Reducing the cancer malnutrition burden: highlights of state-wide collaborations in Victoria

Jenelle Loeliger1, Jane Stewart1, Belinda Steer1, Dr Nicole Kiss2

1Peter Maccallum Cancer Centre, Melbourne, Australia, 2Deakin University, Burwood, Australia

Aim: Cancer malnutrition is common and associated with poor outcomes. The Victorian Cancer Malnutrition Collaborative (VCMC) program of work is a state-wide collaboration between Peter Mac, Victorian state government, Victorian health services and other interested parties. The VCMC program of work aimed to increase understanding and knowledge, and promote strategies for action in order to address cancer malnutrition.

Method: VCMC projects consisted of repeat biennial malnutrition point prevalence studies (PPS), local health service and state-wide projects developing/evaluating resources for patients and health professionals, targeted clinical redesign/implementation projects and system-wide improvements.

Results: Work over the past 8 years has identified the extent of cancer malnutrition in health services, identified service gaps and developed and evaluated resources (including eLearning packages targeting cancer care clinicians, nutrition governance toolkit for practical health service application). More than 22 local and targeted state-wide projects were conducted between 2013-16, focused on improving clinical pathways of care, sustainability of resources, improving malnutrition screening in culturally and linguistically diverse populations and hospital food service models. Cancer malnutrition PPS were conducted in each phase and demonstrated a state-wide reduction in malnutrition prevalence from 31% (2012, n=1693), 26% (2014, n=1913) to 23% in 2016 (n=1351) (2018 result pending). Work in 2017-18 has highlighted clinical practice and education needs in the primary care and community sector in regards to cancer malnutrition. A nutrition oncology care pathway is currently being co-designed by health professionals and consumers in addition to translating/culturally adapting the Malnutrition Screening Tool into Victoria’s top 10 languages other than English.

Conclusion: State-wide collaboration has led to measurable improvements in patient and organisational outcomes, reduced variation through sharing/delivering best practice nutrition approaches and improved multidisciplinary awareness of cancer malnutrition.


Biography: 

Jenelle is the Head of Nutrition and Speech Pathology at Peter MacCallum Cancer Centre in Melbourne. As a clinical dietitian by background, Jenelle is passionate about effectively implementing evidence into practice through innovative leadership, research and service design work focused on improving outcomes for those with cancer. Jenelle also provides state-wide leadership to the Victorian Cancer Malnutrition Collaborative (VCMC) program of work.

Emerging Leaders – realising our value through embedding clinical leadership

Mrs Rebecca Hughes1, Mrs Andrea Hurwood1, Mrs Helen Weston1

1Mobile Rehab, Brisbane, Australia

On a background of an ageing population, rapid growth in the community health sector and changing expectations of consumers, clinical leadership is essential to underpin the future of the allied health professions.

Mobile Rehab is a large private practice delivering allied healthcare services to South East Queensland, Northern New South Wales and the Darling Downs community. Like many health organisations, recruitment, retention and ongoing engagement of a dynamic workforce while delivering quality services can provide challenges. The emergence of early career clinicians seeking leadership roles has highlighted deficits in this area in both training and employer career path offerings.

There is a paucity of information relating to leadership development in the Australian community allied health sector. Parallels between the community sector and rural workforce may be drawn as clinicians often require a generalist scope of practice, work in isolation to their peers and experience higher staff turnover. Research outcomes in rural areas indicates flexibility and clear career progression pathways lead to higher retention rates and staff satisfaction.

With a growing workforce of early career allied health professionals and a strong new graduate program, Mobile Rehab recognised the need to offer leadership opportunities to ensure the continued growth of both our organisation and our clinicians. Following an organisational restructure, the introduction of a cluster model has provided a viable leadership opportunity to emerging leaders.

Information gained through a survey provides insight about the preparedness, confidence and capabilities of the emerging leaders. Ten months post implementation the emerging leaders program has provided significant learnings, that can be shared with other organisations to guide their leadership programs.


Biography:

Graduated with a Bachelor of Physiotherapy/Bachelor of Exercise Science in 2012 from Griffith University after previously having completed a Bachelor of Business at QUT in 2007. Started with Mobile Rehab as a new graduate in 2012 and began engaging within the leadership program in 2014 as an early emerging leader, from which grew the initial stage of the emerging leader program . Following 2 children and 6 years with Mobile Rehab, is now a Regional Manager and enjoys the flexibility of working part time within this role.

