NSLHD Year in Review 2020

NSLHD Year in Review 2020

A YEAR IN REVIEW

2020

NSLHD COVID-19 RESPONSE PAGE 4

STAFF DEPLOYMENT PAGE 39

2020 NSW HEALTH AWARDS PAGE 6

YEAR OF THE NURSE AND MIDWIFE PAGE 10

message FROM the Chief executive

bushfires or any other number of challenges that we face each and every day in our hospitals, community health centres or the community; teamwork. We are extremely privileged to have such committed clinicians who really are leading the way in their discipline. Their advice and support made such an incredible difference and informed the critical decisions that had to be made. Our Clinical Advisory Group, a team of some of our most dedicated and brilliant clinicians from across disciplines worked hand in hand with members of the executive. They are a large part of why our district has been as prepared and managed so well during the pandemic. I would like to thank them all for their time, expertise and support. Our nurses were quite remarkable at taking charge of any space and turning it into a testing clinic, with patient feedback incredibly positive. Our public health unit with its contact tracing efforts and monitoring positive patients – again, teamwork was central to that. There were those who donned a pink vest and helped to form the COVID Care team. This initiative from People and Culture was integral in helping to maintain the wellbeing of all of our staff, including those on the frontline, during a time of great stress and uncertainty. But then there is the rest of the teamwho played a huge role in helping us get to the stage we are now in and that’s our community. I would like to thank you all for doing what was asked of you; we asked you to get tested and you did, we asked you to wear a mask and you did, we asked you to stay 1.5 metres apart and you did that too – we even asked you to respect limits when visiting loved ones in hospital and you did that too. You even went so far as to send our staff food, and children made our staff thank you cards and drawings. On behalf of all of us here at Northern Sydney Local Health District, thank you to all of you who stepped up and played your part in overcoming the challenge that has been 2020. Here’s to 2021 and another year of challenges and triumphs. Until then, stay well and have a wonderful holiday season.

This year, 2020, was a year which held so much promise. It was the first year of a new decade and the year of the Nurse and the Midwife. However in the blink of an eye, 2020 quickly became the year of devastating bushfires and of course COVID-19. It has certainly been a year like no other, especially in healthcare, not just within our district or state or even country, but across the entire world. This year has pushed many of us to our limits professionally and personally too, and while this year might have felt like challenge after challenge, there have been a number of celebrations and triumphs too. While our events like the Innovation Program and Quality and Improvement Awards might have looked a little different, it focused on the same calibre of excellent work being produced. Our district was acknowledged for this work when it won two NSWHealth Awards in the Patient Safety First and Excellence in the Provision of Mental Health Services category, as well as being a finalist in the Transforming Patient Experience category. Speaking of tremendous achievements, back in January, our district united to help our friends and colleagues in Murrumbidgee and Southern NSW local health districts as they battled some of the worst bushfires this state has ever seen. We had staff from across a broad range of disciplines; mental health, nursing, allied health – selflessly put themselves forward and I had personal feedback from both Murrumbidgee and Southern NSW LHDs chief executives about the incredible role they played and how they immersed themselves in the community when they were in dire need. I think those first months set the tone for what was to come. After the fires settled, the COVID-19 virus started to impact us and cause huge disruption to life as we know it. At the very outset of this pandemic, our clinicians were at the forefront of decision-making and advice to care for community. They demonstrated the incredible values of healthcare workers - dedication, care, and professionalism. I could not have been prouder of the resilience they showed and continue to show in our response. One of the first communities in our country to be affected was Ryde. The situation that faced us at Ryde Hospital was a difficult one, and I commend our staff for the incredible work they did to keep others safe and most of all the unwavering care and committment. That’s where the key lies to overcoming challenges – whether it’s COVID or

Deb Willcox, Chief Executive Northern Sydney Local Health District

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message FROM the board chair

