South Eastern Sydney Local Health District
South Eastern SydneyLocal Health DistrictJourney to Excellence Strategy 2018 – 2021“Exceptional care, healthier lives
Table of Contents03Section 1:Our story214Section 2:Our strategicpriorities SESLHD Strategy 2018 – 202122Section 3:Enablers for ourtransformation26Appendix:South EasternSydney LocalHealth District ata glance
Section 1: Our StoryIntroduction and our storySouth Eastern Sydney Local Health DistrictOur StoryOn the next stage of its Journeyto Excellence, South EasternSydney Local Health District isstarting its more ambitious stageof transformation.After three years of reform and steadyimprovement on the "road to excellence",the district is beginning a new chapterworking to empower communities tooptimise their health and wellbeing.This is the story of that transformationIn a world of new demands for personalised, preventative, participatory and predictable healthcare, challengingfinances and new technology-enabled possibilities, we know that “business as usual” is no longer an option.The path we are on is notsustainable. We can’t afford ahealth and social care model thathas become too expensive andoften inequitable.Our starting point is not justhospitals, doctors and institutionsbut patients, people andcommunities too.Our first focus is strong, healthycommunities where people withthe right skills, knowledge,motivation and resources can lookafter many aspects of their owncare, especially if they havelong-term health conditions.We need to keep people out ofhospital as much as possible; butwhen people need them, ourhospitals must offer fair and equalaccess to the best possiblecompassionate care.We will make sure people canmake sense of the differentservices and support for theirneeds and their circumstances.We must make it easier forpeople to find and access the careand support they need.We know, too, that not everybodyis accessing the healthcare theyneed and deserve across ourcommunities. We need a fairer andmore accessible spread ofresources and services. We needto make sure everyone enjoysbetter health results andhealthier lives.3
Section 1: Our Story (cont’d)Why we need to changeWe serve a growing number of people, many of who experience long term health conditions and who are ageing.Furthermore, there are significant health inequities within the geographical boundaries of South Eastern SydneyLocal Health District (SESLHD) with particular population groups and localities experiencing poorer health andwellbeing. The growing demand for healthcare means we are on an unsustainable path of ever increasing demandfor emergency services, hospital beds, outpatient and community services and bigger expenditure on health. Thiscreates the platform for SESLHD to redesign its health services to be more focussed on supporting people to remainhealthy and manage their own care effectively.IF WE DON’T CHANGE, BY 2027 WE WILL HAVE112,500 (50%)21,685 (20%)a need for 480more EmergencyDepartment presentationsmore acute admissionsadditional acute bedsWe also acknowledge that some of ourchildren are developmentally vulnerable,overweight and experiencing stress, whichwill impact longer term on their health andwellbeing if not adequately addressed.Giving every child the opportunity to have agood start to life and taking a life courseapproach to health and wellbeing areimportant elements of our approach. Weare also focused on shifting the balance ofcare from acute hospital services toresponsive and integrated primary,community and social care. These areimportant changes for our health servicesbecause 37 percent of our residents haveone or more long-term health conditionsand the number of long-term healthconditions (multi-morbidity). The number oflong-terms health conditions also oftenincreases with age.4 SESLHD Strategy 2018 – 20211 in 5Children aredevelopmentallyvulnerable1 in 10Have high levels ofpsychologicalstress1 in 4Children areoverweight orobese
Estimated proportion of SESLHD resident population with 30,050)0-2425-44% with multi-morbidity21%30%(57,396)45-6465-84Age Group% without multi-morbidity85 AverageSource: Based on admissions to SESLHD hospitals and extrapolated SESLHD population from method used by Barnett et alNSW Health is well positioned for healthcare transformation. The state government has continued tofind the resources to sustain growth with the most recent budget allocating a record amount of capitalinvestment to continue to build infrastructure across the state. SESLHD has secured capitalinvestment of more than 1.1 billion over the past four years for redevelopments currently inprogress or in the planning stage, however we share the global challenge of reforming manyaspects of our system to cope with the growing demand across all patient cohorts.We have looked across Australia and across the world to find, and learn from, good examples of innovation and bestpractice. We have learned that to bring about transformational change, we need to take a population healthmanagement approach to deliver care that is personalised, predictive, participatory and preventive.Our transformation will be guided by the following principles:1Change, driven by the population's health needsand leveraging their assets and strengths5Whole system redesign and care integration2A reduction in health inequities6Value and sustainability3Genuine community and agency partnerships7Continuous quality improvement4Advances in research and technology8An adaptable and healthy workforce5
