Increasing research within a health service: A five year follow-up research capacity study

Dr Tilley Pain1,2, Mrs Michelle Petersen1, Mr  Malindu Fernando1,2, Ms  Karen Phillips1

1Townsville Hospital And Health Service, Townsville, Australia, 2James Cook Universtiy, Townsville, Australia

 

Aim: Research underpins advances in modern health care.  Building research capacity therefore, should be an essential component of health service operations. There has been an Allied Health (AH) research capacity initiative at The Townsville Hospital and Health Service since 2010. A baseline survey was conducted in 2011 demonstrating high levels of research interest but little experience amongst the AH staff. This study is a follow-up survey to measure subsequent change.

 

Method: Both surveys were distributed via email with a link to Survey Monkey. There were questions about demographics, research experience and need for support as well as perception of research. The unmatched data was analysed with SPSS and all comparisons of categorical data used chi square tests.

 

Results: Baseline survey response rate was 48% and follow up survey was 41%. Significant increases in research experience were seen in generating research ideas (p=0.18); developing questions (p=0.028); writing proposals (p=0.005); applying for grants (p=0.027); writing ethics applications (0.014); quantitative research methods (p=0.004); analysing data (p=0.006) and publishing (p=0.004). The increase in experience was supported by a decrease in the need for support for the same activities. AH staff considered the benefit of research was to improve clinical care of patients.

 

Significance: These results demonstrate research capacity building of allied health professionals is successful. The high levels of interest and the benefit of improving care suggests further capacity building would continue to increase research activity. To demonstrate the value of allied health to improving the health status of our communities, allied health must participate in research.

Creating quality practice education experiences: Impact of Barwon Health’s occupational therapy practice education program

Ms  Sue Rowan1, Ms Kelli  Nicola-Richmond2, Associate Professor Michael Curtin3, Mrs Nikki Lyons1, Ms Nicole  Shaw1

1Barwon Health, North Geelong, Australia

2Deakin University, Geelong, Australia

3Charles Sturt University, Albury, Australia

 

Aim: A collaboration between Barwon Health and Deakin and Charles Sturt universities sought to evaluate the impact of a new Practice Education Program on the quality of the learning experience for both students and supervisors, and the capacity of the health service to offer placements.

 

Method: A mixed methods research approach using an on-line survey was used to gather perceptions of students and supervisors of the Program.  All students and supervisors who participated in the Program in 2015 were invited to complete the survey at the completion of placement.

Results: Thirty-six occupational therapy students and 42 supervisors completed the survey.  Students indicated that the Program assisted them to feel welcome prepared and supported. The initial group orientation, the tutorials during placement, and the facilitated reflective practice sessions were reported as particularly beneficial. The supervisors indicated that these elements of the Program reduced their workload when supervising students, which contributed to the health service increasing the number of placements offered . Capacity increased by 945 days from 2013 to 2016.

 

Significance of the findings to allied health: The Victoria Best Practice Clinical Learning Environments Policy requires health networks to be accountable for the quality of the practice education experiences provided. A consideration is the provision of quality learning experiences to justify the payment for placement. In response Barwon Health developed an occupational therapy Practice Education Program that has led to quality practice education learning experiences and has provided opportunity to increase the number of placements.

Student volunteers supporting the inpatient breakfast group: A mixed methods evaluation

Mrs Erin O’Shanassy1, Mrs Melissa Mew1, Mr Luke Moresi2, Mr Terence Yau2, Dr Danielle Hitch1,2

1Barwon Health, North Geelong, Australia, 2Deakin University, Geelong, Australia

Aim: The Breakfast Group (BFG) provides a valuable opportunity for occupational therapy (OT) staff to assist subacute inpatients regain independent living skills.  However setup, pack up and portering impacts on staff time and potentially service efficiency.  This pilot study aimed to evaluate the use of OT student volunteers to assist with these BFG tasks in a 100 bed facility that runs 12 BFGs per week across 3 wings.

Method: A mixed methods approach was adopted.  Staff time, group duration, patient numbers and waiting list data were analysed using descriptive statistics to compare a convenience sample of BFGs run with and without volunteers. Thematic analysis of anonymous qualitative feedback gained from surveying the perspectives of OTs, allied health assistants, volunteers and patients was completed.

