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Northern Territory Department of Health Library Services Historical Collection
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Annual Report
Royal Darwin Hospital Management Board
Year Ending 30 June 1995
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Royal Darwin Hospital Management Board
AJ/corrupondencs: • ChaitmB{J PO Box41326 Casuarina NT0811 • Ts/: (089) 22 8180 • Fax: (089)22 8870
18 October 1995
The Hon Fred Finch, ?vfLA Minister for Health Services GPOBox3146
DARWIN NT 0801
Dear Minister
I have pleasure in submitting the Annual Report of the Royal Darwin Hospital Management Board for the year ending 30 June 1995, in accordance with Section 25 (1) of the Hospital Management Boards Act.
Yours sincerely
Dr Len Notaras Secretary
Royal Darwin Hospital Management Board
CENTRAL LIBRARY
2 3 OCT 1998
TERRITORY HEAL TH SERVICES
ANNUAL REPORT
ROYAL DARWIN HOSPITAL MANAGEMENT BOARD 1994/95
This report has been compiled in accordance with Section 25 of the Hospital Management Boards Act 1980 and is a report on the operations of the Board and of the Royal Darwin Hospital during the 1994/95 financial year.
1. OPERATION OF THE BOARD
1.1.1 COMPOSITION
The composition of the Board for the year was:
Mr Peter Owen Mr Peter Fisher Mr Kevin Davis Dr Ian Humphrey Dr David Douglas Dr Leonard N otaras Mrs Judy Giarola
1.1.2 CHANGES
Chairman Vice Chairman Member Member
Secretary/General Manager Medical Superintendent Acting Director of Nursing
Changes to the Board during the year included:
The Board acknowledged the resignation, due to ill health, of the former Chairman, Mrs Christine Nathanael. Mrs Nathanael resigned from the Board in July 1994, having served as a Board Member since July 1991 and as Chairman of the Board from April 1993. Mrs
Nathanael's valuable contribution to the Board and to the Royal Darwin Hospital was acknowledged with the presentation of a plaque by the Minister for Health on 10 July 1995.
Dr David Douglas ceased to be Secretary of the Board in June 1995, following his redeployment in that month. Dr Douglas had been Board Secretary for two years, and appreciation of his contribution to the Hospital and the Board was conveyed officially by the Chairman.
Ms Jane Hogan, formerly Royal Darwin Hospital Director of Nursing, left the Hospital to take up an Acting appointment as Northern Territory Principal Nursing Consultant in October 1994, and was replaced on the Board by Acting Director of Nursing Mrs Judy Giarola.
Dr Leonard Notaras commenced duties with the Royal Darwin Hospital as Medical Superintendent in October 1994. In June 1995, Dr Notaras became Board Secretary, in his capacity as Acting Hospital General Manager.
The Board gratefully acknowledges Dr Malcolm Dunjey's six month contribution as Acting Medical Superintendent prior to October 1994. Dr Dunjey has since returned to his position as Chief Medical Officer for the Northern Territory.
1.2 BOARD MEETINGS
Board meetings were held on a regular monthly basis. Detailed reports were received at each meeting from Finance, Nursing and Medical Services. Management Board Trust Account statements were tabled at each meeting. Royal Darwin Hospital statistics, including the status of Elective Surgical Waiting Lists; hospital through-put; and overall hospital performance were critically reviewed and analysed. The minutes of the meetings of the Hospital Management Boards of other Northern Territory Hospitals were also received.
1.3 ANCILLARY BOARD ACTIVITIES.
In 1994, Board Members Mr Peter Fisher and Ms Jane Hogan attended the Australian Hospital Association Congress in Canberra. The Chairman of the Board, Mr Peter Owen, was actively involved throughout the year in the Work Health Review Committee. The Board was also represented on the Royal Darwin Hospital Patient Care Evaluation Sub Committee [Mr Peter Owen Chairman]; the Joint Institutional Ethics Committee of the Royal Darwin Hospital and the Menzies School of Health Research; the Counter Disaster Committee; the Royal Darwin Hospital Trust Fund Administrative Committee; and the Finniss River Fund Raising Committee.
