change champions & associates newsletter november 2014

Change Champions & Associates Newsletter - NOVEMBER 2014

NEWSLETTER

C o n t e n t s

For innovators in

healthcare & beyond

N OV E M B E R 2 0 1 4

P. 1 Colonoscopy Service Improvement Project Sarah Mavrikis, Kerry Leaver, Jayne Sandford Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health

P. 6 CODE GREED: Protecting Our Frail Aged Char Weeks Innovation Leader Change Champions & Associates

P. 10 Valuing People: A web based organisational self-assessment tool Christine Pappon Valuing People Project Manager Alzheimer’s Australia

P. 11 Kids Acute Liaison in Mental Health (KALM) Cassandra Hainsworth Registered Psychologist, The Department of Psychological Medicine, The Children’s Hospital at Westmead, NSW

P. 13 The Accelerated Chest pain Risk Evaluation (ACRE) Project Wade Skoien ACRE Project, QLD

P. 15 Standardised Surgical Set Ups Improve Efficiency and Cost Peter Stewart, FRACS, General Surgeon, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District

P. 17 The Cunningham Dax Collection–

Art & Mental Health Anna Zagala Acting Manager, Operations and Communications Officer Dax Centre, VIC

P. 19 WORKSHOPS & IN-HOUSES

P. 32 BLOG CORNER

(Continued p. 3.)

With more than 500,000 procedures occurring each year, many Australians will

require at least one colonoscopy during their lifetime. The often feared procedure is a

crucial tool in the prevention and early detection of cancer and major health

problems associated with the gastrointestinal tract.

The demand for colonoscopy services is increasing and the provision of equitable and

appropriate services complex, given that it is used as both a diagnostic tool, and a

screening and surveillance tool. People often have to wait to receive the procedure,

and given the important functions it’s vital that public hospitals are providing access

in a consistent and appropriate manner.

Southern Adelaide Local Health Network (SALHN)

Colonoscopy Service Improvement Project

2 Change Champions & Associates Newsletter - NOVEMBER 2014

Workshops with Char Weeks

[p. 21] Manage Your Energy Not Your Time

[p. 22] Moving Forward: Accepting and Embracing Resistance to Change

[p. 23] The New Leaders Toolkit

[p. 24] Managing Up (How to help your boss add value to your work)

Workshops with David Schwarz

[p. 25] Board Appointments Master Class

Workshops with Robyn Attoe

[p. 26] Delirium and the Older Person

[p. 27] Managing Behavioural and Psychological Symptoms of Dementia

Workshops with Alice Rota- Bartelink

[p. 28] The ABC of BOC– Working with Older Adults with Complex Care Needs

[p. 29] The Challenge of Long Term Alcohol Abuse in Older Adults

[p. 30] The Service Providers Toolkit: Improving the Care of Older Homeless People

Workshops with Julie Faoro

[p. 31] The Long Stay Patient

In-house workshops

www.changechampions.com.au

Call for abstracts & posters

Respecting Our Loved Older One’s Wishes– 2 day seminar [p.5]

Scheduled courses 24 NOVEMBER 2014 (VIC), 08 DECEMBER 2014 (Auckland, NZ)

Building Resilient Teams at Work [p. 19]

with Kathryn McEwen

25 FEBRUARY 2015 (1/2 day workshop in Melbourne, VIC)

Care Homes Programme [p. 4]

with Pam O’Nions

26-27 FEBRUARY 2015 (2 day seminar in Melbourne, VIC)

Respecting Our Loved Older One’s Wishes [p. 5]

APRIL– MAY 2015 (travelling one-day workshop, to WA, QLD, NSW, VIC)

Working effectively with clients experiencing family estrangement [p. 20]

with Kylie Agllias


In order to achieve this, SA Health initiated a statewide

Colonoscopy Service Improvement Project in 2014, as a

result of a recommendation from the Commonwealth

Government’s National Definitions for Elective Surgery

Urgency Categorisation Project. The recommendation

proposed for the expansion of Elective Surgery urgency

categories and national reporting arrangements to include

medical procedures, such as gastroenterology scopes.

SA Health is focussing a significant effort on improving the

delivery of gastroenterology services, starting with

colonoscopy. This will be achieved through the introduction

of statewide arrangements for waiting list management,

similar to those that have proven effective for elective

surgery services in South Australia.

In June 2014, statewide policies and guidelines were

developed: most importantly, the introduction of standard

urgency categories for patient prioritisation. The project

teams within each of South Australia’s Local Health

Networks are tasked with their implementation. Let us now

focus specifically on the Southern Adelaide Local Health

Network (SALHN).

The first phase is to implement a consistent and structured

Booking List Information System (BLIS) for each of the three

hospitals within SALHN; Flinders Medical Centre,

Repatriation General Hospital and Noarlunga Hospital. All

three sites are very different in terms of size and service

provision. Once implemented, BLIS will create a standard

waiting list by site and this will enable a demand and

capacity modelling exercise to be undertaken at a site, LHN

and state level to understand the demand for scopes and

the timeliness of procedure across the SA Health system.

Important first steps have been to gain network-wide

clinician support for the project and agreement on urgency

categories for each of the procedures included. From 1 July

2014, each referring clinician has been assigning the

urgency categories in line with the developed policy and

protocol.

