Serving the Shire of Mount Alexander
-By Robert Hoshowsky
Although it is known today as Castlemaine Health, the history of the organisation which delivers a diverse range of inpatient, outpatient and outreach services to the Shire of Mount Alexander goes back all the way to 1853, soon after gold was discovered in the region, and the year the modern hypodermic needle was invented. Known originally as the Castlemaine Benevolent Asylum, it expanded over the years from a small wooden building into an institution with a series of hostels in the 1960s and 1970s under the name Alexander, and soon developed an innovative aged care assessment and rehabilitation program. In the mid-1980s, Alexander amalgamated with the Castlemaine District Community Hospital to become the Mt Alexander Hospital and in 2009, it was renamed Castlemaine Health. It was also around this time that Castlemaine Health’s new Chief Executive Officer Graem Kelly became part of the organisation.
“I saw Castlemaine Health as having an opportunity to develop,” says Mr Kelly, who was hired as CEO of the organisation in January of 2008. “It had big opportunities to become more than it was at that time.” In just four years, Mr Kelly has brought about significant and positive change at Castlemaine, both in the nature and degree of services provided to the 17,000-member community in the Shire of Mount Alexander, and to the almost 700 staff members. As a public hospital incorporated under the Health Services Act of 1988, Castlemaine has a variety of programs and services which are funded by the Department of Health, Department of Human Services, Department of Education and Early Childhood Development and the Department of Health and Ageing.
The changes at Castlemaine, and the opportunities for its growth, are in many ways a continuation of Mr Kelly’s earlier efforts while serving as CEO and Director of Nursing of Robinvale District Health Services (RDHS), a position he held for over 11 years. With an extensive background in health care that spans 28 years, Mr Kelly is a fellow of the Australian Institute of Management, a fellow of the Australian Rural Leadership Foundation, a member of the Australian College of Health Service Executives, a member of the Victorian – Patient and Client Management Systems Product Planning Group (PCMS PPG) and a Graduate Member of the Australian Institute of Company Directors. Currently a National Councillor for the Australian Health and Hospitals Association, Mr Kelly also holds a Diploma from the Australian Institute of Company Directors. While at RHDS, Mr Kelly and the organisation were recognised with a variety of awards for public service, rural health, and quality systems for acute and aged care. Greatly adding to the value of RHDS – which was $2 million when he started and $12 million when he left – Mr Kelly remains most proud of changing the culture of Robinvale, making it a place where people wanted to work, and attracting staff from an hour’s drive away from the site.
Key Initiatives and Improvements
In just four years as CEO, Mr Kelly has introduced a number of initiatives at Castlemaine Health, which continues to provide a wide range of health and support services and residential care accommodation to meet the health needs of Central Victorian residents of all ages. “We have been restructuring to ensure we become much more slim and efficient and streamlined in terms of communication, and in terms of accountabilities,” he says, “and we are engaging staff to be innovative and encouraging them to have a capacity to deal with effective change management.” Under Mr Kelly’s guidance, the organisation now has a more decentralised management style, which benefits staff and volunteers as lines of communication are more open than ever before, allowing for increased opportunities for professional development. “We have developed an educational precinct, and are looking to be an educational leader both in-house and for external users,” says the CEO.
Along with an improvement in staff support services and a more engaged style of management, both managers and staff are being held to higher standards of accountability, while becoming a greater part of Castlemaine’s decision-making processes. The changes are extremely positive for the organisation as a whole, which is also benefitting from a closer working relationship with political representatives in the Shire of Mount Alexander area and the region.
For Castlemaine Health’s staff and volunteers, there have been a number of positive and forward-looking achievements and initiatives, not least of which was the name change in 2009 which, says Mr Kelly, made them more comfortable about looking at the organisation as a corporate entity. “If you’re wearing the Castlemaine name, then you have pride behind the name you’re wearing.”
