National Clinicians Network
NT Forum 2013 - Report of outcomes
‘Transfer of Care: Rural and Remote Perspectives’
CONTENTS
1.
Executive summary ....................................................................................... 3
2.
Background and Purpose .............................................................................. 6
3.
Context for Improving Transfer of Care ......................................................... 6
4.
3.1
A Northern Territory Perspective....................................................... 6
3.2
A National Perspective ...................................................................... 7
Transfer of Care – Critical Issues and Interfaces........................................... 7
4.1
Panel Discussion .............................................................................. 7
4.2
Plenary Discussion ........................................................................... 8
4.3
Small Group Work Sessions ............................................................. 9
4.3
Plenary Discussion – Common Solutions and Owners ................... 12
5.
Next Steps ................................................................................................... 13
6.
Appendices .................................................................................................. 14
6.1
Appendix 1 – National Lead Clinicians Group Membership ............ 14
6.2
Appendix 2 – NT National Clinicians Network Program ................. 16
“…… Transfer of care is about I own responsibility for this
care and it's mine until I effectively give it to somebody
else. Then it's theirs until they effectively give it back to me
or to somebody else as well. ……” Forum participant
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1.
EXECUTIVE SUMMARY
The Northern Territory (NT) National Clinicians Network (NCN) was delivered in partnership
with the NT Medicare Local and the NT Department of Health on 31 May 2013. Its purpose
was to engage clinicians in improving transfer of care across the patient care pathway in
multiple settings. The forum was attended by over 100 delegates including clinicians across
all health areas, health executives and managers, representatives from health professional
bodies and consumer representatives.
Objectives
The aim of this report is to summarise the outcomes of the forum and the possible solutions
identified to improve transfer of care. The report will assist in the provision of effective clinical
handover across the different parts of the health system and transfer of care into the
community.
The focus – Transfer of Care
Transfer of care, despite being an integral part of clinical care, remains a high risk area for
patient safety. Clinical handover is the transfer of professional responsibility and
accountability for some or all aspects of care for a patient, or group of patients, to another
person or professional group on a temporary or permanent basis.1 This process differs from
discharge where care and treatment is at an end and the patient or family assumes
responsibility for ongoing health maintenance.
Procedures in transfer of care can vary between Local Hospital Networks (LHNs), Medicare
Locals and primary care and individual clinicians. The complexity of transfer of care across
and within the different governance arrangements and for different patients exposes a health
system which is fragmented. Poor or absent handover and transfer mechanisms can have
serious consequences for patients, leading to a delay in diagnosis or treatment, discontinued
care, medical and medication-based adverse events, avoidable re-admissions, and
inefficiencies in managing patient flow into hospital and on return to the community setting.
Communication problems are a major contributor to adverse events in hospital with 70 per
cent of sentinel events being attributed to communication errors and approximately one in
five patients experiencing adverse events.
Transfer of care is not a new concept. There has been substantial work undertaken in this
area by various stakeholders, including the development of standards, guides, and
resources to support best practice, literature reviews and other projects. This includes work
by the Australian Commission on Safety and Quality in Health Care (ACSQHC) and state
and territory governments.
The agenda
The Northern Territory Minister for Health and Minister for Alcohol Rehabilitation, the Hon
Robyn Lambley MLA, provided a Northern Territory perspective of the unique challenges in
delivering health care in remote communities and the upcoming implementation of a
decentralised services framework. The Australian Government Minister for Veterans’ Affairs,
Minister for Defence Science and Personnel, Minister for Indigenous Health and Minister
1
Australian Commission on Safety and Quality in Health Care (ACSQHC), September 2011, National Safety
and Quality Health Service Standards, ACSQHS, Sydney.
3
Assisting the Prime Minister on the Centenary of ANZAC, the Hon Warren Snowden MP,
provided a national perspective on health service delivery in the NT and its challenges,
commenting on partnering with community controlled health organisations and how the
geography of Australia challenges the provision of good health care services. Both Minster
Lambley and Minister Snowden talked about the importance of understanding and
respecting Indigenous culture to provide health services in the Northern Territory’s regional
and remote communities.
