RNSH SERT INSTITUTE OPERATIONAL PLAN REPORT JANUARY TO JUNE 2024
SURGICAL EDUCATION, RESEARCH & TRAINING (SERT) INSTITUTE ROYAL NORTH SHORE HOSPITAL
Northern Sydney Local Health District Royal North Shore Hospital Reserve Road St Leonards NSW 2065
E: NSLHD-RNSH-SERTInstitute@health.nsw.gov.au
This work is copyrighted. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the SERT Institute at Royal North Shore Hospital.
Published July 2024
RNSH SERT INSTITUTE OPERATIONAL PLAN REPORT
Table of Contents
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SERT Reporting Timeline
2
Introduction
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Executive Summary
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Key Priority Area 1 : Operations & Business
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Key Priority Area 2 : Promotion & Engagement
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Key Priority Area 3 : Research
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Key Priority Area 4: Education & Training
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Key Priority Area 5: Innovation & Quality Improvement
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Key Priority Area 6: Data & Audit
SERT Institute Reporting Timeline
January to June 2024 Operational Report
JUL 2024
SERT Advisory Committee
8,603 NOV 2024
SERT Advisory Committee
Total Surgical Procedures
July to December 2024 Operational Report
JAN 2025
FEB 2025
Surgical Awards Night
23/24 Research Activity Report
MAR 2025
SERT Advisory Committee
APR 2025
January to June 2025 Operational Report
JUL 2025
SERT Advisory Committee
SERT Advisory Committee
NOV 2025
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Introduction
The Operational Plan Report serves as a tool for evaluating progress towards the Surgical Education Research and Training (SERT) Institute's strategic objectives from 2023-2027. It focuses on six key areas and outlines future objectives, aligning with the needs of stakeholders, including the North Shore campus and the Northern Sydney Local Health District's commitment to patient-centered care.
The SERT Institute key priority areas are:
1. Business & Operations 2. Promotion & Engagement 3. Research 4. Education & Training 5. Innovation & Quality Improvement 6. Data & Audit
This report translates the overarching goals of the Operational Plan into actionable and measurable activities.
It provides a structured framework for tracking progress, ensuring that initiatives are delivered and coordinated effectively by both the SERT Institute and the Data Analysis Surgical Outcome (DASO) Unit. The progress and achievement of the planned objectives will be guided by the Operational Committee meetings and evaluated through the SERT Institute Advisory, established in April 2024. This framework enhances accountability and promotes continuous improvement in surgical education, research and training
This report was proudly produced by the RNSH SERT Institute Team. Wide distribution of this document is encouraged.
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Executive Summary
The Royal North Shore Hospital (RNSH) Surgical Education Research and Training (SERT) Institute was established in 2017 under the Division of Surgery and Anaesthesia, with the support of the Northern Sydney Local Health District (NSLHD) Chief Executive. It is a clinician initiative established to promote, assist and encourage the engagement of surgeons in academic and surgical quality improvement activities that will result in improvement in patient outcomes and clinical care. This initiative was identified to overcome barriers that impact on the capacity of surgeons to be involved in academic research, clinical auditing, clinical leadership, teaching, mentoring, clinical governance roles and processes across the hospital. The development of the 6 key priority areas was guided through broad consultation with key stakeholders and are aligned to the NSLHD strategic plan 2022-2027, in addition to the Clinical Governance Plan, Research Strategy, Digital Strategy and Precinct Plan 2022. This 6 monthly report provides an overview of the SERT Institute progress against 6 Key Priority areas for 2023–2027.
Significant Achievements Priority Area 1: Operations & Business
In April 2024, the SERT Institute Advisory Committee was established, sponsored by the NSLHD Chief Executive. Membership includes board representatives, senior surgeons, key stakeholders, clinical and research academics. This expert committee aims to provide leadership, strategic guidance, oversight of activities and initiatives of the Institute. It encourages broad stakeholder engagement, consultation and a platform to recognise surgical, research and educational achievements. Priority Area 2: Promotions & Engagement In 2024, the SERT Institute launched a Data Network aimed at uniting individuals and teams from various departments across RNSH working with data. This initiative was designed to encourage knowledge sharing, foster collaborative problem-solving, and provide support and guidance. Members included the Performance and Analytics Unit, Intensive Care Unit (ICU), Emergency Department, Medical Oncology, Bone Marrow Transplant, Radiation Oncology, Medical Imaging, and Renal departments. The SERT Institute website was redesigned and transitioned to a new platform in December 2023. As it evolves, it will showcase achievements, highlight education, training and research initiatives, significant publications, conferences, awards, innovation, and quality improvement projects. Over the past three years, the SERT Institute has forged strong partnerships with the Western Local Health District (WSLHD) Research Education Network and University of Sydney (USYD) to develop a junior consultant leadership program - Fostering Leadership Across Systems in Health (FLASH).
