2009 annual report - The Health Roundtable

THE HEALTH ROUNDTABLE LIMITED
2009 ANNUAL REPORT
Promoting Innovation in Health Care
THE HEALTH ROUNDTABLE MISSION
The Health Roundtable Limited has operated since its inception in 1995 as a non-profit
collaborative organisation:
•
•
•
To provide opportunities for health executives to learn how to achieve Best Practice in their
organisations;
To collect, analyse and publish information comparing organisations and identifying ways to
improve operational practices; and
To promote interstate and international collaboration and networking amongst health
organisation executives.
MEMBERSHIP
Organisational Membership in The Health Roundtable is open to health services across Australia
and New Zealand, subject to approval by the Board of Directors. Each member organisation
nominates its most senior operational executive to serve as a Personal Member of the
Roundtable. Personal Members elect a Board of Directors to provide administrative governance,
and meet as a group twice yearly to shape the agenda and review progress.
Activities of The Health Roundtable are supported by annual membership fees, subscription fees,
and corporate sponsorships. We receive no direct government funding.
INFORMATION SHARING AMONGST MEMBERS
The Health Roundtable focuses on operational improvement by identifying best practice within
the membership, and then sharing insights amongst the members to improve practices. Data
provided to The Health Roundtable are freely shared amongst participating members, but are not
disclosed to other organisations. However, general insights and methodologies are freely
available to the public through the Health Roundtable website: www.healthroundtable.org.
In order to maintain frank and open discussion, all members agree to abide by The Health
Roundtable Honour Code which requires that:
• No member shall criticise the performance of other member organisations, or use any of the
information to the detriment of a fellow member.
• No external distribution of data or conclusions based on Health Roundtable data is made
without the unanimous consent of all contributors.
1
REVIEW OF OPERATIONS FOR CALENDAR YEAR 2009
During 2009, The Health Roundtable grew to 70 health service organisations (from 53 in 2008).
These health services encompassed 139 separate inpatient facilities (up from 104 in 2008). This
growth was due primarily to the decision by the Health Service Management Innovation Council
of Victoria to encourage health services to participate in benchmarking activities.
The Health Roundtable is focused on helping members identify and reach “good practice” in
health care delivery by addressing three key questions:
1. What does good practice look like?
2. What is the gap between my health service and good practice?
3. How can we develop staff to achieve good practice?
A total of 761 people from member organisations throughout Australia and New Zealand
participated in one or more Health Roundtable activities during the year. Approximately half of
the attendees at each Roundtable are new to the collaborative process used in our meetings. In
addition, we conducted over 100 webcast/teleconferences with individual health service teams
and benchmarking groups during the year to augment the face-to-face meetings.
1. What does good practice look like?
In 2009, we developed a special program to introduce international “good practice” techniques
for patient safety to Australia and New Zealand, leveraging the tools from the Patient Safety
First! Campaign in England. This unique program provided 12 of our member organisations with
training on techniques to introduce major changes in clinical practice in two key areas:
-
Reducing harm from deterioration
Reducing harm from high-risk medications
Each year our members nominate major issues that are affecting their performance. Those with
the broadest support and which have the largest apparent variation in practices are then selected
for review at a major Health Roundtable meeting. In 2009, the members selected three major
topics to break new ground in identifying good practice:
-
Improving the Stranded Patient Journey
Sharing innovations in work force redesign
Reducing inpatient mortality
Highlights of these five major initiatives are shown on the following pages.
2
1. Identifying
Good Practice
March – October
2009
SAFE
Patient Care
Program –
Reducing
Harm from
Deterioration
The aim of the SAFE Patient Care Collaborative was to eliminate inpatient
harm in two key areas. Twelve teams from Member hospitals from Australia
and New Zealand worked on projects to:
• Reduce in-hospital cardiac arrest and mortality rate through earlier
recognition and treatment of the deteriorating patient.
• Reduce incorrect prescribing, dosing, and administration of anticoagulants, oncology drugs, and insulin.
The project teams developed explicit goals, learned the techniques used
internationally, and began the arduous task of changing long-standing work
practices regarding patient observation.
The teams met as a group three times during the eight month program and
were supported by fortnightly teleconferences and site visits between
meetings.
A key component of the project to reduce harm from deterioration is to
improve the quality of patient observations and to speed up the process of
alerting senior staff when a patient begins to deteriorate.
Nine teams in the Deteriorating Patient Project reviewed the Observation
Charts in use internationally, and most found that the Compass System
developed by Canberra Hospital most closely matched their needs. Several
of the teams were able to begin implementing the new observation charts
and alert systems quickly.
During the year, Health Roundtable staff and the team members also
provided input based on their experiences so far to the Australian
Commission on Safety and Quality in Health Care project on “Recognising
and Responding to Clinical Deterioration.”
3
1. Identifying
Good Practice
March – October
2009
The three other teams in the SAFE patient care program focused on
reducing harm from medication errors in separate high-risk areas
(chemotherapy, insulin and anti-coagulants). These teams reviewed their
existing processes, finding many examples of opportunity for error.
SAFE
Patient Care
Program –
Reducing
Harm from
High-risk
Medications
New processes were designed and trialled during the program with the aim
of simplifying and standardising the process for clinical and support staff, as
well as for the patient. Early results from the trials were very positive, with
more work to follow in 2010.
The SAFE Program in 2009 concluded with presentations by each team to
Stephen Ramsden, the leader of the Patient Safety First! Program. Stephen
also provided insights to fellow Chief Executive Officers based on his
experiences at Luton & Dunstable Hospital. He called for greater
commitment by health service leaders to improve Patient Safety, outlining
the key safety goals he and his Board set, measure and disclose each month.
4
1. Identifying
Good Practice
May 2009
Improving
the
Stranded
Patient
Journey
‘Stranded Patient’ was
the short-hand term to
refer to those patients
who remain in hospital
for acute care
treatment for a period
of greater than 21 days.
Although these patients
form a small proportion
of the overall inpatient
cohort, they take up a
disproportionate
number of bed days and
in many cases have their hospitalisation extended as a result of medication or
clinical complications arising directly from their hospital treatment.
The Roundtable in May focussed on how to identify and eliminate the causes
for “stranding” and to rescue those patients who are staying longer than
appropriate for their original clinical need.
Following the meeting, Health Roundtable staff updated existing data measures
to begin tracking long-stay patient bed-days and episodes in routine reports.
