change champions & associates newsletter may 2014

Change Champions & Associates Newsletter - MAY 2014

NEWSLETTER

C o n t e n t s

For innovators in

healthcare & beyond

M AY 2 0 1 4

P. 1 Tele-Health: Its Time Has Come?

Prof. Branko Celler

Project Director

CSIRO National Telehealth Trial

P. 6 Why Are They Still Here?

Bridie Egan

Social Work Department,

St Vincent’s Hospital Melbourne

P. 8 Occupational Therapy Competencies

Australia

Catherine Studdert & Nadege Van

Drempt on behalf of the OTCA Team

P. 11 The Enhanced Management of

Orthopaedic Surgery (EMOS) at Coffs

Harbour Health Campus

Andrew Wong

Orthopaedic Care Coordinator

Coffs Harbour Health Campus

P. 12 When Financial Downturn and Mental

Health Collide

Char Weeks

Innovation Leader,

Change Champions & Associates

P. 14 The Living Conditions Program

Mercy Splitt

Catholic Community Services NSW/ACT

P. 15 UPCOMING WORKSHOPS

P. 43 Challenges Integrating Health

Care Services

Dawn Skidmore

Tele-Health: Its Time Has Come?

(Continued p. 3.)

Telehealth has many different meanings

to different people. Most commonly in

Australia it refers to tele-consultations

between specialists and patients

located either in remote areas or in

residential care facilities. This is

presently being reimbursed by

Medicare. However one of the more

important and value adding aspect of

telehealth service delivery in the future

will be at home telemonitoring of

patients with complex chronic condi-

tions such as congestive heart failure

(CHF), Chronic Obstructive Pulmonary

Disease (COPD), diabetes, and morbid

hypertension.

Telehealth technologies can be used in

general practice, community health

centres, community nursing setting and

delivery of specialist consultations to

better manage patient flows, optimise

clinician time and triage patients before

they see a clinician. Telehealth is also

used in palliative and end-of-life care, in

the management of cystic fibrosis,

cancer and numerous other conditions.

Prof. Branko Celler

Project Director, CSIRO National Telehealth Trial

2 Change Champions & Associates Newsletter - MAY 2014

If you are reading this as a PDF, click on the page number

to be taken straight to that workshop page.

Why not consider printing out one of our workshop posters for your

bulletin board at work? Help spread the word!

Workshops with Alice Rota- Bartelink

The ABC of BOC– Working with Older Adults with Complex Care Needs Adults

Who Display Behaviours of Concern [p. 17]

The Challenge of Long Term Alcohol Abuse in Older Adults [p. 35]

The Service Providers Toolkit: Improving the Care of Older Homeless People [p. 36]

Workshops with David Schwarz

Proven Governance: How Effective is Your Board or Management Committee? [p. 16]

Workshops with Kathryn McEwen

Building Resilience at Work [p. 18]

Workshops with Elise Wald

Making a Difference in Sleep- [p. 19]

How to Influence Behaviour Change in Patients with Chronic Illness [p. 20]

How to Influence Behaviour Change in Patients with Severe and Persistent

Mental Illness [p. 21]

Workshops with Robyn Attoe & Daryl Oehm

Sex, Sexuality and Culture: Addressing Social Diversity in Aged Care [p. 22]

Workshops with Robyn Attoe

Managing Behavioural and Psychological Symptoms of Dementia [p. 23]

Bathing without Battles [p. 24]

Delirium and the Older Person [p. 25]

Workshops with Kylie Agllias

Working effectively with clients experiencing family estrangement [p. 26]

Workshops with Julie Faoro

The Long Stay Patient [p. 27]

Workshops with Glenn D. Payne

Social Media Workshop [p. 28]

Workshops with Char Weeks

Manage Your Energy Not Your Time [p. 15]

The New Leaders Toolkit [p. 29]

Managing Up (How to help your boss add value to your work) [p. 30]

Creating a Culture of Innovation [p. 31]

The Change Implementer’s Toolkit [p. 32]

Moving Forward: Accepting and Embracing Resistance to Change [p. 33]

Handy Hints for the Novice Conference Presenter [p. 34]

Workshops with Stephanie Newell & Mitchell Messer

Pathways to a Consumer Focused Organisation– Government and Managerial

Approaches [p. 37]

UPCOMING workshops

www.changechampions.com.au


Articles Upcoming Events Resources Opinion

The international evidence for the benefits of telehealth for

the management of chronic disease is now overwhelming.

The Whole System Demonstrator (WSD) Programme of the

UK Department of Health provided the following Headline

Findings in December 2011.

− 15% reduction in A&E Visits

− 20% reduction in emergency admissions

− 14% reduction in elective admissions

− 14% reduction in bed days

− 8% reduction in tariff costs and

− 45% reduction in mortality rates

Other smaller and more targeted studies report reduction in

hospitalisation of up to 60%, and high levels of patient

satisfaction.

In the US, the Veterans Health Administration (VHA)

introduced a national home telehealth program, Care

Coordination/Home Telehealth (CCHT) in 2003 to coordinate

the care of veteran patients with chronic conditions and

avoid their unnecessary admission to long-term institutional

care. Between 2003 and 2007, the census figure (point

prevalence) for VHA CCHT patients increased from 2,000 to

31,570 (1,500% growth).

Routine analysis of data obtained for quality and

performance purposes from a cohort of 17,025 CCHT

patients shows the benefits of a 25% reduction in numbers

of bed days of care, 19% reduction in numbers of hospital

admissions, and mean satisfaction score rating of 86% after

enrolment into the program. Veterans now being monitored

are in excess of 600,000.

CSIRO is currently undertaking a trial

called Home monitoring of Chronic

Disease in Aged Care which is an

initiative funded by the Australian

Government.

The trial is being carried out in six locations in five states

along the Eastern coast of Australia and involves 25 test

patients and 50 case matched control patients at each site.

Each site represents a different model of care for the

management of chronic disease ranging from a hospital

based chronic disease management program staffed by

specialist clinicians to GP only community care.

Test patients are supplied with an easy to use clinical

monitoring unit from Telemedcare which measures blood

pressure, pulse oximetry, glucometry, spirometry, ECG, body

temperature and body weight as well as administering a

range of clinical and wellbeing questionnaires. Patients can

also message or video conference with their clinical care

coordinator.

Given the wealth of international evidence it could be asked

what objectives are being met by this trial that have not

been already reported internationally. This project has many

unique characteristics designed to provide statistically robust

evidence to Government that can help inform decision

makers and determine future funding models. As well as

reporting on health care outcomes, this trial is also studying

health-economic outcomes, acceptability of the service to

patients and carers as well as clinicians, the impact of

workplace cultures and the need for organisational change

management.

CSIRO is also developing novel risk stratification and decision

support algorithms to monitor on a daily basis changes in the

patient’s health status and to alert the clinical care

coordinator so that a timely and optimal response can be

mounted to avoid unnecessary hospitalisation. We will also

be able to automatically generate a report on the patient’s

condition and upload it to the PCEHR databases so that it can

be available to the patient’s GP and other clinicians for

viewing.

Whilst full results of this trial will not be available until April

2015, preliminary data have been encouraging. Patients are

uniformly positive on the benefits of the tele-monitoring and

report increasing awareness of their condition and a much

greater capacity for self management. We have collected

many examples where an exacerbation in the patient’s

condition has been detected and early intervention either

avoided hospitalisation or resulted in a better outcome. A

typical example as reported by the Clinical Care Coordinator

is as follows.

(Continued p. 4.)

Tele-Health: Its Time Has Come? Continued from p. 1.


“I noted from measurements taken 18.2.14 that Patient X had a very slight

decrease in SpO2 (2% from baseline), drop in spirometry and increase in

temp (though technically still afebrile). She had reported a change in how

she was feeling and her cough in her COPD questionnaire. I messaged via

the TMC Unit and then decided to call her on 19.2.14. Though patient had

commenced oral antibiotics the previous week (initiated by GP after I

recommended she see him) she had not improved and had more cough. I

then contacted outpatient department to establish if her Respiratory

Physician had a vacancy in his clinic that day and secured it for her. I

contacted patient with the appointment time and produced a report for the

Consultant.”

(Reported by the Clinical Care Coordinator)

We’ve even produced a case study video (http://

tinyurl.com/casestudyvideo) to showcase examples of

patients who have been actively engaged in the trial and

seeing positive outcomes.

