Executive summary

What we do

• During 2018 396,974 times people were treated and cared for in a country emergency department equivalent to 1,088 people a day
• 5,359 hospital stays in country hospitals for people with acute mental health, alcohol or drug conditions in 2018
• In 2018 129,049 hospital stays of which 29% were Aboriginal people
• 4,517 babies born in country hospitals in 2018
• 15,700+ patients seen in 2018 who were on the elective surgery waitlist
• We provided 77% of the public inpatient care and 72% of the public outpatient care required by country people
• 47,901 telehealth patient appointments and services in 2018* up 12%+ since 2017:
  • 2014 - 19,537
  • 2015 - 27,381
  • 2016 - 36,341
  • 2017 - 42,472
  • 2018 - 47,901

* including outpatient, emergency and mental health

Who we are

• 10,652 people employed by WACHS
• 96.4% of our staff work from country locations
• Staff gender profile - 18% males 82% females
• Women in executive and senior leadership positions - 55%
• 445 Aboriginal people employed
• 300 interns and recent graduates started with us
• Age profile:
  • 24 and under - 5%
  • 25-54 years - 64%
  • 55 and over - 31% 

Caring for our patients

WA Country Health Service at a glance

Our patients, their families and carers are at the centre of everything we do. The WA Country Health Service is the largest country health system in Australia; providing comprehensive health services to people living in country areas across Western Australia.

What we provide

Our services span across an area of more than 2.5 million square kilometres, from Kalumburu in the Kimberley to Albany in the Great Southern providing:

• Emergency and hospital services
• Population and public healthcare
• Aboriginal health services
• Mental health services
• Drug and alcohol services
• Child, community and school healthcare
• Emergency Telehealth Service
• Residential and community aged care services

From nursing posts and outreach services, to child health clinics and bustling regional hospitals, the WA Country Health Service plays an important role in the lives of people in our country communities. Across the state we have:

• 6 large regional hospitals
• 15 medium sized district hospitals
• 48 small hospitals
• 31 health centres and nursing posts
• 24 community-based mental health services
• 4 dedicated inpatient  mental health services
• 178 facilities where population health teams are based
• 600+ residential aged care beds

According to the latest available Australian Bureau of Statistics Estimated Resident Population (ERP) data (2017), the population of WA Country Health Service’s catchment area is 531,510 people. Almost 11 per cent of these people (57,716) identify as Aboriginal.

The population we service is diverse and expansive and as a result has widely varying health needs. People living in rural and remote areas experience poorer general health than those in metropolitan areas and Aboriginal health and life expectancy, in particular, is significantly lower than that of non-Aboriginal people.

Government funding and some industry investment over recent years has brought about a transformation of country healthcare through major and minor capital works. More towns now have contemporary infrastructure including expanded hospitals, greater emergency service capacity and modern facilities and equipment. Coupled with technological and service innovations such as Telehealth, the WA Country Health Service is now delivering health care closer to home for more country Western Australians than ever before.

Population of our catchment - 531,510 - 11% identify as Aboriginal.

Outstanding care every day

It’s our challenge and privilege to provide outstanding healthcare to the 530,000-plus people living in country WA, and to be the ones who regional communities trust to take care of them in times of ill health. WA Country Health Service employs more than 10,000 people working across more than 100 facilities, ranging from regional city hospitals to small health centres in some of WA’s most remote and sparsely populated towns.

In 2018-19, our teams across the state provided quality healthcare to almost 400,000 emergency patients, facilitated more than 129,000 hospital admissions and discharges and helped to deliver over 4,500 babies.

We know that providing the best possible health care doesn’t just impact on people’s day-to-day health. It also has a positive impact on the economic and social sustainability of our country communities.

Access to good quality healthcare can be a major factor affecting people’s decisions to live in regional WA. It can also mean the difference between life and death for tourists and travellers who run into trouble while taking in the sights and scenery of our magnificent state.

WA Country Health Service is the largest employer in most towns across regional WA and so we take seriously our responsibility to the communities of which we are a part.

Our commitment to providing the best possible healthcare can be seen in the significant achievements we are proud to acknowledge across our service in 2018-19.

129,049 hospital stays in 2018 

Our staff celebrated

Country nurses celebrated

At the WA Country Health Service we employ more than 4000 nurses and midwives, making up 42 per cent of our workforce. We know that we employ some of the brightest and the best, and the consistent recognition of our nursing teams and staff at a whole of state level is testament to the work that our nurses and midwives do caring for country communities every day.

Our remarkable teams were recognised at the 2019 WA Nursing and Midwifery Excellence Awards with 19 of the 38 finalists being from country communities. Country nurses and midwives took out eight of 12 category wins and Andrea Rieusset, Nurse Practitioner from Fitzroy Crossing Hospital, was named 2019 Nurse of the Year. It is the second year running that a WA Country Health Service nurse has scooped this prestigious award.

Andrea was celebrated for her determination to make a difference with vulnerable people in the Kimberley. She has worked since 2005 in emergency departments in Broome and across the Kimberley and is the clinical lead for the Kimberley Family and Domestic Violence working group. Andrea has worked tirelessly for women and children experiencing family and domestic violence in Kimberley communities, making a significant contribution to improving services and outcomes.

