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Northern Territory Department of Health Library Services Historical Collection
HISTORICAL
5COLLECTION
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Annual Report
Royal Darwin Hospital Management Board
Year Ending 30 June 1996
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Royal Darwin Hospital Management Board
All correspondence: • Chairman PO Box 41326 Casuarina NT 0811 • Tel: (089) 22 8180 • Fax: (089) 22 8870
10 October 1996
The Hon. Denis Burke GPO Box 3146 DARWIN NT 0801
Dear Minister
Please find attached a copy of the 1995/96 Royal Darwin Hospital's Annual Management Board Report.
Due to the fact that in recent weeks, two Board Members have been unavailable, the report has not yet been formally ratified. This, however, will occur at the Board Meeting scheduled to be held on 21 October 1996.
YOU S faithfully
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CENTRAL LIBRARY 2 3 OCT 1998
TERRITORY HEAL TH SERVICES
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ANNUAL REPORT
ROY AL 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 of the Royal Darwin Hospital during the 1995/96 financial year.
CHAIRMAN'S COMMENTS
The 1995/96 year has been a time of particular challenge. Increased demands for services and continued high occupancy rates have placed staff and resources under considerable pressure.
However, the challenge has been met with significant increases in patient throughput and a further lowering of average occupancy times. The efficiencies that have been gained are gratefully recognised by the Board as attributable, in large measure, to the dedication and efforts of the hospital staff.
While the Board is committed to responsible and accountable financial management, it also acknowledges that increases in services and throughput, result in associated increases in the cost of staffing and consumables. Further, developments and advances in technology, and the need to repair and replace equipment, all contribute to further costs. In addition, the random element of acute emergency and trauma admissions, makes the task of prediction exceedingly difficult. While many such costs may be offset to an extent through efficiencies in throughput and length of stay, the Royal Darwin Hospital has continued to operate in a climate of tight financial restraint.
The achievement ofDivisionalisation and devolvement of management and financial accountability to the clinical areas is seen as a most positive change, presenting a structural reform that will drive further improvements in efficiency to be delivered. The planned introduction of Casemix and Output Based Funding from 1 July 1996 is also a key change for the Hospital and should provide a valuable source of information for the management decision-making and planning for the Royal Darwin Hospital.
The Board and Management see the program of developments in technology, (both in information systems and initiatives including introduction ofTelemedicine), together with the establishment of the Clinical school critical to the future of Top End Health Services and the Royal Darwin Hospital. The Royal Darwin Hospital remains committed to delivering 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 contributed to making the vision and goals of the Hospital a reality for the benefit of all Territorians.
1. OPERATION OF THE BOARD I.I.I COMPOSffiON
The composition of the Board for the year was:
Mr Peter Owen Dr Len Notaras Mr Peter Fisher Mr Kevin Davis Dr Ian Humphrey Ms Sandra Smiles
1.1.2 CHANGES
Chairman
Secretary/General Manager Member
Member Member
Executive Director Patient Care and Nursing Services
Changes to the Board during the year included:
Dr Len Notaras was appointed General Manager of Royal Darwin Hospital in November, 1995.
Ms Maisie Austin commenced as a member of the Board in October 1995 and tendered her resignation with regret in January 1996. Ms Austin's contribution to the Board was acknowledged.
Ms Judy Giarola, ceased as Royal Darwin Hospital Director of Nursing Board Member in July 1995 and Ms Sandra Smiles, Executive Director Patient Care and Nursing Services
commenced duties with the Board in August 1995.
Dr Ian Humphrey retired at the end of his term as a member of the Board, and was formally thanked for his valuable contribution .
. 1.2 BOARD MEETINGS
Board meetings were held on a regular monthly basis. Due, however, to the resignation and retirement of Ms Austin and Dr Humphrey, some inconvenience was experienced in achieving quorum. The Board is hopeful, however, that replacement members will soon be identified and appointed.
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 Surgery 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.
