Department of Health

Board Director Induction Training Webinar Series 2021 Session 1

  • 31 August 2021
  • Good afternoon everybody. I'm Jo Flynn, I'm the chair of the Boards Ministerial Advisory Committee, which advises the Minister of Health on appointments to public health entity boards in Victoria and I'm your facilitator and chair for this session.

    I'd like to welcome you all and as I open the session I'd like to acknowledge the traditional custodians of the lands where all of us are gathered across Victoria and pay my respects to their elders past present an emerging and to any Aboriginal elders who are with us today.

    This is the first of our orientation sessions for 2021 and it's an overview of the Victorian health system. In a moment, will play a pre recorded welcome from the Minister for Health, the Honourable Martin Foley.

    You can understand, Mr Foley is very busy at the moment. But he wanted to be part of this session. We will have some comments from Professor Euan Wallace who's the secretary of the Department of Health, and then our two presenters are Jody Geissler the Deputy Secretary of the Department of Health and Robin Hudson, who's the acting CEO of Safer Care, Victoria.

    Can I have the next slide please? Thanks, Justine.

    So the Boards Ministerial Advisory Committee just briefly provides advice for the Minister to make sure that boards are skilled and independent, and effective. We work with the boards to try and identify skill gaps and advise on how they can best be met and sort of oversee the appointment process, including having a conversation with the chair of each health service in the next few weeks in relation the next round of appointments, which, because of the nature of the process, needs to start already, even though some of you have just started and I'd like to particularly welcome people who are new directors in the Victorian health system.

    I know we've got a number of new director's, a number of people have been reappointed to their boards, as well as some very experienced directors and it's great to have you all here and I hope you enjoy the session.

    A couple of things to say at the beginning firstly all the slides will be shared and a video recording of the webinar will be posted on the department website and sent to each of you after the meeting, so you don't need to take notes furiously and just to note that the slide packs are quite detailed and that's in order to allow you to have that material that you could come back to. Although it may not all be covered and the last thing to mention is that we have a question and answer session at the end of the meeting and we'd encourage you to post your questions and to indicate those questions that you see that others have posted that are of high priority So that we can make sure we address the things that are of most concern.

    So I'd like to now organize for the video from Mister Foley to be played.

    It'll just take us a minute to get that up live, and then we'll continue the rest of the webinar, thanks.

    Minister Foley - Welcome

    Thank you, and good afternoon everyone.

    I would like to first acknowledge the first people and the traditional owners of the land on which you stand, I pay my respects to their elders past and present and to elders from other communities who may be here today. Representatives of the world’s longest continuing culture. Unfortunately, I am unable to be with you in person to welcome both new board service directors and those returning for renewed terms.

    Thank you for accepting your role as health service board director. I hope that you find this role as a personally rewarding experience as you contribute to the local community and the state as a whole.

    There are 13 metropolitan and 6 regional public health services, as well as 60 public hospitals, Ambulance Victoria and Health Share Victoria to which the government appoints directors.

    As a board director you are accountable to the Government on behalf of the people of Victoria for the performance of your health service. Each health service board works with me as the Minister for Health and in accordance with government policy.

    Your role as a board director is an important and challenging, overseeing the strategic direction, and financial and service performance for the health service, as well as keeping in mind the opportunities for surrounding health services and improvements to the broader health system.  In addition, you are responsible for governing the health service by meeting the regulatory and government policy requirements and standards. Some of these include developing statements of priorities and strategic plans for the operation of the health service, monitoring compliance with those statements and plans, and developing financial and business plans, strategies and budgets to ensure the long term viability of the health services. Directors are not expected to participate in the day to day operational management of the health service. That is the role of the CEO and the executive team.

    The board is, however, collectively responsible for monitoring the performance of the CEO.

    I encourage you all to familiarise yourselves with the Operation Meroo special report released in April 2021 by the Independent Broad-based Anti-corruption Commission (IBAC) into alleged corruption that occurred in Victoria. This report is an incredibly valuable resource for all board directors into their role.

    We have also adopted the National Weighted Activity Unit (NWAU) as the basis for funding in 2021-22. This now align us with other states and territories and meets the commitment made under the National Reform Agreement to implement a National Funding Model.

    Using the national classification system will reduce the conversion effort and allow greater comparability between the Victorian health services and our peers in other jurisdictions. Health services will now also have more flexibility to move resources across services in this model.  This new funding model will be important to understand as you develop your financial and business plans.

    Boards will play a vital role in supporting the implementation of the new Health Service Partnerships strategy and ensure the delivery of priorities. As systems leaders, the ability of boards to model and foster collaboration will be critical drivers of the Health Service Partnerships’ success.

    Your actions as a board director are likely to involve the oversight of changes due to the two recent Royal Commissions to deliver reform into aged care founded on the principles of respect, care and dignity, and create a future mental health and wellbeing system that provides holistic treatment, care and support for all Victorians.

    The COVID-19 pandemic has placed additional pressures on our service delivery and consequently on our governance and I am grateful for your time and commitment. This pandemic is not over and I thank you for your continued efforts as we work to overcome the ongoing and lasting challenges to our sector.

    I look forward to working with you to ensure we build a stronger and more resilient Victorian health system.

    If I could now welcome and introduce Professor Euan Wallace who is the Secretary of the Department of Health, thank Euan.

    Secretary Euan Wallace – Welcome

    Welcome everyone. Thank you for joining us, if you're new joining in your new role as a board director and commitment to our wonderful state health system and services, and let me also begin by acknowledging country and paying my respects to elders past, present and emerging.

    Look, looking at the program ahead of you this afternoon you'll hear from people far more learned and expert in the functions for you as a director than I am, so I don't wish to take up time by superficially covering some information that you're going to hear shortly in much more detail than I can do justice. 

    Suffice to say, your role as a board director is important. It's important because our boards are important and ultimately they are. You are. Accountable for the performance of our health service and so literally or almost literally our lives are in your hands, so don't feel any pressure.

    And what I hope you'll find is that your role is very varied and particularly if your background is not a health one, you'll find it challenging. But that's OK. And I also want you to be a challenger, so I want you to challenge your service to be the very best that it can be, and then a wee bit better again, because that's what your community, that your health services is serving wants of you.