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Executive Summary Continued
Priority Area 3: Research Department of Surgery and Anaesthesia Research Activity Report
In 2020, the inaugural RNSH Surgical Research Activity Report 2018-2020 was published. This was a compilation of 3 years research across all surgical subspecialties. Following positive feedback, the next iteration published in 2023, covered 2021-2022 and included all RNSH Division of Surgery & Anaesthesia (DoSA) services - ICU, Trauma, Anaesthesia, Pain & Allergy management services. These reports were actively promoted through several media channels including the NSLHD Board and Executive teams, disseminated to all surgeons and presented at clinical meetings. These reports highlight the volume of research and quality improvement activity across DoSA by individuals and specialty service, in addition to identifying areas for collaboration. Surgeon Engagement Survey The SERT Institute conducted a survey to gauge surgeon engagement, focusing on identifying barriers to academia, research and clinical audit. The barriers identified include work life balance, limited resources to support research and clinical audit, and a lack of awareness regarding pathways to achieving academic titles. The survey findings have been presented and discussed at various forums, shared with the executives and has guided SERT Institute planning. The DASO Unit has continued to support surgical departments lacking data assistance by developing custom databases to enhance clinical audits, Morbidity and Mortality (M&M) meetings, and overall reporting and research. During 2023-2024, new databases were developed for Breast, Hands, Ophthalmology, Burns and Plastics, and Colorectal services. The Orthopaedic Spinal Trauma Database also underwent an upgrade during this period.
Priority Area 4: Education and Training Masters of Surgery
In collaboration with USYD, the SERT Institute has supported the Masters of Surgery Program on the Northern Sydney Campus by appointing an academic lead. This lead provides oversight of the program and manages the clinical skills laboratory (Kolling Institute). Since 2020, there has been a significant increase in enrollments (currently over 100 per year), and an increase in elective subjects from 6 to 20. Surgical Leadership Series This priority area 4 focuses on strengthening medical education, training, and leadership. In September 2023, the RNSH Surgical Leadership Series was introduced, bringing surgeons together to discuss the expectations, challenges and skills required to foster a positive and supportive surgical culture across DoSA, that in turn flows into each sub-specialty service. The initiative is being designed by surgeons for surgeons through consultation, collaboration, and sessional feedback, ensuring it meets needs and expectations.
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Executive Summary Continued
Approximately four leadership development sessions will be conducted per year. The sessions are professionally facilitated by Dr Renee Lim, Director of Program Development from the Pam McLean Centre. The first session explored leadership models and influences with the second follow-up session exploring how leadership personalities, styles and models influence and shape a team. Subsequent sessions will explore conflict resolution, surgical culture, before progressing to strategic service planning.
Priority Area 5: Innovation & Quality Improvement Ray Hollings Award
In May 2023, the SERT Institute hosted the second Ray Hollings Surgical Awards in partnership with the RNSH Gastroenterology Department's Harry Cumberland Awards. Each year, over 80 surgeons and distinguished guests attended. In 2023, 3 recipients received the Ray Hollings Surgical Award, aimed at supporting high impact surgical innovation and quality improvement initiatives. Priority Area 6: Data & Audit During 2023-24, the DASO Unit supported multiple departments with no dedicated data support by creating customised databases for clinical audits and M&M meetings. The new Colorectal database now allows semi-automated data uploads from SurgiNet, eliminating the need for registrars and fellows to manually enter basic demographic and surgical data. A similar streamlined process was implemented for the Orthopaedic database. Additionally, the Hands department's database was expanded to include Patient Reported Outcome Measures (PROMs) and a system to track follow-up clinic attendance and PROM compliance. This year, the DASO Unit introduced Microsoft Power BI in multiple departments to enhance reporting and integrate with NSLHD technologies. The DASO Unit Data Request Portal was also upgraded to enable both internal and external stakeholders to submit data requests, facilitating better tracking of additional and out-of-scope requests. In 2023, the DASO Unit received 62 out-of-scope requests and a total of 27 additional requests from January to June 2024. Governance and processes for releasing and sharing information outside of NSLHD are in development and historical datasets from excel spreadsheets are currently in review for transition to new databases for the following services: Pancreatic, Breast and Endocrine.
