Table of Contents

Vision:

A community that values fairness, health and wellbeing

Mission: Banyule Community Health will provide health and community services that are accessible and relevant to the needs of our community. We do this by working together with trust and respect.

Values:

Respect Excellence Partnerships Leadership

Welcome.......................................................................1 About the Quality of Care .........................................2 Participation ................................................................3 2010 Consumer Feedback Results...........................6 Demographics - the people we work with ...........8 Diversity........................................................................9 Human Rights............................................................11 Governance & Management ...................................13 Finance Summary .....................................................15 ATSI ..............................................................................17 Accreditation/CQI .....................................................18 Clinical Safety and Quality.......................................19 Infection Control ......................................................22 Dental Indicators ......................................................23 Evidence-based Care................................................24 Health Promotion.....................................................25 Continuity of Care ....................................................28 How to find us...........................................................33

Our services, Our groups Carer Support Network

Needle & Syringe Program

Clinic Nurse

Neighbourhood Renewal

Community Choir

NEODAS (Drug & Alcohol)

Community Health Nursing

Community Midwifery Service

Dietetics

Dental Services

Emergency Relief Family & Reproductive Rights Program (FARREP) Financial Counselling Gambler's Help

Personal Support Service Migrant Resource Centre

General Counselling

Occupational Therapy

HARP program: Chronic Disease Management Program

Olympic Adult Education

HARP program: North East Diabetes Service HARP program: Community Link - Rapid Response Our cover features artwork from participants of the parents involved in our early years programs. Standing in the foreground is Stan and Sharon, whose stories are featured on page 10.

BANYULE Community Health

Northern Region Home & Community Care Dietetic Services

Paediatric Occupational Therapy Pharmacotherapy Physiotherapy

Health For Life

Podiatry

Intake Medical Service

Somali Men's Planned Activity Group (PAG)

Men’s Shed

Speech Pathology

Men’s Lunch

WorkHealth Checks Program

Welcome

Dear Member The past year has been an eventful period in the history of our health care system, with the biggest changes to the health system since Medibank (Medicare) was introduced. Banyule Community Health participated in the discussions around structures which would deliver better health outcomes within the spirit of the new Commonwealth health agenda to communities located in the Northern Region of metropolitan Melbourne. Our active participation was to ensure that when the timetable for the reforms was due, Banyule Community Health would be at the forefront of the roll out with the hope that positive benefits over a period of time will be delivered to this community. The heralded reform was by and large welcomed due to the current fragmented state of primary health care, however, we believe that the reform initiative did not go far enough. For Community Health Centres it would mean that responsibility for their funding would revert to the Commonwealth via a structure called Medicare Locals or primary health care organisations, signifying no significant change in the short term in the manner we

provide services or programs to our community. Whatever the outcome we are confident of the place community health will play will continue to be crucial. We believe the reform committee did not lend itself time to examine the critical issues facing health reform in this country; issues such as bridging the health gap that still exists today by encouraging equity of treatment and access, promoting civic activism around health and wellbeing and strengthening an integrated approach to achieving good health for all. The content of the BCH Quality of Care & Annual Report demonstrates that our work is built on the principles that we say were missing from the health debate. We work to ensure that the community’s voice is always present and heard in the development of our services and programs. However, we are not alone and nor can we do this alone; we work with other organisations who share our values, purpose and vision for an equal and just society. The partnerships, sharing of resources and pushing the boundaries of health are critical to BCH having the most impact on the current

inequalities in health that exist in our community. Through this strategy we believe that we will in the long term succeed in achieving our vision resulting in a positive and healthy effect on individuals, families, neighbourhoods and communities and on a global level through our work in the Somali Region of Ethiopia. We hope you appreciate this report. We are very proud of the work undertaken by everyone associated with Banyule Community Health; volunteers, Board Directors and staff in the pursuit of our strategic vision, a vision that is built around you at its core. We thank you for your continued support and look forward to embarking on the journey of health reform whatever shape or form that it takes.

Jim Pasinis Chief Executive Officer

Melinda Brooks Chairperson

2009 Quality of Care REPORT

1

About the

Quality of Care Report Banyule Community Health produced its first Quality of Care report in 2007. Since then we have been working on continuously improving the report as we seek to better inform the community about how our service is operating. In undertaking this task we are faced with a number of challenges. Firstly, we need to balance the information needs of a wide audience that includes our consumers, local community, staff and the agencies that fund our services. To create this balance, we aim to demonstrate the quality of our services through personal stories and experiences that

Consumer group The Quality of Care Report consumer group has a central role in developing this report. Some members of the group have been with us from the beginning and bring that experience with them to our discussions and decision-making about the report. We gratefully acknowledge the contribution of all members of the Quality of Care consumer group: Alan Pearce Geoff Smith Maggie Ryan Joan Griffiths Julie Watson

the individual can relate to. We also aim to provide statistical data that provides evidence of our performance and that meets the reporting obligations of the Department of Health. Secondly, we need to reach as much of our local community as possible. This means that year on year we have been increasing the number of report copies printed and expanding the number of distribution points with the support of our partner agencies. We also make the report available in an electronic format for people with internet access. This year we will be printing 1800 copies

Feedback on the 2009 Quality of Care Report Banyule Community Health was again short-listed for a Public Health Award for Excellence in reporting on quality and safety in health care. We have been short-listed each year since developing our first report in 2007. Each year we review and act on feedback received from all sources in our efforts to continuously improve our reporting. In 2009, we received 13 responses from clients and community members via our tear-out form contained in this report. We received 3 responses via our SurveyMonkey survey linked to the report on our website. All respondents reported that the report was easy to read and interesting. “I picked up a copy at the local library. It’s the first I’ve seen and it really increased my understanding of what BCHS does, and my respect for your work” “Great job to you and all staff there! This years reports are very good, and its nice to know how people are doing in the community. My son is a client and we’re thankful to be able to go somewhere close to home where

2

BANYULE Community Health

of the report. We will mail a copy to each member of the health service, and will make the report available at local libraries, maternal and child health centres and local schools. Our report is also available for download on the internet at the Banyule Community Health website: www.bchs.org.au This year we will seek to reduce our environmental impact and promote the electronic report better through local free press.

he feels safe and easy access of getting to BCH centre.” “Can you please make available on e-mail (paper-free option) – this saves much paper.” The Department of Health also provides us with feedback and suggested incorporating more information on outcomes and effectiveness. In response to all feedback, in 2010 we will: • promote the electronic version of our report more widely • increase the size of the font used in the report and • incorporate suggestions provided to improve the content of the report.

Participation Community Participation Framework & Action Plan "Thank you for all the effort you put into the walking group. I think it's really important to have such a group. It's a motivating way to keep exercising after having a baby" (Participant)

Pram walking group

Banyule Community Health welcomes and encourages community members to get involved in program and organisational levels of the agency as well as in their individual care. This allows us to work in partnership with our local community to provide high quality care and programs. We have developed a framework and community participation action plan to assist us to strengthen and recognising all the wonderful ways community members currently participate at Banyule Community Health. It also contains new ways to improve and implement participation across all aspects of the agency. The agency acknowledges there are a number of ways people are able to participate and values each of these equally. This can range from providing information and feedback right through to delegation and control. Our community participation

working group has chosen the following areas of focus:

for the community to have a voice in decision making within the agency.

• Human Resources

Through the implementation of our existing and new community participation initiatives, Banyule Community Health has been able to implement 100% of the eight strategies specified in the Department of Health’s “Doing it with us, not for us” Policy.

• Communication • Planning • Governance • Individual Care Internal processes across the agency are important to ensure we facilitate, encourage and support community participation. In one of our key focus areas, Human Resources, we are currently developing ways consumers can be involved in recruitment and interviewing processes along with ensuring the agency employs staff who are committed to community participation in health care. We have also established two consumer representative positions on the Client Services and Staffing Committee. These initiatives increase opportunities

2009 Quality of Care REPORT

3

Olympic Village Primary School Breakfast Club - Breakfast, a positive start to the day Local school children start the day the right way with a healthy breakfast. Olympic Village Primary School provides free breakfast foods every Thursday morning to students. Research has shown that children who eat breakfast are more likely to have a better attention span and an increased ability to learn. It has also been reported students have improved attendance and improved behaviour, compared to children

Pictured, Rayhana Kobi, Prep with sisters Mavjana and Afraa, Grade 6

A Prep student’s drawing of the breakfast program

4

BANYULE Community Health

that skip breakfast. The Olympic Village Breakfast program emerged from discussions in 2009 between the school Chaplin and Banyule Community Health to trial a breakfast program for all students, particularly those who didn’t eat before coming to school. The idea was endorsed by the School Principal who, with the support of Banyule Community Health, assisted volunteers to provide breakfast for children once a week. Since that time parents and grandparents of the school community have provided breakfast to between 35 to 40 students on a weekly basis prior to school starting. This is approximately 50 percent of the student body. The students sit down in the school kitchen to eat breakfast, with a choice of cereal, including weetbix or cornflakes with low fat milk and a choice of raisin toast or wholemeal toast with a variety of spreads. “It’s nice to have a choice,” said one student, “we take a piece of fruit for recess or lunch, sometimes watermelon, apples, bananas, mandarins, it’s great.” An 11 year old student said “I’m always at school on time for breakfast days. It’s nice to have parents coming to help, and teachers too! If you ask for something, they just do it. They’re just nice people.” “That’s what we’re there for,” one of the volunteers said. “There’s nothing worse than kids sitting in class with a rumbling tummy.” The program has supported parent’s to come and sit with their kids to eat breakfast and has assisted in developing relationships between the families and the school. The school Chaplin said the breakfast program “allows people to build trust in the school and identify further need for families.” The breakfast program is having a significant impact on school attendance and prompt arrivals. Teachers have also reported better concentration from students on breakfast day. “All schools should do it,” said one of the volunteers.