A Range of Services
At Castlemaine Health, the population of the Shire of Mount Alexander is able to access a wide range of health services both at the facilities themselves and through outreach services in the community, which are also provided to the neighbouring Shires of Central Goldfields and Macedon Ranges, reaching a combined population of over 60,000. With Acute/Sub-Acute Facilities (65 staffed beds), Castlemaine provides a range of medical, obstetric, paediatric, rehabilitation, respite, surgical, accident and emergency, and geriatric evaluation and management services. In residential aged care, Castlemaine has a number of facilities available for high care (90 beds), low care (75 beds), and transitional care (six beds) patients. Community services encompass district nursing services, palliative care/post acute care, aged care assessment services, volunteer and support programs, community aged care packages, and a great deal more.
Client services include medical, nursing and personal care, podiatry, occupational therapy, speech therapy, dietetics, psychiatry, infection control, radiology and ultrasonography (provided on site by Bendigo), radiology, and a host of other services. In terms of corporate training, Castlemaine offers health information services, public relations, fundraising, and more.
In the health services field for almost three decades, Mr Kelly has worked hands-on in virtually every nursing capacity, from ward nurse to associate charge nurse, director of nursing, and nurse unit manager. This experience has given him a definite advantage which he has used to the betterment of Castlemaine. “I can hold my own in terms of knowing where a clinician is coming from,” he says, “and make balanced judgements compared to someone whose experience is in finance alone.”
Unlike other institutions, hospitals are huge, complex entities with their own sets of unique departments and personalities. Mr Kelly concedes that Castlemaine had a history of standoffs between management and staff in the past, which did not help in keeping the organisation up to date or appropriately meeting community needs. This was a situation he chose to address immediately after becoming CEO, when he set about making departmental managers feel their input was valued and made them an integral part of the Castlemaine Health management team. “You have to allow people to have a voice in decision-making, and how they can make change,” he says of the organisation, which continues to move forward with positive staff members who embrace change rather than resist it, and are able to work well with like-minded individuals.
“Hospitals are huge, complex animals,” Mr Kelly comments. “They really are a Hilton Hotel with a medical process of 15 different quantities, in community, acute-based, and other social support services. So they are a complex animal in terms of how they operate, and they are very clinical in terms of the power that’s generated by those pressure groups.” The positive changes initiated by Mr Kelly and others have been acknowledged and appreciated in the comments they garner from patients, who frequently provide feedback – the organisation typically receives about 30 instances of feedback monthly. “Three may state there is some need for improvement, but the other 27 are always glowing in terms of the care they receive. To have that sort of ratio is pretty good.”
Along with a staff of approximately 660 employees, Castlemaine Health offers adult day services, planned activity groups, transportation, respite services, a community rehabilitation centre, allied health services, and many other services made available through the generous assistance of social support volunteers. Men and women of all ages and backgrounds, social support volunteers give their time to help others, and are positive and reliable individuals who provide older persons and adults with disabilities living in the community with one of the greatest gifts of all: companionship and interaction with others. Activities range from simple conservation to walks, social outings, and other forms of community involvement for individuals with mobility limitations.
The Future of Health Care
There are, says Mr Kelly, a number of issues facing the provision of health care in Australia today, including cost controls and how institutions like Castlemaine can appropriately serve their local communities. “Given that no community is the same, when you’ve got an overriding cost monitoring systems that tries to bring conformity, conformity is the end product if you’re not careful,” he cautions. “In some ways that is appropriate; in other ways, it can be very dangerous.” Along with the need for government to address the growing health costs of today, Mr Kelly says one of the biggest growth areas is the need to be proactive when it comes to managing health behaviours that lead to chronic illnesses. “There is a big push within the Australian system at the moment to look at trying to change behaviour which leads to poor health outcomes such as diabetes, obesity, and high blood pressure, which often have life behavioural issues,” he says. The world of today may be very different from the way it was 159 years ago when Castlemaine was founded, but if the past four years are any indication, CEO Graem Kelly and the staff and volunteers at the organisation are creating a healthy future for the Shire of Mount Alexander.