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Northern Territory Department of Health Library Services Historical Collection
HISTORICAL COLLECTION
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Royal Darwin Hospital Management Board
All correspondencs: • Chairman PO Box 41326 Casuarina NT 0811 • Tel: (089) 22 8180 • Fax: (089) 22 8870
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October 1993The Hon Mike Reed, MLA
Minister for Health & Community Services DARWIN NT 0801
Dear Minister
RE: 1992/93 ANNUAL REPORT
Herewith find the 1992/93 Annual Report of the Royal Darwin Hospital Management Board.
DAVID Secretary
Royal Darwin Hospital Management Board
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CENTRAL LIBRARY 2 3 OCl 1998
TERRITORY H nt SERVICES
CHAIRMANS REPORT
The year ending 30 June 1993 again saw many changes. In this economic climate i t has been necessary throughout Australia to cut funds to Government institutions. Royal Darwin is no exception, however we have been able to ensure a continued high standard of patient care and this is basically due to the dedication from management staff in all areas, reviewing and improving services.
The Committee Structure has been in place for almost 12 months and through i t Board Members and staff have had a much closer relationship in the running of the hospital.
This has proved valuable in developing processes for Quality Assurance throughout the hospital at all levels.
During the Year of Indigenous People the Board has encouraged all areas of the hospital to assess the special needs of Aboriginal people. Special attention is also being given to improving the appearance of the main entrance to the hospital while accepting the need for Aboriginal patients to have contact with family and friends in an outdoor environment.
I would like to take the opportunity to personally thank the three retiring members of the Board for their dedication and also to the General Manager, Lindsay Pyne who has moved on to 'greener pastures'.
I also express my appreciation to the three new members, and General Manager Dr David Douglas who have settled so quickly into their roles and given me so much support in taking over as Chairman in the last quarter of the year.
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Christine Nathanael Chairman
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ROYAL DARWIN HOSPITAL MANAGEMENT BOARD ANNUAL REPORT 1992/93
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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 1992/93 financial year.
1. OPERATION OF THE BOARD 1. 1 Composition
The composition of the Board at the time of writing the report was as follows :
Mrs Christine Nathanael Mr Peter Owen
Mr Kevin Davis Mr Barry Ryan Dr Ian Humphrey Dr Pauline Wilson Mrs Jane Hogan Dr David Douglas
Chairman Vice Chairman Member
Member Member Member Member Secretary
Three new members, Mr Peter Owen, Mr Kevin Davis and Dr Ian Humphrey were appointed to the Board in March 1993. They replaced outgoing members, Mr Richard Giles, Mr Reg Lowry and Dr Gerry Goodhand. The present members of the Board wish to acknowledge the significant contribution made over time by these three people.
1.2 Areas of Responsibility
The Board has in previous years subdivided operational areas of the Hospital and allocated them specifically to appointed members. This approach is now less rigidly adopted with, Board members accepting responsibility through their position on Board Advisory Committees. The Committee membership is as follows
Patient Care Evaluation Committee - Christine Nathanael (Chairman)
Counter Disaster Committee - Kevin Davis (Member) Financial Services Committee - Peter Owen (Member)
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1.3 Board Meetings
Board meetings were held on a regular monthly basis. At these meetings reports were received from:
Finance Maintenance Nursing Security
Medical Services
Minutes of meetings of Hospital Management Boards of other Northern Territory Hospital's were also received together with the monthly reporting statistics of the Royal Darwin Hospital.
1.4 Major Issues
Significant issues for the Board were the flow-on effects of the Cresap Review and the implementations of the recommendations of that Review. The budgetary implications of the changes arising from the Cresap Review were of significant concern to the Board.
The service implications arising from the adoption of recommendations of the Cresap Review centred on availability of beds and availability of theatre time. The reduction in the number of available beds within the Hospital may be related to an apparent increase in the frequency with which the Hospital is unable to accept routine booked surgical admissions. A study of bed utilisation was commissioned by the Hospital as part of a broader study of efficiencies in clinical services within the Hospital. Better bed management is being pursued but the question of bed population ratios needs to be clarified.