The evidence is strong that telehealth

for the management of chronic disease

is well accepted by patients and leads

to improved healthcare outcomes and

reduced hospitalisation, so why has

telehealth not yet become an accepted

model of health service delivery in

Australia?

There are many reasons that will be fully identified as the

CSIRO trial reaches completion. A preliminary analysis

however suggests:

1. Lack of funding models for telemonitoring of patients at

home, reflecting the fact that Medicare traditionally

only funds services delivered by clinicians to patient

face to face. Funding for telehealth however is available

from the Commonwealth through it Consumer Directed

Care (CDC) initiative.

2. Limited support from GPs who are often unaware of the

international evidence, cannot see how they can be

remunerated for their participation, and are be

concerned that telehealth may disrupt the traditional

patient doctor relationship.

3. Community nurses often become strong advocates of

the benefits of telehealth, but may initially see it as

disruptive of their normal patient centric work

practices.

4. Lack of capability or willingness in some local health

districts to embrace change and carry out the necessary

organisational change management required to

introduce a new mode of health service delivery into

established service models and workplace cultures.

In our own trial we have experienced all of these concerns

and have had to work through many organisational and

workplace issues, but in most cases Clinical Care

Coordinators and Project Officers have recognised the

benefits to their patients and have become strong advocates

of at home telemonitoring. General Practitioners are also

becoming more involved as they begin to recognise the

benefits to their own patients. Similarly a number of our

partners in the trial are now considering how to sustainably

retain and grow telehealth services within their own

organisations, based on the many positive patient

healthcare outcomes and organisational efficiencies that are

becoming evident.

(Continued p. 5.)


http://tinyurl.com/casestudyvideo

http://tinyurl.com/casestudyvideo


Many early adopters have been predicting a massive boom in the use of telehealth for more than a

decade. However it may be that at long last that is becoming a reality. The most recent prediction

comes from Ronald S. Weinstein, M.D., Director of the Arizona Telemedicine Program who in an

interview with the Association of American Medical Colleges said, “Virtualization of health care is

the future of medicine. Many hospital and private practice services will be outsourced by

telemedicine. I think that is on the close horizon. We’re estimating that 50 percent of all

medical transactions will be done electronically by 2020.”

A similar future can also be predicted with some confidence for Australia if we are to retain a

sustainable universal healthcare system and a vibrant and efficient primary care and aged care

sector as our population ages and the burden of chronic disease increases.

By Prof. Branko Celler

FIEEE, FTSE, FACHI, FIEAust

Project Director, CSIRO National Telehealth Trial

Principal Scientist | Digital Productivity and Services Flagship

Computational Informatics

CSIRO



‘Why are they still here?’

Factors that influence numbers of days spent waiting for discharge for patients with no fixed

address who are deemed medically ready

Bridie Egan

General Medical/Intensive Care Social Worker

Social Work Department, St Vincent’s Hospital Melbourne

The care of homeless patients is of particular interest to St

Vincent’s Hospital Melbourne (SVHM) however responding to

their needs can be complex and challenging. For SVHM this is

a key social justice priority and it is also high on the agenda of

the State Government’s Victorian Homelessness Action Plan

2011-2015.

Homeless patients generally require extensive input from

social work clinicians in public hospitals, especially in relation

to discharge planning. However, managing the range of issues

this patient group presents in order to determine their

discharge pathways and needs can be influenced by the type

of admitting unit, difficulty in obtaining demographic

information and complexity of dual diagnoses. The majority

of research into medically ill homeless people has focused on

emergency department admissions and there is little data

available concerning those being discharged from acute units.

In response to this lack of information two studies were

undertaken to further our understanding of the needs of this

patient group.

1) A pilot study completed by the author focussed on patients

admitted to acute units who were identified as being

homeless. Preliminary findings from this study indicated that

this patient group uses a high number of days waiting for

discharge (WFD) once medically ready (MR) and are more

likely to experience primary homelessness with no fixed

address (NFA) (Egan, 2012).

It was thus important to better understand the discharge

pathways for those admitted to the acute wards with NFA as

well as key demographic information and attendance at

follow up care.

2) The second study considered whether service delivery

models could be developed to reduce average length of stay

(LOS) whilst also improving the continuity of care for this

patient group.

(Continued p. 7.)

TABLE OF

CONTENTS Articles Upcoming Events Resources Opinion


The aims of this study were:

To identify factors that influence the number of days spent

waiting for discharge (WFD) for patients with NFA who were

deemed MR, including factors impacting on continuity of

care.

To calculate the financial impact of missed opportunities for

the hospital to attract additional revenue where the length

of stay (LOS) exceeded the Victorian state average,

according to the Diagnostic Related Groupings (DRG’s)

A sample of 34 patients listed as having NFA over a 24

month period (January 2010 - December 2011) was

identified and an audit tool was developed to capture

relevant data including demographic information, continuity

of care and impact on the health service.

SVHM LOS data for the sample was compared with the

Victorian State average LOS according to DRG’s and

calculations were made on the ‘missed opportunity’ for the

hospital to obtain additional revenue.

Results:

Patients had a combined LOS of 313 days (average of

9.2 days)

53% had a LOS above the State average. SVHM could

have attracted an additional revenue of approximately

$73,000 if those bed days were used to treat additional

patients with similar issues/conditions

A total of 84 days were spent WFD after patients were

deemed to be medically ready to leave the hospital

Factors contributing to the WFD days included patients

waiting for an available bed at SVMH’s ‘Cottage’ (a short

stay ‘home-like’ environment for peo-

ple experiencing homelessness) and for crisis

accommodation via external support services.

26% had a known forensic history and 55% of those

have returned to prison since the audit was completed

77% had drug and alcohol issues, 59% had mental

health issues and 52% of this cohort had dual diagnoses

53% of the total sample had at least one

re-presentation to SVHM within 12 months of the

audit being completed

62% had outpatient follow up appointments

booked, however only 48% attended these

46% accessed two or more programs/services

within SVHM to facilitate discharge planning

This research highlights that patients with NFA admitted to

acute wards at SVHM attract higher numbers of WFD bed

days than DRG averages and they are more likely to use

multiple internal programs at SVHM to facilitate discharge.

This patient group is more likely to have multiple co-

morbidities and to re-present to the hospital within a 12

month period post discharge but is less likely to attend

outpatient appointments.

The final phase of this body of research will utilise these

results to inform possible process improvements and the

development of an integrated model of care to optimise

discharge planning for patients with NFA. Process

improvements could include practice guidelines for Social

Work around prioritisation and consultation with medical

staff to discuss and identify alternative outpatient follow-up

options. Additionally, education to Patient Services Clerks

regarding the collection of homeless patient demographic

and contact details upon admission (such as mobile phone

numbers) would be worthwhile to ensure these patients can

be contacted for follow up care and support.

Acknowledgements

This study was funded by SVHM’s Research Endowment

Fund and acknowledges expert support from Sonia

Posenelli, Dr Carrie Lethborg, Cheryl Apperley, Danielle

Moss, Kathryn Dalton and Una McKeever.

For more info, please email:

[email protected]


https://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=8BXCx4sWLZyVWM&tbnid=b2af-bSGOxh-AM:&ved=0CAUQjRw&url=https%3A%2F%2Fwww.stvfoundation.org.au%2Fnews&ei=t-FdU7mTNM6WkwXO7oGYAw&bvm=bv.65397613,d.dGI&psig=AFQjCNGMxmW


Occupational Therapy Competencies Australia (OTCA) Website (otca.net.au)

Supporting the development, achievement and evidencing of occupational therapy

students’ graduating

The University of Newcastle │ La Trobe University │ James Cook University

Charles Sturt University │ University of Western Sydney

By Catherine Studdert & Nadege Van Drempt on behalf of the OTCA Team.

At the end of 2010 an Office of Learning and Teaching Grant

was awarded to the University of Newcastle and its four

partner universities to create a student-focussed website to

support the development of and evidencing of Occupational

Therapy students’ graduating competencies. In September

2011, the early work of our Project Team (Susan Ryan,

Catherine Studdert, Paul Sijpkes, Carol Hills, Kim Nguyen,

Carol McKinstry, Lee Zakrzewski, Michael Curtin and Matthew

Yau) was presented at the Change Champions & Associates

conference entitled: Innovative Strategies For Engaging and

Supporting Net Generation Students (http://

www.changechampions.com.au/resource/Joel_Pilgrim.pdf).