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1.3 ANCILLARY BOARD ACTIVITIES
The Board established a working party [Mr Peter Owen, Mr Kevin Davis, Dr Len Notaras and two Departmental representatives] to view Accreditation Standards and examine aspects and responsibilities under the Hospital Management Board Act 1980.
Chairman of the Board Mr Peter Owen participated as a member of the interview panel for the position of General Manager in October 1995.
Three important sub-committees report to the Board :
The Royal Darwin Hospital Patient Care Committee;
The Aboriginal Health Care Committee; and
The Specialist Medical Appointments and Credentialling Committee.
Board Members also consulted with the group conducting the Top End Master Development Plan - Silver, Thomas, Hanley.
Board Members Mr Peter Fisher and Dr Ian Humphrey attended the AHA Congress.
The Board has also established a close working relationship with the Board of the Darwin Private Hospital. Several joint meetings have already been held, the first being attended by the Minister for Health, the Honourable Mr Fred Finch. The purpose of the relationship is to identify mutually beneficial efficiencies and enhance the quality and range of services, while minimising unnecessary duplication.
1.4 ROYAL DARWIN HOSPITAL AUXILIARY
The Royal Darwin Hospital Auxiliary once again provided invaluable support to the Hospital through fund raising and voluntary activities.
1.5 HOSPITAL INSPECTIONS
The Hospital Inspection Protocol adopted in 1993 was continued. In November 1995, the Board examined a proposed three year cycle of visits, allowing each department to be visited over the membership of each Member of the Board (three years).
Inspections ofHospital facilities during 1995/96 included Social Work, Aboriginal Liaison Unit, Same Day Care Unit and the new Renal Unit. Each inspection consisted of an information and fact finding visit to the Department, followed by discussions with the staff The visits precede the monthly Board Meeting and formed an important element in the maintenance of Quality Assurance in the Hospital.
1.6 INFORMATION SESSIONS
The information transfer initiative introduced in 1995 continued through the year. Specialist officers from areas including Quality Assurance and Hospital Accreditation and Surgical Waiting List management, briefed Board Members - answering questions and seeking advice.
Board members have also attended information sessions on the principals and implementation ofCasemix based funding, and were fully briefed by consultants from the Deloitte Group.
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:
Variety Club of Australia, Northern Territory Division Noonamah frog races
Vending machine proceeds Private Practitioner Trust Funds Finniss River Charity Picnic Race Day Renal Ball
Stems Jewellers
Sitzler Bros (Darwin) Pty Ltd
Harley Owners Group: NT Darwin Chapter
At the Board's direction, contributions were made to a range of initiatives including:
Visit by Professor Alan Walker to Canada
Australia Quality Council "E-team" Project, involving secondary school students Public Liability Indemnity Insurance for staff using the Hospital Gymnasium Special Care Nursery
High Dependency/Oncology Unit in the Refurbished Ward 5B Microscope purchase for the Pathology Department.
As part of the 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 disbursements made by the Board during the year included funding the attendance of a variety of conferences for nursing, medical, allied health and administrative staff. The Board also continued to administer funds held by the Private Practice Trust Fund. 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 Tenggara Timor Province, Indonesia. The program of successful exchanges involving medical and nursing staff from all three hospitals continued during the year.
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During the year, income amounted to $306,500, of which $96,123 was received by way of grants and a further $137,206 from various donations. Expenditure for the year totalled
$133,897.
The financial accounts for the year ended 30 June 1996 have been audited by Horwarth, Gamble and Partners.
2.0 OPERATIONS OF THE ROYAL DARWIN HOSPITAL [RDB]
The Royal Darwin Hospital remains the principal Acute Care and Tertiary Referral Hospital in the Northern Territory. The Hospital services a population in excess of 130,000 with 289 designated acute care beds, and continued in its role, retrieving patients from the northern- most areas of Western Australia and the Southern Provinces of Indonesia. Through the year, Royal Darwin Hospital experienced a time of unprecedented demand for services. More than 85% of all admissions were unplanned acute admissions, a factor that had a significant impact upon budget and service planning.