Progress on each KPI is documented and indicated using the colour coding tabs below.
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Key Priority Area 1
Operations and Business 1.1 Ensure the direction and future growth of the SERT Institute is aligned to the needs of the District in the context of academic surgery, clinical governance, business acumen and workforce planning. The SERT Institute’s vision and direction was guided through broad consultation to develop the initial 3 year SERT strategy 2019-2021 and superseded in 2023, with the development of 6 key priorities areas and an operational reporting tool spanning 2023-2027. These documents were aligned to the NSLHD strategic plan and strategy published in 2023. In April 2024, the SERT Institute Advisory Committee was established, sponsored by the NSLHD Chief Executive. Membership includes board representatives, senior surgeons, key stakeholders, clinical and research academics. This expert committee aims to provide leadership, strategic guidance, oversight of activities and initiatives of the Institute. It encourages broad stakeholder engagement, consultation and a platform to recognise surgical, research and educational achievements. 1.2 Secure infrastructure and resources to support future growth. In late 2019, the SERT Institute was relocated to level 4 of the RNSH Acute Services Building within the Department of Anaesthesia. The current space allows direct access to the operating theatres and interaction with surgeons. The SERT Institute will remain in this location indefinitely due to the limited space available at RNSH. DoSA has 14 surgical departments, over 100 surgical consultants and 5 FTE Data Managers supporting 6 sub-specialty services, including the Trauma service. In November 2023, the SERT Institute conducted a GAP analysis of each surgical department to assess their capacity to support clinical audit, M&M meetings, clinical reporting, research and quality improvement activities. The outcome of the analysis has supported the establishment of three new data manager positions in 2024-2025 financial year (FY) for the following services: Orthopaedics, Pancreas and Breast surgery. The SERT Institute continued to work across all surgical specialty services throughout 2023-2024 FY to support quality improvement projects and developed new databases for several unsupported services: Colorectal, Hands, Plastics, Perioperative Medicine Service, and the Surgical Outcomes Committee.
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1.3 Establish a high performing team with shared vision and common goals. Individual learning pathways for staff are yet to be developed, this activity is planned for 2024-2025. Regular staff meetings and planning sessions are scheduled throughout the year to keep staff informed, seek input and share progress across portfolios and projects. 1.4 Strengthen workforce capacity and skills through training and education. From 2020, the DASO Unit has extended an invitation to Data Management teams across RNSH (medical and surgical services) to network and join regular Lunch & Learn Sessions. During the COVID pandemic period (2020 to 2023), these moved to online sessions and included morale and team building activities due to the increased level of working from home conditions. In 2023, the sessions continued with the introduction of a hybrid model combining both online and face to face options. These sessions provide opportunities to share knowledge, skills and learnings with others, in addition to showcasing achievements, new projects, and identifying challenges/obstacles data analysists, managers and researchers face and address across different sub-specialty areas. Network sessions are scheduled four times per year.
All staff have maintain up-to-date with mandatory training in addition to upskilling on new data management systems introduced by NSW Health.
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Operational Plan Report: Key Priority 1
Key Priority Area 2
Promotion & Engagement
2.1 Raise the profile and presence of the SERT Institute across RNSH. In 2023, the SERT Institute website was redesigned and transitioned to a new platform, launched in December. It will continue to evolve over the next 12 months. The website will showcase achievements, highlight education, training and research initiatives, significant publications and news, conferences, awards, innovation and quality improvement projects.