Residents Group 3081 Banyule Breast Cancer Support Group

“Forget Me Nots” The Banyule Breast Cancer Support Group was established in approximately 1997 and has continued to evolve in various ways over the years. It consists of a group of vibrant women at different stages of their breast cancer journey who meet on the first Monday of the month at Banyule Community Health. A second, purely social group meets at Urban Grooves Café in Greensborough in the evening on the third Monday of the month. Regular evaluation of the group demonstrates a diversity of needs. Some want information on cancer related topics, others prefer the social component of outings or lunches out. However, the dominant factor which keeps members coming back is the support and friendship they give each other.

This is not a sad or depressing place but rather an opportunity for women to share their experiences and knowledge, to support those who are experiencing difficult times, to have fun or shed a tear. Social outings are a highlight and always well attended, as are more serious presentations on coping with stress or how best to deal with lymphodema. The group is flexible and fluid, allowing members to choose which meetings they attend. Banyule Breast Cancer Support Group is a special place for sharing, for honoring the memories of those special friends who have passed away over the years and for experiencing new things together. Above all, it is a place of great dignity and courage.

In the past year the local West Heidelberg community formed ‘Residents Group 3081’ an independent voice for local residents. Initially supported by the Neighbourhood Renewal Program through the BCH Community Development role, the group now stands independent and has become a passionate and fearless advocate for improved living standards for the local community. The group has now met on numerous occasions with the Minister for Housing, the Shadow Minister, signed off on an agreement with the local housing office and made a written and verbal submission to the Parliamentary Inquiry into Public Housing. The Residents Group 3081 have become vital in a community that is suffering from housing stock that is ageing and not meeting the needs of residents. The group have brought the health debate back to the basic human needs to have safe and secure housing. The voice of those most affected is very powerful and loud.

Walk with Wheels Walk with Wheels is a great example of how Banyule Community Health has supported members of the local community to participate and take control in addressing a local issue. Walk with Wheels is a social support group for people who use walking aids. This includes anything from a walking stick to a frame or wheelchair. The group was established in April 2009 by Brian and Geoff (coconvenors). Brian and Geoff met at the Recharge steering committee with Banyule City Council that worked to map places where people with electric wheelchairs and scooters could recharge their aids. Brian and Geoff decided there was a need for less mobile people who are often socially isolated to be able to meet and support each other. After meeting a few times, Geoff approached Banyule Community Health to ask about use of space for gatherings. Since then the group has grown. There are now 21 members of the group and the group has since moved to a bigger location with additional disabled car parking. It remains under the auspice of Banyule Community Health who continue to support the group. The group is running weekly art classes with an art teacher – acrylic painting, oil painting and drawing. Walk with Wheels also held an expo showcasing mobility aids. The group welcomes new members. Interested people can contact Geoff via Banyule Community Health reception.

2009 Quality of Care REPORT

5

2010 Consumer feedback results Consumer Feedback – complaints and suggestions Client complaints provide us with an valuable source of consumer feedback, and are an important mechanism for consumer participation in delivery of our health services. Over the last 4 years, incremental system improvements have made the complaints system more accessible to Banyule Community Health consumers and have resulted in an increase in the amount of formal and informal consumer feedback.

Increase in formal consumer feedback over time

Number of formal complaints

70 60 50 40 30 20 10 0 2006

2007

2008

2009

In 2009, there were 109 episodes of feedback. This included: • 15 compliments • 11 suggestions • 60 formal complaints and • 23 staff complaints or suggestions A spike in formal complaints in 2009 is partly in response to the closure of the medical practice at Greensborough. There were 23 complaints about the closure of the medical practice at Greensborough, 11 complaints about waiting time for dental treatment (either on the waiting list or in the waiting room) and 6 complaints about car parking at Greensborough.

“I am very impressed with the services provided and the level of care by the professionals and general staff too. It is a very valuable service to the community.” We are very satisfied with the care we receive for our son. We find the staff are professional and caring. We are thankful for all of the information, educational resources he received for the services he attended and for the support we receive. Thank you. I never have had a problem with this service I’ve had here. I’m very proud to call Banyule Community Health my doctors. Thanking you.

6

BANYULE Community Health

Consumer survey findings Banyule Community Health conducts a triennial consumer satisfaction survey to gather consumer feedback that may be used to inform quality improvement strategies. Following the last survey in 2007, an improvement strategy was developed and implemented that addressed areas identified for improvement. The consumer survey was conducted again this year as a repeat of that survey activity to enable comparison of results. Between 17th May 2010 and 4th June 2010 when the Primary Health Care Consumer Opinion Survey was distributed to clients attending centre-based appointments at Greensborough and West Heidelberg, and to clients visited by Banyule Community Health staff at home. The survey assessed consumer satisfaction with Banyule Community Health in three main areas: • The centre environment/home visit option • Service provision, and • Special needs. 287 completed surveys were returned from the West Heidelberg and Greensborough sites. Of these, 221 were from West Heidelberg and

66 from Greensborough. 15 home visiting surveys were returned. Responses were rated as “Very Satisfied” for Centre Environment and Service Provision domains in the survey if the consumer reported that they were “Very Satisfied” with every element in that domain. Where a rating is given below “Very Satisfied”, it is considered that there is room for improvement. Overall, Banyule Community Health consumers reported high levels of satisfaction with the environment at both the West Heidelberg and Greensborough sites. In most areas, consumer satisfaction was stable or improving compared with our previous survey in 2007. The exception was a decrease in the satisfaction in the Centre Environment domain. Reasons for this decrease, including reported difficulties with car parking, were explored, however no clear relationships were found. The most plausible reason is that the last survey was conducted shortly after moving into a new building at West Heidelberg, and satisfaction may have been elevated at the time as a result.

Indicator

2007

In the recent GP survey the area that was rated most highly in client satisfaction was “Do you feel that you are being treated respectfully by your doctors and staff” at 84%. It reflects Banyule Community Health’s motto of “working together with trust and respect”, the culture of the organisation and the commitment of staff to working along side of clients in a manner that is respectful.

In response to the findings from the survey and suggestions from survey comments, Banyule Community Health will be developing an action plan that addresses identified priorities for improvement.

2010

Trend

Satisfaction with 34.7% “Very Centre Satisfied” Environment

26.8% “Very Satisfied”

Satisfaction with 52% “Very Service Provision Satisfied”

53% “Very Satisfied”

Special Needs Language

87% language needs met

90.6% language needs met

Cultural

74% cultural needs met

74% cultural needs met

Physical

84% physical needs met

88% physical needs met

2009 Quality of Care REPORT

7

Demographic Data

Demographics the people we work with

Preston Alphington/Fairfield Clients by 19% Ivanhoe West Heidelberg/Bellfield Preston Mill Park 2% 2% 3% Alphington/Fairfield Bundoora 2% 2% The majority of our clients 19% 30% Ivanhoe Heidelberg/Rosanna/Viewbank/Eaglemont (30%) come from the 3081 West Heidelberg/Bellfield 7% Macleod postcode area of West Mill Park 2% Heidelberg. Watsonia Bundoora 2% 30% Greensborough/Briar Hill/St Helena 8% Heidelberg/Rosanna/Viewbank/Eaglemont Lower Plenty 7% 2% Macleod 7% Montmorency 10% 6% Watsonia Other Greensborough/Briar Hill/St Helena 8% Lower Plenty 2% 7% Montmorency 10% 6% Other 3%

2% Postcode 2%

Clients by age group 6% 27% 21%

6% 27% 21%

23%

23%

Contacts by Program 23% 23% 7% 26%

9% 5% 4% 8% 1% 1% 3% 3%

8

30% 3%

BANYULE Community Health

0-19 20-39 0-1940-59 60-79 20-39 80+ 40-59

There has been a significant increase in the representation of 0-19 year olds in service data, with this group now comprising 27% of our client group.

60-79 80+ Dental Medical AOD Clinic Nursing Counselling Dietetics Emergency Relief Gambler's Help Adult OT Physiotherapy Podiatry Other

There were 60,233 client contacts across all clinical areas over 2009/10. The majority of these were in the medical area where 17,575 client contacts were made.

11%

1%

Australia China England Greece Australia Italy China Lebanon England Somalia Greece Former Yugoslavia Italy New Zealand Lebanon Other Somalia Former Yugoslavia New Zealand Other

1% by Country of Birth Clients 4%

11%

1% 1%

Diversity Diversity

4% 1% 2%4%

1% 2% 4% 1%

The vast majority of our clients (73%) were born in Australia. This is consistent with the 2006 ABS data for the City of Banyule, where 75% were born in this country. Similarly, comparing our client profile with the other major groups in our community by country of birth, we find that in most cases these populations are represented in a similar proportion or better. It also identifies, however, that continued efforts are needed by the health service in engaging people from India and Malaysia.