In what has been a challenging year for everyone, but especially our health system, there have been some remarkable feats of achievements within our District. We should all feel incredibly proud of our doctors, nurses, allied health workers, engineers and support staff who showed what can be achieved when working together under difficult circumstances. If this year has proven anything, it is that our district has such a resilient workforce that can endure any challenge thrown at it. From the outset of the COVID-19 pandemic, the leadership shown by the Chief Executive, Deb Willcox, the district and hospital executive teams and senior clinicians across the district has been superior. The board would like to extend its gratitude to all staff in how they came together and were able to prepare our hospitals and services for an anticipated surge in COVID patients. The district showed leadership in working with community and partner organisations, including the Northern Sydney Primary Health Network, to support aged care facilities in our district in the event of a COVID-19 outbreak. We have established a strike force response to provide a 24/7 immediate response to the 112 aged care facilities in or local health district; and we are working with GPs and aged care providers to ensure they are kept informed of the latest advice in relation to COVID-19. Importantly, throughout this pandemic, we have kept business as usual and one of our achievements has been the release of the Diversity, Inclusion and Belonging Strategy. The strategy contains the voice of our staff and offers a wonderful opportunity for us to show our community, and employees, that we are prioritising diversity and inclusion in our organisation. The benefits of diversity and inclusion are multiple for our organisation. Diversity brings new perspectives and with new perspectives come the opportunity for better problem solving and increased productivity. We made several partnerships while developing the Diversity, Inclusion and Belonging Strategy for guidance and support, including the Male Champions of Change. I am proud to be the district’s Male Champions of Change and help to drive our mission to achieve gender equality, advance more and diverse women into leadership and build safe, respectful and inclusive environments for all.

Another investment in our staff which continues to grow is the Leadership and Talent Program, identifying and investing in our leaders. Our staff are our most valuable asset and by investing in their talent and supporting future leaders, as an organisation we are laying the foundations for the district’s future. This year we also began a project the board is very excited about, planetary health. This recognises the inextricable link between the health of our planet and the health of our population, with a focus on the importance of climate change and environmental sustainability. The district continues to strengthen its research capabilities with the release of the Kolling Institute’s Research Strategy . This outlines the areas of excellence the Kolling wants to prioritise, positioning the institute as a centre of translational research excellence improving patient care. The strategy will improve research outcomes by harnessing the strengths and expertise of the district and The University of Sydney. The board is incredibly pleased the district has unveiled plans for the Northern Sydney Health, Education and Research Precinct Plan for Royal North Shore Hospital. By forming a precinct it will enable the hospital and the district to be more competitive for research and grant funding, attract leading researchers and create strong academic linkages with universities and create employment opportunities that will benefit our Northern Sydney communities and patients. On behalf of the board, we look forward to seeing the progress of some of these great initiatives in 2021. We would like to thank all our staff, volunteers, researchers, and everyone associated with Northern Sydney Local Health District. You should be so proud of what you have achieved this year during such challenging times.

Trevor Danos AM, Chair Northern Sydney Local Health District Board

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Ryde Hospital staff with a simple message for the community

NSLHD responds to COVID-19

From building wards in under a week to training new nurses in intensive care, Northern Sydney Local Health District used all available resources to prepare for COVID-19 at the outset of the pandemic.

One of the very first actions it took was to set up an executive level incident management team which met daily to ensure the hospitals and services were appropriately resourced. The dedicated district team comprised of clinical advisors from respiratory, intensive care, emergency, infectious diseases and surgery, as well as district directors. Chief Executive Deb Willcox said the team would continue to come together throughout the pandemic to undertake planning for additional beds, equipment and resourcing as well as provide advice on personal protective equipment (PPE) and best clinical practice. “Together we are working on our district-wide response and preparedness, with special focus on emergency care, respiratory medicine, infectious diseases, and

possible place to care for patients with COVID-19.” More negative pressure single rooms have been created, meaning more infectious patients will be able to isolate to protect staff and patients. Many nurses underwent training to be upskilled in intensive care, under the supervision of ICU nurses and doctors. At Hornsby Ku-ring-gai Hospital, the emergency department was split into hot and cold zones to reduce the potential spread of COVID, with hot for patients suspected of COVID-19 while other patients could continue to be treated. More clinicians and health services turned to telehealth with many patients able to receive treatment or follow up consultations over the phone or video calls.

