Public complaints (RMCLHN. Annual Report 2020-21)

Number of public complaints reported

Additional metrics

Data for the previous year is available at DataSA website - RMCLHN Data for years prior to 2019-20 related to the former Country Health SA is available at DataSA website - CHSA.

• RMCLHN complaints key performance indicators are included in the suite of performance measures presented to the Governing Board.
• Performance targets of complaints acknowledged in less than two days and responded to in less than 35 days are monitored monthly.
• All responses to complaints are reviewed by RMCLHN Executive members and also by the CEO to ensure high quality and consistent responses are provided to consumers.
• Safety Learning System consumer feedback data and consumer experience surveys are reported monthly in the RMCLHN Quality and Safety reports.
• Comprehensive consumer feedback reports are developed quarterly providing analysis and identifying feedback trends.
• A review of the RMCLHN complaint management framework during 202021 resulted in the inclusion of ‘You said – We did’, to emphasise the improvements made to the provision of services for consumers as a result of their feedback.
  

Compliance Statement

Riverland Mallee Coorong Local Health Network Inc is compliant with Premier and Cabinet Circular 039 – complaint management in the South Australian public sector — Yes

Riverland Mallee Coorong Local Health Network Inc has communicated the content of PC 039 and the agency’s related complaints policies and procedures to employees — Yes

Service improvements

Riverland General Hospital

• RMCLHN took over the responsibility for medical service delivery of the RGH ED as at 1 December 2020, following a 10-year period of private management. The transition has allowed the Network to simplify governance of the ED and to improve coordination of the service. Other factors influencing the decision included difficultly recruiting and retaining medical staff, the COVID-19 pandemic, and the need to meet growing demand. From 1 December 2020 to 30 June 2021 over 20 Medical Practitioners of varying levels have been employed, including a Clinical Director Emergency Department. The medical roster also transitioned to a four x 10-hour roster aligning with other SA Health sites providing further overlapping of medical shifts and increased patient safety.
• Planning has occurred for the development of an Extended Emergency Care Unit that will provide a short-term treatment, observation, assessment, and reassessment of patients following triage, assessment, and treatment in the ED aimed at reducing unnecessary hospital admissions.
• The inpatient (internal medicine) unit has transitioned over the last two years to a salaried model providing 24-hour inpatient medical cover for the hospital wards. A full time Physician position oversees part time medical officers on the inpatient ward and an additional General Practitioner Consultant facilitates assessments and reviews of paediatric and mental health admissions providing a patient centred care approach.
• Recruitment to a salaried Specialist Anaesthetist based at RGH ensures oversight of pre- and peri-operative anaesthetic care of surgical and obstetric patients and input into the management of emergency situations across the Network.
• Development of a Medical Services Team including a coordinator and administration support to develop and implement systems and processes and undertake rostering and recruitment of medical staff. A temporary project manager assisted with the information technology transition, assets and resources and information systems.

Riverland Academy of Clinical Excellence (RACE)

• RMCLHN has a commitment to train its own clinical workforce, creating and improving relevant evidence bases for our clinical practice, and bringing the benefits of integrated teaching research and clinical care to the communities in our region. RACE is the vehicle for this commitment. RACE articulates RMCLHN’s ambition to be a centre of excellence in rural health and highlights our commitment to medical education in our region and counteracting medical workforce shortages in line with the South Australian (SA) Rural Health Workforce Strategy, SA Rural Medical Workforce Plan and the National Rural Generalist Pathway. Accreditation has been granted for intern and trainee medical officer training posts which will assist the Network to work towards an evolving pathway to Rural Generalist qualifications.
• The research arm of RACE is led by the Executive Director of Clinical Innovation/Director of Research, with the Network collaborating with various universities, medical research institutes and organisations.
• The Education and training arm of RACE is called The Academy Pathway, led by the Executive Director of Clinical Innovation/Clinical Director of Training.  This will enable medical graduates to undertake all the required postgraduate training to achieve a Rural Generalist Fellowship based in RMCLHN. The vision for RACE is that the Network will become a highly sought-after training region for medical graduates.

Research

• RMCLHN is partnering with the South Australian Health and Medical Research Institute (SAHMRI) on a COVID-19 related clinical trial that involves the installation of Ultra-Violet filtration systems in the air conditioning at Bonney Lodge and Hawdon House RACFs. This aims to reduce the risk of airborne virus transmission between residents, staff, and visitors and Barmera is one of four sites nationally that are trialling the filtration system.

Clinical Risk Management

• Significant work has been undertaken in RMCLHN on incident management and the analysis of incident data. An additional 1.0 full time Clinical Risk Manager position has been appointed (total of 1.5 full time equivalents) resulting in greater capacity to undertake comprehensive analysis of serious incidents and provide education and shared learnings to all staff.
• An Adverse Events Committee for the Network and a Mortality and Morbidity Committee have been implemented this financial year.
• Serious incident management has also been a focus with a new tool developed for serious incident investigations and utilisation of multidisciplinary investigation teams. The tool is based on root cause analysis principles providing a more comprehensive investigation of the incident resulting in strong actions and recommendations. A protected Root Cause Analysis, under the Health Care Act 2008, can be authorised by the CEO if required.
• Consumers experiencing falls, especially more than one fall, have been a particular focus for the Clinical Risk Managers with positive outcomes and a decreasing trend in the last quarter. Initiatives implemented include Tai Chi for older consumers in several sites, the introduction of ‘Easy moves for active ageing’ programs, use of laser sensors, increased use of Vitamin D and calcium, targeted education programs and individual case reviews.
• A Pressure Injury Action focus group was formed in November 2020 in response to an increase in pressure injury/ulcer/sore incidents. Examples of improvements implemented include development of a repositioning chart to assist staff with decision making, more timely referrals to allied health professionals, equipment inventory available for sites to access, recommendation of minimum pressure relieving devices equipment and ongoing education.
• A medication reflection tool has been introduced in RMCLHN prompting staff to reflect on why the medication incident occurred. A discussion is then held with the manager to enable provision of support and guidance for the staff member.
• A Challenging Behaviour working group has been formed in RMCLHN to ensure implementation of the Challenging Behaviour Strategic Framework released in November 2020, with utilisation of the policy directive, guideline, and toolkit.

