A Community-Based Answer to Local Needs

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-By Robert Hoshowsky

Around the world, the nature of health care provision is changing, and while some rural communities might lag behind the times, this is not so in the Alpine Shire communities. Alpine Health is meeting the health care needs of community members through a multipurpose service model that is dynamic, innovative, and a prime example of how skilled staff, volunteers, and members of the community can come together to improve the lives and health of residents.

“I think we would best describe ourselves as the true, local, multi-service, rural health agency,” says Lyndon Seys, Chief Executive Officer at Alpine Health. “We provide services for people from the cradle to the grave, and these days, a little bit before the cradle with prenatal. Where we don’t do it ourselves, we have relationships with other agencies who do it with us, and who do it locally.”

When he came to Alpine Health in 1999 to help establish a new kind of multipurpose health service agency in Australia, Seys brought decades of health care experience with him. “I’ve worked in the public health system in Australia and the United Kingdom for the whole of my working life, which is 40 years,” he comments. Prior to Alpine, Seys started as a diagnostic radiographer, and achieved degrees in Health Administration from the University of New South Wales, and a Master of Arts degree in Health Management from Leeds University in the UK. His fast experience includes working as a senior health bureaucrat in the Department of Human Services in Victoria, a director for health services in the Northern Territory, and serving as a CEO for various country and regional health departments across Australia.

With Seys at the helm, Alpine Health has not only grown, but is today upheld as a shining example of the positive change that can happen when hospitals, government, and like-minded members of the community band together.

The Amalgamation of Three Hospitals

Established in November of 1996, Alpine Health is the result of the amalgamation of three rural hospitals and residential facilities, encompassing Bright District Hospital and Health Services, Tawonga District Hospital, Myrtleford District War Memorial Hospital, Barwidgee Lodge and Kiewa Valley House nursing homes, Hawthorn Village Hostel and Myrtleford Extended Care Accommodation Centre. Providing integrated Acute Health, Community Health, and Community and Aged Residential Services for residents and visitors of the Alpine Shire, Alpine Health has three multi-purpose sites located in the townships of Bright, Mount Beauty, and Myrtleford.

Incorporated as a multi-purpose service under the Victorian Health Services Act of 1988, Alpine Health is funded by State and Federal levels of government, and has a Board of Management to represent the community in decision making, with three Community Health and Advisory Groups (CHAG) advising the Board and Management Team. Prior to the formation of Alpine Health almost 16 years ago, health care in rural Victoria was facing a crisis. In 1991, a joint Commonwealth/State task force was established to address the challenges involved in providing services to rural and remote communities, with an emphasis on a multi-purpose service model which would improve the flexibility of health programs and see aged care and health services become more cost-effective and coordinated to community needs.

“Over 15 years ago, all of the small hospitals prior to amalgamation were struggling financially,” comments Seys. “They were struggling to find a role that was appropriate for them, because the Victorian system had moved to Casemix-based funding models, which did not do well for small rural hospitals like ours.” The system (which had primarily focussed on institutional-based delivery, basic front-line hospital services, and residential aged care) now has agencies that are progressive, along with small hospitals and services which are financially viable. “It’s a progressive organisation which has expanded service delivery well into the community, so well that the demand for community-based service delivery far exceeds the utilisation and demand for institutional service delivery. It is focussed on the needs of individuals and the delivery of services locally.”

A Wide Range of Services

When it was formed, the mission and vision for Alpine Health was clear: to improve the health and well-being of people within the Alpine Shire, and become recognised leaders across Australia in the improvement of health and well-being through well-integrated and sustainable services. Alpine Health’s philosophy – which includes recognising the rights, dignity and independence of its clients, being flexible and responsive, and fostering links and co-operative relationships with related service providers – extends across the comprehensive range of services offered in acute care, aged care and community. Some of Alpine Health’s many medical services include accident and emergency care, acute medical inpatient care, peri-operative services, day surgery (minor procedures), endoscopy, midwifery and maternity, palliative care, pathology, renal dialysis, and radiology.

At Alpine Health, locals of the shire are also able to access a number of specialised community and support services, including the team midwifery program, diabetes education, district nursing service (including hospital in the home, post acute care), adult community activity and recreational services, palliative care volunteer service, health promotion workers, occupational therapists, dieticians and more. According to CEO Seys, Alpine Health sees about 2,500 persons each year through its hospitals as in-patients; 5,000 a year in urgent care or emergency care centres; 150 a year through residential aged care services, and 80 a year through community-based service. Additionally, they make numerous presentations through their community-based service delivery programs. “All the community work has quite clearly grown since 1996,” he says. “All of the health promotion work is new, and all of the thousands of people whose lives have been touched by the work that we do – that is all new.”