2% 6781, 73%

2% 1%

6781, 73%

Ki ng do m

Ita ly Ch in Ne Gre a w e Ze ce al an d In M di a al a Ge ysia rm Sr any iL an k Cr a oa Fm S tia r Y om ug ali os a la Le via ba no n AT SI

5 4.5 4 3.5 53 4.5 2.5 42 3.5 1.5 31 2.5 0.5 20 1.5 1 0.5 0

ni te d

PercentagePercentage of local population of local population (ABS) and client (BCH) U (ABS) profile and client profile (BCH)

Figure 1: BCH client profile vs Banyule City Council demographics

600 500 400

500

100

Interpreter usage To improve access to the health service by people from culturally and linguistically diverse (CALD) backgrounds, the importance of the use of qualified interpreters has been emphasized to both staff and clients of the service. As a result, we have seen continued improvements on previous years in the use of interpreters, with close to 500 interpreter bookings made in 2009-10. The majority of these were for people in the Somali, Arabic, Cantonese and Mandarin language groups. The increased use of interpreting for Chinese languages indicates that access to our services for the Chinese community is improving.

0

Number of bookings

Number of bookings

ed

200

na

ce

d

a di

ia

ny

M

G

S

ka

tia

li a

ia

on

SI

s o It hi a lav n In n AT ay m a Lan roa over ee l a m gd Increase in Cinterpreter ba al erusage C So gos etime Gr ea in ri it 600 Un

300

y al

m

K

w Ne

Z

L

u rY Fm

ABS 2006 BCH 2010 ABS 2006 BCH 2010

400 300 200 100 2005/06

1006/07

2007/08

2008/09

2009/10

0 2005/06

1006/07

2007/08

2008/09

2009/10

Interpreter use by language 10% 2%

22%

3%

10%

4% 6%

2%

22%

3% 4%

6%

6% 19%

6%

6% 9%

6%

7%

6%

Somali Arabic Auslan Somali Cantonese Arabic Mandarin Auslan Italian Cantonese Serbian Mandarin Turkish Italian Vietnamese Serbian Greek Russian Turkish 19% Vietnames Other

Greek 9 Russian Other

2009 Quality of Care REPORT 9% 7%

6%

Two of Us Stan’s Story It all started in July 2009 when I had heart failure. I was in the Austin and was in a bad way …I had three visits within two months; the longest was for 6 weeks. Sharon visited me at home in West Heidelberg. I had been living there for about four years. I lived like a hermit and never went out. I didn’t even know that the Community Health Centre existed and didn’t know anyone in the neighbourhood. I was sick and didn’t even realize I was getting sicker and sicker. After I got out Sharon visited me at home a few times and then we decided to meet at the Community Health Centre. Sharon linked me in to things at the centre …. the Men’s Lunch, the Life Skills Café, the Huff and Puff Group and the Community Choir. The receptionists have also got me into see Dr Singh now. Now I walk everyday from home to the centre. I never did that in the past, I would just stay home all day. I feel like part of the family at the

centre, it’s got a family atmosphere here. I know everyone and everyone knows me. I’m very well known throughout the community now that I come here. It’s great to have a chat and a coffee. My neighbours say to me “are you going home” when I head off to the centre. I’m barely at home now. The Community Choir meets every Tuesday at the Centre. We just had our first big gig. The Choir has

changed the way I think; I put the past behind me and look to the future. People around me have noticed the change. I’m much more patient and I look after myself. If I had continued on the path I was on I would be dead by now. Meeting Sharon changed things for me …she’s an angel of mercy. I haven’t been back to the hospital since Sharon and I met. I’ve got a hell of a lot of time for Sharon.

appointments with me before Christmas last year, he wore red glasses and a Santa hat and played his harmonica. I recall reception phoning to tell me that a “happy santa” was ready and waiting for his appointment. Appointments with Stan were aimed at improving his health condition by implementing ‘best practice’ management guidelines for heart failure. These included health education, clinical support and monitoring strategies. It became obvious that Stan’s heart health crisis, general health and wellbeing were all intertwined. Stan’s heart health crisis was compounded by social isolation and the resulting lifestyle patterns he had developed. Needs for social inclusion and a daily purpose were important for Stan before he could even consider, or feel empowered to manage his heart health. Involvement in the local community through BCH groups, such as ‘Huff n

Puff’, community choir, exercise groups, mens’ lunch and the mens’ shed, as well as contact with people at the Life Skills Café, have led to Stan feeling welcome and supported. These social links have given Stan a purpose to leave home and walk each day, which in turn has physically strengthened him and improved his well-being. Stan is part of the BCH community and comfortable enough to also voice his concerns and grievances, which is an important part of belonging. I often see Stan and say a quick ’hello’ as I come and go from BCH between client visits. He is managing his health so well at the moment that we only need an appointment every 4-6 weeks to monitor and review progress and highlight goals. I admire Stan’s commitment and congratulate him on his wonderful health achievements in the past year.

Sharon’s Story I am a Respiratory/Cardiac Outreach Nurse based at Banyule Community Health (BCH) for the Hospital Admissions Risk Program: Chronic Disease Management Program (HARP COMP). I work with people facing many health challenges related to lung and/or heart disease; generally visiting them in their home and sometimes at BCH or the Austin Hospital. I am also involved in facilitating a support group called ‘Huff n Puff’ with my co-worker, Yvette. Although on the surface many of my clients appear fragile, all of them are strong, resilient and courageous. They face daily challenges related to their disease process and battle to maintain their independence and reach goals. Stan was referred to me for HARP COMP following a number of hospital admissions. He is quite a character and a likeable fellow. When Stan began coming to BCH for

10

BANYULE Community Health

Cultural Action Plan The most significant trends in the CALD population between the 2001 and 2006 census were increases in the Chinese and Indian populations. A number of strategies in the Cultural Action Plan therefore target these communities. In 2009/10 the achievements of the group have included: • Working to establish links with local providers of tertiary education to better understand the health needs of international students and raise awareness of Banyule Community Health services that may be accessed by students • Research project investigating barriers to speech therapy

experienced by “at risk” families • Recruitment of bilingual workers in the Gambler’s Help team • Delivery of Eat Well Play Well program to Somali families • Working in partnership with Children’s Protection Services and Mercy Hospital for Women to coordinate appropriate services through the New Directions Program for pre and post natal ATSI women As a result of efforts to engage these targeted cultural groups, compared with 2008/09 data: • Representation of Chinese community in service data has

Human Rights

increased from 0.3% to 1.3% • Representation of ATSI community has increased from 0.7% to 1.2% (for more information refer to ATSI pages of this report). Further work is required to engage the local Indian community, as there has been a negligible increase in their accessing of services.

Bilingual Workers in Gambler’s Help CALD communities experience significant barriers to accessing mainstream Gambler’s Help (GH) services according to research and evidence. Barriers include limited awareness of available services, lack of confidence that a service can assist, concerns around confidentiality and issues associated with stigma and problem gambling. In response to the identified need for a greater bilingual counselling service capacity and reach within the GH sector, the Office of Gaming and Racing (OGR) have funding a two year demonstration project that will deliver a targeted and coordinated bilingual counselling services model across the North and Western Metropolitan region to both the Vietnamese and Italian communities.

Joint BANYULE COMMUNITY HEALTH/WHLS housing submission Banyule Community Health made a joint submission with the West Heidelberg Community Legal Service to the Family and Community Development Committee of Inquiry into the Adequacy and Future Directions of Public Housing in Victoria, on 29 January 2010. The staff of Banyule Community Health contributed to the joint submission by responding to a series of questions from the legal service about issues to do with their clients and public housing. These client/patient experiences were then de-indentified and written up by the legal service for inclusion in the joint submission. Key issues that the

workers from overcrowding, poor maintenance, children leaving home because of living conditions, deleterious housing conditions leading to poor health, pathways in and out of homelessness and back again and issues around safety and security. Many of these concerns raised highlighted breaches of the Victorian Charter of Human Rights and Responsibilities which the Office of Housing must act compatibly with as it is a public authority bound by the legislation. In addition, workers from BCH underwent training in their teams on how they can use the Charter to broker better human rights

outcomes for their patients/clients. Many staff at BCH having been armed with how they can use the Charter in their day to day work with community members have reported positive break throughs. BCH staff participated in this advocacy work with commitment and enthusiasm seeing it as a critical opportunity to strive for improved outcomes for community members on an individual level and to contribute in policy and legislative reforms that can address the systemic causes of some of the identified problems.

2009 Quality of Care REPORT

11

Disability Access Project

and staff from government and service agencies. An interactive staff training session about working with people with intellectual disabilities was attended by 75 staff and was followed by several requests for more training in the area. Finally, a Disability Action Plan has been developed to ensure the needs of people with all types of disabilities continue to be considered in the organization and that they are included as valued members of the Banyule Community Health community.

