Changing the way Occupational Therapy does business in an acute public hospital

Miss Lauren Matheson1, Ms Debra Phillips1

1The Townsville Hospital, Townsville, Australia

Background: Australian public hospitals are increasing in pace and complexity driven by an aging population and rising incidence of chronic conditions. Therefore, hospitals focus on immediate patient care and discharge. Allied health professions, including occupational therapy, play a major role in the delivery of multidisciplinary care within the acute hospital setting. There is, however, an incongruence between the medical model in acute care and the philosophy underpinning occupational therapy. The Occupational Therapy Department at The Townsville Hospital acknowledge the disparity between our profession’s values and the demand for high patient turnover in acute settings, and have decided to take action. We have identified areas of potential influence: referrals; prioritisation; and workload across teams.

We are in the early implementation phase of redefining the delivery of occupational therapy services on acute wards of The Townsville Hospital by implementing change in areas of potential influence.

Method: Three quality projects were commenced to address 1) referrals, 2) workload allocation and prioritisation and 3) working in teams. Activities undertaken thus far include literature reviews, benchmarking, internal focus groups and surveys.

Results: To date, a specific set of referral flags has been developed and the department priority tool has been modified to include a needs assessment screening process. We are trialling a team-based approach to managing workload on medical wards. Initial feedback from staff indicates more equitable workload distribution, an increase in work satisfaction and staff morale, improved confidence in clinical reasoning for junior staff members and provision of occupational therapy services to patients most in need.

Conclusion: This project demonstrates it is possible to maintain professional identity in the acute hospital setting by undertaking a multifaceted staged project to change the way we do business. Outcomes of this project will have relevance to occupational therapy departments in acute care settings across the country.


Biography:

Debra and Lauren are senior occupational therapists at The Townsville Hospital, the tertiary referral hospital for North Queensland. They are two of the lead clinicians working on quality improvement projects to redesign occupational therapy delivery within the acute hospital environment

Barriers to uptake of low intensity digital mental health apps and online programs in Allied Health. Defining the Policy Landscape

Dr Ruth Crowther1, Mrs Heidi Sturk1

1Queensland University Of Technology (QUT), South Brisbane, Australia

Globally, a considerable amount of funding has been invested in the development and delivery of low intensity, digital interventions for mild to moderate mental health issues. Despite such investment however, countries have achieved varying levels of success in increasing the uptake of these interventions, despite the ever increasing and compelling evidence base for their effectiveness.

In the Australian context the National Mental Health Commission’s Review of Mental Health Programmes and Services reported that digital services had been poorly integrated and difficult for people to access and navigate. In response, the Department of Health invested $4.7 million for 2018/2019 towards ongoing development and refinement of the digital gateway Head to Health, with a key aim being to increase awareness and uptake of digital mental health apps and programs.

Despite this increase in funding and the work of eMHPrac partners in providing training in selection and utilisation of digital mental health resources in clinical practice for all health professions, uptake appears to be slow with ongoing barriers being reported.  A challenge remains that much of the evidence showing effectiveness of digital interventions does not necessarily provide information on how such interventions can be embedded effectively within the existing health system. Yet, mental health experts and advocates remain optimistic that digital mental health programs have huge potential to enhance accessibility and increase cost-efficiency of services, whilst overcoming geographic obstacles to service utilisation and promoting consumer empowerment.

This presentation will therefore consider the current policy landscape and the systemic challenges associated with removing existing barriers and increasing uptake of low intensity digital interventions in Australia. It will draw upon the policy drivers and organisational factors that have been shown to be effective in other parts of the world, specifically the UK, Sweden and the US, and consider their application in our unique Australian context.


Biography:

Dr Ruth Crowther is a Senior Research Fellow on the eMHPrac (e-Mental Health in Practice) project. Ruth’s role is to develop, deliver and evaluate national training on digital mental health resources to allied health practitioners and service providers. Her research interests include the integration of digital mental health resources into healthcare, and effective implementation of evidence based mental health policy. Ruth has over twenty years experience in applied mental health research, public health and teaching in both the UK and Australia and is a member of the APS E-Psychology and Buddhism and Psychology Interest Groups.