The forum comprised both panel and small work group discussions which considered the
critical issues relating to transfer of care. The panel discussion focused on a specific case
study to identify key transfer of care issues and responsibilities from a remote and regional
perspective. The small work group discussions identified areas for improvement in transfer
of care and specific solutions to address these issues.
Key outcomes
Participants discussed a number of issues impacting on the effective transfer of care specific
to remote and rural communities. Staff turnover, health literacy, information systems and
cultural sensitivity were themes that permeated the various discussions on patient transfer of
care issues. Participants agreed that for patient care coordination, health literacy and family
involvement is critical in the quality and continuity of care. In discussing specific issues and
solutions, participants identified the following key areas requiring action:
1. Improving health literacy
Communication is key to managing and transferring care of a patient between medical
services, but a shared understanding of what is being communicated is essential. Clinicians
must be equipped and capable of talking with one another to create shared meaning and
they must be able to talk with their patients to ensure that they create shared understanding
of the patient’s situation and care needs. Access to Indigenous health interpreters was
identified as a key issue in effectively communicating with patients about their condition and
care. Participants also highlighted the importance of identifying and including the key
decision-maker, who may not be the patient or even a family member, in discussions about
the patient’s continuity of care.
2. Supporting the workforce and increasing capacity
Managing continuity of care is made increasingly difficult with high staff turnover and
disparate information systems. The challenge of providing services to remote communities
requires flexibility in work models and embedding non-clinical roles such as Aboriginal
community workers into the health care system. Models of flexible work arrangements, such
as four week rotations, have been implemented in some positions alleviating burn-out and
allowing health care providers to build ongoing relationships with their communities. Forum
participants felt this needed to be more fully supported by a policy framework or initiative.
3. Orienting clinicians to NT services and remote practice
Transfer of care in remote settings offers unique challenges for clinicians. Patients that live a
significant distance from services and may move from location to location, require clinicians
to have a clear understanding of where they are transferring their patient to and what
services they will be able to access. Orienting staff to NT systems and providing specific
training and support to deliver health services in a remote setting will ensure that when
transfer of care occurs, it is to appropriate and available services. Dr Mark Wenitong
proposed that orienting clinicians “..about how we do referrals and how specialist services
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are provided and people are referred back to communities et cetera so everybody
understands what's available, what's out there, what they can refer into and back from”.
4. Using ehealth and interconnecting information systems
Access to patient information has been a recurring theme throughout the state and territory
forums. Multiple information systems complicate accessing patient information and are time
consuming, requiring staff to enter patient information into different systems. The NT
electronic health record system, myEHR, received positive feedback from participants who
commented that uptake in remote communities was ‘excellent’. This system provided a
range of patient information including medications and pathology. At the national level, the
implementation of the Personally Controlled Electronic Health record (PCEHR) is a key
example of adding to multiple systems and there were many concerns about integrating
these systems. With the PCEHR currently having less capability than the NT myEHR,
participants were concerned about losing the capacity that has been built with myEHR.
Next steps
The National Lead Clinicians Group will develop and disseminate a proposed action plan for
implementation. The Group will engage with other stakeholders across the health system,
and use its networks and partnerships to ensure the solutions identified ultimately inform
systemic changes to improve outcomes for patients.
In addition, outcomes from this forum were provided as input to a National NCN forum held
in June 2013 and will be considered by the National Lead Clinicians Group in their broader
work.
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2.
BACKGROUND AND PURPOSE
The National Clinicians Network (NCN) has been established by the National Lead Clinicians
Group, a Ministerial advisory committee (see Appendix 1 for membership) formed to advise
the Federal Minister for Health on clinical issues. Working in conjunction with jurisdictional
clinical bodies, the NCN brings together clinicians to enhance multidisciplinary clinical
leadership and engagement in the Australian health system.