2.2 Pursue opportunities to showcase surgical achievements and improved outcomes.
One of the SERT Institute’s goals is to establish a platform where surgical research and innovative projects can be shared with colleagues and the community. This platform also aims to attract benefactors interested in supporting and tracking the progress of research, quality improvement projects and clinical trials conducted at RNSH. To establish and ensure sustainability of the platform, the SERT Institute team submitted the following grants: July 2023 - submitted grant application to the North Foundation to support a surgical forum – unsuccessful. March 2024 - submitted Health & Medical Research Sponsorship grant application to support surgical forum – unsuccessful. 2.3 Strengthen and grow key partnerships, collaborations and networks that advance the SERT Institute vision. Key partnerships include: 2021 - 2022, the SERT Institute initiated a collaboration with WSLHD and USYD to develop a junior consultant leadership program “FLASH”. Sydney Health Partners - research collaboration and networking. USYD to support the Masters of Surgery and Clinical Skills Lab. The Northern Clinical School providing sponsorship for research awards. The NSQIP Collaborative Network.
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2.4 Increase surgeon engagement in non-clinical activities.
Following individual consultation and feedback from a surgeon engagement survey conducted by the SERT Institute in 2023, surgeons identified the need for a local leadership training program that addressed fundamental leadership skills and the complexity of managing high performing surgical teams. The SERT Institute leadership team together with education consultants have led the development, introduction and facilitation of a surgical leadership series, designed by surgeons for surgeons. In September 2023, the first formal session was held focusing on leadership models, followed by sessions on leadership style and personalities, conflict management and resolution, progressing on to exploring surgical culture. All sessions are held afterhours and are well attended. Continuous feedback from consultants is used to guide further program development. Approximately 4 sessions per year are planned. Regular bi-monthly meetings have been established with CE and DoSA executives. The SERT Institute leadership team also attend relevant meetings such as Heads of Department, Grand Rounds, surgical data and research meetings. 2.5 Promote surgical activity and achievements. The DASO Unit continues to work closely with all surgical departments to assess clinical audit needs with a primary focus on M&M meetings, development of Terms of Reference and meeting documentation. In 2021 and 2023, the SERT Institute produced comprehensive surgical reports for 6 departments highlighting activity, innovation and quality improvement projects, research and notable achievements.
The SERT Institute report highlighted achievements across all sub- specialty services.
Surgical Medical Benefits Schedule (MBS) coding: In order to accurately report on surgical data and support surgical billing, MBS codes are recorded at time of surgery in the operation reports. A significant documentation gap was identified in May 2024 and the SERT Institute has been working with finance and specialty departments to address retrospective data gaps for 2022-2023 and 2023-2024 FY to increase overall compliance at time of surgery and support revenue generation. The project is on track to complete 2022-23 FY missing data by 30 June 2024.
Operational Plan Report: Key Priority 2
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Key Priority Area 3
Research
3.1 Strengthen the capacity of surgical departments to undertake research. The SERT Institute administered a surgeon engagement survey to identify barriers to academia, research and clinical audit. The barriers identified include work life balance, limited resources to support research and clinical audit, and a lack of awareness regarding pathways to achieving academic titles. The survey findings have been presented and discussed at various forums, shared with the executives and has guided SERT Institute planning. To support surgeon’s capacity to undertake research and quality improvement activities, the SERT Institute is exploring the establishment of a project support officer that would support ethics applications and monitoring and statistical analysis. In addition, the DASO Unit provides support to departments with no dedicated data resource to improve or develop bespoke databases and facilitate clinical audits, M&M’s and overall patient outcome reporting and research. In 2023-2024, databases were developed for Breast, Hands, Ophthalmology, Burns and Plastics and Colorectal services, in addition to an upgrade to the Orthopaedic Spinal Trauma Database.
A new database was developed to support clinical audit, registry reporting and research projects for the NSLHD Trauma Service.
3.2 Foster and promote a collaborative research culture across surgery.
In 2020, the inaugural RNSH Surgical Research Activity Report 2018- 2020 was published. This was a compilation of 3 years research across all surgical subspecialties. Following positive feedback, the next iteration covered 2021-2022 and included all DoSA services (ICU, Trauma, Anaesthesia, Pain & Allergy management services).
Future research activity reports will be published every 2 years. The next edition covering 2023-2024 will be published in 2025.
From 2018-2022, RNSH surgeons published over 900 research manuscripts, with over 100% increase in activity in 2022 compared to 2018 (Figure 1).
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Figure 1. Surgical research activity published by RNSH surgeons from 2018-2022.