SALHN’s key obstacle for implementing the first phase is

that gastroenterology scopes are managed differently at

each site, resulting in variations in patient management and

service structure: this is in part due to different funding

models at the sites. From a quality and safety perspective,

this creates an opportunity to deliver standardised best

practice across SALHN. The SALHN gastroenterology

services are keen to develop the concept of one service

delivered across three sites and a key enabler in achieving

this is the consultative approach taken to engage all

stakeholders in the rationale for change and using their

expert knowledge to identify and resolve the barriers to

implementation.

One other significant barrier is the multiple IT legacy

systems in place. This means the LHN is unable to create

one network-wide scope waiting list. The challenge will be

coming up with innovative ways of integrating the three

independent waiting lists to facilitate equitable access to

network services for patients.

The second phase of the project will use the service

modelling to inform future service planning and facilitate

robust resource allocation decision making in the tight fiscal

environment health is currently operating within.

SA Health’s commitment to improving patient outcomes is

demonstrated by this service improvement initiative, which

will ensure equitable and timely access to public

gastroenterology services for all South Australians.

Colonoscopy Service Improvement Project, continued from page 1.

Kerry Leaver Operations Manager Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health

Sarah Mavrikis Project Officer Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health

Jayne Sandford Clinical Practice Improvement Officer Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health

Articles Upcoming Workshops In Houses Blogs


1/2 DAY WORKSHOP WITH PAM O’NIONS

25 February 2015, Melbourne VIC

Background

There is a growing appetite for

improvement across the aged care sector

coupled with increased demand from

residents, relatives, commissioners and

regulators. This makes it essential to share

best practice and support improvement

initiatives… and to do so now.

The Care Homes Programme is designed to

help care homes strengthen

communications with the wider health and

care community and improve resident,

relative and staff experience. It is divided

into two parts: Wellbeing and Connect.

Care Homes Wellbeing focuses on

improving resident, relative and staff

experience by creating better

communication channels within care

homes.

Care Homes Connect focuses on

strengthening external relationships by

creating more effective communications

between care homes and the wider health

and care community

Facilitator name:

Pam O’Nions RN BSc MNsg GDipED DipBus

Doctoral Candidate

Senior Consultant, Qualitas Consortium

Objectives:

The focus of this interactive workshop will be

to introduce you to the Care Homes

Programme to find ways that help the aged

care facilities to better engage with staff,

residents & relatives and enhance

communications between the different

groups.

Learning Outcomes:

At the completion of the workshop the learner

will have been introduced to the Care Homes

Programme structure and tools to:

empower staff to make the improvements

that residents and relatives want

improve safety through better

communication

improve efficiency to release more time

caring for residents

improve relationships between aged care,

local community and the wider health and

social care system

Change Champions & Associates presents:

To register your interest email: [email protected]

Keep an eye out on the website! Visit www.changechampions.com.au


Abstracts & Posters due 15 November 2014

at midnight

Delivering integrated, consumer directed care where,

when and how it’s needed.

Olympic Park, Melbourne VIC, AUSTRALIA

INVITED KEYNOTE SPEAKERS

Dr Régis Blais, Pan Canadian Home Safety Study, University of Montreal, Canada (confirmed)

Carol Foster, Locality Manager, Adults North, Nottingham Citycare Partnership, UK (confirmed)

Prof Peter Gonski, SouthCare, South East Sydney LHD, NSW (confirmed)

Tracy Haddock, PEPS Manager, Bedfordshire Partnership For Excellence in Palliative Support

(PEPS) Co-ordination Centre and Local Implementation Manager, Vitrucare End of Life Pilot St

Johns Hospice, UK (confirmed)

Rod Quantock, Comedian, Dinner Speaker (confirmed)

Dr David Skyes, General Manager, Learning and Development, Alzheimer's Australia VIC

(confirmed)

EARLY DELEGATE REGISTRATIONS ARE NOW OPEN Visit www.changechampions.com.au

PROGRAM COMING SOON!


Protecting Our Frail Aged

Staff, Patient and Visitor Safety in Healthcare Facilities

An iced to the eyeballs hipster hurls obscenities while fist

punching moths in the cool night air, just missing a

paramedic’s right temple. Elsewhere in a hospital

emergency department, a ragged homeless woman,

screams “I’ll cut you” as a medical team tries persuade

her that she is safe from the demons rampaging through

her mind. Nearby, a new arrival, Arthur, an ashen faced,

portly bloke who had been complaining of pain in his

chest and shoulder tips, fades quietly out of life. And in a

local nursing home, Jorge, has rammed his wheelchair

into a nursing director’s shins during another attempted

breakout through the code locked glass doors because,

“That bitch won’t get me a doctor”. Jorge has already

forgotten that his doctor has just left his side.

These are all examples of behaviours, some far worse

than depicted here, that our dedicated healthcare teams

regularly endure while just doing their job. The reality is

that people in pain, be it physical, emotional,

psychological or self inflicted can become extremely

unpredictable and potentially dangerous. The offspring of

our frail aged share that same potential when life appears

to suddenly go pear-shaped for their parents.

