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Northern Territory Department of Health Library Services Historical Collection
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Royal Darwin Hospital Management B~arp ,., r:..._~~~~
All correspondence: • Chairman PO Box41326 Casuarina NT0811 • Tel: (089) 22 8180 • Fax: (089) 22 8870
)_ ( October, 1992
The Hon Daryl Manzie, MLA
Minister for Health & Community Services DARWIN NT 0801
Dear Minister
RE: 1991/92 ANNUAL REPORT
Herewith find the 1991/92 Annual Report of the Royal Darwin Hospital Management Board.
Yours sincerely
g;. /
Secretary
Hospital Management Board
CENTRAL LIBRARY
2 3 OCT 1998
TERRIIORY H :TH SERVICES
ROYAL DARWIN HOSPITAL MANAGEMENT BOARD ANNUAL REPORT 1991/92
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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 Royal Darwin Hospital during the 1991/92 financial year.
1. OPERATION OF THE BOARD 1.1 Composition
In July 1991, Mrs Christine Nathanael and Mr Barry Ryan were appointed as members of the Hospital Management Board to fill existing vacancies. The composition of the Board remained constant throughout the year, enabling a cohesive approach to Board functions and responsibilities.
1.2 Areas of Responsibility
The concept of subdividing operational areas of the Hospital and allocating them specifically to appointed members was again adopted for the 1991/92 financial year, as follows:
Mr Richard Giles (Chairman)
Governing body and Management, Accident and Emergency Service, Medical staff organisation, Social Work services and Rehabilitation Medicine Services.
Mr Reg Lowry (Member)
Medical Records, Pharmacy Service, Occupational Therapy and Speech Therapy.
Physiotherapy,
Dr Gerry Goodhand (Member)
Mrs
Mr
Operating Theatre Service, Anaesthetic and Laboratory Services.
Christine Nathanael (Member)
Nursing Division, Special Care Nursery and Radiology Services.
Barry Ryan (Member)
Environmental Services, Dietary Services and Library Services.
1. 3 Information Services
During the year, Board members were kept informed of activities and developments throughout the Hospital on a monthly basis through the receipt of Committee minutes and functional area reports as detailed below:
i. Committees Ambulatory Care
Drugs and Therapeutics Infection Control Medical Records Operating Theatres ii. Reports
Finance Maintenance Nursing Security iii. Other
Minutes of meetings of Hospital Management Boards of other Northern Territory Hospitals
Royal Darwin Hospital Monthly Statistics
The Board wishes to acknowledge the assistance provided by staff members in the compilation of reports.
1. 4 Board Meetings
Board Meetings, which are held on a regular monthly basis, were generally well attended throughout the year. Additional meetings called for specific purposes included the submission of a paper to the Cresap Review and a joint planning meeting with the Hospital Executive Committee.
During the year a number of representatives of the Hospital staff and external organisations were invited to attend meetings to assist the Board on specific matters and topics of
interest.
1. 5 Major Issues and Areas of Board Involvement
During 1991, the Hospital Management Board undertook a major review of its role and function. As part of that review, Board Members together with Hospital Management visited several hospitals in Adelaide and the Hunter Valley region of New South Wales where they examined the structure of the Management Boards in those places. As a result, recommendations were made for a streamlined Committee Structure for ROH, with members of the Management Board having an active involvement on a number of Hospital Committees.
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All existing RDH Committees are to be disbanded from 1 July 1992, with all committees in the new structure charged with increased responsibilities as decision making bodies.
Cabinet Decision 7023 accepted the Cresap recommendation that "the powers of the Management Board of Royal Darwin Hospital be expanded to include financial management".
Following discussions with the Department on this matter, it was agreed that the Board could take on this responsibility under the existing Act, whereby the Board is empowered (under Section 22 (1) (a)) to give direction and advice on any matter relating to the operation of the Hospital. Section 22(b), which precludes the Board from giving "directions" in relation to staffing and financial matters, does not preclude the Board from giving advice.
