires recognising strategy or to access the full copy, click here.
the significant contribution of health care to
Australia’s carbon footprint as a cost within REFERENCES
“The brief focuses on how Australian governments should now
the value equation and focusing on the populations 1. World Commission on Environment and Development.
consider an effective and proportionate value-based response to
who are most vulnerable to the impacts of (1987). Our Common Future: Report of the World Commission COVID-19, Long COVID and its other longer-term consequences,
on Environment and Development. Viewed 11 January 2021:
climate change. http://www.undocuments.net/our-common-future.pdf
that considers both patient health outcomes and costs.”
The brief also recommends that strong leadership
2. Giddings B, Hopwood B and O’Brien G. (2002).
is demonstrated across the health system through Environment, economy and society: fitting them together into
a series of actions, including the commitment to sustainable development. Sustainable Development. 10(4):
187-196. https://doi.org/10.1002/sd.199
achieve net zero emissions. Australia is one of a group of countries who has reduction in healthcare utilisation and deferral
3. Borgonovi E, Adinolfi P, Palumbo R and Piscopo G. Framing
Data-driven improvements in the health outcomes the Shades of Sustainability in Health Care: Pitfalls and succeeded in limiting and largely controlling the of care. There are also lingering concerns about
of individuals and populations should be enabled. Perspectives from Western EU Countries. Sustainability. 2018; spread of COVID-19 within the national borders. mental health, well-being and health workforce
10(12):4439. https://doi.org/10.3390/su10124439
However, improved health outcomes should not be As a result of these effective control measures, burn out. As we move toward a post-COVID world,
achieved through care pathways that create poorer 4. Ibid.
Australia has suffered a much lower burden of this has the potential to impact negatively on
health outcomes from their environmental impacts. 5. United Nations. (2015). Transforming our world: the
COVID-19 disease than most other countries; health outcomes.
2030 Agenda for Sustainable Development. Department of
Health workforce strategies and plans must Economic and Social Development. Viewed 15 January 2021: with rates of infections and deaths being an The Australian Healthcare and Hospitals
recognise the impact climate change will have https://sdgs.un.org/2030agenda order of magnitude lower than those seen in Association’s (AHHA) Deeble Institute for Health
on exacerbating health workforce shortages, 6. WHO: World Health Organization (2020). Climate Change most other high-income nations. Policy Research recently published a health
particularly in rural and remote areas and already and Human Health. Viewed 15 January 2021: https://www.
However, in those countries which have suffered policy brief titled Managing the long term health
who.int/globalchange/global-campaign/cop21/en/
vulnerable communities. more severely than Australia, concerns about consequences of COVID-19 in Australia. The brief
7. Porter M and Teisberg E. (2006). Redefining health care:
Funding models should be introduced to Creating value-based competition on results. Boston, Mass: the long-term consequences of the pandemic focuses on how Australian governments should now
incentivise environmental sustainability and climate Harvard Business School Press. are increasingly focused on the long-term clinical consider an effective and proportionate value-based
and health research that provides a strong evidence 8. Teisberg E, Wallace S and O’Hara S. (2020). Defining sequelae being seen in survivors of COVID-19, response to COVID-19, Long COVID and its other
base to support health sector sustainability must and Implementing Value-Based Health Care: A Strategic
including Long COVID and a wide range of other longer-term consequences, that considers both
Framework. Academic Medicine: Journal of the Association
be supported. ha
of American Medical Colleges. 95(5): 682-685. conditions. Additionally, during the COVID-19 patient health outcomes and costs. >
https://doi.org/10.1097/ACM.0000000000003122 pandemic, Australia experienced a large scale
14 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 15
issues brief “Although estimated case
numbers in Australia are
low, the emergence of Long
COVID provides an opportunity
to implement new approaches Deeble Institute for Health Policy Research
to integrated, well-coordinated,
multidisciplinary, person
centred care.”
A path forward • the development of regular, updated clinical
Primary prevention of COVID-19 should be guidelines that reflect evolving evidence on the
prioritised as the most effective means of long-term management of post-COVID care; and
mitigating the long-term health consequences of • MBS and PBS benefits that adequately support
infection at population level, however plans must patients living with Long COVID or other sequelae
be put in place to allow rapid scaling-up of long- and other “safety net” measures put in place to
term care were COVID-19 control measures to fail. mitigate out-of-pocket costs for chronic disease
Although estimated case numbers in Australia management to support these patients fully.
are low, the emergence of Long COVID provides The Australian and state and territory governments
an opportunity to implement new approaches to should consider the long-term care consequences
integrated, well-coordinated, multidisciplinary, of COVID and its associated additional cost burden
person centred care. This will require health care in resource allocation and risk management
professions to be supported to work at the top of decision processes in parallel with COVID-19
their scope of practice and should occur through: control strategy policies.