To a certain extent, Australian health professionals are

supported by standardized codes for dealing with

emergencies. There’s code blue that alerts everyone to a

medical emergency like Arthur’s chest pain and loss of

consciousness. Code black signals a personal threat. In

Victoria, there’s a code grey, called by a clinician to signal

aggression or violence.

All of these codes stem from the recognition that the

safety of staff, patients and visitors is paramount. How

safe is a cognitively impaired nursing home resident when

one of their offspring whispers sweet nothings like, "Let

me take care of everything. You can trust me with all of

your money. I'm not greedy like the others."

Acute Hospital Episodes Connect Older People and Their Families to Frailty

Too often, it’s an acute hospital episode, such as after a fall,

that first connects older people with not only their frailty,

but the fragility of their physical and/or cognitive

independence.

Relatives, friends and extended families can be caught off

guard emotionally as they struggle with the difficult to

digest truth that their older loved one is losing their ability

to care for them self. Conflicting opinions, expressions of

grief, ulterior motives, perhaps fuelled by lingering sibling

rivalries or estrangement, may be even more distressing to

their frail parent than the harsh reality of their health

predicament. How safe are our elderly when they are

frightened, confused and not in control of their offsprings'

behaviours?

CODE GREED

Char Weeks Innovation Leader

Change Champions & Associates

Articles Upcoming Workshops In Houses Blogs Contents

(Continued p. 7.)


Some families huddle into an all for one, and one for all,

team. In these families nearly everyone is willing to do that

little bit extra to smooth the transition from hospital. Their

focus is on the care and wellbeing of their loved one. They

seek to fully understand their loved one’s wishes and to

actively encourage their participation in discussions of

options and final decisions. In the ideal family, at least one

trusted person might know the whereabouts of a will, any

powers of attorney, enduring guardianships, medical

guardianship, advance care plans, organ donations and

decisions about who gets what and when. Such a high level

of organisation may well alleviate pressures, concerns and

fears about the future for all concerned.

Their loved one can leave hospital on a new journey to a

place, perhaps to home, perhaps not, where they can

receive the care that they need and still be happy and as

independent as their condition allows.

But not every family is cordial, generous, caring and sharing.

Harmful Effects of Family Conflict and Family Estrangement

According to family conflict expert Dr Kylie Agllias*, there is

mounting evidence that family conflict and estrangement

are far more common than families care to share. The

stigma and embarrassment attached to family conflict and

estrangement may be unbearably painful for some

members. Others, unable to cope with the embarrassment

of appearing dysfunctional, will do anything to brush any

brand of disharmony under the carpet in the name of blood

ties and kinship.

Then, there are those families whose members are openly

shameless about playing out the blame game, nurturing

conflict, pitting one against another and feeding

estrangement in the hospital ward, nursing home or

anywhere else that facilitates an airing of how hard done by

they are compared to everyone else.

Healthcare facilities across the spectrum are full of stories

such as that about the son who refused to allow his mother

to be discharged from a hospital to a nursing home until

she, against her wishes, granted him a power of attorney.

There is the anecdote of the son who appeared out of

nowhere to make regular appearances at his dying father’s

bedside.

During many of these encounters, the son apparently would

leap on any opportunity to demonise his father’s deliciously

attractive second wife as an uncaring gold digger. As the

father’s condition deteriorated, the son is said to have

removed an art collection and furniture from his father’s

home, apparently in an effort to spare the valuables from

the ensuing post mortem carve up. Stories abound of

threats to stop visiting the older person if they don’t make

financial contributions to shore up future appearances.

It’s hard to find a convincing argument that these vulnerable

patients and residents are actually safe, especially from

their own families.

It is probably as difficult for healthcare professionals as it is

for patients and residents to sift fact from fiction when it

comes to perceptions and attributions of avaricious or

malicious intent among family members. This is particularly

the case with pernicious family dysfunction, where

members may appear to be caring so as to make others

seem comparatively less than caring. Emotions may run

high, motivations may appear questionable and

communication may remain just perfunctory. Distrust has

the capacity to spread faster than you can spell ebola as

disaffected relatives focus on issues among kin rather than

actually helping their loved one to optimise their version of

a quality life

If no tangible evidence to support claims of ill will exist, then

it can be difficult to discern that a relationship with an

elderly parent is abusive. That is why we need a Code

Greed…

Protecting Our Frail Aged, Continued from p. 6.

(Continued p.8)


CODE GREED


The Value of a Code Greed

Code Greed is very loosely based on the “Richardson

Principle” that if there is a horse by the name of Self

Interest running in a race, then back it. While not

condoning gambling, visitor behaviours that reek of self

interest sit at the heart of the need for a Code Greed. If

Code Greed were to be adopted, it might be emerald

green, the colour of envy. It is possible that convenience

and self interest may offer in part, an explanation for the

sometimes dismal visitor turn outs for residents in many

of our aged care facilities. As an aside, it’s hard to miss

the selfless devotion of some offspring of some nursing

home residents.

Code Greed would exist essentially to protect the frail aged

from coercion, manipulation, unreasonable sense of

entitlement and any other subtle or overt form of financial,

legal, psychological or physical threat from a visitor, and

especially, visitors named Relative.

Code Greed would be patient or resident centred. It should

be respectful of every patient or resident's right to be

treated with dignity. It should support the patient or

resident to have their expressed wishes heard and actioned

as reasonable.

