More than 9,200 miles away and 15 hours ahead of Chicago rests Sydney, Australia — the most populous city, with about 4.6 million people, in a country that pretty much comprises an entire continent.
Danny O'Connor serves as CEO of the Western Sydney Local Health District, a massive public hospital system with three acute-care hospitals, a mental health hospital and seven community health centers. Simply put, if anyone needs healthcare services on the west side of Sydney, WSLHD provides it.
The Australian and U.S. healthcare systems are not at all structured the same —Australia has a universal, publicly funded healthcare system, though individuals can buy private health insurance to cover out-of-pocket costs. About half of Australians have additional, private health coverage on top of public coverage. The hospitals are mostly government-owned (70 percent of all beds are in public hospitals), and they are reimbursed through state revenues and supplemental payments from its federal government. However, there are some similarities between the U.S. and Australia. For example, Australia runs its system through a program named Medicare, and the country still has an extensive network of private providers.
The most recent health data from the Organization for Economic Cooperation and Development dig deeper into the details of the healthcare systems in Australia and the U.S.: Australia spends 8.9 percent of its gross domestic product on healthcare, whereas that total is at almost 18 percent for the U.S. Per capita health spending in Australia is about $3,800, compared with $8,508 in the U.S. Life expectancy in Australia is among the highest in the world, at 82 years, roughly two years higher than the average of all OECD countries. For the U.S., life expectancy is around 78.7 years.
Other OECD statistics to chew on: The U.S. has 2.5 physicians per 1,000 people, below the OECD average, compared to 3.3 physicians per 1,000 people in Australia, above the average. Australia also generally has lower in-hospital fatality rates within 30 days of admission for heart attack and stroke compared with the U.S.
Despite all the disparate facts and figures, Mr. O'Connor says his system is focusing on many of the same initiatives as American hospitals: population health, health IT and managing chronic conditions through better public health efforts.
The Pacific Ocean may separate the two countries, but some issues in healthcare can be felt everywhere. Here, Mr. O'Connor corresponded to talk about what it's like to run a hospital district in Australia, how population health and technology are influencing his district's strategies and how the triple aim is embraced worldwide.
Question: How would you describe the Western Sydney Local Health District? How many hospitals/facilities do you oversee, and what are other major facts to know?
Danny O'Connor: The WSLHD was established in 2011 and provides district secondary, tertiary, statewide and quaternary public hospital services, as well as community health services to the residents of western Sydney. [We also care for] those referred from regional areas, as well as other local health districts and interstate.
Major WSLHD facilities include Auburn Hospital, Westmead Hospital, Blacktown Mount Druitt Hospital and Cumberland Mental Health Services. There are seven community health centers providing in-home services in community settings, such as schools and residential aged-care facilities.
The community we serve is culturally diverse, with nearly 50 percent of residents born overseas. We provide services to more than 11,000 people who identify as Aboriginal. Socioeconomic disadvantage is associated with poorer health and higher demands for care: 22.2 percent of WSLHD residents are in the two most disadvantaged deciles of the Socio-Economic Indexes for Areas and the Index for Disadvantage.
Additional population statistics: Our current population in WSLHD is 876,000. The district's growth in population from 2009 to 2013 was 7.8 percent. Between 2011 and 2021, the district's population is projected to increase by 2 percent per annum, or 163,000 people. This is nearly twice the rate for [our state of New South Wales]. In 2011, our Aboriginal population accounted for approximately 1.5 percent of the district's population. Forty-three percent of the district's residents were born overseas, 45 percent of local residents spoke a language other than English at home and 32 percent of local residents reported a family income of less than $1,000 per week.
Q: What does the Western Sydney Local Health District do to ensure quality healthcare and high patient satisfaction?
DO: At WSLHD, we are committed to providing high-quality healthcare through a range of initiatives. These include the New South Wales Patient Survey, which allows the district the opportunity to receive feedback from consumers to compare benchmarking and satisfaction results. The New South Wales Clinical Quality and Patient Safety Program led to the establishment of clinical governance units responsible for the implementation of quality and safety initiatives across local health districts.
These initiatives, including infection control measures and reducing medication errors, are designed to support clinicians and managers with improving quality and safety for patients and will focus on promoting and providing the delivery of the best care in health services. Key to the success of the program is the active involvement of doctors, nurses, allied health professionals, health managers and our community.
WSLHD promotes evidence-based practice, as well as programs for innovation and service redesign/development aimed at building capacity and enhancing an internal culture of engagement and teamwork. We are also committed to incorporating professional leadership roles in our district executive teams to promote evidence-based practice and clinical involvement in the delivery and planning of health services.
