Quality Account – How we care for you

Previous quality stories

• Quality Account 2022 - 2023: Sterile Processing Services (SPS), the “quiet achievers” of infection control

  

  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.

  

  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.

  

• Quality Account 2021 - 2022: Consumer Representatives at the Eye and Ear

  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 importancee of this role in the overall patient experience and emphasises that the patient voice matters.

   

• Quality Account 2021 - 2022: Creating cultural change, an interview with our 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.

• Quality Account 2020 - 2021: Infection Control and creating a COVIDSafe hospital

  

  Infection Control has always been an important practice across the healthcare sector, possibly never more so than in the current environment. The goal of infection control management is to reduce the risk of patients contracting preventable infections which in turn improves the overall quality of care.

  Helen Marquand joined the Eye and Ear in April 2020 as the Infection Control Coordinator. Helen has been an integral part of ensuring our hospital follows the Department of Health (DH) guidelines and is as prepared as possible in the event of a COVID-19 outbreak. Helen shares more of how her role has evolved and adapted over the past year due to the impacts of COVID-19.

  Helen describes her early roles in infection control within hospital environments:

  “Infection control functions were very much education focused, and being the central point of contact for all departments across the hospital, which included providing advice during construction work projects. Surveillance and responding to small infection outbreaks in the hospital was also a big part my role. I would conduct ward rounds to ensure patients were safe and the preventative measures were being correctly implemented.”

  In March 2020 the role of infection control in a hospital setting developed significantly to support the fight against the spread of COVID-19. The focus for Helen was implementing the DH guidelines in clinical settings to support a COVIDSafe environment. This included advising on PPE protocols, physical distancing in waiting rooms and staff tea rooms, enhanced cleaning, and the introduction of QR codes and visitor screening at entrances.

  “We did everything we could to protect our staff and patients, but there was no vaccination to roll out or mask fit testing requirements which changed the course of 2021 for the entire sector,” explained Helen.

  Comparatively, the direct impact of COVID-19 at the Eye and Ear in 2020 was low with very few COVID-positive patient or staff cases. However, there was a lot of hard work happening behind the scenes. A group of expert staff from around the hospital, including Helen, joined forces to form a COVID-19 working group. Those involved planned and implemented COVIDSafe processes, many of which you can still see in our hospital today. The processes are regularly reviewed as a way of adapting to the changing COVID-19 environment.

  “Some of the DH guidance applied more to larger hospitals conducting a broad range of treatments. Many of our treatments involve close patient contact and sometimes patients can’t wear PPE appropriately. This means we needed to adapt. Staff compliance was key,” Helen explains.

  While 2020 was unprecedented and believed at the time to be the COVID-19 peak, it was 2021 that has proved most challenging.

  “I think no one could have predicted the year that was 2021. It was very hard to prepare for. Last year, as a specialist hospital we were somewhat protected, there weren’t many exposure sites and our theatre activity was reduced,” explained Helen.

  The biggest challenges this year for Helen, and the Eye and Ear more broadly, has been the unpredictable nature of the lockdowns and the flow on effect. Add to this the management of the vaccination rollout and the implementation of the hospital’s Respiratory Protection Program (RPP) made for a difficult year for all Victorian health care providers.  The RPP implements respiratory protection processes to minimise the risk to respiratory hazards, such as infectious agents. Due to COVID -19, there has been a significant uptake in usage of Respiratory Protection Equipment (RPE), and with it the need for health care workers to be trained and supported to wear and use RPE effectively.

  “When I started, the infection control team was just me, and now we have our Respiratory Protection Program Coordinator, as well as a number of casual staff members that have helped with administering the vaccination and administration support,” Helen said.

  We are proud of our staff for continuing to provide expert care to our patients while navigating the changes to the sector.

  “It has been really tough for our staff to have to reduce visitor numbers and have patients unable to see their loved ones. However, we can all see the bigger picture and that it is essential protocol for keeping staff and patients safe. This understanding has then allowed staff to approach patients with compassion and empathy,” explains Helen.

• Quality Account 2020 - 2021: Support services during COVID-19 and responding to family violence

  

  The Social Services Unit is an important part of the Eye and Ear that provides support to our patients. The unit has continued to deliver quality care to our patients via patient transport, interpreting, social work or family violence support. In 2020 the hospital also appointed a dedicated Disability Liaison Officer to support patients who needed this assistance.

  Maureen Plain, Manager of Social Services, explains that it has been a challenging yet rewarding time for the team as they adjust to the impacts of COVID-19.

