LMHN Regional Review March 2024

Welcome to the Loddon Mallee Health Network's showcase of current projects and initiatives, helping 17 member hospitals in the region to care for their communities.

Regional Review Issue 6 | Summer 2024

First Nations Peoples ED/UCCs

Loddon Mallee Shared Services

Loddon Mallee Public Health Unit

In this issue

Welcome from Di Newell, Interim General Manager of Loddon Mallee Health Network Reimagining Emergency Care for First Nations Communities in the Loddon Mallee Now Live: LMHN members’ resource ‘Headquarters’ Rapidly Evolving Loddon Mallee Public Health Unit

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Cover Photo: Water tower Swan Hill Opposite: Redesdale Bridge, Heathcote By Anthony Webster Imagine Pictures

Acknowledgement of Country We acknowledge the First Peoples of Australia who are the Traditional Custodians of the land and water where we live, work and play. We celebrate that this is the oldest living and continuous culture in the world. We are proud to be sharing the land that we work on and recognise that sovereignty was never ceded.

Family violence is a health issue

Welcome to the Summer 2024 edition of the LMHN Regional Review

Colleagues,

successful in recruiting an Anti-Racism Lead, First Nations Projects to support this important learning. System Reform for First Nations Communities within Emergency Departments (EDs) and Urgent Care Centres (UCCs) is underway across the Loddon Mallee Region (LMR). Read more on page 6-9. We are busy exploring opportunities to continue ongoing developments within the region as some projects conclude in June. The next quarter will see us revise our Regional Strategy for the next 12-18 months, with ongoing opportunities to provide education, workforce developments, and improvements to patient care. I would like to thank the LMHN members, stakeholders and staff for supporting our team as we manage the current changes and move towards a refreshed network later this year.

Our year has commenced with the finalisation of our Boards – Part A and Bart B – respectively chaired by Peter Abraham and Eileen Hannagan. We are moving into an era of change, with a focus on optimizing our resources through shared services, joint procurement, shared initiatives and projects, and coordination of workforce planning. We are supporting some innovative initiatives this year and can advise that our partnership with Safer Care Victoria to build a Regional System of Clinical Governance has engaged with CEOs, Board Chairs and Quality Chairs, as well as key staff who are working in the Quality and Risk space, has seen the delivery of two workshops. This initiative is working towards a shared vision that enables the identification of improvement opportunities across the Loddon Mallee region. The action from these workshops will be led by three LMHN Fellows and staff from our diverse teams who will become champions of change. We are continuing our LMHN River Journey of Truth Telling grounded in Transformational Accountability moving towards Anti-Racism, and have been

Our strategy includes ongoing opportunities to provide education, workforce developments, and improvements to patient care.

Yours sincerely Di Newell

Interim General Manager, Loddon Mallee Health Network, Chief Information Officer, Loddon Mallee Shared Shared Service.

LMHN Regional Review | Issue 5 | Summer 2024

Reimagining Emergency Care for First Nations Communities in the Loddon Mallee

Dr Mishel McMahon, Proud Yorta Yorta Woman and Senior Research Fellow at Latrobe University

System Reform for First Nations Communities within Emergency Departments (EDs) and Urgent Care Centres (UCCs) is underway across the Loddon Mallee Region (LMR). A First Nations Best Practice Framework (BPF) will be delivered mid-2024. All 17 LMHN healthcare services and Aboriginal Community Controlled Health Organisations (ACCHOs) are showing their commitment, and stronger partnerships are beginning to grow. A First Nations-led research project, prioritising the voices and lived-experience of First Nations researchers and healthcare professionals in hospitals and community is underway in collaboration Latrobe Rural Health School, funded by the Department of Health. The need to vastly improve the accessibility, cultural safety and outcomes for First Nations Peoples when they visit emergency care is well-documented. Despite well-intentioned decades of research, it’s the critical implementation of research findings that fails for First Nations communities. It is crucial this solution-based project delivers a BPF for LMR emergency service providers who understandably have different challenges and different context, as the first ‘Discovery Stage’ of the project has shown.