Our country nurses who were formally recognised:

• 2019 Nurse or Midwife of the Year and Excellence in Aboriginal Health category winner – Andrea Rieusset, Nurse Practitioner, Fitzroy Crossing
• Excellence in Person Centred Care – Team award – Bunbury Midwifery Group Practice
• Graduate of the Year – Elizabeth Churchill, Registered Nurse, Denmark Hospital
• Excellence in Enrolled Nursing – Patricia Tolland, Advanced Skilled Enrolled Nurse, Exmouth Hospital
• Excellence in Midwifery – Kathryn Brown, Clinical Nurse Manager, Maternity, Kalgoorlie Health Campus
• Excellence in Rural and Remote Health – Gloria Masekane, Clinical Nurse Manager, Mount Magnet Nursing Post
• Excellence in Primary, Public, Community and Residential Care – Di Smith, Nurse Manager, Northampton Hospital
• Excellence in Leadership – Nathalie Pass, Director of Nursing, Health Service Manager, WACHS Midwest

We were also very proud to cheer on Lorraine McGowan, a Midwife at the Hedland Health Campus, who was recognised as the only Western Australian finalist at the national 2019 HESTA Nursing and Midwifery Awards. A finalist for the Midwife of the Year Category, Lorraine was recognised for her sincere dedication to empowering country women during their pregnancy and birth, ensuring they are supported with adequate information so that they can make informed choices about their health care.

Video - Meet all of our Finalists at the 2019 WA Nursing and Midwifery Excellence Award (YouTube) 

Country doctors awards

Each year the Western Australian country health community comes together to celebrate the outstanding contributions made by clinicians working to serve rural communities. Together with Rural Health West, the WA Country Doctors’ Awards are presented annually in six categories, along with awards to recognise and thank those who have worked in regional WA for 20, 30 or 40 years.

WA Country Health Service is incredibly proud of all our doctors and their daily commitment to making a difference, sometimes in challenging circumstances and so we are proud to celebrate those of our doctors who were formally acknowledged at the 2019 WA Country Doctors’ Awards:

Director of Psychiatry for Adult and Older Mental Health, Dr Roland Main was named Metropolitan-based Specialist Bush Champion of the Year for his tireless work in championing improved access to mental health services for rural residents. Dr Main has worked in country mental health since 1992 and provides clinical leadership for the delivery of all public, adult mental health services across regional WA.

Dr Kelly Ridley was named the most outstanding junior doctor, receiving the Rising Star Award for her early-career achievements. Dr Ridley completed much of her junior medical career at Albany Health Campus, working as an intern, resident medical officer, basic trainee in psychiatry and senior registrar in addiction psychiatry.

Karratha paediatrician Dr Anand Deshmukh was named Specialist of the Year for providing clinics in the Pilbara communities of Karratha, Roebourne, Pannawonnica and Onslow, as well as responding to all paediatric emergency cases. In addition to his clinical excellence, Dr Deshmukh is widely respected for his dedication to providing his community with kind and compassionate paediatric care..

Public health physician Dr Clare Huppatz won the category of Medical Leadership, recognised for her passion for driving change and results to create better health outcomes for Goldfields communities. Dr Huppatz was an integral member of the award-winning WA trachoma program which is working to eradicate an infectious eye disease that can lead to blindness.

[Images (PDF only): Dr Roland Main; Dr Kelly Ridley; Dr Anand Deshmukh; Dr Clare Huppatz] 

Improving the health of Aboriginal people

Around 21 per cent of the Western Australian population (531,510 people) reside within regional Western Australia. Of this number, almost 11 per cent (57,716 people) identify as Aboriginal people, compared with just two per cent of the metropolitan population. The proportion of Aboriginal people in the population varies immensely between regions, from three per cent in the South West to almost 50 per cent in the Kimberley. As Aboriginal people are significantly represented in our country communities, the WA Country Health Service strives to ensure that ‘Aboriginal health is everybody’s business’.

Throughout the course of 2018-19, in consultation with our staff and stakeholders including Aboriginal communities and Aboriginal community controlled health organisations, we have developed an Aboriginal Health Strategy which outlines our commitment to driving improvements in health outcomes for country Aboriginal people in WA. The strategy includes our vision to improve health outcomes by providing culturally safe and secure services that are accessible, high-quality and evidence-based. It highlights culture as a key determinant of Aboriginal health and wellbeing, the importance of working collaboratively with key Aboriginal health stakeholders, strengthening our Aboriginal workforce and the cultural competency of WA Country Health Service staff.

Having to stay in the metropolitan area for treatment can be difficult for our country Aboriginal patients. Often people have to travel long distances and are separated from family and support networks for extended periods. In 2018-19 we planned for the successful transition of the Elizabeth Hansen Autumn Centre to the WA Country Health Service, which took place on 1 July 2019. The facility is a 32 bed residential hostel accommodating Aboriginal people who require specialist medical treatment and their carers, from remote and regional communities. Going forward, we will investigate options to ensure regional Aboriginal people access culturally safe accommodation when they are required to attend Perth for their health care needs. This initiative will include exploring the potential to partner with Aboriginal community controlled health organisations and Not-For-Profit sectors to ensure services such as the Elizabeth Hansen Autumn Centre are community led, culturally safe and remain viable into the long term.

Coming to Perth for treatment can often be a distressing and disorienting time for Aboriginal patients. We continue to operate the expanded Country Health Connection Meet and Greet service. The service was enhanced in 2018 and now operates from 6.00am to 10.00pm Monday to Friday and as required on the weekends. This provides eligible Aboriginal patients who travel to Perth for treatment with a friendly face to greet them and ensure they arrive safely at their destination, which may include medical appointments.

[Image (PDF only): Aboriginal Health Officer Leeann Pederson showcasing the shopping bag she painted to promote eating healthy fresh fruit and vegetables as part of the Midwest region’s healthy lifestyle education that uses art activities to encourage participation.] 

Improving the health of Aboriginal people - Part 2

Nationally, Aboriginal and Torres Strait Islander people over the age of 40 have rates of vision loss three times that of non-Aboriginal and Torres Strait Islander Australians. Rates of blindness are six times higher among Aboriginal and Torres Strait Islander adults. Many causes of vision loss are avoidable, such as trachoma, a contagious bacterial eye infection that can lead to visual impairment and blindness. In 2018, the WA Country Health Service, in partnership with the Department of Health, identified 40 communities in country WA as being at risk of trachoma. All of these communities received trachoma screening and health promotion activities to help communities prevent and treat the infection.

