Allied Health innovation: Thinking strategically and differently

CaraJane H. Millar1, BHSc (SP), MHA

1 Allied Health Manager -Language Services and Workforce Innovation.  Alfred Health.  

In many daily situations people have problems to solve, many decision are quick, easy and efficient, “Which shoes to wear, what to have for breakfast?” others are more complex “What patients fit the prioritisation tool, which way do I react/respond to my partner/colleague or friend?” and some seem insurmountable, “How on earth will I fit everything into my time today?” Do you feel you need to solve a problem but can’t at the moment?

There are many things that will make issues/problems seem insurmountable and there is nothing like tight resources to make one think differently.  Hopefully you will find an alternative resolution –you can become more “innovative”.

This session will ask some of the key questions to identify a problem that could be considered in a different or innovative way.  The problem will be defined and key questions will be provided to consider:

  • Is the organisation ready for change?
  • Does this change fit with professional scope of practice AHPRA or professional association requirements?
  • How as clinicians can you be more daily-efficient to find the time release to try a new way of working?
  • How to evaluate, report and get the ‘word-out’ about this innovation?
  • How do you ensure good governance.

Thomas Edison was one of the first inventors to apply the principles of mass production and large-scale teamwork to the process of invention, hence he was innovative, he though differently and efficiently this session will encourage you to think like Edison and allow a safe space for innovation.

The global tracheostomy collaborative: A multi-disicplinary quality initiative improving the lives of children and adults who have a tracheostomy around the world

Ms Tanis  Cameron1,2, Ms  Charissa Zaga1,2, Ms Kristy McMurray1,2, Ms  Jack Ross1, Dr  David Roberson2,3,4

1Tracheostomy Review and Management Service (TRAMS) Austin Health , 2Global Tracheostomy Collaborative, 3Department of Otolaryngology, Boston Children’s Hospital, 4Department of Otology and Laryngology, Harvard Medical School

Aim: The Global Tracheostomy Collaborative (GTC), founded in 2012, is an international multi-disciplinary Quality Improvement (QI) collaborative which strives to improve outcomes in both paediatric and adult tracheostomy care (www.globaltrach.org). Dr David Roberson, ENT Specialist, Boston Children’s Hospital and Harvard is the lead in this world first tracheostomy QI . The GTC works through the following key drivers: Patient and family participation, multi-disciplinary tracheostomy care, a HIPAA-compliant REDCap database to track and benchmark outcomes among member hospitals, creation of institution wide tracheostomy policies and protocols, and coordinated interdisciplinary education for all providers. The aim of this study is to report on the process, outcomes, future directions of this tracheostomy quality collaborative. Austin Health in Melbourne Victoria is a founding member and the Australasian lead site for the GTC with a team led by allied health professionals, nurses and doctors.

Method: Establishing mission and vision, international clinical governance, committee structure, website formation, creation of and reports from international HIPAA-compliant REDCap database, 4 international kick-offs and ongoing global recruitment.

Results: Since April 2014, over 50 hospitals in the United Kingdom, Sweden, United States, Singapore, Qatar, and Australia have joined the collaborative. 770 individuals from 125 institutions attended GTC launch meetings in Boston (April 2014), London (July 2014) Melbourne (October 2014); and Baltimore (April 2016). 1000 additional individuals from over 20 countries attended virtually. All disciplines (anesthesia, critical care, pulmonary, respiratory care, physiotherapy, speech pathology, nursing, social work, and hospital management) were represented at the meetings. Data collection has been successful with 1500 new tracheostomy cases entered into the database by 19 institutions and counting.

Significance of the findings to allied health: This world first global initiative has strong allied health leadership  and membership.  Allied health are key to this specialist healthcare community.

Opportunities and challenges in achieving transformational change in allied health: A South Australian experience

Dr Saravana Kumar1, Ms Catherine Turnbull2

1School Of Health Sciences, International Centre for Allied Health Evidence, University Of South Australia, Adelaide, Australia

2Department for Health and Ageing, South Australia, Adelaide, Australia

 

Aim

Australia is confronted by a number of health care challenges. Successfully addressing these challenges requires a health system which is nimble, responsive to change and takes a system-wide focus. While achieving change in health care is complex, allied health in South Australia has successfully achieved this across a range of professions. This presentation will showcase these and the positive impacts on health care processes and outcomes.