Early findings include a need to repair the ‘trust gap’ for First Nations Peoples, growing the First Nations workforce in emergency care and improving Cultural Safety in the design, the processes and clinical practice of Emergency Departments and urgent Care Centres to name a few. But for real, positive change and actual system reform, respecting the voices, relational worldviews and research process of First Nations People is paramount. “My message is very simple”, Dr Mishel McMahon, Proud Yorta Yorta Woman and Senior Research Fellow at Latrobe University explains. “Do we want accurate, effective research findings that enables actual system change and high engagement during implementation?” Common misconceptions and assumptions about First Nations research is a barrier to change. Positioning First Nations methodologies, capacity building in First Nations communities, allowing space for deep listening, reciprocity, rapport, relationships and tangible benefits for First Nations communities, for example, can cause people (including non-First Nations researchers) to assume that the research process is ‘too hard’ or too long.

able to) talk from their cultural self, which means the research findings hold high social capital with the intended target population. Which for this study is Aboriginal and non-Aboriginal professionals connected to emergency care. Without relationship- based research, which is a longer, high engagement process, there is danger of people shutting down because they have given-up on research or are simply burnt out by the system that many of us are ashamed to admit, remains inherently racist. Building relationships “This project is unique in that it is relationship-based. The data collected is authentic and sometimes holds discomfort,” said Mishel. “Sure, it takes longer to develop and build rapport with all stakeholders – positioning everyone as a pivotal part of the ‘research body’. In line with First Nations relational concept of equality there is no hierarchy - from the CEOs to the ACHOS to the ED staff to the patients in the community. Every voice and experience is heard and taken into account,” said Mishel. We are asking non-Aboriginal people to understand the competitive, individualised Western research processes have not worked, we are not getting the data we need, health outcomes for First Nations communities are not improving.

For real, positive change and actual system reform,

respecting the voices, relational worldviews and research process of First Nations People is paramount

“But it’s actually the opposite, it allows for authenticity,” said Mishel. People can (or should be

Continued overleaf

LMHN Regional Review | Issue 6 | Summer 2024

Every voice is heard and taken into account

Aboriginal flag colours with spiral: birth, death and re-birth. Excellence in First Nations health is continuing, even through our experience of colonisation, it is our cultural inheritance. Dr Mishel McMahon

“So all of this extra work in relationship-based research means that when we get to implementation stage, key stakeholders already engaged, they are invested and the probability of meeting the needs of the localised communities is increased.” A monthly Governance Group meeting of around 90 invitees from LMR health services and ACCHO’s has been taking place, And will continue for the duration of the project. Also to address a high level of engagement, Jean McMahon, First Nations Strategic & Partnerships Lead, LMHN recognised that shorter ‘touch-base’ 30 minute meetings would be beneficial for each of the 17 LMHN member hospitals in the region and ACCHO’s in the LMR. Creating another space for truth telling and learning the unique context of each organisation. This has proved to be positive in engaging some healthcare workforce who previously had not, or perhaps felt unsafe to share their concerns. “The touch-based sessions are so important for people to ground and connect, to build that relationship, it’s helping them to focus, and we are engaging people we may not have before,” said Jean. “Also, we’ve had the occasion when a group member has had to leave and attend an emergency. It’s the nature of the work and understandable. Some ED/ UCC and ACCHO staff may be unable to engage, so we are trying to communicate in different ways with as many people as we can throughout this project,” said Jean. Taking pause for action

the 12 month timeline, is there are times due to the reciprocal nature of First Nations-led research when the research group have to ‘down tools’ and reschedule, to address challenges or requests from health services and ACCHO’s. “So for reciprocity to happen, it means that sometimes we stop our planned schedule for the week and attend to a real-time priority, such as completing a rapid review from the literature for a particular hospital / topic or reaching out to a stakeholder a member has identified as pivotal to the project,” said Mishel. Culturally Safe design One of emerging components of Best Practice Framework that’s coming out of the current findings is a need for Cultural Safety in evidence-based design of EDs and UCCs. “In our research we are finding that EDs need to have a space for community, maybe it’s an outdoor area, maybe it’s a bigger room, because a lot of time when First Nations people come in they will come with their family, it’s a kinship system, its collective identities, it’s the extra caring roles people hold, so it’s a bigger group. And if the ED is actually designed in a way to hold that, there’s more chances of First Nations people staying in and getting the care they require,” said Mishel. Solution-based Mishel says to create opportunity for system reform, it means her focus needs to stay on strength based solution, what’s currently working well and what’s not working, and what innovations are occurring nationally and internationally for First Nations

people accessing emergency care. Then through the expertise and leadership of the project’s Governance Group develop a BPF tailored specifically for LMHN members, ACCHO’s and their communities, which is submitted to Department of Health for implementation Stronger partnerships During engagement with Governance Group members ACCHOS are telling us they need data that will allow them to match their services to their communities health needs as reported in the emergency care data,” said Mishel. “Highlighting the necessity for strong partnerships with ACCHO’s in the LMR.” There is a lot of ground to be covered the Discovery stage of this project has revealed many possible components of a BPF. Many of the region’s CEOs and executive staff have engaged with Jean around cultural safety, accountability and white fragility and have started their leaning journey of personal bias, sitting with discomfort and reflecting their own identity. The ‘Narrative Stories’ of the next Dream Stage of the project will ensure we get a real life contextualised solutions from LMR health services and ACCHO’s, that will hopefully enable system reform within our emergency care services, and First Nations communities can regain their excellence in health previously held by their Ancestors.. Lastly Mishel explains, the literature is also stating that initiatives which enable First Nations people better access to emergency care, also improves access, experience and outcomes for many other people groups.

