Enabling Hospitals to be more Inclusive and Responsive to People with Intellectual Disabilities and Acquired Brain Injury

Bigby, Christine, Douglas, Jacinta; and Iacono, Teresa,

Living with Disability Research Centre, La Trobe University

Abstract:

Introduction: There is much evidence internationally about the poor quality of hospital care for people with intellectual disabilities but very little about that of people with acquired brain injury post rehabilitation. Evidence from Australia and Victoria has been limited. This study aim was to provide evidence about the processes and practices that enable hospitals to respond to the particular needs of these two groups.

Methods: Mixed methods were used in a study conducted across three Victorian health networks. Sixty primary participants with intellectual disabilities or acquired brain injury were recruited as they commenced a hospital encounter and followed through to discharge. Unstructured non-participant observation and semi-structured interviews were conducted with patients, those accompanying them and hospital staff about their respective experiences of accessing and being treated in hospital or treating these patients.

Results: Almost all encounters began in Emergency and close to half (46%) moved from Emergency to a short stay unit or a ward. Most patients spent longer in Emergency than the benchmark standards, had numerous diagnostic tests and were treated according to relevant guidelines. Qualitative analysis revealed promising strategies and processes within four themes (support, information, collaboration and knowledge) that could be applied across the hospital journey.

Implications: This study demonstrates more positive hospital care processes for people with intellectual disabilities than identified overseas. It has enabled identification of a clear set of strategies to guide the development of hospital practices to improve the care experiences and health outcomes of people with intellectual disabilities that can now be piloted.

Full report available from http://hdl.handle.net/1959.9/563685

Biography:

Professor Christine Bigby is Director of the Living with Disability Research Centre at La Trobe University and Professor of Social Work. Her research is focused on the effectiveness of programs and policies that aim to support the social inclusion of people with intellectual disability in adulthood and later life. She has been particularly interested in system interfaces – informal and formal support, and mainstream and specialist services. She has published 6 book, 35 book chapters and over 135 peer reviewed journal articles. She has had continuous funding from the ARC for her research since 2004 as well as research funding from industry and state governments. She is the founding editor of the Journal of Policy and Practice in Intellectual and Developmental Disabilities and was Editor of Australian Social Work from 2008-2013.

 

 

Overcoming language barriers for radiotherapy patients with an instant translation device: A feasibility study

Mr Darren Hunter1

1Peter MacCallum Cancer Centre, Melbourne, Australia, 2Monash University, Clayton, Australia

Abstract:

Aim:
This study sought to determine the validity and accuracy of an instant translation device (ITD) to aid daily communication between radiation therapists (RTs) and Mandarin-speaking patients.

Method:
Two Mandarin-speaking interpreters and six RTs were recruited to the study. One hundred and eighty eight common radiotherapy phrases were compiled by the study investigators and independently translated to Chinese (simplified) by the interpreters blinded to each other. Medical terminology was omitted from the study as it was deemed outside of the intended scope of practice. The RTs read these phrases verbatim into the ITD, allowing the interpreters to record the Mandarin output. A scale of 0-4 was afforded by the interpreters; a score of 4 indicated agreement, and 0 was incoherent. An average score of >3 (>75%) indicated satisfactory translation.

Results:
Preliminary findings suggest a strong agreement between the true Mandarin translation and the device output across conversational language (78.3%), common enquiries (84.9%) and simple identifiers (86.2%). Treatment instructions scored a compliance of 61.7% – largely influenced by colloquialisms and slang terms that were rarely accurate.

Significance of the findings to allied health:
An ITD is a useful tool to improve radiotherapy communication. Stage 2 of this study will investigate patient and staff satisfaction with the ITD. We anticipate this will allow for more effective engagement and management of care within the radiotherapy department. Further research could investigate expansion across multiple languages, and broader health applications.

Biography:

Darren Hunter is a Deputy Charge Radiation Therapist at the Peter MacCallum Cancer Centre. With 9 years clinical experience spanning regional and metropolitan Victoria as well as experience abroad, Darren holds a strong interest in improving patient care within radiation therapy services. Darren’s research has specifically enquired upon complementary therapies, integrative oncology and more recently, cultural and linguistic diversity.

The early career Aboriginal and/or Torres Strait Islander speech pathologist position: A Monash Health close-the-gap initiative

Ms Alice Robins1, Ms Michelle O’Rourke1, Dr Abby Foster1,2

1Monash Health, Melbourne, Australia, 2La Trobe University , Melbourne, Australia

Abstract:

Aim:
To create an Early Career Aboriginal and/or Torres Strait Islander speech pathologist position

Method:
In the context of Monash Health and state government policy commitments to closing the gap, this innovative two year position was developed by an Aboriginal staff member in collaboration with speech pathology and allied health management and members of the Aboriginal and Torres Strait Islander Working Party. This position provides diverse experiences to nurture professional development in a culturally safe environment. The process of developing the position will be shared.