    Indeed you'll see very varied information come across your desk and board papers and I would just ask of you, that when you're looking at that just ask yourself if I was a patient here what would I want 'cause usually the answer to that question will shape your decisions. The decision of board and the decisions of your service in the right direction.

    Now I'm beginning to wander into others material and I promised not to do that. So, let me stop there. Let me tell you just a wee bit about the department and how I see our role sitting alongside yours. 

    So, no surprise we have a brilliant department you're about to hear from two of our very best leaders this afternoon in Jodie Geissler and Robin Hudson, so both Jodie and Robin and the rest of the leadership team in the department are really working hard to establish what is the new department I'll come to that in a second. The department as a key partner to you and to the sector and but not just as a partner also a leader and innovator, and again, not just here in Victoria, but nationally and progressively we hope internationally. 

    And so I'm thrilled that you've decided and able to join us on that journey.

    So we are a new department, we were established on the 1st of February this year, from what was the Department of Health and Human Services and our Sister Department what is now the Department of Families Fairness and Housing, who continue to do lots of work very close to us. We share lots of common clients.

    But with any new department comes new opportunities to reflect and revise, perhaps reshape what we believe could be, should be, the future of Victorians health and Victorian healthcare and our ultimate vision is that Victorians are the healthiest people in the world. Now, personally, I've got to lose a bit of pandemic fat for us to deliver on that. But we are genuine about it. So, when people ask you, what do you do on that board of that health service you can say quite honestly, well, I’m actually working to make Victorians the healthiest people in the world.

    Now, I don’t want you to get put off by the size of that challenge of the ultimate vision. Although I did warn you that your role will be challenging, but, so if I was to bring the horizon of that vision a bit closer, a bit more proximate, I would sum up what we hope that you will help us deliver is better connectedness. So, first of all, better connectedness between your health services, so you can see that already evolving through the health service partnerships that are now pretty much in flight. I would say they are very much in flight and actually Minister Foley met with the board chairs of the lead partnership health services earlier today to share some of his vision for those partnerships.

    So, we're going to be asking you through your board roles at your service, how is it you can work closer and better with your sister services in your partnership. That may make you take decisions that will stop services in one hospital to consolidate in others, creating efficiencies of scale that enables you, and your other services to invest in new services or better services.

    So again, think outside your walls. Better connectiveness with sister services but also better connectedness with community providers and primary care providers. Something that we've not done terribly well in Victoria. Actually, in Australia overall because of the split funding system that we have with the government funded largely state government funded hospital system and our Commonwealth funded primary care system.

    There are some brilliant examples in Victoria of shared funding between Commonwealth and state to try and help deliver, that we want to see, we want to see more of that, so more partnerships with your local primary health care networks, primary care providers, local government and so on. Really providing more care closer to home and you'll see, more of that closer to home narrative and theme in the work that comes out of the department.

    Because I mean, let's not kid ourselves, most patients don't actually want to come in and use your services, no matter how wedded you are to your hospital. Most people don't actually want to come in and use it, they would rather have their care at home, if there was a choice.

    So again, ask yourself. If I was the patient what would I want?

    So, I also want you to think of the better connectedness between the hospital, you, the board, the executive and the workforce. We have a really skilled healthcare workforce in Victoria. A reflection in part on very high performing schools of nursing and midwifery, our university teachers in physiotherapy, OT or radiography etc and of course our medical schools.

    It is perhaps no wonder that Melbourne is ranked 7th in the world of best hospital cities. But in the department, we want that real excellence, that's evident in Melbourne to be true no matter where you live in Victoria.

    In terms of better connectedness with our workforce, our workforce is damaged and some will characterize it as being burnt out, I prefer the phrase emotionally exhausted. But whatever you call it, don't underestimate it. Your health service cannot provide good patient care unless those providing the care feel cared for themselves - safe and supported. Workforce wellbeing is both a Ministerial and a departmental priority and the department led by Safer Care Victoria,you’ll,hear from Robin this afternoon and is working with services to try and seek to address that emotional exhaustion in your workforce. 

    It won't be easy fix. It will require the board to lead on initiatives. To ask questions and to invest, and I mentioned that, because you will see lots and lots and lots of data coming across your desk in your board papers and I just ask you to look out for the data on workforce wellbeing and if it's not there, ask for it and if it is there, seek to understand it and ask about it, because your workforce is your most precious resource. Not just because it consumes almost 80 per cent of your health services budget, and because all too often, poor patient outcomes are explained by poor workforce wellbeing.

    So, if you see the first ask about the second. Actually, there's no better way to understand your workforce than to meet with them. And so, as a new board member, ask the chair and ask your Chief Executive, can you go for a wander every so often before a board meeting, wander the wards and the clinics. Don't do that every time, because your workforce has to deliver patient care, but you should be meeting the nurses, your physios, your junior doctors, and so on, your cleaners, your kitchen staff. You should be meeting with them, and talking with them, and sharing their stories. I can tell you, I was a frontline health care worker myself, and meeting a board director is a really big deal.

    You'll hear some home truths, so encourage you to do that. 

    Listen, I’ve said enough, Jo, I just hope I've given you, particularly those of you who are new to this role a bit of flavour of our vision, it is an ambitious vision of the department and for the Victorian health system. I hope it's a vision that you can share and be part of, and just be reassured that maintaining an open dialogue between us, in the department and health services is a key priority for us and I look forward to working together with you. Not just to meet the current challenges of the pandemic, but to build a better, stronger, more collaborative health system that has best patient outcomes and who knows in five, 10-15 years. Victorians maybe the healthiest population in the world.
    Jo. thank you.

    Thanks very much. Euan. 

    We very much appreciate you coming to open the session and give us the challenge of ensuring that Victorians are the healthiest population that they can be. And setting out some challenges for board directors.

    So, let's proceed with the webinar, and just to remind you that we have a question and answer function, and encourage you to post some questions in there, so that we can address those questions as the session goes on. 