Therefore, the expansion of the Board's powers were felt to be satisfied by Management Board representation on the Hospital Financial Services Committee.
Royal Darwin Hospital Auxiliary
The small, committed team comprising the Hospital Auxiliary are to be congratulated for their fundraising achievements during the year. Once again, functions such as the Melbourne Cup Luncheon, Fashion Parade at Government House, Games Days and the highly successful Finniss River station race weekend have proved very successful.
Funds raised by the Auxiliary have been channelled into necessary items to enhance the quality of life for patients during their stay in Hospital. This year, soft furnishings, wall paintings and other items have been donated for improvements to Ward 4A, the morgue viewing room, Orthopaedic Ward and Delivery Suite.
1. 7 Hospital Inspection
The Board conducted its inspection of the Hospital on 2 September 1992, accompanied by Mr Ray Norman, Secretary of the Department of Health and Community Services.
1. 8 Management Board Trust Account
The Trust Account is operated by the Board for the purposes of accepting donations and sponsorships and raising funds for such purposes within the Hospital as are approved by the Board. During the year funds were raised from a range of activities including: proceeds from Hospital Lottery;
Noonamah Hotel frog race; proceeds from vending machines;
Kiwanis Scholarship donation; Airductor donation towards quality assurance; Toshiba sponsorship of Hospital Ball.
Some of the fund disbursements made during the year were:
venetian blinds for Ward 2A; gymnasium equipment; framed prints for the first floor; funding attendance at various conferences for nursing, medical and administrative staff;
assistance with Sister Hospitals exchange programme.
2. OPERATION OF THE ROYAL DARWIN HOSPITAL (RDH) 2.1 Major Events and Activities
In line with Cabinet Decision 7023, work practices at RDH have been reviewed and modified producing a number of efficiencies designed to achieve savings. The majority of these decisions were implemented with a minimum of disruption to services and no industrial disputation.
While some difficulties have been experienced through the closure of one operating theatre and 10 acute beds from January 1992, Hospital management continues to monitor the situation in an effort to minimise the effects on patient care.
Faced with the challenge of maintaining a health service in a climate of reduced Government spending on health care, RDH will introduce a Unit Bed Management Program from July 1992 which is seen to be of paramount importance in achieving a more efficient utilisation of resources. The principles of the program involve the allocation of beds on an indi victual unit basis, giving Medical Specialists the overall responsibility for the management of their beds. The program was developed to address issues such as the increasing demand for hospital beds while reductions in Government funding result in bed shortages; frustration and inefficiency caused by inadequate bed management and late cancellation of elective surgery.
In preparation for the introduction of a form of casemix funding by the Commonwealth Government from July 1993, RDH is developing a data base to monitor trends in inpatient costs by Diagnosis Related Groups (DRG's).
Resources have been allocated towards establishing a cost model for ROH in addition to several other selected projects.
In May 1991, Management Consultants Campbell Associates undertook a major review of Pathology Services at RDH.
The Review report examined a number of issues including the efficiency and cost effectiveness of pathology services, the competitive strategy and relationship with private pathology providers, and the management structure and work practices of the Pathology Department. A Working Party has been charged with implementing the review recommendations.
Over the last 12 months, ROH has conducted a trial within the Paediatric Department of a decentralised clinical management structure. This structure is said to enhance cost effectiveness by placing greater decision making responsibility and financial acceptability where the majori~y of health care expenditure occurs with clinical departments. Depending on the evaluation of the trial in January 1993, decisions will be made regarding the introduction of this management structure throughout the Hospital.
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During 1991/92, Royal Darwin Hospital initiated the development of a II Sister Hospital II relationship with the Professor Johannes Hospital' in Ku pang and the Soe Hospital, both in the Nusa Tenggara Timur Province of Indonesia. The sister hospital arrangement aims to provide an exchange of nursing and medical personnel between the two countries to assist in professional development. The Governments of Indonesia and the Northern Territory are fully supportive of the exchange and major funding for the project has been made available through the Australian International Development Assistance Bureau (AIDAB} and the Australia-Indonesia Institute.