• a national post-COVID Centre of Excellence Support should also be provided for research
and state-based care coordination centres; that focuses on health policy, health economics,
• a nationwide COVID-19 data registry that social determinants and more directly on the
combines patient-level data on COVID-19 and effect of COVID-19 on the structure and function
subsequent health and healthcare utilisation of the health system.
history; Although Long COVID is not yet fully understood,
• ommissioned research and modelling on the health policy makers should be preparing to
morbidity burden of Long COVID and post-COVID address it. ha
sequelae in different age and population
groups that supplements emerging data on the For more information about Managing the
mortality burden of COVID-19 and associated long term health consequences of COVID-19 in
control measures; Australia or to access the full copy, click here.
Figure 1. Possible health system impacts of COVID-19 over the short to longer term time horizon.
16 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 17
ELIZABETH TEISBERG,
PHD
Patients
First
Executive Director, Value
Institute for Health and
Care, Dell Medical School
and McCombs School of
Business, The University
of Texas at Austin
“Clinicians need to ask each patient: What matters to you?
What does this mean and what is needed to achieve it? What brings you joy? Asking these questions helps clinicians
recognise—and connect with—patients as individuals.”
GraphicStock
There are opportunities everywhere to improve instead, it requires relationship-centred delivery of Of course, what most concerns individuals patients, yet the ability to do needlework need
health care value by recognising unwarranted care. The healing relationship matters. We can depends on the health issues they face and the not be measured for every patient. Retaining vision
differences in health outcomes and closing those create systems that make respect, empathy, and contexts in which they live. So, Patients First is the outcome to be measured and improved.
gaps. To see the gaps, one starts from the patient kindness normal in the care processes, rather means knowing what matters and using that The dynamic of improvement requires research
perspective: Patients First. than extra work undertaken by clinicians and knowledge in care delivery, care design, and with patients and families who have shared
Why patients first? Patients are why health staff. Health care is full of smart, caring, hard- care improvement. Clinicians need to ask each medical circumstances. The research enables
care exists: the purpose of health care is to help working people, working in systems that often patient: What matters to you? What brings you insight on patients’ hopes and fears, the
individuals and families with health issues. don’t make the right things easy or make enough joy? Asking these questions helps clinicians outcomes that matter to them, and the obstacles
‘Patients’ include everyone who needs and time for human interaction. Clinicians then put recognise—and connect with—patients as and gaps that make those outcomes harder
wants help, not just those who present for in extra effort because they care. It is no wonder so individuals. It is foundational to high-value, to achieve. From these insights, health care
care. This observation has two implications. many health care professionals feel worn down. relationship-centred care. improvement can focus on achieving outcomes
One is that care needs to be designed to include If systems were redefined to make the right things Asking what matters to individuals is consistent beyond current successes, and beyond improving
people who are underserved or served ineffectively easy—to truly be relationship centred—there would with, yet different from, developing systems to the in-clinic experience. Of course, every patient
now. The other implication is that the highest-value be support for the patients, the families and the measure patient-centric outcomes and drive ongoing should receive safe, respectful, compassionate
health care prevents people from becoming clinicians. The starting point is to be explicit improvement. Both are needed. For illustration, care; the point is simply that kindness and safety >
patients. So, when health care really gets it that transforming to high-value health the shared outcome that matters to patients at should be the norm, not a stretch goal. Kind,
right, the design of care is human centred, care requires clarity that the purpose is to help risk for diabetic retinopathy may be retaining safe care should focus on helping improve
meaning it addresses individuals’ and families’ and to heal, enabling quality of life and dignity of eyesight; however, individual patient goals may health outcomes.
needs effectively, inclusively, and, when death. To achieve this purpose, care must focus be driving, reading, doing needlework, or seeing The Value Institute for Health and Care uses a
possible, proactively. on achieving the outcomes that matter most to the smile on a grandchild’s face. The specific qualitative research approach that works with
Patients First does not mean clinicians last; individuals and families. goals frame the individual discussions with groups of individuals facing similar medical
18 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 19JULIE McCROSSIN AM The Courage
to Measure
Patient Advocate,
Cancer Survivor and
Grandmother
“My experience
of treatment and Outcomes:
A Patient’s
recovery from stage
“Patients First can be implemented to achieve both empathic four oropharyngeal
response to patients and professional support for clinicians cancer taught me
to focus on the
Perspective
by accelerating teams’ learning and improvement.”
experience of my
clinical team.”
challenges and life circumstances to gain transformation that improves outcomes of
insights on what outcomes matter and what gets relationship-centred, high-value care.