3.3 Enhance internal and external collaborations and partnerships. The RNSH Data Network was established by the DASO Unit in early 2024 to bring together individuals and teams working with data across RNSH. These included teams and individuals from the Analytics and Performance Unit, Intensive Care Unit, Emergency Department, Medical Oncology, Bone Marrow Transplant, Radiation Oncology, Medical imaging and Renal departments, including representatives from Health Information Services. The network aims to foster knowledge sharing, problem solving, collaboration, support and advice.
The DASO Unit will host network meetings 3-4 times per year.
3.4 Recognise and promote surgical research achievements and researchers through a variety of multi media channels.
The Surgical Research Activity Reports were actively promoted through several NSLHD media channels including the NSLHD Board and Executive teams, disseminated to all surgeons and presented at clinical meetings. The report highlights the volume of research and quality improvement activity across DoSA by individuals/surgical specialty service in addition to identifying areas for collaboration. The SERT Institute aims to establish an annual surgical research symposium that would showcase the excellent quality and volume of research undertaken across surgery. An invitation will be extended to community stakeholders and potential benefactors interested in supporting research.
Operational Plan Report: Key Priority 3
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Key Priority Area 4
Education & Training
4.1 Deliver and coordinate quality postgraduate surgical education and training.
The SERT Institute has supported the delivery of the Masters of Surgery Program by establishing a dedicated Academic Program Lead position.
This lead provides oversight of the program and manages the clinical skills laboratory (Kolling Institute). Since 2020, there has been a significant increase in enrollments (currently over 100 per year), and an increase in elective subjects from 6 to 20. In 2021, the SERT Institute initiated a collaboration with the WSLHD Research Education Network to develop the medical leadership program - Fostering Leadership Across Systems in Health (FLASH) - specifically for early career consultants. FLASH is a 9 month program conducted across both campuses, targeting senior trainees and junior consultants up to 7 years. It is now supported and offered by the NSLHD People & Culture Learning & Development Unit.
4.2 Adopt a clear and transparent framework to determine surgical training pathways across the Northern Campus.
Not yet started
Planned for 2024 - 2025
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4.3 Facilitate the growth of clinical leadership
Surgical Leadership Series
In 2023, the SERT Institute focused on strengthening medical education, training, and leadership. The aim of the RNSH Surgical Leadership Series is to bring surgeons together as a collective to discuss the expectations, challenges and skills required to foster a positive and supportive surgical culture across DoSA that in turn flows into each sub-specialty service. The initiative led by the SERT Institute leadership team, is being designed by surgeons for surgeons through consultation, collaboration, and feedback. This ensures it is sustainable and tailors the series to the needs and expectations of our surgeons. The Leadership Series is an extension of the new consultant leadership program (FLASH) developed in 2021 - a collaboration between WSLHD and NSLHD. A minimum of four leadership development sessions will be conducted per year with the first two sessions held in 2023 (11 September and 11 December). Two more sessions have been conducted in the first half of 2024 with three more planned for the second half. All sessions are well attended with approximately 25 participants in each. They are professionally facilitated by Dr Renee Lim, Director of Program Development from the Pam McLean Centre. The first session explored leadership models and influences, with the second follow-up session in December exploring how leadership personalities, styles and models influence and shape a team. The next two sessions will focus on conflict resolution and surgical culture before progressing to strategic and service planning.
Operational Plan Report: Key Priority 4
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Key Priority Area 5
Innovation & Quality Improvement
5.1 Identify and promote surgical innovation opportunities. In May 2023, the SERT Institute hosted the second Ray Hollings Surgical Awards Night. This night was held in conjunction with the Harry Cumberland Awards as part of a collaborative partnership with the Gastroenterology Department. This night saw over 80 surgeons and distinguished guests in attendance. Three recipients were awarded with the Ray Hollings Surgical Award, supporting high impact surgical innovation and quality improvement initiatives. The SERT Institute explored potential funding opportunities to support research and innovation. The Ramsay Research Foundation and the North Foundation Grants were identified. The SERT Institute supported several surgical teams applying for these grants and resulted in an additional $27,000 grant to Dr Leo Pang through the Ramsay Research Foundation to support his novel Head and Neck Cancer Screening day and will enable additional screening days to be held in 2024.
