Page 156 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Symposiums

S11.1 Improving Clinical Effectiveness 14:30 Theatre 1

Using Technology-enabled Smart Systems to Improve the Value of Care
Milstein A
Clinical Excellence Research Center, Stanford University, USA

In other service industries, forms of automation have enabled substantial improvements in both efficiency and reliability.
Healthcare has moved slowly in reaping the benefits of automation because of its inherently intimate nature and because of
the complexity and adaptiveness of the biological and behavioural systems underlying health and healthcare. The presenter
will review the primary applications of automated systems and illustrate Stanford’s artificial intelligence research in the least
used of these applications that may offer the highest yield in the near-term.

S11.2 Improving Clinical Effectiveness 14:30 Theatre 1

Wednesday, 4 May Scope of Clinical Practice: The Critical Role of the Capacity and Capability of the Healthcare Facility
O’Sullivan D
Metro North Hospital and Health Service, Brisbane, Australia

An isolated autonomous doctor is unable to deliver modern medical care in its entirety. The care identified and prescribed by
a doctor is delivered within the complex, complicated and sophisticated systems of the modern hospital many important and
critical parts of which are invisible to that doctor. If one or more of these parts is missing or not functioning at an appropriate
level, the carefully identified and prescribed care cannot be delivered as envisaged potentially resulting in patient harm.
The doctor and the care systems must “fit” together with the doctor undertaking patient care (diagnostic, therapeutic and
palliative) that is within the capacity and capability of that particular hospital.

How to succinctly and accurately describe a hospital’s capability is challenging. A number of Australian jurisdictions have
developed standard descriptive frameworks of clinical service elements. These elements include support services and
staffing levels required to safely deliver a particular clinical service. Once done hierarchical categorisation, from simplest
to most complex, using a numerical scale is undertaken. Variously known as role delineation statements or clinical service
capability frameworks (CSCF), these documents focus on clinical services. A hospital is therefore not described in terms
of a single number but rather a list of clinical services each of which has an identified level. This is a useful tool within the
“credentialing process” given the consistent and systematised documentation of a clinical service capability that can then
be matched with the doctor’s credentials. Whilst the doctor has one set of credentials, she may have a number of “scopes
of clinical practice”. For example a cardiologist may have a scope of clinical practice for interventional work at the tertiary
hospital with a Cardiology CSCF level 6, diagnostic work at a secondary level hospital (Cardiology CSCF level 5) and
consultation at another hospital (General medicine CSCF level 4). Whilst the role of the doctor has long been recognised as
a critical element in the safety and quality system, the hospital’s capacity to deliver that prescribed care and the matching of
doctor to hospital capability is just as important in our quest for ongoing improvement in safety and quality for our patients.

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