The General Manager of the Royal Darwin Hospital, Mr Lindsay Pyne, resigned from his position in November 1992. The new appointee, Dr David Douglas, did not take up his position until March 1993. During the interim, the position of Acting General Manager was filled by Mr Neil Fitzpatrick. The Board acknowledges the very significant contribution Mr Lindsay Pyne has made to the growth of the Hospital over the last few years, and wishes him well in his new position in Hobart, Tasmania.
The Board also wishes to thank Mr Fitzpatrick for his significant maintenance role during the interregnum. Finally, the Board is looking forward to working with Dr Douglas to further develop patient services at the Royal Darwin Hospital.
1.5 Royal Darwin Hospital Auxiliary
Again, the Board acknowledges the significant contribution made to the comfort of inpatients as a result of the fund raising efforts by the Auxiliary members. Although their numbers are not extensive, this group is most energetic and again arranged a series of successful functions.
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The most recent contribution of the Auxiliary is $9,000 towards a new Mani tor and Life Support pack for use in the recently refurbished Intensive Care Unit of the Hospital.
1.6 Hospital Inspections
The Hospital inspection protocol adopted by the Board has been modified and commencing July 1993, regular monthly inspections will be carried out. An inspection program has been developed so that in a three year cycle, all significant aspects of the Hospital will be physically inspected by Board members. This forms part of the Board's Quality Assurance program.
1.7 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 are approved by the Board.
During the year, funds were raised from the Hospital Ball;
Noonamah Hotel's annual Frog Race; proceeds from vending machines and advertising in the Hospital Bulletin. Firemen from the Navy organised a major fundraising event to raise money for the Burns Unit. Off-shore oil exploration company Noreen International made a generous donation to the Accident and Emergency Department to purchase training resources and clinical equipment. Noreen's donation is the second in recent years and is gratefully acknowledged.
The Board wishes to express its appreciation to these companies and the many other donors not mentioned above, for their financial and material support throughout the year. Special thanks should be made to the community groups that help decorate the Hospital each year for Christmas and other festive occasions.
During the year the Board purchased a quantity of scarves and ties which are being sold to Hospital staff. They are proving popular and are being worn by increasing numbers of staff.
Some of the fund disbursements made donations to the Social Work Contingency Account for patients coming into hospital in emergency situations without financial resources; gymnasium equipment; purchase of photographs and colour television for the Burns Unit. Training equipment for the Accident and Emergency Department was also purchased from monies donated by Noreen International. A small number of medical and other professional staff were sponsored to attend conferences/training workshops to enhance their clinical skills.
2. OPERATION OF THE ROYAL DARWIN HOSPITAL 2.1 Indigenous People
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1993 is the Year of Indigenous People. Aboriginal people make up a significant proportion of the client group of the Royal Darwin Hospital. Although Aboriginal people account for approximately one quarter of the population of the Northern Territory, they account for over a third of the bed days, of the Royal Darwin Hospital. In particular, Aboriginal people spend longer in Hospital recovering from particular illnesses and also appear to have different disease patterns from non- Aboriginal people. This is particularly noticeable in the Children's Ward where gastro-enteritis is a major cause of Hospital admission for Aboriginal children, but is very much less of a problem for non-Aboriginal children.
The introduction of Case-based funding across Australia is anticipated within the next two to three years. This will have particular problems for Northern Territory hospitals and the Royal Darwin Hospital in particular because of the difference between disease patterns between Aboriginal and non-Aboriginal people. Case-based funding is built upon the concept of average costs for treating particular diseases. For the Royal Darwin Hospital, where one third of the patients lie outside this "average" grouping, there will be particular difficulties in meeting the costs of treating these people.
A specific initiative the Hospital has undertaken in an attempt to identify the particular needs of Aboriginal patients is the development of a post-discharge patient satisfaction questionnaire specifically targeting rural Aboriginal people.