Quality Assurance
The Hospital Quality Assurance Steering Committee, as the committee responsible for the co-ordination and oversight of quality assurance activities within the Hospital, has been very active over the past year.
Early in the year, an eminently qualified author and speaker on quality assurance, Mary Ell, visited Darwin to conduct a series of workshops. Over 350 staff members who attended the workshops found them to be informative and invaluable to the success of the Hospital's quality assurance program.
Significant progress has been made in ensuring that all individual departments/units have a quality assurance plan developed for their area which identifies the activities to be undertaken during a specific time frame.
2.3 Nursing
Resulting from Cabinet Decision 7023, a total of 26 nursing positions were lost, including ten positions deleted through the closure of beds and an operating theatre. While overall staffing levels have been maintained at the allocated maximum staffing level (MSL}, the need to continue to respond to high bed occupancy and patient dependency levels by employing casual nurse shifts has resulted in a significant increase in expenditure.
Between April and June 1992, a Nurse Utilisation Study was conducted in all hospital wards which are using a Patient Dependency System for deployment. The survey is completed but the findings are not yet available. In addition, Nurse staffing reviews were conducted in the Operating Theatre and Accident and Emergency Department during the same period.
A time efficiency system 'Compuclock' was trialed for 3 months in the Surgical Wards (November to January). The system was found to have many benefits for time recording and salary payments, and has the capacity to interface with the Personnel Information Payroll System proposed for use in Northern Territory Government Departments.
2.4 Medical
The work of Medical Administration was considerably enhanced during the year by the employment on a part time basis of two Assistant Medical Superintendents, Dr Barbara Bauert and Dr Gerry Goodhand.
Considerable time and effort has been devoted towards negotiations with the Commonwealth Medical Officers Association (CMOA) and the Australian Medical Association (AMA) in regard to the implementation of a new classification structure with attendant salary increases for Medical Officers in the Northern Territory. Negotiations are currently in their final stages and the new Medical Officers Award is expected to be implemented in the very near future.
The Board believes the new package will go a considerable way to overcoming the problems of recruitment and retention of skilled medical staff, particularly to centres outside of Darwin.
Key staffing appointments during the year included:
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Mr John Whiteford Mr Richard Powell Ms Amanda Ralph Ms Jenny Woodhouse
Chief Pharmacist Laboratory Manager
Medical Records Administrator Senior Physiotherapist
Maintenance and Security
The fire safety upgrade of the Main Ward Block and subsequent ward refurbishment program continued throughout 1991/92, moving into special care areas such as Delivery Suite and the
Intensive Care Unit.
Implementation of the Cresap recommendations saw the reduction of 19 trade positions in the Maintenance Department. Major projects completed during the year included repairs to the swimming pool, painting and refurbishment of the staff village units, alterations to offices and partitioning in data processing and purchasing/contracts areas.
The frequency and nature of security incidents occurring on the campus are matters of continuing concern. Proposals for increased building security by means of a door control system have been investigated. A new secure Mental Health facility to be built on the Hospital grounds during 1992/93 should also alleviate some of the problems being experienced in this area.
2.6 Public Relations
The dedication of a staff member to the Public Relations function has continued to provide the media and public with a constant point of contact and a consistently reliable source of information. This has improved the Hospital's image and is considered an asset in maintaining patient, public and staff morale at a high level.