Section 1: Our Story (cont’d)The change we want to seeIn South Eastern Sydney we want to move towardsa world that looks a lot more like this: Person-centred – designing care around and with people, so that their needs and their experiencesare at the centre of how we think, how we plan, how we design our services, how we invest and howwe deliver care Making sure we care for and support people in, or close to, their homes so they can stay asindependent as possible for as long as possible Making sure our hospitals remain world-class but that we think beyond their walls to address thedeeper challenges of health and wellbeing for and with the community Providing safe, reliable and compassionate care that makes sense for each person, by doctors,nurses and other health professionals that are working with the best available training and evidence People will have the knowledge, skills and confidence to stay healthy and, when it is necessary, tomanage periods of ill health or some aspects of living with longer term conditions Much better links between health services and other agencies, such as education, communityservices, justice, transport, primary care and local councils so together, we can improve the healthand wellbeing of our communities and whole population across our region Using digital and other technologies not only to provide the best hospital services and treatments, butto improve the way we communicate, share information and knowledge with our staff, patients andtheir families, and our partners in other organisations.This means we have to change the way we relate to and work with other organisations inside and outsidegovernment, with community organisations and with individuals and families themselves.In the end our ambition can be summed up into these five key strategic themes:Safe, person-centredand integrated careEveryone in ourcommunity will haveaccess to safe,compassionate andhigh quality healthcare.That care will beprovided either athome, or as close tohome as possible6Better valueWe will deliver value toour patients throughmaintaining financialsustainability and usingour resources in a waythat is consistent withour priorities SESLHD Strategy 2018 – 2021Community wellbeingand health equityWe will work togetherwith our partners toachieve health,wellbeing and equity forour sharedcommunitiesWorkforce wellbeingWe will create anenvironment where ourpeople can beaccountable, happyand well, andsupported to reach theirpotentialFostering researchand innovationWe will focus ontranslating researchand innovation intoclinical service modelsthat deliver positivehealth outcomes
The journey so far: Our achievements and challengesSESLHD has achieved much since it commenced on the Journey to Excellence three years ago.The SESLHD Roadmap to Excellence 2014-2017 is underpinned by the Institute for HealthcareImprovement’s Triple Aim of health of population, cost of care and experience of care1. Major gainsin all three aims have been made over this period. This has provided us with a solid foundation tobegin to move forward on our transformation program.Achieving financial sustainability and better valueSESLHD has made significant gains financially over the past three years, throughshifting the narrative from efficiency gains to better value care. The DistrictProgram Management Office (PMO) has worked with the facilities and Districtdirectorates to identify, plan and implement opportunities to reduce waste andduplication across the system resulting in significant cost savings. The MedicalExecutive Directorate is also focusing on reducing unwarranted clinical variationusing analytics and leading practice guidelines to encourage consistent practice. 