Reviewing Allied Health – no longer the back seat driver

Sue Fitzpatrick1

1Illawarra Shoalhaven Local Health District, Port kembla, Australia

The value of allied health is strongly recognised in health literature, however, this recognition is not readily translated to the prioritisation and utilisation of allied health at local health system levels.

Illawarra Shoalhaven Local Health District underwent an external review of the two largest hospitals in the district.  The rationale for the review was to examine staffing and utilisation, allied health’s role in facilitating patient flow and allied health governance systems. 54 recommendations were made across a range of jurisdictions which were accepted allied health and executive members.

Allied health efficiency should be in the hands of allied health clinicians and leaders. This paper details the process of planning and performing a formal review of allied health and the process of implementing recommended changes. Ownership of the review process and embracing recommended changes was the most important part of evidencing efficiency and in driving new changes in clinical work and clinical governance.

Changes to date include an all of allied health triaging system, sarcopenia program, stroke interdisciplinary assessments and a malnutrition pathway. Enabling allied health across all professions and levels was a significant facilitator of acceptance and innovation following the release of the review report.

This paper will detail the process of the review from choice of reviewers, to provision of information to the reviewers, the review process, report and implementation of the recommendations. Reflection on the process is key to the lessons learnt and the need to have allied health in the driver’s seat when examining systems and processes.

The outcomes of the review process will include what worked well and pitfalls of the process and includes the good, the bad and the contentious. The lessons from the review process take allied health from back seat to front and driving the road to demonstrating efficiency and innovation in the healthcare environment.

Philip, K (2015). Allied health: untapped potential in the Australian health system. Australian Health Review 244-247.


Biography:

Sue has a background as a speech pathologist. Sue completed a doctor of health science in 2016 in clinical supervision in allied health and currenlty works as the executive director of allied health the illawarra shoalhaven region on the south cost of New South Wales. Sue is interested in collaborative leadership and building leadership capacity in allied health professionals.

Development and implementation of a novel dietetics governance structure in a new tertiary facility

Mrs Kylie Clavarino1, Mrs Catherine Beckton1, Miss Katie Benton1, Mrs  Catherine Mc Farlane1, Mrs  Rosemary Sander1, Mrs Sarah  Bloomfield1, Mrs Alison Blundell1, Mrs Gai Moritz1

1Sunshine Coast Hospital And Health Service, Sunshine Coast, Australia

Background: On transition to the new Sunshine Coast University Hospital and Health Service (SCHHS), Allied Health (AH) was redesigned to a decentralised / dispersement model; where each clinical specialty has a dedicated AH multi-disciplinary team. AH teams are managed operationally by an AH Advanced Clinician, housed within individual specialty services.

Traditional discipline based operational management and centralised departments ceased. Professional governance was provided remotely by HP5 Advanced Clinicians and discipline based Professional Leads, creating separate operational and professional management lines. Six months after implementation, AH Leadership undertook a quality analysis of the current structure. Additionally, dietetics completed staff satisfaction surveys. Both indicated that there was confusion around roles and responsibilities, reporting and communication. A lack of professional support was highlighted, especially for new staff to SCHHS at time of transition (30% of the Dietetic workforce).

Aim: This project aimed to develop and implement a professional team based governance structure. Six Dietetic teams were formed and led by HP5 Advanced Dietitians to provide clinical and professional support for dietetic staff whilst continuing to work within the broader AH dispersement structure.

Methods: Design and implement a team-based Dietetic Governance Structure, following whole change management processes.

Results

  • A dietetic team-based governance structure was implemented Feb 2018.
  • All Dietetic staff across the SCHHS has access to an Advanced HP5 Dietetic Leader and supported clinically and professionally within teams.
  • A dietetic strategic plan has been developed with measurable key performance indicators (KPIs).
  • Staff satisfaction survey will be repeated and focus groups will be conducted to determine the success of this initiative. Furthermore, quantitative data such as the number of KPIs met will be analysed.

Discussion: Implementation of a team-based dietetic governance structure is expected to enhance professional and clinical governance, with greater staff engagement and an increased number of KPIs met.

