Nepean Blue Mountains Local Health District Strives to Improve the Lives of All

Nepean Blue Mountains Local Health District, the venture magazine

When people unite for a common purpose, they can move mountains. When that shared mission is caring for others in times of need, mountains are moved every minute of every day.

Just ask any one of the 6,000-plus staff of the Nepean Blue Mountains Local Health District (NBMLHD), whose task is to provide community health and hospital care for people living in the Blue Mountains, Hawkesbury, Lithgow, and Penrith Local Government Areas, as well as providing tertiary care to residents of the Greater Western Region of New South Wales.

According to Clair Ramsden, NBMLHD’s Executive Director for Operations (EDO), “Our mission is to deliver quality care to the communities we service by providing safe, accessible, and integrated health services resulting in positive experiences and outcomes. We work to improve the health and wellbeing of our patients, their families, and our community.”

The NBMLHD’s catchment area covers nearly 9,200 square kilometres of extremely diverse territory that includes rural, metropolitan, and regional areas. “Within the District, facilities include Nepean Hospital, which provides tertiary level care. It is supported by the district level hospitals comprising the Blue Mountains District ANZAC Memorial and Lithgow with sub and non-acute care provided at Springwood Hospital and Portland Tabulam Health Centre,” Ramsden explained. It also includes a public private partnership with Hawkesbury Hospital.

“Primary care and community health centres are located throughout the District and provide nursing and allied health services in chronic and complex, child and family, drug, alcohol, and mental health streams to patients as close to their homes as possible, even in regional and rural areas.”

The population served by the NBMLHD is diverse, and growing. At present, over 380,000 receive care and health services, and the health system projects that number will grow by about 34 per cent by 2036 (2011-36). Over that same period, people over 70 are expected to comprise 16 per cent of the total population, compared to 9 per cent just two years ago. EDO Ramsden states “There is a predicted increase in the 70-84 age group of 166 per cent from 2011 to 2036 and a 250 per cent predicted increase in 85 and older age group for the same period.”

There’s a wealth of new faces in the District as well, thanks to the development of the Western Sydney Airport. Early projections indicate 17,400 new residents will take up life in the District during the project’s seven-year duration.

It’s an exciting and invigorating time for the organisation. As EDO, Ramsden is responsible for directing and leading the effective and efficient planning and delivery of all acute clinical services within the district and ensuring that these services are aligned with the strategic priorities of the Local Health District and Ministry of Health. She is also accountable for ensuring integration within and across networks to achieve quality care delivery. Operations has an annual operating budget of approximately $830 million and a workforce of 4,400.

The British-born Ramsden, an emergency trauma nurse by training, is in her second stint at NBMLHD. In her first seven years in the District, she served as Executive Director of Nursing and Midwifery, and then as Executive Director of Organisation Performance, Strategy and Implementation. After a brief engagement in another health district, she chose to return to Nepean.

“I’ve managed to work my way from arriving in Australia as a registered nurse to the Executive Director of Operations for the District. The leadership culture here is a very positive and mindful one. Kay Hyman, our Chief Executive, is very approachable. She sets the direction for accomplishment, and within that has flexible work practices. She assures that we have a balance of work and our personal lives. I role-model that behaviour to my direct reports because it is so important. You have much better engagement with your staff when you have work-life balance.”

Creating a person-centred health service culture

Nepean Blue Mountains Local Health District, the venture magazine

As the District endeavours to provide integrated care across the communities they serve, there has been a necessary shift in thinking about the health service culture as a whole. NBMLHD’s approach to care is centred on the needs of the person, is proactive rather than reactive, works to operate as one integrated system, and increases multidisciplinary and multisystem care.

“The integration of care is fundamental to the delivery of services that improve experiences for people, families, and carers, for service providers and clinicians, health outcomes for the population, and cost efficiency of the health system,” Ramsden said. “Our services should provide seamless, effective, and efficient care that reflects the whole of a person’s health needs, from prevention through to end of life, across both physical and mental health, and in partnership with people, their care givers, and families.”