44.5 millionworth of wasteout of thesystem safelyover three years.Executing phase two of the transformational journey willrequire SESLHD to maintain its focus on financialsustainability and to invest wisely in alignment with thestrategic priorities. This will be achieved through rigorousgovernance, accurate reporting, service linemanagement and creating a culture of accountability.ResearchWe have become a member of an integratedhealth science network of global significancein NSW, known as The Sydney Partnership forHealth, Education, Research and Enterprise(SPHERE). This will further enable our staffto deliver world-class clinical care fromstate-of-the-art facilities.SPHERE was founded on the basis of partnership andcollaboration, recognising that in this new economic andrapidly developing scientific research and healthcareenvironment, single institutions struggle to remaininternationally competitive. The SPHERE network bringstogether three universities, two Local Health Districts,two Specialty Health Networks, seven medical researchinstitutes, nine major teaching hospitals, and, the NSWMinistry of Health.We have also developed a SESLHD Research Strategy2017-2021 which is focused on applied and translationalresearch that is directly relevant to improving health careand the wellbeing of patients and the community. Itspans prevention research within communities through toclinical research within hospitals and services.1 Institutefor Healthcare Improvement, The IHI Triple Aim, ges/default.aspx Accessed13 November 20177
Section 1: Our Story (cont’d)Capital developmentA learning organisationWe have been successful in securing fundingfor a number of major capital redevelopmentsacross many of our health campuses. Overthe last three years the St George Emergency Department( 41 million), Sutherland Hospital Car Park ( 10 Million),Bright Building, Prince of Wales ( 114 million) and AcuteServices Building, St George Hospital ( 277 million) haveall been completed. Construction works are nearingcompletion at The Sutherland Hospital, where a newEmergency Department, additional inpatient, critical carebeds and refurbishment works are being built at anestimated cost of 62.9 million.SESLHD is making a significant investmentin building capacity and capability across thesystem to develop whole of system improvements.SESLHD is building an improvement culture throughoptimising staff engagement and investment ininnovation, organisational development, improvement,and quality and safety.The Randwick Campus Redevelopment has beenannounced at an estimated cost of 750M. It willtransform health services for the Randwick communityby creating one of Australia’s leading centres for healthand wellbeing, committed to the integration of health,research, education and teaching.Integrated careThe District has commenced on a journeyof healthcare integration. Fundamental tothe success of this journey will be partneringwith members of the community, patients andwith multiple external partners, to achievemore aligned, integrated health and social care.Over the past three years SESLHD has achieved muchin the way of healthcare integration. A HealthOne facilitywas established in the Sutherland Shire which works withprimary care including General Practitioners andCommunity Health Services and patients to focus onpreventative care and self-management of their longterm conditions. A second example of successful careintegration across SESLHD is the Diabetes CareCollaborative. The Collaborative, which was launched inMay 2015, uses an internationally recognisedimprovement methodology, known as a BreakthroughCollaborative. The Diabetes Care collaborative hasalready assisted 12 primary care practices to increasescreening of diabetes patients, with the aim of reducingrisk of acquiring diabetes related complications.8 SESLHD Strategy 2018 – 2021In May 2016, SESLHD launched its Patient Safety Program– Towards Zero Together. This encompassed an AcuteAdult Patient Safety Program and a Mental Health PatientSafety Program and was supported by the development ofthe Improvement Education program. Over 2017, twentynine ward based teams have engaged with the Acute AdultPatient Safety Program and work commenced on six pointsof care: sepsis, falls, pressure injuries, infection-relatedventilator associated infections (IVAC), deteriorating patientand medication safety. To date, over 2500 of our staff haveaccessed the Improvement Education Program and PatientSafety Programs.SESLHD is identifying and nurturing its current and futureleaders through offering a wide range of leadershipprograms, such as the Emerging Leadership program, theClinical and Executive Leadership Programs and theClinical Executive Leadership Programs.The nursing workforce has recently introduced ‘TheHeart of Caring’, which is a framework to support thewellbeing of our nurses so that they can delivercompassionate, high quality care. Our nurses andmidwives revealed that ‘The Heart of Caring’ to themmeans providing ‘Person Centred Compassionate Care,‘making a difference to the care experience’, ‘supportedby ‘teamwork’ and that ‘self-care and well-being isessential to achieving better outcomes.Forging genuine andenduring partnershipswith our communityPartnerships with consumers and our community arecrucial to achieving an effective and sustainable healthsystem for the future. As such, we are proactivelyseeking out and drawing upon the assets and strengthsthat individuals and communities have to optimise theirhealth and wellbeing and support self-care. We are codesigning our services with consumers and the broadercommunity to maximise their satisfaction with ourservices and address their health needs adequately.
