Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
This work served to identify need and capacity for increased diagnostic clinical measurements services in Mount Isa Hospital. After determining priority for home-based sleep studies, a tele-health model of care was developed for the local community.
Dates: Not available
Implementation sites: North West Hospital and Health Service
Aim
To provide more quality clinical measurements services closer to home.
Outcomes
- A new diagnostic testing service in a remote hospital
- Care closer to home for the North West community, including First Nations patients
- Utilisation of tele-health to improve access and health outcomes
- Revenue for the health service expected at $31,130 annually
- Patient travel subsidy scheme expenditure reduced by $143,220 each year
- Improved local clinical capacity and role attractiveness, with expanded scope in a supported environmen
Background
North West Hospital and Health Service serves a unique population in an uncommon environment. The health service provides care for approximately 27,605 rural and remote patients over a geographical area of more than 300,000km, with majority of the population living within a five km radius of a major mining operation (North West Hospital and Health Service, 2024b). The largest town, Mount Isa, has a First Nations population of 30.8% and outreach towns of the catchment include discrete Aboriginal communities (North West Hospital and Health Service, 2023). Health care needs of the population are complex, and the medical workforce is often transient due to the rural location (Coombs, Campbell, & Caringi, 2022).
Presently, many patients are required to travel considerable distances to access health care that would likely be considered routine in larger cities. The nearest tertiary facility is a plane flight or approximate 10-hour drive from Mount Isa Hospital, and many patients already travel large distances from their homes to reach this Hospital in the first instance. The cost of transporting patients to a tertiary facility is a great burden on the health service. The emotional, physical, and spiritual cost of health complications for patients electing not to travel for recommended care is difficult to measure and hard to imagine.
Utilising full scope of practice, a clinical measurements department can include cardiac, respiratory, neurological and sleep testing (Queensland Health, 2023). In this region, face-to-face clinical measurements services are provided only in the ‘hub’ location – Mount Isa Hospital. These tests are limited to non-invasive cardiac tests of exercise stress testing, Holter and event monitors, and ambulatory blood pressure monitoring (North West Hospital and Health Service, 2024a). A respiratory nurse provides spirometry testing. As much of the clinical measurements testing is unavailable locally, patients of this health service are currently travelling to the connected tertiary facility or opting not to complete recommended testing at all (Coombes, Campbell, & Caringi, 2022). This is particularly prevalent in the First Nations population, who have connection to country and prefer to stay on country for care, particularly when unwell (Nolan-Isles et al., 2021). This highlights the potential for reduced access to the community.
This project aimed to investigate the following overarching problem statement: “The inability to provide local clinical measurements services in a rural hospital may be impacting patient health outcomes, reducing access to care and possibly causing staff and patient frustration.”
Methods
A range of diagnostic activities was undertaken to thoroughly understand the problem and identify its root causes. The process intentionally sought broad input to capture the perspectives of staff, patients, and the wider health service. Methods included staff and patient surveys, a root cause analysis workshop, literature review, benchmarking with comparable services, analysis of patient travel data, mapping of the holistic patient journey, and an assessment of current workforce capacity (Table 1). Lean healthcare redesign underpinned this body of work as a method to improve capacity for potential expansion.
| Data collection method | Details |
|---|---|
Staff survey | A voluntary paper‑based survey was distributed over three months to doctors, specialists, and clinical staff in respiratory, cardiac, sleep, and neurological domains. It achieved 22 responses (55%), with cardiac and respiratory staff overrepresented. The survey identified existing local services, staff perceptions of access limitations, and desired future services. It also served as initial stakeholder engagement, with all respondents expressing interest in project updates. |
Patient experience feedback | Patient feedback was collected via a QR‑code survey open for two weeks, yielding nine responses. It captured patient perspectives on current services, access challenges, and factors influencing attendance. Responses could be anonymous or identifiable. |
Root cause analysis | A small group of key stakeholders—including the project lead, sponsor, and two steering committee members—conducted a structured session analysing causes across processes, people, policy, equipment, and environment. This contributed to early development of the project risk matrix. |
| Literature review | Literature was reviewed throughout to fill knowledge gaps and support methodological choices. Evidence guided the selection of Lean healthcare redesign as an appropriate framework for remote settings and informed the design of the patient survey, particularly regarding barriers and enablers for First Nations people. |
| Benchmarking | Mount Isa Hospital’s diagnostic services were compared against CSCF level‑four requirements and against similar facilities, with two services selected as reasonable comparators. |
| Patient travel data | Travel data revealed the financial burden of patients travelling for diagnostic tests and assisted in determining which services were most needed locally. The dataset’s main limitation was the absence of patients who declined testing due to travel barriers. |
| Holistic patient journey | Patient stories shared during appointments provided qualitative evidence of the impacts of limited local diagnostic services. One patient consented to having his story used in de‑identified form. |
| Workforce capacity | The department consists of one FTE, supported by four upskilled Allied Health Assistants and three physiotherapists trained for leave relief. Despite limited equipment volumes (e.g., four Holter monitors), the absence of a waitlist and increased delegation indicate sufficient capacity to expand services without additional staffing. |
Thorough analysis of collected data revealed the most considerable gap within the scope of clinical measurements services to be home-based sleep studies. A business case for change was developed, shared and supported by the Executive Leadership Team. An official partnership between the health service and its tertiary partner was developed, supported by a memorandum of understanding, which included tele-health supported appointments for equipment application and removal, and offsite analysis and reporting at the tertiary centre.
