Clinical Governance

St Vincent’s Health Australia’s clinical governance program is the cornerstone of its reputation for delivering excellent patient outcomes, and ground-breaking clinical practice and research. To deliver this service, we work in partnership with leaders, managers, staff, patients and the community to ensure that the appropriate systems and processes are in place to achieve our ambitious plans at scale and pace.

In 2017/2018, all SVHA facilities met the core requirements and achieved accreditation with the Australian Council on Healthcare Standards (ACHS).

100% of SVHA facilities were also accredited under the National Safety and Quality Health Service Standards.

Nothing is more important than keeping our patients and residents safe during their stay with us.

Each year our teams perform thousands of operations and see hundreds of thousands of patients. In 2017-18 there were 5,599 babies delivered and we completed 4,487 knee replacements, 3,138 hip replacements, and 1,271 open heart procedures across St Vincent’s Health Australia’s facilities.

Although our outcomes are generally excellent and there is a strong system-wide commitment to continuous improvement, we know that safety and quality lapses can occur and these can have a major effect on people’s lives and on the broader health system.

During 2017-18, over 290,000 patients or residents underwent care at one of our facilities. During this time there were 38,803 clinical incidents notified across our public, private and aged care facilities.

That means that, on average, approximately 13% of patients and residents experienced some kind of incident during their stay. Of these, 97% sustained minimal to no harm, 906 sustained an event requiring additional medical care, and less than 0.02% resulted in significant harm or death.

A hospital-acquired infection (HAI) is an infection that can be picked up in a hospital or health care setting, or from outside the environment, brought in by another infected patient or staff member.

Across SVHA we monitor a number of HAIs that are commonly found in health care settings, such as Staphyloccus Aureus (SAB), a type of bacteria that can be found on human skin and which is often referred to as ‘staph’ or ‘golden staph’.

St Vincent’s Health monitors SAB infections every month. The national target is for health organisations to have a rate less than two infections per 10,000 patient care days. The rate for SAB across SVHA’s facilities during 2017-18 was 0.72 infections per 10,000 patient care days.

The spread of HAIs can be controlled and reduced by ensuring our staff, patients and visitors frequently wash their hands. This is the single most important factor in reducing infections in our hospitals.

SVHA monitors how often staff wash their hands or use an antiseptic gel prior to providing care to our patients. In 2017-18, St Vincent’s Health’s hand washing compliance was 84%.

In 2017, St Vincent’s Health introduced the Clinical Assurance and Reliability Program (SCARP), a new initiative that builds on the previous Clinical Quality and Safety System and provides a mechanism for evaluating and improving the quality and reliability of patient care through clinician-designed and led assessments and which complements existing clinical audit programs at the facility level.

Our first SCARP assessment conducted in early 2018 looked at the management of patients arriving at one of our Emergency Departments following a heart attack. Our review identified that 100% of patients presenting to either of our public emergency departments received a percutaneous angiogram within 12 hours of onset of treatment. The majority of these patients had a “door to needle time” of less than 90 minutes.

Clinical Governance

InSpired To Care

InSpired To Care

St Vincent’s Health’s Inspired to Care program embeds the three principles of person-centred care – ‘we feel welcome’, ‘we feel valued’, and ‘we feel safe’ – across the organisation, uniting staff in a shared aspiration. The program supports facilities to embed the person-centred care principles and provide a consistently positive care experience to every patient and resident.

A central element of Inspired to Care is the adaption of an evidenced-based framework. These frameworks support development of a sustainable culture that promotes accountability, fosters innovation, and consistently delivers a great patient experience and best quality outcomes over time.

As of 2017-18, 100% of SVHA’s public and private hospitals have implemented an evidenced-based framework.

In parallel, St Vincent’s Care Aged Care Service is implementing a Lifestyle and Wellbeing Model – an operating framework which brings to life SVCS’s mission, vision, and values. The model is person-centred and incorporates the language of Inspired to Care.

In 2016-17, St Vincent’s Health launched the Inspired to Care Grants Program with project funding of up to $10,000 for staff initiatives which addressed one or more of the organisation’s person-centred care principles and which were informed by patient or resident feedback.