Our Board Community Partnership Committee whichcomprises other government agencies and members ofour local community has agreed to work together toaddress a range of community issues. The Committeehas a number of joint initiatives underway, including ayouth mental health first aid program to assist people inthe community to support young people who at risk of orexperiencing early signs of mental health conditions.Why we develop a DistrictstrategyOur quest for health equityEach strategic priority within this strategyhas been assigned several OutcomeMeasures. These measures have beendesigned as ‘stretch’ goals. The OutcomeMeasures within our strategy will requiretruly innovative, multifaceted and oftenlong-term actions and initiatives. We haveintentionally listed our Outcome Measuresas ‘stretch’ goals so that our people canthink and act in a transformational way1.In South Eastern Sydney there is widevariation in health status between differentpopulation groups and localities. SESLHDrecognises these inequities and as such hasdeveloped an Equity Strategy. The EquityStrategy takes a systematic and whole ofsystem approach to improving the health andwellbeing of our most disadvantaged groupssuch as people who are subject tohomelessness and Aboriginal People. Anumber of important equity initiatives are wellunderway, such as a “Doing it differently”community grants co-production initiative, incollaboration with Bayside Council and localcommunities to improve social networks andrelationships. A second area of focus hasbeen working through with our partners tomake greater investments in the early years oflife so every child has the best start to life.This Strategy has been developed inpartnership with our staff and community toguide SESLHD towards transformationalchange over the next three years andbeyond.“Strategies and plans are notends in themselves. They are partof the larger process that aims toalign priorities with the real healthneeds of the population . Andmake better use of all availableresources for health – so that allpeople in all places have accessto quality health care and livelonger, healthier lives as a result”21 Instituteof Healthcare Improvement, Science of Improvement, Tips for Setting ve/ScienceofImprovementTipsforSettingAims.aspx Accessed 13 November 20172 Wold Health Organisation, National health policies, strategies and plans sed13 November 20179
Section 1: Our Story (cont’d)Sound foundation for investment decisionsDirect capital infrastructure planningIdentifying actions to improve health outcomesRecognising community needsand assetsPredicting trends andpreparing for changeInforming future service deliveryprioritiesWhy do weplan healthservices?Testing options through qualitativeand quantitative data analysisIncluding the views of providers andconsumers of health servicesThe role of the Local Health District is to ensure strategicand health service plans are developed to guide the deliveryof services and ensure they meet the needs of thecommunity. The Local Health District is required to developorganisational plans in compliance with the annual ServiceAgreement with the NSW Ministry of Health.Developing the Visionand StrategyTo refresh the vision and strategy for how healthservices in SESLHD could change, the ChiefExecutive of SESLHD led an engagement andplanning process which commenced in May 2017.As a first step, a comprehensive internalconsultation and review process wasundertaken. A series of workshops weredesigned by the Chief Executive to bring theDistrict Executive Team together to: Reflect on the results of the investmentmade over the last three years Construct the transformation narrative andambition for the next three years and Agree the principles for execution10 SESLHD Strategy 2018 – 2021Supporting a whole of systemapproach to health and wellbeingResponding to particular healthissues, emergencies or service needsMeeting legislative requirementsFurther to the Executive team workshops, a session washeld with the SESLHD Board to share the emergingnarrative and to obtain their initial feedback. A process wasthen undertaken to consult more broadly with localclinicians, communities and service providers. Over theperiod from August through to September 2017, over 200staff members, consumers, community members andpartners were engaged and consulted. The feedback fromthis engagement process was instrumental in developingthe Journey to Excellence 2018-2021 strategy.Secondly, a thorough review of externaltransformational healthcare systems aroundthe world that have demonstrated successwas undertaken. Much of the thinkingaround our transformation narrative hasbeen influenced by looking at models suchas the Canterbury Health system in NewZealand and the NUKA system of care inAlaska. These models were also referencedthroughout the internal consultation processto stimulate thinking and demonstrate thepotential for SESLHD to transform how itdelivers care. All of this work hasculminated in the five strategic priorities forSESLHD which are described in detail insection two of this document.
