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Northern Territory Department of Health Library Services Historical Collection

DL HIST 362 .11 TEN 1989

"UNDERSTANDING THE CONCEPT OF ROLE DELINEATION OF HOSPITALS"

IN THE NORTHERN TERRITORY

NT DEPARTMENT OF HEALTH AND COMMUNITY SERVICES

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HISTORICAL COLLECTION

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NTRAL LtBRARY 1 3 OCT 1998

TERRITORY H~l TH SERVICES

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•oNDERSTANDING THE CONCEPT OF ROLE DELINEATION OF HOSPITALS•

IN THE NORTHERN TERRITORY

Written by Dr J Teng

Medical Administrator Northern Territory Department of Health and Community Services May, 1989

"UNDERSTANDING THE CONCEPT OF ROLE DELINEATION OF HOSPITALS"

IN THE NORTHERN TERRITORY

Int rodu ctio n

Role Delineation of Hospitals (of clinical services) is being carried out in the Northern Territory at present.

This process needs to involve different groups of people which include the community, the hospital, the health professionals, the Regional Administration and the Government.

Misconception of the issue of role delineation of hospitals has led to confusion and conflicts in discussions and decision

making.

Hence it is important that there is an understanding of the

concept of role delineation of hospitals so that discussions can revolve around a commonly understood theme, and produce

meaningful and effective decisions.

The Author feels that" a picture speaks a thousand words" and hence many diagrams are used to get the message across

ef fecti vel y.

Furthermore, only essential information that helps the

understanding of the concept of Role Delineation of Hospitals, is included so there is no unnecessary clouding of the mind to grasp the concept.

Concept

Role Delineation of Northern Territory hospitals:

1. Is an integral part of but NOT the hospital's strategic management plan.

Departmental Corporate Plan

Regional Strategic Management Plan

Hospital Strategic Management Plan

Role Delineation of Hospitals

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2. is a process by which conscious objective role delineation decisions are derived by consensus between the Department of Health and Community Services, the community, the hospital management, the health professions and the Regional

Administation, with respect to rational community needs and the ability of the Department/Government to provide.

Comrruni ty Needs

Population profiles Vital statistics

Throughput of patients Accessibility of other

hospitals and services Geographical isolation

LOCAL COMMUNITY

HEALTH PROPES SIONALS

DECISION

HOSPITAL MANAGEMENT

Government's Ability to Provide

Money

Human resource Facilities Technology

DEPARTMENT

REGION

3. is a process by which

(a) general services are designated, e.g Core Services

General Medicine Special Medicine General Surgery Special Surgery Obstetrics

Perinatal Care Paediatrics

Accident and Emergency Psychiatry

Dental

Geriatrics and Rehabilitation Community Health Programs

(e.g. Developmentally Disabled, Drugs and Alcohol,

Palliative Care)

Support Services Pathology

Pharmacy Radiology Anaesthetics ICU

CCU

Physiotherapy

Occupational Therapy Nutrition

Speech Pathology Social Work

Biomedical Engineering

(b) the complexities and extent of each type of service are described and given a level which indicates what that particular service should provide or is capable of

providing. Examples for General Medicine and Pathology fol low.

GENERAL MEDICINE

ASSESSED LEVEL OF CORE SERVICE

A

LOCATION •••••••••••••••••••••••••••

Min. Level of Support Services LEVEL

I

O

lNo service.

DESCRIPTION OF CORE SERVICE

/Path./Phar./X-Ray/Anaes/N.Med/ ICU Io Io Io I Io o

3

6

eterra an management so e y y genera, pract toners.

s rn eve

I av a i lab 1 e. Phys1cian consu tation

Re erral and management primarily by General 3

!Practitioners with postgraduate training in medicine I lor by specialist physicians, may have access to Resident!

!Medical Officer equivalent. Has high dependency area.

I

I consultation available. Access to Allied Health I

I Professionals. I

edica services provide y enera pecia 1st I Physicians supported by Residents and Allied Health

!Professionals or their equivalent in the Private I Hospital field. Has separate coronary care/intensive I care unit. Salaried Allied Health Professionals.

enera hys1c1ans, supported y eg1strars, es1 ents land Allied Health Professionals. Some 1ub-specialties

!part of the Medical Department. Has a teaching and I research function. Nursing staff with relevant quali- lfications and experience.

