Inter-professional education and primary care : EFPC position paper

Inter-professional education (IPE) can support professionals in developing their ability to work collaboratively. This position paper from the European Forum for Primary Care considers the design and implementation of IPE within primary care. This paper is based on workshops and is an evidence review of good practice. Enablers of IPE programmes are involving patients in the design and delivery, providing a holistic focus, focussing on practical actions, deploying multi-modal learning formats and activities, including more than two professions, evaluating formative and summative aspects, and encouraging team-based working. Guidance for the successful implementation of IPE is set out with examples from qualifying and continuing professional development programmes

Redesign and innovation in hospitals: foundations to making it happen

This paper describes key features of hospital redesign processes in Australia by analysing Victorian, NSW and other models. It discusses frameworks and drivers of large scale change in health systems including challenges and barriers to success.  The use of systems thinking and institutional entrepreneurship to support achieving change is described.   Insights are provided to enable policy development that can support innovation and system redesign. What is the problem? Australia\u27s demand for healthcare services is escalating, driven by an ageing population with complex health care needs, rising rates of chronic illness, increasing health care costs and rapid information technology innovation. These pressures may not be adequately met within the health system\u27s current and future economic capacity. Therefore, healthcare services and systems must achieve wide-ranging reform and redesign if they are to meet these challenges. The key questions for those working as health services leaders are: how can we support the innovation and change required to address this reality? and what should national policy makers do to support this work? What does the evidence say? Considerable evidence describes overlapping aspects of successful redesign in hospitals. These include: leadership to achieve change; the use of data to monitor and evaluate change; coherent alignment to organisational strategic plans; the development of organisational culture that is ready for change; and ensuring integration of change into routine practice. Systems thinking and institutional entrepreneurship offer approaches to change and redesign that take into consideration networks and relationships of individuals, teams and clinical disciplines working within it, resources and current processes and the cultural context of the organisation. What does this mean for health service leaders? In order to fully meet the requirements for redesign and innovation, health service leaders will need to address a number of key areas. First and foremost, leaders need to develop their organisational strategic vision around the concept of redesign and innovation and build staff understanding of the importance of these concepts. Staff must be given the capacity and confidence to pursue meaningful change in their everyday operations. Leaders must recognise the benefits of data and analytics and support the development of systems to utilise these tools. Innovative practices from outside of the health sector should be studied and adapted, and partnerships with industry and academia must be pursued. What does this mean for policy makers? Policy makers need to commit to investment in the concept of redesign and innovation. They should consider funding models that reward health services for innovation. Policy makers must support health services to pursue and sustain meaningful change while recognising that transformation requires time, perseverance and willingness to learn from success and failure

Briefing to the incoming Minister of Health 2014

Executive summary This briefing provides you, as the incoming Minister, with information on challenges and opportunities facing the New Zealand health and disability system, and how the Ministry can advise and support you to implement your Government’s priorities for health. The Ministry looks forward to discussing with you how to progress your health policies, including: providing high-quality health services; healthy communities; a strong and engaged health workforce; quality aged care and mental health services. The New Zealand health and disability sector provides world-class services, is driven by a trusted, passionate and skilled workforce, across a spectrum of public, NGOs and private providers, and serves a population that can generally access the care it needs, when it needs it. There are, however, many pressures and environmental changes that require both immediate management and longer-term strategic change. As Minister, you have a number of levers at your disposal to guide system change through setting policy direction, legislation and regulations, funding models and performance management, as well as influencing culture and leadership. Every New Zealander will, at some point in their lives, rely on our health and disability system. It is a large and complex system with multiple decision-makers and mixed public and private ownership models. It operates in a dynamic, continually changing environment characterised by well-known global and local challenges, including:   changing population health needs and burden of disease (especially the rising impact of long- term conditions and risk factors, such as diabetes and obesity)   the growing impact of health-care associated infections, antimicrobial resistance and emerging infectious diseases, eg, Ebola   rapid advances in technology, developments in personalised medicine and changing public expectations   an ageing population, and a workforce that is ageing along with the population   a constrained funding environment for the foreseeable future   a growing fiscal sustainability challenge as health consumes an increasing proportion of total government expenditure. These challenges are placing pressure and new demands on the way public health and disability services are currently delivered. Significant gains in the overall health of New Zealanders could be achieved by concentrating on people who have poorer health outcomes, complex health needs or who need a stronger voice. These might include vulnerable children, older people, people with long-term conditions, people with mental health and addiction problems and people with disabilities. Health and disability services need to build on current progress and adapt to future needs. The health system’s ability to provide a sustainable, quality public health service depends on keeping ahead of the challenges. This briefing provides some suggestions for where we could work with you to meet these challenges. There are opportunities to make better use of existing resources, people, facilities and funding, through new ways of delivering services that keep people well with better prevention and early Briefing to the Incoming Minister of Health v intervention. Significant gains could be made by developing a longer-term focus on preventing disability and illness in the first place. There are new opportunities for the health workforce to work in different ways with a broader range of colleagues across the health and wider social sectors, and with partners in the community. To better equip the New Zealand health and disability system for the future, we suggest focusing on four areas. 1  Better integrate services within health and across the social sector: Strengthening integration within health and across government to support the most vulnerable, reduce inequities and address issues outside the health and disability system that impact on health. 2  Improve the way services are purchased and provided: Ensuring funding models support change, building and supporting the key enablers and drivers of change: workforce, health information and capital. 3  Lift quality and performance: Driving performance through measuring and rewarding the right things to improve quality. 4  Support leadership and capability for change: Supporting strong governance, clinical and executive leadership and capability across the health sector.&nbsp