References

Dawber, J. et al. A realistic review of allied health management in Queensland Health: what works, in which contexts and why. July 2017 State of Queensland (Queensland Health)

Allied Health Professions Office of Queensland, Department of Health. Allied Health Clinical Governance Framework in Queensland Health. March 2015. State of Queensland (Queensland Health)


Biography:

Kylie Clavarino is an Advanced Dietitian Leader who has worked in various leadership roles including Director, Clinical Lead and Multidiscipline Leader for Gastroenterology services within the SCHHS since 2005. Having worked in evolving AH structures in the preceding 5-6years Kylie has a strong focus on maintaining staff support and engagement to improve the quality of patient care.

An initiative to build research capacity within a physiotherapy department and Allied Health service: Hits and misses over a 24-year period

Kathy Stiller1

1Central Adelaide Local Health Network, Adelaide, Australia

Background: Building research capacity within a busy clinical allied health department is important but can be limited by time, resources and expertise. In 1995, a role was created in a physiotherapy department whereby an individual with an interest and expertise in clinical research was identified and a proportion of their workload (12 hours/week) designated to fulfil a research co-ordination role. The aim was to foster research and build research capacity. In 2015 this position was expanded from physiotherapy to a broader allied health role. This paper reports the achievements associated with this initiative, highlighting its successes, difficulties and failures.

Method: A retrospective descriptive review of research-related activities undertaken over a 24-year period within the Physiotherapy Department and Allied Health service of an adult, tertiary, public hospital was carried out.

Results: Since the introduction of a designated research co-ordinator in 1995 there have been 173 major publications involving allied health staff in peer-reviewed journals. Other successes have included numerous conference presentations, the broad range of clinical areas where research has been undertaken, the clinical relevance of this research, the large number of staff involved, collaboration with other hospital departments/universities and staff involvement in post-graduate degrees. Difficulties have included slow recruitment rates, resource issues and lack of a career structure for those interested in pursuing research as a career option. Failures have been infrequent but have included the need to abandon studies due to slow recruitment, and personal feelings of being a ‘jack of all trades and master of none’.

Conclusions: Identifying a clinician with an interest and expertise in clinical research and quarantining time to enable them to fulfil a broader research co-ordinating role has been successful at fostering research and building research capacity within both physiotherapy and then more broadly across an allied health service.


Biography:

Kathy Stiller works 12 hours per week as allied health research coordinator for the Central Adelaide Local Health Network after having undertaken this position in physiotherapy only for 20 years. Prior to this Kathy worked in ICU at the Royal Adelaide Hospital for over 20 years.

Developing emerging researchers in Allied Health – the role of mentors

Professor Michal Schneider1

1Monash University, Clayton, Australia

Many Allied Health practitioners hope to engage in research at some stage of their professional career. Evidence-based practice (EBP) and research methodology are today part of the curriculum and, in theory, should prepare future health care practitioners to engage with research and EPB. However, in clinical practice, this often falls by the wayside despite best intentions. Common hurdles include time pressures, lack of resources, a poor research culture and lack of research career pathways. One way to overcome some of the obstacles include facilitating mentorship for emerging researchers. Using the Victorian Allied Health Research Framework, recently established by the Department of Health and Human Services (Victoria) as an example, this presentation will describe the role of mentors in supporting, developing and maintaining a positive research culture for practitioners working in Allied Health.


Biography:

Prof Michal Schneider is the Deputy Head and Director of Research at the Department of Medical Imaging and Radiation Sciences, Monash University. In February 2019, she started her role as the inaugural Allied Health Research and Translation Program Director at the Department of Health and Human Services, Victoria. She has published over 120 papers in diagnostic imaging and radiation therapy research (clinical and educational) and currently supervises 13 PhD students in these disciplines. She is keen to assist the Allied Health Workforce to develop a better research culture and foster research and evidence-based practice.

Retrospective analysis and future trends in allied health leadership and workforce: from therapy divisions to gig-economy aggregators

Dr Rosalie Boyce1,4, Professor Susan Nancarrow2, Dr Olivia King1, Dr Paul T. Jackway3

1University Hospital Geelong, Barwon Health & South West Healthcare, Geelong & Warrnambool, Australia, 2Southern Cross University, Gold Coast, Australia, 3NegInfinity Pty Ltd, Brisbane, Australia, 4University of Queensland, Brisbane, Australia

The development of ‘allied health’ has been accompanied by several shifts in public sector business models that have shaped the way allied health is organised. Each shift has had implications for both leadership and the workforce.

