Establishment of a community advisory committee at a major teaching hospital.

Austin Hospital is located 14 kilometers from the center of Melbourne, Victoria, Australia, and serves a population base of some 500,000 people. The hospital has 568 beds and receives referrals locally, statewide, nationally, and internationally. Unlike some other major teaching hospitals in Melbourne, Austin is situated outside the main business area and hence has a defined geographic community as its referral base.

In 1987, as part of its Health Service Agreement with the Victorian Health Department, Austin Hospital included a clause to the effect that a Community Health and Rehabilitation Advisory Committee would be established, with the aim of improving patient care, including rehabilitation and domiciliary care, through consultation with the community and community-based agencies. It was decided to invite representatives from:

* District Health Councils in the hospital's catchment area.

* Community Health Centers with Austin Hospital nominees on their Boards of Management.

* The Royal Australian College of General Practitioners.

* The District Nursing Service.

* The Disability Advisory Council of Australia and the Australian Council for Rehabilitation of the Disabled (consumer representatives).

* Local government.

* Community Services Victoria.

* The Department of Health's regional office.

* The Board of Austin Hospital.

The Director of Medical Services at Austin Hospital was asked to chair the Committee, and it was decided that there should be one other representative from the hospital sitting on the Committee.

Establishment of the Committee

The agenda for the first meeting of the Committee, Feb. 25, 1988, was to determine the name of the Committee, its aims and terms of reference, and its working parties. The Committee was the first to be established in the State of Victoria, although the hospital has since had many inquiries from other hospitals wishing to establish similar structures.

A decision was made at the first meeting to use the name "The Austin Hospital Community Advisory Committee," and that name is still current. The terms of reference agreed to were:

* To promote improved communication between Austin Hospital and the community.

* To identify resources currently available to facilitate patient care in the hospital's primary catchment area.

* To identify resources required to improve patient care in the above area.

* To develop health education and preventive medicine programs aimed at both the general public and health care professionals.

* To identify and pursue health issues of community concern.

It was agreed to establish four working parties:

* A Patient Care Issues Working Party to consider access to hospital and community health services, needs of the ethnic community, women's health issues, consumer satisfaction, informed consent, review of patient relations with the hospital, and information provision for the print handicapped.

* A Rehabilitation and Domiciliary (including Palliative) Care Working Party to consider coordination of institutional and ambulatory rehabilitation services; domiciliary care for the aged and/or disabled, including hostel and nursing home arrangements; domiciliary care of the terminally ill, particularly those with cancer; links between institutional and domiciliary care, including home support services; discharge of patients (protocols to ensure that these patients are looked after at home); provision of support to enable discharged patients to rejoin the workforce where possible; and facilitation of better understanding between the hospital and Community Services.

* A Health Education and Promotion Working Party to consider facilitation of education between health care professionals; promotion and rationalization of health education programs, using resources for both the hospital and the community; improvement of quality of life; and prevention of disease and injury.

* A Demography and Epidemiology Working Party to consider demography of available health care facilities and personnel (service mapping) and identification of trends in disease states in the local population. This working party met for six months; fulfilled its terms of reference; and, as there was no ongoing business, ceased to meet.

The Community Advisory Committee meets bimonthly and receives minutes in writing from each of the working parties, with the chair of each working party, who sits on the Community Advisory Committee, speaking to the minutes and answering questions. The Community Advisory Committee also considers items of business in its own right, refers issues to the working parties, gives direction where required to the working parties, and usually invites a guest speaker to address the meeting at the conclusion of business.

The working parties, which are now referred to as subcommittees, meet on a monthly basis and consider issues relevant to their terms of reference. Terms of reference of both the Community Advisory Committee and its subcommittees are reviewed every 12 months. From the start, both the Community Advisory Committee and its subcommittees have been "action-oriented." The committees are anxious not to just hold "talk fests," but to get things done.

On Nov. 28, 1988, the first seminar organized under the auspices of the Community Advisory Committee took place. Entitled "In Sickness and In Health," it was an exchange between health care workers in the hospital and the community. The seminar established two very important things:

* There was a great deal of common ground between health care workers in the hospital and the community, but we needed a lot more understanding of each other's needs and difficulties.

* Seminars in this format were a very effective means of information exchange and dissemination.

A number of seminars have since been held on a wide variety of topics--from "The Role of Consumers and Community Groups in Quality Assurance" to "Hepatitis C for Health Care Workers." A series of breakfast seminars has been held for general practitioners on topics nominated by them. Uniformly, the seminars that have been held have been extremely well attended.

Among the most important of the achievements of the Committee and its subcommittees have been:

* The establishment of a community palliative care service in the immediate municipalities surrounding Austin Hospital.

* The establishment of culturally relevant services, including modification of admission documentation to establish a database and identify language difficulties of non-English-speaking patients, translation of health/hospital information into 12 languages, a cultural awareness workshop established in the Staff Development Program, and multilingual sign-posting.

* Improvement of disabled patient access.

* Establishment of a volunteer transport service.

* Two health promotion projects, with receipt of $17,500 in funding.

* A consumer advocacy project

* Establishment of a discharge planning working party, with the objective of establishing "best practice" in the transition of patients from hospital to the community.

Each year, an ad hoc subcommittee meets to provide input into the hospital's Health Service Agreement. By this means, the Community Advisory Committee has a direct say in the hospital's objectives and course for the next 12 months.

A number of Committee members have commented on the value of networking through the Committee and on how much they have been able to achieve through meeting with and getting to know service providers.

Review

The Community Advisory Committee and its subcommittees have reviewed their activities every 12 months, and, in 1992, the Community Advisory Committee commissioned a formal review of its operations by an outside agency.(*) The review, conducted under the auspices of the National Centre for Health Program Evaluation and the Centre for Program Evaluation, Institute of Education, University of Melbourne, found that a major strength was that "the membership of the Committee was seen to provide a unique opportunity to gain access to a wide range of opinions and share information between different sectors of the hospital and the community. Members from the community particularly value the commitment of the senior hospital staff and the subsequent opportunities to form closer links."

The review also found a weakness in the number of consumer representatives on the Committee, a matter of concern to the Community Advisory Committee over the years. It has been difficult to get consumer representatives to attend the meetings of the Committee, and those who have been invited and attended have tended not to retain their membership for a prolonged period. The Committee continues to address this problem and currently has a consumer representative from the Alzheimer's Society and the widow of a former palliative care patient.

Conclusion

As stated in the review, "The Committee and its working parties have successfully nurtured and developed vital links between the community and the hospital; however, the Committee, Austin Hospital, and indeed the health care system are now entering a new era. The Committee and its working parties provide an established structure on which to base future hospital/community initiatives. Such initiatives may herald the future direction for hospital and community-based health services."(*)

(*) Herd, A., and others. "Austin Hospital Community Advisory Committee and Working Parties Final Evaluation Report," July 1993.

At the time this article was written, Dr. Michael R. (Taffy) Jones was Director of Medical Services, Austin Hospital, heidelberg, Victoria, Australia. He is now Director of Medical Services at Alfred Healthcare Group, Melbourne.