Method

Using a case-study approach, new models of care from allied health disciplines (such as physiotherapy and nutrition and dietetics) and clinical areas (such children’s health and development) were trialled across South Australia. Quantitative (such as waiting time, cost, and safety) and qualitative (patient perspectives) were captured to measure the impact.

Results

The results these case-studies indicated a number of positive impacts on health care processes and outcomes. The new models of allied health care reduced waiting times, improved efficiencies (by reducing cost) and access to care while ensuring safety (no adverse events). Patients were receptive and satisfied with these allied health-led new models of care (with no patient complaints). Implementation of these models of care has highlighted critical success factors which need to be identified early, such as identified need, stakeholder engagement, effective use of data, if successful and sustainable change is to be achieved.

Significance of findings to allied health

South Australia has made significant contributions to transformational change in allied health. Lessons learnt from South Australian experience has national and international significance as change is the new norm in 21st century health care.

Giving a voice to people with chronic communication impairments: A feasibility study

Ms Michelle Sargent1, Ms Sharon Flitman1

1Peninsula Health, Frankston, Australia

Aim: The present quality activity sought to explore the benefits of social singing amongst subacute outpatients with long-term acquired speech and/or language deficits including aphasia, apraxia of speech and dysarthria.

Method: Seven participants attended a social singing group for 90 minutes per fortnightly, where they participated in warm up activities, sang songs and socialised over afternoon tea. The Stroke Aphasia Depression Questionnaire (SADQ-10) was administered at baseline and again after six sessions of the group. A participant evaluation questionnaire of satisfaction was also completed after six sessions.

Results: A large drop in total depression score was identified between baseline (41) and follow-up (20) as measured by the SADQ-10. The evaluation questionnaire revealed increased engagement and participation in activities outside the group setting. Of the participants interviewed, 92% reported enjoying the group, with 75% reporting having made new friends through the group. Many carers, clinicians and clients themselves also reported improvements in confidence, social engagement, and speech and language outcomes following participation in the music group.

Significance of Findings to Allied Health: These results support the implementation of singing groups to increase mood and quality of life for patients with chronic communication disorders. Future research is required to more rigorously test the effect of such groups with larger participant numbers.

 

Clinic service review for speech and language-delayed children with cleft palate

Carli Maddocks1, Rachel Kerr1, Emma Holmes1

1Royal Children’s Hospital, Parkville, Australia

Aim:

Children with a history of cleft palate are screened at 18 months of age using the Communication and Symbolic Behaviour Scales (CSBS) questionnaire, due to increased risk of speech and language delay. Children who fail are offered an appointment with Speech Pathology. This clinic review involved trialling a group clinic with the following aims:

  • Ensure timely access to services prior to routine 3 year old review
  • Ensure early identification and referral to community Speech Pathology
  • Provision of standardised education for parents via e-health
  • Increased time efficiency of group format compared to individual

Method:

A 6 month trial of group service delivery was compared with individual appointments in the same time period the previous year. Various data were collected regarding number of children seen, attendance rates, and outcome of the appointments e.g. referrals to community services, patient demographics etc. Parent questionnaires obtained information on satisfaction with the clinic information and structure.

Results:

All project aims were achieved, including a 400% increase in children seen and 95% of the children requiring follow up or referral. Standardised education was provided within the clinic appointment with plans to be converted to e-health.

Significance of the findings to allied health:

Review of service delivery models, including tertiary care, can result in improved utilisation of clinic resources, increased time efficiency for clinicians and parent satisfaction. The results also reinforced the importance of early identification and service access for children at risk for communication delays.

The wait is over: Early health care delivery for acquired hand condition

Miss Kelly Briody1, Miss Zoe Milner2

1Monash Health, Clayton, Australia, 2Melbourne Health, Melbourne, Australia

Aim:

To evaluate if changing a model of care reduces the waiting time for common health conditions. Acquired hand conditions referrals e.g. carpal tunnel syndrome, trigger finger and basal joint arthritis increase public health service demands. Management of these patients typically involves lengthy delays between referral and initial medical appointment. As a result, conditions worsen, limiting the viability of nonsurgical management. Positive patient outcomes are then more difficult to achieve.