    I'd like to just make a couple of observations. If I could have the slide up in relation to the role of Directors in the health system. We've already had some insight into that from the things that Euan said, but essentially it's critically important that everybody recognizes when you're appointed as a director, that you have legal responsibilities under the Health Service Act, and there is a great deal of support available to you, but in short, your priorities are to act in the interests of the health service at all times, to act with integrity and in good faith, to hold yourself and each other to account. Obviously you need to attend all the meetings, there is a statutory requirement that you attend at least 70 of the meetings, but the expectation is that you will attend almost all the meetings, and obviously to be prepared and have read the board papers and be ready with your questions and comments.

    It's really important that you look beyond the obvious. It's not that you need to mistrust the information that's there, but you need to challenge yourself about it, and challenge yourself about what are you missing and for instance Euan has just there, given us a reminder about the importance of making sure that you're getting data about the wellbeing of your workforce, there's all sorts of data available to you, but you need to be getting a comprehensive set of data.

    And it's really important that you’re curious, and that you're curious about the health service, that you're now responsible in part for the governance of, but also curious about what's happening in the system more broadly, what we can learn from other health services, what we can learn from those close to us, and further away. Who are the experts that we can call upon? Who are the peers that we can reach out to, and what's happening in the broader health care system. And, of course, it wouldn't be appropriate not to acknowledge the challenges that COVID has created for us in the last almost 18 months now and will continue to create in the foreseeable future, and the additional pressure that puts on us. But also the challenge, to make sure that we're seen to and oversighting and continuing to improve and develop all aspects of our health services, while at the same time dealing with whatever challenges COVID presents.

    So I'd now like to reference very important document which is the director's toolkit which contains so next slide please. Yes, thanks all that you need to know in a sense about being a board director. It is a living document and its revised. But it's a great resource for boards, and it's it sets out essentially the responsibilities that you have in your role as director with a lot of important resource material to support that.

    So now, I'd like to hand over to our next speaker who is Jodie Geissler she is the Deputy Secretary, Commissioning and System Improvement at the Department of Health. Jodie is going to talk to us about the structure of the Victorian public health system. I'm very pleased to have Jodie here, and welcome her, and will just hand over the audio controls to her so thanks.

    Thank you, Jo. Thank you very much for having me, it is a real pleasure to be here. I too would like to begin by acknowledging the traditional owners of the land which we gather pay my respects to elders, past, present and emerging.

    And it also like to extend my congratulations to the new board appointees. It's exciting that you're on board now and we're really looking forward to working with you. I've just got a couple of things to touch on today as Jo says about the system, and the first thing and this slide goes to it. Is about really the structure of context within which boards operate, I think importantly with this slide as Euan said it's not necessarily about some technical relationships. It's also about the collaboration between these elements of the system. But this is trying to distil down basically, how the system relates at a very simple level. So Victoria, has a system of public administration which really relies on thousands of public entities to deliver a range of services and functions. All very essential to Victoria, many of those entities, not just our health services and hospitals, are overseen by a board of directors who operate independently of the state, while remaining accountable to the Minister.

    A Health Service Board and its individual directors do have, as Jo said, formal duties and responsibilities and these are to the Secretary, the Minister, and the public. Therefore, it's really important to conceptualize how the chair, the board collectively, each individual director, and the CEO and how those roles relate to each other, how they interact with the Minister, the Department of Health and other key stakeholders. And that's really what the department is here to help you with.

    The department is a key entity for boards and does act in a variety of capacities, including in a stewardship role, and I'll just pause on that for a second, because we sometimes get quite confused by what that means, but ultimately as a steward for the system, the department is responsible for the overall outcomes of the system. Health services themselves, act in the best interests of the organization and the people they serve.

    So this pyramid, I'll let you read it offline, but I hope it helps you get some clarity around the different roles in the system, and hopefully it's useful moving forward. The next slide please.

    So, the department, this really articulates for the role of the department visa vie the role of the board. So, start with the department, it has it has responsibility for developing and delivering policies and programs that support and enhance the wellbeing and health of all Victorians and Euan spoke to a very broad and ambitious vision in that regard.

    I'll give you some colour and movement on that when I talk about my own division, but it is important to recognize, and again Euan touched on this, the department has a really broad perspective, on the causes of ill health, and the drivers of good health, and that goes to the social and economic context, within which people live and incidents and experience of vulnerability. So it isn't just always a health frame, but a social frame and I think that's very important. That framing does allow the department to put people right in the center of care and right in the center of our system, and that's really important. 

    The board is responsible for setting the vision and the strategy and direction for the organization in line with departmental and government policies that come through. The boards responsible for setting in shaping the organization, including safety and quality culture, it's responsible for oversight of the outputs in the resource management of your entity, determining risk appetite, a really important one, and overseeing management and control of risk, and monitoring performance of course, and that includes the performance of your CEO.

    My teams done a little bit of distillation of some of the most important areas of good practice, and I'm sure you will discuss these as a board. And indeed I'm sure this series will go into some of these, but I just thought I'd call out a couple that Euan has also touched on.

    It's really good practice for a board to consider how the CEO manages the rest of the staffing cohort and their wellbeing, as Euan has said it's really important, therefore, that the CEO doesn't or shouldn't really be the only person that presents at board meetings. How does the board hear from other staff and other voices. And certainly a clear one, the teams given me, if the board doesn't understand anything that they're receiving in terms of board papers, they should speak up, and there's a whole heap of themes that have come through our governance team, over many years and are in that tool kit, that you could pick up and have a read of, but always happy to discuss those. Next slide. Thanks team.

    So, in terms of the types of services, hospitals and health services we have in Victoria under the Health Services Act, you can categorize our services into public health services or public hospitals. Broadly speaking, public health services are pretty big, very large in fact, in terms of service delivery, budgets, assets, relative to public hospitals. Public health services include Alfred Health, Austin Health and Barwon Health. Public Hospitals for example, include Alexandra District Health and Bairnsdale Regional Health. Both types of health services, it's important to recognize have their own boards of directors and they are responsible for the effective and efficient governance of their health service.
    And of course, the board is responsible for that health service being compliant with relevant legislation. I think that's a topic further down the track in this series.

    The board has to ensure that the Minister and where applicable the Secretary are advised about significant board decisions, are informed in a really timely manner of any issues of public concern or risks that may affect that health service. Next slide, thank you.

