From the Chief ExecutiveWelcome to the first edition of Compass, the official newsletter of NSW Health Pathology.

Compass will highlight the organisation’s achievements and priorities and the interesting projects happening across the state. It will also showcase the people of pathology.

The Director General approved the establishment of NSW Health Pathology in November 2012 after an extensive consultation period. Working with our public pathology services over the last 18 months, and particularly in my six months as Chief Executive, I’ve come to see that our people are our greatest strength – and our talent pool is getting even stronger.

Since NSW Health Pathology was officially created in late 2012, we have established our nine-member board which is chaired by Dr Steve Flecknoe-Brown, a practicing clinician from

Broken Hill and the former chair of the Western NSW Local Health District Board. You’ll hear more from him in the next edition of Compass.

Professor Roger Wilson, former Executive Director of the South Eastern Area Laboratory Service, joined us in April as Chief Pathologist.

The executive team has welcomed two recent appointments: the Director of Communication & Stakeholder Engagement Carina Bates and the State-wide Manager of Planning and Performance Dr Sue Carter.

And applications have recently closed for the organisation’s Chief Medical Laboratory Scientist. I look forward to sharing good news on this front soon.

The Executive Team will corral the leadership, financial, workforce, and corporate skills to make our public pathology services even stronger – and ensure our clinical teams can continue to focus on what they do best.

The state government has given us a very clear mandate: create a truly integrated public pathology service that achieves the benefits of scale and coordination while also delivering safe, technologically advanced, and reliable services

that are accessible across our metropolitan, regional and rural communities.

It’s a tall order and will require new ways of thinking and working together. But I’m already seeing great strides, and collaboration is key.

From budgeting and pricing, to procurement, benchmarking and information technology, we have put the right people in the same room and asked them to start thinking differently. To consider not just their local needs, but what we all need to do to deliver on the mandate.

That collective approach is reaping benefits in other arenas. We are getting better traction with many of our local

health district partners, although there is more to do, and we have a seat at the table on a number of state-wide issues that affect pathology’s future.

I know we have a lot of work ahead in areas like workforce, strategic planning, and developing strategies to maximise pathology assets and logistics, just to name a few.

I’m confident we are stronger and can achieve more if we do it together, and I look forward to sharing the journey with you.

I’m confident we are stronger and can

achieve more if we do it together, and I look

forward to sharing the journey with you.

Compass is a publication of NSW Health Pathology

compassISSUE 1 MAY/JUNE 2013NEWSLETTER

• I N F O C U S •

Dr Sue CarterManager State-wide Planning and Performance

What do you love about your role in pathology?

Having the opportunity to work with a new group of people as part of a new organisation.

I’m responsible for facilitating a state-wide approach to planning and performance. That involves learning from the work that’s been done before and then

building processes and systems that see the NSW Health Pathology executive working together with the five networks, including the Forensic Analytical Science Services (FASS), to develop plans and performance measures that are meaningful and help make our services even stronger.

What does a typical day at work involve?

I came on board in April after 34 years with Hunter New England Local Health District, so I’m still finding my feet. I’ve been out and about meeting with the pathology network directors, operational managers and leadership within FASS to talk about how they’ve managed planning and performance.

What improvement are you working on to strengthen pathology services in NSW?

My first priority is to develop a draft five-year strategic plan for NSW Health Pathology. We’ll be hitting the road soon to share the draft with staff across NSW and give them a chance to provide input.

I’m also working on a performance management framework that will give us better insight into our performance as a state-wide service, but also see more clearly how each sector of pathology is performing at a local level. With this the networks can learn from each other by seeing what’s working well and where we can improve.

Who are some of the people you admire most?

Barack Obama – he is a true statesman. But mostly my mum. For the past 20 years she has been a carer – first for my dad, then my grandmother and now her disabled brother. She is truly selfless.

What is your favourite charity or cause ?

Medecins Sans Frontieres (Doctors Without Borders). They are wherever needed without fear or favour. The volunteer health professionals provide care for some of the most vulnerable people in the world and do so in very difficult circumstances.

Change or status quo?

Both have their place, but for me in this role at this time, it is all about change and that’s exciting.

Chocolate or strawberries?

