When giants run; Urology makes leaps and bounds

Our COVID-19 response has shown that Monash Health, one of the largest healthcare providers in Australia, can mobilise its more than 18,000 employees with surprising agility. One example of many where our people are setting a standard to follow includes a recent whirlwind of activity in our Urology Department.

Key points

  • Director of Urology, Scott Donnellan outlines how iconoclastic innovation, ‘can-do’ attitudes and teamwork across all levels have helped the unit hold their own and even implement improvements during the pandemic.
  • Four key actions have led to innovations that paved the way for safety and better patient outcomes now and into the future.
  • Exciting changes include a less invasive ambulatory lithotripsy procedure for kidney stones to reduce inpatient stays and an Australian-first ‘survivorship clinic’ for long-term assistance following prostate cancer treatment.
  • Impressive leadership at Monash Health combined with the response from Government leaders, the Health System and our community, have set the tone to navigate through uncertain times and support the urology team to deliver exceptional results.

Heads of Urology across the state are complimenting Monash Health’s proactive approach and the remarkable achievement of not just holding our own, but making gains in patient outcomes during a pandemic.

We took a moment to speak with the Director of Urology, Scott Donnellan, to find out how a healthcare giant was able to run during this time of COVID-19.

Scott explained, “When COVID-19 kicked off, we felt that if we could just hold our ground as a surgical unit, we’d be winning. Thanks to an organisation-wide willingness to challenge current processes and to innovate, we’ve actually made improvements.

Iconoclastic innovation is the term I’ve used to describe the radical changes in the delivery of patient care, the safety of healthcare workers, and education for our training specialists necessitated within days and weeks by COVID-19. The only way this was possible is through strong support and excellent communication from the Executive Team and the ‘can-do’ attitude of my team. Even with any personal challenges they are facing, I couldn’t be prouder of how my team has stepped up.

“Our Registrars, who are the lifeblood of the unit, face the challenges and general anxiety of their community in uncertain times; one has a newborn baby to care for, another spent her first Easter away from family because of travel bans. Their attitude, however, is epitomised by a comment from Patrick, one of our senior Registrars; “I’ll do whatever is necessary to help the unit, from intubating someone in ICU to washing linen, I don’t care, whatever it takes. I will give 250%”. They’ve certainly done what it takes, and then some.

“Although stressful, this has also been an exciting time to work at Monash Health. We were able to enact things quickly because the Executive has heard our voice, and decisions once made were supported to ensure the unit could set up the new ways of working rapidly. We are thrilled with the results.”

Like many aspects of life in a time of COVID-19, implementing changes that would ordinarily take months and weeks has seen turn arounds of just days. “There are four actions I can name that made the biggest difference,” Scott said.

“The decision by the Executive team to transfer the majority of surgery from our public hospital to nearby private facilities was seamless. It meant we have continued to treat high-risk Category 1 and 2 patients effectively; Monash was the first major Metropolitan Hospital to establish this alliance effective within days of significant COVID-19 restrictions. The Urology team has offered great support, actually reducing our urgent waiting lists during this period.

“We then established an innovative treatment pathway for our unique ambulatory lithotripsy service for kidney stone patients. Our unit treats more kidney stones than any other hospital network in Australia, and the usual treatment paradigm involves multiple anaesthetics and invasive procedures. We are now running an emergency lithotripsy service for suitable patients who can have treatment of stones as day cases without a full anaesthetic.

“Lithotripsy means less risk to patients and using fewer hospital beds. The result is more beds for sicker patients and less risk to anaesthetists and theatre teams because administering an anaesthetic is one of the highest risks for COVID-19 transmission to medical employees. A GP hotline was set up by Monash Health so that GPs can discuss sick patients directly with our team. In the case of kidney stones, such patients can avoid the Emergency Department and potentially have the stone treated at Casey Hospital within hours and return home the same day. During a pandemic, or at any time really, this is excellent news all round. We had the whole team putting up their hands to run this service as it is delivering quality and timely care for patients and is an example of the best use of hospital resources.”

Even among all this activity, the team found time to make improvements such as mapping out a step-by-step pathway of the patient journey from presentation to discharge for those with prostate cancer. This will provide consistent excellence in the care of this group of patients.

The pathway includes a new initiative to perform prostate biopsies without anaesthetic to reduce excessive waiting times for public patients and minimise the risk of COVID-19 transmission to caregivers. Australia’s first ‘survivorship clinic’ was established by Consultant Urologist Gideon Blecher during this period to manage the longer-term lifestyle issues arising from prostate cancer treatment. The team are also evaluating the possibility of creating a pilot project to assess public-in-private robotic surgery for prostate cancer patients. Potentially providing world-leading cancer outcomes and reduce inpatient stay to less than 24 hours compared to three to five days for open surgery.

As well as operational innovations, many across the organisation are enjoying the benefits of Monash Health’s expanded digital capabilities to remain connected. Scott agrees this has assisted in maintaining connections with patients and the team, “This has been a game-changer. In a time of physical distancing and isolation, we’re using Telehealth to ensure our waiting lists don’t get impacted while providing safe and appropriate care to our outpatients. The employees’ and managers’ forums on Webex have been vital in keeping us updated on a plethora of changes. We want to maintain video conferencing into the future for our Urology Cancer Forum, where all major cancer cases are discussed in weekly multi-disciplinary team meetings.

Image taken pre-COVID-19 physical distancing requirements. Left to right: Mr John Kourambas – Senior Urologist (AKA ‘Stone Master’), Mr Scott Donnellan – Director of Urology, Mr Gideon Blecher – Consultant Urologist

“Overall, I have to say that I’m delighted with the response from our Government leaders, our Health System and the community in general in trying times. I am really impressed with our leaders within Monash Health, especially Andrew Stripp and Martin Keogh, who have set the tone and navigated the hospital so effectively and communicated so openly throughout the COVID-19 journey. It has brought everyone together with an ‘all troops are on board’ attitude. As a community, we tend to laud sports stars and actors, but I have seen many heroes in recent weeks as the entire network has banded together in response.  As a Unit Head, this has been an extraordinary time, stressful at times, but amazing and reassuring to see the agility with which we have been able to pull this off.”

Thank you, Scott, for this insight into the great work within the Urology Unit. It’s just one highlight, among many at Monash Health, of Executive stewardship and teamwork at every level, showcasing what is achievable when giants run.


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