The focus on value-based health care offers a new My life-saving treatment of 33 sessions of radiation
in the way of them achieving what matters. Please join us! valueinstitute.utexas.edu/
opportunity to give patients and their families a therapy, bolted down to the bed of my radiation
We’ve found that patients often don’t readily Together we can improve health; we can
voice so we can achieve real-time improvements in machine by a rigid thermoplastic mask, plus weekly
articulate these things, even to wonderful, beloved improve care; we can make kindness and
treatment in partnership with our multidisciplinary chemotherapy, was brutal. This is not a complaint.
doctors and nurses. Instead, they say thank you. respect the norm; and we can reduce health
team. At the same time, we can collect large It is simply a fact. The side effects, short and long
So, the most caring and respected clinicians disparities. It all comes back to understanding
data sets to enable us to do systemic, structural term, are tough.
may not hear about challenges that they and addressing unmet needs—even the
improvements to care over time. This approach I came to understand that members of
could help mitigate or address. With the right unarticulated needs of the people we serve.
gives an active role to patients and their families. compassionate, multidisciplinary cancer teams are
research, clinical teams can anticipate these This means, of course, the starting place is
It is, quite simply, a win-win-win situation. almost frightened to truly comprehend the impact
unarticulated concerns and use the insights patients. Patients First. ha
It takes courage to measure results, including on patients and families of the treatment regime
gained to improve care delivery, track a few
finding out what your patients and families really because they are not sure they can address the
highly meaningful outcomes, and speed learning Dell Medical School’s Value Institute for Health
think. My experience of treatment and recovery unmet need. Cancer teams are working so hard
for the clinical team. In this way, Patients First and Care is the global leader in value-based health
from stage four oropharyngeal cancer taught me to deliver the basic curative care, or care to
can be implemented to achieve both empathic care and a proud partner of AHHA. The two
to focus on the experience of my clinical team. prolong life, it would be too overwhelming to
response to patients and professional support for organisations are proud to present the Australian
I needed to understand their perspective and collect and interrogate the nature and scope of
clinicians by accelerating a team’s learning and health community with a series of high quality
challenges if I were to work with them to improve our unmet needs.
improvement. That improvement, in turn, enables workshops and short courses. If you’re interested in
the experience and results for head and neck This is especially the case with the impact on
better care and outcomes for future patients. finding out more about how you can get involved
cancer patients like myself. families. My cancer treatment was all outpatient >
The Value Institute for Health and Care is a contact communications@ahha.asn.au.
hub of an international community driving
20 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 21“In my keynote address to
the Value-Based Healthcare
Conference 2021 in Perth,
I described three positive
examples of clinical teams
who have had the courage to
measure outcomes for patients
and improve care. The first
example gives a voice
to families as well.”
care. My family and friends drove me to and from had the courage to measure outcomes for patients Advanced Speech Pathologist and Researcher, These three examples show us that it is possible
the hospital and kept me alive as I progressively and improve care. The first example gives a voice who worked at Princess Alexandra Hospital in for a caring group of skilled clinicians to really
lost speech, swallowing, cognitive capacity and to families as well. Brisbane for 15 years in radiation oncology and listen to patients and families and to make change.
