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About › Publications › Quality Account 2021-2022

Quality Account 2021-2022

The Quality Report explores improvement and change initiatives at the Eye and Ear focusing on patient experience and overall quality of care.

The Eye and Ear’s Sterile Processing Services (SPS) – The “quiet achievers” of infection control

A man wearing a scrub hat and blue scrubs smiling against a white wall with a computer in the background

Every day, medical procedures are undertaken in healthcare settings globally, which require a wide range of supplies, instruments and equipment. Patient safety hinges on these instruments being properly cleaned, sanitised and sterilised.

The Sterile Processing Service (SPS) at the Eye and Ear is a specialised area responsible for receiving, storing, processing, distributing, and controlling the professional supplies and equipment (both sterile and non-sterile) for the care and safety of our patients.  The importance of the function of this team cannot be over stated.  The team provides service to all of the operating theatres and outpatient clinics throughout the hospital.  Though the services they provide might not be visible to the average patient, nonetheless their role is absolutely critical in supporting patient safety.

Randy Rufo, Nurse Unit Manager of SPS – Surgical Services explained the importance for the SPS team to work closely with other areas of the hospital

“The goal is always to meet the demands required for the best patient care without compromising on standards of practice.”

The upgrade of SPS’s facilities due to the progress of the Eye and Ear’s redevelopment has resulted in a new very large, modern department with state-of-the-art facilities and a workflow which is unidirectional which ensures infection prevention standards are met.  The standard – AS/NZS 4187:2014 “Reprocessing of reusable medical devices in health service organisations” and sets out strict requirements for the reprocessing of reusable medical devices in healthcare settings.

The initial cleaning of instruments begins at the end of the procedure in which the reusable medical equipment is used. After this cleaning, all items require thorough cleaning and disinfection in the equipment reprocessing area before sterilising.

Medical staff member organising equipment

Randy notes:

As stated in the standard, it is vital that staff are educated and competent in relation to effective infection prevention and control. This includes ongoing staff education and induction relating to infection prevention and control, and competency.

SPS run two automated washer disinfection machines connected to an automated chemical dosing system supplying the washers with pre-set dose of chemicals to be used for surgical instruments.  The department uses an electronic tracking system to allow for easy tracking of instrument usage, monitoring of supplies, as well as reduction of paper waste.

It is estimated in a three-month period that there are around 1,536 steriliser cycles run resulting in more than 120,000 sanitised instruments.

Of course, SPS is just one cog in the Eye and Ear’s extended model of care.  There must be ongoing consultation to ensure that the instruments that are used are compatible with the cleaning, disinfection and sterilisation equipment available. To ensure devices can be processed in accordance with the recommended cleaning and sterilisation procedure (known as instructions for use or IFU) there are ongoing reviews via the hospital’s Product Evaluation committee and in accordance with The Australian Standard AS/NZS 4187.

When at full strength, the SPS team consists of 27 hard-working health professionals.  When asked what motivates the team most Randy simply stated:

Knowing we can help improve the lives of our patients.

A staff member in the Sterile Processing Service (SPS) at the Eye and Ear

Previous quality stories

  • Vision impaired Consumer Representative Sandra Knight, discusses her role as a Consumer Representative and the newly appointed Chair of the CAC Consumer Working Group. Watch as Sandra explains the importance of this role in the overall patient experience and emphasises that the patient voice matters.

  • Barbara West smiling at camera
    Equity and Inclusion Coordinator, Barb West

    At The Royal Victorian Eye and Ear Hospital we are committed to providing an inclusive and respectful environment, free from discrimination.

    Barb West joined the Eye and Ear in March 2022 to support our action plans and work to further build a culture of equity and inclusion. Barb comes from a professional background in academia, landing what would have been her dream job at 33— tenured professor at a university. It was at this time she realised she wanted more from life and decided to move from her then-home in California to Melbourne. From here, Barb wrote a number of books, including a book on the history of Australia and a book about Australian culture and the workplace. Barb and her partner started their own intercultural consulting business to help organisations incorporate equity and inclusion into their workplace in an impactful way.

    Importance of difference, equity and inclusion

    Through her experience as an intercultural consultant, Barb has worked with a range of clients on supporting a variety of intercultural projects. These projects included working with universities to support them in appropriately welcoming their international student cohorts and working with healthcare institutions on improving their informed consent practices.

    “What we found was that many patients were saying ‘yes’ but didn’t always know what they were saying ‘yes’ to. I worked a lot in upskilling this form of communication,” said Barb.