  “The resilience of the team and the entire healthcare sector has been outstanding to witness and be a part of. Supporting our patients is our number one priority and each team member has adjusted their practice to ensure patients receive the best care possible,” says Maureen.

  In some cases, transport and telehealth services came together to reinforce quality care for patients.

  “We utilise the Red Cross for our patient transport services. In a normal year, this service is fairly self-sufficient, however it has been in and out of operation due to lockdown restrictions, which has meant our team need to think outside the box and explore options for our patients on a case-by-case basis,” Maureen explained.

  Currently requests for patient transport are accessed via telephone and Telehealth is used where appropriate. Telehealth is especially useful when patients aren’t able to use public transport or catch a taxi to the hospital.

  “COVID-19 resulted in the suspension of external onsite interpreters during peak stages, with these bookings being transferred to telephone. At first, this was disruptive, with bookings difficult to change, however the process has adapted to accommodate sudden lockdowns and we can now quickly change bookings to telephone when needed.

  We have also seen the development of an online portal offering an alternative to these requests which will reform our translating services and reduce the time taken to process them,” Maureen explains.

  Strengthening our hospital’s response to family violence (SHRFV) has been operating in public hospitals since 2018 in response to recommendations from the Royal Commission into Family Violence. SHRFV has been supported at the Eye and Ear via the introduction of family violence procedures and staff training. These enhancements have helped our staff develop the knowledge and skills to identify family violence, assessment and referral processes.

  In line with the recommendations, the Eye and Ear also implemented the Multi Agency Risk Assessment Management (MARAM) framework. This ensures services are effectively identified and assessed in order to manage family violence risk. MARAM also highlights issues around family violence, not just for patients but also for staff.

  Maureen noted that the Eye and Ear saw a decline in referrals during lockdown periods, but an increase once lockdown ceased, which was reflective of what was occurring in the community. The opportunity for survivors of family violence to leave the home is reduced during a lockdown and therefore the opportunity to seek assistance is also lessened. COVID-19 has provided many pressures for everyone, and this has only further exacerbated family violence within homes.

  The Eye and Ear takes a holistic approach to patient care. Treatment is provided with consideration of a patient’s mental health and social wellbeing to solicit the best health outcomes.

  These issues need to be addressed in order to support discharge planning, continued engagement with the hospital as well as future treatments. It is vital that all patients are provided with the opportunity to be referred to a social worker for more comprehensive support.

  Throughout the pandemic, new programs have been implemented and several improvements have been made.  The hospital has seen a high degree of collaboration and leadership on many fronts. Interestingly even though patient numbers have reduced, social work has continued to have a consistent number of referrals.

  During this period, the social workers, family violence and disability liaison officer have addressed some complex issues that patients have experienced including but not limited to: family support networks; home care; disability; family violence; children at risk and mental health.

  The Eye and Ear’s new Disability Liaison Program, a great initiative by the Victorian Government, will provide support for individuals with a disability to access vaccinations and receive support within the clinical setting. This service is also noted in the Hospital’s Disability Action Plan.

  People with disability were not coming to their appointments as much due to COVID and so now the focus is on vaccinations. However, the service extends further. It is about making sure that people with a disability have access to the right advice, guidance ensuring they have equal treatment. In addition, the ability to link with other Disability Liaison Officer’s across the state will help streamline information to further assist patients with a disability.

  The Eye and Ear takes a holistic approach to patient care. Treatment is provided with consideration of a patient’s mental health and social wellbeing to solicit the best health outcomes.

  These issues need to be addressed in order to support discharge planning, continued engagement with the hospital as well as future treatments. It is vital that all patients are provided with the opportunity to be referred to a social worker for more comprehensive support.

  Throughout the pandemic, new programs have been implemented and several improvements have been made.  The hospital has seen a high degree of collaboration and leadership on many fronts. Interestingly even though patient numbers have reduced, social work has continued to have a consistent number of referrals.

  During this period, the social workers, family violence and disability liaison officer have addressed some complex issues that patients have experienced including but not limited to: family support networks; home care; disability; family violence; children at risk and mental health.

  The Eye and Ear’s new Disability Liaison Program, a great initiative by the Victorian Government, will provide support for individuals with a disability to access vaccinations and receive support within the clinical setting. This service is also noted in the Hospital’s Disability Action Plan.

  People with disability were not coming to their appointments as much due to COVID and so now the focus is on vaccinations. However, the service extends further. It is about making sure that people with a disability have access to the right advice, guidance ensuring they have equal treatment. In addition, the ability to link with other Disability Liaison Officer’s across the state will help streamline information to further assist patients with a disability.