Introduction

The Royal Victorian Eye and Ear Hospital (The Eye and Ear) is a world class specialist hospital in eye, ear, nose and throat (ENT) care, and is the largest public provider of ophthalmology and ENT services in Victoria. As Australia’s only specialist eye, ear, nose and throat hospital, the Eye and Ear has been providing care for the senses for 150 years.

The Eye and Ear has over 50 different outpatient clinics for the diagnosis, monitoring and treatment of vision and hearing loss and provides a 24 hour emergency eye and ear, nose, and throat service.

In 2014–15 the Eye and Ear cared for over 250,000 patients, with over 200,000 outpatients and over 40,000 emergency patients and over 14,000 inpatients.

The hospital provides medical, nursing and allied health training, with all Victorian Ophthalmologist trained through the hospital. In collaboration with Universities and research partners, the Eye and Ear undertakes world leading research.

A major redevelopment is currently underwayto create a modern internal structure. The redevelopment will be completed in 2018 and provides an excellent opportunity to continue to build the hospitals capacity to provide safe, effective and efficient, patient centred care into the future.

The hospitals current strategic plan was developed in 2013 and expires in 2018. Many of the key actions, aims and objectives have been complete or are near completion and a strategic plan refresh is required to ensure the hospital continues to work towards the identified strategic goals.

The refresh process will not alter the identified strategic imperatives, but will update the objectives and outcomes focusing on the next three years (2016-18), and will continue reflect our Vision, Mission and Values.

Vision

Improving quality of life through caring for the senses

Mission

We aspire to be the world’s leading eye and ear health service by:

  • Excelling in specialist services
  • Integrating teaching and research with clinical services
  • Leading workforce capability
  • Partnering with consumers and community
  • Building a sustainable future

Values

  • Integrity
  • Care
  • Teamwork
  • Excellence

Strategic imperative 1

Excel in innovative specialist Eye and Ear health services

Achievements

  • Clinic established to provide specialist treatment for balance disorders
  • Cochlear services expansion with regional support services
  • Telehealth Eye connect device trialed- providing timely access to emergency assessment for acute eye issues in rural settings
  • Australian Commission on safety and quality in health care national standards achieved
  • New model of care implement for ocular trauma patients
  • New model of care for glaucoma patients based on risk stratification

Drivers and Data

System drivers

  • Demand for care is growing faster than funding
  • Increasing focus on service system integration, partnership collaboration with community based care playing a growing role in health care delivery.
  • Not all Victorians have equal access to appropriate and timely healthcare or get the same benefits. Compounding this, peoplewith the same health care needs can be treated verydifferently,with different outcomes, depending onwhere they are treated (Health 2040). As a result there is growing pressure to reduce variation in healthcare through use of protocol drive care.
  • Address barriers to consistent outcomes for all Victorians. E.g. Aboriginal Health, socio-economic disadvantage, mental health, disability etc.
  • Optimally manage demand to ensure a balance between timely treatment for the most urgent conditions, accessible highly specialist care and high throughput/ demand services.
  • Ongoing financial constraints
  • Need to harness the opportunity provided by telehealth and technology

Data

The Hospital provides a significant percentage of Eye and Ear care across the state

  • 46% of Elective ophthalmology surgery in Victoria (with 40% of total cataract surgeries)
  • 12% of Elective ENT surgeries in Victoria
  • 16% of ED presentations related to eyes, ear, nose and throat.
  • 75% of patients attend from the north west metro area and 10% from regional/rural areas

Questions to consider

  • What steps can we take to ensure consistent, equitable, safe, patient centred care across the state?
  • What other opportunities do we have to partner with other organisations to better manage demand and redirect care appropriately to the community?
  • How can we continue to build and embed our statewide role?
  • What top five things should the hospital bebest known for?
  • What should we be doing more of and less of?
  • How can the hospital support consistency of health care outcomes and care delivery?

Strategic imperative 2

Integrate teaching and research with ophthalmology and ENT clinical services

Achievements

  • Mandatory training matrix developed in line with National Standards
  • E-learning system implemented for mandatory and non-mandatory training packages
  • New governance structure supporting teaching and training
  • Research strategy developed
  • Partnership agreement signed with research partners
  • Fundraising on track for new education centre
  • Signed partnership agreements in place with research partners and membership of the Melbourne Academic Centre for Health
  • The Hospital is the parent hospital for training of 100% of the state’s Ophthalmologists

Drivers and Data

System drivers

  • Research funding shrinking in the context of a highly competitive market
  • Growing focus on research that can be readily transferred to practice
  • Promotion of simulation teaching methodology- implications for future teaching and training
  • Online teaching and training development ensuring flexibility and accessibility
  • Consumers playing a larger role in teaching, training and research
  • Trend to better integrate teaching activities across professional disciplines

Question to consider

  • How can we build greater collaboration between teaching and our research partners?
  • What can we do to optimise the opportunity provided by the redevelopment to build research and teaching?
  • How can we continue to promote translational research?
  • How can we align resources to further integrate teaching and training services, reducing professional silos?
  • How can we streamline research education activities across the precinct
  • What opportunities exist to better integrate teaching activities across disciplines at the Eye and Ear.