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2.7 Hospital Expenditure Expenditure ($OOO's)
Salaries and Allowances Administrative & Operational Capital Items
Other Services Property Management
2.8 Hospital Activity Statistics AUTHORISED BEDS (end of year)
Occupied bed days
Average daily occupied beds
Patients in Hospital at end of year Admissions for the year
Average length o·f stay (days)*
LIVE BIRTHS STILL BIRTHS DEATHS
On arrival In hospital Non-admitted Autopsies OPERATIONS Major Minor Dental
OUTPATIENT CONSULTATIONS AND TREATMENTS
RADIOLOGY
Inpatients x-rayed Outpatients x-rayed PHYSIOTHERAPY
Inpatients
Number of treatments Outpatients
Number of treatments OCCUPATIONAL THERAPY General Inpatients General Outpatients
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1990/91 1991/92
41,171 41,944
12,147 12,711
817 1,062
2,323 2,032
5,243 5,739
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61,701 63,488
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1990/91 1991/92
311 293
96,914 91,730
266 251
256 220
15,281 14,953
6.3 6.1
1,260 1,284
26 16
167 167
198 174
20 8
278 211
2,451 2,380
4,853 3,301
379 205
78,356 78,832
10,301 10,970
24,271 23,449
17,025 14,303
22,984 20,578
7,861 9,417
8,183 11,128
1,925 2,621
523 621
* In this report, the "Average length of stay (days)" is calculated by dividing the number of "Occupied bed days"
by the number of "Admissions for the Year".
3. CHAIRMAN'S COMMENTS
The year ending 30 June 1992 was again a year of considerable development initiative and change for Royal Darwin Hospital,
its management, staff and patients.
Some of those changes were initiated externally (eg the changes arising out of Cabinet Decision 7023, which in turn accepted the Cresap recommendations). However the majority of changes ( including a majority of the Cresap recommendations) were initiated by the management and staff of the Hospital and will, I am sure, result in long term benefits for the Hospital and the service it provides to its patients.
This annual report outlines the major events and activities throughout the year. I would however like to take the opportunity to give particular recognition to the following:
1. Budgetary Performance
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for the third year in a row the Hospital operated inside its budgetary allowance, notwithstanding a reduction (in real terms) of the budgeted allowance and an increase in the level of activity throughout the Hospital. I would particularly like to thank cost centre managers and all staff for their budgetary performance.2. Sister Hospital Relationship our relations with the Professor Johannes Hospital in Kupang and the Soe Hospital in Soe, Nusa Tenggara Timur Province, Indonesia developed throughout the year. There were a number of exchanges involving doctors and nurses from all 3 Hospitals. Strong personal relations have already developed and it can reasonably be expected that the relationship will continue to develop with many benefits to both the two Indonesian hospitals and Royal Darwin Hospital. It is envisaged that the program will continue through professional exchanges paid for through overseas aid funds. The principal benefits to Royal Darwin Hospital are through the professional development of our own staff and the money that can be derived through the operation of a professional training scheme.
3. Committee Structure - following extensive consultations a revised committee structure for the Hospital was adopted and took effect from 1 July 1992. The review was as a result of initiatives undertaken by the Hospital Management Board in reviewing its role and function. The net effect has been to reduce the number of committees to about one third of those previously operating. It has provided each committee with defined terms of reference and key functions along with a clear statement of its position in terms of reporting, accountability and role within the Hospital. All Board members have roles to play within the various committees and it is hoped that this will enable Board members to take a more effectual role in the management of the Hospital.
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As mentioned in the body of this report the clinical management trial in the Paediatrics Department has continued successfully throughout the year. It is to be hoped that the trial will form the basis for clinicians to have greater control and accountability in respect of the operation of their areas. In addition the bed management program, case mix study, continued fire upgrade and relocation of certain departments throughout the Hospital have meant that changes again have been the order of the day.
In conclusion, I would like to again thank the various dedicated members of the Hospital staff for their efforts throughout the year. Hospital services and funding will continue to be the subject of review and change. Their high cost will ensure that they remain a high priority in the eyes of politicians and health administrators alike. The management of Royal Darwin Hospital is committed to ensuring that these changes result in improved patient care continuing to be provided within a responsible budget.
I would take the opportunity to thank the Hospital's General Manager, Lindsay Pyne and his hard working executive for their support and encouragement throughout the year.
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NGovernment Printer of the Northern Terrritory