over 20kgs in weight over six weeks. My recovery My first example is an electronic, web-based was instrumental in the development of this tool. I urge you to ask yourselves, ‘What tools can we
has involved a multitude of appointments with patient-reported outcome tool called My Health She is now at the Menzies School of Health give patients and families so they can report to us
a variety of doctors, dentists, nurses and allied My Way from Princess Alexandra Hospital Brisbane. Research. My Health, My Way is validated for carers. during treatment, and we can improve their care
health professionals over eight years. This continues It offers two ways to hear the patient and family Over 7,000 entry points of data have been received. in real-time?’ Imagine the professional satisfaction
today. In the acute phase, it involved the safe voice during cancer treatment — via a stand-up It has led to a 25% drop in outpatient appointments. you will experience if you could also generate large
administration of a multitude of medications, podium in the waiting area with a touch screen, Overservicing has been reduced, while data sets and build the evidence base for structural
including essential opioids for pain relief, plus the or by a personalised SMS message to their device. underservicing has been addressed. Increasingly, improvements to your models of care. On top of
management of crucial oral care to address what They can enter data on how the experience the right patient gets the right care, at the right this, you will give an active voice to patients and
happens inside a mouth and throat subject to of treatment is going, connect with the team time, from the right professional. families. When you, or someone you love, is a
extensive radiation. Yet, amazingly, the family and receive automatic referrals based on the The other two examples I outline in my patient, you don’t want to be a cork bouncing on
carer receives very little attention. information provided. It addresses physical, presentation are an app at the Peter MacCallum the ocean of the health care system and subject to
In my keynote address to the Value-Based emotional, home, distress and other needs. In the Cancer Centre and the NSW Health Osteoarthritis tidal forces you can’t influence. You’ll want to help
Healthcare Conference 2021 in Perth, I described video of my presentation, you can see pictures of Chronic Care Program Service. yourself and others. We’re in this together. ha
three positive examples of clinical teams who have this tool and my interview with Dr Bena Brown PhD,
www.juliemccrossin.com
22 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 23Winner of the 2021 Value-Based Health Care Innovation Award
EMMA WARREN
Smile Squad
Communications Lead
Smile Squad
recognised as
school dental
innovator
Smile Squad means that
every Victorian child can
have a healthy smile
Students at Fitzroy North Primary School celebrate the launch of Smile Squad services at their school
Parents and students all over Victoria are quickly The award, sponsored by Queensland Health, ‘We have learnt a great deal from previous health, all while saving families time and money,’
becoming familiar with the bright orange fleet, recognises projects in their start-up or early phases programs and those learnings have armed us said Ms van Altena.
smart uniforms, friendly staff, and great customer of development that are significantly innovative with the knowledge and experience needed to ‘Our aim is to add value to the relationships
care the Smile Squad school dental program delivers. and was presented at the 2021 Value-Based Health deliver a truly innovative next generation service,’ we have with all community dental agencies to
Smile Squad is the Victorian Government’s free Care Conference. he added. provide support in the provision of Smile Squad
school dental program. Smile Squad provides free DHSV Chief Operating Officer Mark Sullivan School dental program Director Melanie van oral health services to as many eligible students
annual oral health examinations and free follow was delighted by the win and highlighted the Altena reflected on the key aspects of the Smile as possible.
up treatment for all Victorian public primary, importance of delivering innovative, accessible, Squad program that will lead to improving health ‘Smile Squad provides its patients with excellent
secondary and specialist school students. high-value dental care to all Victorian public school outcomes that matter to patients — students dental care that is consistent, trusted and held to
In May 2021, extensive planning, collaboration, students. attending Victoria’s public schools. a high standard. That high standard of care comes
and testing were rewarded as Dental Health ‘School dental services have existed for a number ‘The Smile Squad value proposition is simple — to without cost to the student’s family and students
Services Victoria (DHSV) was awarded the of years and we’re excited that Smile Squad has increase access to dental services for public school enjoy the experience of having a dedicated,
Innovation Award at the inaugural Value-Based seen the return of dental vans to our schools,’ students, reduce preventable hospitalisations due supportive, and caring oral health team to help
Health Care Awards. said Mr Sullivan. to dental conditions and improve students’ oral them take control of their own oral health. >
24 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 25Student receiving a dental The bright orange
check-up at Fitzroy North
Primary School
Smile Squad
treatment van fleet
“The free program adds
value for the government
by reducing the number
‘When the program reaches full rollout by the over four years for the Smile Squad school experiencing tooth decay and reducing those of school aged children
end of 2023 ,we will reach approximately 650,000 dental program. preventable hospital admissions. experiencing tooth decay and
students attending public primary, secondary and Dental vans started visiting a limited number of Smile Squad has been planned and implemented reducing those preventable
specialist schools at more than 1,500 locations schools in Term 3 2019 as part of a Proof of Concept in line with the DHSV value-based health care hospital admissions.”