Chocolate, because it makes everything better. Is there really any debate?

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NSW Health Pathology Board

Dr Steve Flecknoe-Brown (Chair), Clinician

Dr Kerrie Chant, Chief Health Officer for NSW Health

Associate Professor Peter Stewart, Network Co-Director, Sydney South West Pathology Service

Dr Stephen Braye, Network Director, Pathology North

Professor Graeme Stewart, Director, Clinical Immunology & Allergy, University of Sydney

Dr Bruce Sanderson, Director, Clinical Governance, Central Coast Local Health District

Murray Austin, Technical Operations Manager, University of Western Sydney

Ms Kay Hyman, Chief Executive, Nepean Blue Mountains Local Health District

Ms Vickie Taylor, Chief Executive, Northern Sydney Local Health District

NSW Health Pathology Executive Team

Tracey McCosker, Chief Executive

Professor Roger Wilson, Chief Pathologist

Under recruitment, Chief Medical Laboratory Scientist

Professor Dominic Dwyer, Network Director, Pathology West

Dr Trevor Cobain and Dr Rob Lindeman, Network Co-Directors, South Eastern Area Laboratory Services

Professor David Davies and Associate Professor Peter Stewart, Network Co-Directors, Sydney South West Pathology Service

Dr Stephen Braye, Network Director, Pathology North

Kevin Forward, Director, Forensic Analytical Science Service

Vanessa Janissen, Director Corporate Strategy, Systems and Support

Martin Sainsbury, Director, Workforce and Culture

Tom Hoppe, Director of Finance

Michelle Williams, Director, Management Accounting and Revenue Services

Sue Carter, Manager, State-wide Planning and Performance

Carina Bates, Director, Communication & Stakeholder Engagement

Financial foundations more than just numbers

One of the keys to success in any critical service – public or private – is to get the financial foundations right.

And that’s just what teams across the NSW pathology system have been working together to do.

Priority number one: develop 12-month operational budgets and establish a clear budget management framework for all sectors of NSW Health Pathology.

The organisation’s Director of Management Accounting and Revenue Services, Michelle Williams, spearheaded the process and found that building the budgets was more than just crunching numbers.

“At the outset, we had five pathology networks, each of which had built and managed their budgets in different ways,” she said.

“We had to get those systems speaking the same language and reporting the same data.”

The solution: establish detailed, transparent budgets based on the same set of ground rules, formulas and principles.

Simple enough, Ms Williams thought, but what she didn’t expect were the flow-on benefits.

“The budget building process was actually a vehicle for building relationships, trust and greater understanding of the many facets of pathology,” she said.

“We now have many more people actively engaged in the finances

and learning from one another. That includes operational leads, management accountants and individual cost centre managers.

“This has led to greater faith in the process and the data – and greater confidence in making decisions that affect the bottom line.

“Most importantly it helped people establish some really critical relationships that will carry us forward as a unified team, “she said.

The budget build-up work has been complemented by a fee-for-service framework that more clearly defines the cost recovery approach across all of the public pathology networks in NSW.

Vanessa Janissen, Director of Corporate Strategy, Systems and Support, said having all of the networks on a standardised cost recovery model was a key goal in the early days of NSW Health Pathology.

“When NSW Health Pathology came to be, we had very different cost recovery models across the various networks,” she explained.

“Having a standard model based on activity was about three things: building consistency, building transparency and building trust.

“The process is giving us a better handle on the revenue we’re generating and how to plan for the future, but it’s also helping us build stronger relationships with our partners, especially the local health districts.

“We’re engaging more closely with them and sharing clear, sound data about the services we’re providing.”

But that’s just the first step in pathology’s pricing journey.

The next phase is to break down the various revenue segments and take a closer look at the most appropriate way to charge for different pathology services in the future, the rates to use, the activity levels and how to deal with extra unplanned activity.

“We need to create the standards, put rigour around the processes, and work with our partners to ensure they have confidence we are delivering quality while being as cost efficient as possible,” she said.