Board Members have also consulted, on a number of occasions, with the group conducting the Top End Master Development Plan - Silver, Thomas, Hanley.
A number of joint meetings were held during the year with the Board of the Darwin Private Hospital. The Minister for Health, Mr Fred Finch, attended the first meeting, and the outcome of this unique initiative promises mutual benefit to both parties.
1.4 ROYAL DARWIN HOSPITAL AUXILIARY
The Royal Darwin Hospital Auxiliary again provided invaluable support to the hospital through fund raising and voluntary activities. Fund raising activities included the 5th Apnual Finniss River Station Charity Picnic Day; a Fashion Parade at Government House; and a Gala Fete.
Contributions have been made to the refurbishment of the Paediatric Isolation Ward and to Ward 4B with the generous donation of a television.
1.5 HOSPITAL INSPECTIONS
The Hospital Inspection Protocol adopted in 1993 was continued. Throughout the year, Board Members regularly inspected a variety of hospital facilities including Pharmacy, Paediatrics, Radiology, Rehabilitation, Social Work, and the Aboriginal Liaison Office. The Inspection Program allows for each Department to be visited over the membership period of each Member on the Board, that is, every three years. The inspections consist of an information and fact finding visit to the Department, followed by discussions with the staff. The visits, precede the monthly Board Meeting and are an important element in the maintenance of Quality Assurance in the Hospital.
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1.6 INFORMATION SESSIONS
A new information transfer initiative was introduced during 1995, improving Board Member's participation in day-to-day hospital activities. Specialist Officers from areas such as Quality Assurance and Hospital Accreditation, Surgical Waiting List management, briefed Board Members - answering questions and seeking advice.
The Minister for Health formally met with the Board Chairman and Vice Chairman on a regular basis, as did the Secretary for Health, and the Regional Director - Operations north. Such attendance provided an invaluable opportunity for the initiation of action and information transfer.
1.7 MANAGEMENT BOARD TRUST ACCOUNT
The Trust Account is operated by the Board for the purpose of accepting donations and sponsorships and raising funds for such purposes within the Hospital as are approved by the Board. During the year, the Board accepted donations from members of the public, local charities and Service Clubs. Funds were also raised from a wide range of activities including:
Noonamah frog races Vending machine proceeds Private Practitioner Trust Funds
Finniss River Cup Charity Picnic Race Day Harley Owners Group: NT Darwin Chapter At the Board's direction, significant contributions were made to:
The Nationally acclaimed Paediatric Isolation Ward 7B Mural Project;
The provision of a state-of-the-art Twin Headed Pathology Teaching Microscope;
Refurbishment of Ward 4B;
The provision of hospital teaching and educational aids - such as over-head projectors.
As part of an existing agreement with the University of Sydney to enable final year medical students to carry out their Rural placement in Darwin, the Royal Darwin Hospital Management Board, in conjunction with the Warden of Clinical Studies, continues to administer funds provided and donated for the purpose of student travel and placement.
Other fund disbursement made by the Board during the year included funding the attendance at a variety of conferences for nursing, medical, allied health, and administrative staff. The Board also continues to administer funds held by the Private Practice Trust Fund, and this financial year significant contributions were made by Dr TT Lee for the purpose of establishing a fully furnished grieving room within the hospital; Dr Rao for the continuing purchase of ENT equipment for Top End Hospitals; and Dr KC Lee for the purpose of establishing covered car- parking.
Through the administration of the Trust Fund, the Board continued to assist in the development of the Sister Hospital Relationship with the Professor Johannes Hospital in Kupang and the Soe Hospital in Soe, Nusa T enggara Timor Province, Indonesia. There were a number of successful exchanges involving doctors and nurses from all three hospitals.