The target group for screening are 5-9 year olds. In 2018, 93 per cent of the children in the communities were screened. The overall prevalence rate of active trachoma in screened children was 4.6 per cent, an increase of 0.5 per cent from 2017. Although this was a slight increase, the number of communities requiring treatment has reduced. The screening program continues to make inroads in reducing the threat of trachoma and the children in 34 communities will be screened in 2019.

Health promotion is a key component of the WA Trachoma Control Program and is delivered by way of the Squeaky Clean Kids program which is now embedded in the four WA Country Health Service regions where the disease is prevalent (Goldfields, Kimberley, Midwest and Pilbara). The program aims to reduce trachoma by overcoming barriers to good hygiene in remote communities, such as the cost of soap, by providing free soap to households and community facilities to promote the concept and practices of the ‘Clean Faces’ program.

A Hip Hop video ‘Mount Magnet Trachoma Free Scene’ was written and filmed with school children from Mount Magnet. This was released in October 2018 in recognition of Mount Magnet being trachoma free. The video promotes key messages around trachoma control such as Clean Faces, Strong Eyes. The free soap provided as part of the Squeaky Clean Kids program is also promoted.

Video - Mount Magnet Trachoma Free Scene

Our values in action

Kimberley team leading the way with interpreting service

For many Aboriginal people, going to hospital can be a difficult and unsettling experience, particularly those for which English is not their first language. Across the Kimberley region there are almost 200 remote Aboriginal communities, and more than 30 Aboriginal language groups.

There are multiple Aboriginal languages, Aboriginal English and dialects spoken, and for many Aboriginal people English is their second, third or fourth language.

The WA Country Health Service, in collaboration with Aboriginal Interpreting WA, is leading the way with a program to provide increased interpreting services in some Kimberley hospitals. The pilot, which has now been extended, enables Aboriginal interpreters to be on standby to support Aboriginal people in need of medical attention and their families.

Prior to the pilot program, the provision of interpreting services for Aboriginal patients was arranged as required, but this could sometimes take time for an interpreter to be sourced and arrive on site. The new program enables culturally appropriate onsite interpreting services in hospitals across Broome, Derby, Fitzroy Crossing, Halls Creek and Kununurra and assists clinicians to engage with interpreters to create an environment where Aboriginal people feel heard and understood.

Interpreters work alongside medical, nursing and support staff in various departments based on patient needs. They assist in relaying clinical information such as diagnosis, medication, discharge and patient transfer; assist in family meetings and provide general information.

At the end of the initial pilot program, the team evaluated the success of the program and found the use of interpreters had increased. From 1 July 2018 to 31 March 2019, interpreters were used on 2,906 occasions, interpreting more than 19 Aboriginal languages. Importantly, the program has been an excellent contributor to the broader Kimberley team’s understanding of language requirements for Aboriginal people and continued our ongoing journey in improving the cultural security of people using our services.

Video - WACHS is leading the way with a unique interpreting service

[Image (PDF only): Mary-Anne Yanawana talking with her clinician Melanie Marley, with the help of interpreter Ainsley O’Connor.]

Healthy art

In recent years, as part of the $1.5 billion infrastructure investment program underway across more than 80 WA Country Health Service capital projects, the organisation has made a commitment to consider the natural environment and cultural life of the local community in our public art process. From Kununnura in the north to Esperance in the south, the public art program has delivered extraordinary results, with local stories and imagery now woven into all new and refurbished health facilities.

During the project design phases the WA Country Health Service capital works teams have utilised the Western Australia State Government Percent for Art Scheme to connect with local community members, promote consumer engagement and input to achieve functional health facility design outcomes. Small workshops were held to create conducive environments for local artists to produce art concepts to be later integrated into the design and wayfinding strategies.

At Canarvon Health Campus, for example, local artists came together to create a striking entrance artwork called ‘The River,’ depicting the longest river in WA and telling a story of local history, desert ecology, pastoralism and marine life. As people move into the facility they pass artwork designed to engage local people to identify local paddocks and sheds, find hidden birds and animals and consider what painted symbols represent such as lightening, water and bush medicine.

In Kalgoorlie, artist Tony Pankiw worked in close consultation with health representatives and community to create his Spinifex collection for the campus’ redevelopment. Spinifex is a grass that is abundant throughout the region. This central theme is boldly displayed in the external artworks and perforated screens across the front of the facility creating an enclosed courtyard. Scenes and images of mining, pastoralism, streetscapes and nature have been used to inform the design.

[Images (PDF only): Kalgoorlie Health Campus, Carnarvon Health Campus]

Yuwa - Art for Wellness, Welcome and Wayfinding

Everyone who arrives through the front doors of the newly redeveloped Esperance or Kalgoorlie Health Campuses notices the bright and bold entry statements that provide welcome to all. Vinyl floor designs, which flow throughout the facilities, have been created from the motifs and imagery from locally commissioned artworks and included a number of local Aboriginal artists. The project aims to welcome Aboriginal people and help them feel that they are respected, safe and welcome.

In consultation during the redevelopment of both campuses, community reference groups noted the fear that Aboriginal patients often felt when attending hospital facilities, and that their visits were often associated with the sickness or the death of a loved one and that it was made more difficult when English was a second, third, or even fourth language. The consultation process resulted in many ideas for how to make health facilities more welcoming for Aboriginal people, a theme emerging across WA Country Health Service sites. The inclusion of local stories through the use of art in wayfinding was decided upon as one strategy to building a more culturally secure and welcoming environment.

