In 2019, St Vincent’s Health Australia introduced iCARE, a new five-year strategic framework to support the organisation in its quest to lead the world in safe, efficient, person-centred care.
In 2020, this plan has been complemented in four key areas:

iCARE STRATEGIC FRAMEWORK

iMPROVEMENT CLINICAL GOVERNANCE ASSURANCE RESEARCH EXPERIENCE

The St Vincent’s Experience

The St Vincent’s Experience program embeds the three principles of person-centred care – ‘we feel welcome’, ‘we feel valued’, and ‘we feel safe’ – across the organisation with the goal of amplifying the voices of our patients, residents, and families, and empowering our staff to consistently deliver and improve on their quality of care.
SVHA is strongly committed to a patient-centred health care system and conducts parallel processes for measuring patient experience.
The first is the Hospital Consumer Assessment of Healthcare Providers and Systems’ (HCAHPS) biannual survey which provides trend data going back to 2014 and allows performance to be benchmarked against 89 Australian and 2790 international comparison hospitals.
SVHA’s most recent results for the period April-June 2020 indicate that:

THE % OF PATIENTS WHO RATED OUR HOSPITALS 9 OR 10 OF 10 HAS CONSISTENTLY IMPROVED OVER THE PAST TWO YEARS

The second process SVHA follows for measuring patient experience is the Net Promoter Score (NPS). This year, 29,000 patients responded to the two-question NPS survey, with more than 90% including an optional written comment.
SVHA’s NPS result for 2019-20 was 73, exceeding the organisation’s target of 70.
When SVHA introduced the NPS survey in March 2019 it focussed on overnight-admitted inpatients. During the year the survey population was expanded to include patients undergoing a day procedure.
In the initial pandemic period between March-June 2020, SVHA’s NPS increased significantly from around 70 to over 80. An analysis was undertaken to understand what was behind the increase with the aim of sustaining the improvement.

NPS Trend by Survey Completion Date

The analysis found that a combination of factors were involved, including:


Staff, and nurses in particular, attracted the highest number of survey comments. Doctors have a bigger influence on the NPS score but are mentioned to a lesser extent, which may reflect the more frequent contact patients have with nurses.
Finally, as part of its ongoing efforts to maintain and improve the St Vincent’s Experience, SVHA’s Ethos program – the organisation’s tailored approach to embedding safe, respectful and professional behaviour among all staff and introduced in 2017 – has now been made available to over 20,000 staff.

Accelerating Improvement

Traditionally, performance against a set of targets has been managed through regulatory and payment levers, restructure, and policy-making. SVHA has begun work to establish a group-wide improvement program which will go beyond these methods to tackle complex problems where the issue isn’t completely understood and where the answer isn’t known.
The program will utilise the subject matter expertise of people closest to the issue – staff and service users – to identify potential solutions and then test them. The program will build on the improvement work currently underway in our public hospitals and scale this expertise across SVHA.

Life Changing Research

St Vincent’s Health Australia understands the vital role that medical research plays in improving health outcomes. With involvement in over 2000 active clinical studies and more than 500 clinical trials, SVHA works to bring about advances in medical care that are directly applicable to clinical practice.

St Vincent’s Health has continued to grow its national research activities during the year despite some activities being put on hold due to COVID-19.
When the pandemic hit, SVHA’s clinicians and researchers pivoted to explore research relevant to the challenge created by the virus. More than 60 clinical research projects related to COVID-19 are currently underway across the organisation, covering prophylaxis, diagnosis, the tracking of cytokine responses to infection, antiviral therapies, and treatment of inflammation-related disease including lung dysfunction and respiratory failure. Many of these projects involve national and international collaborations.
SVHA has also been selected as a pilot site for the implementation of the new National Clinical Trials Governance Framework developed by the Australian Commission for Safety and Quality in Health Care.

Targeting Zero

St Vincent’s Health is working towards achieving zero preventable clinical harms with a focus on sentinel events and hospital-acquired complications (HACs) through clinical governance and audit.
During 2019-2020, SVHA provided care to 280,000 patients in our public and private facilities and 1,936 in our aged care division. While there was a 20 per cent increase in our aged care residents, there was a drop of 15 per cent across our public and private facilities. This is primarily a direct result of the impact of COVID-19 on hospital activity in the last four months of the year.
With more than one million episodes of care provided by SVHA’s facilities each year, the vast majority are safe and effective. However, we know that despite robust systems and processes, adverse events and harm do occur and that any incident causes distress for patients, families and staff.
In 2019-20, there were 51,553 incident notifications across our public, private and aged care facilities. This reflects a 12 per cent increase in reporting over the 12 months. Despite the increase in notifications, over 95 per cent of incidents resulted in minimal or no harm with only 0.16 per cent resulting in serious harm or death.

1 being most severe, 4 least severeNumber includes some deaths that were not unexpected but reportable to the Coroner 1.2. Severity SVHNS SVHM Private Aged Care 1 1 10 18 50 2 4 2 125 148 2068 178 3 3441 6435 2927 1109 4 3295 6702 6068 18974 Total 6871 13304 11113 20265

From July 2019 to June 2020, SVHA recorded only one national ‘sentinel event’ after 11 months of zero notifications since the introduction of the new Australian Commission on Safety and Quality in Health Care definitions in July 2019 – a significant achievement.
Open disclosure is performed on all incidents resulting in any degree of harm and a review – a root cause analysis (RCA) – is completed on all incidents resulting in serious harm or death.
Each year, SVHA’s clinical teams perform thousands of operations and see hundreds of thousands of patients. In 2019-20, our hospitals performed over 143,000 procedures (including surgery, cardiac catheters and endoscopies).
During the year, there were 56 falls across St Vincent’s Health’s public and private facilities which resulted in serious harm (ie: fracture or closed head injury), which represents less than 1 per 10,000 patients admitted to hospital.
Staphyloccus Aureus (SAB) is a type of bacteria that can be found on human skin and which is often referred to as ‘staph’ or ‘golden staph’. St Vincent’s Health experienced 38 SAB infections across public and private facilities during 2019-20 representing a rate of 0.6 per 10,000 patients admitted. The national benchmark is fewer than two infections per 10,000.
SVHA also completed more than 5,800 hip and knee joint replacements in 2019-20. Less than 1 per cent were complicated by a deep surgical site infection.

The St Vincent’s Clinical Assurance and Reliability Program (SCARP) was introduced in 2017 to provide the Board, divisions, facilities, clinicians, and the public with assurance, transparency, and visibility of the clinical care provided across the organisation, in accordance with evidenced-based guidelines.
SCARP assessments – which are carried out in collaboration with clinicians – are key to identifying any discrepancies, which in turn informs improvements and assurance. The assurance process is integral to maintaining health care accreditations and jurisdictional licensing.
During the year, SVHA’s SCARP team completed assessments against Acute Coronary Syndrome, Stroke, Colonoscopy and Venous Thromboembolism (VTE).
Each assessment provides clinical teams with detailed information to assist them in identifying opportunities for improvement. Other assessments supported by the SCARP team included clinical documentation, delirium, and a follow up to a previous acute stroke assessment.
Finally, the Measurement Analysis and Reporting System (MARS) is SVHA’s electronic clinical auditing tool. MARS provides a standardised platform for facilities to audit and assess compliance, performance, and variation at a ward, unit, and facility level against evidence-based guides and accreditation criterion.
During 2019-20, facilities across SVHA completed over 150,000 clinical audits aligned to national standards. In addition to the above, from March to June 2020, more than 125,000 COVID-related audits were completed.