Fast forward 3 years, and we are excited to tell you that the

team have successfully achieved exactly that: they have

designed, developed and implemented the Occupational

Therapy Competencies Australia (OTCA) Website, an

innovative and interactive student-centred website where

students can find a range of tools and resources to help guide

them, better understand and gauge their competency

development, and to evidence, track and store their

achievements.

Why was OTCA created?

The need for an Occupational Therapy student-centred

website was identified because:

The 2010 Australian Minimum Competency

Standards for New Graduate Occupational

Therapists had been recently revised by

Occupational Therapy Australia (OTA)

There was no existing National framework for

evidencing competence

National Registration was introduced in 2012

requiring students to evidence their competencies

prior to graduating and becoming registered to

practice

To engage students in their learning using

technology in an interesting way, particularly as

many students are tech-savvy familiar with a

variety of media.

The initial research undertaken by the team with

students, practice educators and Heads of Schools with

occupational therapy programs showed they wanted

resources and tools that would provide:

Examples of competent practice

A way to better understand practice

A way to gauge their competency development

A way to better understand the competency

requirements and Standards

A way of showing and evidencing their developing

competence

An ePortfolio where students could store and track

their record of achieved competence and evidence.

(Continued p. 9.)

TABLE OF



How does OTCA support students to achieve and

evidence their competencies?

Central to OTCA is its framework of two key tools:

Competencies

1. The three Occupational Therapy Competency

Development Levels (Emerging, Consolidating and

Competent to Graduate) – designed to help students

and their educators gauge their competency

development

2. The Occupational Therapy Practice Process designed to

help students better understand the general steps of

practice from the request for service/referral for a new

client, identifying and prioritising the client’s main

issues, developing goals, intervention and evaluation.

This is an interactive tool through which students can

access a range of resources (videos, audio, documents,

quizzes, etc) to support their competency development.

Other tools unique to OTCA include:

The Occupational Therapy Competencies Evidencing

Matrix (OTCEM) (Figure 1.) – a competency evidencing

mechanism containing a range of competency

statements mapped to the 2010 Standards (OTA)

embedded within each Occupational Therapy Practice

Process Step against the three levels. Students use this

to self-assess their competence by ticking achieved

competency statements with the option to describe

how they achieved it and upload supporting evidence. If

appropriate, the practice educator can verify the

achievement.

The Practice Placement Cycle (Figure 2.) designed to

facilitate all aspects of preparing for and making the

most of valuable fieldwork placements. Thus students

can use the cycle to guide them to prepare for practice,

write a letter to their practice educator, develop their

learning objectives, self-assess and evidence their

competence and reflect on their placement and plan for

their next.

A secure customised ePortfolio where students can

record, track and store their their letter to their

educator, learning contract, reflections, self-assessed

OTCEM, supporting evidence and any other appropriate

item of achievement. So by the time they graduate,

students will have a number of useful artefacts

including documents, forms, case studies, presenta-

tions, reports and letters they can provide as evidence

that they are competent to graduate and safe to be

registered to practice. The ePortfolio also enables

students to see how far they have come in their

professional journey. Additionally, ePortfolios may be

used to assist new graduates with job interviews and

once they are ready to start practicing.

(Continued p. 10.)

Figure 1: OTCEM Figure 2: Practice Placement Cycle



How can OTCA be used to further engage students in their learning?

A range of fun, educational resources providing exemplars of competent practice and professional

behaviour can be accessed through the Steps of the Occupational Therapy Practice Process,

including:

Examples of forms used in practice settings

Videos featuring students, real clients, practice educators and lecturers

Interactive quizzes related to each process Step

Personal growth resources.

Where is the OTCA Project up to now?

The OTCA Website was launched at the University of Newcastle in May 2013. The five project partner

universities are now using OTCA with their occupational therapy students. Five additional Universities

have now subscribed to use the website in their programs, with a number of other universities

expressing tremendous interest. Exciting updates and tools will continue to be added. OTCA has been

presented nationally and internationally and will be presented in Japan in June and at a multi-

disciplinary forum at the University of Newcastle. Rebecca Pockney, Gjyn O’Toole, Amelia Reddall and

Nadege Van Drempt are now involved with the team at the University of Newcastle.

OTCA – Beyond 2014?

The OTCA Website has been designed for Australian Occupational Therapy students. However, it has

been identified that this valuable tools’ innovative framework has great potential to be adapted for

use in other disciplines and internationally.

For further information or to enquire about how you could utilise this innovative and

valuable resource, please contact Project Manager:

Catherine Studdert

Phone: +61 (02) 49216629

Email: [email protected]



The Enhanced Management of

Orthopaedic Surgery (EMOS) at


Andrew Wong

Orthopaedic Care Coordinator


The Enhanced Management of Orthopaedic Surgery (EMOS)

was launched at Coffs Harbour Health Campus in November

2013. Coffs Harbour is located halfway between Sydney and

Brisbane. It has a population of approximately 70 000

people but provides medical services to another 50 000 in

the surrounding areas. It is a region with a higher

percentage of older population.

Osteoarthritis currently affects around 8% of the population.

A report for Arthritis Australia conducted by Access

Economics predicted that this figure will increase to 11% by

2050, which prompted us at CHHC to plan how best we

could meet an increasing demand for total hip and knee

joint replacement at our facility.

High volumes of Total Hip Replacement and Total Knee

Replacement surgeries are performed at Coffs Harbour

Health Campus each year with same to better length of stay

as compared to peer hospitals. The aim of this program was

to investigate how the length of stay could be further

reduced and patient satisfaction improved. Extensive

consultative processes involving both hospital staff and

patients were performed highlighting local issues with

current joint replacement processes. A literature search

was also conducted for current evidence in the

management of Total Hip Replacement and Total Knee

Replacements.

Overwhelmingly, a solution to meet the aims of the program

while addressing some of the local issues pointed to the

Enhanced Recovery or Fast-track Model of Care. The

principles which Coffs Harbour Health Campus decided to

adopt include:

Prehabilitation and planning to optimise patients

pre-operatively

Use of pre-operative analgesia and nutritional

supplements

Spinal anaesthesia with local infiltration

Use of tranexamic acid

Early mobilisation within 7 hrs of surgery

Active patient participation

Standardisation has been achieved through the formulation

of the EMOS pathways for Total Hip Replacement and Total

Knee Replacement patients as well as through ongoing

education of staff. This has led to a reduction in variation

and a reduction in length of stay with our EMOS patient

group as opposed to the non-EMOS patient group. To date,

30 patients have undergone Total Knee Replacement or

Total Hip Replacement surgery under the EMOS program

and 51 patients utilising standard care, with length of stay

being 3.86 days and 5.19 days respectively. Preliminary

feedback from patients who have utilised the EMOS

program has been positive.

The current plan for the EMOS program at Coffs Harbour

Health Campus is to further achieve standardisation of joint

replacement processes through the development of a

patient education DVD to be used at all hospitals

surrounding Coffs Harbour. Furthermore, with justification

of beneficial results, plans are for EMOS pathway to

transition to standard care in the future.

For more info contact:

[email protected]

TABLE OF



When Financial Downturn and Mental Health Collide

Char Weeks

Innovation Leader


There is mounting international evidence that suggests a spike

in suicides and attempted suicides during harsh economic

times such as the Great Depression, global financial crisis and

more recently, during Greece’s financial turmoil 1,2,3.

The reasons for suicide are complex. Economic downtown and

personal financial distress have been well documented as

precipitants of death by suicide. Recent research indicates a

link between economic downturn and risk of cognitive decline

in middle aged Americans3.

In recent years, the American Association of Suicidology has

attempted to raise awareness about the link between

economic decline and suicide rates. The association cites a

direct relationship between unemployment rates and suicide

with unemployed people being two to four times more likely

to suicide than those who are employed3.

This relationship between unemployment and suicide is deeply

concerning considering that Australia is in the grip of its own

transition from post industrialisation to technological

revolution. This is particularly noticeable in the recent and

proposed job losses in the Australian manufacturing sector.

Looking forward, with technology as an enabler, the pace of

change is likely to increase exponentially. For some, this

mourning of the loss of the familiar, the stable, and the

reliable may seem unrelenting and exhausting. For others,

future employment and financial uncertainty and concerns

that “the lucky country” may not be quite so, may be

disturbing. And for those so genetically, economically or

socially predisposed, future uncertainty may precipitate an

erosion of psychological wellbeing.