The National Lead Clinicians Group (LCG) conducted a series of state and territory NCN
forums around Australia, in conjunction with state-level clinical bodies. The purpose of the
NT forum was to engage clinicians in improving transfer of care to strengthen the quality and
safety of care, streamline the patient journey and consider these aspects across a range of
situations and settings which may include rural and remote areas. It also aimed to stimulate
personal reflection on how each clinician could contribute to improvements in clinical
handover in their practice setting (see Appendix 2 for forum program).
Adjunct Professor Russell Stitz, Chair of the National LCG, welcomed over 100 clinicians
and health professionals to the Darwin Convention Centre and encouraged participants to
focus on solutions from both system and personal perspectives. Ms Lynette Glendinning of
Tempo Strategies facilitated the forum.
3.
CONTEXT FOR IMPROVING TRANSFER OF CARE
3.1
A Northern Territory Perspective
The Northern Territory Minister for Health and Northern Territory Minister for Alcohol
Rehabilitation, the Hon Robyn Lambley MLA, provided a Northern Territory perspective on
the challenges in transfer of care and health management in general faced by NT health
care professionals. Minister Lambley commented on the remoteness of many areas in the
NT, some of which were made inaccessible by annual flooding, and the difficulty of retrieving
patients in these areas when they required care. The Minister highlighted that although there
is some consistency across medical facilities and equipment, each community is culturally
and/or socially diverse making transfer of patient care different each time. Improving transfer
of patient care also requires a commitment to ensuring that services are delivered in a way
that is both effective and respectful of the cultural rights and values of NT Indigenous
communities.
Minister Lambley noted that implementing the new services framework for the NT,
decentralising health care and reducing the role of the NT Department of Health, will be a
challenging time for health care service providers. However, it will also be an opportunity to
change how health services are delivered. It will mean local people can make decisions
about the provision of health care in their communities. The Minister commented that the
size of the NT and remoteness of many communities requires patients to rely on the Patient
Assistance Travel System (PAT) to attend medical appointments. This system is currently
under review, and changes may place financial pressure on both patients and health service
providers.
The Minister discussed how the NT shared electronic health record system, myEHR, has
improved the health care experience for patients and providers in regional and remote areas
since 2005, and has the potential to help in the process of transferring patients. The Minister
reinforced the importance of a consistent handover process and transfer of care in delivering
the best possible patient care.
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3.2
A National Perspective
The Australian Government Minister for Veterans’ Affairs, Minister for Defence Science and
Personnel, Minister for Indigenous Health and Minister Assisting the Prime Minister on the
Centenary of ANZAC, the Hon Warren Snowden MP, delivered a national perspective on
building partnerships to deliver health services across Australia, focusing on the unique
issues faced in the NT.
Minister Snowden commented on the relationships he has built with Indigenous people and
health workers in the public health care system and in private practice. The Minister noted
that through his long relationship with Aboriginal people, he has learned that the geography
of Australia can mitigate against the delivery of good health care services. The Minister used
the provision of renal care services as an example of the difficulties in delivering services in
Central Australia where patients have had to travel across state borders to seek treatment.
Building partnerships, the Minister stressed, was key to getting the right outcomes for
patients. Although the Australian Government funds initiatives to address issues in chronic
care, it was not actually delivering these services on the ground. The Minister said that it is
the partnerships built with state and territory governments are key to good health outcomes.
The Minister also emphasised the importance of building relationships between health care
professionals and commented that transfer of care will not work if professionals do not work
together. This also extends to patients and communities, particularly in the NT where cultural
considerations and workforce issues increase the difficulties in ‘getting the right people in the
right places to do the right work’.
The Minister reinforced the importance of transitioning people through health care
processes, ensuring the patient pathway is well understood, coherent and that information is
transferred with the patient so they get the best possible care from beginning to end, no
matter where they are from.
4.