During the year income amounted to $199532.27 of which $63699.00 was received by way of grants and a further $60,922.00 from various donations. Expenditure for the year totalled
$177,771.74 of which $115,288.96 was allocated for the purchase of equipment, the mural project in ward 7B and other items as mentioned above.
The financial accounts for the year ended 30 June 1994 have been audited by Howarth Gamble and Partners.
2.0 OPERATIONS OF THE ROYAL DARWIN HOSPITAL [RDH]
The Royal Darwin Hospital remains the principal Acute Care and Tertiary Referral Hospital in the Northern Territory. Serving a Top End population in excess of 120,000 with 265
designated acute care beds, and retrieving patients from the northern most part of Western Australia and the Southern Provinces of Indonesia, the Royal Darwin Hospital has experienced a time of growth and unprecedented clinical development.
The Royal Darwin Hospital is committed to the concept of "best practice" and the provision of readily accessible, Acute and Trauma Services, as well as select Tertiary and Specialist
Secondary Services. The Hospital is dedicated to a policy of "cultural awareness", "service effectiveness", and "improved outcomes" provided within a quality framework.
Throughout the year, the Hospital continued its long association with the University of Sydney and received a number of senior medical students undertaking a variety of terms and studies.
The secondment is well recognised nationally, and placement has tended to be competitive.
2.1 IDGHLIGHTS AND ACHIEVEMENTS
During the year, a number of significant clinical highlights occurred - all contributing to the Royal Darwin Hospital's status as "a centre of clinical excellence". Amongst the highlights were:
The opening in November 1994 of the Royal Darwin Hospital Self Care Unit - a Urut that has proved invaluable in providing continuing care for those not able to immediately return home upon discharge from hospital;
Successful recruitment of nine highly credentialed senior specialists to the full time staff of the Royal Darwin Hospital;
The opening in June 1995 of an on site In-Patient and Out-Patient Rehabilitation Unit, directed by a highly credentialed and respected Medical Rehabilitation Specialist and employing a team of expert Allied and ancillary Health Workers;
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Consolidation of Top End Renal services - including the Nightcliff Dialysis Service - under RDH management, and preparation for the establishment of an on site, ten bed Renal In-Patient Unit;
Close liaison and co-operation with Aboriginal and Community Service groups;
Successful negotiations with representatives of the Indonesian Government, with a view to extending the existing "Sister Hospital link" to include the treatment of compensable patients;
Developing improved relations with the Menzies School of Health Science and the Northern Territory University;
Facilitation of the establishment of a Graduate Clinical School on the RDH site, intended to train and graduate local Territory medical practitioners;
Implementation of a formal, Divisionalised Management Structure, designed to improve clinical services and enhance efficiency. Management responsibility is systematically being devolved to three broad Units - Surgery, Medicine, and Child and Maternal Health;
Improved clinical relationships with Community Services and other Top End Hospitals;
Preparation for the establishment of a comprehensive Same Day Surgical Facility in the
area of Ward 8A; ·
Opening of the Nationally acclaimed, refurbished Paediatric Isolation Ward, with its culturally unique Aboriginal theme mural;
Development of a Corporate Pathology plan that will link pathology facilities housed at the RDH with those of other centres, creating efficient economies of scale;
Establishment of a highly successful Patient Complaint facility, enabling patients, not only to air grievances, but to achieve speedy resolutions of outstanding issues.
2.2 MEDICAL SERVICES
All major specialties are now represented on-site at the Royal Darwin Hospital - Surgery, Medicine, Paediatrics, Obstetrics and Gynaecology, Medical Imaging, and Pathology. Over the year, more than twelve new specialists joined the hospital staff in areas including - Surgery, Orthopaedics, Medical Administration, Rehabilitation Medicine, Obstetrics and Gynaecology, Anaesthetics, ENT, and Accident and Emergency, with others still to arrive in Paediatrics, Pathology, Obstetrics and Gynaecology, and Nephrology.