In 2017-18, the Inspired to Care Steering Committee awarded 14 grants totalling $122,616. Eleven projects are complete, two are underway, and one is scheduled to commence in 2018.

One grant went to the Pharmacy team at St Vincent’s Hospital Melbourne which had an idea for improving the time in which patients with Parkinson’s disease receive their medication.

Parkinson’s disease affects around 80,000 Australians. There’s no cure but the symptoms can be managed by medication – but there’s a catch: Parkinson’s medications are time critical, and other drugs commonly used in hospitals can make them ineffective.

The risk is a rapid worsening of their symptoms, including pain, difficulty swallowing, stiffness, and delirium, which can lead to a much longer stay in hospital.

Using their Inspired to Care grant, the Melbourne hospital’s Pharmacy team reviewed the clinical notes of 100 patients, surveyed 112 staff and spoke with 14 patients and carers. With advice from the National Prescribing Service and Parkinson’s Australia, they introduced a range of interventions, including alerts, labelling, after-hours medication access, and education for clinical staff.

The results have been impressive. Documentation of an electronic adverse reaction alert jumped from 6% in 2016 to 72% in 2018; the percentage of missed doses fell from 10.6% to 4.4%; and late doses dropped from 6.5% to 2.6%. It’s also had a big impact on how long patients spend in hospital. The average length of stay for all patients with Parkinson’s disease was reduced from 4.5 days to 3.7 days.

For patients admitted from the Emergency Department, the improvement was even more significant, falling from 5.4 days to 3.8 days.

Patient Experience

Patient Experience

SVHA is strongly committed to a patient-centred health care system. In 2016, we launched our “Welcome, Valued and Safe” program, an integral part of which is measuring our patient’s experience through regular feedback. While much of this is received and managed at the ward and unit levels, St Vincent’s Health continuously surveys our patients using an external provider.

One measure of patient experience is the ‘Net Promoter Score’ or NPS, or how likely a patient is to recommend our facility to a family or friend for their health care. SVHA has an NPS target for sites to achieve of greater than 70.

Across all SVHA’s facilities for 2017/18, our result was 74.6% would recommend our facilities to family or friends.

For the second consecutive year, SVHA’s Inspired to Care Week has proven a successful way to keep staff informed and encourage them to engage with the program’s ‘welcome, valued, safe’ message by inviting them to share their thoughts via postcards and videos.

This year the competition received 150 postcard entries and video submissions with 28 entries being judged as eventual winners.

InSpired To Shine

InSpired To Shine

In 2016, St Vincent’s Health Australia embarked on a program of cultural change called Ethos. Ethos was developed to help build a culture of respect and safety in the workplace. It encourages employees to speak up and report incidents that undermine patient and staff safety, as well as providing an avenue to acknowledge those who demonstrate positive behaviour and are exceptional role models.

Ethos recently celebrated its first operational year at St Vincent’s Hospital Melbourne, and in 2017-18 the program began rolling out across three additional SVHA sites: St Vincent’s Private Hospital Melbourne, St Vincent’s Hospital Sydney, and St Vincent’s Private Hospital Sydney.

St Vincent’s is also collaborating with Metro North Hospital and Health Service in Brisbane, which will be launching Ethos in late 2018, a development which recognises the strong interest in the program among the wider health care sector.

In its first year of implementation across both the public and private St Vincent’s hospitals in Melbourne, there were:

  • More than 300 reports submitted through the web-based Ethos reporting tool.
  • One-third of reports were about positive behaviours, two-thirds about negative.
  • Close to 250 Ethos reports have resulted in an informal conversation with relevant staff, inviting reflection.
  • Nearly 100 staff have been recognised for being role models.

During 2017-18, St Vincent’s Health was awarded a $1.2m National Health and Medical Research Council grant, in partnership with the Australian Institute of Healthcare Innovation, to evaluate Ethos over three years.

Work has begun with more than 4000 staff responding to a Longitudinal Investigation of Negative Behaviours survey – the first of its kind in Australia – which will be repeated in two years.