I

As level plus edical Department consisting mainly of

!sub-specialties in designated areas. Department has I both teaching and research functions. May have State

!wide role.

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I I I I l I I I

5 6

2

2

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5 6

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2

3

5 6

· 1

I I I I

I I I I l I I I

0 2

5 6 6

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l I I I I

- - - - -

DATE • ••••••••••••••••

CCU jB.M. j

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2

2 2

6 6

Comments

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8

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SUPPORT SERVICE.

ASSESSED LEVEL OF SUPPORT SERVICE

A -

LDCATION ....••••••••••••••••••••.•• PATHCX..OGY DA TE •••••••••••••••••

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I

LEVEL·- DESCRIPTION

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o serv1ce.

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I

I No on site pathology service. B1ood and specimen co11ecting service, 24 hours per day, seven days per I jweek. Collection of specimens controlled by, and responsibility of, receiving laboratory. I

I I

3 jSpec1mens collected as in 1 plus capacity for grouping and cross matching and Blood Storage facilities

I

Ion site. Carries out a defined range of "urgent" tests. Controlled and staffed by a large laboratory I

!of which it is an outpost. Keeps infection control records and monitors them. I

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4 1Bas1c pathology service on site as formal Department ^of Pathology. Performs range of service as in 3 I I plus defined range of routine tests for a single or group of hospitals. Has full Blood Bank and can I

!perform blood gas analysis. Locally managed, but with defined links to large laboratory. Keeps I

I infectious control records and monitors them. I

I I

5

!Large Pathology Department. May provide services for other hospitals (Group Laboratory). Divided i~tol

!common subsections, e.g. Biochemistry, Haematology, etc. Each subsection has trained technician in I

!charge. Department has Medical Director. Immunology, virology, cytology and frozen sections available!

Ion campus. May have registrar in training. May do teaching and research. Full involvement in I

I infection control. I

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6 IAs level 5 plus special tests, tissue typing on campus. ·May provide State referral service. Teaching I

land .research. Specialist registrar in training. I

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COMMENTS

(c} and an account is taken with respect to other relevant existing services in the region and the Territory.

E.G.

OTHER EXISTING REGIONAL SERVICES - COMPLEMENATRY/SUPPORTING LINKAGES

Private Practices e.g. X-ray,

CT

Private Hospital Service

OTHER EXISTING TERRITORY SERVICES - COMPLEMENI'ARY/SUPPORTING LINKAGES

Model One

Srnal le r Hospital of Region (1)

e.g. KH

Srnal le Hospital of

Region (3) e.g. Gove DH

Larger Hospital of

Region (2}

e.g. RDH

)

Model Two

Larger Hospital of

Region (4) e.g. ASH

Smaller Hospital of

Region ( 4}

e.g. T/C

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OTHER EXISTING TERRITORY SERVICES - COMPLEMENTARY AND SUPPORTING LINKAGES

Model Three

R D H

A S H

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and 4.provides a rational basis for a region's future planning and development of its hospital, that is, a 'blue print' from which future plans can evolve.

E.G.

Present Role Future Role - Version 1

e.g. e.g.

Medicine Medicine

-

^{Level 3}

-

^{Level 4}

Surgery Surgery

-

^{Level 3}

-

^{Level 3}

Future Role - Version 2

e.g.

Medicine

- Level 4

Surgery

- Level 4

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To help with understanding the concept, the main aims of role delineation are highlighted such as

1. to ensure adequate patient care and safety;

2. to promote an understanding by the community and the service providers of the general functions and capabilities of each hospital with respect to community needs and resources;

3. to provide a rational framework through which Northern Territory Hospitals can network with one another in

utilising available resources and provide support services through referrals;

4. to provide a context for assessment of hospital staff requirements and clinical privileges;

5. to provide a context for assessment of hospital standards and quality of patient care; and

6. to provide a "blueprint" basis, for future development and review.