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The future of the ACI and it’s patient centred clinical networks. Beyond Garling. HNE Health Quality Exposition & Scientific Program Tamworth, Sept 2010. Hunter Watt Chief Executive, ACI. 15 September 2010. Patient Centred Care.

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beyond garling

The future of the ACI and it’s patient centred clinical networks

Beyond Garling

HNE Health Quality Exposition & Scientific Program

Tamworth, Sept 2010

Hunter Watt

Chief Executive, ACI

15 September 2010

patient centred care
Patient Centred Care

1.24 To start with, a new culture needs to take root which sees the patient’s needs as the paramount central concern of the system and not the convenience of the clinicians and administrators. ……………

Garling Report - Overview Nov 2008


Garling’s vision?

‘…use the existing clinical network model to involve clinicians and patient representations in continuous clinical redesign to deliver better and safer patient care’

Recommendation 67, Final Report

clinical innovation and enhancement agency
Clinical Innovation and Enhancement Agency

1.28 The first step is to engage the dedication of clinicians in designing new models of care which are supported and actively championed by clinical leaders in the field, which are evidence-based best practice, and which can be monitored to track the degree of success. To achieve this, I have taken up the many existing networks of clinicians and recommended that they become part of a new, more comprehensive agency which will be tasked to coordinate and drive constant innovation across the whole system. I have suggested that it be called the Clinical Innovation and Enhancement Agency, and be responsible for continuing reform and improvement of clinical models of care and practices

Garling Report - Overview Nov 2008


Clinical Innovation and Enhancement Agency

1.75 To address clinician involvement at the state-wide level, my recommendations suggest that continual innovation and improvement must be driven from the bottom up by the clinicians who are going to deliver the care. NSW Health should establish a Clinical Innovation and Enhancement Agency, which uses networks of clinicians to champion and drive change and improvements for the good of the patients. The Agency needs a central reservoir of skills to help these networks and my recommendations are quite specific about this.

Garling Report Overview Page 12

nsw health budget
  • NSW recurrent annual Health budget = 15.5B
  • That is $2,124 for every patient in NSW per year
  • NSW spends ~ 42M per day - not including Medicare

NSW State Budget 2010

health expenditures as a percentage of gdp selected countries 2006
Health expenditures as a percentageof GDP, selected countries, 2006

J Deeble: Oct 2009

rate of increase in expenditure on health
Rate of increase in expenditure on Health

Over the 10 yrs to 2005 Australia had the highest rate of growth in “real” expenditure per person of all OECD Countries

  • Patients
  • 2009 - 45% all public hospital patient > 65yrs. (many better served by care in community and home – e.g. chronic disease)
  • Increasing numbers of young people attending ED’s – significant numbers with mental illness and drug and alcohol related issues
demographics cont
Demographics (cont)
  • Workforce
  • Maldistribution – ‘sandstone curtain’
  • Changing expectation of workforce
  • 22% nurse workforce qualify for retirement in 2011
  • Statutory Body – established January 2010
  • Determination of Functions
  • State-wide remit
  • Models of Care – evidenced based - robust generic methodology
  • Implementation – in partnership with DoH and LHN

NSW Agency for Clinical Innovation

aci vision
ACI Vision

Improving health care outcomes:

  • drive patient-centredclinical innovation
  • harness knowledge of clinicians, managers and consumers
  • build sustainability and continuous improvement across the system
  • NSW Health but at “arms length”
  • AHSs
  • Other statutory health organisations
  • NGOs (consumer bodies)
  • Researchers
our partners
Our partners
  • Bureau of Health Information
  • Clinical Excellence Commission
  • Clinical Education and Training Institute
  • Cancer Institute NSW
  • Sax Institute
features of the aci clinical networks
Features of the ACI Clinical Networks
  • Across hospital and LHN boundaries
  • Clinicians (doctors, nurses, allied health) and Health Managers
  • Community (patients, carers and NGOs)
  • Equal partnerships
  • Evidence-based and data driven
aci clinical networks
Aged Health

Anaesthesia and Perioperative Care

Blood and Marrow Transplantation

Brain Injury Rehabilitation




Gynaecological Oncology


Nuclear Medicine


ACI Clinical Networks
  • Nutrition
  • Ophthalmology
  • Pain Management
  • Radiology
  • Renal
  • Respiratory
  • Severe Burns
  • Spinal Cord Injury
  • Stroke
  • Transition Care
  • Urology
  • Emergency Care Institute
aci our role beyond garling
ACI – Our Role beyond Garling
  • Peak Body in NSW for
    • engaging clinicians and community
    • state wide remit
    • broad Determination of Functions: chronic and acute services
    • produce evidenced based models of care
    • Assist with implementation
aci our role beyond garling1
ACI – Our Role Beyond Garling
  • Peak body in NSW
    • support implementation of models of care with local evaluation
    • and potentially work with National Lead Clinician Group and ACSQHC at national level
aci national health reform
ACI & National Health Reform
  • Establish national standards
  • National models of care
  • Local Lead Clinician Groups
  • National Lead Clinician Groups
  • advise on ‘service delivery, optimal models of care and methods to improve clinical outcomes’
in a time of reform
In a time of reform
  • Lead the debate across NSW and influence at Commonwealth level
  • Develop models of care in priority areas
  • Support implementation and communication across the system
  • Demonstrably reduce unwarranted variation in health outcomes across NSW


aci relationship with lead clinician groups local health networks and nsw health
ACI relationship with Lead Clinician Groups, Local Health Networks and NSW Health
  • Assumptions
  • LHN instituted as proposed
  • National and Local Lead Clinician Groups are established
  • Changes to ACSQHC go ahead
  • Each LHN has an Executive Clinical Director or equivalent
  • Hospitals or clusters of hospitals within LHN have Clinical Councils

NSW Local Lead Clinician Group

LHN Executive Clinical Directors

National Lead Clinician Group


ACI Executive Management Team

ACI Clinical Networks


ACI Clinical Forum


1.210 NSW Health will not be able to move forward to embrace system wide reformswithout the support of the community. This necessitates leadership from all involved in the political process to accept that the good of all citizens in NSW, and the provision of health care in an orderly and systematic way, must prevail over individual, sectional or geographical interests whose motivation is largely, if not entirely, self interest. It necessitates strong leadership from all the clinicians and managers who work within, or as a part of, NSW Health.

Garling Report - Overview Nov 2008


Level 3, 51 Wicks Road

North Ryde NSW 2113

PO Box 6314

North Ryde NSW 2113

T + 61 2 9887 5728

F + 61 2 9887 5646

ABN 89 809 648 636

Hunter Watt

Chief Executive ACI