In Kalgoorlie, seven local artists were selected to paint a collection of works that promote the health campus as a place of wellness, health and safety, a place where all are welcome. The vinyl floor designs are supported by displaying the original paintings in public areas, along with their stories. The region is also using the artwork in pamphlets and other forms of media, and incorporating the designs into staff uniforms.

At the renal dialysis unit, where patients can spend hours at a time receiving their treatment, local artist Buodoon Edie Ulrich’s painting ‘Springtime in the Bush’ has been incorporated into colourful, backlit ceiling panels. Staff are reporting that patients are now less likely to leave without receiving treatment or before they are discharged and that people feel more welcome, less afraid, and more supported in their treatment.

"This is my home that I see around me and it makes my heart feel good."
- Kalgoorlie renal dialysis patient

[Image (PDF only): Springtime in the Bush, by artist Edie Ulrich in the Kalgoorlie Renal Dialysis Unit.]

Buodoon Edie Ulrich: Buodoon Edie is a celebrated artist, linguist, teacher and children’s book author who specialises in art that depicts her family in the bush collecting bush foods and celebrating colours of the wildflowers. Edie is a Tjupan woman who runs bush tours as a respected elder, and recently presented to UNESCO in Paris for the 2019 Year of Indigenous Language to highlight the importance of preserving traditional Aboriginal languages in Australia.

"Staff are reporting that people feel more welcome, less afraid, and more supported in their treatment."

Improving the health of Aboriginal people

We know that health outcomes are better for patients who feel culturally safe in healthcare services. People are more likely to access the services they need if they feel welcome and safe to do so. Across our services we continue to make improvements in the cultural security of the services we provide and the cultural competency of our workforce.

In 2019 the world celebrates the United Nations Educational, Scientific and Cultural Organisation (UNESCO) International Year of Indigenous Languages.

In 2016 the United Nations Permanent Forum on Indigenous Issues reported that 40 per cent of the estimated 6,700 languages spoken around the world are in danger of disappearing, with the majority of these being indigenous languages. Similar to the way we use Aboriginal art in wayfinding to help people feel welcome in our services, the use of local language can be a powerful message of inclusion.

At Broome Health Campus the central courtyard has been revitalised to improve cultural security for Aboriginal patients, their families and carers. The courtyard is themed to represent the five language families from across the Kimberley and features five circular seating areas with a smoking pit for ceremonies. The entrance of the hospital now also includes an acknowledgement of country in both English and Yawuru, as well as an exit message with the phrase “our lives matter, get treatment, stay well.” in both Yawuru and English.

The courtyard is part of the Lighthouse Hospital project, a joint initiative between the Heart Foundation and the Australian Healthcare and Hospitals Association. The project is working to drive change for Aboriginal patients in the acute care setting with a hope to promote and improve health outcomes particularly relating to coronary heart disease.

"Narli nunyja yagarrjinngany, Walmajalanji, Ngani jan-gabardu"
Our lives matter, get treatment, stay well

In the South West all staff have learnt a Noongar ‘word a month,’ building to a sentence that says "Hello, I am happy to see you. Later". Each month the word, its pronunciation and meaning are displayed on all personal computer screensavers, and the initiative is discussed at team meetings and the regional executive.

"Kaya, Ngany djoorabiny noonook djinang... Boorda"
Hello, I am happy to see you. Later

[Image (PDF only): Midwest Regional Aboriginal Health Consultant Rani Randall with a Badimaya body chart which will be displayed at all of our health sites on Badimaya country. Rani is working to distribute other language posters, which she has sourced with the help from the Irra Wangga Language Centre, throughout health sites in the Midwest region.]

[Image (PDF only): Broome courtyard smoking ceremony]

Mentally healthy country communities

In country WA, to the availability of primary health and specialist services often leads to people accessing services later in the development of mental health disorders, resulting in later diagnosis, intervention and increased likelihood of physical co-morbidities.

The WA Country Health Service continues to focus on improving access to high quality, culturally secure and integrated mental health and substance use services for country people. We do this in partnership with the Mental Health Commission, the WA Primary Health Alliance and other government and non-government agencies.

This year we have commenced development of a mental health and wellbeing strategy to set out the future direction to drive reform through the delivery of contemporary mental health and substance use disorder services across country WA. Our mental health team has also commenced a program of service review and reform.

Across the state we are investing in improved access and facilities for mental health consumers. On top of existing funding, this year the State Government provided an additional $1.4 million and committed an additional $2.4 million per annum to expand our existing inpatient mental health service capacity in the Goldfields. The funding will pay for more mental health staff including doctors, nurses and allied health professionals to work towards improving mental health inpatient treatment and care for people in the Goldfields region.

Country patients face significant challenges in accessing appropriate and timely support to manage acute mental health, alcohol and drug conditions, particularly after hours. The Sustainable Health Review Panel recommended an immediate action to implement a pilot of the Emergency Telehealth Service model in at least one other specialty in the country and metropolitan area.

Specialist mental health was proposed as the initial specialty to trial due to increasing mental health service demand and unmet need.

Throughout 2018-19 the organisation worked towards the establishment of a Mental Health Emergency Telehealth Service to provide 24/7 access to specialist mental health nurses and psychiatrists to support patients presenting with acute mental health, drug and alcohol conditions. In July 2019, the Mental Health Emergency Telehealth Service commenced providing 24/7 access to specialist support to 80 WA Country Health Service sites.

Within the first weeks of service, approximately 75 per cent of the patients seen were able to remain at site with the provision of mental health specialist care provided remotely.

"Across the state we are investing in improved access and facilities for mental health consumers"

Around half of these patients were from Aboriginal communities and were provided culturally appropriate mental health care, highlighting the ability of the Mental Health Emergency Telehealth Service to reduce inequities in the provision of mental health services to vulnerable communities. Service demand is already rapidly increasing as this service gains momentum.

