Guardianship in hospitals: A health services/OPA pilot program

Ms Dina Watterson1, Ms Fiona McAlinden2, Mr Tass Kostopoulos3, Mr Paul Newland4

1Alfred Health, Melbourne, Australia, 2Monash Health, Melbourne, Australia, 3Eastern Health, Melbourne, Australia, 4Office of the Public Advocate (Victoria), Melbourne, Australia

Background: This collaborative project between three metropolitan health services and the Office of Public Advocate Victoria (OPA) explores the impact of increased availability of advocate guardians delegated by the Public Advocate on healthcare system value, sustainability and outcomes. The pilot targets a particularly-vulnerable group: hospital-based recipients of VCAT guardianship orders, made on evidence of a cognitive impairment indicating a lack of capacity to make important lifestyle and personal decisions. The primary aim of the pilot is to reduce the time these patients spend waiting for allocation of a guardian, decreasing patient risk and increasing value by releasing healthcare system resources.

Method: A multi-institutional, cross-sectional pilot program created a dedicated hospital guardian team within OPA, funded by the partner health services, to reduce the time to guardian allocation for patients within these services. The impact of the pilot was measured through an historical control group design, with initial data collection over 12 months, followed by yearly cohorts of post-implementation patients.

Results: Under this pilot the time from guardianship order lodgement to guardian allocation has significantly decreased from 46.5 to 23.1 days, halving the average time hospital-based patients spend waiting for a guardian. Estimated cost savings are $15,355 per patient, or over $5 of healthcare system resources released per $1 spent on increased staffing.

Discussion: These findings demonstrate how collaboration and investment by healthcare providers in non-health areas can deliver substantial benefits for healthcare system value and sustainability in an area of patient vulnerability and growing demand.


Dina Watterson is the Associate Director of Allied Health at Alfred Health and an Occupational Therapist with over 20 years clinical, management and project experience. Dina is driven by improving health systems and processes to get the best outcomes for patients.”

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