Code Greed might also be clinically led.

Code Greed could be called, for example, when any health

professional:

hears or sees a patient or resident showing signs of

sudden or unexplained onset distress before, while or

after being visited

overhears repeated conversations that focus on the

denigration or belittlement of another family member

overhears any visitor applying even the most subtle

pressure to give them money or sign any documents

observes tension or arguments between patient or

resident and visitor eg “Go. I don’t want you here.”

The effective implementation of Code Greed, rests on the

frail older person being able to provide a family history, by

name, by relationship and emotional connection, including

those estranged, self distanced, incarcerated or just living

overseas.

The next challenge for health professionals is to

triangulate the family history and relationships between

relatives to ascertain the family dynamics and alert them

to potentially difficult encounters. For example, when

there is friction between siblings that is obviously

disturbing for the resident or patient, one might be

refused visitation while the other is present.

Protect Yourself - Plan Your Own Transition to Frailty What people seem to consider late is that frailty is one of

life’s milestones, just like that first milk tooth pushing

through pink gums and that rolling stumble into your first

steps. There are a million and one books available on all of

those life stages from conception to cremation. But who

talks about frailty as a life stage. Some how frailty is

thrown in with all the other diseases that go hand in hand

with ageing.

Sure people talk about whether they will or won’t wish to

go to a nursing home but very few people plan out their

options for frailty, like they would their family, career or

retirement.

How often have you heard teenagers declare, “When I am

18, I am going to do what I like!” But when you have

arrived at 85, it’s a little hard to stomach someone you

hardly know telling you that you can no longer do what

you like. Being forced to accept your limitations and the

limits of your edition surely opens a whole new mass of

emotions, that may be played out as rebelliously, angrily,

defiantly or acceptingly as you might have at 17 years and

11 months.


Protecting Our Frail Aged, Continued from p. 7. CODE GREED

(Continued p. 9.)


So why don’t we plan for frailty? Do we believe it won’t

happen to us? Do we see our frailty inching towards us as it

lumbers across distant hills and valleys like a rusty stage

coach with four lame horses? Maybe we just have blind spot

in our frailty hemisphere. Or are we simply naïve enough to

think that when our time comes, our best interests will rise

first and foremost above all else, because “we have our

family if nothing else”?

Why not offer us frailty checks at 50 years of age when the

Government sends us that anniversary invitation for bowel

cancer screening. How about at our 60th birthday, when we

receive our first Seniors card? Or maybe, we could receive a

trip to our general practitioner for a reflex hammer to the

knee, a memory test and a blood test when we announce

our retirement from paid work.

Older adults should consider writing a plan for their very

own transition towards frailty way, way before they need

transitional care from hospital to wherever. To ensure that

their wishes including alternate or fall back plans in the

event of emergency, are crystal clear, the personal

transition plan to frailty would, ideally, be discussed and

shared with family members.

For the good of their own health and wellbeing, older

people need to remain in control of living their lives,

including their dependence on others. For many, though, it

becomes a time fraught with grief, fear and a swirling

washing machine of bleeding emotions. Worse, it is often

compounded by opinions thrust upon them by everyone

who thinks they know better about where they should go

and who should take care of them and how. No wonder

many frail older people feel worthless, unloved and become

depressed. It’s hard for many people come to terms with

such a harsh reality that they are no longer able to care for

themselves.

Char Weeks Innovation Leader

Change Champions & Associates www.changechampions.com.au

*Dr Kylie Agllias' renowned Master Class, Dealing Effectively with

Clients Experiencing Family Estrangement will be held in capital

cities in Australia in May 2015. Registrations open at

http://www.changechampions.com.au

Respecting Our Loved Older One’s Wishes: Delivering integrated, consumer directed care where, when and how it’s needed.

26-27 February 2015, Melbourne VIC

Health, community and aged care professionals are frequently faced with the dilemma of how to care for older people while respecting their wishes and preserving their mobility and independence. Increasingly, when offered a choice, many older people prefer to remain in their home for the remainder of their life. Yet, in the context of the whole family, the availability and myriad of services and service providers, somehow enacting that decision sometimes comes with a whirlpool of complexities. This practical two day seminar is designed to examine changes in the way that healthcare is delivered to older Australians with a particular focus on person and family centred models of service and care delivery.

EARLY REGOS ARE OPEN! Visit www.changechampions.com.au


This article can be republished if author and source are clearly acknowledged.

Protecting Our Frail Aged, Continued from p. 8. CODE GREED


Valuing People: a web based organisational self-assessment tool

Christine Pappon Valuing People Project Manager

Alzheimer’s Australia

What is the resource? The concept of person centred care is not new, however many

organisations struggle with implementing person centred

models of service and care delivery. Alzheimer’s Australia has

developed the Valuing People resource to support community

aged care providers move towards more personalised services.

The development of this national resource was informed by

industry leaders through a Consortium, consumers and

academic experts through advisory committees and a change

management consultant. It has been supported by both local

and international literature on person centred care and has

been independently evaluated.

Two major pilots provided the opportunity to test the resource

with a range of consumers, staff and organisational

representatives and reinforced that the self-assessment

highlights areas of both strength and need for improvement

for community aged care providers.

