Transforming

complex health care

Effective 01/2016 Review date: 12/2016

Transforming Complex Health Care RBWH Model of Service Delivery
Introduction
World-class patient care
Royal Brisbane and Women’s Hospital (RBWH) is a 1002-bed quaternary and tertiary referral teaching hospital located
at the Herston site within Metro North Hospital and Health Service, close to the Brisbane CBD. It is a key provider of
health care services for Queensland Health. It provides high-quality care over a comprehensive range of specialties,
including medicine, surgery, orthopaedics, obstetrics, gynaecology, neonatal intensive care, and trauma services. It is
the largest tertiary referral hospital in Queensland providing state-of-the-art medical care to more than one tenth of all
patient services for Queensland, as well as serving patients from northern New South Wales and the Pacific Rim. It also
supports its regional partners via Telehealth and outreach.

Research driven
RBWH hosts an annual healthcare symposium which showcases the hospital’s research strengths and attracts
worldrenowned speakers. In many medical, allied health and nursing areas it is a leader, successfully bridging
innovative science with state-of-the-art clinical medicine.
The Centre for the Advancement of Clinical Research promotes innovative clinical research within the hospital to assist
current and future researchers participating in research programs and providing links between researchers and funding
opportunities, such as RBWH Foundation. The centre is complementary to, and liaises closely with RBWH Foundation, whose
key role is to raise funds for research and manage any grants placed through the Foundation.
The hospital fulfills a significant teaching and research role with links to universities from the Group of Eight, a coalition of
Australia’s leading universities and Universitas 21 which is an international network of 21 leading research-intensive
universities in thirteen countries.

Teaching emphasis
RBWH collaborates with world-leading tertiary institutions and has been committed to training and mentoring the next
generation of leaders in innovative health care, providing a wealth of opportunities for physicians, nurses, and allied
health professionals. These talented men and women, in turn, lend fresh and innovative perspectives on treating and
caring for patients.

Safety and quality focus

RBWH is committed to delivering world-class health care through continuous quality improvement aimed at enhancing
patient-focused services and achieving national and international best practice and standards of care. This key focus is
achieved through:
• collaboration with consumer groups, government departments, health care providers, clinicians, accreditation bodies,
health professionals, education providers and others
• a combination of individual excellence and well-designed systems and processes
• data collection and analysis, review of health care processes and redesigning systems to improve efficiency and mitigate and
manage risks.

Reaching out to the community

The work of RBWH has always been guided by the needs of patients and their carers. The hospital has strong links with its
local communities and takes every opportunity to build, improve and sustain health care delivery and maintain or increase
the health and wellbeing of those who live and work in these communities.
This document aims to provide both information and guidance to our staff, consumers, carers and families, other health
facilities, our partners and the community, about how we function at RBWH. This document will be reviewed annually
and provided as part of the orientation process for new staff.

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Model of Service Delivery
The purpose of the Model of Service Delivery is to provide guidelines for practice and service provision, within the context
of a new, innovative and evolving service.

In July 2012 Queensland implemented the National Health Reforms and as part of these reforms RBWH defined its Vision
and Mission to provide clear direction for its service delivery model.

Vision
To be a world-class academic, tertiary and quaternary health centre taking care of our community.
RBWH will provide peak services in tertiary and quaternary care and will ensure that all secondary and primary care is
provided close to the patients’ home/local catchment area, where ever possible.

Mission
Knowledge-led, world-class care, education, training and research.
‘Transforming Complex Health Care’
As an organisation, RBWH provides world-class specialised care. Additionally, we seek to lead the world in education,
training and research.

Key principles
To support RBWH’s Vision and Mission statements a number of underpinning principles where determined to focus RBWH’s
efforts to be a world class health care provider including:
1. Patient-centred care
2. Evidence-based practice
3. Education and training
4. Partnerships
5. Capable staff
6. Governance
7. Leadership
8. Efficiency.

1. Patient-centred care
We will provide, for an agreed group of patients; equitable, evidenced-based, timely, efficient, high quality care which
achieves clinical outcomes that meet both patient need and clinician satisfaction.

Patient and family-centred care places an emphasis on collaborating with patients and families and acknowledges that
families, however they are defined, are essential to patients’ health and well-being and are allies for quality and safety
within our healthcare system. At RBWH, we integrate the core concepts of patient and family-centred care in all
we do. For members of the health care team this is encapsulated through:
Equity—committed to providing equable access for all population groups to the health care that is available.
Dignity and respect—listen to and honour patient and family perspectives, , choices, knowledge, values, beliefs and
cultural backgrounds. Ensure the planning and delivery of care incorporates these patient and family contributions.
Information sharing—communicate and share unbiased information with patients and families in ways that are affirming
and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in
their care and decision-making regarding their care.
Participation—patients and families are encouraged and supported in participating in care and decision-making at the level
they choose.
Collaboration—patients, families, health care practitioners and hospital leaders collaborate in: policy and program
development; implementation and evaluation; health care facility design; and professional education, as well as in the
delivery of care.