TRANSFER OF CARE – CRITICAL ISSUES AND INTERFACES
4.1
Panel Discussion
A panel discussion, facilitated by Ms Glendinning, was used to identify the critical issues that
must be addressed to improve transfer of care. A case study was used as a point of
reference to guide the discussion and the panel was asked for their perspective on what
failed in the transfer of care of the patient, and what key actions would have improved the
patient’s outcome. The panel included:
Dr Mark Wenitong – National Lead Clinicians Group
Ms Bhavini Patel – Senior Clinical Advisor, Northern Territory Department of Health
Dr Karen Stringer – General Practitioner and GP Hospital Liaison Officer
Dr Charles Kilburn – Director of Child and Maternal Health, Royal Darwin Hospital
Mr Jason King – Aboriginal Health Practitioner and Chair of Local Health Board, Santa
Teresa Community (Mr Jason King was absent on the day of the forum)
The case study focused on a 12 year-old patient diagnosed with obstructive sleep apnoea
complicated by weight gain leading to obesity. After repeated referrals to the ear, nose and
throat (ENT) specialist, surgery was recommended. Due to staff turnover, poor transfer of
care between health care professionals and poor communication with the patient and family,
the patient died 7 days prior to scheduled surgery at age 16.
Panel members identified three key issues from the case study commonly faced by health
care professionals in the NT:

identifying who has responsibility in the transfer of care;
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
the need to consider a range of systems that better support patient management;
and

complexities associated with case management or patient advocacy.
All panel members agreed that in this case study there was a failure to ‘close the loop’ on
referrals between clinicians and specialists. Often a referral is sent but there is no
confirmation it is received and the patient is not contacted to make the required appointment.
The case study provided a clear example of this, with repeated referrals to the ENT required
before the patient was seen. Forum participants confirmed this was an ongoing issue in the
NT. Dr Karen Stringer explained that in an urban setting the family are often the primary
advocates ensuring recommended actions are followed up, or if necessary, the health care
centre will take on this role. With high staff turnover in the NT and patients who often do not
understand the implications of their medical situation, this advocacy does not always take
place. To address these issues it is necessary to have systems in place that go beyond
‘ticking off’ that the patient has been seen and a referral made. Systems should have the
capacity to ‘close the loop’ and ensure that referrals have been received and appointments
made.
The role of advocacy and case management was also identified as a common challenge in
the NT. In the case study, the GP was the case manager but with turnover of staff, lack of
appropriate systems and a patient who was changing location, identifying who is responsible
for case management is difficult. The high mobility of the Indigenous population in the NT
and the way health services are provided make it critical to prioritise case management and
patient advocacy. This case study highlights the challenges faced in the NT in providing care
to patients who are often highly mobile, not familiar with the health system, may not
understand their medical situation, and who are not proactive in seeking medical care.
Dr Mark Wenitong stated that in the NT they are working with “populations that are more
sensitive to bad procedures or bad processes”. The lack of case management and
communication at a clinical level interfered with the whole process of transfer of care and
this was compounded by a lack of effective communication with the patient and the patient’s
family. In discussing the systems in place, Dr Wenitong identified some relatively constant
workforce groups, including nurses and Aboriginal health workers, that tend to be underutilised in a systems approach. While many models place doctors as central to handover
processes, Dr Wenitong commented that a recent PhD report identified Aboriginal health
workers as highly effective in reducing avoidable hospital admissions.
4.2
Plenary Discussion
The plenary discussion identified health literacy, improving systems and managing and
retaining the workforce as critical issues in improving transfer of care. Communication with
patients whose first language is not English is a challenge. Clinicians require the skills to
explain complex and technical medical ‘jargon’ in plain language and in a way that they can
create shared meaning with the patient. One participant commented that clinicians “…have a
duty to be able to develop stories for our clients, no matter whether they are Aboriginal or
anywhere…”. Another highlighted the benefits of “…using pictorial representation of the
body, talking first about how the body’s supposed to work before you go into talking about
pathology…”.