Literature indicates patients with acquired hand conditions can be successfully managed by a senior hand therapist.

Methods:

A clarificative evaluation was used to scope existing pathways at Monash Health (MH) and Royal Melbourne Hospital (RMH).

Results:

A change in the credentialing of senior hand therapists, to implement an advanced practice screening clinic, allowed the identification of clients appropriate for non-surgical management.

Over 15 months, 269 referrals were assessed between sites. Results of pre and post model change indicated the advanced practice role reduced the waiting time, to an average of 26 (RMH) to 55 days (MH) from beyond 6-12 months. Sixty-four patients with acquired hand conditions have been removed from public health waitlist during this time.  Plastic surgeon consultants agreed that patients reprioritised from the screening clinic, due to severe clinical presentation, required surgical intervention.

The clinic is currently continuing at MH, with ongoing funding being sought at RMH.

Significance of the findings to Allied Health:

Changing the model of care and introducing advanced practice clinicians can positively influence patient flow and positive clinical outcomes. They are sufficiently skilled to identify patients with acquired hand conditions appropriate for non-surgical management and escalate for surgical opinion.

 

Driving innovation in allied health services for a health network

Ms Amy Thomas1, Dr Helen Shoemark2, Ms  Janeen Bower1, Ms Lucy Forrest1

1Monash Health, Clayton, Australia, 2Temple University, Philadelphia, USA

 

Aim:

While allied health research informs interventions in medical and community settings, little attention is given to the development of clinical service delivery. Development of services is often ad hoc and reactionary in response to periods of rapid transition. The “Sustainable Innovation: Building equitable services for consumers across the Monash Health network” project is a multi-phase clinical project designed to reconfigure a flexible model for the music therapy service across the lifespan populations cared for in the Monash Health network.

Method:

Kazdin’s mediator-moderator model provided the scaffolding (Kazdin, 2007; Robb 2012)  and principles of team science (Salas, Fiore & Letsky, 2012) were employed to construct progress through active discussion.  Key components included:

-Respect, before pride – allowing all perspectives to be given a place in the discussion

-Creative strands – were discussed until exhausted, rather than tolerated.

-Diagram as place-holder – visual representations as provisional impressions to keep concepts accessible while language was explored

-Resisting the premature conclusion –leaving decisions open to modification

This process promoted retention and growth in caseload while new systems were progressively tested via clinical audits of referrals and session purposes.

Results:

The outcomes to-date included the introduction of a new theoretical platform to support the network priority to keep patients in their community. On this platform, referral priorities have been revised and streamlined and music therapy service targets increased to better meet patient needs and health network priorities. This paper will include explain the processes and outcomes, with illustrations of increased efficiencies.

Significance of the findings to allied health:

This project illustrates an applicable model of team process to develop robust systems which can retain a clear patient focus while being responsive to rapid systems change.

Transdisciplinary emergency department practice: Five years in, lessons learnt

Ms Jessica Toohey1, Ms Heather McInnes1

1Western Health, St Albans, Australia

Aim:

Transdisciplinary practice extends clinicians to practice beyond the scope of their traditional professional boundaries.  Transdisciplinary practice is identified as a model of healthcare delivery with the potential to address future healthcare needs, and is predicted to increase in prevalence.  As a key stakeholder in healthcare reform, allied health professions need to take a lead role in shaping current and future transdisciplinary models.

ethod:

Available literature largely focuses on established areas of transdisciplinary practice such as paediatrics, and primarily focuses on either proposed issues and benefits or clinical outcomes resulting from transdisciplinary practice.  There is a knowledge gap regarding pragmatic concerns of establishing and running a transdisciplinary service.  This presentation describes the lived experience of a group of allied health clinicians undertaking a transdisciplinary role in an Australian context, intending to share their practice wisdom to assist knowledge dissemination for others undertaking or seeking to develop transdisciplinary roles.