    So now I'll just talk a little bit about the department so Euan painted, he gave us the colour and movement in the department. I'll bring it down to kind of organizational structures and just bear with me. It looks more exciting than it is. We are a new department. It's a pretty exciting time for us. The vision and the priorities are being shaped in terms of how we are accountable and how we have established ourselves.

    This is what it looks like on a page. We have ten divisions in the department. And you can see actually some of the priorities come through in the structure. Really proudly, we have an Aboriginal Health Deputy Secretary for Aboriginal Health. We want a few health departments across the country with that, and we're pretty proud of it. So we're driving a really important agenda through that part of the department. We have a Mental Health division which comes out of the Royal Commission into Victoria's Mental Health System, a huge program of work, many, many government priorities coming through that division, we have Public Health. We have the COVID-19 Public Health division which is led by Jeroen Weimar. You would have seen him on the TV quite a bit and then we have the Health Infrastructure Division. We have Safer Care Victoria, and you'll hear from Robin as one of our key partners. And then across the bottom there are three divisions Reform and Planning, which is really about pushing forward the agenda, the future agenda for our health services and system, and the planning around that. We have our Regulatory Risk, Integrity and Legal division. And our Corporate Services division, both of which really support the functioning, good functioning of the department and the service system more broadly.

    In terms of the Commissioning and System Improvement that is the division that I lead, and certainly that is the division that hopefully, you get to know quite well, our functions within Commissioning and System Improvement, are policy and program design, we support implementation of programs across the department. We're responsible for purchasing services and performance monitoring, we identify and implement service improvements, often in partnership with Safer Care, and we are responsible for leading engagement with the healthcare sector noting that lots of parts of the department also do that, but we are responsible for that key partnership. And I'll just go to the next slide. Thank you.

    In terms of this, it is an overview of my division. And once again, I share this because you might have a bit to do with it over time, so we have eight branches within my division and they cover as you can see, Aged Care, State-wide Programs, Budget and Performance Support. They spend a lot of time with the CEO's. Rural and Regional Health, Metropolitan Health Services and Ambulance and within that branch is our governance team responsible for the appointment process for board directors. And also this program of work with you today. We've got our Community Based Health Services, Digital Health, and Workforce Strategy Wellbeing and we also have in the top right there under System Improvement and COVID-19 Health Response, a team who are dedicated to the health service elements of the Covid response, so Gerome has the big public health response. The contact tracing etc. We have this specific response for our health services specifically. Next slide, thanks.

    Just in a nutshell, let you read this in your own time, but we are really proud that the division has launched its own strategy for the year moving forward. And these are, some of the things that we're going to focus on. You can see that we're really committed to service improvement. We're committed to sustainable services, and that includes strengthening our governance arrangements, were committed to enabling the system through a stronger workforce and collaboration. And of course, we have our emergency preparedness work underway.

    In terms of the next three slides and just going to touch very briefly on some of the priorities that you'll see come through our division, and out to health services in the next 12 months, in particular, so, next slide please. 

    So the first is emergency demand and you will undoubtedly have conversations about this at your board meetings. There are significant challenges with our emergency departments at present given increasing demand. We have additional increases in mental health, aged care, NDIS services, and accessibility of those services, meaning that we have people in hospitals waiting for those services, and that impacts the flow of patients through a hospital and that goes right down into an emergency department. So when you hear about patient flow and emergency demand, that's a really important concept. COVID-19 it won’t be a surprise to any of you, has added further complications to an already very stress system. We've seen that play out in the media dialogue today, around some of our services in the West in particular, and then we have workforce fatigue as Euan said a really important consideration, and competing demands around where you put workforce during the pandemic, we need vaccination staff, we need testing staff. We also need staff in our emergency departments so, emergency demand is a really, really key priority for my division and a good thing for you to be discussing, and certainly hope you can contribute to some of the problem solving. Some of the things we're doing just for your awareness is we're thinking about how we care for people in their homes so that they don't get to a space of needing inpatient care. As Euan said it's the last place people want to go anyway. I think that prefer to get care in their home where they can, how we support the recruitment of additional emergency department staff. How we upgrade and expand our emergency departments, to support that flow of patients, and how we address best practice models of care within emergency departments. And also I should shout out a number of pieces of work going on with Ambulance Victoria too, in this space, and they all interrelate, and they are complex, and I really look forward to working on them with you. Next slide. Thank you.

    The second priority you hear from my division about no doubt in time, most likely through the CEO, is our elective surgery waiting lists. Through COVID-19 many of you will be aware, we've had to pause non urgent elective surgery at different times. Everyone has done their best to keep it going whenever they can, but certainly restrictions have been necessary at times, so, that has added to our wait lists, and it's actually also related to the emergency demand problem I presented earlier. Whereby if your emergency departments are very busy, your staff are moved to that point, it's urgent care, obviously, and that can slow the rest of the system down. We've got a huge program of work underway in this space, to deliver additional elective surgery procedures. We've got a lot of additional funding for that, we're looking at more private providers coming into the mix and partnerships with private providers to deliver elective surgery. We are certainly collaborating with all health services to find additional capacity in the system, and we're looking at any policy reforms we can bring in, that support people while they're on the waiting list or to access the right care. And then just the final slide from me. Thank you.
    Is our workforce, so going back to this theme that Euan highlighted, it's a huge priority for the department and certainly for my division, within my division, as I showed you we have a workforce branch within Safer Care Victoria, there is also a lot of wellbeing work underway. In essence, the challenges are really clear, we have increasing levels of fatigue. People haven't had enough respite through the pandemic and extended lockdowns. We've got a surge in COVID-19 demands. As I said, testing, vaccination capacity, all occuring alongside regular activity throughput through the system. We've had disrupted workforce pipeline. We haven't been able to get in workforce from interstate or overseas, as we normally would as a system, so that's a key focus for us. How we boost out workforce in other ways and then of course we have ongoing rural workforce shortages. That's not new, but it's been compounded in this current environment. So emergency demand, elective surgery and workforce are three of our key priorities, we have plenty of other priorities, but they're probably the ones that you hear about a lot, in coming months, and I was really keen to share this with you today, and I appreciate the opportunity to give you line of sight of some of the work that we've got underway. Looking forward to working with you. Thank you, Jo.