Up Next: ‘Design’ roundtable discussions with Governance Group members to design a final draft of the Best Practise Framework and final stage ‘Destiny’ where the Best Practice Framework will be submitted for implementation to Department of Health and other key stakeholders mid-2024.

Another point of difference of this project, despite

LMHN Regional Review | Issue 6 | Summer 2024

Valuable Online Platform - LMHN SharePoint now Live

Pyramid Hill, Cohuna.

All 15-member health organisations in the Loddon Mallee Health Network can now benefit from a single Share Point or online resource site for all concluded Regional priorities and projects. Loddon Mallee Health Network (LMHN) has been working behind the scenes with Loddon Mallee Shared Services (LMSS) to provide member access to resources in one click, including access to LMHN Governance Documents and Contact Lists, Committee/Network groups Agendas and Minutes. The aim is to support healthcare teams with well- structured and easy to navigate folders containing information and resources including project guidelines, templates, reports, checklists, training and marketing materials. Projects such as the LM Allied Health Project (STAY), Statutory Duty of Candour, Surgery Recovery and Reform, and Perinatal Project will have the same basic structure depending on the size and complexity of the project outcomes. For example: Project Plan / proposal

Di Newell, Regional Chief Information Officer is pleased to finally have a space available where everyone can access these resources. “Our role is to support the health services in the Loddon Malley navigate the challenges in the priority areas and support their teams with information and resources to improve efficiencies and ultimately to give back valuable time to staff for patient care.” All member hospitals in in the LMHN will have read access to everything on the head-quarters site that has been uploaded by a formal process. Content will be reviewed annually.

Our role is to support the health services in the Loddon Mallee navigate the challenges in the priority areas and ultimately to give back valuable time to staff for patient care.

Any questions regarding the Share Point please contact:

Gina Stewart gstewart@lmhn.org.au Executive Governance Support or; Abbie Place, aplace@lmhn.org.au Acting Manager of Regional Programs.

Enter Headquarters member site here: LMHN Members - Home (sharepoint.com)

Approved Regional Documents Contact Details of project lead

LMHN Regional Review | Issue 6 | Summer 2024

Rapidly evolving Loddon Mallee Public Health Unit

The Loddon Mallee Public Health Unit (LMPHU) has been rapidly evolving over the past 6-12 months, as its functions and capabilities in prevention and population health, communicable disease, environmental health and emergency management have expanded. In that time the LMPHU has established a Primary Care and Population Health governance structure, developed the Loddon Mallee Population Health Plan 2023-25, The Climate Change in Health Framework, and transitioned notifiable conditions to local management. The unit aims to collaborate, communicate and build capacity through established and developing networks at regional and sub-regional levels. To do this effectively the LMPHU has set up offices and teams in Bendigo, Castlemaine, Echuca and Mildura. Communication has also been a focus for the unit and has seen the inclusion of the Bendigo Health website LMPHU page, increased targeted public health messaging . Social media and the distribution of the LMPHU Public Health Update has also improved communications. This is a fortnightly publication that provides situational awareness on current public health issues and risks and is shared with regional stakeholders. A communications community of practice has also been established. This allows appropriate messaging and assets to be shared across the region for stakeholders and other organisations to utilise, in turn having better community reach across the Loddon Mallee.

“We’re really excited to see the role of the public health unit consolidate over the last six months and play a growing role supporting the community and our partners across the region,” LMPHU medical director Naveen Tenneti said. LMPHU operations manager Emma Vains shared the same enthusiasm, saying this was an important step forward for the unit. “We’re excited in the public health unit to be part of this evolution and play a growing role in supporting the community and our partners across the region,” she said. Prevention and Population Health The Loddon Mallee Population Health Plan 2023-2025, identified three priority areas of focus, Healthy Food Systems, Mental Wellbeing and Climate Change and Health. Implementation plans were developed in consultation with key agencies within the sub-regions of Loddon, Mallee and Murray. These implementation plans will guide the work over the coming 12 months and will be evaluated against each priority’s objectives. Work is well underway, with the team commencing projects that exhibit place-based initiatives and participation. Healthy Food Systems The Loddon Team has been working alongside Healthy Loddon Campaspe (HLC) to support its Healthy Food System Framework (Flourish). This resource will bring together stakeholders to move

