Day Stay Unit Development at Canterbury Hospital

This assignment explores the development and implementation of a day stay unit at Canterbury Hospital. The focus is on how this new unit will enhance the environment for clinical practice. It draws upon relevant research and literature to support its arguments.

Running head: PUBLIC HEALTH
Health Service Plan for Women’s Health and Neonatology
Name of the Student
Name of the University
Author Note

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Executive Summary
The health service plan aims to improve delivery of health services and performance of the
healthcare system to better meet the needs of women and neonatal population. It will comprise of
a process that will align the effective delivery of existing maternal, gynaecological and obstetrics
health services to meet the changing need patterns. It will utilize future health resources such as
space, staff and infrastructure to address the issues. This will bring about an new policies and
directions to cater to the emerging health trends and will work to improve better health
outcomes.

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Table of Contents
1. Introduction..............................................................................................................................3
2. Planning principles...................................................................................................................3
3. Goals and strategies..................................................................................................................4
4. Demographic analysis..............................................................................................................6
5. Needs Assessment....................................................................................................................7
6. Service Profile..........................................................................................................................9
7. Current activity levels..............................................................................................................9
8. Catchment and reverse catchment..........................................................................................10
9. Situational analysis.................................................................................................................10
10. Future services and role delineation...................................................................................11
11. Recommendations...............................................................................................................11
References......................................................................................................................................13
Appendix 1.....................................................................................................................................15
Appendix 2.....................................................................................................................................15
Appendix 3.....................................................................................................................................16
Appendix 4.....................................................................................................................................16
Appendix 5.....................................................................................................................................17
Appendix 6.....................................................................................................................................17
Appendix 7.....................................................................................................................................18

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1. Introduction
The Sydney Local Health District aims to achieve excellence in the healthcare services for all
community residents. Its mission is to ensure that the community has adequate access
opportunities to best quality patient-centred care services. It works towards promoting
evidenced-based, efficient, culturally appropriate and timely treatment (Sydney Local Health
District, 2017). It is supported by extremely skilled, accountable and committed staff. A plethora
of research, technologies and education supports the organization.
This report will outline a health service plan for women and gynaecological health services.
The primary aim of the women’s health service plan will be to improve the wellbeing and health
of women who experience poor health in the community. The health service plan will address a
range of preventive services for women without affecting the health quality standards. It will also
offer free medical, nursing, nutrition and counselling services to the women who are vulnerable
in the region. The service will identify women who face difficulty in accessing healthcare
opportunities due to the effect of cultural or language barriers, substance abuse, mental issues,
violence or sexual identity issues.
2. Planning principles
Emergence of health service planning since the past decade represents a major progress and
has introduced an entirely new avenue of opportunities that work to improve the quality, quantity
and effectiveness of environmental and personal health care. The methods that are used in
healthcare planning lead to a more effective involvement of constituency, when compared to

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previous methods. Healthcare planning functions to develop a comprehensive administrative
mechanism (Lewis, 2015). This mechanism ensures sound health program operation. The
planning, reform and performance form an integrated cycle that depends on a variety internal and
external influences and stakeholders.
The service plan will provide several strategies and high direction level for the development,
reform and investment related to the service. Proper planning will be needed to built the delivery
models or meet the needs of the target population. The reforms, values, processes and behaviours
will be taken into account during its implementation (Fahey & Shenassa, 2013). It will help in
keeping a track of the positive effects or improvements in patient outcome. Moreover, effective
budget management and staff retention will play an essential role in the planning.
3. Goals and strategies
GOALS STRATEGIES
ObjectivesStrategiesformulationImplementationPerformancemonitoringReviewandevaluation

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Patient-centred care Promoting consumer, family and community
centred care for fostering collaborative
partnerships within the private, public and non-
government health sectors (Elwyn et al., 2014).
Within communities Abiding by the National Safety and Quality
Health Service Standards (NSQHS), the health
partners, service staff, local citizens,
stakeholders, carers and consumers will be
involved and engaged in the planning and
implementation process.
Safe and high quality service delivery Focusing on safe and appropriate healthcare
service delivery. Innovative clinical practices
and delivery models will be used in
combination with evidence-based,
contemporary clinical standards and policies
(American College of Obstetricians and
Gynecologists, 2014). The planning and
reforms will be built on strong qualitative and
quantitative data.
Improving population health Investing in the services for achieving health
gains for large number of women and neonates
to reduce mortality and morbidity.