Discussion
The success and momentum of this project was strongly linked to timely initiation and strong, open-minded leadership. Additionally, support for the project within the local team was easily achieved due to involvement of the Leadership Development Program. This program – provided to rural and remote allied health services through the Office of the Chief Allied Health Officer (OCAHO) – involves supported post graduate study, mentoring support and a workplace project. This informal leadership helped to ensure the project kept moving and both experts and peers were available to assist with issues if they arose.
Project success was also assisted by established relationships within the smaller health service, which fast-tracked early and ongoing engagement. Flexibility toward stakeholder communication was key, with some stakeholders engaged by email only and others on an ad hoc basis or strictly in person. Being flexible, adaptable to individual’s preferences, and gently persistent ensured stakeholders and relevant decision makers walked together throughout the process and momentum persisted.
A notable challenge within the project occurred when ordering the necessary diagnostic equipment. Unfortunately, after receiving timely approval to order the equipment in May 2025, changes to funding streams meant a new process needed to occur. This challenge resulted in an unexpected eight-month delay, with the equipment ordered in January 2026. This equipment was delivered to the service in Mach 2026, with appointments expected to commence soon thereafter.
The key difference of this project to other comparable tele-health supported programs is that it was initiated, designed and led by a remote health service. This allowed careful consideration for local context, need and climate, while also building local capacity and empowerment. Smaller services are in the best position to walk alongside their own community to develop a new service and ensure it is the right service delivered the right way. Local staff ownership of the program is critical to long term success and sustainability, as well as contributing largely to local community service uptake and acceptance. Local ownership increases the motivation to deliver the service and deliver it well. This subsequently reduces the likelihood of staff burnout through a sense of choice, which is a particularly prevalent risk for generalist staff in remote areas (McGrath et al., 2025).
This project, or parts of this work, could be reproduced within clinical measurements, allied health or other diagnostic testing areas. Tele-health supported appointments have been occurring in many forms for some time, including partnerships between health services in Queensland Health such as the Royal Brisbane and Women’s Hospital Tele-Cardiac Investigations and Tele-Sleep Pilot programs. The model used in this project is likely to succeed in other rural or remote hospitals that have significant travel expenditure and distance to diagnostic care.
The next steps for this project are to commence appointments and embed the service into business as usual, with ongoing service evaluation and improvements over time. There are plans for local skill sharing to the Allied Health Assistant team to further increase local capacity and service sustainability, including leave coverage. Professional development opportunities for the remote staff member will also be explored through potential education or training by the tertiary site.
We are grateful to have the opportunity to use tele-health to empower the remote health workforce and provide care closer to home for our community. Smaller, remote service providers can drive meaningful change in service delivery.
References
- Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22(438). https://doi.org/10.1186/s12913-022-07829-2
- McGrath, K., Matthews, L. R., Heard, R., & Hancock, N. (2025). Levels of compassion satisfaction, burnout and secondary traumatic stress in rehabilitation healthcare workers in rural and remote Australia and their associations with demographic and work-related variables. Australian Journal of Rural Health, 33. https://doi.org/10.1111/ajr.70128
- Nolan-Isles, D., Macniven, R., Hunter, K., Gwynn, J., Lincoln, M., Moir, R., Dimitropoulos, Y., Taylor, D., Agius, T., Finlayson, H., Martin, R., Ward, K., Tobin, S., & Gwynne, K. (2021). Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health, 18, 3014. https:// doi.org/10.3390/ijerph18063014
- North West Hospital and Health Service. (2023). Strategic Plan 2021-2025. Queensland Government. https://www.northwest.health.qld.gov.au/about-us/corporate-documents-and-publications/
- North West Hospital and Health Service. (2024a). Allied Health. https://www.northwest.health.qld.gov.au/clinical-services/allied-health/
- North West Hospital and Health Service. (2024b). Strategic Plan 2024-2028. Queensland Government. https://www.northwest.health.qld.gov.au/about-us/corporate-documents-and-publications/
- Queensland Health. (2023). Clinical Measurements. Queensland Government. https://www.careers.health.qld.gov.au/allied-health-careers/registration-requirements/clinical-measurements.
Key contact
Lucy O’Neill
Senior Clinical Measurements Scientist
North-West Hospital and Health Service