Claudio Petri Orange Houses

The health and service needs of people with intellectual disabilities were highlighted throughout the demonstration project and led to other activities aimed at raising awareness of this group throughout our community. Perhaps most notably the Department of Human Services, Disability Services, used the evidence of health and service need

collected by Care Coordinators to successfully advocate that people with intellectual disabilities are awarded a high priority for access to statewide dental and community health services. At a more local level, Banyule Community Health and Banyule Nillumbik Primary Care Alliance hosted an exhibition that show cased the works of 21 artists with intellectual disabilities from Araluen Art Connects program. The opening night was a great success and attended by 170 people including artists, families, carers, local media, members of the community

David Waterhouse Wooden Houses

Banyule Community Health continued to improve access to health services for people with disabilities as part of its broader commitment to equitable provision of quality care for all community members. We recognized that people with intellectual disabilities were not always able to get the health care that they needed because of cognitive impairment and related communication difficulties. For these reasons two Disability Health Care Coordinators reviewed the health needs of over 100 people with intellectual disabilities living in local supported accommodation. As a result of the review Care Coordinators worked with carers, support staff and health providers to facilitate access to quality care for people with high support needs and intellectual disability. Funded by the Department of Human Services, Care Coordinators were employed by Banyule Community Health through a project that we carried out in collaboration with Darebin Community Health, the Banyule Nillumbik Primary Care Alliance and Disability Accommodation Services.

12

BANYULE Community Health

Governance and Management Our Board of Directors

The names of the directors in office at any time during or since the end of the financial year are:

Melinda Brooks Peter Ogden John Ferraro Frances Baum Denis Swift Bill Barber Abdallah Ahmed Larry Stephens David McKenzie

Director Profiles Denis Swift Qualifications: BBus (Bachelor of Business), MHA (Masters Degree in Health Administration (UNSW) Experience: Recently retired from full time work, Denis has held senior executive positions with Mercy Health & Aged Care, Greater Southern Area Health Service (NSW), Bayside Health, including the Alfred Hospital, Transport Accident Commission (TAC), Austin Hospital and the Victorian Department of Human Services. At both the Austin and Alfred Hospitals he held fixed term appointments as

David McKenzie Qualifications: BA Econ (Bachelor of Economics) Commenced his career as a primary school teacher and has taught at many local schools such as Watsonia, Viewbank, Greenhills, Briar Hill and Eltham. Experience: David was a foundation member of the Diamond Valley Council (1964) and Shire President 1969 – 1971.

Chief Executive Officer. Denis is an Associate Member of the Australian Society of Accountants, an Associate Member of College of Health Service Executives and a Member (and inaugural Chairman) of the Australian Health Service Financial Management Association. Over the years he has been involved in numerous health industry committees and up until recently Denis was an adjunct senior lecturer at La Trobe University, Faculty of Health Sciences. Special Responsibilities: Member of the Client Services and Staffing Sub-Committee

Member of the House of Representatives for Diamond Valley 1972-1975. Former Chairman of the Publications Committee of the House of Representatives and Chairman of the Joint House and Senate Publications Committee. The National President of the Association of Former Members of the Australian Parliament. Special Responsibilities: Member of the Audit and Finance Sub Committee

2009 Quality of Care REPORT

13

Strategic Plan There are no accidents… Much of the work and improvement achieved by Banyule Community Health and described in this report is the result of considered planning and follow-through with delivery. This

begins with the Banyule Community Health 2009-12 strategic plan. The strategic plan describes three key strategic directions with goals related to each direction. From this plan we develop an annual operational plan

that also draws in activity planned in integrated health promotion, diversity, quality and risk, and that responds to feedback from teams and community.

Goals/Objectives

Strategy

Outcome

1.1. Services are responsive to the changing needs of the community

Be proactive in utilising research and Over 8 successful funding submissions including evaluation mechanisms to explore a for a Mental Health Project Worker, Worker wider range of funding opportunities Healthchecks, Bilingual Workers, Men’s Shed and Expansion of Peer Connection program.

Quality Services

Use existing and new partnerships to Formal partnership agreements developed with 4 strengthen our capacity to deliver agencies: Banyule City Council, NEPCP, Austin healthcare within a social model Health, Mercy Hospital for Women. 1.2 Enhance Client outcomes through coordinated healthcare delivery

Explore new approaches to healthcare delivery and client management.

Protocols developed with BCC for assessment framework and implementation of HACC Active Service Model. Model for chronic disease management and care planning developed.

Positive Working Environment

Healthy Communities

1.3 Identify and address Broaden models of service delivery in Action plan for a new model of service delivery in barriers to access and Northern Banyule developed. order to meet the community’s equity access needs

14

1.4 Use technology to increase our ability to meet the needs of our community

Adapt new ways of using technology

SMS messaging introduced in Dental and costings for messaging in other areas secured. Recruitment of members via the internet – 100% increase in BCH membership.

2.1 The community to be actively involved in health and wellbeing

Increase community awareness of health issues

3 year Integrated Health Promotion Plan developed. BCH accreditation for Worker HealthChecks achieved and program implemented.

2.2 Encourage community participation in all operational areas.

Ensure community participation principles are embedded in all aspects of program planning and delivery

Community Participation Framework and Action Plan developed. Consumer reference groups for chronic disease, Quality of Care and Peer Connection programs. Training delivered to 42 staff. Community satisfaction survey undertaken in medical practice and whole of agency.

2.3 Actively advocate addressing health and social inequities

Consult widely and mobilise the community on issues that affect their wellbeing.

Joint submission with West Heidelberg Legal Service

3.1 Improve flexibility in Explore family-friendly and better working conditions work-life balance practices

Working from Home policy established Staff Climate survey completed and action plan developed.

3.2 Support innovation in workforce and professional development

Embrace leadership development and implement clinical leadership roles.

System of clinical supervision introduced in Allied Health. 3 new clinical supervisor positions established and additional external supervision sourced.

3.3 An organisational structure that meets the needs of the community

Embed clinical governance principles and risk management

Clinical supervision position descriptions and contracts developed and implemented; clinical supervisors appointed.

BANYULE Community Health

Finance Summary As a result of community requests in 2008 and positive feedback in 2009 we have again produced financial statements separate to our Quality of Care Report. This year, we have made the Banyule Community Health Annual Report & Financial Statements available online at www.bchs.org.au/annualreport as well as providing a printed version to members of Banyule Community Health.

Banyule Community Health is a large and complex organisation, with over 130 staff. Our income and expenditure are both in the order of 1.1% 0.6% $11,000,000 per annum and the table 0.4% 2.5% and charts on this page provide a 11.9% money breakdown of where this comes from and how it is spent.

83.5%

Income 0.6% 1.1% 0.4% 2.5% 11.9%

INCOME

83.5%

Government Grants Patient Fees Donations

9,354,537 1,335,874 40,963

83.5% 11.9% 0.4%

Interest Received Rental Income Other Income TOTAL INCOME

70,946 121,276 276,058 11,199,653

0.6% 1.1% 2.5% 100.0%

Government Grants Patient Fees Donations Interest Received Rental Income Government Other Income Grants Patient Fees

EXPENDITURE Employee Costs Depreciation & Amortisation Motor Vehicle & Travel Client Programs & Medical Expenses Repairs & Maintenance Rental Expenses Equipment Purchases Lease Expenses Consultancy Fees Printing & Stationery Cleaning Expenses Other Expenses Borrowing Costs TOTAL EXPENSES SURPLUS/(DEFICIT) for the Year

Donations 8,213,982 209,659 142,919

74.4% 1.9% 1.3%

675,009 132,260 178,717

6.1% 1.2% 1.6%

60,046 160,627 182,673 82,603 122,039 865,604 17,333 11,043,471

0.5% 1.5% 1.7% 0.7% 1.1% 7.8% 0.2% 100.0%

156,182

Interest Received Rental Income Other Income

Expenses 1.7% 0.7% 1.5% 0.2% 1.1% 0.5% 7.8% 1.6% 1.2% 6.1% 1.3% 1.7% 0.7% 1.9% 1.5% 0.2% 1.1% 0.5% 7.8% 1.6% 1.2% 6.1% 1.3% Employee Costs 1.9%

74.4%

Equipment Purchases

74.4%

Lease Expense

Depreciation & Amortisation

Consultancy Fees

Motor Vehicle & Travel

Printing & Stationery

Client Programs & Medical Expenses

Cleaning Expenses

Repairs & Maintenance

Other Expenses Purchases Equipment Borrowing Costs Lease Expense

Rental Expenses Employee Costs

Depreciation & Amortisation

Consultancy Fees

Motor Vehicle & Travel

Printing & Stationery

2009 Quality of Care REPORT Client Programs & Medical Expenses

15

Cleaning Expenses

Repairs & Maintenance

Other Expenses

Risk Management Banyule Community Health has long been committed to ensuring that as far as is practicable, harm does not occur to clients, the community, staff, the organisation or the environment. From early 2008, we commenced a project to develop a more systematic process for addressing risks. Since that time, a Risk Committee has been established to assess, monitor and review risks and develop risk treatment plans. Having identified the key

organisational risks, the Risk Committee has worked to develop treatment plans for each of those risks. Treatment plans are now in place for all significant organisational risks, with strategies being implemented and monitored for effectiveness.

each team now works through a process of identifying, assessing and planning to manage risk at their team meeting. This helps to capture information about potential risks that may not be reported through the incident reporting system, our other main source of risk data.

Our challenges are now to maintain the system through the involvement of all staff in identifying and reporting risks and working to reduce risks. To facilitate this process,

Our developing Risk Management system was commended by QICSA at the time of our external review for accreditation in October 2009.

Identify Risk All staff and clients are encouraged to Identify risk via Incident Reports Discussion at Team meetings Referral to Risk Committee

Treat Risk Discussion at team meetings How risk is to be treated is documented in meeting minutes if it is low. How risk is to be treated is documented in a treatment plan if it is high it is referred to Risk Committee

Monitor and Review Risk Risks are regularly reported to the Board of Directors via a standing agenda item. The Board are informed not only of the risk, but what management and staff do to treat it.