Several hospitals began projects to monitor patients who reach the 21-day
threshold. Initial assumptions that only elderly patients are stranded due to lack
of nursing home space have been proven wrong. Instead, a wide range of
patients are affected – often with multiple co-morbidities, complex social issues,
complications of care, or lack of senior medical attention. Special programs have
been developed to carry this initiative forward into 2010.
5
1. Identifying
Good Practice
July 2009
Sharing
Innovations
in Workforce
Design
Fourteen health services met to examine the progress made since the last
Workforce Roundtable, which was held in 2005. They found that progress had
been made in a number of areas, such as the introduction of Nurse
Practitioners.
Some key findings were:
• Vacancies in Nursing are a major concern, but few vacancies were reported
in Allied Health and Technical sectors of the health workforce.
• Electronic referrals were the most common use of technology with least
common being electronic order entry and use of electronic medical records.
• There was wide variability in the rights and privileges of Nurse Practitioners.
• Emerging career types included Nurse Sedationist, Nurse Endoscopist, Allied
Health Assistants and Primary Care Workers.
Unfortunately, demographic trends for the next decade indicate that the pace
of change is far too slow to deal with the wave of staff retirements and the
shortages of potential staff.
Teams identified a variety of additional action items from the Roundtable
meeting, including to:
Identify and implement technology that will minimise the need to grow
staff (e.g. Robotics)
Recruit/train additional nurse practitioners and advanced Allied Health
Practitioners to meet increasing needs
6
1. Identifying
Good Practice
October 2009
Reducing
Inpatient
Mortality
Our Patient Safety Roundtable in 2009 was held in conjunction with the SAFE
Patient Care Final Workshop to allow cross-fertilisation of ideas between
both groups. In addition to Stephen Ramsden, we were honoured to have Dr
Raj Behal, Chief Patient Safety Officer at Rush University Medical Center in
Chicago return to work with the group on additional mortality reduction
techniques.
Participants reviewed draft standardised mortality rates for their health
services using Dr Behal’s suggested methodology (used by academic centres
across the USA). These suggested a 50% variation in outcomes between
hospitals – some of which is due to differences in data quality and coding,
some due to differences in access to palliative care services, and some due to
differences in clinical practice.
Dr Behal then described new practices being developed at his hospital to
improve the ability to eliminate the causes of sentinel clinical events.
Responding to a futile effort to eliminate error by revising policies and
increasing education, his hospital has implemented a new tool to evaluate
the quality of improvement recommendations, called the “Safety Treatment
Plan.”
7
2. What is the gap between my health service and good practice?
The Health Roundtable collects and analyses a wide range of data provided by its member
organisations to identify differences that highlight potential innovations in performance. The
following pages summarise the breadth and depth of the reports available to members and the
interactive meetings and personalised webcast discussions provided to discuss the results.
During 2009, The Health Roundtable team of analysts collaborated with staff from member
organisations to analyse large amounts of data, including:
- Over 3,900,000 inpatient records representing over 12,000,000 bed days
- Over 4,300,000 emergency department presentations, of whom 1,290,000 were formally
admitted to hospital
- Over 5,000,000 allied health records detailing approximately 4,000,000 hours of professional
time, which were then linked to the corresponding inpatient episode data
- Almost 1,000,000 contacts made by mental health professionals with their community clients
- Over 1,300,000 imaging records from radiology imaging services to gauge the timeliness of
services to patients during their hospital stay
Summary reports from these analyses were provided to the participants in each benchmarking
group to enable them to compare results with each other. In addition, over 6,000 customised
narrative reports were produced to provide clinicians at each member facility with details of their
clinical performance for key patient groupings compared with their peer organisations in The
Health Roundtable. All reports are stored in an online library on the Health Roundtable website,
and are available for downloading by key staff members in every member organisation.
The Health Roundtable takes care to ensure that only administrative data about patients is
submitted by member organisations, without disclosure of patient-identifying information.
Examples of the processes to “Close the Gaps” in performance using this wealth of data are
shown on the following pages.
8
2. Closing the Gap
Inpatient
Casemix
Data
Every 6 months, the Health Roundtable produces a suite of reports, Excel
workbooks and Access databases designed to assist members in finding
improvement opportunities based on their inpatient casemix data.
The information provided allows members to examine the comparative
data at all levels of the organisation. Deeper analysis at the procedure and
diagnostic code level is also provided. Reports are customised for each
member organisation to highlight the most relevant peer group based on
key screening criteria. In addition, special reports are often produced based
on specific requests from member organisations.
Special data products have been developed for members, including tools to
predict the expected date of discharge, reports that identify short-stay
surgery opportunities, and assessments of coding quality.
The aim of the reports is to assist analysts at the health service to identify
opportunities for improvement, and the key people at other facilities who
can assist with implementation of innovative solutions.
The breadth and depth of reports available is illustrated in the diagram
below, depicting the range of information available to clinicians and
managers at a typical hospital.
9
2. Closing the Gap
Emergency
Presentation
Data
Emergency Presentation Data Benchmarking provides trend information for
each member organisation with comparisons to other health services:
• Overall volumes by hour of day, day of week, and month
• Percentages achieving time to be seen targets
• Percentages achieving time to disposition targets
10
2. Closing the Gap
Key
Performance
Indicators
Key Performance Indicator Benchmarking brings together outcome
indicators derived from casemix and emergency data, together with
selected clinical and workforce measures. Member Chief Executives receive
a Scorecard that provides performance trend information and comparisons
with peer hospitals.
This six-monthly service:
• Highlights changes since the last report
• Provides trend analysis over four years
• Identifies leading health services on each indicator to identify
innovators
11
2. Closing the Gap
Imaging
Journey
Following a successful Roundtable on the patient journey through
imaging services in 2008, an ongoing benchmarking group was set up in
2009 to analyse imaging volume, timing, and utilisation by merging the
data set with inpatient activity.
Imaging benchmarking reviews included indicators such as:
Total volume for the fiscal year
Reports available with 24 hours (and 48 hours) of exam
Median imaging procedure time
Time from procedure started to report available
Time from an emergency/inpatient/outpatient exam request
received to exam started
% of reports that are read post patient discharge
% of reports that are released after patient discharge
Percentage of patients in each DRG receiving imaging services by
modality, with focus on differences in repeated testing (Example
shown below)
The most significant innovation reported in 2009 was that one member
described an “open access” imaging department, with no appointments
and request forms sent WITH the patient, reducing delay from 15 hours
to 1 hour. Wards are responsible for delivering inpatients for general xrays, while an Imaging Patient Service Assistant returns the patients. The
result: 91% of x-ray images are available in less than 3 hours after
request.