Visiting Interstate Services have also been extended in an effort to provide T erritorians with an appropriate comprehensive range of accessible clinical services. These extended services include: Cardiology [adult and paediatric]; Neurology; Paediatric General and Orthopaedic Surgery; Neurosurgery; Urology; Oncology; IVF; Rheumatology; and
Plastic/Reconstructive Surgery.
It is envisaged that the development of such on-site services will ultimately limit the need to transfer patients away from Darwin, thus reducing costs and enhancing continuity of care.
The Hospital, along with the Department, has remained committed and sensitive to the work- practice needs of Junior Medical Officers. The success of this commitment is reflected in the recent Medical Officer Award negotiations carried out in Darwin.
2.3 ·NURSING SERVICES
The Royal Darwin Hospital Nursing Service consists of 472 Full Time Equivalent [FTE] staff to service 290 authorised beds (265 Acute Beds), operating theatres, the emergency department and out patients department. A Nursing outreach service to the Self Care Unit is provided.
To accommodate the hospital specialty areas, the Nursing Service has focussed on professional development in areas such as Renal, Neo-Natal Intensive Care, Adult and Paediatric Intensive Care, Radiology and Hyperbaric Medicine.
Professional development services have been supplied to Katherine, Gove, Geelong (Victoria), top end of Western Australia, Indonesia, Batchelor College, St Johns Ambulance, Northern Territory University and Community Care.
The Nursing Service at Royal Darwin Hospital has a commitment to Quality Health Care and to Total Quality Improvement whilst considering cost efficiencies. This is reflected in the Nursing Service's active participation in the development and implementation of the Divisionalised Management Structure which aims to further enhance patient care.
The Nursing Service said farewell to Ms Jean McMillan who retired in April 1995 after 23 years of valued service at Royal Darwin Hospital. Jean is wished well in her retirement.
The Board also expresses its' sincere gratitude to Mrs Judy Giarola for her tireless work throughout the year as Acting Director of Nursing at the Royal Darwin Hospital.
2.4 QUALITY PROGRAM
The Hospital Quality Assurance Steering Committee, as the Committee responsible for the co- ordination and oversighting of Quality Assurance activities within the hospital, has continued to be active over the year.
Throughout the year, the Hospital's Quality Assurance Program has continued to grow. All patient care and support departments are directly involved in a number of well documented activities and have set in place Quality Assurance Plans. The focus remains upon shifting to measured outcomes, a fact well demonstrated by the success of a number of patient and staff satisfaction surveys. Plans remain for full Hospital Accreditation within the next two years.
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2.5 STAFF CHANGES
A number of staff changes have occurred during the financial year 1994/95.
Management
Dr Leonard Notaras took up appointment as Medical Superintendent in October 1994, replacing Acting Medical Superintendent, Dr Malcolm Dunjey who returned to his position as ChiefNorthem Territory Health Officer.
Dr David Douglas, General Manager for the two years prior, left that position, and was temporarily replaced by the Medical Superintendent in an Acting capacity.
Obstetrics and Gynaecology
Dr TT Lee, after almost 30 years of valuable service retired as a full time Hospital Specialist.
Dr Henry Cho, formerly of Newcastle NSW, was appointed full time Staff Specialist in Obstetrics and Gynaecology and Head of Department.
Surgery
Dr Peter Riddell, one of Australia's leading Surgical Trauma Specialists, moved from Adelaide to take up a full time staff appointment at the Royal Darwin Hospital. Mr Riddell was later appointed Head of the Surgical Department.
Regretfully, Dr Gamel Mousa announced an intention to resign, and will be much missed as a clinician who has made a selfless contribution to the Hospital's Surgical Services.
Rehabilitation
Dr Howard Flavell joined the Royal Darwin Hospital full time staff as the Top End's first resident Rehabilitation Specialist. As Director of the Royal Darwin Hospital's Rehabilitation Unit, Dr Flavell has already made a valuable contribution to patient care. ·
Orthopaedics
Dr Michael Fleming joined the Hospital Staff as a part time staff orthopaedic specialist,. and congratulations were warmly extended to long time Territory doctor, Mr Robin Cripps who was recognised by the College of Orthopaedic Surgeons as holding Specialist Status.