This 3 year project sought to improve the quality of

community-based support services by developing an evidence-

based Person-Centred Community Support Framework and

Organisational Self-Assessment Tool.

The result is a resource that is unique for a number of key

reasons:

The self-assessment process captures the perspectives of

staff, managers, consumers and families/carers to develop

a current organisational picture

It supports community aged care providers to implement

organisational change strategies to facilitate best practice,

person-centred support.

The analysis of the feedback and associated report is

generated online so as to minimise the workload for

organisations undertaking the self-assessment

Why is this important? Alzheimer’s Australia recognised the need to support

community organisations to move towards personalised

services that are underpinned by dignity and respect for all.

Valuing People is premised on the belief that organisations can

only be person centred if all aspects of the organisation adopt

a person centred approach.

For those organisations that have already developed a service

model that seeks to promote person centred care, Valuing

People is not intended to replace it. Rather it will support you

to determine how well these principles are being applied

across your service initiatives.

For more information contact: Christine Pappon Valuing People Project Manager [email protected]


mailto:[email protected]


Kids Acute Liaison in Mental Health (KALM)

Cassandra Hainsworth Registered Psychologist,

The Department of Psychological Medicine, The Children’s Hospital at Westmead, NSW

Background:

The KALM project was conducted in the Emergency Department at the Children’s Hospital Westmead as part of

the NSW Agency for Clinical Innovation (ACI) and the Centre for Healthcare Redesign (CHR) Diploma program.

In partnership, Psychological Medicine and the Emergency Department (ED) conducted the KALM project

because of the issues below:

Mental health (MH) presentations to the ED at the Children’s Hospital at Westmead have increased

exponentially (120%) since 2010, with research suggesting that this figure will continue to increase in the

future. The increase of mental health presentation has impacted on achieving the National Emergency Access

Target (NEAT) (4-hour rule) while maintaining quality of care.

There is also a change in when patients are presenting to the ED. Weekend presentations are up by 48% from

2011. There is also an increase in morning and night presentations. With limited CNC coverage due to staff

shortages, the current practice is that psychiatrist registrars are called in for all mental health presentations

after hours. This puts pressure on the mental health budget.

The nature of mental health presentations to the Emergency Department (ED) has also changed, with self-harm

and suicidal ideation making up 50% of all mental health presentations in 2012 compared to 20% in 2002.


(Continued p.12)


Kids Acute Liaison in Mental Health (KALM), Continued from p. 11.

The aim of the study:

To measurably improve the model of care for children and adolescents presenting to The Children’s Hospital

at Westmead Emergency Department requiring urgent mental health care.

The KALM project established a clear pathway and guideline for all mental health presentations. The pathway

aimed to

improve collaboration between the Emergency Department

and Psychological Medicine, ensuring patient care was always the prime focus. It also helped eliminate lengthy

delays for patients which in turn improved the National Emergency Access Targets (NEAT).

Results:

The results of the study have been extremely positive, with key improvements already resulting in significant

benefits including:

Close collaboration between the Emergency and Psychological Medicine Departments in the

assessment and treatment of mental health patients in the ED. This work is now shared equally by

the two departments, resulting in better care and less delays for patients presenting with mental

health issues.

Improvement in Psychological Medicine response time to ED consultation and attendance, meeting

the KPIs set for the project.

By the end of the eight week initial trial, the pathway was followed 89% of the time.

When the pathway was followed the NEAT target was achieved 100% of the time over the last

three weeks of the trial.

The ED medical staff conducted a brief HEADSS/MSE assessment on all mental health patients by

the end of the trial as per the KALM pathway guideline.

60% reduction in the cost of overtime for Psychiatry Registrars.

Acknowledgements:

Expert support from all the members of the KALM working party and steering committee:- Alison Lee, Prof

David Bennett, A/Prof David Dossetor, Tim Hoffmann, Dr Mary McCaskill, Leonnie Dawson, Alan Gardo, Earle

Durheim, Sangita Jaipuriar, Karen Munro, Andrea Worth, Dr Adrian Bonsall, Dr Vanessa Crawford, Dr Chandra

Ayer, Marny Thomas and the Official Visitors.

For more info, please email

[email protected]


mailto:[email protected]


Each year in Australia an estimated 500 000 patients present to hospital Emergency Departments (EDs) with

possible cardiac chest pain. Up to 85% are eventually diagnosed with non cardiac causes, but require either

extended ED stays or admission for diagnostic workup.

Current risk stratification guidelines dictate protocols that prohibit compliance to the National Emergency Access

Targets (NEAT), which state that by 2015, 90% of patients presenting to a public hospital ED will need to leave the

ED or be admitted to hospital within 4 hours.

The ACRE Project was designed to shorten the traditional cycle of evidence – guideline – clinical practice. Recent

high level evidence - demonstrated in the ADAPT trial, has shown that the risk stratification of patients with

possible acute coronary syndrome (ACS) can be safely fast tracked using accelerated diagnostic protocols (ADPs).

This clinical redesign project and the implementation of the protocol aim to:

Improve in National Emergency Access Targets (NEAT) across QLD for patients presenting with

possible cardiac chest pain

Improve patient journeys by reducing unnecessary time in hospital awaiting tests

Identify a group of low intermediate risk patients that can be safely, accelerated and discharged

allowing resources to be allocated to higher risk patients

Reduce the percentage of admissions in the possible cardiac chest pain cohort

The Accelerated Chest pain Risk Evaluation (ACRE) Project:

Clinical Redesign to Achieve NEAT Compliance

Wade Skoien ACRE Project, QLD

(Continued p. 14.)



