Page 3252 - Week 09 - Tuesday, 21 August 2018

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Subsequently, ACHS provided ACT Health with a period of 90 days to remediate those matters that did not meet the 33 core criteria. ACT Health was re-assessed on its implementation of these not met criteria through a process called an advanced completion survey. Two surveyors from ACHS conducted this survey on site at Canberra Hospital and Health services between 3 and 5 July 2018.

ACT Health staff have risen to the challenge to address the 33 core criteria. I can advise you that ACT Health has made all the improvements necessary to achieve re-accreditation. I can further advise that ACT Health has been awarded re-accreditation for a further three years, which is the maximum allowable period. The surveyors were highly complementary of the improvements ACT Health and its staff have made since the initial site visit in March 2018.

The final accreditation survey report observed that ACT Health underwent significant transformation to address the improvements required. It further noted that ACT Health has taken the necessary steps to ensure the implementation of sustainable systems and processes that provide direction and strong governance from both a corporate and clinical governance perspective. The surveyors acknowledged, and were impressed by, the extensive work undertaken, staff engagement, leadership and commitment to achieve this result and to drive positive change in the culture of the organisation.

ACT Health was observed to have a positive culture of cohesion and teamwork, as well as a commitment to the delivery of safe and effective care. This has enabled the organisation to achieve great outcomes for all Canberrans. The surveyors are confident that ACT Health will sustain these achievements due to the systems and processes implemented and its commitment to delivery of excellent and safe health care.

Examples of the exceptional improvements that ACT Health have achieved include the active management of ligature points by ACT Health whilst still ensuring a recovery-focused environment for the consumer. The surveyors acknowledged the leadership of the mental health, justice health and alcohol and drug service division and the large body of work undertaken to address the recommendations.

The staff and leadership team in food and environmental services at ACT Health demonstrated to surveyors a can-do approach through the implementation of sustainable improvements. Surveyors commended ACT Health staff on their collaboration, leadership and commitment to improve the standards of care evident across the multidisciplinary team.

The surveyors applauded ACT Health for the positive and direct action that has occurred over the past three months in improving compliance with the use of the surgical safety checklist. A robust and sustainable policy, including performance escalation pathways for ongoing individual non-compliance, has been implemented. Effective communication and education processes have also been implemented to support staff and ensure that they sustain this improvement.


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