In order to facilitate the timely transfer of mental health patients requiring tertiary level care and to reduce at times the poor outcomes as a consequence of these delays. In 2018-19 we have worked with metropolitan hospitals to develop an agreement on the process for transferring mental health patients from a country emergency department to emergency departments at metropolitan hospitals. This happens at times where all alternatives to definitive and safe mental health care in the region have been exhausted.

Our Statewide Specialist Aboriginal Mental Health program continues to provide culturally secure services to Aboriginal people. Additional staffing in this area, including a new senior leadership position means that Aboriginal people will be significantly represented now comprising 10 per cent of our overall mental health workforce.

[Image (PDF only): Katie Papertalk, Aboriginal Mental Health Coordinator for the Pilbara.]

Our staff celebrated

Midwest drug and alcohol workers recognised at national awards

Two members of the WA Country Health Service’s Midwest Community Alcohol and Drug Service team were recognised at the 2018 National Indigenous Drug and Alcohol Conference with Tracey Saylor and Annette Pepper both receiving awards recognising their contribution to their community.

Ms Saylor was awarded the Remote Worker award in recognition of the important commitment and contribution she has made to reducing the harmful effects of drug and alcohol use among Aboriginal and Torres Strait Islander people in the Midwest over the last five years. Ms Saylor has been working in the drug and alcohol field for the past 28 years and for the last five years has been based in Meekatharra making a positive impact in the community as a qualified counsellor, Minister and diversion worker.

Tracey’s colleague Annette Pepper won the Coralie Ober Honour Roll award for her outstanding contribution to reducing harm associated with alcohol and other drug use among Aboriginal and Torres Strait Islander peoples.

The award recognises Annette’s exceptional effort over the past 16 years providing counselling for the Geraldton community. Her community work has included developing and coordinating programs for women in prison and running programs for the homeless and disadvantaged.

"I love what I do," Ms Pepper said. "I was stunned to be awarded; I would never have dreamed I would win something like that for the nation."

"Building relationships and trust with my clients and the community is so important," Ms Saylor said. "I believe in second chances and I will never give up on someone. Keeping young fellas out of prison and educating them – that’s my calling. I’m passionate about what I do."

"I was stunned to be awarded; I would never have dreamed I would win something like that for the nation."
- Annette Pepper

[Image (PDF only): Annette Pepper and Tracey Saylor from the Midwest Community Alcohol and Drug Service team.]

Engaging with our consumers

Actively involving patients, their families and carers in the planning and delivery of their care, ensuring our services are respectful of, and responsive to, their needs and values is at the core of the care we strive to achieve for all country Western Australians.

As well as involving consumers in the design of new and improved services, we are continually developing new and improved ways for consumers and carers to have input into improvements. Capturing, reviewing and responding to consumer feedback helps us to continually improve.

Throughout 2018-19 we have continued to improve the ways we listen to people about how they have experienced our services. We hear from people in a range of different ways, be that informally via social media or through more formal mechanisms such as our district health advisory councils, community engagement forums, or through our complaints mechanisms and Patient Opinion.

In the South West region an innovative café-style forum has been very successful in 2018-19 in increasing consumer involvement in health decision-making. An informal café-style approach was suggested by the participants of the Partnering with Consumers workshop in May 2017 and hosting consumer engagement cafés became a key priority for the region this year. The
concept was originally trialed in Busselton in September 2017, and was followed this year by Manjimup, Margaret River, Collie, Augusta, Bridgetown and a follow-up session in Busselton, meeting a commitment made at the trial café.

Participants representing all members of the community, including Aboriginal and other cultural groups, were encouraged to attend and feedback from those who attended has indicated that they found the informal style made it easier for them to give feedback about services because the smaller groups promoted discussion and encouraged their input. The region was commended for
its consumer engagement strategies in a recent accreditation survey and continues to roll out its unique engagement cafés across towns in the region with a move towards focused conversations relating to specific services and opportunities to move to a co-design model of working with consumers and communities.

"We are always happy to hear about the experience of our patients, their families and carers."

[Image (PDF only): Kerry Winsor, Regional Director South West, joins the conversation over a cuppa at the Bridgetown Consumer Engagement Café.]

Patient Opinion is an independent web-based consumer feedback platform that allows the people who use our services, their families and carers to comment on their experiences. The platform allows people to communicate with health services quickly, via their phone or other electronic device, and provides a channel for us to keep in touch with people regarding the outcome of their feedback and what action we have taken.

The site is independently moderated and is intended to supplement and enhance existing feedback and complaints systems by providing a more informal and real-time avenue for consumers to be heard. The platform has steadily gained momentum with consumers sharing their stories via the website regularly across the state. District health advisory councils continue to help promote the feedback platform in the community and to encourage people to share their stories.

Consistent with our annual patient survey results, the majority of stories shared on Patient Opinion have been complimentary of our dedicated and caring staff. These stories are shared with the relevant staff and teams to highlight and celebrate their achievements, recognise and reinforce positive behaviours, and increase staff engagement. This contributes to building a strong, positive and person-centred service culture, which in turn, provides for positive and caring experiences for the people who use our services. 

Over the course of 2018-19, we received 550 stories, an 80 per cent increase on the previous year, and as of 30 June 2019 those stories have been viewed on Patient Opinion 116,572 times. These posts generate a process of feedback to staff and review of systems to help improve day to day care. They also allow us to acknowledge staff that have been commended for their care and dedication. Positive or complimentary stories made up 66 per cent of the stories added this year. A number of these stories have also led to the implementation of a material change in the way we provide our service. Feedback and responses are openly logged for everyone to view, including our Executive and Board members.