    Thanks very much Jodie and as I said earlier, Jodie’s slides will all be available to people following the webinar, will send them to you in the next couple of days. I'm also very keen to encourage you to post some questions. We’ll hand over to our next speaker in a moment, but then we hope to have 15 minutes or so for questions at the end. And please indicate which questions you're most interested in. If you have a scan through those that have already been posted.

    I'd like to now introduce Robin Hudson, who's the Acting CEO of Safer Care Victoria and Robin's going to talk about one area, very important area, of responsibilities of directors in health services, which is Quality and Safety. Thanks Glenn. If you could hand over to Robin.

    Hello everyone, thank you so much for the opportunity to join you at this stage of your induction to your new board or for those that are just getting a bit of a refresher. I hope the slides are not the same ones you've seen previously. But, I want to add my congratulations to you all, the role you have taken up, or you continue to do, is important to the quality of care and the safety and the outcomes of Victorians, when they experience your health service. Whether that's for medical care, surgical interventions, to have babies, or in fact to say goodbye to a loved one at the end of their life.

    I'm going to give you a whistle stop tour really, of quality and safety and as I've listened to everyone speaking so far, I can see massive overlaps between what I'm going to say and what you've heard already. But I will encourage you at the end of this, to join some further opportunities that safer care offers, so stay tuned at least to the end. So, if we could just switch slides please.

    So, I'm hoping that most of you have heard of Safer Care Victoria, but just in case you haven’t, we were established in 2017, as a recommendation from targeting zero, or what's colloquially called the Ducket report, and we really were put in place as a result of a really tragic and preventable scenario where a number of babies passed away. So, we provide a deliberate separation from the Department of Health. We elevate the importance of quality and safety, and we have a really clear mandate. Our vision is ‘outstanding health care for Victorians, always’. The ‘always’ captures that need to be consistent and to not have a variety of outcomes, regardless of the clinical procedure that's underway. 
    We have a very clear aim and at the moment. We're trying to improve healthcare across Victoria by a very clear date, the 30th of June 2023, and we're aiming to have it ‘be safer, more effective and person centered’ as part of our very deliberative, and purposeful strategy that we've been executing over the last couple of years. But really, we know we can't do this as an entity, where we sit in the system, so our job and our purpose is to enable you in health services to deliver just that. The safe, high quality care and experiences for patients, carers, and staff. Can we switch slides please.

    So, if nothing else, I want to give you two things that you absolutely, positively need to read on a rainy Wednesday in Melbourne, at least if you're in Melbourne in lock down. The one on the left is published by Safer Care Victoria. It was done in 2017 together with the health sector. As a result of huge amounts of feedback that we received on former documents. And it describes what good clinical governance looks like, and I'm going to spend a few slides talking about that. But that document is absolutely well worth the read. The other one is from the Institute for Healthcare Improvement, so for those that don't know the IHI are globally world leaning and recognized, both implementation, and thinking body around, how to improve quality and safety, in health care. And Safer Care Victoria has the deep pleasure of being a strategic partner with the IHI and we do lots of our work together. So both of those documents are great places to start when considering quality and safety and your role as a board director. Could we switch sides please.
    So really, what is clinical governance? And this is taken from the Victorian clinical governance framework that I've just shown you, and really, when it's looking good, it's an integrated system of processes, leadership and culture. That at the core provides that safe, effective, person centered healthcare, get really used to me saying those three words which is underpinned by accountable and continuous improvements, and very clear, measurable goals. So, what does good look like? This statement tries to recognize that health care is inherently complex and high risk, but it does also call out, the commitment that every person in the organization, must have to delivering, again, I'm going to say it, safe and effective and person centered health care. May I have the next slide, please.

    This is actually probably the very, very beginning of the kind of clinical governance definitions, and this was done in 2001, and you can see the six items along the side there, from the US National Institute of Medicine. And really what it did was trigger global change in terms of the way health systems were run and the way we were thinking about clinical governance, and I'm going to do a slight plug for the kind of work that we do at Safer Care. This particular framework when released in the states lead to 100,000 lives campaign. And that campaign aimed to reduce patient harm across about three, I think it's three quarters of all hospitals in the United States at the time, so around about 3100 hospitals, so it's totally possible to work together in Victoria. And at the end of 18 months, so just 18 months they had reduced, or at least prevented harm in 122,000 occasions. So Safer Care will be launching in a couple of months 100,000 lives campaign of our own, and we will be looking for your engagement and involvement, as we embark upon trying to do almost exactly the same thing, as they did in the States in order to make sure that we have, safer care for our people. May I have the next slide?
    And of course, all of this really matters, because as Euan said, you need to make sure that we're providing the care that we would like to receive as well and unfortunately, that's not always the case. In Australia, one in nine patients are harmed according to Australian studies, and these complications cost Australian public hospitals around about four billion a year. And private hospitals, more than about a billion. And you can just imagine what that funding could in fact do, if it was put to other uses. So it really matters that you pay attention to quality and safety to prevent that harm. Could we have the next slide please?

    So the board's role. What is the board role in all of this? Well ultimately you are actually accountable for the clinical governance of your system, and the clinical care provided by the organization. And while we acknowledge that everyone has got a part to play, ultimately it is your responsibility. In order to achieve this, the organization must have a robust safety culture where staff feel safe and are provided with opportunities to speak up about safety, and the culture is set in the right way, and I’m sure we have all read all sorts of management textbooks, from the fish rots from the head, to many others, where it clearly calls out the role of the board, in establishing and setting the culture of the organization.

    And probably the cornerstone of good clinical governance is providing patient centered care, so listening to what your patients, or your consumers, or your residence, or the families that enter your organization, listening to what they experience, and how they participate in the care that's delivered a crucial indicators to quality and safety of your organization. May have the next slide, please.

    So here are just some words on a page, of course, but these are key actions for you to consider, as you do your role. We need you to ask questions, questions about quality and safety. So, what is the culture of the organization? Do staff speak up? What does your people matters survey data tell you. Do you do other pulse checks? Are the pathways for speaking up clear? Can you understand them? Do you know what needs to happen if there is a complaint or concern raised. Look at trends over time, not just the quarter that's being presented to you. And as Jo said earlier, be super curious.