Establishing Telehealth within Redland Hospital’s Physiotherapy Musculoskeletal Management Clinic’s model of care to improve patient access to services

Vicki Parravicini1, Andrea Jeffrey1, Karen  Lucas1, Mr Michael Harris1

1Queensland Health – Metro South, Brisbane, Australia

Background:  The Physiotherapy Musculoskeletal Management Clinic and Conservative Management Service (PMMC and CMS) is an allied health-led multi-professional conservative management alternative pathway for clients referred to the Redland Hospital Orthopaedic Specialist Outpatient Service. The aim of the service is to reduce the Orthopaedic wait list and support timely access to appropriate care. The service provides patients with earlier access to an expert assessment by an Advanced Musculoskeletal Physiotherapist, whose role is to assess, diagnose and provide multi-professional allied health case management. This management includes physiotherapy, nutrition and dietetics and psychology.

Objectives: The purpose of this project is to improve access to the service by enhancing Telehealth capability and utilisation within the Redland Hospital PMMC and CMS. This project will deliver services by the allied health team at the Redlands facility directly to the client’s home. It will provide an alternate option to benefit clients who live on the Bay islands, mainland clients whose work commitments limit access to Redlands Hospital during business hours, and those who have difficulties accessing the service.

Project Implementation: December 2018 – June 2019.

Project Evaluation: Project Evaluation will be completed in July 2019 with data to be presented at the Allied Health Conference in August.

The project evaluation will include: Demographic information, Clinical outcome measures, Episode details, Discharge outcomes, patient satisfaction and Clinic productivity data (Occasions of Service, FTA/Cancellations rates). Barriers, enablers and key lessons learned will also be discussed.

Discussion: Currently 80% of face to face clients who attend the PMMC and CMS at Redland Hospital remain off the Orthopaedic Wait List. The aim of this project is to examine whether Telehealth can provide improved access for clients and deliver similar clinical outcomes compared to face to face. It will also aim to establish Telehealth within the existing PMMC and CMS model of care and increase the application of Telehealth by other allied health professions and teams.


Biography:

Vicki is an Advanced Musculoskeletal Physiotherapist working in the Physiotherapy Musculoskeletal Management Clinic and Conservative Management Service at Redland Hospital. She is the team leader of a multidisciplinary allied health team that aims to reduce the Orthopaedic Wait List by providing earlier assessment, diagnosis and  multi-professional allied health case management. She has a Masters Degree in Musculoskeletal and Sports Physiotherapy and was a physiotherapist at the Commonwealth Games at the Gold Coast for Track and Field. She has also worked as a physiotherapist with the Queensland Academy of Sport Track and Field Jumps Squad and has in interest in Telehealth.

A new self-catering model of food service delivery for the University of Canberra (UCH) Adult Mental Health Rehabilitation Unit (AMHRU)

Janna Lutze1, Lorna Munro2, Dorothy Aawulenaa2, Jacinta Bryce1, Susan Davis1, Kannan Sakthivel1, Deanna Skitt1, Nanette Taylor1, Susan Jacques1, Andrew Slattery1

1Canberra Health Services, , Australia, 2University of Canberra, , Australia

Background:  A self-catering food service model was implemented within the new UCH AMHRU.  This unique model allows consumers to prepare and cook their own meals within a pod kitchen, facilitated by occupational therapists and allied health assistants.  Each pod group select a main course meal from two options daily, and are provided with fresh ingredients and recipes from the kitchen with the aim of enhancing independent living skills.

Methods:  A preliminary assessment of the adequacy of this food service model was undertaken.  Two student dietitians investigated; (i) menu and recipe compliance with the ACI Standards for Consumers of Inpatient Mental Health Services(1), (ii) quantitative dietary intakes and food patterns of consumers’, and (iii) key stakeholder feedback on the self-catering model implementation via qualitative semi-structured interviews.

Results:  The food service model achieved 78% compliance with the ACI Standards(1), with small areas for improvement identified, such as improved variety of meals (hot) at lunch.  Food intake data from a sample of four consumers was highly variable.  Some consumers met, and exceeded, key nutrient recommendations (e.g. in total energy, protein, saturated at, sodium and vitamin C).  Others did not appear to achieve adequate intakes for important nutrients (e.g. fibre and magnesium).  Lunch was found to be generally consumed outside of the unit (e.g. purchased from local cafe), and breakfast was frequently skipped.  Most consumers were highly engaged and satisfied with the evening meal and self-catering model.

Opportunities:  Six key opportunities to enhance the food service model were proposed;

  • greater staffing assistance to consumers at breakfast and lunch to improve engagement,
  • enhanced labelling of delivered food items and more user-friendly recipes,
  • modifying evening recipes to suit special diet needs (e.g. vegetarian),
  • improved protein profile of the lunch meal,
  • further nutritional assessment of the mid-meal snack service, and
  • advocacy for an ongoing dietitian role within the AMHRU.
  1. Agency for Clinical Innovation. Nutrition standards for consumers of inpatient mental health services in NSW. Sydney: NSW Agency for Clinical Innovation; 2013.