The Royal Darwin Hospital is committed to the concept of "best practice" and the provision of readily assessable Acute and Trauma services, as well as select Tertiary and Specialist
Secondary Services. The Hospital is dedicated to a policy of "cultural awareness", "continuous improvement" and "service effectiveness", delivered within a quality framework.
Royal Darwin Hospital continued close links with the Menzies School of Health Research, participating in a variety of research projects.
1995/96 saw the retirement of Professor Alan Walker as Head of Paediatrics and former Medical Superintendent. Professor Walker will retain a close working relationship with Royal Darwin Hospital, following his appointment as Clinical Dean of the new Northern Territory Medical School.
Specialties represented at the Royal Darwin Hospital include general surgery, medicine, obstetrics and gynaecology, nephrology, rehabilitation, ear nose and throat, ophthalmology, dermatology, plastic and reconstructive surgery, paediatrics, psychiatry and orthopaedics.
Some specialty services are delivered on a visiting basis by interstate consultants including cardiology (adult and Paediatric), neurology, neurosurgery, oncology, urology, podiatry and rheumatology. Clinics are conducted in pain management; for sleep disorders; prosthetics;
orthotics and for maxillofacial problems.
In January 1996, Darwin Urban Mental Health Services became a Division of the Royal Darwin Hospital. The purpose of this integration, was to enhance the clinical presence of the Division, while preserving its' unique service objectives, as outlined in the National Mental Health Strategy.
A range of diagnostic radiology facilities, including magnetic resonance imaging and pathology services, supplement and support speciality services. Hyperbaric, reproductive medicine and nuclear medicine facilities are also available.
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 continues to be well recognised nationally and placements have tended to be competitive.
2.1 HOSPITAL EXPENDITURE Expenditure (SOOO's)
Personnel Expenses Operational Expenses Capital Equipment Total
2.2 HOSPITAL STATISTICS Authorised Beds (end of year) Occupied Bed Days
Average Daily Occupied Beds Average Length of Stay (days) Separations for the Year Surgical Cases
*Waiting List Elective Surgery
1993/4 43,568 18,764 603
$62,935
281 80,652 221 5.80 13,849
5,723
1994/5 48,197 21,725 1,022
$70,944
290 94,853
260 5.10 20,022 6,574 2,074
1995/6 51,620 23,583 629
$75,832
289 96,092 270 5.02 25,590
8,224 1,144
(* Census on Patients on Elective Surgery Waiting Lists as at 30 June 1995 and 30 June 1996) 2.3 IDGBLIGHTS AND ACHIEVEMENTS
During the year a number of significant clinical highlights were achieved - all contributing to the Royal Darwin Hospital's status as "a centre of clinical excellence". Among the highlights were:
• The Casemix Implementation project continued as a priority in 1995/96, with the Hospital allocating resources to facilitate its scheduled introduction from 1 July 1996. The
requirement for coding of Diagnostic-Related Group (DRG) data will provide a key source of information for measuring and assessing future performance of the Hospital's services.
• Royal Darwin Hospital completed the change from centralised service delivery to a Divisionalised structure with the establishment of a Division of Medicine, Division of Surgery, Division of Maternal and Child Health and Division of Mental Health Services.
The impact of devolvement of accountability and greater autonomy to the Divisions was reflected in efficiency gains and greater throughput of patients during the year. Increased efficiencies through Divisionalisation and work practice improvements resulted in a saving of approximately $2m in nursing services in 1995/96.
• The Hospital continued initiatives in 1995/96 to attract and recruit highly credentialled and nationally/internationally recognised Specialist staff. Successful action included
appointment of the Head of Paediatrics/Head of the new Maternal and Child Health Division, Dr David Brewster, and also the Director of Microbiology, Dr Garry Lum.
• Overall 1995/96 separations increased by 5,568 to a total of25,590. Bed utilisation through the year remained high, with an average 95% occupancy.
• In November 1995, the Minister opened a new Pre-admission clinic and Same Day Procedure Unit on the eighth floor of the hospital, an initiative which resulted in a substantial increase in the number of same-day surgical cases performed.
