2. The Australian Landscape
• The Productivity Commission Report; Caring for Older
Australians, August 2011 notes;
– Ageing of the Australian population—by 2023, 20% of the population will be
over 65 years of age
– Preference for independent living arrangements and choice
– Increase in morbidity among aged and management of chronic conditions
(diabetes, dementia, arthritis, visual and hearing impairments)
– Reduced access to carers and family support
– High and unmet demand for limited number of community care packages (of
services)
– Decline in demand for residential low care
– Restriction of high care residential places to ‘extra service’ places that attract
higher accommodation bonds
3. The Australian Landscape
ACAA 30th Annual Congress (November 2011)
• Productivity Commission Review and Reform
– The release of the aged care report from the Productivity Commission raises the
prospect of unprecedented reform of aged care. Will the Government take up this
challenge?
• Residential Care, Community Care and Retirement Living Interface
– As is the case in many overseas jurisdictions Australia is gradually seeing a coming
together of care and accommodation systems that had previously operated in silos.
Will this trend continue?
• Innovative Service Models
– Will tomorrow's consumer be happy to accept todays solutions? Will technology
change the face of care options? Will future consumers take much greater
management of their healthcare and health data?
• Community
– Australians are emphatic that they wish to stay in their own home and live
independently for the rest of their lives. Is this aspiration sustainable?
4. About Silver Chain Group
Our Purpose
To create, build and sustain
community capacity to optimise
health and wellbeing for
individuals in their homes and
communities
Statistics 2010:2011
Hours of care: 1,619,124
Clients assisted: 62,337
Clients visited per day: 4,943
Occasions of service: 2,271,426
Klms travelled : 20,797,206
Staff (Volunteers): 3,380 (411)
Revenue $193 million
5. Silver Chain major programs
• Health Care
– Home Hospital, Hospital in the Home Program, Post-Acute
Care, Community Nursing
– Diabetes, wound and continence management and advice clinics
– In-home palliative care
– Remote nursing
• Community Care
– Home and Community Care (HACC) - personal care, domestic
assistance, social support, respite
– Community Aged Care Packages / EACH Packages
– Independence Programs: Home Independence Program, Personal
Enablement Program, Social Enablement
– HACC Regional Assessment service – metro wide
• Commonwealth Respite and Carelink Centre
– Aged care information gateway and manage brokering of respite for carers
• Training and Education
7. Patients/
ComCare Client
Clients
Demographics, Alerts, Clie
nt History, Previous Patient
Diagnoses... Record
Record source of referral and
services requested
Referrals
Contract and Clinical
Eligibility Patient
Eligibility
Assign client to a Round
and Schedule
Schedule
Single/Group
Assessments using
“Questionnaires”; Care
Plans generated Assessments
and Care Plans
Equipment
Management
Service
Record of Delivery
services, consumables, etc..
.
Clinical Clinical
actions, indicators, diagno Record
sis...
Wound
Management
Discharge
8. Patients/ Commissioners/
ComCare Client
Clients Management
Demographics, Alerts, Clie
nt History, Previous Patient
Diagnoses... Record
Record source of referral and
services requested Contract
Referrals
Management
Contract and Clinical
Eligibility Patient Block
Eligibility Contracts/Fees for
Service
Assign client to a Round
and Schedule
Schedule
Single/Group
Assessments using
Care Packages
“Questionnaires”; Care
Plans generated Assessments
and Care Plans
Equipment
Management
Service and Clinical
Service Costs by Client and
Record of Delivery Groups
services, consumables, etc..
.
Clinical Clinical Reporting to
actions, indicators, diagno Record Funders
sis... Management
Reporting
Wound
Management
Discharge
Finance
System
9. Patients/
ComCare Modules and
Commissioners/ Care
Process Flows
ComCare Client
Clients Management Providers
Demographics, Alerts, Clie
nt History, Previous Patient Organisation(s), Position
Continuous
Diagnoses... Record Organisation s, postings and
Improvement
Chart employees...
Record source of referral and
services requested Contract Candidate
Referrals Record of employment
Management (recruitment)
Tracking applications...
Contract and Clinical Care Provider Employee details, service centre, hours of
Eligibility Patient Records work, classification, qualifications
Block
Eligibility Contracts/Fees for
Scheduled/
Service Messaging
Assign client to a Round Training completed, position/emplo
and Schedule yee...