critical care. We are so extremely fortunate to have such high calibre clinical staff, who are true leaders in their disciplines and always have our patients and staff at the centre of their advice,” she said. At the onset of the pandemic, staff worked tirelessly in preparing for an anticipated surge of patients. Intensive care units (ICUs) doubled their capacity and teams of experts established a high dependency unit (HDU) at Royal North Shore Hospital in under a week – something that would normally take years to do. “The speed in which our staff have been able to achieve some of this is remarkable,” Deb said. “Everyone is working together, no matter what speciality they come from, to ensure we are in the best

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COVID-19 teams on the ground

As part of NSLHD’s response to the rapidly evolving COVID-19 situation, a dedicated COVID-19 care team and front door team, tasked with taking temperatures and conducting health checks, have been deployed to work across the district to support staff.

and the front line against COVID-19, but they aren’t daunted by the responsibility in front of them. As well as taking temperatures and conducting health checks, the team relays updated health guidelines to those entering our hospitals. The team of 40 staff at Royal North Shore Hospital alone has been essential in keeping staff, patients and visitors safe. But behind the masks are smiles from across hospitals and professions ranging from registered nurses, enrolled nurses, assistants in nursing and administration officers. Since early March, staff like Registered Nurse Samantha Johnson have been present at major entry points of Royal North Shore from 5am to 11pm, seven days a week.

Donning pink vests, the COVID-19 care team offers workforce support and advice to all staff and managers, as well as check in on staff members’ wellbeing. The team also helps source relevant information for staff, feedback any concerns to the district executive and follows up on any questions if they can’t immediately answer. Director People and Culture Paula Williscroft said: “We have a wonderful 10,000-strong team of experienced, caring and professional health workers. “I am very proud of our staff who remain absolutely focused on the delivery of health care to our patients and community during the COVID-19 situation.” The front door team are the first people visitors see when they walk into hospitals across the district

“Being at the hospital you can always be pulled into different roles,” she said. “COVID-19 expanded quite quickly so it was just a matter of jumping in and helping out. It’s protecting the hospitals, the community and the patients.” For Assistant in Nursing Danielle Sanz, she saw it as a chance not just to keep everyone safe, “With everyone, we have a smile on our face and we greet them happily and positively which hopefully has a domino effect on their day,” she said. Danielle said the team took pride in offering guidance in a period of constant change. but also impart some much needed positivity given the unfolding situation.

COVID care team

RN Samantha Johnson, Benji Rengasamy and Danielle Sanz

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District does the double at NSW Health Awards Northern Sydney Local Health District had twice the cause for celebration after claiming two NSW Health Awards.

“It has been a goal of the unit for a number of years to manage behavioural disturbance in a least restrictive and trauma informed manner and reduce the use of seclusion and restraint. “The feedback from people who have been admitted to the unit, when they recover, and their families has been really positive and our overall rates of acute behavioural disturbance, including injury rates to people in the unit and staff, have reduced as well.” Royal North Shore Hospital Intensive Care Staff Specialist Dr Jonathan Gatward said he was thrilled the team got to take home the award, along with its Australian Council on Healthcare Standards and Quality and Improvement awards. “It means a great deal to us to win this award,” he said. “We are so proud of this project for three reasons. Firstly, the reduction in arterial blood gases has been sustained over three years - we have not seen a slide back to our old ways of over-ordering.

The mental health intensive care unit (MHICU) at Hornsby Ku-ring- gai Hospital claimed the Excellence in the Provision of Mental Health Services Award with its project ‘Reducing Time in Seclusion in the Mental Health Intensive Care Unit’. Royal North Shore Hospital’s intensive care unit won the Patient Safety First award with the project ‘Reducing Inappropriate Arterial Blood Gas Testing in a 58-bed Quarternary ICU’. MHICU Nurse Unit Manager James Wall said the fact the competition was of such a high calibre made it all the sweeter to win. “The other nominees had terrific projects; we were just happy to be nominated in the end but it was a nice surprise to win,” he said. He paid tribute to his staff and the support the team received as part of their project, which has greatly benefitted consumers and staff alike. “It’s really rewarding for the team to see their hard work pay off,” James said.