Key action items under way by members include:
Improve number of ED CT scans per hour
Improve inpatient flows through department by 15%
Reduce reporting time in CT to 48 hours by March 2010
Reduce % of inappropriate requests for CT
12
2. Closing the Gap
Maternity
Twelve hospitals participated in the Maternity benchmarking group in 2009.
Australia-based keynote guest speakers addressed each of two meetings of
the group:
Innovations in Antenatal Care
The first meeting of the group reviewed the following topics:
Antenatal care booked at the closest public hospital
Community midwifery
Shared Care IT system (where Midwives, GPs, and Obstetricians all
have access to the same records
Introduction of group antenatal sessions
An important antenatal Key Performance Indicator is the rate of diabetes
diagnosed in pregnancy. This was found to have a range of 2%-10% across
participating health services. An even more significant finding was that the
rate of diabetes diagnosed in pregnancy increased by 30% over the last four
years.
Innovations in Postnatal Care
The second meeting focused on innovations in postnatal care. Women
consistently rate the care they receive in hospital after birth less favourably
than either antenatal or intrapartum care. It was felt that this was linked to
organisational issues such as continuity of care, the routine nature of some
practices (such as postpartum observations), and flexibility to provide
individualised care
Some innovations in postnatal care that were developed:
Home-based postnatal visits for those with early discharge
Improved midwife to patient ratio
Regular rounding by NUM
Handover conducted at bedside
Change in visiting hours to allow for more rest time
13
2. Closing the Gap
Nursing
In 2009, this benchmarking group continued its collection of nursingrelated patient care indicators by detailed analysis of ICD10 codes in
inpatient datasets.
Reducing Reliance on Agency Staff and Retaining Current Staff
The key meeting of the Nursing group focused on staffing
issues, leading to several initiatives including:
Changing the management of time allocation of additional nursing
staff for each patient “special”
Developing a marketing campaign geared to Generation Y staff, to reduce
vacancy rates
The participants at the meeting also reviewed data on:
• Turnover Rate
• Ratio Div 1 to Div2
• Hours per Div 1 nurse
• FTE casual internal pool nurse
• FTE external agency and
• Ratio Casual to Div 1 nurses
internal pool nurses
Most health services are now relying heavily on their own internal pool of
casual nursing staff, rather than on external agencies, as shown below:
14
2. Closing the Gap
Clinical
Costing
The Clinical Costing Improvement Group continued in 2009 to enable health
services to compare their detailed costing data for inpatients at the DRG level.
An annual suite of reports includes comparative analysis for inpatient costs at
the DRG and organisational level.
Clinical costing comparisons allow members to:
• Identify high-cost clinical services compared with peers for review and
action
• Identify cost variations within the inpatient journey at a detailed level, such
as pathology, prostheses, imaging, theatre, medical, and allied health
Action items for The Health Roundtable during 2009 included:
• Developing new customised reports to make costing information more
relevant to CEOs, managers and clinicians.
• Developing special analyses using cost data to highlight the cost impact of:
o ED & Surgical delay
o Misadventure and complications
o Emergency vs non-emergency patients
Examples shown below: (1) Comparison of cost per episode for Elective vs
Emergency patients receiving a hip replacement (DRG I03) in 2008/2009. (2)
Comparison of component costs between member hospital and Exemplar
hospital.
15
2. Closing the Gap
Allied Health
The Allied Health Benchmarking Group continued to collect and analyse
professional activity data to identify differences in time allocations by
patient type. The Health Roundtable merges the allied health activity
information with inpatient casemix information to identify differences:
-
In overall time per patient by allied health discipline by DRG
In pre-admission and post-discharge time per patient
In the timing of the first allied health contact per patient
In clinical care time ratios overall
A suite of nine reports is provided to each participating health service to
assist in identifying innovative practices, including an overview / screening
report by DRG to provide a high-level comparison.
In 2009, the main topic for the Allied Health meeting was to demonstrate
the effectiveness of Allied Health staff in addressing patient flow and cost
issues in the health system. Each participant highlighted achievements to a
panel of senior executive representatives, gaining experience in “businessstyle” presentations, and sharing insights with colleagues, such as the
following case study:
HRT0919 AHBG 2009
Interdisciplinary Allied Health Team in
Rapid Assessment Medical Unit – 7-day
week model
Discharges
ALOS
Discharges <48 hrs
Additional AH cost
Net $$ benefit
August 08
130
4.4
11%
August 09
227
2.8
20%
$180,000/year
$100,000/month
16
2. Closing the Gap
Mental
Health
The Mental Health Benchmarking Group continued its work in 2009,
expanding the scope of activities to include community care comparisons, in
addition to inpatient comparisons.
A large proportion of Mental Health staff activity, particularly in Child &
Adolescent Services, is conducted on an ambulatory care basis, which is not
captured in hospital inpatient data systems. Instead, centralised systems at
the government level are often used to capture this information. The
Health Roundtable team worked with member organisations and
governments to extract and analyse the community data, and to facilitate
discussions about differences in practice that are appearing in the data.
The emerging data highlights large differences in the mix of mental health
clients across services.
Example 1: In Child Services, the proportion of time spent with Mood
(affective) disorder clients (F30-F39 below) ranges from 5% to 50% of
overall activity.
Example 2:
Contact Hours per Adult
Schizophrenia client
over 6 month period
varied by health service
from 6 hours to 23 hours
17
2. Closing the Gap
New Zealand
Chapter
The New Zealand Chapter of the Health Roundtable includes all Health
Districts in New Zealand and focuses on matters specific to the New Zealand
health environment.
Meetings were held in March and September 2009. Members focused on
national priorities of improving Stroke Services, meeting the 6-hour target
for waiting time in emergency departments, and improving operating
theatre effectiveness.
Improving Stroke Services: Health services agreed on a set of specific
indicators to measure over time to gauge the effectiveness of Stroke
Services. These are: Rate of Thrombolysis, Quality of Stroke Coding, Percent
Discharged to Usual Place of Residence, and Percent Receiving Either CT or
MRI Scan.
Meeting the ED 6-hour Target: The ED stream focused on implementing
solutions to meet the national target for shorter stays in ED (95% of patients
to be admitted, discharged or transferred from an Emergency Department
within 6 hours). By the end of 2008, 80% of presentations across New
Zealand were already managed within the 6 hour target.
Improving Operating Theatre Effectiveness: Dr Ken Catchpole, a human
factors expert from England, conducted a workshop on Identifying and
Reducing Adverse Events. Key indicators were agreed, including Return to
Operating Theatre Rate, Day of Surgery Admission Rate, and Elective
Surgery Cancellation Rate.