A successful pilot study at Nambour General Hospital (NGH) was achieved in 2012-2013. The existing chest pain

guidelines at NGH ED were modified to incorporate a pathway termed SLIC (Short Low Intermediate risk Chest pain).

Patients directed along this pathway were discharged from the ED after 0 and 2 hour serial ECG and Troponin testing, for

an outpatient exercise stress test and then followed up by phone at 30 days to monitor outcomes and safety.

Throughout the pilot study, 1762 patients presented to NGH with chest pain. Approximately 19% of the ‘possible cardiac

chest pain’ presentations (i.e. excluding the confirmed ACS and clear non cardiac chest pain presentations) were

designated as SLIC patients, which matched the results of the ADAPT trial. This represented 214 patients that were suitable

for early discharge and outpatient follow up, thus avoiding admission. The average ED LOS for the SLIC patients was less

than 180 minutes, well under the 240 minutes required to meet NEAT.

This also contributed to reduced ED LOS overall, for all chest pain presentations. Comparing the most recent 6 months of

the pilot study to the six months immediately before implementation of ACRE, the average ED LOS for all chest pain

presentations had fallen from 425 to 344 minutes, an average reduction of 81 minutes.

Following the success of the pilot study, a grant from the Queensland Government Health Innovation Fund (HIF) was

awarded for statewide rollout of the project, supported by the Queensland Health Clinical Access and Redesign Unit

(CARU). The accelerated diagnostic protocol has now been implemented in a further eight major sites throughout

Queensland, with a number more currently in the planning stages of implementation.

Early data from a number of our current sites have shown that the protocol is achieving the aims outlined above. We are

confident that this trend will be replicated in all sites when data becomes available.

For further information about the ACRE Project, visit: http://www.health.qld.gov.au/caru/html/acre.asp

Figure – Average ED LOS at NGH for All chest pain, SLIC and non-SLIC patients from July 2012 to January

2013.

The Accelerated Chest pain Risk Evaluation (ACRE) Project: Continued from p. 13.


http://www.health.qld.gov.au/caru/html/acre.asp


Standardised Surgical Set Ups Improve Efficiency and Cost

Peter Stewart, FRACS, General Surgeon,

Division of Surgery, John Hunter Hospital, Hunter New England Local Health District

The John Hunter Hospital in Newcastle, NSW is the tertiary hospital for the Hunter New England Local Health District

(HNELHD), with approximately 550 laparoscopic appendicectomy and cholecystectomy operations performed annually.

HoPreviously, each of the thirteen surgeons in our Acute General Surgery Unit had an individual preference card for both

laparoscopic appendicectomy and laparoscopic cholecystectomy. Furthermore, due to operating theatre case load and a 24

hour surgeon roster, one third of appendicectomy and two thirds of cholecystectomy patients had their operation booked by

one surgeon but were operated on by another. This caused confusion, with incorrect or unavailable equipment in the

operating theatre leading to time delays, frustration and excess cost due to opened but unused equipment.

Phase I: What was happening

To define the pre-existing situation, cost analysis per case

and per annum was performed. Researchers observed op-

erations to determine the frequency of opened but unused

items, and variation of equipment from the preference

card. Staff time and motion was assessed by recording the

number of scout nurse excursions to the equipment supply

area for items not on the preference card. Qualitative costs

were assessed by conducting a survey of operating theatre

nursing staff that assessed satisfaction regarding equip-

ment variability.

The optimal solution to this issue was to standardise the

set up cards and equipment for laparoscopic appendicecto-

my and cholecystectomy operations.

Phase II- Implementing change

All thirteen surgeons collaborated in the development of

an agreed list of essential single use items for each opera-

tion. Two industry suppliers were invited to prepare the

required equipment, and the most competitive price for

the preferred items to be purchased as a kit was negotiat-

ed by an independent medical administrator.

The standardised set up card and kits were introduced into

clinical practice in May 2013.

Phase III- Description of change

Implementation of standardised set ups and equipment

resulted in

Reduced cost

Improved efficiency

Improved staff satisfaction

The standardised kits resulted in a total annual cost reduc-

tion of over $78,000. The kits also reduced the variations

from the preference card, or opened but unused items

from 75% of cases to 37.5%. Post implementation analysis

identified most of these variations to be due to a single

equipment issue, which was easily rectified. Staff efficiency

has improved. Nursing staff excursions to central supplies

for additional equipment occurred more than five times

per case prior to the implementation of the standardised

set ups, reduced to around once per case since implemen-

tation. Satisfaction surveys demonstrated the kits have

received overwhelming support from both nursing staff

and surgeons.


(Continued p. 16.)


A Laparoscopic Cholecystectomy kit as it is supplied and stored (above); the contents of a Laparoscopic

Cholecystectomy kit (below). The items encircled yellow are supplied in all kits and so purchased at a

discount rate, but only opened on an ‘as needed’ basis. If not used they can be used for another operation.

