When do allied health professionals lose confidence to perform evidence-based practice activities? A cross-sectional study.

Dr Marlena Klaic1,2, Associate Professor Fiona McDermott2, Professor Terry Haines2

1Royal Melbourne Hospital, Parkville, Australia, 2Monash University, Frankston, Australia

Introduction

Australian allied health professional groups typically have accreditation or registration requirements which mandate training in EBP skills within undergraduate courses. It is likely that recent Australian graduates from the allied health professions are equipped to undertake a range of EBP activities. However, published research continues to find that clinicians report a lack of skills as a significant barrier to EBP, despite the commitment of education providers and registration bodies to facilitate this.

Objective

To examine the relationship between allied health professionals’ confidence to perform a range of EBP activities and the number of years worked clinically and highest level of qualification received.

Method

Analytical cross-sectional survey. Allied health professionals from two major metropolitan hospitals in Australia were eligible to participate in the study. Attitudes, beliefs, skills, knowledge and behaviour related to EBP were measured using a previously validated instrument. Data analysis included box plot analysis and multivariable regression with adjustment for the highest level of qualification received.

Results

A total of 288 (n=288) surveys were completed, representing a 58% response rate. Allied health professionals begin to lose confidence related to EBP activities within the first five years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with post-graduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time.

Conclusion

Recently graduated allied health professionals are typically equipped with the knowledge and skills to confidently participate in EBP activities. However, these skills degrade quickly. If allied health professionals are to provide a practice that is evidence based, there must be investment in strategies which ensure maintenance of EBP skills, confidence and behaviours. Further research determining the timing, frequency and format of these strategies is important.


Biography:

Dr Marlena Klaic is the DHHS appointed Allied Health Research & Translation Leader at the Royal Melbourne Hospital. She has 20 years’ experience working clinically in neurological rehabilitation, research and project management. Marlena completed her PhD on “Enhancing the uptake of evidence-based practice with allied health professionals: A quasi-experimental study”.

How can we better utilise our assistant workforce in speech pathology?

Maria Schwarz1, Professor Elizabeth Ward2, Associate Professor Petrea Cornwell3, Mrs Anne Coccetti1

1Logan Hospital, Meadowbrook, Australia, 2Centre for Functioning and Health Research, Brisbane, Australia, 3School of Allied Health, Griffith University, Brisbane, Australia

As demands on Allied Health Practitioners grow within health services, delegation to Allied Health Assistants (AHAs) is increasingly being suggested as a management strategy to reduce demand and increase efficiency. Delegation to AHAs is reported to be an effective workforce solution in a number of areas of adult speech language pathology (SLP) practice. However, reports of AHA delegation in the area of dysphagia management are limited.

The aim of this study was to synthesise information from policy documents and current clinical practice to examine the nature of AHA delegation in dysphagia management.

A mixed method design involving a document review of 13 policy documents on AHA delegation, and a survey of 44 SLP managers regarding current delegation models was conducted.

Results indicate that policy and current practice were largely congruent. Despite policy support for AHA delegation, 77% reported using delegation models but only 26% used them fairly often/very often in dysphagia management. Both policy and survey findings support AHA training prior to task delegation, however, the nature of training was unspecified. Good governance is integral to successful delegation and managers recognised the need to increase standardisation of AHA capability assessment.

The Australian health service is moving towards a more consistent and defined scope of practice for AHAs, which is reflected in increased utilisation of AHAs for previously AHP specific tasks such as dysphagia management. There is growing interest in improved utilisation of AHAs, with an emerging literature of policy and position papers to support implementation of these positions in the healthcare setting. However, further clarification is required regarding the specific tasks AHAs are permitted to complete, how competency in these tasks will be measures and supervised and what training is required for AHP’s to successfully implement delegation practices into the workforce.


Biography:

Maria is a clinical speech pathologist with experience in acute dysphagia management, as well as in training and supervising allied health assistants. She is currently completing a PhD at the University of Queensland investigating the expanding role of allied health assistants in dysphagia management within the acute hospital.