Results:
Individual, workforce and community implications will be discussed. This initiative creates employment pathways for Aboriginal and/or Torres Strait Islander speech pathologists, enhances workforce cultural awareness and improves the provision of culturally safe healthcare.

Significance of the findings to allied health:
While 3% of the Australian population identify as Aboriginal and/or Torres Strait Islander, they make up only 1% of the health workforce.  Aboriginal and/or Torres Strait Islander peoples are often disadvantaged in regard to health, education and employment. Aboriginal and/or Torres Strait Islander peoples are half as likely to be employed compared to their non-Indigenous counterparts. Aboriginal and/or Torres Strait Islander people delivering health services to their own communities is critical to the provision of culturally safe services. Therefore increasing the number of speech pathologists who identify as Aboriginal and/or Torres Strait Islander is essential. This initiative demonstrates Monash Health’s proactive approach to Aboriginal and/or Torres Strait Islander recruitment and retention.

Biography:

Alice Robins is a proud Yuin woman, who has grown up in Victoria. Alice completed her Master of Speech Pathology at La Trobe University in 2017 and was employed by Monash Health in 2018.

Training for health professionals on transgender and gender diverse affirmative practice in a health context

Mr Andrew Wale-corey1, Ms Simone Sheridan1

1The Royal Melbourne Hospital, Parkville , Australia

Abstract:

Background:
A recent Australian study found that Transgender and Gender Diverse (TGD) patients experience high rates of discrimination when accessing mainstream healthcare services.  Lack of knowledge of TGD issues and insensitive questioning were the most common forms of reported discrimination (Department of Health, 2014).  Research suggests that the TGD population experience poorer physical and mental health outcomes due to stigma and social exclusion (Department of Health, 2014). Improving the provision of TGD affirmative health care may contribute to decreased health disparities and assist in creating safe and accessible health care for TGD people.

Objectives:
To develop, implement and evaluate an education and training package on affirmative language and sensitive questions for Nursing, Medical, Allied Health and Administrative staff.

Methods:
Single site cross-sectional survey measuring participants’ knowledge and confidence related to TGD experiences and affirmative practice skills.

Results:
Preliminary results for 98 participants (79 nursing staff and 19 Allied Health Clinicians) show an increase in knowledge regarding the use of TGD safe language, importance of pronouns and asking sensitive questions to TGD patients. Furthermore, many participants identified an increase in knowledge regarding TGD experiences and inclusive/affirmative practice. The study is ongoing.

Significance:
Improving health professionals’ TDG knowledge and affirmative practice skills can assist in mitigating the effects of discrimination and harassment, which in turn may improve TDG health and wellbeing. This study describes a time efficient, low-cost method to deliver education and examines its effectiveness.

Biography:

Andrew Wale-Corey is a Social Worker at the Royal Melbourne Hospital.  Andrew has clinical experience in Emergency Surgery, Trauma, Stroke, Cardiology and Neurology and has a keen interest in LGBTIQA inclusive and affirmative practice.  Andrew is the Deputy Chair of the RMH LGBTIQA Working Party, a member of the Family Safety Advocacy Initiative, and was recently nominated for an Allied Health Respect Award for their work with LGBTIQA patients, staff, advocacy and education.

Simone Sheridan is a Clinical Nurse Educator at the Royal Melbourne Hospital Nurse bank.  Simone has a dedicated interest in providing safe and accessible care for all patient with a focus on the LGBTIQA community.  Simone is a key member of the RMH LGBTIQA Working Party and runs the ‘Let’s Talk about Sex’ training day.

Establishing the viability of videoconferencing as a method of increasing access to interpreters at Western Health

Ms Anna  Novak1

1Western Health , St Albans Road, Australia

Abstract:

Background:
Language services at Western Health receive approximately 3500 requests for interpreters per month. One of the challenges is access to interpreters 24 hours a day, at short notice,  across multiple locations.  Video conferencing is a potential solution to  improve access for CALD patients and improve  patient experience. This project is funded the DHHS in partnership with Language Loop.  Language Loop (interpreting service) developed a  application for video interpreting called VideoLoop The app is available on designated ipads for video calls.

Aims:
The aims of this project is to scope videoconferencing as an adjunct to established services such as face-to-face interpreting and telephone interpreting, in areas where gaps have been identified.

Aim one (access):

  • Occasions of interpreting service delivered by videoconferencing

Aim two (acceptability of technology)

  • Inbuilt rating/feedback system in the videoconferencing app and patient feedback after each call.