In the case study there was a divergence in understanding of why the surgery was required
and the outcome for the patient. Family concerns about the surgery, which were not
adequately addressed, led to a delay in gaining parental approval for treatment. This
highlights the importance of having family members and/or an interpreter present to start the
process of creating shared understanding. Getting the communication right empowers
consumers, whether it is the patient, their family or carer, their extended family or even
8
members of their community, and gives them a sense of control as they navigate across the
healthcare system.
One participant commented that better processes and systems were more important than
advocacy. Dr Karen Stringer explained that in the hospital setting in the NT, there is a mix of
paper and electronic systems that often do not interface with one another. There are manual
systems for sending out and receipting letters and managing waiting lists that are dependent
on people rather than a systematic approach. This leads to breakdowns in the system where
referrals are not confirmed as received and follow-up is slow if patients do not attend a
scheduled appointment. Participants acknowledged that the electronic health system assists
with this but there is still much improvement to be made and other systems need to be better
integrated and rely less on individuals. A participant confirmed that there needs to be a
unified approach to systems where there is more coordination between specialist outreach,
outpatients departments and telehealth.
Strengthening clinical governance, particularly in the area of incident reporting, was raised
by one participant as an area of concern. While reporting systems were well developed in
hospitals they were not as well developed at the interface between primary care and
hospitals. Events that occur following discharge may not be reported to the hospital.
Capturing this information can inform improvements in the transfer of care for patients.
With patients who are frequently unable to navigate the system and who often have limited
access to services, participants felt it was extremely important for health care professionals
to understand how hospital and primary health systems operate in remote communities.
Access to services is compounded by high staff turnover, as many health care professionals
do not stay in the health system long enough to learn the systems. Professional respect
within the health system for the contribution all health workers make to patient outcomes
should be recognised as an important contributing factor in good transfer of care. Managing
and retaining the workforce through orientation and flexible work models were identified as
strategies that are working in some locations but required a policy framework to extend the
practice and availability of these options to other locations.
4.3
Small Group Work Sessions
Following the plenary discussion, delegates moved into three workshop groups to discuss
and develop solutions to transfer of care issues in the context of three specific areas. The
solutions identified and the key groups/organisations involved in their implementation are
listed under the three specific areas:
1. Systems to support continuity of care in the context of increased staff
turnover
Orient clinicians to NT services and systems
 Providing a map or directory of services available across the NT will provide
guidance to clinicians about what services are available in remote communities when
making referrals. The NT Department of Health is currently developing an on-line
directory of services in Indigenous communities for use by health professionals.
 Providing appropriate training to staff on using current systems, including handover
and discharge summaries will ensure that the systems in use will be used effectively
across the health sector.
 Ensuring staff have competence in remote practice, through orientation and training,
will provide increased understanding of community and cultural considerations in
patient transfer and care.
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Key groups involved include NT Department of Health, Northern Territory Medicare Local,
local health networks and universities.
Flexible Workforce Models
 Providing a policy framework for flexible workforce models will increase employment
options which could lead to decreased staff burnout and attract practitioners to
commit to long-term employment. Employment models include rotation, increased
R&R and job-sharing.
 Indigenous health workers develop long term relationships with communities and are
an under-utilised resource. Embedding these roles into the health workforce structure
and ensuring they have career pathways and capacity development and training will
provide an additional resource for both clinicians and communities.
Key groups involved include NT Department of Health, local services and Northern Territory
Medicare Local (through workforce initiatives).
2. eHealth and shared health records – what is working well and what can be
improved
Interconnected information systems
 Developing a system that brings together all e-systems at the point of care and
includes medications, travel information, referrals and appointments would be a
comprehensive tool supporting co-ordinated patient care.
 Use of record tools, such as the NT Shared Pregnancy Plan of Care system, facilitate
managing patients who are mobile and moving between communities.
 Ensuring that the PCEHR and myEHR link together will reduce duplication and
maintain records already collected on myEHR.
Key groups involved include the Australian Government, NT Department of Health and local
health service providers.