It is hoped that this initiative will give the staff of the Hospital a far greater understanding of the special needs of this client group. The Board is also exploring the opportunities for supporting Aboriginal Health Workers during their training program.
2.2 Teaching Hospital Status
The Hospital has this year consolidated links with the Sydney University and has, for the first time, received undergraduate medical students as part of the formal training program of the Sydney University School of Medicine. The students are rotated to the Royal Darwin Hospital for a six week period, part of this time is spent outside the Hospital, either in district hospitals or working with local general practitioners. Dr Allan Walker has been appointed the Associate Dean Clinical for this new teaching arrangement.
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During 1992/93 the Royal Darwin Hospital has continued its sister Hospital Relationships with the Professor Johannes Hospital in Kupang and the Soe Hospital, both in Nusa Tengarra Timur Province of Indonesia. The majority of the activity in the last twelve months has consisted of continuing trips by Dr John Hargraves, who continues to provide surgical services to the people in these areas. Due to funding limitations, the number of staff exchanges has been less in the current financial year than in 1991/92.
2.3 Medical Services
The Medical Officers' Agreements was concluded in August 1992 and negotiations are continuing to have the Agreement formalised into an award. As a result, all Medical Officers received a salary increase.
In April 1993, the Hospital's radiology services were contracted to a private radiologist following the resignation of the Hospital's staff radiologist. This lead to an improvement in the services offered with the establishment of a Magnetic Resonance Imaging (MRI) facility, which is provided by the private radiologist on a contractual basis.
There were changes of personnel in key areas during the year, with the appointment of a Chief Pharmacist, Mr Jim Carlton, and a Chief Social Worker, Mr Chris Stephens. The Hospital's Specialist Orthopaedic Surgeon, Mr Baddeley, resigned from being a sessional specialist and the Hospital is in the process of recruiting a suitable replacement.
The Commonwealth's Artificial Limb and Appliance Centre located at Royal Darwin Hospital is to be transferred from the
Commonwealth Department of Veterans' Affairs to the Department of Health and Community Services on 1 August 1993. A review of the services, conducted by external consultant Dr John Hurley, made a number of recommendations. These will be incorporated in association with changes to Territory rehabilitation
services currently being implemented.
2.4 Nursing Services
The Nursing Service has seen a high turnover of staff in senior nursing positions resulting from the pursuit of career opportunities. These positions have been temporarily filled from Nurses in the service. The long term benefit is a better developed and stronger management team for the clinical services.
The Quality Improvement Program in Nursing took a slight set back in reaching its targets for 1992/1993 due to the departure of its co-ordinator midway through the year. However, a number of units have worked hard to review their standards and design an instrument or tool by which their standards can be measured.
Job redesign for the positions of Nurse Co-ordinator and Area Nurse Manager were achieved towards the end of 1993. The preparation of ward rosters was transferred from Nurse Co- ordinator to Area Nurse Managers at ward level.
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An information booklet for all new nursing staff was finally printed and distributed. Its near publication was deferred because information previously prepared was altered to reflect the enactment of the Northern Territory Public Sector Employment and Management Act, 1993.
In-house courses to overcome skill deficit were conducted during the year for the Hyperbaric Unit, Critical Care/Intensive Care and Special Care Nursery. In addition, a first course in Orthopaedic Nursing was conducted. Fifty per cent of the staff (one hundred per cent of the course participants) successfully completed the course requirement through personal achievement supported by strong team commitment from their unit.
Industrial Relations matters have presented no major issues during the year. The Enrolled Nurses wage adjustment (Phase 2) is underway. Penalty rates for Enrolled Nurses who commenced prior to 16 July 1992 will be adjusted downward.
Senior Nurses have participated in the Department's Strategic Planning Seminars and Hospital Services Division's Meetings. A number of staff development sessions have been well attended during the year the majority with the assistance of the Staff Development Services.