Suicide has the third highest burden of illness in Australia

behind all cancers and cardiovascular disease. In 2012, more

Australians died from suicide than road related car accidents

and deaths attributed to skin cancers4. According to KPMG,

the economic cost of suicide in Australia in 2012 was

estimated at $1,675 million in direct (e.g. coronial inquests,

police and ambulance services, counseling support for friends

and relatives) and indirect costs. Of the estimated 65,000

Australians who attempt suicide each year, around 38,000 first

present at a hospital emergency department5, suggesting that

crisis has been a key motivator for seeking help. This raises

questions of where and how the precipitants of suicide

attempts or the patient’s own recognition that they may be a

danger to themselves and others, are recorded. There appears

little available information about how many Australians who

attempt suicide do so because of unbearable financial distress.

In recent years, we have seen a stronger investment in mental

health programs across the continuum of care, support

networks, consumer advisory groups, websites, media

campaigns and help lines. Perhaps, one of the most

memorable and humorous push media campaigns is

beyondblue’s, Man Therapy, designed to raise men’s

awareness about the common symptoms of anxiety and

depression. This television advertisement aired during three

weeks of cricket in 2014 and apparently attracted 19,000

visitors to its website, mantherapy.org.au during this time6.

As they say, you can lead a horse to water, but you can’t make

it drink. With all the good will in the world, it can be

frustrating for loved ones when a sufferer is so incapacitated

by thought distortions that they are unable to get out of bed

and shower, let alone purposefully navigate their way through

the maze of programs on offer and figure out which part of

what program will help them to make the difference that will

become the first step in their recovery.

As a pull intervention strategy, the Australian Government is

rolling out its Partners in Recovery Program where the focus is

on bringing together a team of services and supports across a

multiplicity of sectors to facilitate recovery for people with

severe and persistent mental illness7.

(Continued p. 13)

TABLE OF



This program has great potential if the person at the centre

of the care is sufficiently empowered to be able to articulate

their needs and to have those expressed needs respected

and acted upon as appropriate and without prejudice. There

is also potential for the social determinants of health,

including financial wellbeing, to be actively integrated into a

wholistic recovery plan.

Since time immemorial, some people have worried about

having enough money to pay their bills and feed their family.

Does it not seem strange that service delivery for two

common and often interrelated issues, mental health and

financial distress remains so very early 20th century. Is it not

reminiscent of the days of waiting for the milkman, the

butcher, the baker and the greengrocer to deliver purchases

for the Sunday meat, three veg and pudding lunch before the

advent of that ubiquitous one stop shop, the supermarket.

The growing number of services and resources available for

people with mental health concerns who are also suffering

financial hardship appear dishearteningly at odds with:

1. the stigma, either real or perceived, still attached to

financial failure or mental illness or both.

2. the insidious nature of mental illness progression.

3. the person’s ability to seek help, perhaps as a result of

deep shame, denial, severity of illness, a sense of futility

or a belief that if the financial problem was resolved

they might feel better and vice versa.

4. the person’s vulnerability and ability, including paralysis

of thought, to be able to deal with threats from creditors

or comply with the normal run of business, taxation or

even personal household bill responsibilities.

5. the person’s vulnerability to unscrupulous purveyors of

debt resolution services.

6. easy access to financial and budgeting advice, advocacy,

counseling and services, consumer credit services and

fee free legal advice.

7. greater transparency about processes that dispassionate

creditors can take to recover a debt together with

affirmative action options for people with mental illness

that are recovery focused and lead to debt resolution.

8. health legal and financial professionals including debt

collection agencies’ ability to work as a cohesive,

supportive team towards a client centred improvement

journey that builds a sense of achievement, confidence

and esteem for the client and progressively reduces

debt. (Some larger banking and financial organisations

such as American Express and National Australia Bank

have excellent supportive care to debt reduction

programs in place).

Health, legal professionals, business and credit providers’

capacities to be able to understand the actual needs and

capabilities of the sufferer lie at the heart of building partner-

ships toward recovery. For example, bankruptcy is often

suggested as the obvious escape from pernicious financial

distress. But such a well intentioned suggestion may be

perceived by the sufferer as more the final straw in a psycho-

logically torturous battle within that ignites further mental

decline. Who can forget the ABC’s heart wrenching Landline

story, Losing the Farm8, where a farmer who had just put

down his last few sheep because they were unfit for sale, then

took his own life.

This disconnection with the person who is liable for the

payment of a debt may be exacerbated when the

professional:

has been neither willing nor able to connect with the

persons’ true values; and or,

feels that they don’t have the skills to provide advice

about how to access financial advice and assistance or

health care; and, or

believes that they are just doing their job in applying

pressure to collect the debt.

The opportunity exists for primary care consultations to

include family history of mental illness, assessment of financial

situation, employment security, gambling history, values and

behaviours around credit acquisition/management, budgeting

and saving.

To be able to tap deeply into a patient or client’s true values

requires that professionals be able to put aside their

knowledge and suspend their own judgment to seek first to

understand and then generate a plan that can meet each

parties objectives. That can be equally confronting both for

professionals whose strengths lie in supporting client recovery

and those with a focus on the bottom line.

__________________________________________________

For more info, email Char Weeks at:

[email protected]

(References on p. 44)



The Living Conditions program, which is offered by

Catholic Community Services, is a Case Management

program which assists people affected by hoarding and/or

squalor, within Sydney, the Illawarra, the Southern

Highlands and the Hunter Region.

A referral can be made by service providers, health

practitioners, family, neighbours, or by the person them

self, which is then followed by a comprehensive assess-

ment to identify unmet needs. These needs include

tenancy related, financial, medical or support with linkag-

es back into the community, due to the social isolation as a

result of the impact of the hoarding and/or squalor.

The program encourages independence by involving the

client in the decision making process and empowering the

person to be able to take maximum control of the situa-

tion to achieve desired outcomes.

The Living Conditions Program

is not a 'clean up service'.

...Rather, the service aims to assist someone to sort

through their own items (that have accumulated over

many years, for various reasons) and make realistic

decisions about discarding them. This can be a lengthy and

traumatic process in which the client is supported through

a multi-disciplinary approach and the setting of realistic,

achievable goals within set time frames.

Catholic Community Services has developed a training

package targeted at paid employees at any level within

Community, Health and Government sector, family,

friends, neighbours, or volunteers unsure of how to

approach a situation.

The Hoarding and Squalor workshop provides attendees

with a greater understanding of possible reasons as to why

people hoard and/or live in squalor, and learn the skills to

engage and gain trust.

For more information, please visit http://www.catholiccommunityservices.com.au/services/programs/living-conditions-program

Or contact Mercy Splitt at [email protected]

The Living Conditions Program

A case-management program assisting people affected by hoarding and/or squalor

Mercy Splitt

Service Manager, Hoarding and Squalor Consultancy

Homelessness, Mental Health & Disability

Catholic Community Services NSW/ACT

TABLE OF


http://www.catholiccommunityservices.com.au/services/programs/living-conditions-program



mailto:[email protected]


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NEW!


Change Champions & Associates presents a brand new workshop

Manage Your Energy

Rather Than Your Time

Full Breakfast Workshop with Char Weeks

If you are over trying to manage your time so that you can do

everything on your wish list on time all the time, this workshop

might be for you. Join Char Weeks for this practical and inspiring

workshop which could change the way you do everything.

15 August 2014, 07.00-09.30

Melbourne, VIC

Register today!



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NEW!

PROVEN GOVERNANCE:

How effective is your Board or

Management Committee?

A practical and challenging Master Class with expert David

Schwarz for executives and leaders who not only wish to make

a difference, but want that difference to be measurable.

Thursday, 24 July 2014 in Melbourne VIC (09.00-17.00)

Friday, 25 July 2014 in Sydney NSW (09.00-17.00)

Register online: www.changechampions.com.au

Proven Governance is a powerful test of a

Board/Committee's resolve to embed its

values and principles into the fabric of the

Board/Committee itself.

Proven Governance is underpinned by the

belief that the actual values to which

individuals and organisations say they are

committed to, will, and should, find a place

in the actual behaviour of those individuals

and organisations. In simple terms, many

individuals and organisations espouse lofty

values and principles. However, the actual

behaviour of those in governance may, or

they may not be, aligned with these

espoused values and principles. The key is

that the organisation is able to articulate,

by reference to practical examples, the

way their values are built into the

governance of the organisation.