The platform continues to be strongly supported by the district health advisory councils and Health Consumers Council WA, and the site is monitored by both local health service staff, as well as local district health advisory council members and our Board and Executive receive regular reporting on our performance. In 2018-19 approximately 96 per cent of story authors who chose to indicate whether the response they received was helpful, agreed with that statement.

View website - patientopinion.org.au

Watch video - It takes a team: Geraldton Health Campus

550 - Number of stories received during 2018-19, an 80 per cent increase on the previous year.

Our family would like to thank and acknowledge all the wonderful staff at Northam Hospital for the special care they have given to our Mum over the last five weeks. Nothing has been too much trouble and, although Mum could be difficult, you all showed compassion and kindness during a very difficult transition in her life. You are all amazing.
 - A Northam family

A short while ago, I was faced with the possibility of losing the better part of my leg. I went to the Donnybrook Hospital and from the way I was treated from the very start, I knew things were going to turn out for the better. The nursing staff who treated me proved to be top of their game, and I was quickly diagnosed and effectively treated. They were kind people who made me feel welcome and comfortable. It was very reassuring and I believe that helped in the process of healing. It’s no exaggeration to say that they saved my leg, and for that I will always be grateful.
- Donnybrook Hospital patient

I turned up at Bunbury Hospital for my first ever day surgery. The nurses, anesthesiologists and doctors were fantastic with me. Made me feel relaxed and all were happy to help in any way they could. All so supportive. Excellent and professional people.
- Signed, ‘Smiley’

I went into labour recently and my baby was born a day later at Esperance Hospital. From the moment I went into labour until returning home 5 days later, I had the most incredible care from my midwives and the doctors.
Many people were involved in the labour and delivery and throughout I felt I was in the best hands and that my baby and I were their number one priority.
The care following the delivery was also outstanding and I cannot thank everyone enough. The Esperance Hospital should be very lucky to have such incredible staff and should be given the credit they deserve.
- A new Mum in Esperance

We have been using the Patient Assisted Travel Scheme (PATS) for many years now in accessing the health care needed to maintain our child’s health.
The customer service via the team in the Kalgoorlie PATS Office is exceptional. I am always given information accurate to my needs, we feel welcome and comfortable in the space and the staff are fantastic at reassuring us everything is taken care of. Keep up the great work - your smiling faces make tough days better.
- Kalgoorlie Parent

I broke my wrist in Coral Bay and was attended to at the nurses station, assessed by the Emergency Telehealth Service and then we drove to Carnarvon Hospital. We were attended to promptly but being evening we had to stay in town and the staff assisted us with finding accommodation at short notice. I returned the following day for x-ray and was greeted again by my doctor who very proficiently set my wrist so that I could travel back to Melbourne. I was very impressed with the overall treatment and professionalism. I wouldn’t recommend a broken wrist on holiday, but it was fantastic that this service was available.
- A traveler to Coral Bay

116,572 - Number of times stories on Patient Opinion have been viewed (as of 30 June 2019)

We strive to provide the highest quality of health care to our patients, their carers and loved ones. However, we acknowledge there are times we may unintentionally fall short of delivering the standard of care that we aspire to. Not all of the feedback we receive is complimentary. By listening to and reflecting upon the feedback of our consumers we work to improve the services we deliver. Platforms like Patient Opinion are vital in helping us hear more feedback from the people we serve.

"There are several issues I would like to feed back relating to my experience with the patient care I received at the Perth Orthopaedic Clinic and Telehealth follow-up consult in my region."
- Anonymous

What we heard

"I was discharged after my second knee operation and returned to my home town in country WA with discharge advice to attend via Telehealth in two weeks for review.

"There was a lack of communication between Telehealth in Perth and regional services, as no contact was made to confirm a follow up appointment booking.

"I contacted the service to confirm my appointment and was told no appointment had been made.

"After following up with the Perth telehealth team the next available appointment was not for several weeks – totalling
6 weeks post-operation before my knee was reviewed."

What we did

In a joint working group our regional telehealth team worked with the metropolitan hospital to look at the communication process across the whole pathway for this patient and other country patients with a similar journey.

"Thank you Anonymous, for providing feedback to WA Country Health Service on your experience of the delayed Telehealth appointment on site after your second operation in the city. That is frustrating and concerning to hear that you had to follow up about your own Telehealth appointment. Your care was poorly coordinated after you were discharged and I apologise to you.

"The coordination of your care between the Metro Hospital and Regional Telehealth has been discussed at a joint meeting between our two services to help identify where issues arose and where improvements can be made. As a result of your feedback there are new changes that are being made to processes for Telehealth appointments.

"We are already working on improvements to the technical systems that support telehealth appointment bookings so that this process is more integrated across the health sites involved. We have also identified new communication strategies that will be implemented so that urgent appointments are scheduled more effectively and to ensure that other requirements for the appointment (such as x-rays and other investigations) are completed when needed. A key part of this is to make sure that patients are kept informed during the process if there are issues with scheduling appointments.

"We are passionate about country consumers receiving seamless follow up care in their region, especially after care is provided in the city. It is clear your experience was not good and I’m sorry that this occurred. Thank you again for providing this feedback, and allowing us the opportunity to improve our services for future patients."

[Image (PDF only): Kerry Winsor, Regional Director South West, joins the conversation over a cuppa at the Bridgetown Consumer Engagement Café.]

Our staff celebrated

Customer service excellence a Pinnacle in the Midwest

WA Country Health Service Midwest has again been recognised for their commitment to consumer engagement, taking out the inaugural ‘Patient Opinion Award’ at the Health Consumer Excellence Awards as part of Patient Experience Week.

The region was also recognised with two other accolades this year, with Geraldton Health Campus again acknowledged by the Australian Patients Association as the most outstanding regional hospital in Australia and also winning the Customer Service Excellence award category at the Australian Institute of Management WA Pinnacle Awards.