Results:

“Lessons learnt” across a number of domains will be presented, identifying existing and potential challenges and actions.  Navigating dual governance structures; balancing disparate discipline practice frameworks within transdisciplinary care; team composition considerations; developing and maintaining  transdisciplinary culture; education and training responsibilities and standards, and data and performance indicators to attribute disciplinary input will be explored.

Significance of the findings to allied health:

There is a clear impetus for allied health to proactively identify and manage the challenges and opportunities of allied health emergency department transdisciplinary roles, and those more broadly.  This will ensure the advancement of transdisciplinary practice, whilst addressing the current and future development of the allied health workforce.

 

A pre-treatment speech pathology/dietitian specialist clinic for head and neck cancer patients receiving (chemo)radiotherapy

Ms Jane Harrowfield1, Ms Megan Watson1, Dr Jacqui Frowen1

1Peter Maccallum Cancer Centre, Melbourne, Australia

Aim:

To test the feasibility and clinical efficacy of a pre-treatment speech pathology and dietitian specialist clinic for head and neck cancer patients. The clinic aims to: 1) Improve patient experience and clinical outcomes and 2) Streamline speech pathology/dietetic services between hospitals sharing patient management.

Method:

This pilot study used a pre-test, post-test quasi -experimental design. The study included 26 patients with head and neck cancer who were planned to receive radiotherapy (with or without chemotherapy). Fourteen patients received usual care and 12 participated in the pre-treatment clinic along with usual care. Outcome measures were collected pre treatment, at the beginning and at the end of treatment. Outcomes included: patient experience, patient clinical outcomes, organisational outcomes and service delivery.

Results:

Patients who participated in the pre-treatment clinic had a greater understanding of the possible swallowing, speech/voice and nutritional problems that could develop during (chemo)radiotherapy.  This result was statistically significant. The pre-treatment clinic did not impact clinical outcomes for dysphagia or airway management; however, nutritional outcomes showed a trend towards less weight loss and a lower malnutrition prevalence for those patients who participated in the clinic.  No difference between groups was seen for unplanned hospital admissions and length of stay. Episodes of care were not increased for dietetics but were higher for speech pathology. This means for dietetics, additional resources are not required and the clinic is cost-neutral.

Significance of the findings to allied health:

This clinic demonstrated the advantages of providing a pre-treatment multidisciplinary clinic in the setting of head and neck cancer, particularly for dietetic management. This pilot study could provide a template for allied health teams who want to work collaboratively, allowing for improved clinical outcomes while minimising the need for additional resources.

Allied health assistants in ABI: An interdisciplinary model with an embedded AHA workbook competency program

Ms Shaeron Murray1, Ms Jacqueline Salway2, Ms Jacqui Morarty1, Dr Delwyne Stephens1

1Alfred Health, ABI Unit, Caulfield, Australia, 2Alfred Health, Caulfield, Australia

 

Aim:  The role of Allied Health Assistants (AHA) is being expanded across healthcare networks in Victoria, to enable Allied Health Professionals (AHPs) more time to focus on higher level tasks, such as patient diagnosis and treatment planning. The Victorian Government is investing in the development of the AHA role, and envisions AHAs of the future to be delivering broad ranging and innovative care.

 

Method:  At Alfred health’s Caulfield Hospital in the Acquired Brain Injury (ABI) Unit, AHAs are an integral part of the interdisciplinary team. Six AHAs work closely with in-patients who have experienced severe to catastrophic ABI. The AHAs are not aligned to a discipline, and are supervised by AHPs. They work with up to 6 different AHP disciplines, and often work with a particular patient undertaking tasks for a number of different clinicians, working to achieve patient goals.

Method:  In order to support AHA staff with the high level of interdisciplinary learning and management of complex patient caseloads, a learning program – the ABI AHA Workbook – was developed by AHP expert in ABI. The program is designed to be worked through individually, in small groups, and 1:1 with the AHA’s supervising AHP. Competencies cover a broad range of areas within Speech pathology, Physiotherapy, Occupational therapy, Nutrition, Psychology, Orthotics, Neuropsychology, and Social work.

 

Results: The AHA model will be outlined, and the AHA workbook will be demonstrated, as an example of an innovative practice model in Allied health. Further, ways in which the program is to be evaluated and shared will be discussed.

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