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PAGE 2

The ABC of BOC Working with Older Adults with Complex Health

Care Needs Who Display Behaviours of Concern

Join recognised expert, Dr Alice Rota Bartelink,

in this full-day practical case-study workshop.

Workshop Content

This practical case study day offers a vibrant, supportive,

but strictly confidential forum for professionals who are:

Uncertain about where to start unraveling

complexities in caring for older adults who display

behaviours of concern

Keen to understand the implications of behaviours of

concern e.g. the impact and flow-on effect on staff,

patients, clients, residents etc.

Interested in discovering tools and techniques to be

able to more effectively identify and prioritise the

management of behaviours of concern displayed by

clients

Recognise the need to be able to measure the

success of behaviour interventions and management

plans

09 May 2014 – Auckland, NZ

23 May 2014 – Perth, WA

06 June 2014 – Sydney, NSW

20 June 2014 – Mackay, QLD

22 Aug 2014 – Hobart, TAS

in-house opportunities!

REGISTER ONLINE!

DATES


Need some practical tools to help

you unravel and prioritise those

complexities to deliver the best

outcomes for your clients?



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12 May 2014

In Auckland, NZ

It is not too late to register!!!

BUILDING RESILIENCE

AT WORK

KATHRYN MCEWEN is an

organisational psychologist,

company director and

executive coach. Join her

for this stimulating workshop,

purposely designed to

provide you with the

strategies and tools you

need to build resilience at

work.

A Full Day Workshop

for Leaders and Leadership Teams

The most valuable assets in any organisation are their people.

Today’s executives and leaders appreciate the need to be on top

of their game all of the time; regardless of the pressures they face

from an ever changing environment. They are expected to be

able to support their teams through a myriad of challenges while

maintaining a positive work environment.

This practical workshop is for the emotionally intelligent: those who

understand that RESILIENCE is a key characteristic of a healthy,

productive and sustainable team.

Who Should Attend

Executives, managers and team leaders from any government or

professional or industry sector. Delegates are welcome to bring

case studies for discussion in strictest confidence.

For more info, or to register online please visit:

WWW.CHANGECHAMPIONS.COM.AU



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Workshop with Elise Wald

Making a Difference

In Sleep

A workshop on sleep therapy techniques

so you can assist patients to improve

their sleep without medication

For allied health professionals, GPs, nurses,

sleep technicians and any other professional

working with chronic and complex conditions

Thursday, 19 June 2014

09.30-16.30 in Melbourne, VIC - with Elise Wald




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How to influence

BEHAVIOUR CHANGE in patients with chronic illness

2-day workshop with Elise Wald

21 & 22 May 2014 - Darwin, NT, Australia

09 & 10 June 2014 - Perth, WA, Australia

17 & 18 July 2014 - Sydney, NSW, Australia

15 & 16 September 2014 - Dunedin, New Zealand

23 & 24 September 2014 - Auckland, New Zealand

REGISTER ONLINE TODAY!




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How to influence

BEHAVIOUR CHANGE

in people with severe and persistent mental illness

2-day workshop with Elise Wald


15th & 16th May 2014 — Melbourne, VIC, Australia

21st & 22nd July 2014 — Sydney, NSW, Australia

17th & 18th September 2014 — Dunedin, New Zealand

25th & 26th September 2014 — Auckland, New Zealand

Register online today!



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16 July 2014– Mackay, QLD

Workshop with Robyn Attoe & Daryl Oehm

Culture, gender identity, sexual orientation and sexuality are integral to

personal identity and our sense of well-being. Without attention to social

diversity it is difficult to provide person centred quality aged care.

This interactive workshop is designed to:

draw on your experiences working with culture & sexuality in aged care,

address similarities in cultural and LGBTI competencies,

draw on broader issues of diversity in our community, and;

plan strategies to provide aged care that is respectful of emotional and

physical needs.

Sex, Sexuality & Culture

Addressing Social Diversity in Aged Care



23 Change Champions & Associates Newsletter - MAY 2014 www.changechampions.com.au

Up to 90 % of people who have

dementia will experience behavioural

and or psychological symptoms during

the course of their illness .

16 May 2014 - Perth, WA

18 July 2014 - Mackay, QLD

+ In house opportunities

available at your facility

Managing Behavioural

& Psychological

Symptoms of

Dementia

One day workshop with Robyn Attoe

OUTLINE

1. Discuss the different types of dementia, the changes to the brain and the behaviours

staff may see in each type of dementia

2. How to communicate effectively with the person with dementia (PWD)

3. How the environment impacts on behaviour and how staff can modify the environment

to reduce BPSD

4. Discuss and define Psychological Symptoms of dementia and how to manage them

5. How staff can assist in the transition from home to hospital or residential care by

identifying the needs of the PWD and then providing a detailed strengths based care

plan for the PWD

6. Discussion of case studies and more …

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PAGE 2 Articles Upcoming Events Resources Opinion


Bathing Without Battles

A practical workshop

with Robyn Attoe


The process of bathing is usually pleasurable and relaxing for

most people! In contrast, bathing can be both a distressing and

traumatic experience for people with dementia and their carers.

This workshop will assist you to see bathing as not a task to be

performed but rather a human interaction that can be pleasant

for both carer and the person with dementia.

This workshop is suitable for:

1. Anyone who works in the Aged care field including home

care workers and supervisors

2. Anyone partnering in care with a person with dementia

3. Hospital and Residential Care Staff

30 May 2014

Perth, WA

17 July 2014

Mackay, QLD

+ in house opportunities

available at your facility

Register online!

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“You would have to be half mad to dream me up.” -Lewis Carroll, Alice in Wonderland

Full day workshop with Robyn Attoe

“Delirium in older hospitalised people is often overlooked or misdiagnosed due to limited

staff knowledge of delirium features or a perception that all cognitive impairment is due

to dementia” (Australian Government Department of Health and Ageing).

Delirium is a serious medical problem which results in increased length of stay in hospital,

premature institutionalisation, morbidity and mortality in the elderly. Needless to say the

cost to the healthcare system is enormous!

This practical workshop by recognised dementia behaviour expert, Robyn Attoe, is

designed to assist anyone working with older people:

to recognise the delirious patient early

improve knowledge about delirium management

Delirium And the older person

15 May 2014 - Perth, WA

+ in house opportunities available

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PAGE 2



http://www.goodreads.com/author/show/8164.Lewis_Carroll

http://www.goodreads.com/work/quotes/2933712


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Working effectively

with clients experiencing

family es trangement

Full Day Workshop with Kylie Agl l ias 09th May 2014 – QLD (09.15-16.30)

16th May 2014 – SA (09.15-16.30)

30th May 2014 – VIC (09.15-16.30)

or as an in-house at your organisation

Visit the website for more details or to register online!




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Learning Objectives

To identify patients that may benefit from the

application of the long stay model prior to

consuming excessive bed days

To learn how to engage all stakeholders in

the implementation of the long stay program

To develop knowledge and skill in the appli-

cation of the tools and methodology related

to the long stay program model

Register online today!

WWW.CHANGECHAMPIONS.COM.AU

The Long Stay Patient A workshop with Julie Faoro

Many of you will have met Joan. She is a 74 year old widow who was living

independently at home prior to presenting at

your hospital ED in an altered conscious state.

On assessment and investigation, layers of

medical issues appear and need unravelling.

Moving on, our Joan is still in hospital after 154

days. She's frustrated and bored. There is no

agreed discharge plan and Joan just wants to

go home. Your team are reluctant to discharge

Joan because they are yet to be convinced

that all her layers of issues have been resolved.

These sorts of long stays are preventable. And this

workshop with serve as a valuable investment

for your hospital in preventing these long stays.

Is this your patient?

Could you do with some help to free up her bed?

Ideal audience:

ANUM's, discharge planner, case manager, care

co-ordinators, performance analysts and anyone

else who genuinely cares about Joan and her

need to live out her days independently and in

her own home.

DATES

8 & 9 May 2014 – Auckland, NZ

22 & 23 May 2014 – Perth, WA

19 & 20 June 2014 – Sydney, NSW

17 & 18 July 2014– Brisbane, QLD



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28 May 2014 - 09.30-16.30

The Business Centre 365 Little Collins St, Melbourne, VIC

Register online!