Biography: To be confirmed

The case for cross disciplinary reflective practice

Ms Suzanne Dick1

1Harvest Wellbeing, Melbourne, Australia

Suzanne’s consultancy has focused on the training and supervision of staff and creating a climate conducive to organisational growth and innovation. With an emphasis on engagement at all levels of the organisation and an explicit focus on wellbeing as a measure of success, Suzanne works with companies to focus on their people as their most valuable asset, exploring the simple steps organisations can take to improve their overall performance. She has worked therapeutically with individuals with significant mental health and social issues in addition to working with organisations in the areas of policy development, program design and evaluation and improving staff performance.

Suzanne’s strengths include emotional intelligence, integrity, and diligence enabling her to engage effectively with stakeholders and to work both independently and collaboratively in achieving desired outcomes. Her energy is contagious and because of this she is able to work effectively with teams to quickly generate creative solutions to organisational challenges.

Professional supervision is a long-standing tradition which historically focused on more experienced practitioners within a single discipline offering more junior practitioners within the same discipline a safe space for reflection and technical skill development.  This style of supervision typically focuses on quality assurance and administrative elements of the role, in addition to providing support and practice development (Powell, 1993).

A changing regulatory environment and an increasingly multidisciplinary workforce means there is an increased focus on the provision of high-quality supervision, which may or may not be provided by someone from the same discipline.  In cross-disciplinary supervision there is potentially less technical discipline knowledge, with an increased requirement for

the supervisee to identify technical gaps and seek additional expert support as required.  Instead, cross-disciplinary supervision engenders an increased focus on reflection.  Ghaye and Lilyman (as cited in Hewson, 2012) have described reflection as a complex process, ‘a blend of practice with principle‘, and pointed out that ‘the practice of cyclical reflection can quickly become akin to painting by numbers’ (p. 2).

Using case examples and drawing on her experience as a clinician, supervisor and manager, Suzanne seeks to identify the barriers to developing an effective culture of cross disciplinary supervision and embedding a culture of reflective practice.  Suzanne explores key factors in the success of cross-disciplinary supervision, including the benefits of coming together, creating a safe space for reflective practice and explicitly challenging the concepts of hierarchy and competition between disciplines.  By seeking to understand the purpose of reflection other than as a regulatory or an organisational requirement, there is the potential to create a meaningful space which supports professional growth.  Overall opportunities for innovation are identified, and links drawn between a culture of cross-disciplinary reflective practice and the personal wellbeing of those engaged in caring for others.


Biography:

Suzanne is a registered psychologist with extensive experience in health care, forensic and educational systems as a case manager, psychologist, trainer and organisational consultant.

Podiatry role in Epidermolysis Bullosa: The importance of allowing a patient to have a voice

Ms Laura Iacobaccio1

1Melbourne Health, Parkville, Australia

Background: Epidermolysis Bullosa (EB) is a group of rare congenital skin conditions characterised by skin fragility and recurrent blister formation, resulting from minor mechanical friction or trauma (1). Podiatry plays a vital role in the treatment of EB foot related complications. However, there is currently no EB podiatry guidelines and limited literature to assist clinicians.

Aim: To highlight the importance of patient/clinician communication  and recognising the role podiatry care has in EB management.

Case Study: Ms X, a 46-year-old with recessive dystrophic EB attends an adult EB multidisciplinary service. This patient received podiatry treatment, including standard sharps debridement of painful callus and corns to help her mobility. After this initial consultation, Ms X reportedly endured extreme pain 5-6 days post treatment, affecting her ability to weight-bear. Following this, Ms X provided written feedback, advising standard podiatry care is not always applicable to this patient group.

Results: The treating podiatrist now works closely with these patients to allow them to guide the treatment appropriate for the individual. The podiatrist is also actively working on raising awareness on the differences required in routine treatment when treating EB patients.

Discussion: In light of the complexity of this condition, this patient has highlighted the difficulties she has faced over the years with transitioning from different services and clinicians. Indicating the importance of strong communication skills and need for clinicians to allow patients to have a voice. This also emphasises the need for an international EB podiatry guideline to help clinicians alter their treatment accordingly.

Reference

  1. Harper, N., Orpin, S. & Heagerty, A. (2017). New referrals to an adult epidermolysis bullosa service. British Association of Dermatologists, 177(1), 78-85.