“Second, the project was a huge team effort and shows what can be achieved by a group of clinicians who are motivated to make things better. “Thirdly, this project is about empowerment - trusting nurses and junior doctors to use their clinical judgement and common sense to make better choices around test ordering.” Both Jonathan and James said it all starts with an idea and encouraged others to turn their thoughts into action. “If you’re driven to make a change, you should go for it, no matter how small the project,” James said. Northern Sydney was lucky enough to have three finalists in the NSW Health Awards, but unfortunately Mona Vale Hospital’s Patient Led Handover Project fell just short. Chief Executive Deb Willcox said she was proud of the teams involved and looked forward to seeing the projects continue to improve the lives of patients and consumers into the future.

The winning team from RNSH

Hornsby Hospital’s award winner

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Wellbeing forum a huge success Junior medical officers (JMOs) and senior executive staff from across the district came together in January for the inaugural JMOWellbeing Forum. The evening, which was hosted and facilitated by Julie McCrossin AM, was attended by more than 50 JMOs as a range of topics were explored. Staff were encouraged to share their thoughts on what more can be done at the local level to support junior medical staff, as well as addressing aspects of wellness.

CONNECTING PATIENTS TO LOVED ONES DURING COVID-19

Left to right: Emily Gregg, Dr Josh Pillemer and Social Worker Emily Mahony

It has been one of the hardest aspects of being in hospital during COVID-19; but thanks to an initiative at Royal North Shore Hospital, patients and loved ones will no longer have to go without seeing each other.

when restrictions are relaxed again, I can see this providing a lasting benefit for all.” He said the flow-on effects from the project would greatly benefit other areas of healthcare and enable families to play a key role in their loved one’s recovery. “Having this technology available gives us the flexibility to expand the involvement of the patient in their own care through access to telemedicine services, inclusion in multidisciplinary family conferences which can include family from around the world, and provision of face-to-face language translation services,” he said. “Well beyond COVID-19,

patients in ICU without adding the extra challenge of removing the vital support that comes from visits from their loved ones” he said. “In the past, patients had been haphazardly using their own devices for video calls – but this was not possible for many, given it required patients to have their own equipment and the faculties to use it.” Josh said the isolation of being in ICU was particularly noticeable for those who were transferred to Royal North Shore Hospital far away from their homes. “As a NSW trauma centre, as well as a state-wide burns and spinal cord injury service, we receive patients from all across NSW,” he said. “Being able to facilitate communication with loved ones who are hours away is a tremendous service that helps patients, their families and the health service. Even

The hospital’s intensive care unit (ICU) has installed webcams on existing bedside computers and trained nursing and social work staff in the use of videoconferencing software to ensure patients, including those with COVID-19, remain connected to the outside world. Staff will operate the computer with patients to ensure they are able to call and see their loved ones without being restricted by their injuries or clinical requirements. ICU Staff Specialist Dr Josh Pillemer said the catalyst for the project was some of the restrictions on patient visitation. The project is intended to reduce the isolating effect of these restrictions, especially given the prospect of further restrictions in the event that COVID-19 becomes a larger problem. “It is hard enough for our unwell

this project has great potential to improve the way we care for our patients.”

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It was a Saturday afternoon and Beda Andrews was enjoying her day off from Hornsby Ku-ring-gai Hospital’s emergency department when the Nurse Unit Manager received a phone call to say there was an incident at work. Hornsby team reflects on overcoming COVID-19 emergency