Nursing staff survey following implementation of the standardised set up cards and kits

%

Have the kits been beneficial to our theatre?

Some of the equipment in use during

a laparoscopic cholecystectomy

The standardised kits were subsequently introduced to another

hospital in the HNELHD, and would be applicable to other high

volume units. Through engagement of all staff involved,

opportunities were identified to extend this concept to other

surgical specialties with similar issues such as Obstetrics and

Cardiothoracic Surgery. This innovation project has improved

efficiency, staff satisfaction and cost for our hospital, and

resources released can be used in other ways.

Dr Peter Stewart [email protected]

Or

Dr Peter Pockney [email protected]

Standardised Surgical Set Ups Improve Efficiency and Cost, Continued from p. 15.



Kopi mourning caps – clay head ware used by northern Victoria’s Indigenous communities for thousands of years

as part of mourning rituals – played an important role in a recent professional development workshop held at The

Dax Centre last month.

The Kopi mourning cap represents loss, sorrow and grief. When in mourning, Aboriginal women would cut off

their hair, weave a net of emu sinew and place it on their head. Afterwards they would cover the sinew with

several layers of gypsum, a white river clay, forming the Kopi. Women wore the Kopi from two weeks to six

months depending on their relationship to the deceased. At the end of the mourning period the Kopi was taken

off and placed on the grave of their loved one.

The Dax Centre hosted a two-day experiential art therapy workshop on this Indigenous mourning ritual as part of

a two-year project researching the role of art in promoting healing and emotional wellbeing in Aboriginal

communities.

The workshop – facilitated by artists Maree Clarke and Robyne Latham and professional art therapist Kate

Richards – invited participants to learn about the history of Kopi caps and hear about the revitalisation of this

cultural practice and to explore their own experience of grief and loss.

Seventeen participants from a variety of backgrounds: occupational therapy, art therapy and indigenous health,

worked in pairs to make and decorate their own Kopi caps using clay, feathers, paint and found objects. In

addition to creating caps, attendants also took part in facilitated group reflection. For many it was a powerful

experience.

Located on the grounds of the University of Melbourne, The Dax Centre is a multi-faceted not-for-profit

organisation that promotes mental health and wellbeing through art. At the heart of The Dax Centre is the

Cunningham Dax Collection, a collection of over 15,000 artworks created by people with an experience of mental

illness or psychological trauma.

The Cunningham Dax Collection

Art & Mental Health

Anna Zagala

Acting Manager, Operations and Communications Officer

Dax Centre, VIC

(Continued p. 18)



The Collection is named after its founder Dr Eric Cunningham Dax. Dr Eric Cunningham Dax was a pioneering

psychiatrist who helped reform the mental health system in Australia. He started community-based services such as

Lifeline – a world’s first at the time. Dr Dax strongly believed in the value of art and creativity, and initiated art

programs for patients in institutions as far back as the 1940s. In the 1980s when psychiatric institutions were closed

down Dr Dax began to salvage thousands of artworks from skip bins.

Recent acquisitions include artwork by survivors of the Holocaust and their children, by children from war-torn

Kosovo and East Timor, and by survivors of the Black Saturday Bushfires in 2009.

Staff works closely with artists and communities who contribute their work and life stories to this Collection. The

Dax Centre uses this Collection as the centrepiece of exhibitions, education programs for students at all levels and

for the community at large and professional development.

Those in Melbourne between now and late February can catch the new exhibition Raw Emotion: Contemporary and

Historic Works from the Cunningham Dax Collection.

For more information visit:

www.daxcentre.org or http://healingways.daxcentre.org/

The Cunningham Dax Collection, Continued from p. 17.


http://www.daxcentre.org

http://healingways.daxcentre.org/


2014 DATES

24 Nov 2014– Melbourne, VIC

08 Dec 2014– Auckland, NZ For more info, or to register online please visit:

WWW.CHANGECHAMPIONS.COM.AU

BUILDING RESILIENT TEAMS 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.



Working effectively

with people experiencing

family es trangement

Full Day Workshop with Kylie Agl l ias

24 April 2015– Perth, WA

27 April 2015– Brisbane QLD

29 April 2015– Sydney, NSW

01 May 2015– Melbourne, VIC

or as an in-house at your organisation

A practical approach for health & welfare professionals

Make an inquiry for your facility! www.changechampions.com.au



Change Champions & Associates presents a brand new workshop

Manage Your Energy

Rather Than Your Time

3 Hour 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.

Book this in-house workshop today!

Email [email protected] for more details




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 is this workshop for?

New leaders and project managers

from any industry or public sector who

are keen to develop their skills in

Change Management

BOOK THIS IN-HOUSE WORKSHOP

email [email protected]

for expressions of interest




The New Leaders Toolkit

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

Full day workshop with Char Weeks

This full day workshop is suitable for emerging, acting, tired, frustrated or

continuously improving managers of just about any project, program,

facility, department, group or organisation. It’s about building your

confidence and sharing tips for dealing with some of those tricky

challenges that come with the territory.

For in-house expressions of interest Email: [email protected]




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

Email your expression of interest to: [email protected]

IN HOUSE WORKSHOPS

www.changechampions.com.au www.changechampions.com.au



Board Appointments

Master Class

For in house bookings email:

[email protected]

All you need to know to get

the board position you want.