In a tough year, where the facility faced unprecedented demand for services, the Midwest team’s commitment to providing safe, high quality care remained unwavering. The Midwest was one of the first regions to ‘go live’ with Patient Opinion and the team has taken full advantage of the insights and feedback the application provides to ensure that patient feedback is utilised.

"We recognise there’s no ‘one size fits all’ approach to consumer engagement which is what led us to develop new and innovative approaches to improve engagement and communication between the WA Country Health Service and country communities,” said Jeffrey Calver, Regional Director WA Country Health Service Midwest. “Linking web based platforms like Patient Opinion and Facebook has allowed us to obtain real-time feedback about consumer experiences enabling us to identify and drive service improvement and reform."

Each category winner at the AIM Awards was awarded leadership and management training to the value of $20,000 to donate to a charity of their choice. Project lead Michelle Young said that she had asked for the award prize to be donated to the Leukaemia Foundation. It’s a charity that is close to her heart, as her nephew passed away from Leukaemia in 2013 at the age of 15. The Leukaemia Foundation is dedicated to helping those with leukaemia, lymphoma, myeloma and related blood disorders survive and live a better quality of life.

"We want to build deeper and more personalised connections, actively work with the public and empower local communities to have a greater say in their health care."
- Jeffrey Calver, Regional Director

Read more - Find out more about what is happening in the Midwest

[Image (PDF only): Michele Young, Project Lead Midwest and Elyshia Lanza-Cariccio, Project Support Officer]

Leading innovation and technology

High-speed internet, mobile connectivity, and telehealth are transforming the way that we deliver care in many parts of country WA, and this is only the beginning. By effectively harnessing technology, research, and the innovation capacity of our workforce we are working to create more connected regional and remote communities and ensure that all Western Australians, irrespective of location, have reliable access to the same quality of care.

We are working hard to explore ways to partner more broadly and effectively to achieve better health outcomes, wider choice for consumers, and more focused and efficient services. Rapidly changing technology has created new opportunities to drastically improve health care, particularly in country WA where vast distances, smaller populations and diverse community needs create unique challenges for health care provision.

Travelling long distances for health care can be a difficult and sometimes traumatic experience. We are committed to making patient transport a seamless, supported experience for all country patients and we are working with our partners to develop better ways of coordinating patient movements and supporting the entire patient journey.

This year we have commenced planning for a key step forward in this journey – the WA Country Health Service Command Centre, a 24/7 one-stop shop for our country doctors and nurses to access an expanded range of clinical expertise via virtual technologies. Through the centre we will expand the range of timely specialist advice and support available to front-line clinicians caring for country patients. The Command Centre will deliver a digitally enabled, flexible and dedicated specialist clinical workforce available to every WA Country Health Service facility in real time supporting local clinicians with information to better inform decisions, and better coordinate patient care. We will work to continuously improve service access and coordination to deliver care closer to home.

Also in 2018-19 we have further developed our innovation and development function to connect people and ideas across our organisation and beyond. Historically, our approach to innovation and research has been largely opportunistic and now we hope to build on that by targeting new research opportunities.

We already have in place a research and ethics governance function with an independently chaired Human Research Ethics Committee to assess and authorise these research initiatives. In 2018-19 we have furthered this capacity by focusing on developing our strategy for research and innovation. This strategy will ensure we are well positioned to build capacity, take advantage of opportunities and achieve a vision of the WA Country Health Service as a global leader in country health research.

We have further developed our innovation and development function to connect people and ideas across our organisation and beyond.

"By effectively harnessing technology, research, and the innovation capacity of our workforce we are working to create more connected regional and remote communities."

Expansion of innovative telehealth services

75% of Emergency Telehealth Service patients are assessed, diagnosed, treated and discharged in their home towns.

The use of telehealth, such as videoconferencing and other digital technologies, continues to expand, providing innovative solutions that are improving health service access and the health journey for country people, particularly providing specialist and multi-disciplinary care closer to home.

The Emergency Telehealth Service continues to provide regional clinicians with emergency specialist support when treating critically ill and injured country patients. 80 of our hospitals and other health service sites are currently connected, averaging 1600 consultations each month. On average, 75 per cent of Emergency Telehealth Service patients are assessed, diagnosed, treated and discharged in their home towns. The service operates as a 24-hour, seven day a week service. In 2018-19 there were more than 1600 staff attendances at the Emergency Telehealth Service Clinical and simulation education sessions.

Further expanding our telehealth services, the Rural Acute TeleStroke Service links country emergency departments to metropolitan stroke consultants via telehealth, enabling a joint video consultation with the WA Country Health Service clinical team, the patient, their family and the specialist. This has greatly assisted in early stroke diagnosis and appropriate treatment and transfer where indicated, significantly improving patient recovery and outcomes. This has resulted in a significant increase in country stroke patients’ access to highly specialised, time critical treatment. In partnership with the WA Stroke Services project, we have commenced work to further develop this service to be more accessible to all regions with a 24/7 capacity.

The use of telehealth to deliver cancer care closer to home has again grown in the past 12 months expanding the services available and the ability for people to receive care directly into their homes. The development of a TeleChemotherapy service model has commenced that will enable regional patients to receive low risk systemic cancer treatments, including cytotoxic chemotherapy, at a regional site with the support of specialist clinicians based at a metropolitan cancer centre under video-supervision.

Telehealth is helping to support regional patients by increasing access to specialist support for many country cancer patients such as breast cancer support and for patients who are prescribed oral cancer treatments.

In 2018-19 we have been proud to see the implementation of TelePalliative Care in the Home which is enabling care and support via telehealth during the terminal stage of life, for country patients who wish to die at home. As part of this service, patients are even equipped with technology devices to loan so that they are able to videoconference with their palliative care team from home.