16

BANYULE Community Health

Communication and engagement

Open and transparent culture

Assess Risk All Banyule Community Health staff have the skills and tools to assess if a risk is low, medium, high or very high. Risks are discussed at all team meetings and staff are encouraged to raise their concerns.

ATSI Growth in ATSI use of services

% of total client population

1.4 1.2 1 0.8 0.6 0.4 0.2 0 2005/06

2006/07

2007/08

2008/09

2009/10

The growth in the use of Banyule Community Health services by the ATSI community demonstrates that strategies being implemented to improve access for the community are having an impact.

NANGNAK WAN MYEEK New Directions Program Funding for the New Directions Program was secured by the Mercy Hospital for Women approximately 15 months ago to enhance maternity and follow up services to Aboriginal women and their families whose babies were born at the Mercy Hospital. This includes pre and post natal care, as well as the monitoring of children to the age of eight years. The Children’s Protection Society and Banyule Community Health were invited to become partners in the program. The past 15 months have involved project development in the form of mapping of statewide services related to indigenous families as well as extensive community consultation. Various professionals have been seconded to the program to provide assistance to the manager. Currently a suitable model of care is being explored and developed. Banyule Community Health is very excited for the opportunity to be involved in this program. Indigenous health is a priority of the centre and

ATSI Training Staff training is seen as an important strategy for developing ATSI cultural awareness. To make this more accessible and ensure a high participation rate, on-site training in Indigenous Cultural Awareness was run in September 2009. The training

this is an opportunity to expand our maternity and pediatric services to the local indigenous community. We are well placed in the community health centre to provide a wide variety of different services within and outside the centre. The centre is well connected to local Aboriginal Elders and services who have participated in various ceremonies including the opening of our indigenous garden. We look forward to a productive collaboration with our two partners. was run by Rob Hyatt, State Coordinator Indigenous Sport and Recreation Program with the aim of promoting an awareness of the culture and history of Indigenous Australians, and of the issues and experiences of Indigenous Australian people and communities in society today. 62 Banyule Community Health

Artwork by Alan Brown from Banyule Men's Shed

staff were involved in the session. All participants reported that the session had given them a better understanding of the issues facing the indigenous population – something that is fundamental to improving communication and accessibility of services.

2009 Quality of Care REPORT

17

Men’s Shed The Banyule Men’s’ shed was officially opened in August this year, but in reality the shed’s been far more than a physical building. The development of the men’s shed space is the story of the journey of some eighty odd local Banyule men, coming together over the last 2 years to build a vision. The vision is a place where men of all backgrounds ages and abilities can share mateship, grow ideas, learn new skills and return something of value back into their communities. The shed is home to a large aboriginal mob, and a committed Somalia group who use the shed as a space to reflect and “breathe”, away from the pressure of the everyday The shed is a major initiative of BCHS men’s health promotion and targets men over the age of 18 living within Banyule and surrounding localities, with a particular emphasis on: Men

from CALD/Refugee backgrounds, Older Men, Men with mental health issues, Defence Services Veterans, Under and Unemployed Men, Men from diverse social backgrounds and indigenous men. In the words of the men ‘…The Shed is a place to meet up with your mate or meet someone else. It's a place where you can be without the pressure to do. The Shed is a place where you can learn from others or you can share your talents and skills. It is a place to have a say and have it taken seriously and acted on if needed. It's a place to have a yarn and laugh and it's a place where men can relax; it’s a place to celebrate. The Shed is a place where men can be with other men…’

“It’s added five or ten years to my life, I thought I’d never have again” The men’s shed has some 150 men registered as members and on average 80 men turn up across the week. New enquiries average three a week.

“It’s really saved me “

Accreditation/CQI Accreditation involves a three year cycle of quality improvement initiatives, self-assessment and exernal review.

In September 2009, Banyule Community Health was reviewed externally for accreditation by the Quality Improvement and Community Services Accreditation (QICSA). It was the fourth accreditation review for Banyule Community Health, and covered the West Heidelberg, Greensborough and new Rosanna sites. The outcome of the review was that Banyule Community Health met all QIC standards, and met all HACC standards except “information is provided on services and any changes”. To meet this standard, Banyule Community Health is developing a clinical care appeals process. Despite requiring this further work to be undertaken, Banyule Community Health was rated as “High” standard of performance against the HACC criteria. Banyule Community Health commitment to providing quality services was highlighted by QIC as a feature of the organisation. Additionally, the organisation was commended for: 4 Board commitment and their

18

BANYULE Community Health

4 4

4 4 4 4 4

4 4 4 4

4

knowledge of the Community Health Service’s demographics Planning processes Commitment to leadership through the scholarship program and leadership training Demonstrated commitment to environmental care Systematic and integrated finance systems Finance Code of Conduct The developing Risk Management System The use of comprehensive Practice Manuals to guide day to day operations within programs Cultural competency and flexibility to respond to emerging issues Range of information translated into community languages Consumers clear understanding of their ownership of the organisation The system of intake, initial assessment and referral and the supporting policy and procedure Well documented service access and priority setting procedures

4 Commitment to TrakIT implementation despite the associated problems. Areas for improvement that were identified included: • Improved documentation around governance procedures • Continued implementation of the risk management framework • Improving knowledge management and • Service coordination beyond intake. These, and other areas identified for improvement by staff and management during a selfassessment process prior to the review, have been incorporated into a new three-year quality workplan. Work has already commenced on these initiatives and our progress will be reported to our community via this Quality of Care Report in the future.

Clinical Safety and Quality Safety

Client incidents 2009-2010 1

2

Collapse/Medical Emergency Hitting objects with part of body Slips/Trips/Falls

1 1

Other

In 2009-10, there were 5 incidents reported involving clients. There were no reportable deaths of a Drug and Alcohol client off-site. This number of incidents is similar to previous years when death of Drug and Alcohol client (a mandatory reporting event) is excluded from previous years data. The low numbers of incidents mean that this data is not our most useful source of information for identifying safety issues. Banyule Community Health therefore additionally now focuses on risk identification to continuously improve safety for both our clients and staff. See our article on Risk Management for more information.

students complete year 12 compared with the state average.

ACCESS

The main issues with accessing services were identified as being:

Speech Pathology Access project Paediatric speech pathologists work to identify, assess and manage children who present with a range of communication difficulties including speech sound delays, difficulties in comprehension and use of language, and stuttering. Early language and speech delays in children have been linked to vulnerable school readiness, literacy difficulties and poor academic performance. It is also linked to reduced confidence and self-esteem, and behavioural and mental health issues in the longer term. This is very significant in an area such as West Heidelberg where 53% fewer

As part of a service evaluation and commitment to enhancing the quality of speech and language services provided to the Banyule community, a project was undertaken in late 2009 to investigate access issues for the speech pathology service at Banyule Community Health. The project sought feedback via a survey from key external service providers who made referrals to the service, and families from postcode 3081 (West Heidelberg) who were either receiving treatment from the speech pathologists or had attended the clinic in the past.

information flow to parents, and trialling a new approach to waiting list management. The team has also begun working towards increasing flexibility in how therapy is delivered.

• parents lack understanding of the role of the speech pathologist • difficulty for families managing speech pathology home work in addition to managing family responsibilities • cultural and linguistic barriers • long waiting list • service provider’s experience with the referral process and • lack of flexibility in service delivery model. A series of recommendations were made as part of the report and have since been actioned. These included addressing cultural issues, improving

2009 Quality of Care REPORT

19

25 20 15 10 5 0 Physio

Podiatry

% of appointments not attended (DNAs)

% of appointments not attended (DNAs)

Efficiency

Speech

25

Missed appointments as a percentage of total appointment bookings

20 15 10 5 Paed OT Dietetics Medical 0 Physio Podiatry Speech

Paed OT

Dietetics

Medical

Missed appointments have a great impact on both the efficiency of a health service and access to a service. In some clinical areas, clients do not attend over 20% of booked appointments. This represents a missed opportunity and delay in receiving a service for another client on the waiting list. In 2008, the dental service introduced SMS messaging to remind clients of their appointment in order to improve attendance rates. This strategy is being investigated for all other clinical services in 2011. In the meantime, we encourage all clients to call us with as much notice as possible in the event of a cancellation.

Waiting time (weeks) by program

Although there is a waiting list for most services, people on the waiting list are prioritised to ensure timely access to services. This year the Department of Health’s Demand Management Framework was introduced at Banyule Community Health. The framework provides a set of tools that assist in prioritizing clients when they present for servies. Having a consistent approach for community health services to manage demand across the state supports equity of access, accurate waiting time measurement and benchmarking with other services.

20

BANYULE Community Health

Competence and Education of Staff Credentialing Credentialing refers to the process used to verify the qualifications and experience of clinical service providers to form a view about their competence and suitability to deliver safe and high quality health care services. This includes checking an individual’s education and degrees, professional registration, accreditation where required and work history. Banyule Community Health has strong systems in place to ensure that all staff are suitably credentialed to carry out their roles safely and competently. The credentialing process prior to employment at Banyule Community Health involves: • verification of identity • review of tertiary qualifications • review of continuing professional development • evidence of professional registration • evidence of any accreditation with professional colleges or associations where required • referee checks • police record checks and working with children checks, where required. Following on from initial recruitment, the Human Resources area review current registration annually. This means that Banyule Community Health can ensure its clients that every clinician they see at our service is appropriately qualified to provide a high quality service.