    And when something does happen because you can't make it completely infallible. Does he organization respond quickly? Do you respond quickly? And does the organization blame people and exit them from the organization? Or do they try and learn what the systems contribution was to the problem? So only if we ask these kind of questions, and think about these kind of things, can we drive continuous improvement, to ensure better patient outcomes, and avoidable harm. The success of the organization is totally depended on good clinical governance. And poor clinical governance will almost definitely have an effect on other governance domain such as finance. May I have the next slide please.

    So, I'm going to return just back to this document that I think is fabulous, of course. And draw your attention to that picture on the side there, and really, this tries to describe the intersecting nature of the clinical governance role. It does encompass risk management, clinical practice, leadership and culture, consumer partnerships, an indeed the workforce, for whom we've had heard from Jodie and also from Euan, about the importance of their wellbeing in the delivery of great care. But this is all great that you need the data and information from somewhere to help you get to your decisions and to ask your questions. So the good news is there's loads of reports available. If we just skip to the next slide, please. And then push again. So, I get the image up. Thank you.

    So this is the board safety and quality report, it's generated by VAHI, which is in Jodie slides, inserted in the department, and it provides you with benchmarking and supports you, to monitor your performance against your peers and overtime. But there are other reports as well. There's a perinatal services performance indicator report, which looks specifically at maternity, and you have obviously the Sentinel Events Report, which I'll talk about in a minute as well. But all of these things provide you with key information. If we could just move to the next slide, please.

    So that you can ask these key questions. What are the trends? Are we improving? How do we compare not only to ourselves over time, but how do we compare to other people who are delivering the same services? And then I think there's the question that Euan set out. How good is it that you want to be? What are you prepared to accept. Jodie and her team will set KPIs and there will be a SOP that will tell you how much throughput you need to have. But really what are you prepared to accept as a board. All really key questions in order for you to ensure that your organization is detecting, responding, monitoring at all times, clinical governance. I am going to ask us to go to the next slide, please.

    So this is the Sentinel Events Report. It's a particular subset of adverse patient safety events. It comes out every year, but there is information available to the board about what's happening in your organization at the time of your meetings. And these are wholly preventable, and result in serious harm or death to patients. Health services notify Safer Care of what is happening, and we support you, to review and to understand, what happened in the incident, of this particular patient harm. But we share the lessons learned through this report and I would encourage you to go and have a look at the better, Safer Care website at where your organization sits relative to others. If I could have the next slide, please.

    So, the next steps are really important, because I've just provided you with such a sort of surface view, of clinical governance and in fact, a very small view of what Safer Care can do, to help your organization deliver quality and safety. But in the first instance I would encourage you to register, for the interactive session, which not only reviews the clinical governance framework, but really tries to provide you with live examples, and discusses your roles and responsibilities further, but also helps you with heart health data interpretation, because it is ever so different, if you've been used to looking at other types. So I would encourage you, to sign up if you can. The other element, if we could just move to the last slide.

    Is that there is now a 3 question, a 3 question questionnaire would be fabulous, but it's actually 33 questions, but they relate to all of the key clinical governance concepts, processes and behaviors. So you can do it as an individual board member to find out what your strengths are, but also the areas that youd to be more curious, but also you can do it as a board, and Safer Care will work with you to understand the outcome of that and to provide you with guidance. So again, I would encourage you to get in touch with I think it's Allison in System safety partner within Safer Care with the email at the bottom so. I promised I would finish on time, and I've done it a minute early. So, I hope that gets me a good point.

    Thanks very much Robin. And yes indeed it does.

    So now we've come to the opportunity to answer some questions, and again I'd like to encourage you to post your questions, and we will undertake to get back to you with the questions for the more specific nature, that we haven't had time to answer during this conversation. But the first question that I'd like to address is one that appeared fairly early in the list, which was in relation to an Australian study published last week citing issues reporting cronyism, and nepotism in the public service, and whether these were issues in our health services, and what could a board do in terms of managing them, beyond the standard conflict of interest processes. I think this is a critically important issue. It's an important issue for the integrity of anybody in public office and the integrity of the system, but I really would like to draw your attention to something that the Minister mentioned in the video, which is a recent report from IBAC, the Independent Broad Based Anti Corruption body in Victoria, into an incident or a series of events at a rural health service, which were a failure of integrity and did provide examples of the sort of thing being talked about in this question, and it's unfortunately of an illustration of some serious lapses in governance and accountability. It has all the normal hallmarks of people trying to speak up and being silenced, of close personal relationships between different players, on the board and within the executive of the organization, and not enough accountability and rigor, and it it's very salentry reading because you would think these things couldn't happen. Couldn't be happening now, but the events in this were happening in the 20 teens, so it's fairly recent. There's also another IBAC inquiry in relation to another instance of corrupt behaviour in health service, Operation Liverpool. And I do think that any directors who are coming to these roles, now and in fact anyone who hasn't previously, should actually read the reports because they do really sharpen your focus. Now of course most people working in our health systems, are good, full of integrity, and want to do the best by the community. But sometimes that's not the case, and sometimes just through inadvertence, or complacency, things don't get picked up. So there are very high standards of accountability, and there are people who can advise you, if an issue is there that you are not comfortable about. So, whether it's an issue on your board, an issue with your CEO, an issue sometimes between boards and chairs, we encourage you to reach out, in the first place, is to the governance unit in the department, who will direct you to somebody who can talk to you about your concerns, but don't just let a nagging feeling, go on nagging. It's not doing yourself a service, it's not doing your health services, a service if you don't follow up things that you're uncomfortable about, hopefully we create cultures in our boards, where we are able to have open conversations. It's really important that you have some conversations just the board themselves, without any management present at times. It's important that you are able to have a frank conversation with the CEO, about what's happening in your health service, but poor behaviour at the board level is a really bad example across the health service, and we can't expect people within our health service to behave the way that we want them to, towards their patients and toward each other. If we are not demonstrating from the board level, the sort of behaviour and integrity that we expect across the whole health service.

    I'm now going to ask the microphone to be passed over to Jodie who's going to answer some questions both about the partnering part in the questions, and also about emergency department flow.