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Michelle Williams (front) and members of the NSW Health Pathology finance team Kate Peddie, Peter Williams, Kelly Woods, Tom Hoppe, Rhys Tippet and Vijay Tharumakulasingam

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• P E R S P E C T I V E •

A new era for virology

By Professor Roger Wilson, Chief Pathologist, NSW Health Pathology

I recently opened the 10th Viruses in May conference, which gave me the opportunity to reflect on the changing nature of virology and pathology in general.

It’s hard to believe that SARS first occurred 10 years ago. It’s been nearly 20 years since Hendra virus made its dramatic appearance in Queensland, 30 years since HIV, and 60 years since James Watson and Francis Crick described the structure of DNA.

When I started my pathology training back in 1980, laboratory virology was tedious and had limited impact on patient care. How times have changed.

The last 30 years have been a golden age for virology, with incredible advances in laboratory methods and greater understanding of serious conditions that affect millions of people worldwide. This has given rise to effective antiviral treatments.

Today, HIV is considered more of a chronic disease than the grim reaper of its early days. A cure for Hepatitis C appears to be in reach, and young

women worldwide have access to a vaccine that fights cervical cancer.

It took 12 years to discover the influenza virus behind the 1918 pandemic which killed 50 million people. Now when a flu outbreak occurs, we can learn vast amounts about the strain, its genotype and its genealogy in a matter of days.

Just as the discipline of virology has changed, so has the nature of viruses themselves. The number of new and re-emerging pathogens in on the rise, with many linked to serious illness.

In 2005 it was reported (Woolhouse and Gowtage-Sequeria) that there were 1407 human pathogen species. Of these, 177 were developing (like SARS or HIV) or re-emerging (like tuberculosis or malaria). Just 207 were made up of viruses and prions, but this group accounted for 43% of the emerging or re-emerging pathogens.

So the need for reliable and responsive virology has never been greater, and

its ongoing evolution is part of a fundamental shift that’s taking shape across the many disciplines of pathology.

It’s a shift that is moving us from simply looking at surrogates for the causes of disease, to identifying and directly targeting the underlying cause with new tools.

Today, we can rapidly and reliably detect the presence of a vast range of viruses from clinical specimens, characterise them individually and understand the probability of a particular patient’s response to a particular treatment. Now that’s personalised medicine.

And these advances aren’t limited to virology. With cancer, like viruses, the genome determines the characteristics and behaviour of tumours. With affordable mass scale DNA sequencing imminent, the genetic change in tumour cells will be identified, analysed and linked to prognosis – which will drive new and better treatment options.

We are entering a new era in pathology – one that will see the microscope’s 150-year domination challenged by other tools looking at DNA, RNA, proteins and the bioinformatics associated with the masses of data that will be generated.

Whole new fields and skillsets will be required. And trainees starting out today will see their fields revolutionised, even more so than the past 30 years.

These are exciting times for pathology, full of innovation and ingenuity. Buckle up – it’s going to be a great ride.

The need for reliable and responsive virology has

never been greater, and its ongoing evolution is

part of a fundamental shift that’s taking shape

across the many disciplines of pathology.

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Forensic pathology staff in Sydney have contributed to a Boston University study looking at the connection between high-impact sports and a degenerative brain disease.

The research involves analysing brain matter from deceased former athletes who played in some of America’s roughest contact sports, including American football and ice hockey.

Researchers are testing specimens for a condition called CTE – chronic traumatic encephalopathy – which is associated with dementia. It’s believed CTE is caused by repeated concussions and sub-concussive hits to the head.

The Australian connection came about following the death of former NSW Waratahs rugby coach Barry ‘’Tizza’’ Taylor, who died in late April.

Mr Taylor’s family, who had learned of the Boston University study some time before Barry’s death, requested his brain be sent to Boston for inclusion in the research. It’s believed his is the first Australian specimen included in the research.

Barry Taylor played 235 games for the Manly Rugby Club before moving on to coaching. He began showing signs of early dementia in his 50s and his condition worsened until his death in last month at the age of 77.

Professor Jo Duflou (pictured), clinical director with the Department of Forensic Medicine in Sydney, said honouring the family’s request to donate Mr Taylor’s brain to the research project required quick action and strong collaboration.

“We needed to liaise with many partners – from Mr Taylor’s family to the funeral director, the team at Boston University, the international courier service and staff at the Royal College of Pathologists Australasia,” Professor Duflou said.