In addition to looking elsewhere at transformational healthcare systems, the strategy development process has alsoconsidered the District Planning Framework outlined below.SESLHD Planning FrameworkPremier’s and State Priorities NSW Health Towards 2021 Plan and Strategies Greater Sydney Commission plansService Agreement betweenNSW Ministry of Health and SESLHDSESLHD Strategic Plan – Journey to ExcellenceSets out our vision, purpose, priorities andthe outcomes we are aiming to achieveHealth Care Services PlanOutlines the key directions, actions and outcomes forhealth and resource investment to deliver theSESLHD StrategyClinical Services Strategies & PlansEnabling Plans Asset Strategic Plan Workforce Plan Corporate Governance PlanEnabling StrategiesFor example Integrated Care Quality and SafetyPopulation Health Strategiesand other plans ICT/E-health ResearchAnnual Program of Work/Operational – Business Plans11
Section 1: Our Story (cont’d)Important influencers which SESLHD has considered carefully in developing the strategy are NSW Health strategicpriorities and the service agreement between SESLHD and NSW Ministry of Health.SESLHD is firmly committed to contributing to the NSW Ministry of Health’s goal of shifting the paradigm from volumeto value driven care and our strategy is strongly aligned to the NSW Health Strategic Priorities.NSW Health Strategic Priorities FY 2017-2018NSW HEALTH STRATEGIC PRIORITIES FY 2017-18KEEP PEOPLEHEALTHYPopulationand PublicHealthPROVIDE WORLDCLASS CLINICALCARE WHEREPATIENT SAFETYIS FIRSTINTEGRATESYSTEMS TODELIVER TRULYCONNECTEDCARESystemPurchasing andPerformanceStrategy andResourcesDEVELOP ANDSUPPORT OURPEOPLE ANDCULTUREGovernance,Workforce andCorporateSUPPORT ANDHARNESSHEALTH ANDMEDICALRESEARCH ANDINNOVATIONPopulation andPublic HealthENABLEeHEALTHINFORMATIONAND DATAANALYTICSDELIVER FUTUREFOCUSEDINFRASTRUCTUREAND AND ROBUSTGOVERNANCEeHealthStrategy andResourcesFinance andassetmanagementAlign with SESLHD Strategic PrioritiesData andanalyticsFit forpurposeassets andinfrastructureStrategic enablersCommunitywellbeing andhealth equitySafe, personcentered andintegratedcareBetter valueWorkforcewellbeingResearch andinnovationSESLHD Strategic Priorities 2018-202112 SESLHD Strategy 2018 – 2021Better value
Our strategic prioritiesSESLHD STRATEGYSouth Eastern Sydney Local Health District Journey to Excellence Strategy 2018-2021Safe, person-centredand integrated careWorkforcewellbeingBettervalueEveryone in our community will haveaccess to safe, compassionate andhigh quality healthcare. That careshould be provided either at home, oras close to home as possibleWe will create an environmentwhere our people will beaccountable and can be happy,well and supported to reach theirpotentialWe will deliver value to ourpatients and community throughmaintaining financial sustainabilityand making investmentsconsistent with our vision Decrease the hospitalstandardised mortality ratio by5% each year Increase the number of staffusing systems to review dataIncrease percentage of staffwho recommend SESLHDas a place to work by 10%each yearIncrease the number of hoursgiven back to patients and thecommunity e.g. reduce waitingtimes/reduce number of visits Increase percentage of staffwho recommend SESLHDas a care setting by 10%each year Shift care into the community oroutpatient settings Operate within the budgetallocated to the organisation Decrease adverse events by10% each year Improve patient satisfaction ofcare by 20% each year Reduce emergencydepartment presentations by5% each yearIncrease the number of staffwho have had a performancereview by 10% each year Decrease absenteeism by5% each year Reduce workerscompensation claims by 10%each year Decrease the percentage ofpatients admitted to theemergency department by 5%each yearEnaPartnerships that deliver13 SESLHD Strategy 2018 – 2021Responsive InformationManagement SystemsData &Analytics
Our Purpose:Our vision:To enable our community to behealthy and well; and to providethe best possible compassionatecare when people need it.Exceptional care,healthier livesCommunitywellbeingand health equityFoster researchand innovationWe will work together withour partners to achievehealth, wellbeing and equityfor our shared communitiesWe will focus on translatingresearch and innovation intoclinical service models thatdeliver positive health outcomes Increase staff participation inresearch/innovation education andtraining Increase references to research/innovation outcomes based inSESLHD in the media Increase overall research/innovation funding Increase the number oftranslational research projects Increase the number of SESLHDsubmissions to innovation awards Increase the number of projectsthat use SESLHD Big Data Increase community reporting ofgood health by five percent(proportion of populationself-reporting health as “good”or ‘better’)Increase the number of childrenreaching developmentalmilestones at 18 months and fouryears by five percent.Reduce discrepancies in medianage of death between geographicareas and priority populationsDecrease the rate of preventablehospitalisations due to long-termand vaccine- preventableconditions by five percent930,000People livewithin our District37%of our PopulationHave Long termconditions98,281ADMISSIONSTO ADULT Medical Acute,Surgical & Mental Healthper yearblersFit for purposeinfrastructureA culture of continuousimprovement14