Drawing on a range of Australian and international secondary data sources and public documents we can trace distinct periods of evolution in allied health organisation and analyse their significance from a leadership and workforce perspective:

← Steady state stability and uniformity (< 1990s)

→ Outsourcing; External labour markets (> 1990s)

→ Social enterprise; Public private partnerships (2000s)

→ Complex multi-divisional geographic consolidation (2010s)

→ Gig-economy aggregators; Technology-driven platform proliferation.

We contend that the first three post-steady state phases for allied health have been accomplished through accommodation – with only moderate levels of upheaval and a focus on adjustment.

In contrast, the fourth phase (gig-economy) may be accompanied by more disruptive hallmarks arising from galloping “Uberisation” of app-based and telehealth service models as alternative offerings to traditional public sector care.

Predictions of allied health workforce loss due to AI and robotic substitution have been conservative. However, seismic disruption may come from gig-economy enabled approaches in which client preferences and an “on demand” culture dominate established profession-led practice easily able to be portrayed as staid and unresponsive to innovation.  In other words, models of ‘service’ trump models of ‘care’.  The public sector may also lose workforce to the attraction of highly flexible hours offered by gig-economy businesses; a known risk in highly feminised workforces such as allied health.

Public sector allied health leadership faces challenges because of its low expertise in countering gig-economy challenges and poor mastery of digital technology advances.  The paper will conclude with a discussion of:

(1)          identification of brand strengths associated with public sector allied health practice;

(2)          strategies to help minimise the potential loss of workforce, and

(3)          how to ignite leadership capability to lead in a digital future world.


Biography:

Dr Rosalie Boyce (PhD) is an internationally recognised authority on management, organisation, workforce and leadership of the allied health professions. She has appointments as an Allied Health Research & Translation Lead (with Dr Olivia King) at University Hospital Geelong, Barwon Health / South West Healthcare; the University of Queensland and is Director of Rosalie Boyce Consulting Pty Ltd.

AHP Leadership in Higher Education: Opportunities and Challenges

Dr Vivien Gibbs1, Dr Marc Griffiths

1Uinversity Of The West Of England, Bristol, United Kingdom, 2Uinversity Of The West Of England, Bristol, United Kingdom

The aim of this research was to gain a deeper understanding of the perceptions of key stakeholders in relation to the current extent of Allied Health Professionals (AHPs) in leadership roles within academia in the UK. The researchers undertook an exploration of the potential barriers, challenges and opportunities that exist for AHPs to undertake leadership roles within higher education and used the findings to offer recommendations for the future.

Whilst it is acknowledged that the number of AHP academic staff in the UK is significantly smaller than other professions such as Nursing, it is generally recognised that a lower percentage of AHPs are appointed to significant leadership roles within academia. This is particularly noticeable in posts associated with governance, policy and decision making. This project focused specifically on the reasons why this may be the case, and aimed to identify opportunities for future development models.

Purposive sampling took place to ensure a diverse sample of stakeholders, and the inclusion of the most appropriate participants with different experiences, backgrounds and roles, thereby ensuring a range of perspectives would be obtained. A total of twenty semi-structured interviews were conducted, and the data analysed using thematic analysis in order to explore the initial findings and create core themes.

Several themes emerged from the study, the primary ones relating to lack of confidence and a lack of motivation amongst AHPs to aspire to senior leadership roles, with a preference instead to focus on gaining clinical and research expertise rather than leadership skills. In addition, fewer opportunities appear to exist for AHPs to progress into senior leadership roles, due to a number of reasons which are explored in more depth in this presentation. It was noted that AHPs probably have much to learn from our nursing colleagues in how to move into strategic leadership roles within academia.

A number of recommendations were made to ensure that AHPs attain the ambition, the confidence, the skills and the opportunities required for them to be able to move into senior leadership roles in the future.


Biography:

Vivien has worked in a senior leadership position within academia for the past four years. Prior to that she has worked as a lecturer and as a clinical radiographer. she completed her PhD several years ago, and has published widely on a range of AHP related subjects.