SOCIAL MEDIA

Full day WORKSHOP

with Glenn D. Payne



The New Leaders Toolkit

A Practical Workshop on the Stuff That’s Not in the Book

13 May 2014 – Adelaide, SA 27th May 2014 – Perth, WA 20th June 2014 – Gold Coast, QLD 5th August 2014 – Brisbane, QLD 9th September 2014 – Sydney, NSW 24th October 2014 – Melbourne, VIC

+ in house opportunities also available!

Register online: www.changechampions.com.au

Full day workshop with Char Weeks

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MANAGING UP (How to help your boss add value to your work)

Understand the broader context in which your boss works and

what is important to them as a leader and manager.

Better understand how to tap into your boss’ skills and

expertise to enhance each others’ roles, to build trust, respect

and capability.

Identify strategies to ensure that you and your boss are on the

same page in update meetings and that you are more clear

about what to do when you get back to your desk.

Build confidence in presenting information to your busy boss to

elicit a considered, timely and appropriate response.


Ever bounced into your boss’ office to eagerly report on project progress, only to be met

with a quizzical stare? Ever been stopped mid-sentence by a boss who has no idea what

you are talking about? Ever been asked to cut to the chase when you thought you were

actually giving a brief summary? Did their eyes glaze over half way through a perhaps long

winded explanation? Feel a bit anxious when going into a meeting with your boss?

Here is a 3 hour

workshop that will help

you to make those meetings

with your boss a much more

mutually rewarding

experience

Register online!

2014 WORKSHOPS

09 May 2014 – Adelaide, SA


18 June 2014 – Gold Coast, QLD

01 August 2014 – Brisbane, QLD

05 September 2014 – Sydney, NSW

22 October 2014– Melbourne, VIC

+ in house opportunities also available!

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This practical workshop draws upon the best

international literature and focuses on how to create

a culture of innovation in health and aged care.

Delegates will learn a step by step approach to creating a

culture of innovation in their organisation:

Define what constitutes “innovation” as a

pre-requisite for culture change

Understand the DNA of innovators and how they

inspire others

Consider case studies of innovation in organisations

Look at strategies and tools for fostering innovation in

your organisation

Develop a road map for fostering innovation in your

organisation after the workshop

Full day workshop with Char Weeks

Creating a Culture of

2014

12 MAY 2014– SA

26 MAY 2014– WA

19 JUN 2014– QLD

04 AUG 2014– QLD

08 SEPT 2014– NSW

23 OCT 2014– VIC

In-house opportunities

also available


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For health, aged, primary community care, local

government, member associations and not for profits

professionals who are new to working on projects.

Note: This is a novices only workshop. If you dream at

night about the work of the greats in change

management (i.e. Kotter, Bridges, Lewin, Senge, Moss-

Kanter etc.), you are too experienced to attend.

Register today! Visit www.changechampions.com.au

AUDIENCE

FIRST TIME MANAGING A PROJECT OR PROGRAM?

Excited and enthusiastic about the opportunity to expand your horizons by working on a new initiative? Expert on

the topic area? What about your expertise on how to manage change? Not too many ideas…. Great!

You are the ideal participant in this full day, introductory, interactive workshop.

The Change Implementer's Toolkit 101

07 May 2014 – Adelaide, SA


16 June 2014 – Gold Coast, QLD

30 June 2014 – Brisbane, QLD

03 September 2014 – Sydney, NSW

20 October 2014– Melbourne, VIC

+ in house opportunities available

DATES

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Moving Forward

Accepting and Embracing Resistance to Change

This master class will enable you to:

EXPLORE reasons for and sources of resistance to

change both more broadly and in the context of your

role as a change agent, leader, implementer or

recipient

LEARN strategies for anticipating, addressing and

managing resistance to change and any unintended

consequences

DISCUSS ways to build dynamic coalitions for

sustainable change

MANAGE the messages, manage people and

networks, develop competencies, find comfort zones

DELGATES ARE TO BRING:

1. Organisational chart with names of position

holders de-identified

2. Project proposal or implementation strategy or a

change resistance issue (real or hypothetical)

Who should come?

New leaders and project managers

from any industry or public sector who

are keen to develop their skills in

Change Management

UPCOMING DATES

05 MAY 2014 - Adelaide, SA

19 MAY 2014 - Perth, WA

11 JUNE 2014 - Gold Coast, QLD

28 JULY 2014 - Brisbane, QLD

01 SEPT 2014 - Sydney, NSW

16 OCT 2014 - Melbourne, VIC

REGISTER ONLINE:


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Handy Hints

For the Novice Conference Presenter

Are you doing great work but rarely present in public?

This is a workshop for the novice conference presenter who needs practical

tools to become a confident speaker.

Workshop Program

Introduction

Do you recognise the rabbit in the headlights?

Write a bio that promotes your Best Asset– YOU

Write a great abstract

Learn from the experts

Preparing your presentation

Managing yourself, the venue and the AV

Practice delivering a presentation

Train yourself to answer questions well

BRING A 5 MINUTE PRESENTATION

Upcoming Dates

06 MAY 2014 - Adelaide, SA

20 MAY 2014 - Perth, WA

12 JUNE 2014 - Gold Coast, QLD

29 JULY 2014 - Brisbane, QLD

02 SEPT 2014 - Sydney, NSW

17 OCT 2014 - Melbourne, VIC


BACK TO



A practical in-house master class with Alice

Rota-Bartelink on managing older clients living

with Alcohol Related Brain Injury (ARBI)

The Challenge

of Long Term Alcohol

Abuse in Older Adults

Make an inquiry for your facility!

To facilitate the transfer of skills and knowledge

gained through evaluative research into the

provision of appropriate support to clients living

with alcohol related brain injury (ARBI) this

presentation will provide education on the

effects of long-term alcohol abuse on an older

person and advice on strategies to assist service

providers with managing behaviours of concern

among older clients living with ARBI.

Master Class Aim

“This Master Class aims to improve the life

quality of this often forgotten and neglected

group of people by providing participants with an

understanding of their unique set of care needs

and imparting the skills required to enhance

the delivery of effective care and support.”

- Alice Rota-Bartelink

Workshop Outline

Introduction

Alcohol & Alcoholism

Symptoms

Alcohol and the Ageing Body

Comorbidity

Alcohol and the Brain

The Role of a Neuropsychologist

Treatment

Managing Challenging Behaviour

Aggressive Behaviour

Self Care Practices - Staff

Case Profile

Conclusion

Download the PDF flyer from our website

www.changechampions.com.au and fill out

the expressions of interest form

BACK TO



The Service Providers Toolkit:

Improving the Care of Older

Homeless People

In-house master class with Alice Rota-Bartelink

Introducing Nigel: Case profile

Defining homelessness

– primary, secondary and tertiary

Characteristics of an aged homeless population

Advocating for the older homeless person

Navigating complex service systems

Understanding life roles and the significance of

engaging in meaningful activities

Facing the challenge of “behaviours of unmet need”

The Service Providers Toolkit

Homeless and the Aged

IN-HOUSE

WORKSHOP

This workshop is available as an

in-house at your organisation.

Download the PDF flyer from

our website to read more info

and to fill out the expressions

of interest form.


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Pathways to a Consumer Focused Organisation –

Governance and Managerial Approaches

It is timely for health care organisations, from boards to

front-line staff, to gain a clear understanding of consumer

participation and consumer experience principles.

Set within the context of the current health reforms and

expanding mandatory requirements this Master Class is a

strategic exploration and examination of the health consumer

participation trilogy: consumer engagement, consumer

involvement and consumer partnerships for organisation-

wide quality improvement.

IN-HOUSE MASTER

CLASS

For more details please visit our website and download & fill out an expressions of interest form. We’ll then get back in touch with the relevant information

Audience Profile

Board members, health services executives, clinicians, safety

& quality co-ordinators/managers, risk managers, clinical

governance managers and health consumers.

With facilitators

Stephanie Newell

& Mitchell Messer

Visit www.changechampions.com.au

To download official flyer & register your expression of interest

Book an

in-house for

your facility!

BACK TO



Feel like you’ve bitten off

more than you can chew?

Get the support you need, when you need it .

