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Achieving Process Improvement in Existing Environments

Hear from Keynote Speaker, Paul Butler, Executive Director, South East Metro Cluster (Victoria) on partnering for better health – setting up a collaborative large healthcare organisation

Victorian Health Clusters – a Positive Outcome of the Pandemic

In many ways, the pandemic has been disastrous for the whole country, particularly for Victoria which has had multiple outbreaks and significant periods of lockdown and restrictions. Yet at the same time, because the pandemic has exposed gaps and blockages in the way certain public sector institutions operated, there have been some positive outcomes too.

In the health sector in particular – which was at the forefront of combatting COVID-19 – the Victorian government made changes that are likely to have long-term positive impacts. Paul Butler, the Executive Director of the newly formed South East Metro Cluster, says “traditionally Victoria has had a fairly decentralised public health system with 81 public health services across the state,” meaning 81 separate hospitals. Whilst these still exist, “during the second wave of the pandemic in Victoria,” the Department of Health encouraged, directed and created clusters of health services “as a way of managing the impact of the pandemic.”

Setting up the Clusters

Altogether, there are now eight clusters across the state, with five in rural and regional Victoria, and three in the metropolitan region. The three in the metro area cover the south east, the north east, and central / western Melbourne. The south east cluster in particular comprises “Alfred Health, Monash Health and Peninsula Health,” each with their own existing catchment zones. Though pinning them just to the south east corridor of Melbourne is a bit of a misnomer because “Monash Health is the single largest public health service in Victoria, with Alfred being the second largest.” All three are based and have their major facilities in the south east, but extend their services further afield. Nonetheless, the south east cluster alone “covers approximately two million Victorians, or just under a third of the state’s population.”

Each cluster is also associated with a primary health network (PHN), so the south east cluster works in tandem with the South Eastern Melbourne PHN “to bridge the gap between primary and hospital care.” The catchment areas are not exactly the same, but are “very closely aligned, covering about 95% of the same area.”

Each cluster is administered by “a governing council, which consists of the CEOs of each of the health services and the PHN.” Beyond that, there is “a small secretariat for each cluster, who take responsibility for oversight and implementation of the strategic projects, and provide advice back to each governing council.” The cluster system was set up in mid-2020, though initially it was an opt-in program. The current format, with a secretariat and a more structured format, was only created towards the end of 2020. However, it is “an opportunity to work together and provides opportunities for consistency of models of care, systems and process across health services.” Some of the other opportunities and benefits include the ability to see “who’s performing best in which areas and how we can collectively lift our performance, and a chance to examine health equity and outcomes across the cluster catchments.” It is also about “efficiency gains in economies of scale,” and maybe even an opportunity to “advocate for system level reform, and to put those reform ideas before government.”

“We want to get to a point that how people experience the public health system shouldn’t depend on where they live. We’re very keen to make sure that regardless of where you are located or whether or not you are on a waiting list, you should get the same standard of care.”

Paul Butler, Executive Director, South East Metro Cluster (Victoria)

Another positive impact of the cluster system is that historically, health services “have actually been quite competitive, and perhaps that’s not always been to the benefit of our communities and patients.” Having three health services – as is the case in the south east – all working together makes for greater collaboration, but at the same time, “they are all actually quite different.” Peninsula Health for instance, unlike the other two within the south each cluster, was set up to be “more of a community-based health service.” This translates into “different priorities, and there are strategic direction challenges between the health services, which means they come at issues from opposing angles.” In truth, the formalised structure has only been operational for half a year, so “we’re not quite talking the same language yet, and the health services are not necessarily accustomed to collaboration, but we’re getting there.” Moreover, the Victorian Department of Health has been and continues to be very helpful and is likely to provide further “clarity and direction in the very near future.”

Positive Early Wins

The clusters were set up for collaboration, but even before they were formalised, during the second wave of the pandemic, “health services were tasked with managing outbreaks in residential aged care facilities.” A coordinating committee was set up to “facilitate better coordination, planning and responses between health services and the private hospitals.” Much like the cluster system, in the south east, the committee consisted of the CEOs of the health services and the private hospitals. The committee met daily “to understand the outbreaks in the age care facilities, and the operational demand, which allowed the sharing of workforces and resources where possible.” Whilst many private hospitals were “doing less elective surgery during this period and some of their staff were furloughed, this allowed them to be deployed elsewhere to help us manage residential age care outbreaks.”

Then late in 2020, the state government “announced an allocation $200 million over the current and next financial year for public health services to conduct additional elective surgeries in an attempt to address the deferred care as a result of COVID-19.” There are long waitlists, and previously the government would have discussed with each service how they would have used the money. The south east cluster took a “whole-of-cluster approach on how the funding should be allocated, to prioritise deferred care and long waitlists.” Health services with a higher proportion of longer waitlists were given more funding, with arrangements in place for them to refer cases to other health services within the cluster, should that be necessary. “That’s a very different approach to what would have been taken if we didn’t have a cluster system.”

Future Directions

The cluster system was set up during a crisis but is continuing because it has already proven to be successful.

As such, there are plans for future collaborations and ideas. For instance, it is not uncommon for patients – sometimes at the urging of their doctors – to sign up to waitlists at multiple hospitals, especially for outpatient procedures.

“A study is currently underway to scope out the prevalence of this issue,” but either way, “there’s opportunities there for working together to make sure that there aren’t duplications,” particularly because duplications actually increase waitlists and “the overall wait times for patients.”

Some of the solutions might be “the sharing of waitlists across health services within the cluster, use of digital tools and the standardising of GP referral systems and processes.”

The south each cluster is also exploring “how we can better deliver acute care in a home setting.” All of these plans and collaborations are ultimately designed to ensure “we can collectively improve the opportunities for all of our patients.”

Paul Butler, Executive Director, South East Metro Cluster (Victoria)