Occupational Health and Safety programs have been given a strong emphasis during the year with the Infection Control and the Security Sections of the Hospital playing a major part in this area. The Backpain Prevention Program has a major focus in the Nursing Service as the Hospital aims to reduce its workers' compensation costs.
The Nursing Service is anticipating a restructuring in 1993/94 which includes job redesign for Nurses at the Assistant Director and Area Nurse Manager levels. The proposal is scheduled for presentation to the Nurses Career Structure Central Oversight Committee by the 30 November 1993. The structural changes will bring about changes in work practices, improved communication and a greater degree of autonomy at floor level.
2.5 Support Services
The Fire Safety Upgrade initiative continues with the major activity in 1992/93 being the refurbishment of the Theatre Suite. There has also been major upgrades in the Intensive Care Unit and the Isolation Paediatric Ward.
The Hospital's dependence on high quality information provided in a timely fashion has become more evident with the continuing development of Casemix. A number of reviews have been undertaken throughout the year of the Information Systems available to the Hospital. It is anticipated these will lead to improvements in the Information Systems to both the Pathology Department and the Clinical areas of the Hospital.
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2.6 Quality Assurance
The Board has continued its commitment to developing formalised processes for the Assurance of Quality of Care in all aspects of the Hospital activities. The Board is pleased to report that most areas of the Hospital now have formalised Quality Assurance programs and are providing regular reports on the activities and outcomes of those programs. A major initiative is the adoption of the Hospital-wide clinical indicators program of the Australian Council on Health Care Standards.
This program is dependent on Hospital Information Systems, but will provide, on a routine and semi-automatic basis, information about the general quality of care of patients within the Hospital.
2.7 Hospital Expenditure Royal Darwin Hospital Expenditure ($OOO's) Personnel Expenses Operational Expenses Capital Equipment Other Services Property Management
Total
1991/92 41,944 12,711 1,062 2,032 5,243
62,992
1992/93 44,965 (+) 18,982
685
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64,632 (*) Property management and other services are included
in the Operational Expenses for the 1992/93 financial year.
(+) Approximately $1.7m of the increase is due to one extra pay period falling in the financial year.
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2.8 Activity Statistics for Hospitals 9
TABLE 2: ACTIVITY STATISTICS FOR ROYAL DARWIN HOSPITAL 1990/91, 1991/92, 1992/93
1990/91 1991/92 1992/93
AUTIIORISED BEDS (end of year) 311 293 293
Occupied bed day, 96 914 91754 89 334
Average daily occupied bed1 266 251 245
Patients in Hospital at end of year 256 224 214
Admissions for the year 15 281 14 957 14 892
Average length of stay (days)* 6.3 6.1 6.0
BIRTHS
Non-premature 1260 1284 1 366
Premature 109 161 173
Still-births 26 16 16
DEATHS
On arrival 167 167 147
In hospital 198 174 176
Non-admitted 20 8 29
Autopsies 278 211 245
OPERATIONS
Major 2 451 2380 2 376
Minor 4 853 3 301 3 537
Dental**** 379 205 0
OUTPATIENT CONSULTATIONS
AND TREA1MENTS 78 356 78 832 15 988
RADIOLOGY
Inpatients x-rayed 10 301 10 970 11 266
Outpatients x-rayed 24 271 23 449 24 776
PHYSIOTHERAPY **
Inpatients 17 025 14 303 15 040
Number of treatments 22 984 20578 19 468
Outpatients 7 861 7 339 7 427
Number of treatments 8 183 9417 8 406
OCCUPATIONAL THERAPY***
General Inpatients 1925 2 621 2944
General Outpatients 523 621 719
* In thi1 report, the 'Average length ofltay (day1)' is calculated by dividing the number of 'Occupied bed day1' by the number of 'Admiuions for the Year'.
*** Occupational therapy figurca calculated on number of patient treatments
**** Dental i1 now conducted by visiting specialist and is included elsewhere
Government Printer of the Northern Territory
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