Result: Results from 109 BFGs indicated a slight decrease in group duration and total time spent by staff in the BFG when volunteers were present, though this was not clinically (≤6mins) or statistically (p<0.05) significant. There was no significant difference in patient numbers or waitlists. Survey results indicated improved staff (n=11) and patient (n=29) satisfaction when volunteers assisted with BFG, with improved social atmosphere and more focus on quality of interventions. Volunteers (n=4) valued gaining exposure to a healthcare setting, practicing communication skills and providing meaningful assistance to staff.

Significance of findings to Allied Health: OT Student volunteers assisting with BFGs may not make a quantifiable difference to service efficiency; however their presence was perceived positively by staff, volunteers and patients and improved the quality of this therapeutic experience.

Standardising processes for Videofluoroscopic Swallowing Study (VFSS) clinics: Considerations at a profession and service-wide level

Ms Katrina Webster1, Ms Natasha Moller1

1West Moreton Hospital And Health Service, Ipswich, Australia

 

Aim: 1) To ensure VFSS procedures at Ipswich Hospital are conducted in line with best practice and optimise patient safety; 2) To ensure VFSS procedures are clinically informative to guide speech pathology management of oropharyngeal dysphagia; 3) To improve VFSS clinic processes by exploring opportunities for service efficiencies and utilise support staff

 

Method: A literature review, as well as consumer and stakeholder feedback, highlighted the need to review all aspects of the VFSS clinic. Benchmarking activities were conducted via a nation-wide survey of speech pathologists to understand current practices in VFSS clinics. Development of standardised procedures for competency attainment, triaging referrals, patient education, barium preparation, and Allied Health Assistant support was undertaken. Amendments to the VFSS protocol were conducted in line with literature, and engagement from Radiographers and Medical Physicists. In-services and regular stakeholder meetings involving speech pathology and medical imaging staff was undertaken to ensure ongoing refinement of processes.

 

Results: The implementation of standardised processes for VFSS clinic has resulted in improved confidence and communication for speech pathologists and radiographers involved in VFSS. Speech pathologists have improved consistency of practice, knowledge about VFSS evidence based practice, and have improved clinical judgements about swallow physiology. Patients receive reduced radiation dosage during VFSS procedures and report satisfaction with the Ipswich Hospital VFSS clinic.

 

Significance of the findings to allied health: Significant variation exists across facilities in regards to VFSS clinic provision. This activity highlights the need for improved practices and processes Australia-wide.

Investigating the educational value of interprofessional workshops: A pilot study

Dr Fiona Kent1,2, Mrs Jo  Thorpe1, Miss Jade Courtney1

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

 

Aim: Clinicians need to recognise the roles of others and communicate effectively across professions in order deliver collaborative practice. Interprofessional education (IPE) has been proposed as one model of teaching collaborative practice. Both formal and informal IPE initiatives have been proposed. This study aims to explore the educational value of an interprofessional falls prevention workshop for pre-registration students on clinical placement.

 

Method: A quasi-experimental research design was utilised. Two hour interprofessional falls prevention workshops were conducted opportunistically with students from medical, nursing, pharmacy and allied health on clinical placement across two clinical sites at Monash Health. Another group of students completed an online falls prevention module. Upon completion, all students completed a multiple choice quiz and evaluation of the education intervention. Knowledge gains and evaluation feedback from the two interventions were compared using an independent groups t-test.

 

Results: Early evaluation data is positive. Data collection is nearing completion, and comparative results will be presented.

 

Significance of the findings to allied health: Although the call for IPE to be integrated into clinical settings has been made, the best format for delivery remains unclear. Furthermore, the measurement of knowledge gain has largely been self-report to date. This pilot study has demonstrated that brief educational workshops are a feasible and highly regarded addition to routine profession specific clinical education. A limitation to our data analysis is the validity of knowledge measurement under unequal test conditions.

Using technology to enhance the educational experience of optometry students

Dr Kwang Cham1, Ms Anthea Cochrane1

1Department of Optometry and Vision Sciences, University Of Melbourne, Parkville, Australia

Aim:

Effective communication skills are core generic attributes of allied health professionals, yet are often overlooked in early years of student training. Providing immediate and constructive feedback is imperative to assist students in developing better communication skills. We sought to evaluate the educational value of using a modified University digital application (app).