Testing Models of Clinical Supervision How best to supervise clinical staff in a multidisciplinary primary care setting is an issue being explored within the Allied Health Team. The aim is to identify the most effective model for supervising clinicians in terms of impact on service quality and safety. The introduction of clinical supervision forms part of a restructure of allied health. The team consists of 32 staff from seven disciplines. It has been reorganised from a single team with one team leader into three teams each with their own team leader, reporting directly to the Manager of Clinical Services. Clinical supervisors have also been introduced into the team structure, where sufficient resources existed. The team leaders are responsible for the day to day management of staff, ensuring clinical supervision is provided and being actively involved in the organizations quality and safety structures and initiatives. Clinical supervisors report to the team leaders and are responsible for providing regular clinical supervision to staff in accordance with Banyule Community Health Supervision Policy and Procedures. Clinical supervisors are also responsible for promoting evidence based practice and ensuring professional standards are maintained.

client quality and safety of care in complex clinical situations. We believe that this process will also improve staff satisfaction and retention, as one of the unexpected advantages of providing clinical supervision is the new career pathways it creates for staff. Banyule Community Health’s pilot moves beyond the Victorian Department of Health’s (DoH) clinical governance requirements for community health services and comes at a significant financial cost to the organisation. Once the pilot is completed, Banyule Community Health will conduct an evaluation which will look at assessing how clinical supervision influences care, practice standards and the service.

The formal process of professional support and education will enable staff to develop clinical skills, enhance competence, assume responsibility for their own practice and enhance

2009 Quality of Care REPORT

21

Infection Control Infection control practices within the dental clinic were risk assessed by an external consultant, Healthcare Infection Control Management Resources (HICMR), in April 2010. The purpose of the audit was to ensure that the clinic was meeting all relevant standards, that the standards of practice minimize the risk of cross-infection and to identify any potential for breaches of practice and put in place mechanisms to avoid this occurring. The dental clinic results were excellent, with 97% compliance against all the standards in the clinical practice area (2008 score = 93%), 98% compliance against office-based practice – nonclinical practices (2008 score 77%) and 85% compliance against sterilizing services (2008 score = 81%). The improved compliance rates reflect implementation of recommendations from the previous audit. Comparison with other like facilities by HICMR shows that the Banyule Community Health dental clinic is performing well above the average in infection control. HICMR noted in their report that:

% Compliance

100

97

Infection control comparative risk assessment results comparing Banyule Community Health to the average across other HICMR category 8 client facilites as at April 2010

98

2010 Review

90 84 80 70 60

BANYULE Community Health

Management and staff were also commended for adopting the majority of recommendations from the previous review in 2008.

Banyule Community Health

95

50

22

“Staff practices and standards were noted to be excellent, exemplified by the high compliance score for this assessment.”

85 77

HICMR Category 8

Dental Indicators Figure 2: Repeat emergency care within 28 days under same course of care

Waiting times for dental services have generally remained steady over the past 12 months for general dentistry (wait of under 10 months) and high priority dentures (wait of under 4 months). The waiting times for low priority dentures has, however, steadily climbed.

5.10% 5.00% 5.10% 4.90% 5.00% 4.80% 4.90% 4.70% 4.80% 4.60% 4.70% 4.50% 4.60% 4.40% 4.50% 4.30% 4.40% 4.20% 4.30%

BCH

4.20%

Northern Regions

BCH

Victoria

Northern Regions

Victoria

Figure 3: Unplanned return within 7 days following extraction 1.20% 1.20% 1.00% 1.00% 0.80% 0.80% 0.60% 0.60% 0.40% 0.40% 0.20% 0.20% 0.00% BCH

0.00%

BCH

Northern Regions

Victoria

Northern Regions

Victoria

Figure 4: Dental waiting times 30 25

Wait (months)

The Dental Clinic at Banyule Community Health performed well against all DHSV dental indicators over 2009-10. Clients seen in the dental area at Banyule Community Health are shown to require repeat emergency care less often than the rest of the region and Victoria. The rate of unplanned return following extraction is the same as for the rest of the region.

20

General Denture Low

15

Denture High

10 5 0 June 2010

May

April

March

February

January

December

November

October

September

August

July 2009

2009 Quality of Care REPORT

23

Evidence-based Care Research Coordinator Role in Gambler’s Help

As a reflection of its ongoing commitment to evidence based practice, Gambler’s Help Northern has employed a part-time research coordinator. The role of the research coordinator is to provide advice regarding current research on best practice, to build data collection systems aimed at demonstrating effective practice within the organization and designing research projects of relevance to practitioners

and clients of Gambler’s Help Services. Ultimately the work of the research co-ordinator reinforces the overall aim of building stronger communities by providing high quality services to people living within Banyule and the other municipalities covered by the program. Serena Smith currently fills this role and has a long history researching problem gambling services. Over the last 12 months Serena has been contributed to the work undertaken at Gambler’s Help Northern in the following ways: Producing a best practice research review for Partnership Program run with the Veteran’s Psychiatry Unit (Austin Hospital). This review later informed the development of a group program for Veterans with gambling issues and their Significant Other’s. To contribute to knowledge of best practice interventions within the team by maintaining an up-to-date library of evidence based practice and current trends in the field.

Surveying of research interests of current counselling staff. Advising on the development of data collection tools for evaluating community education activities. Supporting the implementation of OGR Track data collection system, as part of ongoing monitoring of program performance. This involved establishing service wide protocols for assessment and data collection. Reviewing ‘best practice’ policy and procedures with regard to follow up contact with clients. Building an assessment tool for clients entering the Peer Connection Program. Building a data collection system for Peer Connection Program evaluation. Establishing standards of practice and clinical guidelines for support staff. The challenge for in the coming year will be to ensure the excellent work undertaken by the organisation is well known within the community through the preparation of reports, articles and conference presentations.

School Readiness Group - Speech Pathology Research shows an established link between phonological awareness and reading acquisition, as well as a predictive and concurrent relationship between aspects of oral narrative ability and academic performance. Phonological awareness is best described as an individuals awareness of the sound structure of spoken words – word analysis or word attack skills. Oral narrative is the ability to understand and express story telling and involves knowledge of vocabulary, sentence and story structure, and sentence and story grammar. Studies have found that children with speech and language deficits, poor phonological awareness, and weaknesses in oral narrative ability are at risk for language and or reading disabilities.

24

BANYULE Community Health

The School Readiness Group program was developed by Banyule Community Health Speech Pathologists to promote the development of phonological awareness, oral narrative and other skills that are essential to successful classroom participation and to learning to read and write. The goals and activities were drawn from a review of recent research and evidence based guidelines. Children enrolled in the group are prescreened to determine their suitability. The program involves a parent information and training session, and 6 group sessions with the children and their caregivers. After each group session “homework” is given out for the families to practise the skills that have been taught.

Group therapy and parent training service delivery methods were utilized based on evidence showing that when parents are taught how to be language facilitators for children, they have been shown to do it just as well as a speech language pathologist. The positive outcomes of the group that has been running for the past three years have included: • improved child participation and confidence in a group setting • increased knowledge and confidence in parents in how and what to do to facilitate key skills for school readiness • child achievement of group therapy goals (improved phonological awareness skills, alphabet knowledge and oral narrative skills).

Better Health Self Management Program

The ‘Better Health Self Management’ program is a 6-week course for individuals with chronic diseases, empowering them with selfmanagement strategies in a supportive group environment. This course helps people understand that even though they may suffer with a chronic disease that is different to others in the group, they may share the same symptoms. The course is run worldwide and was developed by researchers from Stanford University in America. It was evaluated by its

developers in 1996, with a sample size of 1000 people. Results showed that people with a chronic health condition who attended this group demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, selfreported general health, health distress, fatigue, disability and social activities. They also spent fewer days in hospital and there was a trend towards fewer outpatient visits and hospitalisations.

Better Health Self Management courses were run successfully by Banyule Community Health throughout 2009, and continue to run in 2010. The evaluation of these courses using the Health Education Impact Questionnaire (HeiQ) demonstrated that the majority of participants agreed the program was worthwhile and helped them to set achievable goals to manage their daily lives.

Health Promotion ‘the process of enabling people to increase control over the determinants of health and thereby improve their health” (WHO, Ottawa Charter)

Banyule Community Health delivers a wide range of services to the community. The Health Promotion area has a strong focus on prevention and on targeted communities with the poorest health within Banyule. The three priority areas are

engaging the community with multiple barriers to good health. Many of the projects have a strong ‘wellness’ focus and is supported by advocacy and improved links to services to improve the health of the community.