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RBWH demonstrates patient-centred care through activities such as:
• the care planning process which enables patient and family participation in and encourages ownership of the
patient’s care
• the Patient Satisfaction Survey which provides useful information on the level of consumer satisfaction with the
range of services, and what they would like to change. This feedback informs what areas require
change/service improvement.

2. Evidence-based practice
We will provide innovative clinical and non-clinical services that use validated evidence.
Where it is lacking we create it, where it exists we test it.

Evidence-based practice is fundamental to the health care RBWH delivers and it

encourages all staff to have an evidence-based approach.
This approach and practice requires decisions about health care based on the
best available, current, valid and relevant evidence. These decisions should be
made by those receiving care, informed by the tacit and explicit knowledge of
those providing care, within the context of available resources.
Evidence-based practice can also be defined in population health terms, e.g. ’the conscientious, explicit and judicious
use of current best evidence in making decisions about the care of communities and populations in the domain of health
protection, disease prevention, health maintenance and improvement—health promotion.’
Evidence comes from a range of sources including scientific journals and other publications, population health statistics
and locally collected data. On occasions, evidence does not exist about certain aspects of health care provision and in these
situations RBWH encourages and supports a culture of world-class research to establish this evidence. RBWH demonstrates
its use of evidence-based practice in several ways including, but not limited to:
• the use of outcome measures, such as the Functional Independence Measure (FIM)
• trialing a Goal Attainment Scale (GAS) to evaluate rehabilitation engineering service provision
• Department of Intensive Care Medicine’s (DCIM) use of closed in-line suction to decrease ventilator
associated pneumonia.

3. Education and training

We will take responsibility in educating the next generation, ensure that teaching, learning, education and professional
development is a requisite for working at RBWH.
• As mentioned, RBWH collaborates with world-leading tertiary institutions and is committed to training and
mentoring the next generation of leaders and this is demonstrated in the following ways: combined birth
suite/birth centre morning hand over with neonatologists/obstetric team/midwives/anaesthetists including
students in all disciplines
• grand rounds with multidisciplinary participation including students
• multidisciplinary training for Internal Medicine called ‘Muppets’ and ‘DIMES’— Department of Internal
Medicine Education Sessions
• Medical Emergency Response Training (MERT) for all relevant staff
• nursing e-Leaning self-directed package—dysphagia screening.

4. Partnerships
We will identify principles of effective partnerships, align concepts with other key principles of RBWH, assign accountability
step by step, prioritise/establish who our partners are, and establish partners across the continuum of care.
Our work is guided by the needs of patients and their carers. RBWH has strong links with its local communities and
takes every opportunity to build, improve and sustain health care delivery and maintain and/or improve the health and
wellbeing of those who live and work in these communities.

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RBWH places great importance on its partnerships with other service providers in meeting our patients needs to access
services and to foster a greater community understanding of the role of RBWH as a member of the wider health care
system. Partnerships also provide opportunities for enhancing a shared understanding and staff development,
through knowledge and skills transfer across services and sectors. Examples through which RBWH applies the
partnership principle includes through:
• clinical networks e.g. the Central Area Cancer Network, Stroke Network and others
• our local indigenous groups and services, to provide cultural links and supports to indigenous consumers
• our connection with the university sector, which provide professional development opportunities for staff as well
as recruitment opportunities for RBWH
• our connection with a range of non-government organisations to provide services to patients and carers such as
Queensland Cancer Fund, Diabetes Australia, Motor Neurone Association of Queensland, Primary Health Networks
• research partnerships, which allows pooling of resources, shared information, and avoidance of redundancy
in research work.

5. Capable staff
We will establish a minimum set of standards for all staff and reward and recognise our staff where desired
behaviours/achievements are reached.