Method:

The app is developed to generate pre-determined constructive feedback in real-time. It then creates a structured individualised feedback report that can be e-mailed to students instantly. The app has the flexibility to edit comments, and also allows audio commentary. The app was used to provide feedback following case seminars to Year 1 students over a two-year period. After receiving the feedback report, students completed an anonymous survey assessing feedback quality and app satisfaction.

Results:

114 (response rate = 86.5%) students completed the survey comprising of eight 5-point Likert scale items and one open-ended question. The students strongly agreed or agreed that the feedback report was timely (98%), relevant (96%), high quality (90%), and specific enough to improve on their learning (87%). It helped to identify strengths and weaknesses (87%), and they believe that the feedback will help them to improve their communication skills (90%). The report supplemented verbal feedback well (95%). Students expressed that the feedback report was valuable, allowing for critical self-reflection.

Significance of the findings to allied health:

In a time- and resource-constrained teaching environment, educators constantly explore technology to support student learning and teaching outcomes.We have implemented an app that is staff user-friendly and efficient, and concurrently provides effective feedback that students highly value.

What skills and attributes do health professionals need when working in the home to provide rehabilitation?

Ms Nicole  Shaw1, Mrs  Marita  Woodhouse1, Mrs Kylie Casey1

1Barwon Health, North Geelong, Australia

Aim: Home Based Rehabilitation Program (HBRP) services have acquired an increasingly important profile for both policy makers and service providers within the Victorian Health Sector. Research has shown that providing rehabilitation to clients in their own home has financial advantages and significant rehabilitation benefits.

Evidence from nursing suggests that delivery of care within the home can be complex and requires specialist skill, however there is no research evidence that demonstrates this for rehabilitation nor for client’s perceptions about the skills required of health professionals providing home rehabilitation services. This ethics approved research project sought to explore clients’ and health professionals’ perceptions of the skills and attributes required to provide rehabilitation services in the home.

Method: Utilising a qualitative methodology approach, clients and health professionals were invited to complete a survey that explored their perspectives on the skills and attributes required by health professionals who provide rehabilitation services within the home.

Results: Data is currently being thematically analysed by three independent researchers. It is intended that emerging themes will inform any skills and attributes by allied health professionals unique to providing home rehabilitation services.

Significance of the findings to allied health: Further information about this area will assist the provision of best practice, promote understanding of the skills required to work in this area, inform recruitment, retention and professional development and provide support to a growing service provision area in the health care sector.

Competency framework for ACT Health Clinical Measurement Sciences (CMS)

Ms Kelli Rixon1, Mr Luke Cartwright1, Mr Derek Figurski1, Ms Angela Borbelj1, Mr Martin Urban1, Mrs Annette Carroll1, Mrs Lauren Brooks1

1ACT Health, Woden, Australia

 

Aim: To develop a framework that outlines knowledge, skills, behaviours and attributes required by CMS scientific staff (cardiac, neurophysiology, respiratory and sleep sciences).

Method:

  • Review of:

o             Standards of Practice for ACT Health Allied Health Professionals

o             Allied Health (AH) work level standards

o             AH credentialing requirements

o             Competencies within ACT Health (ACTH) CMS

o             National/International publications about CMS professional standards and training

Results: The Framework consists of five generic domains that allow for consistent application across the disciplines:

  1. Professional conduct
  2. Scientific knowledge
  3. Clinical skills
  4. Procedural proficiency
  5. Professional development

Significance:

  • Historically there have been no CMS-specific undergraduate courses in Australia. The entry point to the CMS professions is an undergraduate degree in medical science or health science. There are CMS-specific postgraduate courses; enrolled students need to be working in the specific discipline.
  • The benefits from implementing the Framework:
  • Providing a standardised approach for the assessment, maintenance and monitoring of knowledge, skills, behaviours and attributes
  • Clearly communicate what CMS need to do to be effective in their role
  • Helping to identifying gaps in competency and training requirements
  • Allowing for effective evaluation of performance
  • CMS are currently non-regulated professions; raising issues of accountability and responsibility. The Standards of Practice for ACT Health Allied Health Professionals are currently the over-arching reference for all ACT Health CMS staff. The Framework aligns with the Standards.
  • ACTH is committed to ensuring AH professionals are appropriately qualified and experienced; through credentialing and defining scope of practice processes. Registered AH professions are governed by a profession-specific framework. Non-regulated professions function outside of a formal regulation structure. Credentialing requirements emphasise the importance for a competency framework for non-regulated professions.