• Healthy & active living • Social inclusion & wellbeing • Drugs and alcohol. The priority areas are tackling the most significant health issues in our community such as obesity, cardiovascular disease, asthma, cancer and mental health which can be prevented or its impact reduced with health promotion strategies, interventions and programs. (AIHW, 2004). The Health Promotion Team consult widely with the community, develop partnerships and build interventions, programs and responses that have the most impact. These interventions are diverse and acknowledge the challenges in

2009 Quality of Care REPORT

25

Community Choir

The emergence of a choir sits against the documented need of the West Heidelberg Community to develop and promote increased opportunities for inclusive, low/no cost, fun, daytime social activities. Three months on, The Keynote Singers: Banyule Community Choir is a well attended, vibrant, weekly activity. The choir operates out of the West Heidelberg site and represents a diverse cross section of the West Heidelberg and larger Banyule Community. The choir is a great example of how a reciprocal partnership can lead to successful health and arts outcomes for everyone involved. The project was co created and is collaboratively managed by members of the West Heidelberg community, community development workers, health workers, artist facilitators and arts workers from Banyule Community Health and Banyule City Council. In this choir,

26

BANYULE Community Health

workers and community members all sing together. By doing this they break down barriers, overcome fears and create a new community together. One member has spoken of the choir being like a family, when asked why he stated: “because we are starting to look to the future together”. Other members have spoken of the choir being “safe”, “social” and “a major break from TV”. A worker involved in the partnership has reported, “I knew that singing promoted health on a theoretical level but now I have experienced it”. Other choir members have spoken of the choir as providing the impotence to start tackling larger health issues like obesity and smoking. “When I started, I knew I loved it and thought - I don’t want to be the fat guy, I just want to be one

of crew- so I started walking to choir, you know to lose weight. Once a week, walk here- now I am walking everyday for an hour. “I like choir, but I smoke. And you can’t get through a line or hit the notes when you smoke as much as I have. So I had to stop. Its months now. But I can get through ‘Black Socks’ ”! Members of the Key Note Singers have noted that since commencing in choir they have found the confidence to apply for jobs and engage in further volunteering commitments.

Youth Website Engaging young people around health is a challenging and sometimes confronting issue. Using new and innovative approaches to reach specific populations is crucial in addressing health from a preventative perspective. Bundoora Secondary College and Banyule Community Health tackled these issues and gave some decision making and power back to a group of Year 10 & 11 students. The students identified the areas of health, the design layout and content. What emerged was an insight into modern communication and opportunities for health to be delivered in new ways. The project gave ownership to local young people and created an instant, confidential and informative portal to a range of health information. Our data tells us that we have had 1422 site hits since July 1st 2009 to our youth website. Feel free to visit and see the great work of our local young people. www.bchs.org.au/youth/

Worker Health Checks The Victorian Work Health Program has reached a significant milestone of 100,000 work health checks over a period of 9 months. This means that 100,000 workers from a broad range of industries (including some staff from Banyule Community Health) have received a Work Health check as part of the Work Health program. Of these workers, it was found that: • 39 per cent had a high risk of developing type 2 diabetes or cardiovascular disease; • 38 per cent reported risky levels of alcohol consumption; • 93 per cent eat less than the daily

recommended intake of fruit and vegetables; • 73 per cent reported inadequate exercise; and • 21 per cent had elevated blood pressure. Banyule Community Health is an Endorsed Service Provider and has been delivering work health checks to worksites since October 2009. In providing workers with the information they need to take action in managing their health, it is anticipated that the program will assist in reducing the incidence of chronic disease and potentially extend lives.

2009 Quality of Care REPORT

27

Continuity of Care - Mental Health VicHealth defines mental health as “the embodiment of social, emotional and spiritual wellbeing. It provides individuals with the vitality necessary for active living, to achieve goals, and to interact with one another in ways that are respectful and just.” Mental illness is a disorder that significantly interferes with an individual’s cognitive, emotional and social abilities. There are a variety of types and degrees of severity of mental illness and mental health problems. Mental ill health is one of the top 3 leading causes of burden of disease in Australia and it is growing. One in five Australians now experience a mental illness in a given year. The prevalence of the problem varies across the lifespan and is highest in the early adult years when people may be establishing families and participating in the workforce. It is estimated that the cost of mental illness is approximately $20 billion including costs from loss of productivity. Adults more likely to experience mental health problems include: • Those with lower education levels • Those unemployed or otherwise

not in the labour force • Those in non-professional occupations • Smokers • Those with doctor-diagnosed high blood pressure • Those told by a doctor that they have depression or anxiety • Those self-reporting poor health status • Those not having private health insurance • Those in households having lower income levels. Aboriginal and Torres Strait Islander people, women, youth and newly arrived migrants and refugees are population groups noted to have poorer mental health outcomes. Where a physical health problem coexists, the challenges faced by people with mental health problems are compounded. People with a physical and a mental health problem are twice as likely to experience reduced workforce participation compared to the general population. Banyule Community Health works

with our local community to address poor mental health across the entire spectrum of care – something that is unique to community health. We run a range of activities that target the social determinants of ill health, in addition to programs that specifically address the known risk factors for mental health problems and the most at risk population groups. Members of our counselling team participate in projects and research that contribute to the knowledge base for mental health. In our holistic approach to treatment we work with our clients to manage both physical and mental health issues, increasing the potential for positive outcomes. We also have dedicated resources working to coordinate the care of people with mental health problems and illness with varying degrees of severity and complexity to help clients navigate the service system with greater ease. This is assisted by strong partnerships with the acute sector that enable community-based interventions and help prevent hospital admission. The chart below provides information on some of our interventions, but is not exhaustive.

Care Continuum

BANYULE COMMUNITY HEALTH Activity

Prevention/health promotion WHOLE POPULATION TARGET

Men’s shed – we provide a work space for men to gather and develop social connections. Neighbourhood Renewal – Banyule Community Health works in partnership with Department of Health in renewing public housing and local open spaces, coordinating providing training and employment opportunities. Ante-natal and post-natal support – our midwives support women who are pregnant and who have recently given birth. School Readiness (paediatric speech pathology and OT) programs target babies and young children to assist them to participate fully in their education and enhance learning opportunities and outcomes Groups – our groups bring people together. Financial Counselling – assisting those who have difficulty managing their finances Emergency Relief – assisting those who have difficulty purchasing food and paying bills Awareness raising through the MILEAGE Group Banyule Community Health applies a social model of health in its approach to clients and works with the whole person Banyule Community Health works to build capacity in the health and welfare sector through: • participating in research and sharing learnings – the Counselling Manager is also an honorary research fellow with Melbourne and Monash Universities. Banyule Community Health staff will present study findings at the Mental Health Services Conference in September this year • participating in clinical rotations for staff development with Austin Health and Neami • developing strong partnerships with treatment and advocacy groups such as the Mental Illness Fellowship (WellWays Program) and CarerLinks North who provide support for carers of people with mental illness

Early intervention IDENTIFY AND MANAGE RISKS (PRE-DISEASE OR EARLY SIGNS OF DISEASE)

GP screening – Our GPs screen for mental health problems and develop a GP mental health plan in order to identify potential for further deterioration. The aim is to prevent client becoming more acutely unwell and requiring hospital admission. Credentialed Mental Health Nurse – this dedicated resource conducts a comprehensive mental health

28

BANYULE Community Health

assessment. The nurse identifies risk factors and develops strategies to manage those factors including referral to other Banyule Community Health services, domestic violence services, housing services, DHS Child Protection Services, Berry Street, Centrelink, Employment Services Partnerships with other services including: • Relationships Australia collocated at Greensborough to address relationship issues • West Heidelberg Legal Service collocated at West Heidelberg and working with Banyule Community Health to advocate for the local community on housing and a range of other issues Dual Diagnosis Project – this was a Banyule Community Health capacity building project that targeted clients with a co-existing mental health and drug or alcohol issue. The project had delivered a carer support package and developed referral pathways for clients with a dual diagnosis. The 6th month research evaluation is almost complete. Banyule Community Health social model of health promotes a holistic and participatory approach to managing health problems. A range of medical, dental and allied health services work together to address physical ill-health problems and thus mitigate some risks for mental ill-health. Drug and Alcohol team members and financial counselors also help identify and manage risks for mental ill health. Counselling and D&A staff have Odyssey House training for dual diagnosis Service Access Team conduct screening risk assessments that assist with prioritising clients for services MILEAGE Group – Mental Illness Awareness Group of Experts is an active support group for people with mental illness. Bushfire Case management team provided support to victims of the Victorian Black Saturday bushfires.

Treatment CLIENT WITH DISEASE PRESENT

Credentialed Mental Health Nurse – links clients with mental ill health to appropriate services. The nurse conducts joint assessment with GP and develops individual treatment plans (see article for more information). Health for Life program works to coordinate the care of clients with chronic disease and promote client’s ability to self-manage their health. Community Health treatment services: • Counselling • Gambler’s Help • Drug and Alcohol • GP • Psychologist Single Session Counselling has been introduced to increase timely access to counseling services. It promotes self-management and enables triaging for services. Partnerships Child and Adolescent Mental Health service Carer support is available to people caring for someone with mental illness Support groups based at Banyule Community Health include MUMS (Mums Understanding Mums Stuff group), Forget-Me-Nots support group for women with breast cancer.

Planned, managed and proactive care

Mental Health Nurse coordinates the development of a Mental Health care plan and ongoing review of the care plan. The nurse has developed relationships and referral pathways with external service providers, and may refer to Neami for psycho-social rehabilitation, drug and alcohol residential rehabilitation or other appropriate service such as North East CASA. “Holistic approach” – manage other health problems, address pain (allied health, dental) Banyule Community Health Service Integration Project is a project that has run over the last 12 months to improve the integration of services between the community and the acute sector. Acute services delivered in a community setting – partnership with North East Community Mental Health Service, the North East Primary Mental Health team psychiatric registrar consults at Banyule Community Health providing a bulk-billing service following referral from the Mental Health Nurse and GP. Membership of networks strengthens links between agencies. Banyule Community Health is a member of the North East clinical and PDRSS alliance. The Gambler’s Help team have a partnership with Austin Health’s Veteran’s Psychiatry Unit.