Emergency Medicine
Dr Vijey Selvarajah joined the staff of the Royal Darwin Hospital as Director of the Hospital's Emergency Department, and the Top End's first resident Emergency Specialist.
Anaesthetics
Dr Kristian Mroz, and later Dr Alison McCready joined the anaesthetic staff of the Royal Darwin Hospital.
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2.6 HOSPITAL EXPENDITURE Royal Darwin Hospital
Expenditure ($000's) 1992/93 1993/94 1994/95
Personnel Expenses 44,965 43,568 48,197
Operational Expenses 18,982 18,764 21,725
Capital Equipment 685 603 1,022
Total 64,632 62,935 70,944
While the hospital's initial historically based budget allocation of $65,121,000 for 1994/95 was increased at First Budget Review to accommodate an annual expenditure of $70,944,000, the year was one of sustained growth and clinical development -growth and development logically associated with an overall increase in service cost.
A substantial increase was recorded in the number of acute care separations - as compared to the previous financial year. Clinical services were significantly expanded with the recruitment of a number of senior specialists. During the year, there was a 13% increase in the number of operations preformed at the Royal Darwin Hospital, a strategy designed to reduce elective waiting lists, and a similarly impressive increase occurred in the number of admissions.
CHAIRMAN'S COMMENTS
The year 1994-1995 has been a time of development and changes which have occurred both within the Royal Darwin Hospital, and without. The Northern Territory Department of Health and Community Services, has changed its name to Territory Health Services, and a new Secretary, Ms Katherine Henderson, replaced Mr Ray Norman earlier this year.
The pressure to deliver a wide range of expensive clinical services to an increasing patient population, has become the challenging focus for health providers in the 1990s:
Throughout the year, the Royal Darwin Hospital has performed extremely well, not only expanding the range of services, but also endeavouring to improve access to all services.
Clinical staffing is fast approaching optimal levels, and a real commitment exists to ensure that budgetary accountability is diligently observed.
With developments in technology, links with other local services, and the formation of the proposed Clinical School, the future for the Royal Darwin Hospital is most exciting. The Royal Darwin Hospital is committed to providing the highest clinical service available to the
population of the Top End and the Northern Territory as a whole.
The Board extends its appreciation to the management and staff, who have all contributed so willingly to this objective.
Chairman
Royal Darwin Hospital Management Board 9
Activity Statistics for the Hospital
ACTMTY STATISTIGS FOR ROY AL DARWIN HOSPITAL 1992/93, 1993/94, 1994/95
1992/93 1993/94 1994/95
AUTHORISED BEDS (end ofyear) 293 281 290
Occupied bed days 79 118 80 652 94 853
Average daily occupied beds 217 221 260
Patients in Hospital at end of year 214 239 251 Separations for the year 13 518 13 849 20022
Average length of stay (days) 5.9 5.8 5.1
BIRTHS
Non-premature 1366 1 382 1468
Premature 173 170 177
Still-births 16 18 12
DEATHS
On arrival 147 176 205
In hospital 173 204 204
Non-admitted 29 41 29
Autopsies 245 225 296
OPERATIONS
Major 2 376 2 372 2 478
Minor 3 537 3 351 4 096
Dental 0 37 0
OUTPATIENT CONSULTATIONS
AND TREATMENTS 75 988 71 724 72 721
RADIOLOGY
Inpatients x-rayed 11266 13 649 12 393
Outpatients x-rayed 24 776 25 517 25 994
PHYSIOTHERAPY
Inpatients 15 040 15 880 15 600
Number of treatments 19 468 20 158 18 717
Outpatients 7 427 7 697 7 258
Number of treatments 8 406 NIA 8 258
OCCUPATIONAL THERAPY
General Inpatients 2 944 1 998 TBA
General Outpatients 719 1 071 1642
Figures represent activity for acute general beds for Royal Darwin Hospital.