across Victoria each year. and the program progressed to statewide rollout in framework. It focuses on ensuring the right
‘The reaction to Smile Squad has been Term 1 2021 following a lengthy pause services are provided in the right place at the
overwhelmingly positive. Agencies, schools, in 2020 due to COVID-19 restrictions. right time and that the clinical workforce is
teachers, parents and students are all telling us The program was inspired by a need and desire utilised to their full scope of practice. We have the values of eating well, drinking well and
they want and are benefiting from our services. to improve the oral health of all Victorian young developed an Oral Health Questionnaire to cleaning well — for life. ha
I’ve heard wonderful reports of students seeing people. Approximately one quarter of all Australian measure what outcomes matter to our patients
an oral health clinician for the first time and children have untreated tooth decay and in Victoria, so their management program can be tailored Smile Squad is a partnership between Dental
others who are overcoming fears based on dental conditions are the highest single cause of appropriately. Health Services Victoria, the Department of
previous negative experiences,’ she added. preventable hospitalisations for children under 10. Smile Squad considers the needs of all students Health, Department of Education and Training,
In the 2019—20 State Budget, the Victorian The free program adds value for the government and is firmly patient-centred. The program has a community dental agencies and public schools.
Government announced $321.9 million in funding by reducing the number of school aged children strong focus on preventive services and promotes www.smilesquad.vic.gov.au
26 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 27DR RICHARD HOLLAND
Consultant
Rheumatologist
PRIYA GNANAKUMARAN
Clinic Co-coordinator
Winner of the 2021 Value-Based Health Care Collaboration Award
Leading Better
Value Care
A patient focused Osteoarthritis Chronic Care Program
Pixaby
Osteoarthritis is a major cause of disability and We recognised that a single physical space, The programme has demonstrated strong re-fracture prevention programme, and OACCP
early retirement in Australia, and it is forecast incorporating individual consultation rooms, an results, with a significant reduction in the all contributed to cost savings of approximately
that by 2030 over three million Australians will be open exercise/assessment space and a meeting number of patients proceeding to total joint $5 million for Sydney Local Health District in the
living with osteoarthritis, with treatment costs room would be essential to deliver healthcare in replacement. Formally-assessed patient outcomes 2018/19 financial year.
expected to exceed $2.9 billion. Data obtained by a way that was sensitive to the needs of patients using Promis29 have been excellent, and most At inception, only patients on the surgical
the Agency for Clinical Innovation indicated that with reduced mobility and function. overweight patients lost weight by three months, waiting list for total hip or knee joint surgery were
few patients had tried conservative management Following an initial review by the musculoskeletal improving with time. Patient feedback has been invited to participate in the programme. With the
prior to joint replacement surgery. The non- clinical lead (senior physiotherapist), patients very positive, and highly complimentary of the success and positive outcomes of the programme,
surgical management of osteoarthritis is frequently are scheduled to attend a multi-disciplinary service provided. Qualitative patient assessment referral criteria have broadened to allow all
fragmented, with most clinicians working in silos. (MDT) clinic. The MDT clinic utilises the skills revealed enhanced confidence and ability to patients to attend the clinic following specialist
The Concord Hospital osteoarthritis chronic of experienced, motivated clinicians including start exercising, and those proceeding to surgery referral. As the service continues to mature, it is
care programme (OACCP) was established in a physiotherapist, psychologist, podiatrist, reported rapid recovery, facilitating a reduction in forecast that the volume of patients accessing the
April 2018, and to date has enrolled over 500 dietician, occupational therapist, social worker length of stay. Assessment of provider experiences service will grow, and in turn, increase the volume
patients. The programme is a coordinated, multi- and rheumatologist. The close collaboration of demonstrated high levels of professional of patients deferring or cancelling their surgery.
disciplinary ambulatory care clinic designed and the clinicians ensures highly coordinated care and satisfaction, achievement and engagement with The COVID-19 pandemic has been a significant
implemented for patients with knee and hip facilitates the discussion of barriers to change and the multidisciplinary clinic format. A whole of challenge to the service in 2020. We have
osteoarthritis as part of the Leading Better Value challenges faced by each patient. experience review revealed opportunities for managed to continue outpatient clinics through
Care (LBVC) initiative and was established after Participants are provided with a comprehensive, increased efficiency such as enhanced psychology the implementation of telehealth, socially-
careful consideration of the needs and challenges evidence-based and individually tailored and podiatry services, distanced and COVID-safe face-to-face services,
of patients with hip and knee osteoarthritis. The management plan focused on maximising health adding value with modest investment. and referral to hospital and community run
objectives were to improve health outcomes outcomes important to the patient. Adjustments In NSW, LBVC services have successfully virtual exercise sessions. The continuity of care,
(pain, function, mobility and anxiety) and patient to the plan are made following regular follow- demonstrated a move from admitted care to particularly in light of cancelled/deferred surgical
experiences in the non-surgical management of up appointments using both clinical and patient non-admitted care. Specifically, the OACCP has procedures due to the pandemic, has been
osteoarthritis of the knee and hip. To address reported outcome measures (PROMs). A robust led to a significant 7% reduction in business as gratefully and positively received by patients. ha
the biological, social, and psychological impacts set of measurable outcomes are used to monitor usual activity for Sydney Local Health District.