Biography:

Laura Iacobaccio is a senior podiatrist at The Royal Melbourne Hospital, working across the Diabetic Foot Unit, vascular, Epidermolysis Bullosa (EB) and Falls and Balance teams. Laura has worked in a variety of acute and sub-acute settings in both Australia and the UK. She has a special interest in the High Risk Foot and EB and is a contributing panel member for the international DEBRA EB podiatry guidelines.

Moving forward with Motor Neurone Disease: Evaluating the impact of a local Motor Neurone Disease group in a regional community

Miss Emily Brown1,2

1Queensland Health,  2Dietitians Association of Australia,

Motor neurone disease (MND) is a complex and progressive neurological disorder, requiring extensive multidisciplinary team input. Consumers living with MND in rural and regional communities often experience difficulties accessing specialist health care as a result of geographical isolation. Due to the nature of the condition, people with MND are at increased risk of social withdrawal, depression and a reported low quality of life (QOL). Additionally, carers and family members also commonly experience emotional, physical and psychosocial burden throughout the disease progression.

To increase consumer and family/caregiver knowledge of motor neurone disease and the treatment and support options available, decrease the feeling of social isolation, and improve overall QOL, the Community Health and Therapy Services (CHATS) team in Mackay developed a community group for consumers and family/caregivers. CHATS consumers with a diagnosis of MND were invited to attend the ‘Moving Forward with Motor Neurone Disease’ group, consisting of monthly sessions delivered by allied health (dietitian, speech pathologist, psychologist, physiotherapist and occupational therapist) and nursing clinicians. The group combines education and opportunities to speak directly to each health professional regarding any concerns outside of individual clinic appointments. Education sessions included information on symptoms associated with the progression of the disease and treatment and support options available, with the aim to provide consumers and family/caregivers the knowledge and confidence to be proactive and better prepared for their journey.

To evaluate the impact of the MND community group, experience and outcome measures from both consumers and family/caregivers will be reported to assess the impact of the group on quality of life and psychosocial parameters. The findings will inform future activities and interventions for consumers living with MND.


Biography:

Emily Brown is an Accredited Practicing Dietitian, currently working in the Community Health and Therapy Services team in Mackay. Emily graduated from the University of Queensland in 2016 with a Master of Dietetic Studies, and has a strong interest and passion for providing nutrition support for people living with motor neurone disease. Since graduating from University, Emily has worked in multidisciplinary community health teams in both Brisbane and Mackay.

Adopting best practices to create an inclusive assessment service for lesbian, gay, transgender & intersex older people

Donna Bainbridge1

1S.A Health, Adelaide, Australia

Older Lesbian, Bisexual, Gay, Transgender and Intersex (LGBTI) people experience different health outcomes, consequences stemming from pervasive discrimination and unconscious prejudice. The growing numbers of LGBTI people seeking aged care services represents a complex, emerging, challenging and urgent area for health services to address.  This presentation addresses how the South Australian Northern Aged Care Assessment and Aged Care Placement Teams are addressing the absence of trained diversity sensitive workers within health services and how addressing this gap will improve outcomes for older LGBTI people.

The project measures staff understanding and knowledge of legal responsibilities, current knowledge and beliefs. Staff will undertake regular measures of knowledge using a tool developed during this project. Training delivery includes cultural and historical backgrounds, use of language that is aligned to a person’s identity, and how LGBTI sensitive practices and policies and procedures support staff to recognise and meet the unique needs of minority groups including LGBTIQ people.

Method : Improve staff knowledge and skills to improve service access through improved support of LGBTI aged care consumers. To demonstrate that a program of education support, key workers and stake holder engagement contributes to the development of skills to better recognise and promote best practice for LGBTI people.  Additionally, an increased awareness across the organisation has been measured through requests to undertake training and participate in other initiatives arising from this program.

Outcome : Staff education, stakeholder support results in an increased awareness and measurement of stakeholder outcomes is ongoing.  Organisation interest is high and is measured through requests to undertake training and participate in other initiatives arising from this program. Additionally, the teams have had contact with international partners and peak bodies who are providing support and mentoring.


Biography:

As a Social Worker across both the Modbury & Lyell McEwin Hospitals In South Australia and throughout my diverse career working in Commonwealth Aged Care Packages, Residential Aged Care and the present. I have acquired a sound knowledge base and experience to achieve the best possible outcomes for patients and families transitioning to residential aged care. During this period working with two patients and their partners who identify with the LGBTI community, has provided me with the insight to the barriers, discrimination, and prejudices of the aged care system. Story telling has been a unique tool for gaining power for this project.