the region’s food system toward a more sustainable circular economy in food production, social equity and increasing healthy eating. The Flourish Framework does not extend to the local government areas of Buloke, Gannawarra, Mildura, and Swan Hill. Consultations were therefore held with stakeholders in these areas to test the applicability of the framework being extended across the region. Participants were impressed but were clear they wanted to undertake the development process to better understand the issues and opportunities of their areas. Because of this, the Mallee team has begun the research and primary stages of putting a Mallee Food Strategy paper together. They have also started work in establishing a Sunraysia Healthy Food Systems Network and Sunraysia Food Relief Network. In the Murray, the LMPHU funded and worked with Njernda Aboriginal Corporation to support the regeneration of an Indigenous garden in Echuca. The team has also supported organisations such as East Wimmera Health Service, Swan Hill District Health and Northern District Community Health to promote healthier more affordable food choices, food sharing events and enhance community gardens. Mental Wellbeing The LMPHU developed a Social Prescribing resource for stakeholders, which can be found here: Social Prescribing (bendigohealth.org.au)

The Loddon Mallee Population Health Plan 2023-2025, identified three priority areas of focus, Healthy Food Systems, Mental Wellbeing and Climate Change and Health.

Robinvale District Health Services

The unit has also joined and provided support to number of groups including the Northern Mallee Regional Mental Health Network and Northern Mallee Integrated Mental Health Network. The Mallee team has worked in partnerships with Robinvale and Mallee Track health services to provide Mental Health First Aid training in Ouyen, Robinvale and Sea Lake. Bendigo Community Health, Dhelkaya Health, Loddon Shire Council, Macedon Ranges Shire, Northern District Community Health, Swan Hill District Health and East Wimmera Health Service are leading projects in each region to provide mental wellbeing and cultural safety training, community mental wellbeing events, support social connection, social prescribing models, suicide prevention activities and supporting sustainability of existing mental wellbeing/suicide prevention networks. Climate Change and Health The team has seen a positive response following the implementation of the Climate Change and Health Framework and subsequently key resources have been developed that support climate action initiatives. The Climate Change and Health resource explains the impacts of climate change on our environment, our

health and co-benefits of climate change action. The Cool Spaces resource was developed to assist with planning, development and utilisation of cool spaces with stakeholders. The Home Upgrades for Climate Resilience Workbook is a new resource that has been developed for households in the Loddon Mallee to assess how their homes may perform in climate events such as fires, floods, storms and extreme temperatures. The workbook identifies priority upgrades that households can undertake to make their home more resilient when these events occur. Visit the LMPHU website for the framework and Climate Change resources such as Cool Spaces, Climate Change and Health and the Home Upgrades for Climate Resilience Workbook. The LMPHU has also been working with health services to support their environmental and sustainability working groups to progress their climate action initiatves. The Mallee team has been working with Mildura Rural City to launch the Cool It Streets Program, which aims to provide quality tree canopy cover by planting semi- mature trees in areas of need. Health protection The unit is working to prepare for local issues around

These resources are currently in development in various languages within our communities. The LMPHU has developed a strong system for awareness of local emergency health risks within the Loddon Mallee region and promote awareness of risks among service providers and provide intelligence and support through amplification of messaging. The team is working through emergency management awareness training to effectively respond to any local emergency management risk supporting department led activities. We have been attending Municipal Emergency Management Planning Committee (MEMPC) meetings across the region and establishing connections with place based agencies to support local emergency health risks within the Loddon Mallee region. Your feedback The team at the Loddon Mallee Public Health Unit welcome your feedback on any issues relating to public health matters. Information can be found at their webpage Bendigo Health Website - Loddon Mallee Public Health Unit or by contacting the unit directly on 1800 959 400 or email LMPHU@ bendigohealth.org.au

communicable diseases, environmental risks and threats and supporting emergency management. A priority for the team has been finalising the transition of the management of notifiable conditions in our region from the Victorian Department of Health to the public health unit. The unit is now the primary point of contact for clinicians and services for receipt of notifications and public health advice for the management of people and settings affected by notifiable conditions (e.g. measles, Japanese encephalitis, COVID-19), with the exception of anaphylaxis, lead poisoning and tuberculosis. Using a place-based approach to notifiable condition management will also equip the public health unit to better identify populations, settings and geographies of higher risk with a view to collaboratively designing preventive programs moving forward. They have also been raising awareness of environmental health concerns, by providing advice

on emerging environmental health threats. The LMPHU has put together resources and

information around summer, heat health, mosquitoes, water safety, sun safety, fire safety and information around bats to share with our community and stakeholders.

Our values: Respect. Integrity. Collaboration.

www.LMHN.org.au

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