5.2 Support new and existing surgical innovation and quality improvement programs across RNSH.
The SERT Institute has supported the Ray Hollings Surgical Awards recipient's projects throughout their lifecycle from initiation to completion. Project support included project planning documentation, review of ethics applications, development of survey and booking tools in REDcap, ensuring the project milestones and deliverables were met within the expected time frames. In 2024, the SERT Institute and DASO Unit has been instrumental in supporting the new direction of the Surgical Outcomes Committee and provided high level analysis of surgical outcomes to facilitate robust review and discussion. The SERT Institute and DASO Unit participated in the Australian NSQIP collaborative meeting in 2023/2024 to gain insight into initiatives and quality improvement projects underway in hospitals across Australia. This will guide future projects and identify collaborative opportunities. In May 2024, RNSH hosted the national NSQIP collaborative meeting.
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5.3 Promote the utilisation of project management tools to plan, develop, implement and evaluation projects.
The SERT Institute and DASO Unit regularly promotes the utilisation of REDCap for a range of projects. Examples include the development of a patient booking system for the Head and Neck screening program. The system allowed patients to select an appointment time and capture relevant information to facilitate follow-up appointments and data analysis. REDCap has also enabled the development of complex databases which incorporate patient reported outcomes measures, clinical images, follow-up appointments and clinical audit and research projects across multiple surgical sub-specialties.
5.4 Strengthen connections and alignment with stakeholders for project sustainability and scalability.
Work in planning 2024 - 2025
Operational Plan Report: Key Priority 5
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Key Priority Area 6
Data & Audit
6.1 Develop and improve surgical reporting processes through embracing new technology capabilities and trends.
In 2023-24, the DASO Unit provided support to several departments with no dedicated data resource and support to design and develop a bespoke database for clinical audit and morbidity & mortality meetings. An example of this is the new Colorectal database which supports a semi-automated data upload from SurgiNet, removing the need for registrars and fellows to input basic demographics and surgery data. A similar process was applied to the Orthopaedic database. The Hands database was expanded to include Patient Reported Outcomes Measures’ (PROMs) and a tracking system for follow-up clinic attendance and PROM compliance. This year DASO Unit adopted and applied Microsoft Power BI in several departments to improve reporting and to align with NSLHD reporting systems.
6.2 Consistent implementation of governance and security measures across surgery data systems and processes.
In 2021, the DASO Unit Data Request Portal was launched for both internal and external stakeholders to lodge a a data request. This has allowed DASO to track additional and out of scope requests. In 2023, 62 out-of-scope requests were receive and a total of 27 additional requests were received from January to June 2024. Governance and processes for releasing and sharing information outside of NSLHD are in development and will align with current policies and national standards regarding data governance and privacy. Historical datasets from excel spreadsheets are currently in review for transition to new databases for Pancreatic, Breast and Endocrine services.
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6.3 Improve engagement and utilisation of available technologies and systems.
The SERT Institute and DASO Unit data managers and analysts regularly attend training sessions on NSW Health systems upgrades and introduction of new systems.
in 2023 - 2024, training was also undertaken on “R” statistical analysis, Power BI, Power Automate and NSW Health Enterprise Data Lake.
Trainings have also been incorporated into the newly established Data Networking meetings.
6.4 Improve clinician knowledge and understanding of clinical audits and processes.
Not yet started
Estimated activity for 2025.
Operational Plan Report: Key Priority 6
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6.5 Maintain a high standard of data quality for reporting accuracy and research.
A high standard of data quality is maintained throughout the surgical department supported by the DASO Unit.
Consultants are regularly engaged in the review of specific databases to determine how the processes and database can be improved. The review identifies opportunities to improve: data collection, efficiency, clinical relevance, clinical audits, research, mortality and morbidity meetings.
Examples of consultation reviews include:
The Orthopaedics department recently implemented changes to increase junior doctor involvement to improve data collection and compliance.
The Hands department introduced several data validation processes to track Patient Reported Outcome Measure compliance and data collection/ compliance by junior medical officers. The Neurosurgery and Interventional Neuroradiology departments reviewed definitions for complications currently reported on in departmental clinical audits, and modified the database to be more clinically relevant and user friendly.
In 2023/2024, the DASO Unit increased the utilisation of coded data to support data requests, aligning to national reporting standards.
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