ABF Clinical Engagement
Susan Dunn & Hirani Jayasinha
ABF Taskforce
May 2013
Why is Clinical Engagement Important?
 Understand their operational contribution in ABF
 Currently clinical practice is reflected in the costing process
which then informs the funding model
 Collaboration in addressing unwarranted clinical variation
 Identification of appropriate clinical practice
 Understand the cost profile of the appropriate clinical cost
 Aim is for funding to reflect the cost of appropriate care
 Ensure correct funding messages are being heard
 Drive improved patient outcomes
Key Strategic Approaches
Communication
Education & Tools
Relationships
Data
Relationships
Relationships
 Promote a culture of partnership between clinicians, policy
makers and administrators with key agencies
– Clinical Excellence Commission (CEC)
– Agency for Clinical Innovation (ACI)
– Bureau of Health Information
– Health Education and Training Institute
– Local Health Districts (LHDs)/Specialty Health Networks
(SHNs)
Agency for Clinical Innovation
Relationships
 ABF Taskforce have engaged with ACI , building relationships with
clinical Networks to discuss funding models and build costing models
based on best practice.
 ACI promotes innovation, by engaging clinicians then designing and
implementing new models of care
 Clinical Networks
– design and support implementation of models of care which spread
best practice across the NSW health system
– provide expert advice to the NSW Government and Ministry of
Health to improve patient care and address inequities in access
 Signs of success,
– positive feedback and the Tupperware effect
Case Study – Renal Dialysis Network
 IHPA required Home Delivered Services to be collected at a patient
level for each patient administrated service
 Unwilling to put this burden of data collection onto clinical staff
 Raised issue with key stakeholders in Renal Dialysis Network
 Developed a solution framework
 Met with Renal Network, Renal Dialysis Network and individual
stakeholders to outline issue and to discuss proposed solution
 Gained support and commitment to work with the solution
 Design phase has now commenced on a reporting solution based on
Prescription, census and leave option
LHD/SHN Relationships
Relationships
 LHD/SHN Clinicians , ABF Coordinators, Non admitted
staff and SNAP staff
 Majority of NSW ABF Workstream Working Groups have
clinical co –chairs and clinical membership
 Providing input into policy direction and policy support
 Improves ability to feedback to IHPA
 Identify clinical champions
 Provide regular information
 Support and focused projects
Hunter New England LHD Case Study
 Working with clinical groups and junior medical staff on improving
clinical documentation
 Improved understanding of use of resources and variation in clinical
management of patients, including length of stay and use of
diagnostics
 Activity/cost data included in Grand Rounds to emphasise issues with
respect to gaining a more holistic view of patient care and discuss
better ways of managing frequent repeating patients
 Comment from a senior clinician that based on the aggregate cost it
would have been better for the patient and system to pay for a full
time carer
Illawarra Shoalhaven LHD Case
Study
 Orthopaedics - identification of prostheses and comparisons
amongst sites has led to further work in standardising implants used
and renegotiating the price with the contractors
 Costing has been used to identify the costs of readmissions due to
surgical infections
 Provision of costing data to Grand Rounds to identify costs of long
stay patients and discuss impact if treatment was varied or supplied
in a different setting
 Use of activity and costing data in working with sites and clinicians on
clinical pathways for selected DRGs
 Reviewing benchmarking reports to compare with peers and
exemplar hospitals
Education - Health Education and
Training Institute
Relationships
 Supports and promotes coordinated education and training
(clinical and non-clinical) across NSW Health System
 Assures workforce competency and the capacity to deliver
safe, effective and efficient health care to the people of
NSW
 Offers an online learning-course on ABF developed in
collaboration with ABF Taskforce
Education &
Tools
Education & Tools
Education - Other
 Documentation – Factsheets, Practical Guide, Casemix
Handbook, SNAP Handbook
 Tools – NWAU calculators: Acute and ED
Data
Data
 Timely, Accurate, Transparent, Comparative, focused
 ABM Business Information System
2011/12, DRG E65A CHRNIC OBSTRCT AIRWAY DIS +CCC
0
2000
4000
Allied
Other
6000
Blood
Path
8000
Imag
Pharm
Mean Costs($)
10000
Med
Pros
12000
Nurs
14000
16000
Data – ABM BIS
Key to pulling it together:
Communication
 Site visits
 Presentations to clinical groups
 Linkage with local ABF Coordinators
 Bulletins and factsheets
 Handbooks, guidelines
 Data timeliness and robustness
 Transparency
 Open and honest communication
Communication
Future Initiatives
 Establishing NSW Clinical Casemix Advisory Committee –
to provide stronger links between NSW Health and
LHDs/SHNs
 Developing further education materials (publications and
online modules) targeted to clinicians
 Providing focused analysis of activity, costing and
benchmarking data for ACI Clinical Networks
– Incompatible ABO renal transplant
– Complex foot clinic
– ED Benchmarking
“What’s in it for me?”
 Understanding that best clinical practice and ABF are not
mutually exclusive
 Quality patient care costs less
 Transparency
 Timely, accurate, comparative data
 Trust
 Communication & collaboration