Suitable for emerging managers working in health,

aged, primary and community care and especially

those new to program, project and other funded

initiative management and those who are:

working in isolated regions or just

working in isolation

those with little previous experience

sufferers of imposter syndrome (i.e.

feeling way out of your depth or certain

that your lack of skills will shortly be

discovered)

Receive support and advice in the areas of:

Strategic planning, program

implementation

Relationship management, networking/

collaboration building and management

Working with a Board/Committee

Managing up

Working with staff

Brain storming

Management self development

Confidential Coaching Service

With experienced certified executive coach

Telephone coaching service available in or out of hours. (Hourly rates) Face to face coaching also available by appointment.

Email: [email protected]


mailto:[email protected]



International RESOURCES

Community services: How they can transform care Edwards N, The King’s Fund (2014). This paper looks at the changes needed to realise the full potential of community services for transforming care. The Transforming Community Services policy, launched in 2008, was mainly concerned with structural changes. While the emphasis on moving care closer to home has resulted in some reductions in length of hospital stay, it is now time to focus on the bigger issue of how services need to change to fundamentally transform care. The paper is based on contributions from a working group of community providers convened by The King’s Fund, which was tasked with exploring how community services can help deliver the transfor-mation in care that was promised by the 2008 policy. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/community-services-nigel-edwards-feb14.pdf

Cellulitis Clinical Pathway Lakes DHB, NZ This document is a pathway document has been approved by the Lakes District Health Board, NZ, Clinical Pathways Clinical Governance Group. It was issued in December 2012 and has been reviewed in May 2013. http://www.lakesdhb.govt.nz/Resource.aspx?ID=24968

Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic François Desmeules, Panagiota Toliopoulos, Jean-Sébastien Roy, Linda June Woodhouse, Marc Lacelle, Manon Leroux, Steven Girard, Debbie E Feldman, and Julio C Fernandes. In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskel-etal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model. http://www.biomedcentral.com/1471-2474/14/162

Tweets about hospital quality: a mixed methods study Felix Greaves, Antony A Laverty, Daniel Ramirez Cano, Karo Moilanen, Stephen Pulman, Ara Darzi, Christopher Millett Background Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services. http://qualitysafety.bmj.com/content/early/2014/04/19/bmjqs-2014-002875.full

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/community-services-nigel-edwards-feb14.pdf

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/community-services-nigel-edwards-feb14.pdf

http://www.lakesdhb.govt.nz/Resource.aspx?ID=24968

http://www.biomedcentral.com/1471-2474/14/162

http://qualitysafety.bmj.com/content/early/2014/04/19/bmjqs-2014-002875.full



Older adults with cancer and clinical decision-making: the importance of

assessing cognition Wee-Kheng Soo, Department of Geriatric Medicine, Eastern Health, Box Hill, Victoria

Cognitive impairment presents unique clinical challenges in the management of older adults with cancer. With an ageing popu-

lation, the recognition and management of cognitive impairment is likely to become more important in oncology practice. Cur-

rently, screening for cognitive impairment is not routinely performed in oncology. However, screening has been shown to de-

tect cognitive deficits in a significant proportion of older adults with cancer. This can have a significant impact on treatment

decisions, including determining suitability for cancer therapy and capacity to provide informed consent. In addition, cognitive

impairment can enhance the risk of complications from cancer and its treatment. Early identification can facilitate appropriate

decision-making and interventions to minimise its consequences. Further research is needed on recognition and management

of cognitive impairment in older adults with cancer. This article provides an overview of cognitive impairment in older adults

with cancer, with the aim of informing clinicians on the importance of assessing cognition.

http://www.cancerforum.org.au/Issues/2013/November/Forum/Older_adults_with_cancer.htm

Depression in older age: A scoping study National Ageing Research Institute

Prepared by Ms Betty Haralambous, Ms Xiaoping Lin, Dr Briony Dow, Ms Carolyne Jones, Dr Jean Tinney and Dr Christina Bryant

Funded by beyondblue: the national depression initiative

Depression affects people of all ages, but this study was particularly focused on the knowledge and information available about

depression and anxiety amongst older people.

This study aimed to identify the gaps in current knowledge about diagnosis and treatment of depression and anxiety amongst

older adults (those aged over 65 years) in Australia in order to identify priority areas for Australian research into older age de-

pression.

http://www.beyondblue.org.au/docs/default-source/default-document-library/bw0143---nari-2009-full-report---minus-

appendices.pdf?sfvrsn=4

Australian RESOURCES

http://www.cancerforum.org.au/Issues/2013/November/Forum/Older_adults_with_cancer.htm

http://www.beyondblue.org.au/docs/default-source/default-document-library/bw0143---nari-2009-full-report---minus-appendices.pdf?sfvrsn=4

http://www.beyondblue.org.au/docs/default-source/default-document-library/bw0143---nari-2009-full-report---minus-appendices.pdf?sfvrsn=4



Gaining a new respect for the other guys: scripted scenarios for inter

professional education in paediatric emergencies Ann Lazarsfeld-Jensen & Donna Bridges, Charles Sturt University

This project aimed to find ways of staging and evaluating simulations as a tool of Interprofessional Education. A series of script-

ed paediatric emergencies was used to create an intense learning environment to explore knowledge exchange and shared

learning between GP registrars and paramedics. Although simulation is a familiar tool in medical education, its use in interpro-

fessional education (IPE) is difficult to facilitate because of its many dimensions.

http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1421&context=jephc

POSTER: Green Light Project-

Improving patient access to Liverpool Hospital Intensive Care Unit

Start Date: 25/02/2013

Completion Date: 30/12/2014

The Green Light project will measurably improve access to Intensive Care Unit beds at Liverpool by improving the timely and safe

transfer of patients into ICU and to wards.

http://www.archi.net.au/documents/our-services/innovations/green-light.pdf

Smoke hazard during a bushfire event Dr Monika Nitschke, Department of Health – South Australia

This presentation is about short term public health impacts from bush fire smoke.

https://www.agedcommunity.asn.au/files/bushfire-workshop-2013/bushfire-advice_nitschke.pdf


http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1421&context=jephc

http://www.archi.net.au/documents/our-services/innovations/green-light.pdf

https://www.agedcommunity.asn.au/files/bushfire-workshop-2013/bushfire-advice_nitschke.pdf



SOCIAL ISOLATION:

Its impact on the mental health & wellbeing of older Victorians COTA—Vicotira

It is well-known that lacking friends and social networks is bad for physical health. The Paper outlines research which is now

suggesting that being socially isolated can also affect mental health, increasing the risk of experiencing mental illnesses such as

dementia, depression and anxiety. COTA Victoria argues that maintaining opportunities for social participation should be a key

factor when policy affecting older people is framed. The experience of social isolation requires a multi-faceted, holistic policy

response.

http://www.cotavic.org.au/wp-content/uploads/2014/02/Working-Paper_Social-Isolation.pdf


Patient safety – handover of care between primary and acute care

Policy review and analysis Dr Lesley Russell, Ms Jennifer Doggett, Dr Paresh Dawda, Mr Robert Wells

The Integrated Care Working Group (ICWG) of the National Lead Clinicians Group (LCG) commissioned the Australian Primary

Health Care Research Institute (APHCRI) to undertake a review of evidence and policy around patients‟ transitions between

the primary and acute sectors.

http://www.leadclinicians.health.gov.au/internet/lcg/publishing.nsf/Content/0BC80B14F241017BCA257A590021F2E8/$File/

Transitions%20of%20Care%20report%20FINAL%207May13.pdf

SEXUALITY: Dementia Friendly Environments Government of Victoria

Strategies for sexual and sensual expression

Strategies for intimacy between residents

Strategies for staff training and awareness

http://www.health.vic.gov.au/dementia/strategies/sexuality.htm

http://www.cotavic.org.au/wp-content/uploads/2014/02/Working-Paper_Social-Isolation.pdf

http://www.leadclinicians.health.gov.au/internet/lcg/publishing.nsf/Content/0BC80B14F241017BCA257A590021F2E8/$File/Transitions%20of%20Care%20report%20FINAL%207May13.pdf

http://www.leadclinicians.health.gov.au/internet/lcg/publishing.nsf/Content/0BC80B14F241017BCA257A590021F2E8/$File/Transitions%20of%20Care%20report%20FINAL%207May13.pdf

http://www.health.vic.gov.au/dementia/strategies/sexuality.htm



As a consultant I am frequently asked to help health care

organisations deliver health care reforms, and in particular,

achieve more integrated services.