18
2. Closing the Gap
Victorian
Chapter
In 2009, a total of 27 Victorian Health Services agreed to participate in a
Benchmarking Group to share ideas on improving length of stay and
reducing variation in care across health services. Using Health
Roundtable data to identify the largest opportunities to reduce variation
in the patient journey, the health services identified one or more specific
opportunities, and began work. There were several common themes:
• Respiratory – 10 Health Services
• Obstetrics – 4 Health Services
• Orthopaedics/Surgery – 4 Health Services
The remaining health services tackled projects across a range of other
specialties and themes. The underlying objective of most projects, either
directly or indirectly, is to improve the patient journey by reducing length
of stay at least to the average of the best four peers.
The progress of projects has been monitored through regular reports to
the Steering Committee which met five times since its election at the May
2009 workshop. The Hospital Reform and Innovation Unit of the
Department of Health provided guidance and assistance on project
definition and direction.
The Health Roundtable trained Project Leaders and team members on
key aspects of comparative data, data interpretation, reports and
customised briefings, and provided insights on project design.
In October, 21 of the health services gathered to showcase their progress
on selected projects, and to enable team members to exchange
improvement ideas with their counterparts at other health services.
Most of the improvement projects commenced in May or June, with
major progress being made in the second half of the calendar year and
progressively into 2010. A preliminary analysis of casemix data through
June 2009 shows some encouraging results. Note that the projects for
Diagnosis Groups (DRGs) highlighted in Red below had not yet started.
% Change in ALOS
July-Dec 08 vs Jan-June 09
Top 10 Targeted DRG Families
6.0%
4.0%
2.0%
0.0%
-2.0%
-4.0%
-6.0%
-8.0%
E62
B70
I08
L63
E65
OO1
G67
O60
J64
F62
19
3. How can we develop staff to achieve good practice?
One of the key issues facing health services is how to train expert clinicians to become
good managers. In many cases, talented clinicians move into new managerial roles with
little guidance on organisational practices, team leadership, project management,
accounting, budgeting, or staff development.
Member organisations in The Health Roundtable often struggle with attempts to
implement major innovations, since they lack a cadre of middle-managers who are trained
to lead an improvement effort. Relying on outside experts or temporary project
managers often provides a “quick fix” which doesn’t last beyond their time on the project.
To address this need, The Health Roundtable developed an action-oriented management
development program in 2007 using well-established “lean thinking” techniques, to
provide project management skills to people selected to implement major improvement
initiatives. In addition, the SAFE patient care program launched in 2009 incorporates
“lean” tools to train staff in key project management skills.
Whilst the Health Roundtable continued to offer two generic Lean Healthcare programs
to member organisations in 2009, there was an increasing demand to provide “in-house”
versions of the program to member organisations. Overall, 206 staff from member health
services attended programs during the year.
Examples of key outcomes from the programs in 2009 include:
Reduction in ALOS for Knee Replacement 14 days to 6 days
Decreased waiting time for dental appointments from 46 days to 10 days by using
Lean rostering
60% reduction in food wasted
100% of IT help desk calls answered within 24 hours
100% of travel requests booked within 24 hours
Theatre Storage freed up by 90%.
Results of these improvement projects are posted on the website for reference by all
member organisations.
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THE HEALTH ROUNDTABLE LIMITED
ACN 071 387 436
ABN 71 071 387 436
DIRECTORS’ FINANCIAL REPORT FOR 2009
Your directors submit the financial accounts of the Company for the calendar year
ending 31 December 2009.
DIRECTORS
The names of directors in office as of 24 February 2010 are:
Linda Sorrell
Amanda Ling
Andrew Bernard
Adrian Nowitzke
Vivian Blake
John O’Donnell
Kathryn Cook
Karen Roach
Ron Dunham
PRINCIPAL ACTIVITIES
The principal activities of the Company during the financial year were:
to provide opportunities for health executives to learn how to achieve best practice in their
organisations
to collect, analyse and publish information comparing organisations and identifying ways
to improve operational practices
to promote interstate and international collaboration and networking among health
organisation executives
The Health Roundtable focuses on sharing innovations in patient care amongst its members so
that they can treat additional patients and continue to improve the quality of patient care.
OPERATING RESULTS
The Health Roundtable continued to operate on a sound financial basis in 2009, with income
balancing expenses. The organisation had a major increase in membership with the addition of a
large number of members from Victoria in 2009.
The organisation recorded a surplus of $63,817 for the financial year, representing 2% of
operating income. The accumulated surplus increased to $225,871 as of the end of the financial
year. The Health Roundtable makes no provision for income tax, as the company is exempt from
income taxation as a not-for-profit charitable organisation.
Almost all expenses are matched against member subscription revenue under an outsourcing
contract with Chappell Dean Pty Limited. Administration and discretionary expenses are offset
against corporate sponsorship and interest earnings.
The overall financial strategy of the Board is to build a surplus of about 10% of annual operating
income as a buffer to cover monthly fluctuations in income and expense. As at December 2009,
the surplus was 7.2%.
21
Organisational and Personal Members of The Health Roundtable at the end of 2009 are listed
below. Status changes as of February 2010 are highlighted with footnotes.