• During 1995/96 a total of8,224 operations were carried out, an increase of 1,650 or 25%
on the previous year.
• During the year, an audit of the Surgical Waiting List was conducted resulting in a significant reduction in the number of people waiting for elective surgery. This, together with an increased surgical throughput has resulted in a 61 % reduction in the number of patients waiting for General Surgery, Oral Maxillary Facial Surgery and Orthopaedic Surgery. The Board continues to play an active role in the monitoring of waiting list management, and is committed to further efficiencies and reductions.
• During the year, the strategy of appointing an additional Ear, Nose and Throat Surgeon for a limited tenure, succeeded in reducing the number of patients awaiting surgery in that speciality by more than 100, while a concerted approach to Eye Surgery, reduced the Ophthalmology waiting time to less than four weeks.
• The Hospital achieved a further decrease in average length of stay for patients from 5. 9 days in 1993/94, 5.6 days in 1994/95 to 5.0 days in 1995/96. The Self-Care Centre/Step- down facility became fully operational in 1995/96.
• Consultancy firm Deloitte, Touche, Tohmatsu was engaged by Territory Health Services to examine the efficiency in services provided by all Northern Territory Hospitals. The Consultants are expected to hand down their findings in October 1996.
• Overall non-inpatient activity rose by 5% in 1995/96, with increasing activity in Specialist consultations, Accident and Emergency and Allied Health.
• On 19 March 1996, agreement was reached between the Finders University of South Australia and the Northern Territory Government to establish a Clinical School at Royal Darwin Hospital. The IO year agreement has set the basis for doctors to be trained locally, gaining expertise in treating the range of medical conditions presented in patients in the Northern Territory. Students will commence in 1998. Professor Alan Walker was appointed as Clinical Dean in February 1996.
• On 1 July 1995 the Darwin Renal Dialysis unit at Nightcliff combined resources with a 10 bed ward in the Hospital, the latter equipped with 6 dialysis machines and capacity for a further 4 machines. The change achieved a closer integration of services and increased quality of patient care through appointment of a full time Nephrologist, Dietitian (part time), Aboriginal Liaison Officer and Social Worker. 1995/96 admissions totalled 6,212, on a par with the previous year.
• A 'Telemedicine' video conferencing facility at the hospital was installed in 1995/96 to assist in the clinical case management of cancer and breast cancer patients, allowing the Hospital to access a team of Oncology Physicians and Specialists at the Royal Adelaide Hospital. The link was installed in March 1996, with trials commencing in April 1996.
Annual savings to the Northern Territory once the facility is fully operational (providing cancer, mental health, plastic surgery and neurosurgical conferencing) are estimated at
$140,000 for Territory patients who would otherwise need to access the PATS program (Patient Assistance Travel Scheme) to travel interstate for consultation and treatment.
• With relocation of allied health services from Parap to Royal Darwin Hospital in June 1995 and the opening of an 8 bed rehabilitation ward, full inpatient and outpatient rehabilitation services were delivered in 1995/96 on the Hospital campus. Demands for services were heavy, with Rehabilitation service output for the year reporting an increase of300%. The Rehabilitation ward bed average occupancy rate through 1996 remained in excess of 95%.
• In September 1995, the Minister opened a new Birthing Suite and Special Care Nursery, making available improved services and facilities for patients of the Maternal and Child Health Division.
• The Quality Assurance program continued to develop, with widespread adoption of the Continuous Quality Improvement methodology. This provided a significant contribution to achievement of efficiencies and improvements in work practices across the hospital through the year. Work towards ACHS accreditation proceeded as a high priority in the Hospital.
• Major upgrades to the Hospital Information Systems and "CareSys" were achieved during the year facilitating greater access to and increasing the availability of accurate information on the operation of the Hospital.
• In January 1996, a Trauma Response Team was established in the Emergency Department to enhance emergency treatment for patients and provide on-site staff education. The initiative saw appointment of a full time Trauma nurse. 1995/96 also saw completion of a review of security facilities in the Emergency Department, resulting in significant
improvements in the security features and procedures in the area.