    Thank you Jo, thank you very much everyone for the questions that are coming through there are a lot of them so I think the teams just trying to prioritize them as we speak. I'll go to the emergency department question first. A very, very articulate question has come through about the fact that emergency departments themselves are just one part of the system, and therefore don't reflect necessarily, how we should tackle the problem or how indeed the system relates more broadly, and that really goes to I think where we started, and certainly the start of my presentation. We can't look I agree, we can't look at things in isolation an emergency department issue is usually a symptom of something much wider, and I think we accept that, and some of the answers lie in the community services, and certainly as I flagged NDIS, aged care etc. If we don't get those services right in the community, we certainly find people staying longer in our health services. That's complex because that's a relationship between states in the Commonwealth, but there's also things that we that within the states grasp, in terms of thinking about care in the home, and other environments and ensuring that people Indeed, are cared for in the most appropriate place that they don't reach an emergency department in the first place. So I just wanted to call out, that I thought it was a really good question. Completely agree with you that this solution isn't just looking at our emergency departments, and I think the emergency departments also agree very strongly with that as well. So I just wanted to thank the person for the question and answer it at a very high level. 

    I think there's a lot of other great questions coming through, one is about our health system or health service budgets, and where they are. So, I might just cover off that really, really quickly. Preliminary cash flow questions are currently being dealt with by my part of the department and the CFO's of hospitals, in terms of when you can expect to see growth allocations, and model budgets it's a couple of weeks away towards the end of this month, September is when the department will be releasing policy and funding guidelines and you'll get across for new board members. You get across those in time and statement of priorities to be published in early November, so that's the sequencing. Is it later than usual? Couple of weeks later than usual. Indeed, for complex reasons involving budget movements and different budget cycles given COVID.

    I think there was a question. Again, there are lots of them around partnerships. As Jo said, I think you've heard from the Secretary and I'm sure the Minister’s message might say the same thing. This is a very, we are a new department and we want to be a very collaborative department, and we are really keen to foster partnerships of any kind. I think in terms of formalised partnerships we've seen the development of health service partnerships, which are really born out of the pandemic response, where we saw health services coming together, in new and innovative ways, and those partnerships have been formalised and I think you'll get across that some of that. Some of those that are now you'll get across those in time, but they are looking at particular system issues by geography so topics that those health service partnerships are taking on, mental health, continued focus on the pandemic, an emergency and elective and better at home care, so we're seeing services come together organically. That's great, but there are a raft of different partnerships including beyond hospitals and health services with community services, and I think as you've heard from the Secretary, that is very much supported. 

    I'll just have a quick look down the list and see if there's any others immediately that I can help respond to. As I said, there's a couple of questions have come through around the health sector engagement review. Now this is a piece of work that has been led by my division around how we can partner better. So this really goes to, how information can flow out to you, as directors and also to your CEOs. We are adopting a new approach, so what we said in my division is, let's talk to chairs, let's talk to CEOs, and let's see what the best engagement methods are for them. Recognizing information can come in multiple different ways, from different parts of the department, and how do we streamline that, and how do we all get across the priorities? And agree the priorities of the day? I think that the review how we've been talking to chairs we've been talking to CEOs. It's almost landed. I think our vision is that we have a summit with the chairs and the CEO's in the room, hopefully in October this year, then from that will flow a series of strategic work plans. Really will be working intensively with CEOs, on some of those shared priorities. It might be workforce, it might be mental health. I think we have to develop those together, and that will be the work plan we will carry through with CEO's. It will come back up to board. So it's a bit of a shared priority setting piece that we hope to do with CEOs and chairs at a summit at a point in time in the year. And that will happen annually, from that will flow a work plan around our priorities, our shared priorities, the CEOs and the department will work together and that will come back to you. So it is landing. It's been a piece under review and I look forward to being able to share that. So you've got you've got line of sight to how that will work.

    OK Robin, are there any questions that you would like to take on from the list? The very long list.

    Thanks, Jodie, it's funny this turning red business, as opposed to the usual method in teams. Perhaps I might also just jump onto the health sector engagement component, because as Jodie describes most materially for this group, of course is the board and chief executive opportunities. Safer Care works more specifically and directly with clinicians and consumers, and so we have close to probably at anyone time around about 500 clinicians that are working on different initiatives and while poultry in number, substantially more than when we first started, around about 50 to 60 consumers who come in, and do certain pieces of work with us from improvement to providing advice to some of the legislative committees that we host including Voluntary, Assisted Dying and the Consultative Council of Perinatal Morbidity and Mortality. So, I think as we consider health sector engagement, there are many different avenues, and I think that connects in some way to one of the questions which is around how do we make sure that events that are harmful are elevated and escalated, and I think there are a number of different ways that we hear that, we hear that through in safer care through our formal processes, such as the sentinel events process. But we also have reviews that we conducted different health services, and also receive concerns and advocacy from clinicians, in different avenues, and work together with boards and chief executives when that happens.

    I think the other thing that's material in that question is also the Duty of Candor Legislation that's moving through at the moment, which will provide protection in the context of those reviews that occur. And I'm really conscious, actually Megan and Anita, who are on the call know loads more than I do around that legislative reform. But it is quite important in terms of protection when someone does participate in a review, it allows them to be open and honest in that way. 

    The other question I could see that was directed directly at me was, around any changes to clinical governance in the context of telehealth. I don't foresee actually a principle change, particularly other than possibly more emphasis on certain types of risk management, which was another question actually that someone had posted. But the telehealth component is being reviewed actually through Jody's area. I think. Is it Jodie? Around Possible? Because we went from zero really on this one, is a long burn innovation, the longest burn innovation in the world, that managed to turn around in three months, to almost 100%, in some cases, and so I think that's where the risk part is because, 100 per cent telehealth carries as much risk as zero percent telehealth. So I think that there is some opportunity, but doesn't change the pillars or the direction, that you might be actually considering clinical governance. It probably doesn't, but what would come out of inquiry in that space may change. 

    There was some questions around. We're almost the question was what's the perfect risk measure? And I think that's a very long answer that's hard to we have yet to arrive at the perfect sweet of risk management. Uhm, will quality and safety metrics. I can keep going. It is really tempting, isn't it? Jody just to keep going? Did you want to moderate us, Jo though?