    Barb later moved back into the academic world and accepted a lecturer position in Hungary, moving there just before the pandemic hit. In late 2021, Barb moved back to Melbourne where she applied for the Equity and Inclusion Coordinator role at the Eye and Ear.

    “I was so impressed and delighted with the Eye and Ear in choosing me as the candidate for this role as I haven’t necessarily followed a standard career trajectory,” explained Barb.

    Key areas of focus for this role include:

    • Supporting further development of our Aboriginal Employment Plan, working closely with our Mirring Ba Wirring team
    • Developing diversity and visibility within the LGBTQIA+ community
    • Disability employment
    • Implementing our Gender Equality Action Plan
    • Upskilling and empowering staff with intercultural knowledge

    “I hope to create a culture of celebration and adaption. I want all staff to be comfortable at work and be able to be 100% authentically themselves. Work environments with this kind of ethos create a vibrant and positive workforce,” explained Barb.

    Gender Equality Action Plan

    In 2020, the Victorian Government introduced the Gender Equality Act, which holds the hospital accountable for making meaningful changes in the workplace in order to strive for gender equality. An audit has been completed to determine the key benchmark statistics. The plan will focus on three key areas of improvement and change with constant consultation with the dedicated Eye and Ear working groups. Barb has commenced working through the actions and influencing change throughout the hospital.

    What this means for patients

    This role will highlight the importance of all forms of cultural and identity difference through increased visibility, adaptation and celebration. Enhanced cultural development training to both educate our staff and create a professional environment based on learning, adapting and the principles of intercultural communication will be undertaken.

    “The overarching goal is to create long term change internally, which will filter through to our communications and actions with patients and carers,” shared Barb.

    By empowering staff with knowledge, we can create better connections to our patients and approach each person with intercultural empathy and understanding.”

    Barb explains that creating cultural change requires building the skills of all staff and ultimately comes down to the way in which we act and communicate.

    She considers the cognitive processing differences as a good example.

    “Are you a linear or a circular communicator? Most professional situations in the English-speaking world require you to speak in a linear manner. In many other languages this is not the case,” explains Barb.

    Linear communication is a type of communication that moves in only one direction, whereas circular communication refers to more discussion-centric communication involving storytelling to develop context around the key message.

    If our staff are skilled in identifying these types of cognitive differences when treating patients, then they will be able to adapt and become better communicators and better clinicians overall.

     

    We will continue to share quality and improvement stories and data on this page throughout 2022. In the meantime, if you would like to learn more about what we are doing to support our patients, consumers, volunteers and staff, please read more in our Partnering with Consumers and Community Plan.

  • The Concierge Team was introduced to the Eye and Ear as part of our COVID-19 response efforts. Watch as some of the team explain their role and the importance of the concierge process for overall patient flow at the hospital.

    smiling headshot of Kathryn Day
    Patient Services and Access Manager, Kathryn Day

    Improving patient services and access

    “I remember the day that COVID-19 truly hit us. It was a Thursday afternoon and the news came through the press conference. It felt like the world stopped, and yet the team stepped up and staff from around the hospital banded together to create a crisis response plan.”

    Patient services, access, team work, improvement and change – these are the core elements of the Patient Services and Access Team. Manager Kathryn Day has worked for the Eye and Ear for over 15 years, but has experienced nothing quite like the past two years.

    Kathryn commenced at the Eye and Ear in her role as Outpatient Bookings Coordinator, and worked her way up to a multi-disciplinary leadership role and during this time has gone from a small team of seven staff to now managing over 80 staff across both sites.

    This team is at the heart of the Eye and Ear and is often both the first and last step of the patient journey.

    Every patient will have some interaction with at least one of Kathryn’s team before they see their treating doctor. The team has a range of responsibilities including processing referrals, sending patient letters, booking patient appointments, supporting clinical triage, managing waiting lists, assisting with patient wayfinding and patient check-in as well as providing support for patients while they are in the waiting room.

    “This team is critical. Without them, clinics wouldn’t be booked and patients wouldn’t get to where they need to go,” explains Kathryn.

    COVID-19 impacts

    When the COVID-19 pandemic hit it was all hands on deck. The team were involved in complex management and rearrangement of patient appointments in a very fast-changing environment and more than ever it became clear how integral their roles were to hospital operations.

    “I remember the day that COVID-19 truly hit us. It was a Thursday afternoon and the news came through the press conference. It felt like the world stopped, and yet the team stepped up and staff from around the hospital banded together to create a crisis response plan. We got as many people as possible on the phones cancelling appointments for the upcoming week,” explained Kathryn.