More and more professionals are looking to share their expertise,

and add to their own credibility, as Non Executive Directors (NEDs)

on Boards and other Committees of Management. But, landing that

first Board position is not so easy, especially when you are pitting

your skills and experience with others who are equally talented and

passionate about the same cause, company or industry

NEDs often describe finding their first directorship as an arduous

and time consuming process. More experienced NEDs suggest find-

ing subsequent board roles can be equally difficult. Not starting your

board vacancy search early enough, relying on existing or stale net-

works and not fully understanding the complexities of how board ap-

pointments are made can cripple your chances of being appointed to

a Board. Addressing these issues is why our Board Appointment

Seminars are so popular.

Each half day seminar, led by David Schwarz (an experienced non-

executive director, international head-hunter, board recruiter and the

MD of Board Direction), is designed to practically demystify the

board appointment process. It will also provide you the skills and

assistance you require to get ‘board ready’ and onto the board you

want.


With

David

Schwarz



“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

For in-house bookings, email

[email protected]



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

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


Up to 90 % of people who have

dementia will experience behavioural

and or psychological symptoms during

the course of their illness .

FOR IN HOUSE BOOKINGS,

PLEASE EMAIL

[email protected]


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 …




The ABC of BOC Working with Older Adults with Complex Health

Care Needs Who Display Behaviours of Concern

Need some practical tools to help you unravel

and prioritise those complexities to deliver the

best outcomes for your clients?

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


FOR IN HOUSE BOOKINGS,PLEASE EMAIL

[email protected]




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




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.




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

application of the tools and methodolo-

gy related to the long stay program

model

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.

IN HOUSE WORKSHOP ONLY! Please email [email protected]


The Long Stay Patient A workshop with Julie Faoro

Many of you will have met Joan.



Corner Kylie Agllias Kylie Agllias (Ph.D.) is a social work academic with a practice background in family counselling, domes-

tic violence, homeless youth and women in corrections. Kylie's world renown research in family es-

trangement commenced in 2007 and is ongoing with different populations. She continues to publish

widely on this topic, with publications including an entry in the Encyclopedia of Social Work and highly

ranked journals including Qualitative Health Research and Affilia. She provides evidence based es-

trangement workshops and master classes to health and welfare professionals and interest groups.Char

Weeks is in internationally certified Executive Master Coach, a graduate of the Australian Institute of

Company Directors. She has formal qualifications in change management from the Australian School of

Business (formerly the Australian Graduate School of Management) and has studied business manage-

ment at the Australian Institute of Management.

Kylie blogs about Family Conflict on the Psychology Today website. To read her articles, simply visit:

http://www.psychologytoday.com/blog/family-conflict

Char Weeks

Char Weeks is an internationally certified Executive Master Coach, a graduate of the Australian Institute

of Company Directors. She has formal qualifications in change management from the Australian School

of Business (formerly the Australian Graduate School of Management) and has studied business man-

agement at the Australian Institute of Management.

Char has a passion for change management and health care service reform and is a strong advocate for

older people’s health and well being. She is the full time carer for her 86 year old mother, Alison.

Writing provides a luxurious vacation from the more mundane aspects of daily life for Char. In 2010,

she published her first book, Handy Hints for the Novice Conference Presenter" which sold in 9 coun-

tries.

Char blogs about a variety of topics including aged care, mental health and change management at:

http://charweeks.hubpages.com/


http://www.psychologytoday.com/blog/family-conflict

http://charweeks.hubpages.com/


We offer a comprehensive, practical

service that aims to put you back in the

driving seat at work.

These are just some of the skills and services on offer:

Improve your effectiveness at work, build a

sustainable, positive team culture that drives

innovation and productivity

Identify and build on your strengths as a leader

Learn practical skills to develop your emotional

intelligence at work

Build your confidence in a new role inc:

choosing your leadership style to achieve the

results you need from your team

how to deal with imposter syndrome

how to make the most of being “the new kid on

the block” in a well established culture

how to deal with situations where you got the

job that someone else in your organisation

missed out on

Learn how to manage your energy rather than your

time

Learn how to support your manager to bring out the

best in both of you

Build your resilience at work with RAW scale

assessment

Learn practical change management skills

(including how to assess readiness, develop a

change strategy and deal with resistance)

Receive confidential advice about complex

change management issues

Access the support you need to help you and your

team survive turbulent times

Develop your presentation skills or simply rehearse

that all important presentation and receive

constructive feedback.

NB: Some services are suitable for tertiary students.

Feel like you’ve

bitten off more than

you can chew?

STRICTLY CONFIDENTIA L

Coaching for Emerging

Leaders, Program and

Project Managers

With Char Weeks

Executive Master Coach

GAICD, GCCM, BMC, CHE, BA

Accredited in Resilience at Work Scale

First consultation minimum 90 mins

Bookings available at our Kew Junction

(take the 48 or 109 tram) or our Little

Collins Street Office

Appointments available between

10.00-14.00 weekdays and Saturdays

Book your appointment

Phone 0467 635 150, or email

[email protected]


Change Champions & Associates

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 november 2014

Documents

work workshops

older adults

care of older homeless

older person

loved older ones

salhn sa health

colonoscopy services

major health problems