An innovative e-Learning tool for enhancing nursing staff competence in dysphagia management

Miss Hannah Toose1, Ms Rhiannon Beggs1

1Royal Melbourne Hospital, Parkville, Australia

Aims:

Successful dysphagia management relies on a consistent, coordinated team approach. Patients with dysphagia are vulnerable to choking, pneumonia, malnutrition, increased length of stay and death. E-learning platforms provide quick, effective staff education. Throughout 2013 the Royal Melbourne Hospital recorded high numbers of clinical incidents involving incorrect provision of food, fluids and medications to dysphagic patients. Streamlined nursing education was required, aiming to substantially reduce errors reaching patients.

Methods:

Key incident themes themes were analysed. In line with adult learning principles, the E-learning tool used problem-based learning with hospital incidents acting as case studies. The tool addresses daily nursing responsibilities, is available via the hospital intranet, accessible to all nursing staff and takes twenty minutes to complete. A pilot of the tool was conducted with eight ‘high risk’ wards. This involved an immediate survey pre and post E-learning training and an additional survey 6-9 months later. Surveys used 10 knowledge based questions and 3 confidence ratings. Low risk ethics approval was obtained.

Results:

A higher volume of nurses completed pre training surveys (N=330) compared with immediate post (N=184) and delayed (N=31) surveys, therefore results were compared in percentages. Common scenarios were well imparted, with learnings maintained; complex and infrequent situations demonstrated lesser retention 6-9 months later. Incident trends showed fewer handover issues and more ‘near misses’ not reaching patients.

Significance of the findings to allied health:

The results are pertinent with high demands on limited Allied Health resources. E-learning coupled with adult learning theory can be effective training for nurses in dysphagia. Findings suggest focusing face-to-face education on complex scenarios in order to compliment E-learning training on foundation skills.

 

Let’s Go Live! A successful training and support model for Electronic Medical Record (EMR) implementation

Dr Ruth Nicholls1, Ms Lauren Andrew1, Ms Bernadette O’Connor1, Ms Emma Mellon1

1The Royal Children’s Hospital, Parkville, Australia

Aim: To present the training and support model and critical factors that ensured successful adoption and implementation of the EMR by Allied Health Professionals (AHPs) at The Royal Children’s Hospital (RCH) Melbourne.

Method: On 30 April 2016, the RCH went live with a comprehensive EMR, embarking on the most significant organisational change ever undertaken by the hospital. Almost 4,000 RCH staff were trained to use the EMR before ‘Go Live’. A multi-staged training program delivered essential education in four key stages: Familiarisation, Getting Ready for Go Live (formal training), Post-Go Live Support, and Business as Usual. Formal training for AHPs encompassed a multi-modal blended-learning approach, with e-learnings, face-face classes, self-directed ‘playground’ practice and a mandatory online proficiency assessment to gain EMR access. Principal Trainers, Credentialed Trainers and support staff (‘Super Users’) were recruited internally to tailor the development and delivery of the AH curriculum, and provide four weeks of continuous ‘floor’ support to AHP ‘End Users’ after Go Live.

Results: Leading up to EMR implementation, AHPs were surveyed on their readiness for Go Live, with survey results used to shape the pre-Go Live training program for staff.  More than 390 AHPs received formal training before Go Live (equating to 2456 classroom hours across 33 sessions) and 98% gained proficiency before Go Live. Additional evaluation data are being collected in late 2016 via a 6 month post-Live survey and the results of the evaluation survey will be presented.

Significance of the findings to allied health: A robust EMR training and support strategy was critical to the success of this large-scale change and numerous factors, including the lessons learned, will be discussed.