Addressing health priorities for Aboriginal and Torres Strait Islander peoples

• RMCLHN has continued focussing on Aboriginal and Torres Strait Islander self-discharge, as self-discharge can cause interruption to further treatment therapies and may be associated with post-operative complications, increased morbidity and mortality, readmission, and increased healthcare expenditure. Regular monitoring of self-discharge rates occurs with monthly reporting of rates to the Governing Board with RMCLHN achieving the key performance indicator target (less than 4.5%) in six of the nine months in the first three quarters. A self-discharge questionnaire is in place and additional Aboriginal Liaison Officers have been appointed in RGH.
• A draft RMCLHN Reconciliation Action Plan has been developed. The Reflect Reconciliation Action Plan is designed to ensure the foundations are in place to meaningfully contribute to reconciliation. The plan recognises that to contribute to meaningful social change requires investment of time and resources and a willingness to reflect and adjust operations in order to cultivate cultural awareness, safety and humility across operations and governance.
• RMCLHN has committed to improving cultural awareness, with the Governing Board, Executives and Operational Leadership all undertaking cultural respect training with valuable learning outcomes and action plans developed. Members of the Executive Team and Governing Board have also participated in ‘on country’ experiences, aimed at improving understanding of the Aboriginal history of the Riverland Mallee Coorong region.
• Posters have been developed for Aboriginal and/or Torres Strait Islander identification utilising local photos that are displayed at sites in RMCLHN using health literacy principles to encourage Aboriginal consumers to self-identify as Aboriginal and/or Torres Strait Islander to improve access to services that are both culturally and clinically appropriate.
• Aboriginal Health Impact Statements are completed for new or revised proposals/projects in RMCLHN. The Aboriginal Health Impact Statement Policy Directive aims to ensure that Aboriginal stakeholders have been engaged in the decisions that affect their health and wellbeing.
• RMCLHN recognises and values the cultural diversity of its workforce especially our Aboriginal and Torres Strait Islander staff and encourages these staff members to engage and participate in a support network. A monthly support network has been instigated for staff who identify as Aboriginal or Torres Strait Islander to encourage retention and to identify supports. The inaugural get together was held on 18 March 2021 on National Close the Gap Day.
• The Mental Health directorate in RMCLHN has implemented the StayStrong ‘app’. The ‘app’ is a tool addressing the wellbeing and mental health of First Nations Australians using a cross-cultural approach. It is designed to promote wellbeing by reviewing strengths, worries and the goals or changes people would like to make in their lives.
• On 29 March 2021, RMCLHN held a small event to unveil a new, large-scale Aboriginal artwork on the facade of the Murray Bridge Soldiers' Memorial Hospital ED. The artwork was developed by artist Sam Gollan, in collaboration with sculptor Karl Meyer from Exhibition Studios, following a six-month project led by the Aboriginal Health Team and Country Arts SA. As part of the project, several local Ngarrindjeri artists developed a competitive artwork submission on the story of what health means to them. The artists were Nellie Rankine, Cedric Varcoe, Kevin Kropinyeri, Allan Sumner, and winning artist Sam Gollan. This project has enabled the Ngarrindjeri community to feel a sense of pride and connection to culture, through sharing their artwork, history, and language with the broader Murray Bridge community. Ngarrindjeri people have always known that health is a holistic concept and cannot be separated from the cultural framework of land (ruwe), language, lore, ceremony, and kinship, which are the foundations of Ngarrindjeri culture.

RMCLHN consumer Experience

• In addition to regular surveys, ‘What matters to you’ has been implemented in RMCLHN where consumer representatives / managers ask consumers an open-ended question about what matters to them. Results of these questions are tabled and discussed at site Quality Risk and Safety working group meetings and Partnering with Consumers Governance Committee.
• Consumer stories are utilised in RMCLHN to raise awareness and provide insight into consumer experiences. Consumers are invited to attend the Governing Board Clinical Governance Committee to share their experience of our health service.

Aged Care Performance Monitoring

• A new framework for measuring compliance to the Aged Care Quality Standards has been developed that includes self-assessment, clinical audits, incident and feedback data analysis, and consumer experience.

Mental Health

• Partnering with the Commission of Excellence and Innovation in Health, to redesign Mental Health Provision in Urgent Care (Emergency Departments).
• Partnering with the Office of the Chief Psychiatrist to redesign non-government organisation provision of mental health care that meets future needs.
• Partnering with the Office of the Chief Psychiatrist planning the Towards Zero Suicide Strategy for South Australia.
• Partnering with the River Murray and Mallee Aboriginal Corporation and Director Aboriginal Services to develop Aboriginal volunteer in-reach services for the emergency department and the Integrated Mental Health Inpatient Unit.
• Launching the positive culture initiative for the Riverland Mental Health Team called HE@RT (Honesty and Empowerment accompanies Respect and Teamwork).