Many of my health care clients are striving to ensure their

health systems are sustainable, of high quality, safe, and fit

for future health needs. Many are working to achieve

seamless integration of care between sectors, struggling to

achieve continuity of care for patients and families and

how to establish effective governance models to create

support and maintain the delivery of quality care involving

multiple providers. Others are facing the challenge of

empowering and supporting the primary care sector to

better engage with the rest of the health care system.

Common difficulties include:

The need to balance the interests and values of all

stakeholders involved in the continuum of care

The fragmented, complex, and often impersonal

health services, that patients and carers report are

becoming increasingly difficult and frustrating to

navigate

Conflicting priorities and timeframes for action of the

various stakeholders and parts of the system

The need for governance mechanisms that meet the

needs of the community while maintaining the

integrity of individual sectors and

Gaps in evidence and understanding on how to

achieve the required outcomes and health service

reforms.

Of course these challenges are not unique to Australia. But

whilst health care reform is occurring across the globe,

achieving the enablers such as pooled funds and its

associated partnership working may be easier to realise in

some countries. In Australia, the complex funding divides

between primary and secondary health care represents an

important barrier.

Are you facing these challenges? Are you in the health care

sector committed to making a difference but not knowing

where to start?

Firstly seek out and make friends with your Medicare

Local. Medicare Locals (MLs) are ideally placed to act as

the binding agent for various health sectors at a local level.

MLs are locally governed and directed by local clinicians

and other community leaders who are in touch with local

areas. They are regional primary health care organisations

working to better connect health services locally and to

find the service gaps that need to be addressed to ensure

communities and consumers get the health services they

need closer to home.

Medicare Locals are making a difference by working with

primary health care professionals, to introduce new

models of health care delivery through expanded

multidisciplinary health care teams. They also:

Support greater coordination of primary health care

services across their designated region

Identify and address local service gaps and determining

priority areas relevant to primary health care to create a

more equitable system

Drive quality improvement through best practice

Report on population health outcomes through Healthy

Communities Reports, published annually by the National

Health Performance Authority

Establish effective partnerships with other health,

community, social and aged care providers, including Local

Hospital Networks, to support local health and care

services

Enhance access to after hours and primary mental health

care services and supporting the uptake of e-health

initiatives including Personally Controlled Electronic Health

Records (PCEHR).

(Continued p. 43.)

Challenges integrating health care services

Dawn Skidmore

[email protected]



Why not see how working with your Medicare Local can

help you overcome some of the challenges you face?

Once you have done this, consider that there, in my opinion,

a number of key requirements that need to be in place if

health service integration is be achieved. Perhaps not

surprisingly, this starts with effective leadership, commit-

ment to collaborative and partnership working and a shared

vision and commitment to quality and safety. After all,

health sector integration is dependent on a these

foundations, along with effective policy and robust and

transparent systems of governance. Only then can effective

and sustainable working relationships be realised. Change

management needs to be managed locally; with committed

resources and an approach that aligns with organisational

cultural values.

Partner organisations need to agree on the shared priorities,

including clinical priorities, and enter into joint strategic

needs assessment (taking a geographical population focus).

The following strategic planning needs to be conducted with

input from providers and users. If you can identify and use

appropriate incentives (such as any pooled funding) then

you may well be able to strengthen the integration and care

coordination processes.

I have seen a number of successful models of integrated

care across Australia. In each of these, patient/community

engagement is an important component. For example

patients and the community participate through patient

experiences and stories. Integrated information communica-

tion technology systems are another common feature.

These systems have been designed to support clinical

information sharing and there is an agreed and committed

use of data and quality improvement tools in planning,

delivery, and evaluation of continuous improvement.

Consider how continuous professional development,

including inter-professional and inter-organisational

learning opportunities can provide training to support new

ways of working, aligning cultures and goals and identifying

workforce capacity across the health care system and

continuum of care.

Good luck in supporting your health care organisation to

deliver health care reforms and at the same time achieve

more integrated services!

Policy context

In 2009, the Commonwealth Government produced A healthier future for all Australians – final report

of the National Health and Hospitals Reform Commission recommending that to achieve increased

health care effectiveness and efficiency, there was a need for changes to healthcare governance in

Australia.

In 2010 Australia’s First National Primary Health Care Strategy Building a 21st century primary health

care system was produced heralding regional service integration as one of the five key building blocks.

Both of these key policy documents demand improved integration of care between the primary care

and hospital sectors.

Australia's primary health care sector, the care you get outside of hospitals, has been reformed

through the development of 61 Medicare Locals (ML) across Australia.


ARTICLE:

When Financial Downturn and Mental Health Collide, Char Weeks (p. 12)

REFERENCES:

1, Wahlbeck K, McDaid D. Actions to alleviate the mental health impact of economic crisis. World Psychiatry, 2012, October,

11(3):139-145.

2 Kentikelenis, A, Karanikolos M, Papanicolas I, Bascu S, McKee M, Stuckler D, Health effects of financial crisis: omens of a

Greek tragedy. Lancet, Volume 378, Issue 9801, Pages 1457 - 1458, 22 October 2011.

3 Haiken M, Suicide Risk in Time of Financial Crisis – real connection. Forbes, http://www.forbes.com/sites/

melaniehaiken/2011/08/10/suicide-risk-in-times-of-financial-crisis-a-real-connection/2/

4 KPMG’s Health Economics, The Economic Cost of Suicide in Australia, October 2013.

5 Woodward, A. Suicide is Everyone’s Business. Article in http://www.lifeline.org.au/About-Lifeline/Media-Centre/Media-

Releases/Media-Release-Files/Why-Suicide-Prevention-is-Everyone-s-Business

6 beyondblue . Media Releases. Men responding in large numbers to beyondblue TV campaign. Jan 2014. http://

www.beyondblue.org.au/media/media-releases/ men-responding-in-large-numbers-to- beyondblue-TV-campaign

7 Partners in Recovery Initiative, http:www.pirinitiative.com.au. Accessed 12 April 2014

8 ABC Landline, Losing the Farm, 6 April 2014, http://www.abc.net.au/landline/archives/landline_201404.htm. Accessed 12

April 2014

Innovation in Health Conference

June 16th and 17th 2014 Novotel Hotel St Kilda, 16 The Esplanade, St Kilda, VIC

The Victorian Healthcare Quality Association, in association with the Centre of Research

Excellence in Patient Safety and the Australasian Association for Quality in Health Care is proud

to announce our upcoming two-day conference showcasing quality improvement initiatives which

have won major awards across Australia over the previous 12 months.

Who should attend? This conference is directed at Quality Managers, Nursing and Medical

leaders and Executives who want to keep abreast of innovative practice by healthcare workers

which has beenrecognised as being outstanding by their peers.

Booking? http://www.trybooking.com/81291

Enquiries? [email protected] which will be accessed daily for any inquiries

http://www.thelancet.com/journals/lancet/issue/vol378no9801/PIIS0140-6736(11)X6043-9

http://www.forbes.com/sites/melaniehaiken/2011/08/10/suicide-risk-in-times-of-financial-crisis-a-real-connection/2/

http://www.forbes.com/sites/melaniehaiken/2011/08/10/suicide-risk-in-times-of-financial-crisis-a-real-connection/2/

http://www.lifeline.org.au/About-Lifeline/Media-Centre/Media-Releases/Media-Release-Files/Why-Suicide-Prevention-is-Everyone-s-Business

http://www.lifeline.org.au/About-Lifeline/Media-Centre/Media-Releases/Media-Release-Files/Why-Suicide-Prevention-is-Everyone-s-Business

http://www.beyondblue.org.au/media/media-releases/%20men-responding-in-large-numbers-to-%20beyondblue-TV-campaign

http://www.beyondblue.org.au/media/media-releases/%20men-responding-in-large-numbers-to-%20beyondblue-TV-campaign

http://www.pirinitiative.com.au/

http://www.abc.net.au/landline/archives/landline_201404.htm

http://www.trybooking.com/81291



invites you to contribute to this publication!

Are you or your organisation working on a new project

or initiative? We’d love to hear about it!

Please send us a 1 page article highlighting the major aspects

of the initiative you are part of.

Email articles, suggestions and advertising enquiries to

Diane Vatinel at: [email protected]

PO Box 302

Kew, Victoria 3101

AUSTRALIA

E: [email protected]

W: www.changechampions.com.au

change champions & associates newsletter may 2014

Documents

mental health

upcoming workshops

aged care

life care

community health centres

older adults

care of older homeless

telehealth technologies