Strategic imperative 3

Lead workforce capability building for Eye and Ear health services

Achievements

  • Workforce strategy published
  • Nursing professional development plan progressed and evaluated
  • Allied Health Credentialing Committee developed
  • Team based models of care implemented in Glaucoma
  • Leadership and change capability framework developed
  • Aboriginal employment plan implemented

Drivers and data

System drivers

  • Growing focus on leadership skills and behaviors, recognising the importance of quality leadership at all levels to improve the quality of patient care
  • Ageing workforce
  • Highly fractional senior medical workforce
  • Workforce gaps- difficulty attracting and retaining highly skilled workforce
  • Growing need for changing skills and role flexibility in existing workforce –aligned with changing need of the community (increase in multiple and complex health care needs)
  • New technologies influencing the way we work
  • Move toward enhancing inter-professional teamwork
  • Balance demand for high quality generalist care and specialism

Data

  • Average age of register nurse at the hospital is 48 and fractional specialist is 50, 10% workforce is over 60

Questions to consider

  • How can we build capability to lead staff through the planned changes including change in physical environment, models of care and service improvement?
  • How can we develop and retain our talent and improve job satisfaction?
  • How can we develop skills and competencies of current workforce to better meet the needs of patients?
  • Which roles would an advanced or extended scope of practicebetter support innovative models of care,improved efficiency and optimise patient outcomes?
  • How can we continue to support workplace health and wellbeing?
  • What steps can we take to better align our workforce with future demand?
  • What are our current critical workforce issues?

Strategic imperative 4

Partner with our consumers, communities and other organisations to deliver improved eye and ear health

Achievements

  • Comprehensive framework supporting consumer participation and volunteers.
  • Two fold increase in registered consumers with consumer involvement in service improvement, working groups, committees and focus groups
  • Partnering with consumers and community plan 2016-19 launched
  • Aboriginal art work purchased and displayed, memorandum of understanding signed with St Vincent’s Hospital supporting capacity building for Aboriginal Health services. Funding secured healthy ears outreach service.
  • Glaucoma model of care developed in partnership with Australian College Optometry
  • Habilitation partnership established for Cochlear services

Drivers & Data

System drivers

  • Increasing demand for consumer directed care, fueled by increased community expectations and evidence of improved outcomes
  • Growing role of primary and community care in service system with a focus on system integration, partnership and smooth care transitions.
  • Development of patient centre outcome measures of healthcare effectiveness and efficiency

Data

  • The Eye and Ear provides care to a diverse range of patients with 17592 interpreter services provided in 2014-15, with 88 languages requested. The top five language constitute 59% of the demand for interpreting (Greek, mandarin, Vietnamese, Cantonese and Italian)
  • 93% of patients rated overall experience as good or very good
  • Access to services, including; wait times for new, review appointments and waits during Hospital attendance, is the most common area of concern accounting for 47% of all complaints
  • 90% ED discharges and 69% inpatient discharges result in a letter to the GP

Questions to consider

  • How can we build our capacity to provide patient and family centred care?
  • What can we do to continue to improve the patient experience?
  • How can we build relationships hard to reach and high risk communities to gather feedback and optimise care outcomes?
  • How can we build our skills knowledge and understanding of our diverse patient cohorts?
  • What teaching/ training could be undertaken to continue to build skills in partnering with consumers?
  • How can we improve our communication with primary care providers?

Strategic imperative 5

Build a sustainable future

Achievements

  • New models of care implemented for Acute Ophthalmology and Surgical Ophthalmologyresulting in a significant increase in surgical conversion rates
  • Clinical services plan developed
  • Digital Health Record including on line pathology implemented
  • Business intelligence tool expanded
  • Successfully undertaken decanting, process review and troubleshooting supporting the redevelopment
  • Significant improvement in performance measures for the ED
  • Review referral criteria, waitlist validation project and other initiatives have reduced the total patients waiting for a new appointment
  • Electronic medical record (EMR) strategy refreshed (for 2015-18)

Drivers & data

  • Exponentially growing demand for health care services predicted for Eye and ear conditions:
  • Hearing loss predicted to increase by 50% by 2050
  • By 2030 it is predicted that the number of people with Age related Macular degeneration will increased by 70% (to around 1.77 million)
  • By 2025 over 3 million Australians (currently 1 million) will have diabetes- with an estimated 15% developing Diabetic retinopathy
  • By 2023 cataract operations will have doubled from 2003 rates
  • By 2030 it is predicted that the number of Australians with Glaucoma will increase by 202-213%
  • Demand for services currently outweigh supply and this pressure will grow
  • Discharge rates for outpatients is 29% for Eye patients and 15% for ENT
  • There are 13,915 patients overdue for a review appointment for eyes and 4017 overdue for ENT
  • Overall surgical conversion rate for outpatient’sclinics is 6% eyes and 5% ears. With the following surgical clinics conversion rate being: SOS 55%, Otology 7%, Rhinology 17%, Head and Neck 12% and Acute Glaucoma 9%
  • Redevelopment and change agenda

Challenges & opportunities

  • How can we use our data (internal and external) to improve efficiency and sustainability?
  • How can we optimise the opportunity provided by redevelopment in terms of improving efficiency and sustainability?
  • What further steps can we take to improve the safety and consistency of service provision and effectively manage risk?
  • Are there any new or potential funding sources available to support service provision?
  • What further opportunities does technology provide to improve efficiency and sustainability?
  • How can the Electronic Medical Records support our clinical services planning and delivery?