Section 2: Our strategic priorities (cont’d)Safe, person-centred and integrated careEveryone in our community will have access to safe, compassionate and high qualityhealthcare. That care should be provided either at home, or as close to home aspossible.ObjectivesOutcome measures1. Maintain safe hospitals and healthservices, and strive to continuouslyreduce harm to our patients Decrease the hospital standardisedmortality ratio by five percent eachyear2. Embed a person-centred andcompassionate approach into our culture,placing the patient at the heart ofeverything we do Increase the number of staff usingsystems to review data Decrease adverse events by 10 percent each year3. Integrate our IT systems so that theyprovide real time information for providingcare Improve patient satisfaction of care by20 percent each year Reduce emergency departmentpresentations by 5 percent each year Decrease the percentage of patientsadmitted to the emergency departmentby 5 percent each year4. Our patients and consumers will havebetter experiences in our healthcarefacilities/services5. Our patients and community will be ableto navigate the healthcare system15 SESLHD Strategy 2018 – 2021
Better valueWe will deliver value to our patients and community through maintaining financialsustainability and making investments consistent with our vision.Objectives1. Provide the right care, in the right pace, atthe right timeOutcome measures Increase number of hours given backto patients and the community e.g.reduce waiting times/reduce number ofvisits Shift care into the community oroutpatient settings Operate within the budget allocated tothe organisation2. Use innovative models that shift care intothe community3. Operate in a financially sustainable way4. Continuously reduce waste andduplication across our system5. Make decisions that align with ourstrategic priorities16
Section 2: Our strategic priorities (cont’d)Workforce wellbeingWe will create an environment where our people will be accountable and can be happy,well and supported to reach their potential.ObjectivesOutcome measures 2. We will improve the physical and mentalhealth of our workforceIncrease percentage of staff whorecommend SESLHD as a place towork to by 10 percent each year 3. SESLHD will be a learning organisation –we are on a continuing cycle ofimprovementIncrease percentage of staff whorecommend SESLHD as a care settingby 10 percent each year Increase number of staff who have hada performance review by 10 percenteach year Decrease absenteeism by 5 percenteach year Reduce workers compensation claimsby 10 percent each year1. Staff will be engaged with our vision“Exceptional care, healthier lives”4. Staff will have the capacity and capabilitythey need to do their job well5. Grow adaptive and accountable leader6. Foster strong clinical engagement17 SESLHD Strategy 2018 – 2021
Community wellbeing & health equityWe will work together with our partners to achieve health, wellbeing and equity for ourshared communities.Objectives1. Focus on wellness, early intervention andpreventionOutcome measures Increase community reporting of goodhealth by five percent (proportion ofpopulation self-reporting health as“good” or ‘better’) Increase the number of childrenreaching developmental milestones at18 months and four years by fivepercent. Reduce discrepancies in median ageof death between geographic areasand priority populations Decrease the rate of preventablehospitalisations due to long-term andvaccine-preventable conditions by fivepercent2. Enable people to stay well and beequipped to manage periods of ill health3. Our community will experience improvedhealth outcomes4. Health inequities will be reduced5. Give every child a healthy start to life18
Section 2: Our strategic priorities (cont’d)Foster research and innovationWe will focus on translating research and innovation into clinical service models thatdeliver positive health outcomes.Objectives1. Build research and innovation capacityand capability within SESLHD2. Increase community access to researchand innovationOutcome measures Increase staff participation inresearch/innovation education andtraining Increase references toresearch/innovation outcomes basedin SESLHD in the media Increase over
SESLHD is building an improvement culture through optimising staff engagement and investment in innovation, organisational development, improvement, and quality and safety. In May 2016, SESLHD launched its Patient Safety Program -Towards Zero Together. This encompassed an Acute Adult Patient Safety Program and a Mental Health Patient
in regional hospitals in central-western NSW, far-western NSW and on the state's north coast. The University has strong partnerships with both public and private sector health services. In 2015, the University joined with Sydney, Northern Sydney and Western Sydney Local Health Districts, the Sydney Children's Hospital Network (Westmead)
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WENDY SHARPE CURRICULUM VITAE Born 1960, Sydney, Australia, lives and works in Sydney and Paris Studies 1978-1979 Art Certificate, Seaforth Technical College, Sydney 1980-1982 B. A. (Visual Arts), City Art Institute, Sydney 1983 Graduate Diploma of Education (Art) Sydney Institute of Education
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the effeCt wAS firSt Performed At the nAtionAl theAtre, london, direCted by ruPert goold And CoProduCed with heAdlong on 13 november 2012. PreSenting SPonSor. 6 . Sydney Theatre Company (2014). The Effect, Program. Wharf 1, Sydney Theatre Company. 7 ABOUT THE DIRECTOR SArAh goodeS Sarah is a Co-Resident Director at Sydney Theatre
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patients, haemodialysis, Health literacy, Decision making * Correspondence: danielle.muscat@sydney.edu.au 1The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, NSW, Australia Full list of author information is available at the end of the article