"Rapidly changing technology has created new opportunities to drastically improve health care."

To the moon and back with telehealth

Telehealth outpatient activity

In 2018, telehealth saved WA patients from travelling 28.6 million kilometres for outpatient appointments.* That’s to the moon and back about 37 times!^^

• 21,415 ** outpatient appointments via telehealth in 2018,** 17.5% increase on 2017
• Average outpatient consults per week via telehealth in 2018 - 412
• More than 7,400 mental health services were delivered via telehealth across WA in 2018

* Total distance by road from receiving location to Perth and return and travel by road for intra-regional appointments, excluding telehealth in home services.
** Excludes mental health occasions of service.
^^ Average distance to the moon is 384,400km.

Q What did travelling to Kununurra to see the ear doctor mean for you and the family?

"When we went to Kununurra before, it was a few days away from community, we drove one time and caught the bus the other. It’s a long way to go for a check-up."

Q What did you think of telehealth?

"Telehealth is really good for us, saves travel and time and I don’t have to be away from my other kids. It was good quality, we could see and hear the doctor really well, it was just as good as seeing them in person. This is our second time being able to use telehealth and we’d be really happy to use again. I’ve told my cousins about it to, their kids have ear problems as well so I told them to ask if they can see the doctor on the TV instead of Kununurra. Telehealth is good for our community."

From time to time, country communities experience a short-term absence of local doctors. The Inpatient Telehealth Service was established in January 2018 to provide support for country inpatients in the absence of a local doctor and to ensure that country people can be ensured of a high standard of clinical care even when the unexpected does arise.

The service allows country people to stay close to home in their local hospital where they would have otherwise needed to be transferred outside of their local area. Instead they can be treated by a medical practitioner via telehealth and with the support of nursing staff on the ground.

As of July 2019, a total of 37 sites have been enabled to keep a total of 194 inpatients closer to home. A total of 93 per cent of these inpatients avoided the need to be transferred at any time during their stay with us. Importantly, the service has been often utilised to care for palliative patients, enabling the later stages of life to be spent with family close to home.

"The average length of stay for Inpatient Telehealth Service patients is two days. That tells us that the Inpatient Telehealth Service can help avoid the need to transfer people long distances for short inpatient stays."
 - Robyn Sermon - Executive Director Innovation  and Development

The model also provides important insights for the potential of telehealth to transform outpatient services.  A collaborative approach to outpatient reform, integrating state-wide outpatient reform strategy, the Patient Assisted Travel Scheme, clinical and outpatient services provides an opportunity to sustainably embed new technologies and telehealth enabled services within the outpatient system also.

"Since the introduction of remote admission capabilities  in June 2019, ITS service activity has doubled."

Watch video - Watch how telehealth is helping thousands of Western Australians

Collaborating with our partners

6,621 - Number of patients accessed by the Royal Flying Doctor Service in 2018 (for Inter-hospital Patient Transfer)

Partnerships are critical to establishing a sustainable health system that ensures all country Western Australians are able to access sustained high quality health services. Health service provision across Western Australia requires a range of service providers working in partnership with health service providers throughout the patient journey to deliver high quality integrated healthcare. In the country, providing integrated care for patients is even more complex.

The WA Country Health Service shares responsibility for delivering care with a range of other state agencies, including but not limited to: metropolitan health service providers, the Mental Health Commission, WA Police, the Department of Corrective Services, and the Department of Communities and its disability services, child protection and family support sections. We also work closely with general practitioners, the WA Primary Health Alliance, Aboriginal community controlled organisations, local shires and other care and service providers in regional and remote communities across the state.

In addition to the relationships we have with other agencies, WA Country Health Service also has a key partnership with the Royal Flying Doctor Service to ensure that country patients can access a higher level of care when they require it. The Royal Flying Doctor Service provides inter-hospital patient transfer services across the state for transfer of patients between WA Country Health Service hospitals or to metropolitan tertiary hospitals.

Similarly, we have a key partnership with St John Ambulance in ensuring that country patients can also be transferred by road either from the place of their emergency, or between hospitals or health sites and there are more than 160 ambulance locations operating in country WA providing this important service. This is achieved through a combined model of volunteer ambulance officers, community paramedics and paid paramedic services. WA Country Health Service works closely with St John Ambulance so that country people have access to this vital service in their time of need.

Health service provision across Western Australia requires a range of service providers working in partnership.

Our values in action

Onslow shines thanks to Chevron’s investment

The WA Country Health Service is currently overseeing the biggest transformation of country hospitals and health facilities in more than a generation.

The $1.5 billion building program is the most ambitious ever undertaken in regional WA and includes more than 80 sites across our vast state. Government funding and industry investment over recent years have brought about transformation of country healthcare through major and minor capital works. More towns now have modern health campuses, expanded services, greater emergency service capability and contemporary facilities and equipment.

Investment by our partners is nowhere more apparent than in Onslow, where a $250 million commitment to the region by the Chevron-operated Wheatstone Project has helped to fund the new $41 million Onslow Health Service.

The Onslow redevelopment opened to patients in December 2018 and includes an expanded three-bay emergency department, a six-bed medical inpatient unit, state-of-the-art ICT and telehealth technology, and a large range of community health and outpatient services brought together in a single healthcare hub.

Importantly, the new facility also provides a modern, spacious and intelligently planned workplace for our staff who make the commitment to work in one of the Pilbara’s more remote towns.

Improvements to infrastructure, along with new patient information systems and a virtual workforce provided by telehealth and emergency telehealth services, combine to provide the best possible care for country communities.

"The new facility also provides a modern, spacious and intelligently planned workplace for our staff."

[Image (PDF only): The Onslow transition team in front of the new building.]