Initial results will focus on user acceptance and quality of video interpreting. This will include feedback from clinicians and patients about their experience using videoconferencing.

Method:
Video Conferencing has been rolled out to community maternity clinics and after-hours maternity clinics.

Outcomes and preliminary findings:
To date there have been almost 100 calls, the application has been useful in reducing wait times for interpreters and improved patient experience when compared to phone interpreting. However there have been challenges with interpreter availability during peak business hours.  Data collection is ongoing and the trial is progressing.

Biography:

I have 15 years’ experience working in the acute health service as a podiatrist specialising in management of diabetic foot complications. During this time I have conducted multiple small projects to improve access and services to these patients. This is my first large scale organisational wide project.

Clinical outcomes of hospital admitted acute patients with limited english proficiency

Mrs Emily Micallef1, Ms Julia Maguire1, Ms Leanne Tao1, Professor Terry Haines1,2

1Monash Health, Clayton, Australia, 2Monash University, Clayton, Australia

 

Aim:

To examine the effect of English language proficiency on hospital length of stay (LOS) and clinical outcomes for acute inpatients

Method:

We completed a retrospective case-control study, with a selection of 399 cases at random from a broader population of 4286 people with Limited English Proficiency (LEP) admitted to Monash Health facilities over a 12 month period.  Controls (who were English Speakers (ES)) were matched to cases based on diagnosis related group (DRG), age (+/- 5 years) and expected LOS. Gender and complexity scores were also closely matched. The LEP and ES classifications were assigned based on the patient’s preferred primary language and interpreter utilisation during their admission.  The matched cohorts were examined for differences in actual LOS, Relative Stay Index (RSI) and clinical outcome rates including: Medical Emergency Team (MET) calls; sepsis; falls; 28-day readmission; medication errors and pressure injury.

Results:

The LEP group stayed on average 2.6 days longer (p<0.05) than the ES group (LEP=7.8 days/RSI 85%; ES=5.3 days/RSI 124%). This difference was most marked in the heart failure (n=74; difference=4.3days) and respiratory infection (n=71; difference=3.2 days) DRGs, with almost no difference detected for knee replacement (n=21; difference=0.3days). Sepsis, MET calls, 28 day readmission and falls rates were higher in the LEP group, although only MET call rates were found to be statistically significant (p<0.05).

Significance of the findings to allied health:

Allied health plays a significant role in the patient journey from assessment, intervention to discharge support and planning across the continuum of care. Quality improvement initiatives co-designed and implemented with allied health may assist to reduce the disparity in LOS and clinical outcomes experienced by patients with LEP.

 

Hands on health: Diversifying the healthcare workforce to improve the long-term health of disadvantaged communities

Dr Shan Bergin1

1Monash Health, Melbourne, Australia

 

 

Aims:

  1. Improve education outcomes and employment

opportunities for disadvantaged youth.

  1. Contribute to diversifying the healthcare workforce.
  2. Improve the long term health of disadvantaged

communities.

 

Method:

An analysis of relative disadvantage and geographical proximity are used to identify potential education and health partners.  Education partners, in collaboration with Hands on Health, identify student participants with an interest in a health career and facing significant barriers to achieving optimal education and employment outcomes.  Student participants are provided with interactive work experience opportunities and ongoing support services including subject selection, study techniques and exam preparation.

 

Results:

In 2016, 123 students and 16 schools participated; a fivefold increase since its inception in 2011. Qualitative data from students, schools and healthcare staff is overwhelmingly positive with the program perceived to be of substantial benefit.  Whilst longitudinal data is required to measure impact on workforce diversity and the health profile of local communities, Monash University reports a 60% increase in enrolments from schools involved in Hands on Health.

 

Significance of the findings to Allied Health:

In an environment where the ‘patient-provider’ relationship is key to ensuring provision of quality and effective care, it is important that the healthcare workforce, including the Allied Health workforce, is reflective of the demographic it serves.  In the longer term, students involved in Hands on Health will ensure the health system is comprised of staff of all ages, ethnicities, cultural beliefs and backgrounds and is better positioned to deliver accessible, responsive care that improves health equity, and improves health outcomes.

Equity in healthcare resource allocation decision making: A systematic review

Ms Haylee Lane1, Mr Mitch Sarkies1, A/Prof Jenny Martin2, Prof Terry Haines1

1Monash University, Frankston, Australia, 2RMIT, Melbourne, Australia

Aim: To identify elements of endorsed definitions of equity in healthcare and classify domains of these definitions so that policy makers, managers, clinicians, and politicians can form an operational definition of equity that reflects the values and preferences of the society they serve.