Q: What, if any, initiatives or programs does your hospital have in place to improve population health?
DO: Staff at WSLHD are committed to identifying opportunities to introduce community-based programs in order to work the public to tackle health challenges.
WSLHD offers the following initiatives and programs:
Immunization programs — childhood immunizations, such as school-based programs, including a flu vaccination program for staff and high-risk patients.
Communicable disease — a Mister Germ program for preschools focused on hand washing to reduce the spread of disease.
Tobacco control initiatives — smoke-free environments, including hospitals and health service groups; regulation of tobacco advertising; tobacco sales to minors compliance monitoring; support programs and cessation services for staff and clients who want to quit; local smoke-free social marketing campaigns supporting statewide campaigns.
Healthy weight — healthy children initiatives include the Healthy Eating and Physical Activity program for early childhood services and primary schools and the Family Health Lifestyle program for children aged 7 to 13 who are overweight/obese and their families…strategies targeting tertiary education settings, including active transport; replacement of water instead of sugary drinks and increasing healthy food choices.
Diabetes strategy — incorporating an identification program into the Healthy Workers Health Check aimed at high-risk members of the community [among other strategies].
Falls prevention — Stepping On program for people aged 65 or older [who] are at risk of falling or who have fallen; strategies to increase older people's participation in strength and balance services.
Q: How does your hospital balance financial needs versus public health/patient safety?
DO: Financial management is an extremely important consideration when working in the public health sector. As a demand-driven organization, it's critical that we consider the needs of the patient and community along with balancing the financial needs of the organization. With the implementation of a new activity-based funding model [Editor's note: Activity-based funding is a new way for Australian state governments to monitor, manage and administer the funding of healthcare provided by public hospitals], it is important the needs of the patient are not compromised. Any additional growth funding is allocated on a prioritized basis to provide the greatest benefit to public health.
Improving the health of the population and patient safety is a high priority. Developing flexible funding models are a key consideration when moving into integrated care partnership. We have a strong partnership and joint governance arrangements with our Medicare Local [a national, government-funded organization focused on primary care], which enables us to focus on ways to improve population health, child and family health, mental health, aged care, chronic disease management and Aboriginal health.
The increasing costs of new technology, along with limited financial resources, provide a constant challenge to us to make the right investment decision to meet patient needs. The [district] will continue to focus on reducing variation as a means to improve quality and cost control.
Q: How is the health district utilizing technology to accomplish its goals? For example, how, if at all, has your hospital employed telehealth?
DO: WSLHD adapted the bring-your-own-device program, which enables approved staff to access clinical applications for the management of patient care within our hospitals. The system is a way of accessing patient data via a Wi-Fi network that is compliant with local privacy laws and security policies.
The [BYOD] system is in addition to Wi-Fi networks that support computers on wheels, increased clinical documentation within electronic medical records and a replacement application for the emergency department information system.
Other initiatives include Eduroam, which allows users from universities with appropriate access to connect back to their university and its resources, which is beneficial to Blacktown and Westmead. [They] are major teaching hospitals in western Sydney.
The trial of an "appointment reminder" linked to our patient administration system has been set to assist in the scheduling of appointments. This acted as a reminder for patients attending clinics, with messages set to their fixed landlines or mobile phones, and allowed patients to respond if an appointment needed to be rescheduled. A queuing system is another initiative that allows us to monitor and change patient flow during visits in order to ensure patients can get to the pathology collector.
We are also now able to access the national health record, which allows patient information to be brought together across multiple locations, including across states. This is a significant improvement to removing boundaries of distance to improve patient care.
Q: Why do you think Australia's hospitals generally fare better, in terms of per capita costs and access, than U.S. hospitals?
DO: The systems are very comparable in terms of quality and access to high-level expertise and technology. We have much to learn from the USA, in particular the work coming from the Institute for Healthcare Improvement and some of the leading-edge work on reducing unwarranted clinical variation in several major health services in the USA.
Q: If you had one piece of advice to offer a U.S. hospital executive, what would it be?
DO: WSLHD staff are committed to improving our performance through a whole-of-hospital and whole-of-community approach to patient care.
Our focus on the Institute for Healthcare Improvement Triple Aim program — providing better care for individual patients — has been central to improving the health of the population and in reducing the per capita cost of healthcare. Working on all three of these areas simultaneously has been a positive way to focus attention the key areas that are essential to providing the best possible health services.
Health professionals are driven by a desire to do their very best for patients, to send a message of pride in teamwork, to set a clear direction of quality first (cost will follow) for the future, and to remember to celebrate success (big and small). Recognition and appreciation are rewarding for staff as well as motivating.
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