• The fire safety upgrade of the main ward block and the ward refurbishment program continued throughout the year.
• The Hospital celebrated its 15th year anniversary on 19 September 1995 with a lunchtime barbecue for staff The Hospital Management Board supported establishment of an
"Employee of the Year" Award, to be awarded annually on the anniversary of the hospital.
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2.4 MANAGEMENT
Dr Len Notaras was appointed as General Manager in June 1995, retaining additional responsibilities as the Hospital Medical Superintendent.
Ms Sandra Smiles, formerly of Adelaide, was appointed as Director ofNursing in July 1995. She subsequently took up appointment as the Hospital's Executive Director, Patient Care and Nursing Services and Deputy General Manager.
2.5 MEDICAL DMSION
Dr Paul Snellingjoined the Hospital staff as the Top End's first full time Staff Specialist in Nephrology in February 1996.
Dr Wendy Hoy was appointed in September 1995 as a part time community renal consultant, to address the increasing rates if renal disease.
Appointment of a Senior Rotating Registrar was approved by the Royal College of Radiologists, to commence in 1997.
2.6 SURGICAL DMSION
Dr Martin Carter, formerly from England and more recently a Colonel with the British Army of the Rhine, was appointed as a full time Staff Specialist in Anaesthesia in October 1995. Dr Alison Mccready, also joined the staff as a part-time Staff-Specialist Anaesthetist.
Dr David Amies was appointed from Canada as a full time Staff Specialist in Ophthalmology in September 1996.
Mr Patrick Bade replaced Dr Gamel Mousa in February 1996 as a visiting Surgeon.
Mr Nick Newman, a recent specialist graduate, was appointed in February 1996 as Australia's first rural surgical trainee through an initiative funded by the Commonwealth Department of Health and Family Services.
Mr Ross Kennedy was appointed as a part time staff specialist in Orthopaedics in September 1995.
Dr Robin Cripps, a long serving Orthopaedic Registrar with the Royal Darwin Hospital, was granted a full Fellowship from the College.
2. 7 MA TERN AL AND CHILD HEAL TB DMSION
During the year, a Specialist Laparoscopic Teaching Team visited from the King George V hospital, Sydney.
The Maternal and Child Health wards completed fire upgrading and refurbishing~ Bed sized cots were purchased in the Paediatric area, improving the comfort of mothers while tending to their infants.
The Division continued to progress negotiations with the Northern Territory University for a Neonatal Intensive Care Course to address the shortfall of skilled Neonatal Intensive Care Nurses at the Hospital.
Dr David Brewster, formerly of Newcastle, NSW and more recently from Malawi, Africa, a highly respected and credentialled academic, joined the Hospital in January 1996 to take up the position of head of Paediatrics and Head of the Division of Maternal and Child Health.
Dr Andrew Miller, a Specialist in Obstetrics and Gynaecology, and formerly of the John Hunter hospital in Newcastle, NSW, joined the staff as a part-time specialist.
A rural "out-reach" program was successfully trialed, with registrars and specialists from the hospital visiting remote communities.
2.8 OTHER CLINICAL AND SUPPORT SERVICES
Dr Jock McLaren ceased employment as the Senior Psychiatrist and Clinical Head of Mental Health Services in June 1996, after many years service in the Northern Territory. Dr Trish Nagel was appointed in June 1996 as a full time Specialist.
Dr Alex Firouz Abadi and Dr Noel Tan joined the Histopathology Department as full time Senior Staff Specialists in April 1996 and January 1996, respectively.
2.9 QUALITY PROGRAM
The Hospital Quality Committee, as the Committee responsible for the co-ordination and oversight of Quality Improvement Program within the Hospital, continued to be active through the year.
1995/96 has seen the Quality Program continue to grow. All patient care and support services are directly involved in a number of well-documented activities and have established Quality plans. The focus has remained upon moving to measured outcomes, with the introduction of Casemix/Output based methodology. Plans to achieve full Hospital accreditation will take place in 1997.
PETER OWEN Chairman
Royal Darwin Hospital Management Board