Method: Systematic review where verbatim text describing definitions of equity were extracted and subjected to a thematic analysis. The full holdings of the AMED, CINAHL plus, OVID Medline, Scopus, PsychInfo and ProQuest (ProQuest Health & Medical Complete, ProQuest Nursing and Allied Health Source, ProQuest Social Science Journals) were individually searched in April 2015. Studies were included if they provided an original, explicit or implicit definition of equity in regards to healthcare resource allocation decision making.

Results: The search strategy yielded 74 papers appropriate for this review; 60 of these provided and explicit definition of equity, with a further 14 papers discussing implicit elements of equity that the authors endorsed in regards to healthcare resource allocation decision making. Five key themes emerged: i) Equalisation across the health service supply/access/outcome chain, ii) Need or potential to benefit, iii) Groupings of equalisation, iv) Caveats to equalisation, and v) Close enough is good enough.

Significance of the findings to allied health: There is great inconsistency in definitions of equity endorsed by different authors. Operational definitions of equity need to be more explicit in addressing these five thematic areas before they can be directly applied to healthcare resource allocation decisions.

Identifying and addressing barriers to safe and effective care of bariatric patients in a tertiary trauma hospital

Ms Jacqueline Kay1, Ms Celia Cosgriff1

1Melbourne Health, Parkville, Australia

Aim: The Royal Melbourne Hospital (RMH) has experienced an increase in the number of bariatric patients needing care. RMH commissioned a project to determine the barriers to safe and effective care, aiming to improve patient outcomes and experiences.

Method: The project team, consisting of two staff members with allied health backgrounds, used the lean six sigma methodology to determine the main barriers to care and determine cost effective strategies to address the issues. Staff engagement, from all levels, occurred from the beginning. Bariatric patients and their carer’s were also interviewed to ensure the project would address their concerns and needs. The project team also undertook an extensive bariatric readiness audit of the hospital to identify the physical barriers to access to each ward and procedural area.

Results:

The barriers identified fell into three main categories:

  1. Physical space
  2. Staff awareness and attitudes to bariatric patient management and complications
  3. Access to equipment.

These barriers had resulted in bariatric patients being unable to access specialist wards, investigative and procedural services (Theatre, Radiology), poor patient outcomes and increased in length of stay. The bariatric readiness audit provided the project team with a road map for better care of bariatric patients, and has guided the development of Bariatric ‘Kits’ with specific equipment, a Bariatric Management Procedure, and the allocation of bariatric patients to the most appropriate room on the specialist ward.

Significance of findings to Allied Health:

Allied Health can significantly contribute to an organisation-wide project, and implement low-cost changes to ensure improved care and outcomes for bariatric patients.

 

Music and home-based music therapy for children and families from diverse cultural backgrounds’ in palliative care

Ms Lucy Forrest1,2, Assoc Prof Clare O’Callaghan2,3,4, Emeritus Prof Denise Grocke2

1Monash Health, Melbourne, Australia, 2Melbourne University, Melbourne, Australia, 3Cabrini Health, Melbourne, Australia, 4St Vincent’s Health, Melbourne, Australia

Introduction: Music can be an important part of children’s and family’s lives, especially when a child is unwell.

Aims: To explore how families from diverse cultural backgrounds engage with 1) paediatric palliative care (PPC); 2) music; and 3) music therapy in PPC. To identify barriers and improve access to home-based PPC music therapy services for children and families of diverse cultural backgrounds.

Method: Three studies informed by grounded theory examined the experiences of 1) parents caring for a child/ren aged 0-12 years in PPC (multi-site, repeated interview design); 2) music therapists providing home-based music therapy in PPC (focus group design); and 3) the first author, who provided home-based music therapy in PPC (ethnographic reflections).  A fourth study employing a meta-ethnographic methodology was undertaken to synthesise the findings of studies one to three.

Results: Six parents, three music therapists and the first author’s reflections on 34 clinical cases informed 20 themes that describe 1) the palliative care journey; 2) the experience of music and 3) the experience of music therapy for children and families from diverse cultural backgrounds.

Key cultural findings include:

  1. Migration, cultural shaming and exclusion can increase isolation, reduce access to supports, and impact coping
  2. Culturally important and meaningful music can support families and help them maintain cultural identity
  3. Cultural/faith beliefs about music shape engagement with music therapy
  4. Maintenance of cultural patterns of relationship in music therapy helps ensure access to culturally appropriate services

Significance of the findings to allied health: These findings are significant not only to palliative care, but also other health settings/contexts, increasing understanding of how cultural beliefs and practices can shape patient/family engagement with healthcare services; and guiding development of culturally responsive healthcare services.

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