Education for eHealth
 Providing good, transparent and comprehensive information about the eHealth
system to patients and clinicians will encourage uptake and effective use of the
system.
 Strengthening eHealth delivery competence through ecase conferencing and
edecision support will provide an additional tool to managing transfer of patients in
remote areas.
Key groups involved include Northern Territory Medicare Locals, colleges, Aboriginal
Medical Services Alliance Northern Territory.
Close the loop in referrals process
 Clinicians and other health professionals must clarify responsibilities for
referrals/notifications at all points to ‘close the loop’ in referral and transfer
processes.
 Providing technical support, e.g. online services in their homes, for remote clinicians
will provide an additional tool and increase accessibility for these clinicians to follow
up referrals and patient transfers.
 Upgrading to an electronic system for outpatient referrals will ensure appropriate
transfer of care of a patient. The New Zealand referral system, HealthPathways,
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acknowledges referral immediately and provides an example of an effective
electronic system.
Key groups involved include clinicians, NT Department of Health, the Aboriginal Medical
Services Alliance Northern Territory, and local service providers.
3. Improving health literacy and including patients and families
Respect for cultural health beliefs
 Understanding the medical and cultural beliefs of Indigenous communities will assist
clinicians to understand the medical care required for their patients and identify
transfer of care requirements.
 Identifying the appropriate decision maker, who may not be the patient or a family
member, and involving them in a ‘care conference’ improves understanding of the
patient’s medical situation and expedites decision-making.
Key groups involved include clinicians, service providers, and policy and governance
bodies.
Provide Indigenous health interpreters
 Providing dedicated Indigenous interpreters trained in basic anatomy and medical
terminology will assist health professionals and patients to gain a shared
understanding of their health issues and increase the patient’s and their family’s
ability to advocate for their own health.
 Alice Springs hospital currently has an interpreter service which assists with
communication between clinicians and patients but this service is not available
outside the hospital.
Key groups involved include the Australian Government and local level employers.
Health literacy for health professionals and communities
 Ensuring clinicians and other health professionals are equipped to communicate with
each other and share meaning will improve understanding of the patient’s care
requirements and who has responsibility when there is a transfer of care.
 Bringing health literacy early into school education, for example into Culture First
classes, will increase patients understanding of basic anatomy and health care and
increase the patients understanding of their medical situation.
Key groups involved include universities, clinical educators and the state school system.
“…we all say we have a health system, but in fact we have multiple islands of people
providing healthcare with multiple funders, so the owners are multiple people and
multiple organisations and it’s very hard to get them all to come together to realize
the same thing, so that’s what I’m saying, it’s people in this room.” Forum participant
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4.3
Plenary Discussion – Common Solutions and Owners
Following the small group-work session, participants engaged in a plenary discussion to
share and discuss the key issues and solutions identified in each small group session.
A recurring theme throughout the forum’s discussions was the need for health care
professionals to have an increased understanding of the context of health care in rural and
remote communities in the NT. Participants agreed that good transfer of care requires
clinicians to understand where they are transferring their patients to and what services are
available in that community. Solutions included a comprehensive directory that enables
clinicians to check what services were available in the patient’s community and where they
can refer patients to. The NT Department of Health is currently developing an online tool
which provides a listing of services available in remote areas, however it is still in the early
stages of development. Other resources mentioned include the NT Health Map and The
Bush Book – which has been used in NT hospitals for over 10 years and identifies health
services in remotes communities.
Participants also supported clinicians gaining on-the-ground experience through work
rotations or placements to develop a better understanding of not just health services but also
of the cultural beliefs and practices of patients and their communities. However, concerns
were expressed about the practice of short-term, one-off placements of medical trainees,
who were like ‘seagulls’ dropping into these communities but not building relationships or
providing any real benefits to community members. One participant commented that
Aboriginal people “….don’t want health tourism and voyeuristic individuals coming for a onelook see or exposure”. Participants identified remote area orientation and training programs
already in place including the Flinders University Northern Territory Medical Program and the
Prevocational General Practice Placement Program.