The benefits of providing such care differ across stakeholders. For patients, Ramsden offered, “Care planning and delivery places the person at the centre of the process and actively involves people, their families, and carers through shared decision-making. Individuals are empowered to direct their care journey according to their needs and aspirations, supported by clear information about the services they need and timely access to those services. Their needs are met regardless of the point at which contact is made with the system.”

On the community side, appropriate care is coordinated through primary health care providers. “In addition to providing acute services, we need to provide more services in the community so that we are keeping people healthy in the community rather than having them come into the emergency department or the hospital,” Ramsden added. To achieve that goal, the District is actively improving partnerships with primary health care providers that will assist flow, health, and social care providers to work in partnerships together, so they can share information and transition people smoothly across from one provider to another. 

Aligning expectations and meeting evolving needs

Nepean Blue Mountains Local Health District, the venture magazine

“I’m accountable for ensuring that the services we provide reflect the needs and reasonable expectations of the community and are delivered in a manner which is cost efficient, cost effective, of high quality, and appropriate to all. It is also my responsibility to assure these expectations comply with the principles of our quality framework and contribute in a positive way to improving the health of people in the District,” Ramsden noted.

The Local Health District leads a strong community consultation process, making sure that communities have a key role in the planning and delivery of health services, and serve as liaisons across other agencies. “Our commitment to openness and honesty is vital to building strong, collaborative partnerships with the community we serve, and providing the best possible person-centred care and support.”

They also manage the development of innovative service models so that resources are appropriately used to provide the best services possible. To that end, Ramsden is deeply involved with the $1.2 billion redevelopment of Nepean Hospital, which is being funded in stages by the NSW government.

Stage 1 of the redevelopment includes a new clinical services tower block to house a new and expanded emergency department, over a dozen new operating theatres, a brand new NICU, 10 additional birthing suites, and over 200 new overnight beds. At the same time, upgrades are taking place at the Nepean Cancer Care Centre, and a new renal dialysis unit at Blue Mountains Hospital is under construction. A multi-storey car park with rooftop helipad will provide better hospital access. Stage 2 is still being planned and will commence immediately following completion of Stage 1 expected in 2021.

“Stage 1 of the redevelopment is being carefully phased to ensure staff can continue to deliver the highest standard of care throughout planning, design, and construction,” Ramsden said. “For the community this will mean services provided in a state-of-the-art building with new technology and new ways of providing care.”

The project is founded on a set of principles that includes the provision of person-centred care, the facilitation of world class health care service delivery that embraces cutting edge technology, treatments and procedures, and the incorporation of innovative and contemporary models of care with the potential to significantly impact performance.

“Health services within the District will be delivered within an integrated framework providing a continuum of care across a broad spectrum of community and hospital-based services. Health services will be delivered through telehealth and other new technologies and innovative models of care,” she pointed out. “Planning for future health services will need to consider specialist services to support an ageing population, such as aged care, cardiac, and respiratory services, medical imaging and nuclear medicine, cancer, supportive, and palliative care and rehabilitation services.”

EDO Ramsden added, “The importance of innovation in health care cannot be overstated. Our District has shown that it can be a force to be reckoned with in this area and will continue to build on its well-deserved reputation of being at the forefront of healthcare. We will harness technology and research to develop better and more efficient ways to deliver health services for the community, working with our partners to make healthcare as seamless as possible.”

Nepean Blue Mountains Local Health District, the venture magazine

Staff engagement has an important role in planning and development. “Seventy-eight per cent of our employees actually reside in our local health district. Our staff represents the population. They live here, they were brought up here, and their children are being educated in the same district.

“From a cultural perspective, we choose to engage our staff in decision-making because if they feel it’s relevant for them, it will be for the rest of the population in our district. We do lots of staff engagement and have forums where there are discussions about different cultural aspects. There’s lots of staff engagement around the redevelopment project, which helps us understand what they require. We also spend time thinking about these needs when we have forums with our consumers to make sure those objectives are aligned.”

Another thing about moving mountains — brute strength can only move rocks. Care, hope, connection, and commitment moves people to the peak of achievement, and it’s what is moving Nepean Blue Mountains Local Health District into the future.