Primary health care for Aboriginal and Torres Strait Islander children

This final report presents the findings from each of the phases of the Engaging Stakeholders in Identifying Priority Evidence-Practice Gaps and Strategies for Improvement in Primary Health Care (ESP) Project. This report is designed for people working in a range of roles including national and jurisdictional policy makers, managers, community-controlled organisations and government health authorities, peak bodies, clinical leaders, researchers, primary health care staff and continuous quality improvement (CQI) practitioners who may have an interest in the interpretation and use of aggregated CQI data to drive decision making. Stakeholders across services and systems that deliver Aboriginal and Torres Strait Islander primary health care (PHC) engaged in a process to analyse and interpret national continuous quality improvement (CQI) data from 132 health centres. We used a consensus process to identify priority evidence-practice gaps in child health care, based on these data. Stakeholders drew on their knowledge and experience working in Aboriginal and Torres Strait Islander PHC to identify barriers and enablers to addressing the priority evidence- practice gaps, and to suggest strategies to overcome barriers and strengthen enablers to addressing the priority evidence-practice gaps. Important messages emerge from these findings

Research into practice : collaboration for leadership in applied health research and care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL)

To address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

Background: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time-limited group program. The incorporation of new service delivery models in routine clinical practice is, however, likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims: To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures: A qualitative enquiry approach included data from six focus groups (n = 34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions: The results of this study will inform the development of a theoretically informed intervention to improve health services’ adherence to aphasia best practice recommendations

Chronic illness care for Aboriginal and Torres Strait Islander people: final report

This project engage a range of stakeholders across different levels of the primary health care system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Overview The purpose of this project is to engage key stakeholders in the use of aggregate continuous quality improvement (CQI) data to identify and address system-wide evidence-practice gaps in Aboriginal and Torres Strait Islander chronic illness care. We aimed to engage a range of stakeholders across different levels of the primary health care (PHC) system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Our research has highlighted the wide variation in performance between different aspects of care and between health centres. While many aspects of care are being done well in many health centres, there are important gaps between evidence and practice in some aspects of PHC. System-wide gaps are likely to be due to deficiencies in the broader (PHC) system, indicating that system-level action is required to improve performance. Such system-level action should be developed with a deep understanding of the holistic nature of Aboriginal and Torres Strait islander wellbeing beyond just physical health (including healthy connections to culture, community and country), of the impact of Australian colonist history on Aboriginal and Torres Strait Islander people, and of how social systems – including the health system - should be shaped to meet the needs of Aboriginal and Torres Strait Islander people. This project aims to build on the collective strengths within PHC services in order to continue improving the quality of care for Aboriginal and Torres Strait Islander communities

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

The Difference that Makes the Difference - Final evaluation of the first place-based programmes for Systems Leadership: Local Vision

1.This report outlines findings from Phase 2 of the evaluation of Systems Leadership: Local Vision, conducted by Bristol Leadership Centre on behalf of the Systems Leadership Steering Group. It is the third in a series of reports capturing the learning and outcomes of the first cohort of Local Vision projects.2.In this report we focus on the outcomes and effects of Local Vision projects in different localities and consider how local context enables or constrains the potential for sustainable change. This analysis is based on case studies, interviews and secondary data.3.Overall, the findings suggest that Local Vision has had a positive impact within each of the areas investigated, complementing existing initiatives and catalysing change and engagement amongst partners and communities. 4.There is good evidence of Local Vision projects raising awareness of systems leadership amongst stakeholders in different localities – in particular in relation to thinking systemically, working collaboratively, engaging with service users, and fostering shared leadership.5.Likewise, there is good evidence that Local Vision has been regarded as a success in most localities, producing benefits and value for a diversity of stakeholders, such as influencing strategy, generating income and opportunities, engaging professionals, and improving services and client outcomes. 6.Whilst, in many cases it is still a little too early to determine the legacy and any lasting change arising from Local Vision, there is good evidence of its ability to catalyse change, influence new ways of working, and build commitment and momentum in relation to ‘wicked’ issues. 7.The case studies conducted during this phase of the evaluation enable the identification of a number of trends across projects that suggest some important ingredients of effective systems leadership interventions. These include start-up conditions (including the nature of the problem/challenge, level of intervention, prior experience of systems working, and imperative for change); local context (including alignment with other initiatives, project ownership, dedicated project support, and senior-level organisational and political engagement); process (including choice of Enabler, engagement with local communities, memorandum of understanding, King’s Fund learning network, and scale and timing of projects); and planning for sustainability (including project leadership, Enabler exit conditions, roll-out, and evaluating outcomes).8.Alongside the collection and analysis of evidence from Local Vision project partners and Enablers, the evaluation also collated and analysed a wide range of independent metrics on localities and the nature and scale of the ‘wicked’ issues that projects were tackling. Whilst these analyses did not reveal many insights into the Local Vision projects themselves, they do illuminate the challenges of benchmarking complex change interventions, and highlight the potential value of data as a leadership tool for galvanising action in complex and contested environments. 9.The report concludes with a summary of key outcomes and recommendations for future activity on Local Vision and related systems leadership initiatives. The evidence from this evaluation suggests that Local Vision can be regarded as a successful initiative that has succeeded in developing and embedding learning about systems leadership and change in the majority of localities where it has operated. As a place-based intervention, supported by skilled ‘Enablers’, Local Vision has successfully catalysed collaboration between multiple stakeholders to address shared challenges.10.The evaluation findings prove testament to the skill and tenacity of the Local Vision Enablers, project partners and the Leadership Centre (who coordinated and supported the initiative on behalf of the Systems Leadership Steering Group) in brokering relationships, facilitating difficult conversations and (re)connecting diverse communities to a shared sense of purpose. In most localities, there are now people committed to thinking systemically, working collaboratively, engaging with service users, and fostering shared leadership that will continue to have an impact for many years to come