Company Report: Sydney West Area Health Service
Care First Connected by passion and technology, the business units of the Sydney West Area Health Service are fast becoming Australia's premier healthcare network

For the clinicians and staffers of Sydney West Area Health Service (SWAHS) patient care truly does come first. Fulfilling that commitment takes a foundation of business acumen, technical advancement, and clinical and business innovation.

Established in 2005 as part of a reorganization of the New South Wales Health public health system designed to improve care through optimized efficiency, SWAHS is comprised of 14 member hospitals and healthcare centers. SWAHS serves a diverse urban and rural population of more than 1.2 million people in a geographic area roughly the size of Holland.

The new organizational structure of SWAHS is based on managerial accountability across its business units, and a knowledge-based approach to service development. At the helm of the reorganized organization is Dr. Steven Boyages, clinician, researcher, and pioneer in the study of iodine deficiency.

“I’m an active physician, an endocrinologist,” he explains. “One of the characteristics of the hormone system is that it’s a very complex system characterized by multiple signals and feedback loops, both negative and positive. That was one of the key factors that attracted me to moving into management and leadership.”

As an active observer of the health care industry and a passionate voice for health care reform, Boyages recognized early in his career that, as he puts it, “There must be a better way of (effecting change) rather than sitting on the sidelines and complaining and whining to management all the time. To make long-lasting change in the healthcare business you have to move into that leadership … any discussion about healthcare reform has to take into account the complexity of the leading and managing of that marketplace, which has its own complex set of conditions.”

MANAGING THE BUSINESS OF CARE
When comparing it to other high performance industries, Boyages points out that the scope and complexity of the healthcare delivery system he oversees makes telecommunications and manufacturing seem relatively simple.

“We’re open 24 hours a day seven days a week. We see over five and a half thousand patients throughout our emergency departments every week. We have 20,000 staff members,” he notes. “Within the healthcare delivery elements we range from prevention and health care services, mental health, women’s services, rehabilitation, aging care and Aboriginal health. We are driven by emergency concerns in a continually changing market. The population is getting more complex as it gets older, but as, as technology gets better, you can do more things to patients that provide more services to help them live longer.”

The other side of this formidable slate of demands is balanced by funding, governmental and supply constraints. “At the moment we spend about 30 percent of the state budget on healthcare,” he continues. With a current operating budget in the area of AU $1.8 billion, the SWAHS spends roughly $300,000 an hour.

“Having said that,” Boyages continues, “we really strive to be on the cutting edge of innovation. And this is driven by our clinicians; they will always be innovating in new ways to provide service. One of the things we’ve done to better the enterprise and provide outstanding care is to establish clinical networks. Critical networks are similar to product lines in like other industries; they cut across the organization.”

At present, SWAHS operates 15 ‘product lines,’ including cutting-edge clinical programs in cardiology, cancer, brain injury, rheumatology, bone marrow transplantation and mental health.

THE TECHNOLOGICAL TERRAIN
An essential aspect of SWAHS’ managerial directive is the effective provision of care over a wide geographical area. A long-time advocate of information technology for health care provision, Boyages assembled teams to develop real-time enterprise monitoring solutions. To that end, SWAHS invested AU$125 million to create a series of clinical networks over which medical records, administrative data and outcome data can be readily accessed and shared.

“Now we’re rolling up the PACs system, which will allow us to archive, catalog and distribute digital images of x-rays throughout the facility, across the facility and even to people’s homes,” Boyages says.

“It’s been really important for us to promote remote consultation. In fact, we have a virtual intensive care unit, which is set of devices whereby you can move the patient through a sophisticated set of programs and can see a range of biometric devices, such as ECG and other biometric inputs. You can relay instructions to clinical teams at other hospitals and make immediate consultative decisions. That’s really remarkable that come treat the size of ours with such large distances.”

The sophisticated enterprise management systems in place throughout the SWAHS network include a set of critically valuable performance management tools. “We developed our in-house set of performance monitoring tools so we can understand the performance of the organization to optimize performance on a clinical and financial basis,” Boyages explains. A range of sophisticated dashboards developed specifically for the organization helps facilitate and optimize organizational performance. “We’re very excited about that because it’s very difficult to do what we do without these very sophisticated web-based business intelligence tools.”

The next frontier in information management for SWAHS is a proposed bedside computing system that will combine basic communication and patient entertainment options such as e-mail and web browsing with a full set of diagnostic reference tools and patient data that clinicians can access while doing their daily rounds.

THE NEXT GENERATION
The real technology fueling the success of the agency is the human kind. “We work very hard and cultivate a can-do attitude through the organization. We’re very enthusiastic and passionate about healthcare, and those are the people that we look for in our system, as well as in our government,” Boyages stresses. “It’s all about talent identification; we are developing and identifying potential leaders early in our formal leadership programs and take them upstream.”

The agency works with several university teaching hospitals, and supports a nationally-regarded Clinical Research Institute. From where Boyages sits, the investment in human capital is the most profitable of all.

“The future generation of medical practitioners and researchers has to be maintained,” he says. “Our ability to drive innovation is very important as a vehicle to attract the best clinicians and the best researchers in the world to the organization. So we’ve invested heavily into our research efforts and our education capabilities. We are in the care business – and we have a directive called Care First, which is about care access and redesign as key elements of what we do and how we do it. We center our efforts around the patient by getting good quality information as quickly as we can, and staffing our service with high quality staff.”

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