TRANSITION	
  CARE	
  QUALITY	
  SERVICE	
  REVIEW	
  
IN	
  THE	
  LODDON	
  MALLEE	
  REGION	
  
CONDUCTING	
  	
  A	
  ...
Introduc@on	
  
Service	
  review	
  
•  Performance	
  
•  Quality	
  
•  Understanding	
  
•  Improvement	
  
•  Con@nua...
Introduc@on	
  -­‐	
  con@nued	
  
Products	
  of	
  review	
  
•  Evidence	
  
•  Conclusions	
  
•  Recommenda@ons	
  
Transi@on	
  Care	
  Program	
  -­‐	
  Background	
  
Transi@on	
  Care	
  Program	
  (TCP)	
  
•  Joint	
  Commonwealth/S...
Transi@on	
  Care	
  Program	
  –	
  Background(2)	
  
Bendigo	
  Health	
  
•  2007	
  –	
  10	
  places	
  
•  2008	
  –...
 Loddon	
  Mallee	
  Region	
  
Popula@on	
  
•  308,	
  782	
  (2011)	
  
•  359,	
  206	
  (2021)	
  
65yrs	
  +	
  	
  ...
NEGOTIATION	
  OF	
  EVALUATION	
  
PLAN	
  	
  
Ques@ons	
  to	
  consider	
  
Key	
  stakeholders	
  ?	
  
Availability?	
  	
  
Funding	
  ?	
  
What	
  evidence	
  is	...
Project	
  aim	
  
•  Review	
  and	
  evaluate	
  Loddon	
  Mallee	
  TCP	
  
service	
  delivery	
  
•  Formulate	
  rec...
Project	
  Objec@ves	
  
1.	
  Review	
  and	
  evaluate:	
  
–  Exis@ng	
  client	
  service	
  delivery	
  of	
  Loddon	...
Collec@on	
  of	
  evidence	
  
Mixed	
  method	
  approach	
  
•  Interviews	
  of	
  key	
  stakeholders	
  and	
  TCP	
...
Interviews	
  and	
  focus	
  groups	
  
Open	
  ended	
  quesFons	
  –	
  exploraFon	
  of	
  themes	
  
•  Service	
  st...
Evidence	
  -­‐	
  standards	
  
•  Transi@on	
  Care	
  Program	
  Guidelines	
  2011	
  -­‐	
  
Quality	
  Standards	
  ...
DATA	
  COLLECTION	
  AND	
  ANALYSIS	
  
Interviews	
  and	
  focus	
  groups	
  
•  20	
  interviews	
  
•  4	
  focus	
  groups	
  
•  45	
  TCP	
  staff	
  and	
...
Evidence	
  –	
  rich	
  data	
  
QualitaFve	
  data	
  
-­‐  Transcribed	
  
-­‐  Collated	
  
-­‐  Themed	
  
-­‐  Trian...
Results:	
  interviews	
  &	
  focus	
  groups	
  
•  Service	
  strengths	
  
•  Service	
  weaknesses	
  
•  Training	
 ...
Results:	
  interviews	
  &	
  focus	
  groups	
  
Service	
  Strengths	
  
•  Capacity	
  
•  Communica@ons	
  
•  Flexib...
Results:	
  interviews	
  &	
  focus	
  groups	
   	
  
Service	
  Weaknesses	
  
•  Aged	
  care	
  assessment	
  
proces...
Results:	
  interviews	
  &	
  focus	
  groups	
  
Training	
  opportuniFes	
  
•  Needs	
  assessment	
  and	
  analysis	...
Results:	
  interviews	
  &	
  focus	
  groups	
  
Staff	
  requirements	
  and	
  resources	
  
•  Back	
  fill	
  for	
  p...
Results:	
  interviews	
  &	
  focus	
  groups	
  
Impediments	
  to	
  service	
  delivery	
  
•  Aged	
  care	
  assessm...
Data	
  Collec@on	
  	
  -­‐	
  Quan@ta@ve	
  (1)	
  
Data	
  Collec@on	
  -­‐	
  Quan@ta@ve	
  (2)	
  	