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Accessible services Delivering services closer to homes will
preserve the quality, safety and sustainability
of the plan. The service will be provided at
local, district and state-wide health centres
(ten Hoope-Bender et al., 2014).
Workforce development Optimizing professional and specialist services
for effective support to the staff. Innovative
workforce systems and health practitioners will
be employed. Strategic workforce planning will
enhance staff retention.
Sustainable services Building women capacity to contribute to their
wellbeing and collaborative resource sharing
will increase effectiveness of the resource.
Value for money will further reduce the length
of hospital stays; promote early intervention
and illness prevention.
4. Demographic analysis
Social and demographic data from the Women’s Health, Neonatal services of the Sydney
Local Health District are needed to support the health service planning in the target population.
The SLHD comprises of 8 local government areas namely, Burwood, Ashfield, Canada Bay,

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Canterbury, Leichhardt, part of City of Sydney, Strathfield and Marrickville. The current
population of the district is around 582,100 and is expected to reach 642,000 by 2021 (Sydney
Local Health District, 2017). The population has shown significant increase of 16.7% since
2001-2011. This increase creates a pressure on the health of women and neonates across the
community. The population projection for all the areas is estimated to be from 531,624 in 2006
to 725,751 in 2036 (Appendix 1). A significant increase in the number of neonates was observed
during 2005-2010 (Sydney Local Health District, 2017). There were an additional 1800 births
every year. The total births in 2005 were 86,589, which showed a huge increase to 95,918 in
2010. A large increase in the birth rate has been observed in Marrickville and Canterbury
(Appendix 2). Moreover, demographic data analysis suggest that the presence of 145,823 women
in 2011, who were aged between 15 to 44 years. The highest proportion of women belonged to
the 20-24 year age group (50.3%) (Appendix 3).
5. Needs Assessment
The needs assessment will include an analysis that will be based on the benchmarks for
newborn and maternal care readiness. The need assessment will act as an effort that will focus on
the critical issues that need attention in the district. It will be thoughtfully designed and will
identify the characteristics and needs of the women and neonates living in the community. A
survey instrument, containing close ended questions will be created. These questions will focus
on maternal health. The instrument will be tested on the target group. It will involve training of
women volunteers as survey administrators (Tamrat & Kachnowski, 2012). Thorough training
will be provided on issue sensitivity, definition of relevant terminologies and protocols for the
administration of the survey. Data from the clinical stream indicate that efficient obstetric
services are provided by the Canterbury and the RPA maternity, neonatal and gynecological

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service. RPA accounts for about 5,500 births per year and the Canterbury hospital services
helped in 1700 births in the year 2012 (Sydney Local Health District, 2017). However, less
maternity and neonatal services are available at Concord and Balmain. Although, Concord
gynaecological service addresses menopause, emergency situation and gynaecological surgeries,
no such provisions are available at Balmain. The data showed a huge prevalence of teenage
pregnancy among the women (49.4%). Teenage parents and their children are vulnerable to poor
health outcomes. It is associated with socially excluded and deprived young people. Low self-
esteem, poor family relationships and unhappiness at schools act as risk factors. This creates
serious consequences on women health and wellbeing (Craine et al., 2014).
Career prospects and higher education get limited. Therefore, the need is to provide means of
early pregnancy avoidance to young women. This will contribute to reducing social exclusion
and inequalities. The health service plan will make well published sexual health advices and
contraceptives available to young people. It will lay a high strong focus on building target
interventions for the target population who are at a risk. Substance misuse and reproductive
health education needs to be made accessible for the youth. The need assessment will also
investigate the factors that contribute to perinatal death. It will evaluate the role of antenatal and
perinatal care, maternal age, marital status, chronic maternal disease, social factors, immigration
and tobacco consumption on perinatal mortality (Yasmin, Kumar & Parihar, 2014). Low birth
rate is the most common factor responsible for perinatal death. It occurs due to congenital
malformations, teenage pregnancy, poor socio-economic background, plural pregnancy, smoking
and drinking. The need assessment will therefore help in developing strategies to increase
awareness on high risk pregnancies. It will provide the scope to promote referral pathways that
will help in reducing neonatal mortality.

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6. Service Profile
 RPA Hospital- It is a tertiary referral obstetric service and contributes to more than 5,500
births per year. The clinical stream includes 7 departments such as high and low risk
obstetrics, infertility, neonatology, benign gynaecology and ultrasound wards. The
Neonatal Intensive Care and Women’s Health ambulatory care service caters for 1,000
and 55,000 admissions, every year. There are several maternity care models. The
maternity inpatient service contains 83 beds (11 for delivery ward, 13 for birth centre, 54
postnatal and 15 antenatal) (Sydney Local Health District, 2017). There exist provisions
for lactation and parent education, midwivery practice, infertility service and early
pregnancy assessment services. 4 gynaecological beds, 12 high dependency, 10 ventilated
and 12 special care cots are available (Appendix 4).
 Canterbury Hospital- A level 4 obstetric service caters to medium and low risk obstetrics.
There were 1700 births in 2012. 14,600 admissions of ambulatory care service occur per
year. Low risk midwifery case models of care exist. The maternity service has 6 bedded
birthing units, 22 bedded antenatal or postnatal ward, and special care nursery with 8
beds, emergency services, lactation services, and elective surgery ad midwifery practices.
 Concord Hospital- It has outpatient clinics, emergency services and provisions for benign
gynaecological surgery (Appendix 5).
 Balmian Hospital- It does not have any maternity, gynaecological or neonatal service.
7. Current activity levels
Maternity services in Sydney Local Health District have shown an increase in birth rates over
past 10 years. Maximum increase has been observed in the RPA hospital. A data analysis of
patient outflow for maternity services in beddays 2010-11 show maximum outflow to other

