Strategic Objectives
The strategic service plan has been shaped by the environment within which MDHS will need to operate including population shifts, population ageing, the level of illness and disease in the community, and social factors which influence the demand for health care.
Overall, the Maryborough district community has:
Ø A relatively stable population with a modest level of growth projected over the next five years, mainly in Maryborough township;
Ø An ageing population, which is likely to have a significant impact on the demand for health services in the district;
Ø Higher rates of illness and disease (by about 10%) compared to the state average. This is especially true for cancer and cardio-vascular disease;
Ø Much higher rates of social disadvantage in the district compared to Victoria generally.
The analysis of our patient profile indicates that:
Ø 95% of all patients that come to MDHS are from the Maryborough district.
Ø MDHS continues to treat more acute patients.
Ø A high proportion of patients from the Maryborough district receive treatment in Ballarat and to a lesser extent at Bendigo. This is often appropriate in order to receive the level of specialist care that they need.
Ø The number of patients attending for emergency care at Maryborough has been steadily increasing. We believe that this is mainly due to lower levels of access to primary medical care in the community.
Ø A broad range of community services (such as district nursing and alcohol & drug services amongst others) have experienced significant growth over recent years. It is an area of high demand that we are struggling to meet. This is made worse because of the difficulty be attracting health care professionals to rural Victoria.
Ø Aged residential care services have also grown over the past few years due mainly to increased bed capacity, but also increased occupancy. There has been a marked shift toward higher dependency residents, placing additional pressure on community services.
The recent capital redevelopment or refurbishment of most services across all three campuses means that the capital infrastructure is a strategic strength of the organisation. However, significant improvements can be made is some key areas.
Clear and widely acknowledged skill shortages at MDHS in nursing, medical and allied health services continue to be a strategic challenge for the organisation.
Where are we heading?
Our Vision for the future is ‘To be a dynamic provider of quality, customer focused, health and community services’.
Maryborough will provide inpatient, primary care, health promotion, community based care and aged residential care based on a model of care that:
1. Ensures customer focused services that deliver seamless service provision.
2. Improves customer access to high priority services at MDHS and through clinical alliances with other organisations.
3. Ensures the provision of high quality care through effective clinical governance systems and processes.
4. Improves the level of self-reliance in health services to our population where clinically appropriate.
5. Develops collaborative arrangements that improve the social and health outcomes of the communities of MDHS.
6. Develops a strong culture of teamwork and common purpose within MDHS.
7. Develops innovative approaches that improve productivity and efficiency to better meet emerging service delivery challenges.
8. Keeps the communities of MDHS informed of the direction and key decisions of the Board.
Within the context of this strategic framework MDHS will be accountable to government and community.
How will we get there?
There are several important components of the strategic services plan, including:
Ø The ‘model of care’, or how service are to be delivered, by MDHS;
Ø Acute care service changes;
Ø Aged residential care improvements;
Ø Community based care innovations;
Ø Workforce initiatives;
Ø Service management;
Ø Partnerships and alliances; and
Ø Infrastructure.
Model of Care
How MDHS plans to deliver health services is important because it can determine how well we are able to meet the increasing demand for services and provide services efficiently and within the funding that is available.
We will maintain acute beds at the current size. At the same time we will move toward a more effective use of the available beds, and increase the type of care in the community where this is appropriate. We will also need to enhance our partnerships with other health care providers and better integrate the care we provide. We also intend to have an increased focus on early intervention and health promotion.
Strategies include:
Ø Focusing on enhancing community and ambulatory care services, including the Hospital Admission Risk Program (HARP), to enable greater flexibility and responsiveness to demand.
Ø Improve the usage of acute beds at Dunolly campus, including the streaming of nursing home type patients from Maryborough to Dunolly.
Ø Develop new models of care for delivering community based services including an enhanced capacity to deliver more intensive home based care.
Ø Expand the community and ambulatory care service capacity.
Ø Develop and expand respite & carer support services, including in hospital palliative care, in home respite and carer training programs.
Acute and sub-acute care
Acute care continues to be a significant role for MDHS. The demand for acute care is increasing. There are two main strategic changes for the next five years. These are:
1. Look to develop new services that better meet the health needs of the community.
2. Improve the use of the existing acute care capability.
With respect to service development, the priority areas for service development are:
Ø Cancer services. We would be looking to establish a viable chemotherapy service at Maryborough consistent with the regional integrated cancer services plan. This would be between 4-6 chairs. It would require local GP support and a critical mass of specially trained nurses. This would be supported by the further development of palliative care services and self-help groups.
Ø Mental health services. There are significant shortcomings in current mental health services which have led to a low level of confidence in the current system. An increase in the incidence of mental health in the population suggests pressure on the system is likely to increase. Key strategies will include:
Ø Community rehabilitation. There is currently an unmet need for community rehabilitation primarily due to the high incidence of cardio-vascular disease in the community. Key strategies include:
i. Developing and enhancing community based rehabilitation programs with either Ballarat Health or Bendigo Health; and
ii. Recruiting the necessary specialist skill base to support an enhanced service.