She immediately returned to work, where she joined Acting Director of ED, Dr Andrew (Andy) Brown, and together the pair swung into action to face one of the department’s toughest challenges. The incident was a staff member diagnosed with COVID-19 and the pair’s immediate priority was the welfare of their colleagues. They needed to quickly identify staff who had been in contact with the affected team member and have them isolate at home. Immediately the ED lost about 18 staff working that day as they quarantined at home. Andy and Beda then needed to find staff to cover their shifts. What followed over the course of the next 24-48 hours was hundreds of phone calls to affected staff, welfare checks and working with their ED colleagues to ensure the department continued to run smoothly and be able to care for patients. They also needed to identify patients who had been in contact with the COVID-19 positive staff member and assist the NSLHD Public Health Unit to start contact tracing. “It was a race against time because our priority was the welfare of our staff. We wanted to tell them first-hand about what had happened before it was made public,” Beda said. “I remember calling staff to tell them (they needed to isolate) and there was a lot of shock.” Setting up an incident control centre away from the main ED floor, the pair worked the phones while they were supported on the floor

Left to right: ED staff Beda Andrews, Carolyn Opie and Dr Andrew Brown

by Clinical Nurse Manager Tristan Miller and Dr Stephen Kearney who managed the department. Dr Felicia Kwok began to oversee the rostering logistics, ED Clerical Supervisor Justine McMahon supported the team, while COVID-19 After Hours Nurse Manager Carolyn Opie and After Hours hospital executive Adrienne Stern assisted the ED in the crucial first few hours. “My focus had always been on responding to a patient who had COVID-19 and the influx of patients so it was a lot of a shock when it was a colleague,’’ Beda said. “But it was so good to see all of our disaster training come into effect and the whole team just pulled together.” What was unsurprising to Andy and Beda was the overwhelming support from their fellow ED colleagues, other hospital and district staff throwing their hands up to help. Doctors and nurses volunteered to perform double shifts, nurses moved to 12 hour shifts, colleagues from other departments came to work in ED and colleagues from other hospitals in the district, including

Mona Vale, Royal North Shore and the Northern Beaches, volunteered to help man the department to cover staffing shortfalls. “We are like one big family and everyone just pulled together,” Andy said. “Everyone was doing it tough in different ways. We had those who were working really hard and worried about the quarantined staff and those at home self-isolating concerned about their colleagues who were working. “Initially we needed to work out what was needed for the first 48 hours and then the next two weeks. Because of the unpredictability of COVID, we didn’t know howmany staff would have to isolate. We lost an entirety of three shifts of staff. A third of the medical wworkforce and about 40 per cent of the nursing staff.” Immediate quarantining, use of personal protective equipment (PPE) and following strict hand hygiene and social distancing protocols were effective in managing the spread of COVID-19 in ED.

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Mona Vale nursing award winners

It is one of the most special days on the calendar in healthcare, but this year’s International Nurses Day took on even more meaning as 2020 is the International Year of the Nurse and Midwife. Paying tribute to our Nurses

of dedication, leadership, and commitment,” she said. “As our proud history has shown, and is manifested daily in our work, nurses continue to show compassion, innovation, creativity, resilience and integrity. “These are extraordinary times, but as always NSLHD nurses, standing firmly on the shoulders of our historical giants, hold firm to the values of our profession and confidently meet the challenges set before us. “NSLHD nurses proudly champion

While the obvious challenges of COVID-19 made this year a little different, nurses across Northern Sydney Local Health District came within 1.5 metres of each other to celebrate. Acting District Director of Nursing and Midwifery Jenny Neilsen paid tribute to the nurses who make such a positive difference to lives on a daily basis. “During the COVID-19 pandemic we have again seen the best of nursing in the daily displays

best practice and quality safe care, and rightly take their place in nursing history.” NSLHD Chief Executive and former ICU nurse Deb Willcox echoed Jenny’s sentiments. challenging, but I want to say a huge thank you to all of you for your hard work and dedication to our patients,” Deb said. “There’s no secret this year has been

Hornsby Nurse of the Year Ashleigh Threw

RNSH New Graduate of the Year Isobel Fraser

Celebrations at Ryde Hospital

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Celebrating our magnificent midwives

Cake, keep cups and confectionery were just some of the ways our wonderful midwives across the district celebrated International Day of the Midwife on May 5. The day recognises the incredible contribution that midwives make to the lives of millions of women and their families around the world. At Royal North Shore, staff were treated to a stunning cake which was baked and decorated by Laura Dangerfield, Divisional Nurse Manager of Women’s and Children’s Family Health. Chief Executive Deb Willcox and Acting Director of Nursing and Midwifery for the district Jenny Neilsen were also on hand, distributing keep cups to staff as a small token of thanks for their hard work.