CLIENT HAS MULTIPLE PROVIDERS. MAY PROGRESS TO HOSPITALISATION IN THE MEDIUM TO LONG TERM.

Intensive care coordination CLIENTS WITH CHRONIC DISEASE AND COMPLEX NEEDS. FREQUENTLY USE HOSPITALS.

Banyule Community Health Service Integration Project (see article) has involved the development of a new service integration framework in partnership with Austin Health, La Trobe University, Nexus, Neami, NEVDGPs – to improve health outcomes for community members and their families and carers who have either a mental illness and/or a drug and alcohol problem Mental Health Nurse facilitates referrals to acute case management team, crisis teams, mobile support and treatement teams and Continuing Care Team. The nurse also coordinates case conferencing on site with both the client and carer present.

2009 Quality of Care REPORT

29

Mental Health Nurse at Banyule Community Health

The importance of general practice as a setting for mental health has been recognised in major policy documents in National Mental Health Strategy by Australian Health Ministers since 1992. The Mental Health Nurse Incentive Program was funded in July 2007 and aims to promote the work of credentialed mental health nurses in partnerships with General Practitioners, private psychiatrists, public mental health services and other health sector care providers. Since March 2009, Banyule Community Health has employed a mental health nurse, working full time since September 2009. Clients are referred to the nurse via their GP at Banyule Community Health provided they meet referral criteria. The mental health nurse adopts a holistic approach to client management which includes: • collaboration with GP and or psychiatrist to provide assessment • coordination of GP mental health care plans • medication monitoring • monitoring of mental state • psycho-education

• support on physical healthcare (eg: comorbidity issues) to clients • support to client’s carer as required • linkage/brokerage with other relevant stakeholders • consultation/advice/support to staff at Banyule Community Health with relevant mental health issues on their clients • coordination of clients for psychiatric review provided by a psychiatric registrar as an integrated service arrangement

piloted between North East Area Mental Health Service and Banyule Community Health. To date, the Mental Health Nurse has assessed 130 clients. The benefit to clients who have used the service have included better access to care and continuity of care from the same professional. It has also meant early intervention and prevention of admission to hospital psychiatric unit, with admission/readmission rates to psychiatric hospital at around 3-4% of clients using the service.

How our access and discharge practices in the medical practice meet the needs of consumers The medical practice at West Heidelberg works closely with the Austin Hospital with the aim of optimal continuity of care for our clients: • Our general practitioners are notified within 24 hours of their clients admission at Austin ED approximately 90% of ED admissions. • Our general practitioners receive faxed discharge summaries within one week, followed up by a

30

BANYULE Community Health

discharge summary sent in the mail a month later. The medical practice is also committed to high quality care planning to help with continuity of care, and as far as possible manage many chronic and complex conditions within the community setting. Care plans are done for active clients with at least 2 chronic diseases and who see three or more service providers. Active clients are defined as clients seen three or more times over the last two years.

Between January 2009 and February 2010 in the GP practice 269 care plans were completed and 243 team care arrangements completed. This is a total of 512 care plans. Of the current active clients in the medical practice, there are 1612 clients with chronic disease. This means that approximately 32% of clients with any chronic disease have a care plan. The percentage of clients with a care plan that meet the care planning criteria will be much higher.

Staff A Day in the Life of… Michelle our medical receptionist Anyone who has spent time at our reception desk will appreciate how busy our reception staff are! They are constantly responding to the needs of our clients and visitors and are often the first contact that people have with our service. As such they are a vital part of the health service team. 7.45am:

8.00am:

8.15am:

8.40am:

8.42am:

9.00am:

9.07am:

9.10am:

Arrive at work. Clients are already queuing up outside the front door, waiting to get in. It’s freezing this morning, so I try to get them in as quickly as I can. The phones are switched over from the night message. They start ringing… I attend to the clients who have been waiting outside the clinic and register their attendance on our computer. Between 8.15am and 8.30am I: • Take 10 phone calls – some of these are people ringing for an appointment, some are general enquiries • Register 6 clients who have attended for appointments • Do 2 needle exchanges • Assist 3 members of staff An Indian family with a child with an intellectual disability come in to see one of the GPs. The family take great care of the child who is demonstrating some impulsive behaviour, but I need to keep an eye on the waiting area to make sure that there are no problems. Another client comes to the desk. “So glad you’re here… Haven’t been to sleep for 3 nights. Really need to see a doctor…” Make an appointment for the client later in the morning. Already most appointments for the day have been taken. Client comes to the desk with a sample to be sent to pathology. I take the sample to pass onto the nurse in the clinic. A client with mental health issues comes to the desk to check their appointment bookings. They have forgotten which day they are meant to attend. I let them know that their appointment with the mental health nurse is not until tomorrow. The client lets me know that they are OK to come in again then. A regular client checks in for their appointment and brings in lollies to top up the lolly jar at the reception desk. He has a chat about how he has been going of late. The phones have temporarily slowed down, but will pick up again when the other doctors arrive – one is due at 10.00am and another at 10.30am. Usually it is even busier in the morning, but one of the doctors is on annual leave.

“The reception staff are always warm and welcoming.” 9.13am:

The doctor has seen their first client, so I also need to organize the billing for the consultation. 9.15am: There is now a queue waiting at the reception desk. Two more clients have arrived for a medical appointment. When a client arrives I click on their appointment on the computer screen. This puts the client in a “virtual waiting room” that the doctor can see in their room. The virtual waiting room also tells the doctor how long the client has been waiting in the real waiting room. 9.23am: Visitors to the centre tell me they are here to see a member of staff. I direct them to the sign-in book on the reception desk and contact staff to let them know that the visitor is waiting for them. Phone calls and clients continue to come in to the reception area throughout the morning. I try to catch up on reading e-mails in between attending to these people. 9.55am: A drug rep comes in asking to speak to someone in the medical area about ventolin and serotide. I arrange for them to speak with the nurse and then to be seen by the doctor. They will have a wait! 10.15am: The mail is dropped off. I separate the mail into general and medical mail, then open the medical mail, date-stamp it and allocate it to the appropriate GP. I have to fit this in around my other duties, so it usually takes me until lunch time to get the mail distributed. 12.00pm: I take a break from the desk to have lunch. Will be back at the desk at 12.30!

2009 Quality of Care REPORT

31

10 years of service

Cynthia Munro Emel Ackay

“The opportunities provided by Banyule Community Health to work along side the local community on a variety of community projects over the years and to experience the way in which the local community reachout to one another and support one another in difficult times is indeed a very special aspect of my work and seeing clients achieving their own personal goals.” Cynthia Munro

Frances Baum Fellowship The Frances Baum Fellowship was again offered to staff at Banyule Community Health last year, 2009 being the second year of the initiative. The fellowship supports employees to develop skills in an area of interest that will also have benefit to our community. The fellowship is named after Sr Frances Baum, one of Banyule Community Health’s directors, and recognizes her outstanding leadership and dedication to the West Heidelberg community and hopes to inspire the same from Banyule Community Health employees. Last year the fellowship was awarded to Naomi Zandt-Mazzone, Health Promotion coordinator, & Julie Watson (Executive Officer Banyule Nillumbik Primary Care Alliance), who submitted a joint proposal to explore a ‘peer support model for chronic conditions at Banyule Community Health’. The opportunity has allowed us to explore our interest in community participation and volunteering and

32

BANYULE Community Health

think about its use in providing an additional option at Banyule Community Health for the increasing number of people with chronic conditions. As part of the fellowship we have looked at the evidence of peer support models, best practice models as well as speaking with staff and community members. One of the biggest things we have learnt is the importance and benefit to people’s health when individuals who have similar experiences provide support to one another.

Leadership Development Program The program is now being offered to staff from Nillumbik and Plenty Valley Community Health services, as well as Banyule staff. This year, five Banyule Community Health staff are participating in the training program. Each of these five people will attend 8 full day workshops that will deliver underpinning skills and knowledge. They will also be supported throughout the program by a mentor, and will be required to undertake a project on the subject of their choice.

Greensborough 3/25-33 Grimshaw Street, Greensborough Telephone: 9433 5111 Facsimile: 9435 8922 Email: [email protected] Opening Hours Monday to Friday: 8:30am - 5:00pm

West Heidelberg 21 Alamein Road, West Heidelberg Telephone: 9450 2000 Facsimile: 9459 5808 Email: [email protected] Opening Hours Monday to Friday: 8:00am - 6:00pm

Online Email: [email protected] Web: www.bchs.org.au 2009 Quality of Care REPORT

33

West Heidelberg: 21 Alamein Road, West Heidelberg, Vic. 3081 Tel: 03 9450 2000 Fax: 03 9459 508

Greensborough: Pauline Toner Centre, 3/25 Grimshaw Street, Greensborough, Vic. 3088 Tel: 03 9433 5111 Fax: 03 9435 8922

Email: [email protected] Web: www.bchs.org.au Banyule Community Health Service Inc. ACN 135 660 454 ABN 87 776 964 889

This report has been printed on fully recycled stock.