With respect to improving the use of existing capability, the main strategies are to:
Ø Reassess clinical management practices and admission and discharge procedures to reduce the high average lengths of stay.
Ø Review of the acute casemix.
Ø Standardise ‘on call’ practices for emergency department presentations.
Ø Develop and refine clinical pathways for common patient groups, particularly chronic conditions.
Ø Improve the usage of acute beds at Dunolly campus.
Community Health
High levels of social disadvantage, illness & disease within the catchment, as well as an ageing population, point to a significant increase in demand for community health services. In the past, many of the community based services have not been effectively integrated.
A major initiative for MDHS over the coming years is to develop community based services around a ‘Centre of Excellence’ model, incorporating leading edge service models and structures and research and training. Other supporting initiatives include:
Ø The collocation of community services in a new location.
Ø Enhanced assessment and intake service capacity at Maryborough, including after hours. This augmented service will cover crisis and emergency situations as well as mental health.
Ø Further develop illness prevention and health promotion programs.
Ø Develop and enhance targeted Alcohol and Drug (A&D), youth and family planning programs based on better needs assessment.
Aged Care
We anticipate an increase in demand for aged care residential services due to an ageing population, increased dependency of existing and future residents, and a limited capacity to increase bed numbers. A modified approach is needed if we are to better meet increasing demand pressures. It is proposed to:
Ø Develop partnerships with other providers regarding the use of available beds on an interim or respite basis. This includes a stronger link with Havilah Hostel.
Ø Investigate sources of Community Aged Care Package (CACP) and Extended Aged Care in the Home (EACH) packages.
Ø Increase the capacity of community based services for high dependency clients.
Ø Increase the capacity of community based service providers.
Ø Enhance dementia specific community programs.
Workforce
Key issues include the under-supply of GP’s in the catchment area, a chronic shortage of allied health professionals and the ageing of the nursing workforce. MDHS will need to look to innovative means of meeting the requirements of a skilled workforce within this difficult environment. It may prove to be one of the most significant challenges over the next five to ten years. Strategies include:
Ø Work with the community at large and the local Division of GP’s regarding a GP at Avoca.
Ø Recruit/train specialist nurse practitioners (or at least specially trained nurses) in Mental Health, Midwifery, Dietetics and Oncology.
Ø Develop processes for supplementing surgical and specialist physician capability at MDHS.
Ø Examine the feasibility of ‘sharing’ health care professionals with neighbouring providers.
A prolonged shortage of allied health professionals, particularly in podiatry, physiotherapy, psychology and dental health has led to service shortfalls. This reflects a shortage in rural Victoria generally, with recruitment and retention issues a major contributor. Strategies include:
Ø Explore innovative recruitment strategies with the Department of Human Services.
Ø Develop relationships with neighbouring health care providers, including shared appointment possibilities.
Ø Enhance RITCH program.
Partnerships and Alliances
Consistent with Department of Human Services policy, MDHS need to foster partnerships and alliances to better deliver services to the catchment population. This has been occurring, and should continue to evolve. Strategies include:
Ø Fostering a closer relationship with Bendigo Health regarding the provision of mental health services.
Ø Develop a cancer service in conjunction with Bendigo Health and the Loddon Mallee Integrated Cancer Service.
Ø Develop a relationship with other aged care providers, including Havilah Hostel, for aged care placements.
Ø Participate actively in the Community Renewal Program with the Department of Human Services who have identified Maryborough as a priority area for community renewal initiatives within the Loddon-Mallee region.
Ø Advocate for specific community transport services to alleviate transport system shortcomings.
Infrastructure
Due to recent capital redevelopments at all campuses, capital infrastructure is a strength of the organisation. However, information technology infrastructure needs to be upgraded to better exploit available technology and improve services. Currently all patient records are manual. Key strategies for the next five years include:
Ø Exploring the potential for computer radiology, picture archiving & communication systems, and a new radiology information system for medical imaging services at MDHS. Study the potential for online transmission of medical images to GP’s and radiologists.
Ø Assess all information technology and information management options, including the feasibility of single electronic record, electronic patient data capture devices and other emergent technologies.
Service Management
The perception of MDHS as an organisation within the broader community needs to be addressed. A lack of effective communication with key stakeholders was expressed during the service planning process. MDHS has recently adopted a more structured approach to service management, and has initiated processes to improve clinical governance structures. This process needs to be supported and further developed. Key strategies include:
Ø Developing communications strategies to enable more open and transparent provision of information with stakeholders and the community. This initiative includes the formation of community consultation groups in each town, forums and a service directory.
Ø Develop a performance monitoring framework based on the ‘balanced scorecard’ approach.
Ø Periodic review of progress toward implementing this strategic services plan.
Ø Develop a clear and demonstrable clinical governance framework including clinical audits, incident reporting and credentialing and privileging.
Ø Reassess admittance and discharge procedures.