Services are provided through clinical, operational and administrative teams. Clinical and non-clinical staff engagement
occurs on a daily basis to support the provision of services that assist patients and their carers to receive the highest level of
care.
The application of this principle requires recruitment of qualified and skilled staff and ongoing skills development through
education and training activities and planned professional development. The organisation of time and resources to support
staff access to suitable education and training is a management priority.
Programs for reward and recognition of staff achievement are part of the RBWH ethos, e.g. annual QuARRIES (Quality
Awards Recognising Remarkable Initiatives and Excellence in Service) awards. RBWH demonstrates the application of
this principle in several ways including:
• use of Performance Appraisal and Development (PADs) Plans
• use of a recruitment and selection processes aimed at identifying competencies and staff skills
• coordinated mandatory training and updates for all staff e.g. fire training
• vocational training and placement, traineeships and clinical supervision
• provision of accessible clinical specialty education within the clinical areas
• reward and recognition programs
• access to a comprehensive range of professional development activities.

6. Governance
We will have an organizational structure that is clear and facilitates transparent lines of delegation and accountable
decision making.

Governance is aimed at achieving organisational goals and objectives and can be described as the set of responsibilities
and practices, policies and procedures used to provide strategic direction, ensure objectives are achieved, manage risks,
and use resources responsibly and with accountability.
The Queensland Health Governance Framework has been adopted by RBWH given the sound governance principles
underpinning this framework. RBWH has developed a governance framework reflecting the local application of these
principles. The framework summarises governance mechanisms and identifies the planning context for service lines and
executive sub-committees to plan for and engage in Metro North Hospital and Health Service and Queensland Health
governance activities as relevant to RBWH.

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7. Leadership
We will have clearly articulated leadership qualities so leaders can set directions and instigate change.
Leadership/performance will be assessed through the performance and development process.

RBWH supports and integrates the National Health Service Leadership Qualities Framework in its leadership roles
and programs.

NHS Leadership Qualities Framework

Setting
Broad
scanning Political
astuteness
Intellectual
flexibility

Seizing Drive for

the future results
Self belief
Self awareness
Self management
Drive for improvement
Leading change
Personal integrity Collaborative
through people working

Holding to
account Effective
and strategic
Empowering influencing
others

service

Through the Performance Appraisal and Development (PAD) process, RBWH encourages staff to identify the key personal
qualities required for leadership, such as:
• Self-belief
• drive for improvement
• self-awareness
• personal integrity
• self-management.

PADs also encourage staff to reflect on their personal qualities as a leader, and to implement practical strategies that will
facilitate improvement in their leadership capability within the workplace.

8. Efficiency
We will have clear performance KPI’s with a governance and reporting framework to support their achievement.

Planning at the strategic and operational level is essential to generate and guide the management of available resources,
establish performance measures and integrate outcomes across the broad spectrum of services provided. In making budget
decisions it is important to be mindful of managing funds efficiently and effectively to ensure the delivery of outputs
equates to value for money. Operational plans articulate an agreed base level of performance to be achieved by RBWH and
its service lines.

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The targets within these agreements are based on Metro North Hospital and Health Service’s (MNHHS) service level
agreement with the Department of Health (DOH).
These three year service level agreements are aimed at ensuring the delivery of, or substantial progress towards, the key
shared objectives of sustainability, financial viability, improved access and quality of service provision. Key performance
indicator (KPIs) targets within the MNHHS/DOH service level agreement are cascaded down to service lines and
individuals through service line operational plans and individual performance appraisal and development (PADs) Pplans.
There are a number of reporting mechanisms for ensuring progress towards the achievement of targets set in
operational plans including:
 fortnightly executive meetings
 monthly RBWH service line engagement meetings with RBWH ED
 monthly RBWH performance meetings with MNHHS executive.
Performance monitoring increases the likelihood of agreed plans being followed and of appropriate variations to plans being
identified and discussed in a timely manner with stakeholders. It is also important in identifying when activities are not
delivering expected outcomes and thereby supports timely reconsideration and review of plans and targets to achieve
appropriate outcomes.
Applying the governance framework means there is a consistent set of KPIs across the organization and an agreed
approach for monitoring performance and ensuring accountability.
RBWH governance structure ensures transparent and clear pathways to communicate, document, report and monitor
achievements against KPIs as articulated in organisational operational plans. Additionally, As a consequence of a robust
governance framework, RBWH staff have clear expectations, accountabilities and understanding of the consequences for
meeting or not meeting agreed performance as per operational plans.

RBWH’s model of service delivery—Transforming complex health care—also provides a consistent approach for contributing to and
aligning with MNHHS’s Putting people first Strategy and its three key dimensions of:

 OUR PATIENTS: to partner with our patients to provide high quality health care
 OUR PEOPLE: to enable, support and professionally develop our people
 OUR PARTNERS: to engage with our partners to improve the patient experience.

RBWH’s model of service delivery provides a foundation pathway for patient centered care that aims not only to enhance a patient’s
experience but also to enhance a staff’s personal and job satisfaction.

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