  
Loddon	
  Mallee	
  Region	
  
•  Occupancy	
  
•  Readmission	
  
•...
PRODUCTS	
  OF	
  REVIEW	
  
•  EVIDENCE	
  
•  CONCLUSIONS	
  
•  RECOMMENDATIONS	
  
EVIDENCE	
  	
  -­‐	
  TCP	
  Guideline	
  Compliance	
  	
  
Australian	
  Government	
  Department	
  of	
  Health	
  an...
EVIDENCE	
  	
  -­‐	
  	
  NSQHSS	
  Compliance	
  (1)	
  
Review	
  and	
  evaluaFon	
  against	
  the	
  ten	
  NaFonal	...
EVIDENCE	
  	
  -­‐	
  	
  NSQHSS	
  Compliance	
  (2)	
  
•  Clinical	
  handover	
  
•  Key	
  handover	
  points	
  ide...
EVIDENCE	
  –	
  Quan@ta@ve	
  	
  
Benchmarking:	
  Victoria	
  
Health Area (Bed Numbers) Occupancy
(%)
Length of Stay
(...
CONCLUSIONS	
  -­‐	
  Issues	
  
•  Par@cipa@on	
  
•  Delayed	
  assessment	
  for	
  eligibility	
  
•  Small	
  numbers...
CONCLUSIONS	
  -­‐	
  Overall	
  
•  Valued	
  and	
  valuable	
  program.	
  
•  Resourcing	
  issues	
  need	
  to	
  be...
RECOMMENDATIONS	
  (1)	
  
Resource	
  and	
  staff	
  requirements:	
  
1.	
  Considera@on	
  of	
  a	
  regional	
  coord...
RECOMMENDATIONS	
  (2)	
  
Unmet	
  needs:	
  
•  Development	
  of	
  a	
  prac@cal,	
  user	
  friendly	
  
TCP	
  guide...
DISSEMINATION	
  OF	
  RESULTS	
  
Audience	
  
Commissioner	
  of	
  review	
  
Stakeholders	
  
Informants	
  
Community	
  
User	
  groups	
  
Consider:	
...
Review	
  process	
  lessons	
  	
  
Stakeholder	
  engagement	
  –	
  broader	
  (ACAS	
  etc)	
  
Balance	
  
Self	
  re...
References	
  
Department	
  of	
  Health	
  (2012)	
  Local	
  government	
  area	
  profiles:	
  Loddon	
  
Mallee	
  Reg...
Upcoming SlideShare
Loading in …5
×

Carol Parker & Sharan Ermel - Bendigo Health - Transition Care Quality Service Review

869 views

Published on

Carol Parker & Sharan Ermel delivered the presentation at 2014 Transition Care Conference: Improving Outcomes for Older People.

The 2014 Transition Care Conference: Improving Outcomes for Older People formed a National account of the consumers' transition care journey within the current aged care environment, highlighted new initiatives to improve TCP access and quality of care, and showcased innovative service delivery models across jurisdictions.

For more information about the event, please visit: http://www.informa.com.au/transitioncareconference14

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
869
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Carol Parker & Sharan Ermel - Bendigo Health - Transition Care Quality Service Review