Organisational Member
Albury Wodonga Health
Alfred Health
Auckland City DHB
Austin Health
Barwon Health
Bass Coast Regional Health
Bay of Plenty DHB
Bendigo Health
Canberra Hospital
Canterbury DHB
Capital & Coast DHB
Central Northern Adelaide Health Service
Colac Area Health
Counties Manukau DHB
Djerriwarrh Health
Eastern Health
Gippsland Southern Health Service
Gold Coast Health Service District
Goulburn Valley Health
Hawkes Bay DHB
Health Waikato
Hutt Valley DHB
John Hunter Hospital
Lakes DHB
Mater Health Service
Melbourne Health
Mercy Public Hospitals
Metro South Health Service District
MidCentral DHB
Nelson Marlborough DHB
North East Health
Northern Health Victoria
Northern Hospital Network
Northern Sydney Central Coast AHS
Northland DHB
Northside District Health Service
NT Acute Health
Otago DHB
Peninsula Health
Peter MacCallum Cancer Centre
Portland District Health
Royal Brisbane & Women’s Hospital
1
Region
VIC
VIC
NZ
VIC
VIC
VIC
NZ
VIC
ACT
NZ
NZ
SA
VIC
NZ
VIC
VIC
VIC
QLD
VIC
NZ
NZ
NZ
NSW
NZ
QLD
VIC
VIC
QLD
NZ
NZ
VIC
VIC
NSW
NSW
NZ
QLD
NT
NZ
VIC
VIC
VIC
QLD
Personal Member 2010
Stuart Spring1
Andrew Way
Greg Balla
Brendan Murphy
Lucy Cuddihy
Lea Pope
Phillip Balmer
John Mulder
Anna Thornton
Nigel Millar
Shaun Drummond
Lesley Dwyer
Geoff Iles
Ron Dunham
Bruce Marshall
Alan Lilly
Peter Van Hamond
Adrian Nowitzke
Kerryn Healy
Warrick Frater
Jan Adams
Chai Chuah
Michael DiRienzo
Cathy Cooney
John O'Donnell
Linda Sorrell
Stephen Cornelissen
Richard Ashby
Murray Georgel
Keith Rusholme
Lis Wilson
Greg Pullen
Andrew Bernard
Lee Gregory
Karen Roach
Jon Roberts
Alan Wilson
Vivian Blake
Sherene Devanesen
Wendy Wood
Ros Jones
David Alcorn
New personal member effective February 2010
22
Organisational Member
Royal Children's Hospital Victoria
Royal Hobart Hospital
Royal Victorian Eye & Ear
Royal Women's Hospital (Melbourne)
North Metro Area Health Service (Perth)
South Canterbury DHB
South Metro Area Health Service (Perth)
South West Healthcare
Southern Adelaide Health Service
Southern Health
Southern Hospitals Network
Southland DHB
St George Hospital
St Vincent’s Health (Melbourne)
St Vincent’s Hospital (Sydney)
Stawell Regional Health2
Sydney West AHS
Tairawhiti DHB
Taranaki DHB
Townsville Hospital
Wairarapa DHB
Waitemata DHB
West Coast DHB
West Gippsland HealthCare Group
Western District Health
Western Health
Whanganui DHB
Regional Health Improvement Network3
Region
VIC
TAS
VIC
VIC
WA
NZ
WA
VIC
SA
VIC
NSW
NZ
NSW
VIC
NSW
VIC
NSW
NZ
NZ
QLD
NZ
NZ
NZ
VIC
VIC
VIC
NZ
N/A
Personal Member 2010
Christine Kilpatrick
Michael Pervan
Ann Clark
Dale Fisher
Amanda Ling
Christopher Fleming
Scott Lisle
John Krygger
Cathy Miller
Shelly Park
Sue Browbank
Lexie O'Shea
Cath Whitehurst
Patricia O’Rourke
Jonathan Anderson
Peter Edwards
Brad Astill
Jim Green
Joy Farley
Mary Bonner
Tracey Adamson
Graham Dyer
Joel George
Ormond Pearson
Jim Fletcher
Kathryn Cook
Julie Patterson
Vacant
This is the second year that all District Health Boards in New Zealand have been members. The
New Zealand Chapter has become more established as a special interest group within the
organisation.
A Victorian Chapter has been established to provide benchmarking and improvement project
opportunities to member organisations within Victoria. The Chapter system allows each group to
compare performance across its members exclusively, as well as with all Health Roundtable
members across Australia and New Zealand generally. Special peer-groupings within the
Chapters have been established to compare facilities with similar size and patient mix.
The Constitution of The Health Roundtable delineates separate roles for Organisational and
Personal members. Organisational Membership is open to publicly-funded health services.
Personal Membership is offered to a senior executive within each Organisational Member.
Voting rights on issues affecting the operation of The Health Roundtable are vested in Personal
Members only.
2
Stawell is unable to continue in 2010
The Regional Health Improvement Network ceased operation at the beginning of 2010, with recommendations to
each of its members to apply to join The Health Roundtable directly.
3
23
Members of The Health Roundtable freely share information with each other, but do not disclose
it externally, in order to maintain frank and open discussion. Each member agrees to follow an
“honour code” as a condition of membership which prohibits: criticism of the performance of
other member organisations, the use of any of the information to the detriment of a fellow
member, and external distribution of data or conclusions based on Health Roundtable data
without the unanimous consent of all contributors.
Under the Constitution, Associate Membership can be offered to a wide range of organisations
and individuals, subject to approval of the Board of Directors. Associate Membership status
provides the opportunity to participate in selected activities as authorised by the Board of
Directors. Associate Members of The Health Roundtable as of the date of this report are as
follows: David Dean, Bill Kricker, David Rubenstein, Colin MacArthur, Michael Walsh, Pat Martin,
Kaye Challinger, Kerry Stubbs, Michael Szwarcbord, and Jennifer Williams. There are no
Organisational Associate Members at this time.
24
Strategic Direction for The Health Roundtable
Following the strategic review of the Health Roundtable in 2008 a five year strategic direction
was determined for the Health Roundtable. Many steps have already been taken to achieve
these goals.
Strategic Goal
Strategies
1 Respond to member needs
The Health Roundtable will
position itself to better
understand and respond to
member needs and develop
specific arrangements to provide
improved support to members
1.1 Develop a better understanding of member needs and satisfaction
with Roundtable programs and services
Action: Member feedback has been used to modify
approaches to programs and services, with a special
effort to visit each member organisation each year to
have face-to-face discussions on site.
1.2 Design membership activities to better reflect the diversity of
membership and the current and emerging healthcare delivery
arrangements
Action: Benchmarking groups established for Victoria and
New Zealand members, and SAFE patient care initiatives
offered to address key quality issues.
1.3 Develop strategies and programs to accommodate new groups of
members, including
- supporting new members through their induction and orientation
to the Roundtable
- ensuring Roundtable programs and services are appropriately
targeted and responsive to their needs
- integrating the new members into the overall Roundtable
structure and offerings
Action: Client Manager and Project Manager roles
established to focus attention on new members and key
projects
2 Enhance the focus of
Roundtable programs
Roundtable programs will be
refocused to better respond to
member needs and support
members in driving improvement
and change in their
organisations
2.1 Streamline the Roundtable’s data collection and reporting program
to provide increased member support and individualised feedback
Action: Executive Briefings further enhanced and
individualised
2.2 Identify key areas of focus for Roundtable programs, based on
issues and problems emerging from:
- review, analysis and benchmarking of Roundtable data
- consultation and discussion with members
Action: Involving a steering group for each major project
to guide the agenda setting and review process, and
capturing key learnings from each project to report back
to Personal Members
2.3 Develop an integrated program to support members to drive
improvement and change in their organisations in these areas of
focus
Action: Developed SAFE Patient Care program and Lean
Healthcare programs to provide in-house support on key
action items identified through the Roundtable data
comparisons
25
Strategic Goal
Strategies
3 Build the Roundtable’s
public profile
The Health Roundtable will
enhance its programs by wider
dissemination of information
3.1 Provide wider dissemination of Roundtable insights about ways to
improve patient care, while safeguarding the range of operational
data provided in confidence to the Roundtable by its members
Action: Key initiative for 2010 is to explore the use of
Podcasts to capture key ideas and provide actionlearning opportunities to a wider range of members
4 Ensure an effective and
sustainable organisation
The governance, planning and
management of the Roundtable
will be effective and will ensure
the future sustainability of the
organisation
4.1 Strengthen the Board’s governance arrangements and capacity
Action: Audit & Compliance Committee revitalised in
2009, with formal review of performance prior to
payment authorisation
4.2 Effectively plan and manage the Roundtable’s operations to
secure future financial sustainability
Action: Building equity to 10% of operating income, and
ensuring long-term continuity through an annual review
process which negotiates services for the “year after
next”
The Board of Directors monitors progress and updates the Strategic Direction regularly.