Participants felt that flexible work models also assisted with clinicians building relationships
in communities. One participant provided an example of two GP’s who rotate four weeks on,
four weeks off. Working in the remote community was not sustainable for either GP, but the
rotation model allows them to build on-going relationships in the community. Flexible work
models not only helped prevent staff burnout and retention but also allowed health
professionals to build knowledge and relationships with remote communities. Participants
acknowledged that flexible work models, such as this, existed but were available mainly to
GP’s and a policy framework was required to ensure it was available across all health
professions. Dr Ameeta Patel acknowledged that there are other strategies to maintaining
and attracting a workforce including family support weekends but that these were available
mainly to GP’s and this initiative also needed to be expanded to other medical professions.
Another suggestion to improve transfer of care, and one identified in most NCN forums, was
the need for an integrated computer system that is accessible across the hospital, primary
care and aged care sectors. Although participants acknowledged that a single system
interface was probably not realistic, moving to electronic referral systems across the health
sectors was considered a key solution in improving transfer of care. An example shared by a
participant of how information systems are facilitating improved health care for some NT
patients is the Shared Pregnancy Plan of Care – which connects pregnant women to health
services even if they move to different locations in the NT. The use of both electronic and
manual referral systems within both primary and secondary health care creates
inconsistency in how referrals are received and actioned. The potential of the PCEHR was
recognised but there was concern about integrating this with the NT myEHR. One participant
noted that “…the problem with the national one at the moment is it’s got much less capability
of the NT one, so if we get people signing up for the national one, we won’t have access to
all their information”. Most importantly, both clinicians and patients needed to be educated in
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effectively using these electronic health record systems. Subsequent to this was the
potential of other electronic resources such as video-conferencing to better link remote
clinicians and facilitate communication.
To improve transfer of care, health literacy, was considered key to improving communication
between clinicians and between clinicians and their patients. It would also lead to improved
patient advocacy. If patients had a better understanding of their own health, and clinicians
were able to create shared meaning about the health issues, then patients would be
empowered to participate in their own transfer of care, including following up referrals and
decision-making. Providing information to a patient about their medical condition, in a way
that is easily understood – such as a story or series of pictures - was also considered an
important way to engage Indigenous people in the management of their health. One
participant commented that story telling was understood by Aboriginal people and this ability
should be developed as part of a clinician’s health literacy training. Health literacy for young
children was also raised with a participant suggesting it may be incorporated into the Culture
First classes. Participants agreed that interpreters played a key role in ensuring that patients
understood their medical situation and health management plan and that this needed to be a
fully funded and managed resource. However, as one participant noted, there is no
nationally accredited health interpreter course for Indigenous languages. The Department of
Immigration and Citizenship funds an interpreter service but this does not include Indigenous
languages.
5.
NEXT STEPS
The National Lead Clinicians Group will consider follow up actions to build consensus
around possible solutions on transfer of care issues, and who may be involved in delivering
these solutions. The Group will also discuss other options and address the various solutions
to facilitate their implementation. It is expected that future NCN forums to be conducted in
2013 will test and build on this work.
This will require the Group’s engagement with other stakeholders across the health system,
and its use of networks and partners to ensure the solutions identified ultimately flow through
to systemic changes that result in improved outcomes for patients.
This forum was part of a series of state and territory forums held in 2012-13 on transfer of
care issues. Suggestions from this forum and other state/territory forums were provided as
input to a National forum held in June 2013, and will be considered by the National LCG in
their future work.
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6.
APPENDICES
6.1
Appendix 1 – National Lead Clinicians Group Membership
Adjunct Professor Dr Russell Stitz, AM RFD (Chair) is Commissioner at the Queensland Health
Quality and Complaints Commission, senior surgeon at the Royal Brisbane and Women’s Hospital
and previously Professor of Clinical Surgery and Head of the Discipline of Surgery for the University
of Queensland. He is a past President of the Royal Australasian College of Surgeons and past
Chairman of the Committee of Presidents of Medical Colleges. He is also a former Director of the
Australian Medical Council.