Schedule
Rosters Assign Care Providers to Rosters; GeoCode
Single/Group
Assessments using using Google Mapping...
Care Packages
“Questionnaires”; Care
Plans generated Assessments
and Care Plans Occupational
Equipment Incident, accident
Safety & recording etc...
Management Process
Health
Mapping
Service and Clinical
Service Costs by Client and
Record of Delivery Groups Car Fleet
Vehicle
services, consumables, etc.. Allocations
allocation, Maintenance,
.
Accidents Mileage etc
Clinical Clinical Reporting to
actions, indicators, diagno Record Timesheets Automatic Completion using Mobile
Funders
sis... Management Technology and Google Maps
Reporting
Wound
Management Nursing Procedure manuals...
Manuals
Discharge
Finance
System Payroll System
10. The Mobile Application
• Large and mobile workforce – need to be able
to provide and capture up to date information 24/7
• Enables our nurses to be able to access information
about clients such as their
details, referrals, diagnosis, alerts, contacts and
services.
• Enables nurses to record in real time the clients
assessment details and information about wound care.
Clients Assessments Admission wizard
Contacts Clinical details Messages
Access comments Wound management Alerts
Service details Schedule/roster Maps and GPS tracking
Task details Timesheet OSH checklist
Client equipment Manuals (nursing & quality) Continuous Improvements
13. The Mobile Benefits
Clients Staff Organisation
Better care Greater safety Reduce overheads
Increased privacy Better information Improve unit costs
Reduced errors Feel connected Efficient processes
Less hospital visits Reduce travel time Increased productivity
Improved quality of Reduce paperwork Reduce travel time
life
Better information
14. The Business Cycle
DATA
ACTION INFORMATION
COMMUNICATION KNOWLEDGE
UNDERSTANDING
17. Mobile Timesheets
DATA
• Auto download of care workers
ACTION workload / timesheet
INFORMATION
• Updated daily for today and 4
days ahead
• Data recorded in real time and
submitted daily
• 600 mobile timesheet users
COMMUNICATION “Oh no something else I have to KNOWLEDGE
learn
and worried that it was going to that
will take up time…….
“But now yeah it great, its been very
easy to learn”
UNDERSTANDING
18. Mobile Timesheets
Total savings
Savings Project
(est.)*
Timesheets (TS) - messaging $60,000
TS - Carrier voice contract $180,000
TS - Calls to Customer Operations $620,000
TS - Remove paper system $500,000
TS – Total estimated savings per year $1,360,000
19. Wound Care
• 16,784 wounds total
DATA
• 2,456 active wounds
• 20,316 assessments
• 21,551 treatment plans
ACTION INFORMATION
• 14,469 treatments
• 353,071 dressings
• 5,943 Notes
COMMUNICATION KNOWLEDGE
“With the phone we can bring wound care
in real time with real data.”………
“We can now prove the worth of the work
our nurses have been doing for years.”
UNDERSTANDING
22. Travel Efficiencies
• A days nursing activity at a location after optimisation: 62 hours of travel reduced to 27
hours and 3708 kms reduced to 1620 kms
• A nursing round after sequencing: Saving = 1 hr 42 mins & 53 km
• Savings potential $6,000,000 per year
23. Route Optimisation and Visit Allocation (ROVA)
ROVA considers
Travel distance to first client.
Travel distance between clients.
Travel distance home from client
Time provider is early for a visit
Time provider is late for a visit
The preferred provider
Visits occurring outside of shift
Providers identified not suitable
The provider ideally suited
Uses genetic algorithms (mimics
natural evolution)
Potential savings ≈ $millions
27. KPI Reporting
• Directs peoples behaviour
• Makes performance visible and focuses attention
• Clarifies expectations and provides objectivity
• Improves execution and promotes consistency
• Country nursing unit cost fell by 40% in 3 months
• Central assessment recording saving $250,000 per year
• At one centre cost per 1 direct hr fell by 11% saving
$24,000 per month
29. Telehealth
Hospital admissions of Silver chain clients over 5 ½ yrs
67,674 individuals
286,185 admissions
Average LOS 7.6 days
Any one day Silver chain clients use 1,085 beds
51% had a diagnosis of chronic disease
Randomised control trial
120 chronic heart failure
80 chronic obstructive pulmonary disease
Findings
Per person cost savings = $2,931 per year
High level of Client satisfaction
Increased self confidence, control and awareness
Improved sense of security and reduced anxiety