  1. 1. TRANSITION  CARE  QUALITY  SERVICE  REVIEW   IN  THE  LODDON  MALLEE  REGION   CONDUCTING    A  QUALITY  SERVICE  REVIEW   Sharan  Ermel   Carol  Parker   Collabora@ve  Health  Educa@on  and  Research  Centre  
  2. 2. Introduc@on   Service  review   •  Performance   •  Quality   •  Understanding   •  Improvement   •  Con@nua@on   •  Replica@on   Processes   •  Nego@a@on  of  evalua@on   plan   •  Data/evidence  collec@on  &   analysis   •  Dissemina@on  of  results   •  Inform  decisions   •  Increased  understanding    
  3. 3. Introduc@on  -­‐  con@nued   Products  of  review   •  Evidence   •  Conclusions   •  Recommenda@ons  
  4. 4. Transi@on  Care  Program  -­‐  Background   Transi@on  Care  Program  (TCP)   •  Joint  Commonwealth/State  funded  na@onal  program  aimed  at:   •  Minimising  the  number  of  older  people  experiencing  inappropriate  extended   hospital  lengths  of  stay  and/or     •  Being  prematurely  admiVed  to  residen@al  care   •  Program  for  the  provision  of  flexible  care  under  the  Aged  Care  Act  (1997)   •  Established  2004-­‐05   •  Na@onally  -­‐  599  flexible  care  places  allocated   •  In  Victoria     •  2009  -­‐  674  places    →  837  in  2011           •  Currently:     •  4000  places  na@onally,     •  1000  opera@onal  in  Victoria     •  364  regional   •  636  metropolitan  based   •  NOT  a  subs@tute  for  hospital  based  care,  nor  a  subs@tute  for  ongoing   community-­‐based  aged  care.  
  5. 5. Transi@on  Care  Program  –  Background(2)   Bendigo  Health   •  2007  –  10  places   •  2008  –  27  places   •  2010  –  58  places   •  Bendigo  –  32  places   •  Swan  Hill  –  8  places   •  Echuca  –  10  places   •  Maryborough  –  4  places   •  Kyabram  –  4  places   •  Castlemaine  –  4  places  (Sept)     •  2013  –  85  places     Mildura  –  July  2010   •  12  places  
  6. 6.  Loddon  Mallee  Region   Popula@on   •  308,  782  (2011)   •  359,  206  (2021)   65yrs  +     •  17%  (Victoria  =    14%)  2011   •  20.8%  (Vic  =    16.7%)  2021   Need  for  assistance  core  ac@vity:     •  5.8%  (Victoria    5%)   Residen@al  aged  care  availability:   •  High  level:  37.6(Vic  42.2)  per  1000  eligible   •  Low  level:  49.2  (Vic  45.7%)  per  1000  eligible    
  7. 7. NEGOTIATION  OF  EVALUATION   PLAN    
  8. 8. Ques@ons  to  consider   Key  stakeholders  ?   Availability?     Funding  ?   What  evidence  is  required?   What  measures  are  available?     Who  is  going  to  conduct  the  review/evalua@on?     What  is  the  purpose  of  the  evalua@on?    
  9. 9. Project  aim   •  Review  and  evaluate  Loddon  Mallee  TCP   service  delivery   •  Formulate  recommenda@ons  to  assist  the   provision  of  best  prac@ce  clinical  care  and  to   best  enable  applicable  Transi@on  Care   standards  to  be  met   Governance  structure     Steering  CommiVee  established  
  10. 10. Project  Objec@ves   1.  Review  and  evaluate:   –  Exis@ng  client  service  delivery  of  Loddon  Mallee  TCP  services  against:   •  Transi@on  Care  Program  Guidelines  2011  -­‐  Quality  Standards   •  Contracts  for  the  Provision  of  Transi@on  Care  Program  Services   •  Na@onal  Safety  and  Quality  Health  Service  Standards    2011   –  Regional  administra@ve    &  repor@ng  processes   2.  Make  recommendaFons  to  assist  TCP  services   3.  Provide  informaFon  and  advice  to  Bendigo  Health  regarding:     •  Addi@onal  support  and  systems  that  may  be  required  in  its  role  as   Regional  Manager  of  the  TCP  Service   4.  Benchmark  
  11. 11. Collec@on  of  evidence   Mixed  method  approach   •  Interviews  of  key  stakeholders  and  TCP  staff   •  Focus  groups   •  Compliance  with  TCP  Standards,  Bendigo  Health  contract,   NSQHSS   •  Compliance  with  repor@ng  and  administra@ve  requirements   •  Benchmarking   –    Staffing   –    Occupancy   –    Discharge  des@na@on  and  length  of  stay  
  12. 12. Interviews  and  focus  groups   Open  ended  quesFons  –  exploraFon  of  themes   •  Service  strengths  and  weaknesses   •  Training  opportuni@es   •  Resource  requirements   •  Staffing  requirements   •  Impediments  to  service  delivery   •  ICT  deficits  and  technical  support  requirements   •  Unmet  need  