Adjunct Associate Professor Melissa Locke (Deputy Chair) (until 29 April 2013) is a practising
specialist paediatric physiotherapist (Fellow of the Australian College of Physiotherapists), holding
an adjunct associate professorship at Griffith University and Immediate Past National President of
the Australian Physiotherapy Association.
Mr Christopher Cliffe is the Executive Director of Nursing & Midwifery for the Cape York Hospital
and Health Service in Far North Queensland. He is the immediate past president of CRANAplus and
is Deputy Chair of the Coalition of Nursing Organisations
Mr Tim Benson is an experienced senior health consumer representative and a member of both
the national and state peak consumer health bodies, as well as the WA North Metropolitan Health
Service Area Executive.
Dr Mark Bowman is a practising dentist in Victoria, federal and state councillor of the Australian
Dental Association and Immediate Past President of the Australian Society of Periodontology.
Professor David Clarke is Clinical Director of Primary Care and Consultation-Liaison Psychiatry at
Monash Health in Victoria and Professor of Psychological Medicine in the Faculty of Medicine,
Nursing and Health Sciences at Monash University.
Professor Nicholas Glasgow is a practising palliative medicine specialist and General Practitioner
in the ACT, and Dean of the Australian National University Medical School.
Ms Helen Gosby is a nurse practitioner in the emergency department at the Children’s Hospital at
Westmead, NSW, and President of the Australian College of Nurse Practitioners.
Dr Alasdair MacDonald is the Director of Medicine, Clinical Integration, Reform and Stroke Care
within the Tasmanian Northern Area Health Service and active in Education and Policy within the
Royal Australasian College of Physicians.
Dr Jennifer May is a practising general practitioner in rural NSW, GP Academic at the University of
Newcastle Rural Clinical School, immediate past Chair of the National Rural Health Alliance and the
Chair of the Rural Doctors Association Female Doctor’s Group.
Professor Tracey McDonald AM FACN is a professor at the Australian Catholic University, with
wide experience in nursing, health services, education and management. This supports her
leadership of clinical practice and research in ageing; clinical and practice development; clinical
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outcomes benchmarking; leadership and governance; and social and health policy. In 2012, she
was invested as a Member of the Order of Australia for her work in nursing, health and aged care,
United Nations Expert Groups and the development of national and international public health and
social welfare policy.
Dr Ameeta Patel is a General Practitioner, Member NT Board of the Medical Board of Australia,
Board Member Rural Health Workforce Australia, Director Northern Territory Medicare Local.
Dr Andrew Pesce is a practising obstetrician and gynaecologist, currently appointed as Clinical
Director in Women’s Health in Western Sydney Local Health District and a member of the Local
Health District Board, as well as the immediate past President of the Australian Medical Association.
Ms Toni Riley is a practising pharmacist in a regional Victorian pharmacy providing opiate
replacement, primary care services and services to residential care facilities.
Winthrop Professor Christobel Saunders is a Professor of Surgical Oncology, academic surgeon,
cancer researcher and teacher of surgery at the School of Surgery, University of Western Australia
since 2002. She has been closely involved in strategic planning and management of health cancer
services in Australia for the last decade as Board member and Advisory Council member of Cancer
Australia, President of the Cancer Council WA, and locally as author of the WA Health Cancer
Services Framework and first A/Director State-wide Cancer and Palliative Care Network.
Dr Mark Wenitong is a founder and past President of the Australian Indigenous Doctors
Association, and the senior medical officer for Apunipima Cape York Health Council, an Aboriginal
community-controlled health service delivering primary care to remote Cape York communities.
Associate Professor Craig Whitehead is a practising geriatrician at Repatriation General Hospital
SA and the Regional Clinical Director for Rehabilitation and Aged Care, as well as an Associate
Professor at the Flinders University Medical School.
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6.2
Appendix 2 – NT National Clinicians Network Program
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