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SLHD hospitals (77% for antenatal services, 68.3% for vaginal delivery, 64.4% for postnatal
services and 60.1% for caesarean delivery services). Outflow to private hospitals was highest for
caesarean delivery (Appendix 6). Lowest outflow was observed to other states for all 4 services.
SWSLHD, overseas and SESLHD showed maximum inflow for maternity services (Sydney
Local Health District, 2017).
8. Catchment and reverse catchment
A state-wide catchment would be needed for effective implementation and success of the
healthcare plan. Of the 8 local government areas, Concord and Balmian hospitals donot show
access to good maternal, neonatal or gynaecological health services. Therefore, the health service
plan needs to be applied to these regions to provide good healthcare opportunities to the women
residents. Another area of priority is Aboriginal health. There are several disparities in pregnancy
related outcomes among Aboriginals. The reverse catchment area would be South Western
Sydney Local Health District and South Eastern Sydney Local Health District since, there is less
patient outflow to these 2 regions.
9. Situational analysis
The RPAH gynecological services contain specialists and generalists. Appointment should be
made on the basis of predominance in practicing operative gynaecology.
 There are 3 gynaecologists at present in RPAH, on call for emergency services. 1 is
involved in elective operating lists and will retire in 5 years. Another has elective
operating lists if a vacancy arises. No on site gynaecology registrar is present for most of
the week.

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 Inadequate floor space in RPAH neonatology and obstetrics services needs to be
addressed.
 Absence of defined budget to replace neonatal intensive care equipment is another issue.
 Voluntary efforts of the staff, donors, parent s and charities sustain the units.
 More than 1200 cases of monitoring outpatient fetal heart rate are performed in RPAH
birth units.
10. Future services and role delineation
Future services include expansion of neonatology and obstetric services at RPA hospital. The
bed numbers and floor space needs should be increased. An increase in midwifery staffing and
neonatal and medical nurse practitioners would be required (Yelland et al., 2013). Administrative
and neonatal ambulatory services will be relocated to separate region. The future services would
also include expansion of obstetric facility with respect to staffing and space at Canterbury
Hospital.
Role delineation will determine that safety standards, staff profile are adequate to ensure safe
clinical services. No major changes are planned for the next 5 years (Appendix 7).
11. Recommendations
Thus, it can be concluded that there is a need to expand women’s health and neonatology
services over the next 5 years. There has been a huge increase in birth rates, with 7,000 births in
2011 at RPAH and Canterbury Hospital. This led to expansion of the facility at RPAH. The
recommendations are stated below:
 Establishment of gynaecological day stays at Canterbury or RPA hospital

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 Consolidation of gynaecological data at RPAH for including Concord and Cantebury
facilities.
 Development of Walk in women assessment care in RPAH.
 Development of day stay unit at Canterbury hospital.
Their effective implementation will work towards producing a better environment for clinical
practice.

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References
American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary
cesarean delivery. Obstetric Care Consensus No. 1. Obstet Gynecol, 123, 693-711.
Craine, N., Midgley, C., Zou, L., Evans, H., Whitaker, R., & Lyons, M. (2014). Elevated teenage
conception risk amongst looked after children; a national audit. Public Health, 128(7),
668-670.
Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared
decision making and motivational interviewing: achieving patient-centered care across
the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.
Fahey, J. O., & Shenassa, E. (2013). Understanding and meeting the needs of women in the
postpartum period: the perinatal maternal health promotion model. Journal of Midwifery
& Women’s Health, 58(6), 613-621.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five
approaches. Health promotion practice, 16(4), 473-475.
Sydney Local Health District. (2017). Women’s Health, Neonatology and Paediatrics Clinical
Stream Position Paper. Retrieved 21 October 2017,
from https://www.slhd.nsw.gov.au/planning/pdf/Womens_Health_Neonatology_and_Pae
diatrics_Clinical_Stream_Position_Paper.pdf

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Tamrat, T., & Kachnowski, S. (2012). Special delivery: an analysis of mHealth in maternal and
newborn health programs and their outcomes around the world. Maternal and child
health journal, 16(5), 1092-1101.
ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., ... &
Renfrew, M. J. (2014). Improvement of maternal and newborn health through
midwifery. The Lancet, 384(9949), 1226-1235.
Yasmin, G., Kumar, A., & Parihar, B. (2014). Teenage pregnancy-Its impact on maternal and
fetal outcome. International Journal of Scientific Study, 1(6), 9-13.
Yelland, A., Winter, C., Draycott, T., & Fox, R. (2013). Midwifery staffing needs; patterns of
variation in demand and capacity, and their possible effects. Bjog: An International
Journal of Obstetrics and Gynaecology, 120, 472-473.

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Appendix 1
Appendix 2

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Appendix 3
Appendix 4

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Appendix 5

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Appendix 6

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Appendix 7