  13. 13. Evidence  -­‐  standards   •  Transi@on  Care  Program  Guidelines  2011  -­‐   Quality  Standards   •  Contracts  for  the  Provision  of  Transi@on  Care   Program  Services   •  Na@onal  Safety  and  Quality  Health  Service   Standards    2011  
  14. 14. DATA  COLLECTION  AND  ANALYSIS  
  15. 15. Interviews  and  focus  groups   •  20  interviews   •  4  focus  groups   •  45  TCP  staff  and  stakeholders   •  12  health  agencies  
  16. 16. Evidence  –  rich  data   QualitaFve  data   -­‐  Transcribed   -­‐  Collated   -­‐  Themed   -­‐  Triangula@on  of  results  –  further  evidence  
  17. 17. Results:  interviews  &  focus  groups   •  Service  strengths   •  Service  weaknesses   •  Training  opportuni@es   •  Staff  requirements  and  resources   •  Impediments  to  service  delivery  
  18. 18. Results:  interviews  &  focus  groups   Service  Strengths   •  Capacity   •  Communica@ons   •  Flexibility   •  Partnerships   •  Posi@ve  Program   •  Team   •  Video  Conferencing  
  19. 19. Results:  interviews  &  focus  groups     Service  Weaknesses   •  Aged  care  assessment   process   •  Accessing  educa@on/ informa@on   •  Administra@on  and  support   •  Care  demands   •  Communica@on  issues   •  Consistency   •  Costs   •  Facility  constraints   •  Funding   •  Managing  wai@ng  lists   •  Soqware  limita@ons   •  Staffing  and  resources   •  TCP  awareness  
  20. 20. Results:  interviews  &  focus  groups   Training  opportuniFes   •  Needs  assessment  and  analysis   •  Specific  therapist  focussed  forums     •  Regional  coordinator  forum   •  Mentoring   •  Allied  Health  Assistant  training   •  U@lisa@on  of  broader  regional  educa@on  opportuni@es   •  Work  shadowing   •  Short,  sharp  clinical  updates  
  21. 21. Results:  interviews  &  focus  groups   Staff  requirements  and  resources   •  Back  fill  for  part  @me  TCP  staff.       Risks  include:   •  Con@nuity  of  care   •  Outcomes   •  Bed  occupancy   •  Repor@ng  requirements   •  Therapeu@c  staff  mix  and  availability   •  TCP  manual   •  Equipment  
  22. 22. Results:  interviews  &  focus  groups   Impediments  to  service  delivery   •  Aged  care  assessment  process   •  Addressing  bed  vacancies   •  Succession  planning   •  Suitable  and  available  backfill   •  Repor@ng     •  Therapeu@c  services  available     •  TCP  awareness   •  Travel  distance   •  Bed  based  versus  community   beds   •  Complex  clients   •  Service  changes   •  Costs     •  Part  @me  staff   •  No  access  to  restora@ve  care   beds   •  Border  regions   •  Referrals   •  IT  issues   •  Bed  blockages   •  Limited  TCP  places  
  23. 23. Data  Collec@on    -­‐  Quan@ta@ve  (1)  
  24. 24. Data  Collec@on  -­‐  Quan@ta@ve  (2)     Loddon  Mallee  Region   •  Occupancy   •  Readmission   •  Death   •  Discharge  des@na@on   •  High  care   •  Low  care   •  Home   •  Average  length  of  stay   •  Quality  ac@vi@es   •  Client  sa@sfac@on   •  Data   •  Mee@ng  aVendance  
  25. 25. PRODUCTS  OF  REVIEW   •  EVIDENCE   •  CONCLUSIONS   •  RECOMMENDATIONS  
  26. 26. EVIDENCE    -­‐  TCP  Guideline  Compliance     Australian  Government  Department  of  Health  and  Ageing  ‘TransiFon   Care  Program  Guidelines  2011  Quality  Standards’   •  Standard  1    -­‐  Op@mising  independence  and  wellbeing   •  Standard  2    -­‐  Mul@disciplinary  approach  and  therapy  focused  care   •  Standard  3    -­‐  Seamless  care  
  27. 27. EVIDENCE    -­‐    NSQHSS  Compliance  (1)   Review  and  evaluaFon  against  the  ten  NaFonal  Safety  and   Quality  Health  Services  standards  (NSQHSS):   •  Governance   •  Partnering  with  consumers   •  PrevenFon  and  controlling  healthcare  associated  infecFons   •  Adherence  to  infec@on  control  guidelines   •  Educa@on  to  clients/carers/families   •  Medica@on  safety   •  PaFent  idenFficaFon  and  procedure  matching   •  Health  agency  procedures  adhered  to  regarding  iden@fica@on  bands   •  Pre-­‐procedure  iden@fica@on  of  pa@ents  