of disease, we included a range of clinicians with the effectiveness of the service, with the focus The diabetic high risk foot service, osteoporosis
appropriate skills in managing chronic disease. on PROMs.
28 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 29“I want a
super fund
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that’s an
low interest expert at
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rates money.”
Interest rates in Australia have reached all-time lows.
What does this mean for you? Vindhya Mendis,
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Why do interest rates go up and down? Is this a It is cheaper for businesses to borrow money and that market conditions could lead to a scenario
good thing or a bad thing? While these can appear invest in economic growth. This may have a positive where cash rates continue to decrease. In some
to be difficult questions, the answers are simpler effect on the value of bonds and the stock market. countries, interest rates have gone below zero.
than you’d think. Your HESTA investment option may hold bonds It’s worth pointing out that there are two
Interest rates are adjusted to help create healthy and stocks. investment options that hold significant
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Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is of a general nature. It does not take into account your objectives, financial situation or
specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about
30 The Health Advocate • AUGUST 2021 The Health
HESTA products you should read the relevant product disclosure statement (call 1800 813 327 or visit hesta.com.au/pds for a copy), and consider Advocate
any relevant • AUGUST 2021 31
risks (hesta.com.au/understandingrisk).DR INES RIO
Chair, North Western
Melbourne Primary Health
Network
Beyond COVID-19
Photo credit Leigh Henningham
Australia’s response to the coronavirus pandemic has not
always been perfect, but we still have much to be proud of
The human and economic cost has been high, but progression, more end organ effects from vascular way through the maze of different providers and a At lower level acuity it may be cognitive
not nearly as high as it could have been. And it has diseases and diabetes, and the effects of poor lack of coordination between services. From where behavioural or talking therapy and mindfulness apps
shown us time and again what we are capable of; mental health on the wellbeing of individuals, I sit, a successful system development has been the and social connection; at low-to medium it may
from the resilience of the millions who endured the families, and communities. The cost of mental HeadtoHelp service in Victoria. be referral to a psychologist or social worker; at
many effects of lockdown to the tireless efforts of illness in Australia is $600 million a day, and only Announced by the Australian Government in medium it may be referral to dedicated health care
healthcare workers, there are many success stories likely to grow with the ongoing fallout from the August 2020 as a measure to support Victorians hubs that have multidisciplinary teams that include
from 2020. pandemic and recent drought and bushfires. struggling through a protracted lockdown, it is mental health nurses, psychologists, social workers,
However, there is no doubt we will be left with We also need to consider the effects of long run by Victoria’s six Primary Health Networks. It alcohol, and other drug workers; and at higher
an ongoing health and economic burden that COVID in our community, given the majority of consists of a state-wide single point intake service acuity to the regional hospital run mental health
needs acknowledgement and addressing. We have COVID cases in Australia have come from our where patients, families or GPs and other health care service.
seen cancer diagnoses fall, fewer presentations region. We need more research and support for professionals can refer all but the most acutely While COVID-19 may have exacerbated it,
to general practice for cardiovascular events, people suffering long COVID, and to reinforce the unwell person to. Australia’s mental health epidemic is far from new,
preventative health screening and chronic disease importance of anyone diagnosed with COVID to stay The central service is staffed by experienced and it has long been acknowledged that we are not
management, and more presentations for distress in touch with their GP in the long term. mental health professionals who (along with dealing with it well. It is beyond time for us to apply
and mental health concerns. I have argued previously that the problem in many referring GP if a GP has referred) make an initial the solutions-based thinking we have shown in the
All of these can be expected to have flow areas is not so much the lack of services, as the assessment and determine the level of care required face of COVID-19 to a problem that affects so many
in effects in the next few years. Cancer stage difficulty for patients, families, and GPs in finding a and then access that service for the person. of us every day. >
32 The Health Advocate • AUGUST 2021 The Health Advocate • AUGUST 2021 33You can also read