At the end of 2008, the Board entered into a new contract with Chappell Dean Pty Limited for
the 2009, 2010 and beyond. The contract provides the Board with increased flexibility to
monitor performance and adjust service offerings, and contains a rolling renewal process to
provide twelve month’s notice of major changes in service requirements and offerings. In
October 2009, the Board agreed to continue the contract with Chappell Dean for calendar year
2011, at the same cost per service as provided in 2009.
Chappell Dean provides a network of consultants, analysts, and administrative staff as well as
the services of Dr David Dean, who is seconded to serve as General Manager of The Health
Roundtable. Key people providing assistance to Chappell Dean and The Health Roundtable
during 2009 included:
Michael Hart, Health Data Manager
Peter Reeves, Operational Consultant
Pieter Walker, Operational Consultant
Bill Kricker, Operational Consultant
Raj Behal, Patient Safety Consultant
Jamie Wilson, Operational Consultant
Brian Dolan, Clinical Consultant
Michael Blatchford, Lean Facilitator
Bernie Mullin, Clinical Consultant
Fabian Chessell, Project Manager
Nicholas Smeaton, Website Designer
Bindy Steuart, Report Preparation
Margaret Dean, Accounts Manager
Janine Gilmour, Allied Health Consultant
Aman Dayal, Systems Analyst
Margaret Colville, System Documentation
Matt Stewart, Project Manager
Chris O’Gorman, Operational Consultant
26
SPONSORSHIP
The Health Roundtable offers corporate organisations the opportunity to participate in its
activities to learn more about the issues facing health services. In 2009, the following
organisations supported one or more of the activities of The Health Roundtable, which helped to
defray administrative costs. In return, they were given the opportunity to participate in meetings
where there is no direct conflict of interest, and have agreed to abide by The Health Roundtable
Honour Code to protect the confidentiality of all Roundtable discussions. The Health Roundtable
welcomes appropriate participation in its discussions of key issues by health industry vendors.
Roche Products Pty Limited (Australia) is part of the International F.
Hoffmann-La Roche Group worldwide that was founded in 1896 in Basel,
Switzerland. Roche has grown from a small drug laboratory into one of the
world's leading research-based Healthcare companies and is known for
many innovative contributions to medicine.
Arranged in two operative divisions, our global mission today and
tomorrow is to create exceptional added value in healthcare. These two
units are: Pharmaceuticals and Diagnostics.
Executive Fitness Management (EFM) is the market leader in providing onsite health and fitness programs to organisations including private and
public hospitals. EFM has 35 on-site locations and over 50 corporate
clients including The Royal Adelaide Hospital, Flinders Medical Centre, The
Royal Melbourne Hospital, Kingston Health, and Cabrini Health. Services
include on-site health and fitness clubs, back to work
rehabilitation programs, executive personal training, corporate massage
and staff health screenings.
Blake Dawson is a national law firm that is a recognised leader in health,
aged care and retirement living. Awareness of the unique commercial,
political and regulatory drivers underpinning the environment in which this
sector operates is a key strength of ours. We help our clients mitigate risk,
achieve their commercial outcomes and plan appropriately for change.
Our long association with leading private and public sector organisations in
the health and aged care sectors enables us to anticipate emerging legal
issues and apply specialist expertise to address those issues. We also
understand that participants in the health and aged care sectors have
diverse requirements, so we work to find individual solutions for our
clients’ unique needs.
EXTERNAL LINKAGES
The Health Roundtable maintained its international affiliate membership in the University
Healthsystem Consortium, a collaborative group of over 100 academic medical centres in the
USA. This affiliation has provided valuable methodological assistance and insights to the
organisation and its members across Australia and New Zealand.
27
AFTER BALANCE DATE EVENTS
Since the close of the financial year in December 2009, no matters or circumstances have
arisen which may significantly affect the operations of the Company, the results of those
operations, or the state of affairs of the Company in subsequent financial years.
DIRECTORS AND AUDITORS INDEMNIFICATION
During the 2009 accounting period, The Health Roundtable paid premiums to insure itself and
each of the Directors and Officers of the company against liabilities for costs and expenses
incurred by them in defending any actual or alleged breach of duty, breach of trust, neglect,
error, misleading statement, omission, breach of warranty or authority claimed against them
while acting in their individual or collective capacities.
The total amount paid for the insurance in 2009 was $1,625.
MEETINGS OF DIRECTORS
During the 2009 calendar year, the Board of Directors met in person or by teleconference on 13
February, 2 April, 29 September, and 26 November, and voted by email on special resolutions
as needed. The Board has developed an extensive risk identification and management process
which is monitored by the Audit & Compliance Committee of the Board. This committee which
includes two external members, Ross Cooke and Colin Holland, met in March, May, and August
by teleconference and reviewed materials by email on a regular basis.
DIRECTORS’ BENEFITS
No director has received or become entitled to receive, during or since the financial year, a
benefit because of a contract made by the company with: a director, a firm of which a director
is a member, or an entity in which a director has a substantial financial interest.
PROCEEDINGS ON BEHALF OF COMPANY
No person has applied for leave of Court to bring proceedings on behalf of the company or
intervene in any proceeding to which the company is a party for the purpose of taking
responsibility on behalf of the company for all or any part of those proceedings. The company
was not a party to any such proceedings during the year.
28
INFORMATION ON OFFICERS AND DIRECTORS
SERVING DURING 2009
OFFICERS:
Ms Linda Sorrell, Director and President (from 2 April 2009)
(Elected 19 March 2008)
Ms Sorrell is the Chief Executive Officer of Melbourne Health in Victoria.