“And we had to do it swiftly and with sensitivity for the Taylor family, who had just lost their loved one and needed to prepare for his funeral.

“The Chief Executive of the College contacted me the afternoon of 29 April about the family’s request, and by the afternoon of 1 May the tissues had been removed and were being prepared for transport to Boston.”

Professor Duflou said the project reinforced that the work of forensic pathologists stretches beyond the traditional perception of simply performing autopsies.

“Through forensic science we can now characterise novel diseases and genetically inherited conditions, which is extremely important for many families,” he explained.

“CTE and its relationship to apparently

minor concussive injury is a condition that has only recently been identified as a significant public health issue, thanks to detailed examination of the brain and clinical links made by forensic pathologists.”

The Boston University research and the role of the Sydney forensic team will be featured on an upcoming story for Channel 7’s Sunday Night program (date to be determined). For more information, visit Boston University’s Centre for the Study of Traumatic Encephalopathy at www.bu.edu/cste.

FACT CHECK• CTE is a degenerative brain

disease found in athletes and others with a history of repetitive brain trauma.

• The trauma triggers progressive degeneration of brain tissue and build-up of a protein called tau which gradually affects cells.

• Changes can begin months, years, or even decades after the last brain trauma.

• CTE is linked to memory loss, impaired judgment, aggression, depression, and progressive dementia.

Source: Centre for the Study of Chronic Traumatic Encephalopathy

Forensic team plays part in Boston brain research

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E-payslips for pathology staff All NSW Health employees, including pathology staff, are moving to e-payslips and e-payment summaries.

This means you’ll be able to access your pay information faster (on the same day as funds are deposited) from any location.

The rollout for NSW Health Pathology staff will be staggered and at this stage will likely begin in late June or July.

StaffLink is a web-based program you can access online from work or home. You have the option of logging on to StaffLink to view and print your pay details, or you can elect to receive your payslip automatically via email each fortnight.

If you don’t already know them, your StaffLink log in details are available from the HealthShare NSW State Wide Service Desk (1300 285 533), and detailed instructions for accessing your pay information online are available from http://intranet.hss.health.nsw.gov.au/__data/assets/pdf_file/0006/159261/StaffLink-v12. 1-ESS-Participant-Guide-Final.pdf

Payslips via emailIf you are already paid via StaffLink, you may have already made arrangements to receive your payslips electronically via email, in which case this will simply continue.

If you would like to receive your payslip via email and haven’t already activated this function, please log on to StaffLink to nominate a personal or work email address. Please note you will not automatically receive an email payslip. You do need to log on to StaffLink to activate this function and nominate a preferred email address.

For more information about StaffLink, e-payslips and e-payment summaries, please visit the HealthShare NSW Intranet (http://intranet.hss.health.nsw.gov.au).

Other benefits include:

• addedsecurityofyour personal information, by removing the risk of paper payslips being lost or stolen

• accesstomoredetailedpayand entitlement information

• environmentalandcost savings by removing the need to print and deliver over 120,000 paper payslips across NSW Health each fortnight.

• N E W S B R E A K •

Coronavirus affects 55 worldwide A novel coronavirus called Middle East Respiratory Syndrome Coronavirus or MERS-CoV has so far affected over 55 people world-wide, resulting in about 30 deaths to-date.*

Investigations are underway to determine the source of MERS-CoV and how it spreads.

Professor Bill Rawlinson, Director of Virology at South Eastern Area Laboratory Services, recently contributed to a live BBC radio program about the virus.

Diagnostic testing in NSW is only available at Pathology West’s ICPMR facility at Westmead, which contains the State PC4 Biosecurity Laboratory where emerging pathogens are handled.

First identified in 2012, MERS-CoV is from the same family of viruses as the one that caused the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, which killed about 770 people.

Coronaviruses cause respiratory infections in humans and animals. They can lead to pneumonia and sometimes kidney failure.

Human cases of MERS-CoV have been detected in Saudi Arabia, Jordan, Qatar, the United Arab Emirates (UAE), Germany, the UK, France, Italy and Tunisia.