Some of the midwifery and women’s health team at RNSH with CE Deb Willcox

“With more than 4200 babies delivered in our district hospitals each year our midwives have impacted the lives of literally thousands of women and their families every woman will remember that moment at one of the most important and special times in their life.” Jenny said despite current events, she hoped staff still took the time to acknowledge each other’s hard work.

“Even though our celebrations will be different this year, I hope you are able to take some time to reflect on the value you as midwives have in women’s lives, especially during these uncertain and difficult times,” she said. “Your advocacy and adaptability in ensuring that women have continuing access to care is to be commended.”

“I would like to thank each and every midwife working in our district clinics, community and hospitals,” Deb said.

CE Deb Willcox with midwife

Midwives at RNSH

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Some of Ryde’s patient story takers

IMPROVING RYDE PATIENTS’ EXPERIENCE ONE STORY AT A TIME Collecting patient and carer stories from the bedside is Ryde Hospital’s latest initiative to improve its patients’ experience.

“The most powerful thing about the initiative is finding out what we can improve on from the patient’s perspective – and it won’t necessarily be the things that we thought we needed to improve on.” In the longer term, Sophie hopes the story taking will become part of Ryde’s culture. “Eventually we hope all our consumers’ stories will be heard and their feedback incorporated into the way they are cared for and for future patients,” she said. Once enough stories are recorded, the teamwill collaborate with clinical governance and the quality team to identify trends and theme the stories.

Earlier this year the nursing team at Ryde, led by Deputy Director of Nursing Sophie Lange, set themselves a challenge: how could they use their consumers to educate staff and improve their practice. “It’s a really difficult thing to do,” Sophie said. “We thought if we could give our consumers an opportunity to tell us their experience while they’re in our care, we could capture that and use it to improve our performance – and that’s when we came up with CAPE.”

The new ‘capturing the patient experience’ initiative, also known as CAPE, involves staff undergoing story taking training so they can sit down with patients and collect direct feedback on their care. So far 14 nursing staff and one allied health worker have been trained to collect stories, and Sophie said after the first month the group had collected 26 stories between them. “CAPE will initially focus on gathering the stories of various cultural groups and falls patients to gather feedback – positive or constructive – and change practices as required,” she said.

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rnsh COVID-19 Research

For many people with COVID-19, the first sign they had the virus was a loss in their sense of smell. Now a team from the Kolling Institute and Royal North Shore Hospital is investigating the correlation between the virus and early symptoms.

Associate Professor Clifton-Bligh, Head of Endocrinology at RNSH

The study involves researchers from Australia and India, and will investigate whether existing blood pressure medications can reduce the risk of severe disease as well as the duration of severe symptoms. Professor Carol Pollock, who will lead the trial at RNSH, said the CLARITY study is investigating whether a class of drugs called angiotensin receptor blockers can improve outcomes for patients. “We’ll also be looking at whether these medications can protect patients against lung injury from COVID-19, a common outcome for those with severe symptoms,” she said. “These existing blood pressure medications have already shown to reduce inflammation and we’re hopeful they’ll reduce the risk of severe COVID disease and guide future treatment advice.” Blood pressure medications have been used widely in the treatment of various chronic diseases for more than 30 years and are affordable and easy to access. The trial has received $1.4 million from the Federal Government’s Medical Research Future Fund.

Associate Professor Meg Jardine and Professor Carol Pollock

The study, led by Associate Professor Rory Clifton-Bligh, is just one of many being conducted as part of the Northern Sydney Local Health District COVID-19 research group. All major specialist disciplines are represented in the group, taking advantage of the breadth of knowledge across the health campus. Rory said a loss of smell had emerged as a common symptom of COVID-19 infection, but the current >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44

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