Dr John O’Donnell, Director and President (to 2 April 2009)
(Appointed to fill vacancy on 16 November 2005. Elected 19 March 2008. Elected President 19 March
2008. Retired as President 2 April 2009.)
Dr O’Donnell is Chief Executive of Mater Health Services in Brisbane, Queensland.
Dr Karleen Edwards, Director, and Vice President (from 2 April 2009). Resigned 26 November 2009
(Appointed to fill vacancy on 4 December 2008, elected on 2 April 2009, and resigned 26 November 2009)
Dr Edwards served as the Chief Executive of the Central Northern Adelaide Health Service in South
Australia during her tenure on the Board.
Ms Karen Roach, Director, and Treasurer (from 2 April 2009)
(Appointed to fill vacancy on 4 December 2008, elected 2 April 2009)
Ms Roach is the Chief Executive of the Northland District Health Board in New Zealand.
Dr David Dean, Company Secretary
(Elected 6 April 2006)
Dr Dean is General Manager of The Health Roundtable Limited, serving in that capacity since its
inception in 1995.
DIRECTORS
Dr Amanda Ling, Director
(Appointed to fill vacancy on 16 November 2007, elected 19 March 2008)
Dr Ling is the Executive Director of the Sir Charles Gairdner in Western Australia.
Ms Vivian Blake, Director
(Appointed to fill vacancy on 16 November 2007, elected 19 March 2008)
Ms Blake is the Chief Operating Officer of the Otago District Health Board in New Zealand.
Ms Kathryn Cook, Director
(Elected 19 March 2008)
Ms Cook is the Chief Executive Officer of Western Health in Victoria.
Mr Ron Dunham, Director
(Appointed to fill vacancy on 23 October 2008, elected 2 April 2009)
Mr Dunham is the Chief Operating Officer of the Counties Manukau District Health Board in New
Zealand.
Dr Adrian Nowitzke, Director
(Appointed to fill vacancy on 4 December 2008, elected 2 April 2009)
Dr Nowitzke is the Chief Executive of the Gold Coast Health Service District in Queensland.
Mr Andrew Bernard, Director
(Elected 2 April 2009)
Mr Bernard is the Executive Director of the Northern Hospital Network in the South East Sydney Illawarra
Area Health Service, covering Prince of Wales and Sydney/Sydney Eye Hospitals.
29
Dr Mark Platell, Director (to 2 April 2009)
(Elected 29 March 2007, Elected Treasurer 19 March 2008)
Dr Platell was the Executive Director, Fremantle Hospital, Western Australia.
Ms Jennifer Williams, Director (to 28 February 2009)
(Elected 27 November 1998; re-elected 5 April 2006. Resigned 28 February 2009)
Ms Williams was Chief Executive of Bayside Health in Victoria.
External Members of the Audit and Compliance Committee
The Board expresses its appreciation to its external members serving on the Board’s Audit and
Compliance Committee for their input to the governance of The Health Roundtable during 2009:
- Mr Ross Cooke, Director of Paxton Partners, a healthcare corporate advisory firm in
Melbourne.
- Mr Colin Holland, Chief Financial Officer of Melbourne Health.
This Annual Report of the Directors of The Health Roundtable Limited is signed in accordance with a
resolution of the Board of Directors.
30
The Health Roundtable Limited
ABN 71 071 387 436
General Manager’s Declaration
I, David Dean, General Manager of The Health Roundtable Limited, declare that in my opinion:
1.
The financial records of The Health Roundtable Limited for the financial year
have been properly maintained; and
2.
The financial statement and the notes for the financial year comply with the
accounting standards; and
3.
The financial statements and notes for the financial year give a true and fair
view; and
4.
Any other matters that are prescribed by the regulations for the purposes of
this paragraph in relation to the financial statements and the notes for the
financial year are satisfied.
_____________________________
Health Roundtable General Manager
David Dean
Date: 24 February 2010
Contact Information:
The Health Roundtable Limited
PO Box 438
Turramurra, NSW 2074
Australia
Australia (02) 9440-2016 New Zealand (09) 889-2551
Web: www.healthroundtable.org
31
The Health Roundtable Limited
ABN 71 071 387 436
Financial Statements
For the year ended 31 December 2009
Ronald Smith & Co
Suite 101, 10 Edgeworth David Avenue
HORNSBY NSW 2077
Phone: 02 9477 1650 Fax: 02 9477 6649
Table of Contents
Detailed Profit and Loss Statement
Balance Sheet
Statement of Cash Flows
Notes to the Financial Statements
Directors' Declaration
Independent Auditor Report
32
The Health Roundtable Limited
ABN 71 071 387 436
Detailed Profit and Loss Statement
For the year ended 31 December 2009
2009
$
2008
$
Income
Special project income
License & Sponsorship income
Subscription fees income
Membership fees
Delegate registration fees
Interest received
Total income
371,845
37,500
2,507,000
13,800
199,229
41,097
3,170,471
158,964
47,500
2,129,500
13,200
189,223
69,692
2,608,079
Expenses
Audit fees
Bank Fees and Charges
Filing Fees
Management & Office expenses
Insurance
Subscription program expenses
Hotel and Venue costs
UHC Membership costs
Special project costs
Total expenses
2,486
62
645
134,631
1,625
2,365,000
205,469
24,891
371,845
3,106,654
2,478
367
105
56,546
1,745
2,142,000
190,853
17,321
187,103
2,598,518
63,817
9,561
Profit from Ordinary Activities before income tax
The accompanying notes form part of these financial statements.
33
The Health Roundtable Limited
ABN 71 071 387 436
Balance Sheet As At 31 December 2009
Note
Current Assets
Cash assets
Receivables
Current tax assets
Total Current Assets
2009
$
2008
$
3
4
142,576
24,970
116,290
283,836
65,667
184,163
99,749
349,579
5
1,035
1,035
1,035
1,035
284,871
350,614
59,000
59,000
23,560
165,000
188,560
59,000
188,560
Net Assets
225,871
162,054
Equity
Retained profits
Total Equity
225,871
225,871
162,054
162,054
Non-Current Assets
Other
Total Non-Current Assets
Total Assets
Current Liabilities
Payables
Other
Total Current Liabilities
Total Liabilities
6
7
The accompanying notes form part of these financial statements.