    Kathryn and her team worked with the doctors on prioritising patients and categorising them as either urgent, telehealth suitable appointments, or patients who could wait.

    “No one knew how long it would be, it was hard to predict. We normally book appointments six-weeks in advance, so we started there. We reviewed every single clinic and every single session, for every single day, for six weeks,” said Kathryn.

    As the pandemic worsened and appointments and surgeries continued to be cancelled things became more complex. While patients were understanding of the cancellations they still required specialist advice and some even began to run out of specific medication that can only be purchased at the hospital.

    “Some patients were running out of eye drops, for example, and they needed a way speak to a doctor and so medical staff joined us in the call centre to take clinical calls. This support streamlined the call flow and made call management more efficient. From this, we made a process for clinical queries that both our doctors and nurses provide support to, ” said Kathryn.

    During the height of the COVID-19 pandemic, Kathryn also onboarded a team of concierge staff to support patient flow and COVID-19 compliance.

    Digital improvement

    One thing was clear, digital support was key. The call centre became a core tool in the hospital’s COVID-19 crisis response, and while we have always operated a call centre, the scalability of our processes proved difficult.

    “There was a day where the call centre nearly blew up! Patients were scared and the volume of calls in bound and out bound was unlike anything I’ve experienced,” said Kathryn.

    The pandemic launched our call centre into an almost constant state of call surge, especially after a press conference aired. Processes were developed that can now be replicated in other scenarios to help support call flow and manage sudden increased call volumes efficiently.

    COVID-19 has provided us with a case study in improvement placing digital acceleration at the forefront of success. It revealed our digital blind spots and our COVID-19 response is helping to inform future initiatives in the Patient Services and Access Team.

    “We have always been very paper-focused, we are now working on an electronic referral system and are looking for opportunities for efficiencies in the digital health space,” explained Kathryn.

    Future challenges and opportunities

    The overall challenge for all health services across the country is making up for lost time and getting patients seen as quickly as possible.

    One way to help alleviate this pressure, is increasing opportunities for patients to be seen in different ways by reviewing and trialling alternative models of care.

    “We have been working on a Department of Health funded initiative that aims to support healthcare demand by increasing the delivery of hospital services in patients’ homes,” explained Kathryn.

    The team is also looking at different approaches to the call centre, placing the patient’s wants and needs at the centre of our communication.

    “What information do the patients want us to know? Do they want to have different ways to communicate with us? Email or live chat for example, these are the types of insights we are looking for,” explained Kathryn.

    We are currently rolling out our digital patient check-in system in the hospital to speed up the reception process and allow for staff and patients to engage in more meaningful conversation.

    “The future that I would like to see is my team having the time, thanks to digital processes like the electronic patient check-in, to engage more with our patients and give them the attention they need,” said Kathryn.

    As our redevelopment nears its final stages, the team will look at restructuring to ensure patient services and access are its primary focus.

    “My team are passionate about what they do and really want to be here. They try their very best to be kind and ensure the patient needs are at the core of their every interaction,” said Kathryn.

  • Watch Executive Director Medical Services and Chief Medical Officer, Dr Birinder Giddy, give an overview of the Eye and Ear’s quality performance over the past year.

    Measure 2018-19 2019-20 2020-21 2021-22
    Staff flu vaccination percentage rate  85% 86% 71% 92%
    Staff hand hygiene percentage rate 80% 83% 87% 87%
    Total number of incidences relating to the administration of blood and blood product wastage 0 0 0 3
    Total number of cases of staphylococcus aureus 0 0 1 0
    Total number of cases of clostridium difficile 0 0 0 0
    Total number of post-operative eye and ear infections Change of reporting 0 7 6
    Total number of patients who fell over with no significant harm 23 28 27 25
    Total number of pressure injuries recorded during an inpatient stay 3 2 4 9*
    Total number of employees Change of reporting 930 934 965
    Total number of interpreter appointments and number of languages 17,023 appts in 79 languages 13,636 appts in 84 languages 9911 appt. 82 languages 9977 appts in 86 languages
    Total number of registered consumers 30 27 25 22

    * Some pressure injuries might not be developed at the Eye and Ear, but were found and reported during skin assessment

Publications

  • Quality Account 2021-2022
  • Quality Account 2020-2021
  • Reconciliation Action Plans (RAP)
  • Research Strategy
  • Strategic Plan
  • Sight + Sound
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