The most recent World Health Organisation update indicates all the European cases have had a direct or indirect connection to the Middle East, including some with recent travel history from the UAE.

*Sources: World Health Organisation, Centres for Disease Control and Prevention, and BBC news online. Figures current as of 6 June 2013.

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NSW Health Pathology will partner with two hospital blood bank laboratories to look at ways to reduce red blood cell waste.

Blood products are a precious resource, and good inventory management is essential not just for the operation of labs but for quality patient care.

Not holding enough stock can hamper clinical care or disrupt routine services. Having too much can affect the viability of products and increase waste.

The National Inventory Management Framework aims to define the optimal inventory level of red cells within the blood sector and develop better processes for effective inventory management.

A ‘proof of concept’ was conducted with the Royal Brisbane and Women’s Hospital in November 2012, which saw a 27% reduction in inventory held by that hospital.

The hospital was able to reduce the number of daily deliveries and still maintain optimal levels of supply, with no increase in the number of urgent orders.

It has since maintained the revised red cell inventory levels and delivery arrangements put in place by the project team.

NSW Health Pathology will partner with laboratories at John Hunter Hospital in Newcastle and the Royal Prince Alfred in Sydney to pilot the

methodology established at the

proof of concept site. Work is

expected to begin later this year.

Additional pilots will be carried

out in other states as well.

Learnings will contribute to

improvements in the effective use of

blood and blood products and may

support requirements of Local Health

Districts per National Safety and

Quality Health Service Standard 7 –

Blood and Blood Products.

The National Inventory Management

Framework is a collaborative effort

between the National Blood Authority

Australia and the Australian Red Cross

Blood Service.

Pathology partners in red cell pilot

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Why Compass?We named the newsletter Compass to reflect the geographic references for many of our services. Pathology North, Pathology West, Department of Forensic Medicine (Newcastle), etc.

It also underscores our commitment to providing quality services across the vast expanse of NSW, including metropolitan, regional and rural communities.

Compass is published every other month by NSW Health Pathology. Staff contributions are welcome but may be edited for length and publication style. To share feedback or contribute content, contact the editor.

Editor: Carina Bates, NSW Health Pathology

Phone: (02) 4924 6717 Email: carina.bates@hnehealth.nsw.gov.au

Comment on Compass We want Compass to be interesting, relevant and something you want to read. So help us make future editions even better by sending us your ideas and feedback. • Have a personal or team

achievement you want to share? • Working on a collaborative project

that will make a positive difference to public pathology services?

• Know an interesting character to profile in our InFocus section?

Send your suggestions to the Compass editor at carina.bates@hnehealth.nsw.gov.au.

Staff to have say in setting directions“You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose.”

They may be simple words from the whimsical world of Dr Seuss, but they hold real meaning for anyone setting out on a new path.

So what’s the direction for NSW Health Pathology?

Staff will have a chance to help answer that question through a series of consultation workshops designed to help shape the organisation’s strategic plan.

The plan will set the overarching direction for NSW Health Pathology over the next five years, serving as a road map of sorts for how we deliver services across the state.

Dr Sue Carter, State-wide Manager of Planning and Performance, said having a strategic plan is critical for any successful organisation, especially a new one like NSW Health Pathology.

“Our plan will capture the vision, values and key priorities for the organisation,” she said.

“It will be built with staff input and will give everyone a clear sense of what NSW Health Pathology is trying to achieve and how it plans to get there.

“Most importantly it will show staff how the work they do contributes to our shared goals and outcomes.”

Some initial work has been done to develop a set of draft strategic directions and initiatives. Those will be road tested and strengthened based on input from clinicians, managers and staff.

Planning is underway to organise between 40 and 50 workshops which will be held at various sites across NSW over the next several months.

The workshops will be run by NSW Health Pathology’s Chief Executive Tracey McCosker, Dr Carter and Vanessa Janissen, the Director of Corporate Strategy, Systems and Support.

The team is also exploring ways to make the workshop materials available electronically, for those who might not be able to attend a scheduled session in person.

Details on the strategic plan consultation workshop schedule will be shared broadly once finalised.

Opening quotation from the book ‘Oh, The Places You’ll Go’ by Dr Seuss.