    I'm back on, that's great. I thought I'd just take a couple more questions. If that's alright, there's a really, really, well liked question, I think in the chat around rural workforce attraction, and I don't have all the answers to that at hand, but I think we should circulate what material we do have in the department. We have done this in the past. Absolutely, we've got different programs and packages and sometimes, it varies by clinician type, and sometimes it varies depending on where the Commonwealth is at, because workforces is shared responsibility. But I think we can get some information out about that, so I just wanted to reassure those people that were interested in that I do think we've got a very different landscape at present, as I alluded to around international recruitment. That definitely is impacting our rural and regional and metropolitan services, particularly rural services, and so it probably not seeing the same level of movement at the moment, which is a huge pressure for our services so I'm happy to get some information circulated, and I think we can do that, that's no problem.

    The other thing that came through, and I probably won't address this in too much detail given time, but in terms of reporting and I think it's just important to highlight that the department in my division has a cycle of performance meetings with health services, so we are actually looking at that cycle and how we can make it a combination of both practical reporting against performance and discussions around particular issues, but also includes some strategy conversation as part of that. And bringing chairs into that conversation perhaps once a year. So that's part of what we're looking at the moment, really important piece of work. But yes, there's a performance cycle and a reporting cycle that comes with that, and that all flows as part of our governance arrangements and the CEOs are very well versed in it, and I'm sure they will report to you on that. So I think Jo, we might be up for time, but I hope we’ve answered some of the questions. And as you say, we will take the rest offline. 

    Thanks very much, Jodie. Thank you for all the questions. I'm sure it's a bit frustrating that we seem not to have answered as many as you would like. However, as we said, we would follow them up, but just wanted to talk a little bit about some of the things that people have identified, again more as the perspective of board. So some of the questions that you've asked more operational and they can be worked through at the board level, and work through with your local Health department in the regions, and through Jodie's area. But I think it's a very daunting thing when you first appointed to Health Service Board, and we've talked to you about some of the risks and traps, but I think it's most people take six months or so to start to feel comfortable and to be taking on the role and there's a lot of goodwill,l in the system to try and make that work for you, and help to connect you. But please talk to your peers if you know people who are on other health service boards. It's tricky at the moment because of lockdowns and so on, but catch up with them. Have some conversations. What are the sort of things that you're excited about? What are the sort of things that you're worried about? People have raised some questions about the challenges for boards of getting to know their health service, and engaging with the workforce during lockdown. And it is really hard and it's one of the things that people haven't been able to do as much as they would have wanted to in the last 12-15 months, but we need to be clever and think of ways of facilitating that. It's important courtesy and just to be clear, it's not the role of a board director to start taking themselves into a health service and marching around without any consultation with the CEO or the whoever is the manager or senior executive in the facility that you're going to. It needs to be part of an organised program. But nonetheless, and it's in a normal environment where able to have a cup of tea with some staff in an area of the health service, and engage with them informally that way. But there needs to be a structure around it. It's very rewarding work though, and there are lots of things that we can learn from each other and some of the themes that are in the questions are about. It seems that we all individually have to invent the wheel. It's not quite like that, but you. It's attention because health services are fiercely independent as a public hospitals they don't like being told you have to do it this way. So there are imperatives working against uniformity. But there are sometimes where it's just simpler to reach out to another health service and say hey, if you got a good report format for this, or if you got a good way of doing that, can we share resources and some of that goes to some of the informal partnerships and ultimately may go to more formal partnerships. 

    I do think it's important that we get the messages from the Minister out to you, and so we will do that either via email link to the video that you can follow or in by sending you the text, but it was a very clear call really to Director of Health Services in Victoria in terms of what the government expects office and I think it's important that you see that.
    I just want to finish up by talking a little bit about the future webinars, but and then thanking our presenters, but I'd like to really thank all of you for participating and apologize for the technical hitches that have made it a bit hard. I just want to draw your attention to a couple of things. I don't need. You don't need to put the slides up Justine, but I'll just refer again to the Director 's Toolkit which has heaps of resources in it and also to the integrity governments governance framework for Victorian public health services and will send you links to those.

    And in relation to the continuation of this series of orientation webinars there are two further sessions. One is on the 30 of August and is on the legal responsibilities of directors of public health boards and the third one in this series is on funding and accountability. So this one was trying to give you an overview of the system, an overview of you, your responsibilities that director and addressing the important areas of clinical safety and quality. But then we go to legal responsibilities and funding and accountability and we recognize that there are many people have taken up director roles on boards who don't have a lot of clinical background and even for people who do the whole systems of clinical governance can seem a bit strange and that's why there is a program of clinical governance training run by Safer Care Victoria and Robin referred to that earlier, but we really do want and expect all new directors to undertake that training through Safer Care Victoria and you will feel much better equipped as a result of having done that to exercise your responsibilities in that space so important to say that all directors are collectively and individually responsible for all aspects of their roles so those of us with clinical backgrounds can't opt out of understanding the finances and risk and audit and those with those backgrounds can't opt out of understanding like clinical risks at a basic level, so you can certainly draw on your colleagues expertise. 

    But there isn't any room for just sort of switching off and thinking that's not my responsibility. It is the responsibility of all of this. So the slides just come up now which indicates those dates, but we will send that out to you and we strongly encourage you to participate. You will be asked for feedback about this session, which I would be grateful if you would provide and as I said, will follow up with the slides with the video with answering the questions that we can, and with the ministers messages. So with that, we'll conclude where only a couple of minutes over, which is pretty good. Going for a tight program. Wish you all a good evening and hopefully will be out of lock down for awhile sometime soon. Thanks everyone.

The department hosted a series of webinars for new and reappointed directors of the boards of public health services and public hospitals. Three webinars were held during August – September 2021 focused on the induction of new directors. The webinars are also able to assist the knowledge of continuing directors. 

The first webinar was held on 11 August, it introduced directors to the Victorian health system. It was facilitated by Dr Joanna Flynn, Chair of the Boards Ministerial Advisory Committee, and it included a Minister’s welcome from the Hon. Martin Foley, the Minister for Health; a Secretary’s welcome by Professor Euan Wallace, the Secretary of the Department of Health; and presentations by Ms Jodie Geissler, Deputy Secretary, Commissioning and Systems Improvement; and Ms Robyn Hudson, the Acting CEO, Safer Care Victoria. 

Reviewed 22 November 2021


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