  28. 28. EVIDENCE    -­‐    NSQHSS  Compliance  (2)   •  Clinical  handover   •  Key  handover  points  iden@fied   •  Handover  tools:  ISBAR/ISoBAR   •  Referral  processes   •  Blood  and  blood  products   •  PrevenFng  and  managing  pressure  injuries   •  Pressure  risk  assessments   •  Repor@ng  of  injuries   •  Educa@on     •  Recognising  &  responding  to  clinical  deteriora@on  in  acute   health  care   •  Preven@ng  falls  and  harm  from  falls  
  29. 29. EVIDENCE  –  Quan@ta@ve     Benchmarking:  Victoria   Health Area (Bed Numbers) Occupancy (%) Length of Stay (days) Total for Loddon Mallee Region 89.7 66.3 Total for Loddon Mallee Region without Bendigo 87.7 62.6 Total for Region B (42) 73.2 52.7 Total for Region B without Major Regional Hospital 71.5 Total for Region C (63) 78.3 52.4 Total for Region C without Major Regional Hospital 73.3 Total for Region D (73) 89.7 60 Total for Region D without Major Regional Hospital 82.9
  30. 30. CONCLUSIONS  -­‐  Issues   •  Par@cipa@on   •  Delayed  assessment  for  eligibility   •  Small  numbers  of  beds  –  part  @me  coordinators   •  Backfill,  service  con@nuity,  bed  occupancy   •  Regional  coordina@on   •  Template  for  standards,  contract  and  NSQHS   standards   •  Compliance  with  repor@ng   •  Benchmarking  
  31. 31. CONCLUSIONS  -­‐  Overall   •  Valued  and  valuable  program.   •  Resourcing  issues  need  to  be  considered.     •  Consider  transparency  and  consistency  of   processes.  
  32. 32. RECOMMENDATIONS  (1)   Resource  and  staff  requirements:   1.  Considera@on  of  a  regional  coordinator   2.  TCP  succession  planning  and  backfill  for  leave  resolu@on   Impediments  to  service  delivery:   1.  Aged  Care  Assessment  process   2.  Alterna@ve  models  of  aged  care  assessment                                                                                           explora@on   Training  opportuniFes   Educa@on  and  training  needs  analysis  to  be  undertaken   ICT  Deficits  and  Technical  Support  Requirements   Standardised    appropriate  and  accessible  TCP  soqware  
  33. 33. RECOMMENDATIONS  (2)   Unmet  needs:   •  Development  of  a  prac@cal,  user  friendly   TCP  guide/manual   •  Development  of  consistent  TCP  communica@on                                                               and  repor@ng  processes   •  Protected  networking  @me  between  TCP  Coordinators   Review  of  previous  report  and  recommendaFons:   •  Reconsider  TCP  becoming  a  standard  agenda  item  on  regular   Director  of  Nursing  mee@ngs   •  Reconsider  invi@ng  Aboriginal  Liaison  Officer  to  provide  VC   educa@on  to  regional  TCPs  
  34. 34. DISSEMINATION  OF  RESULTS  
  35. 35. Audience   Commissioner  of  review   Stakeholders   Informants   Community   User  groups   Consider:   Risks   Confiden@ality   Ownership   Method   WriVen     –  Formal  report   –  Execu@ve  summary   –  publica@on   Audio  visual     Media    
  36. 36. Review  process  lessons     Stakeholder  engagement  –  broader  (ACAS  etc)   Balance   Self  report  –  content  of  responses   Scope  of  review   Access  to  data  
  37. 37. References   Department  of  Health  (2012)  Local  government  area  profiles:  Loddon   Mallee  Region.  Department  of  Health,  Melbourne   Australian  Commission  on  Safety  and  Quality  in  Health  Care  (20110   Na>onal  Safety  And  Quality  Health  Service  Standards.  ACSQHC.     Australian  Government  Department  of  Health  and  Ageing  (2011)  Transi>on   Care  Program  Guidelines  2011  Quality  Standards.  Department  of  Health   and  Ageing,  Canberra   Australian  Government  Department  of  Health  (2008)  Na>onal  evalua>on   of  the  Transi>on  Care  Program.  Australian  Government  Department  of   Health,  Canberra  [online]  hVp://www.health.gov.au/internet/main/ publishing.nsf/Content/ageing-­‐transi@on-­‐na@onal-­‐evalua@on-­‐ summary.htm     Australian  Government    (2011)  TCP  Handbook.  [online]   hVp://www.health.gov.au/internet/publica@ons/publishing.nsf/Content/ ageing-­‐transi@on-­‐handbook.htm~ageing-­‐transi@on-­‐handbook02.htm  

×