Allied Health Governance in the Private Hospital Sector – A National Program of Organisational Renewal and Regulatory Coordination

Ms Rachel Resuggan1, Dr Rosalie Boyce2,3

1St John Of God Health Care Inc., Osborne Park, Australia, 2Barwon Health – South West Healthcare, Warrnambool, Australia, 3University of Queensland, Brisbane, Australia

St John of God Health Care (SJGHC) is one of the largest private sector (not-for-profit) health services in Australia and New Zealand operating 24 facilities (3,407 hospital beds) across acute, sub-acute and mental health services, as well as home-based community care, disability services and social outreach programs.

Process, outcome and innovation data from a three-year renewal program to review, analyse, strengthen and reconfigure allied health governance will be presented. The essential leadership task was to reshape allied health from semi-autonomous facilities into a single SJGHC allied health approach through deploying multiple strategies in both series and parallel. The SJGHC Allied Health Governance Project is the largest multi-site allied health renewal project undertaken in Australia to date.

Key components of initiating and shaping the first phase of change included:

  1. SJGHC values to guide the project
  2. Undertaking system-wide comprehensive review
  3. Establishing single point accountability to drive reforms (allied health project manager)
  4. Utilising a research evidence-base to develop frameworks
  5. Establishing a collaborative university-health service partnership to guide, support and challenge thinking
  6. Fostering collaborative networks with peer services to share ideas
  7. Sourcing models from academic/grey literature to adapt to a private-sector context

Successful achievements of the project to date include:

  • Establishing an Allied Health Leadership & Clinical Governance Network as the governing body providing important advisory function
  • Implementing an organisation-wide Allied Health Credentialing and Scope of Practice Policy, alongside implementation of standardised Position Descriptions for AHPs
  • Developing a national standard for mandatory training and Professional Development Pathways
  • Clinical Supervision Guideline
  • Launching a National Clinical Placement System to support allied health students

The presentation concludes with discussion of Next Steps and an evaluation strategy.


Biography:

Rachel Resuggan is a highly regarded for her extensive expertise in allied health governance and leadership.  Working for St John of God Health Care as the National Project Manager – Allied Health Governance, she is leading the development and delivery of a comprehensive project focused on strengthening allied health leadership and governance structures across the organisation. Rachel thrives on pioneering allied health services and creating strong foundations that provide optimum environments for allied health professionals so that they can deliver excellence in care.  Rachel has led the commissioning and establishment of allied health services for two greenfield hospitals (St John of God Midland Public and Private Hospitals and Fiona Stanley Hospital in Western Australia). Her passion for allied health governance comes from years of leading allied health services, including the North Metropolitan Area Health Service in Western Australia.

Dr Rosalie Boyce (PhD) is an internationally recognised authority on the management, organisation and leadership of the allied health professions. She has appointments as Regional Allied Health Translation Research Lead (with Dr Olivia King) at Barwon Health / South West Healthcare; the University of Queensland and is Director of Rosalie Boyce Consulting Pty Ltd.

Improving Collaboration, Engagement and Influence for Allied Health Practitioners in Complex Multi-Disciplinary Settings

Mr Benjamin Freedman1

1AboutResolution, Cranbrook, Australia

Our ability to contribute to safe and high-quality care is coupled with our ability as practitioners to negotiate and problem-solve with other disciplines in complex and often contested clinical environments. Indeed, no other industry or sector is quite as complex as healthcare, with combinations of clinical intricacies, interventions, interactions and outcomes both infinite and unpredictable. This presentation begins by exploring the concept of health workplaces as Complex Adaptive Systems. This has important implications for how we approach multi-disciplinary engagement, and understand and respond to conflict.

Based on the author’s published work and masters research in healthcare conflict management, this presentation will then explore the key drivers of conflict within multi-disciplinary teams, as well as healthcare negotiation insights from the emerging fields of Resilient Healthcare, Complexity Theory, neuroscience, and Safety II. Allied Health practitioners attending this session will come away with a comprehensive set of techniques to intentionally improve engagement, collaboration and negotiation in complex multi-disciplinary environments.


Biography:

Ben is a nationally accredited mediator, conflict coach and negotiation skills trainer, with a strong background in mental health patient safety and clinical governance. He is founder of AboutResolution, a healthcare-focused conflict management consultancy, and has partnered with a range of healthcare organisations including Primary Health Networks, Hospital and Health Services, Private Hospitals and Universities to deliver clinically-focused conflict management solutions.

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)

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