Community Aged Care

One of the fastest-growing sectors for Alpine Health has been community-based aged care, which has increased considerably since 2008. “There has been a significant shift away from residential aged care, and the demand for community aged care has expanded significantly in the last four years,” remarks Seys. Senior residents of the Alpine area can take advantage of a range of options, such as affordable living in either the independent living units at Bright and Myrtleford, or as a resident in a low or high care facility.

Adhering to the Charter of Residents’ Rights and Responsibilities issued by the Department of Health and Aged Care, residents are treated with respect, their dignity is honoured, and staff endeavour to ensure residents feel comfortable, safe, and well looked after. Relatives and friends are encouraged to visit residents as often as desired, and staff create a welcoming environment in which residents can maintain and enjoy independence whilst having nursing and/or personal care assistant staff available to them 24/7 to assist with daily needs. The nature of care – from low to high – depends on the residence, ranging from Hawthorn Village, to Kiewa Valley House, to Barwidgee Lodge (an information booklet on Residential Care Services is available for download at http://www.alpinehealth.org.au/index.php?page=aged-care-services).

A Range of Choices

At Alpine Health, patients are empowered to make choices regarding their well-being. “Choice is a significant feature of the Australian health care system,” comments Seys. “People do not always have to seek care locally; they can move their care wherever they desire.” This includes transferring from one General Practitioner to another in a different town, if necessary. “All of our doctors work primarily in their private practice. We have, like most rural hospital services in Australia, a division of medical services. All our specialist services come from somewhere else. They come from larger regional centres, and local medical services come from local general practices, and the doctors working in those practices locally come from a mix of rural backgrounds in various parts of Australia and internationally. So we have a mix of Australian and international medical graduates who work here.”

Able to provide basic frontline hospital service – such as X-Rays and basic pathology diagnosis – specialised services such as CAT scans, ultrasound, MRIs and nuclear medicine are able to be facilitated by Alpine Health through larger facilities in the state. Some locals, comments Seys, will receive care in larger centres and return to Alpine Health for hospital, aged care, or community care. “We have transport mechanisms and technological mechanisms, such as video conferencing, in place that enable people to access specialised and general medical services if they need to outside their local community. Choices are very clearly a key component of our relationship with our customer base. We see our role in those terms, helping people to get access to health services if they can’t get access to them locally.” In some instances, patients are sent to larger hospitals for specialised diagnosis, treatment, surgery, or complex births, and then brought back to Alpine Health for recovery, convalescence, and ongoing management.

Core of Volunteers

In addition to highly qualified medical professionals, Seys is quick to point out that much of Alpine Health’s success comes from its many volunteers. Back in 1996, the organisation had 15 volunteers; today, that number has swelled to over 200, working to support the community and provide services in health. “These are services that are led, run, managed, and governed by the community with the support of our clientele, and includes men’s’ health, women’s’ health, cancer support, diabetes support, dementia support, and autism support. Most services in the last five years have come as a result of real community engagement, and we have one of the strongest and most recognised community engagement strategies in this state.” Along with volunteers, Alpine Health benefits from a strong six member management team which is based in the local community.

Alpine Health’s funding, comments Seys, comes from four sources. Two of the largest are the State of Victoria (about 60 per cent of revenue), and the Commonwealth of Australia (20 per cent). The remaining 20 per cent comes from the organisation’s capacity to raise revenue from operations, and community support in the form of donations, bequests, and fundraising. “We have true flexibility to meet the needs of the community and the needs of individuals along the way.” It is this flexibility, remarks Seys, which enables Alpine Health to better meet the needs of community members.

“We have invested in a workforce that is focussed on the needs of individuals. This means that we are highly innovative. We think differently, we think outside of the square, and we’re always focussed on trying to find answers to the really difficult sets of issues that our community finds themselves in, a consequence of their aging, their health, or where they live.” For Lyndon Seys and the many dedicated health care professionals and volunteers, success comes from meeting these needs, with the Alpine Health multipurpose service model being emulated in other areas. “We are being talked about nationally. All state jurisdictions are running with the model, because they can see the real advantages for the two local communities that the model represents.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

December 16, 2018, 3:53 PM AEDT