Meeting growing demand: A review of a nutrition allied health assistant role in a cancer setting

Ms Belinda Steer1, Ms Carmen  Puskas1, Ms Melanie Fairweather1, Ms Jacqueline Black1, Ms Jenelle Loeliger1

1Peter Maccallum Cancer Centre, Melbourne, Australia

The Peter Mac Nutrition Department implemented a nutrition-focused Allied Health Assistant (AHA) role in 2010 primarily to improve inpatient malnutrition screening and referral to the dietitian. Since then, the role has expanded (without increasing EFT) to include screening and simple interventions in other clinical areas such as speech pathology. A review was completed in 2018 to evaluate this role.

A mixed-methods approach, including a survey of key stakeholders of the AHA service and a review of screening data was undertaken.

The survey (n=20) indicated that the most valued AHA tasks were inpatient malnutrition screening, day therapy simple interventions, and inpatient simple interventions. Most respondents (81%) indicated that the AHA completing simple interventions in day therapy was very useful, and 100% felt additional AHA time in day therapy would be very useful. Despite 68% of respondents indicating having the AHA in radiotherapy clinic was very useful, 32% indicated it was somewhat useful with these tasks not being as highly valued here compared to other clinical areas. Most respondents (84%) supported further expansion of the AHA role into speech pathology. Malnutrition screening data indicated the average monthly screening rate reduced from 74% in 2016 to 55% in 2017, well below the target of 80%. This was coupled with an increase by ~30% in the number of patients who required malnutrition screening in 2017.

This review indicates that malnutrition screening should remain a key focus for the AHA role, however other tasks are highly valued, especially in the day therapy setting. The scope of this AHA role needs refining to ensure that screening targets can be met, whilst other areas of high need are being serviced and optimal patient care is being achieved.


Biography:

Belinda Steer is Head of the Nutrition and Speech Pathology Department at Peter MacCallum Cancer Centre in Melbourne. She has over 15 years experience as a clinical dietitian, including over 10 years specialising in oncology nutrition. and has a passion for providing high quality, patient-centred care.

Adopting health practitioner rating websites: Assessing the influence of practitioners’ motivation and system perceptions

Mr Renato Ulpiano1,2, Professor Elisabeth  Wilson-Evered2, Associate Professor Stephen  Burgess2, Dr Scott  Bingley2, Dr Tristan Casey3

1Ladybug House, Mudgeeraba, Australia, 2Victoria University, Footscray, Australia, 3University of Queensland, St Lucia, Australia

In healthcare, the practitioner-patient relationship is shifting from service controlled whereby the practitioner decides on the patient’s healthcare, to patient centred care, where the patient is empowered, to make decisions. Modern healthcare design models view patients as more than passive recipients of healthcare services and instead expect patients to manage their own care and be accomplished in assessing service quality. This is especially true for NDIS participants.

Helping shape this shift is the increasing use of Online Rating  Websites (ORW) to provide feedback on health services. By contrast, ORWs are not commonly embraced by health practitioners or their professional associations. Nonetheless, in a competitive environment health practitioners will also need to attend to what clients are publicly communicating about their service. The aim of this research is to determine the motivational orientation of health practitioners to use such websites along with the role of their perceptions of the characteristics of a ORW. Together, the motivational and technology elements will be assessed in terms of their relative influence on ORW use by health practitioners. A conceptual model, which theoretically explains the relationship between motivation to use and intention to adopt ORWs, will be tested in a cross-sectional study. Participants are Australian health practitioners who will be surveyed using validated scales from proven theories. Structured Equation Modelling will estimate the model and the relative contribution of motivation and systems characteristics on the use of the ORW. The results will inform future research and theorising as well as health practitioners and professional associations about those factors critical for the adoption of ORWs.


Biography:

Renato co-owns and operates Ladybug House which is an allied health practice operating in Melbourne and on the Gold Coast. He is also completing doctoral research that investigates how health professionals will respond to the ever increasing online reviews. He has worked for organisations such as Telstra, Microsoft and recently Aconex. His customer facing experience in other industries has enabled him to apply consumer orientation to his customers that come through the clinic.

123415

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

Conference Managers

Please contact the team at Conference Design with any questions regarding the conference.

Photo Credits: Tourism & Events Queensland

© 2017 Conference Design Pty Ltd