34
The Health Roundtable Limited
ABN 71 071 387 436
Statement of Cash Flows
For the year ended 31 December 2009
2009
$
2008
$
Cash Flow from Operating Activities
Receipts from customers
3,288,567
2,404,211
(3,252,755)
(2,631,677)
Interest received
41,097
69,692
Net cash provided by (used in)
operating activities (note 2)
76,909
(157,774)
Net increase (decrease) in cash held
76,909
(157,774)
Cash at the beginning of the year
65,667
223,441
142,576
65,667
Payments to Suppliers and employees
Cash at the end of the year (note 1)
The accompanying notes form part of these financial statements.
35
The Health Roundtable Limited
ABN 71 071 387 436
Statement of Cash Flows
For the year ended 31 December 2009
2009
Note 1. Reconciliation of Cash
For the purposes of the statement of cash flows,
cash includes cash on hand and in banks and
investments in money market instruments, net
of outstanding bank overdrafts.
Cash at the end of the year as shown in the
statement of cash flows is reconciled to the
related items in the balance sheet as follows:
Corporate Cheque Account
Online Saver Account
2008
13,239
129,337
142,576
10,384
55,283
65,667
63,817
9,561
159,193
(134,176)
(23,560)
(106,000)
(16,541)
15,442
12,000
(60,601)
76,909
(157,774)
Note 2. Reconciliation of Net Cash Provided
By/Used in Operating Activities to Net Profit
Operating profit (loss) after tax
Changes in assets and liabilities net of
effects of purchases and disposals of
controlled entities:
(Increase) decrease in trade
and term debtors
Increase (decrease) in trade creditors
and accruals
Increase (decrease) in other creditors
Increase (decrease) in sundry provisions
Net cash provided by operating activities
The accompanying notes form part of these financial statements.
36
The Health Roundtable Limited
ABN 71 071 387 436
Notes to the Financial Statements
For the year ended 31 December 2009
Note 1: Statement of Significant Accounting Policies
This financial report is a special purpose financial report prepared for use by directors and
members of the company. The directors have determined that the company is not a
reporting entity.
The report has been prepared in accordance with the requirements of the following
Australian Accounting Standards.
AASB 1031: Materiality
AASB 110:
Events after the Balance Sheet Date
No other Australian Accounting Standards or other authoritative pronouncements of the
Australian Accounting Standards Board have been applied.
The financial report has been prepared on an accruals basis and is based on historic costs
and does not take into account changing money values, or except where specifically stated,
current valuations of non-current assets.
The following specific accounting policies, which are consistent with the previous period
unless otherwise stated, have been adopted in the preparation of this financial report:
(a) Property, Plant and Equipment
Property, plant and equipment are carried at cost, independent or directors' valuation. All
assets, excluding freehold land and buildings, are depreciated over their useful lives to the
company.
(b) Inventories
Inventories are measured at the lower of cost and net realisable value. Costs are assigned
on a first-in first-out basis and include direct materials, direct labour and an appropriate
proportion of variable and fixed overhead expenses.
The accompanying notes form part of these financial statements.
37
The Health Roundtable Limited
ABN 71 071 387 436
Notes to the Financial Statements
For the year ended 31 December 2009
2009
Note 2: Revenue
Operating Activities:
Other sales revenue
Interest revenue
Note 3: Cash assets
Bank accounts:
Corporate Cheque Account
Online Saver Account
Note 4: Receivables
Current
Trade debtors
Note 5: Other Assets
Non Current
Preliminary expenses
Less: accumulated amortisation
3,129,374
41,097
3,170,471
2,538,387
69,692
2,608,079
13,239
129,337
142,576
10,384
55,283
65,667
24,970
24,970
184,163
184,163
1,035
1,035
1,035
1,035
Note 6: Payables
Unsecured:
- Trade creditors
Note 7: Other Liabilities
Current
Advance payments
Note 8: Auditors' Remuneration
Remuneration of the auditor of the company for:
Auditing or reviewing the financial report
Other services
2008
23,560
23,560
23,560
59,000
59,000
165,000
165,000
2,486
2,478
2,486
2,478
The accompanying notes form part of these financial statements.
38
The Health Roundtable Limited
ABN 71 071 387 436
Directors' Declaration
The directors have determined that the company is not a reporting entity and that this special
purpose financial report should be prepared in accordance with the accounting policies
prescribed in Note 1 to the financial statements.
The directors of the company declare that:
1. The financial statements and notes, present fairly the company's financial position as at 31
December 2009 and its performance for the year ended on that date in accordance with the
accounting policies described in Note 1 to the financial statements;
2. In the directors' opinion, there are reasonable grounds to believe that the company will be
able to pay its debts as and when they become due and payable.
This declaration is made in accordance with a resolution of the Board of Directors.
39
The Health Roundtable Limited
ABN 71 071 387 436
Independent Auditor Report
Scope
We have audited the attached financial report, being a special purpose financial report
comprising the Directors' Declaration, Statement of Financial Performance, Statement of
Financial Position, Statement of Cash Flows, and Notes to the Financial Statements, for the
year ended 31 December 2009 of The Health Roundtable Limited. The company's directors
are responsible for the financial report and have determined that the accounting policies
used and described in Note 1 to the financial statements which form part of the financial
report are consistent with the financial reporting requirements of the company's
constitution and are appropriate to meet the needs of the members. We have conducted
an independent audit of the financial report in order to express an opinion on it to the
members of the company. No opinion is expressed as to whether the accounting policies
used, and described in Note 1, are appropriate to the needs of the members.
The financial report has been prepared for distribution to members for the purpose of
fulfilling the directors' financial reporting requirements under the Corporations Act 2001.
We disclaim any assumption of responsibility for any reliance on this report or on the
financial report to which it relates to any person other than the members, or for any
purpose other than that for which it was prepared.
Our audit has been conducted in accordance with Australian Auditing Standards. Our
procedures included examination, on a test basis, of evidence supporting the amounts and
other disclosures in the financial statements, and the evaluation of significant accounting
estimates. These procedures have been undertaken to form an opinion whether, in all
material respects, the financial report is presented fairly in accordance with the accounting
policies described in Note 1, so as to present a view which is consistent with our
understanding of the company's financial position, and performance as represented by the
results of its operations and its cash flows. These policies do not require the application of
all Accounting Standards and other mandatory professional reporting requirements to the
extent described in Note 1.
The audit opinion expressed in this report has been formed on the above basis.
Audit opinion
In our opinion, the financial report presents fairly, in accordance with the accounting
policies described in Note 1 to the financial statements, the financial position of The Health
Roundtable Limited as at 31 December 2009 and the results of its operations for the year
then ended.
40