Breaking the Silence: Exploring responses to Domestic and Family Violence in Clinical Practice

Mr Angel Carrasco1, A/Prof Kathleen Baird1

1Gold Coast Health, Southport, Australia

Allied Health Clinicians are often at the front face of health services providing direct clinical support, counselling and specialist referral to women experiencing domestic and family violence (DFV). This presentation explores a qualitative research project that was undertaken at Gold Coast Health investigating the various approaches and responses to domestic and family violence used by clinicians in direct clinical practice from the perspective of a range of health care workers including allied health clinicians. Clinical staff employed at the relevant departments of a large, tertiary hospital were invited to participate in semi-structured interviews which were recorded, and transcribed. These transcripts were then read by two individual researchers and coded for themes and subthemes using an inductive and iterative approach inherent in the grounded theory methodology (Creswell, 1998). Six major themes emerged from the data as being of particular relevance to clinicians working in the area of DFV. These themes were (1) ‘Training and education’ for staff; (2) ‘Resources and support’ for people experiencing  DFV; (3) ‘Perceptions and attitudes’ of both patients and staff regarding DFV; (4) ‘Organisational approach to patient care’; (5) ‘protocols and guidelines’; and (6) ‘Patient safety’. These themes within clinical practice, along with other pertinent issues and recommendations described by participants, will be discussed in this presentation. This research obtained HREC approval by the GCHHS HREC Committee.


Biography:

Angel Carrasco is Director of Social Work and Support Services at Gold Coast Health and was instrumental in establishing the first Domestic and Family Violence Co-ordinator (Advanced Social Worker) role in Queensland Health.

Move Baby Move: Engaging with women with GDM to improve physical activity ‘messaging’

Ms Anne Harrison1

1Mercy Hospitals Vic. Ltd., Werribee, Australia

Background: Physical activity has substantial benefits and minimal risks for pregnant women including those diagnosed with gestational diabetes mellitus (GDM) yet more than 60 per cent of women with GDM do not participate in physical activity as recommended.

Aim: To identify the perceptions of women diagnosed with GDM to physical activity during pregnancy?

Method: The study design was a qualitative study with phenomenology and interpretative description as theoretical frameworks. Participants were pregnant women, with GDM, aged 18 to 40 years who were purposively recruited. Recruitment continued until data saturation. Semi-structured interviews were recorded, transcribed verbatim and returned to participants for checking. Qualitative data were analysed thematically by three researchers independently. Data were coded, compared and themes developed, discussed and defined. Emergent themes were sent to participants and peer-reviewed for confirmation.

Results: Twenty-seven women participated who were of mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5) and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included receiving information about physical activity from credible sources, knowing what type and how much physical activity was safe for their pregnancy, receiving information at GDM diagnosis as this triggered women’s desire to be more physically active, understanding the positive effects of physical activity on pregnancy outcome, and identifying flexible, individually-tailored physical activity options.

Discussion and significance: To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. They wanted flexible, convenient, practical physical activity options that could be tailored to meet their individual needs and fit in with their busy lifestyles. Health professionals can support women with a GDM pregnancy with targeted physical activity messages.


Biography:

Anne Harrison is a physiotherapist with over 30 year’s clinical experience including 20 years of health management experience. She is manager of physiotherapy services at Werribee Mercy Hospital, Mercy Hospitals Victoria Ltd. She has interests in women’s health and translating research into practice as well as health service planning. Anne’s present research is investigating physical activity participation for women diagnosed with GDM. Her qualifications include a Bachelor of Applied Science in Physiotherapy, a Master of Health Administration and she is currently a Professional Doctoral candidate at La Trobe University.

High Intensity Users: A chart audit of multiple presentations to a paediatric emergency department

Ms Jaime Odonovan1

1Lady Cilento Children’s Hospital, South Brisbane, Australia

Background:

High intensity users impact waiting times and the efficacy of Emergency Departments (ED) and have a flow on effect on the functioning and resource use of the entire hospital. There is an absence in the literature regarding the causes as to why there are multiple and avoidable presentations to a paediatric tertiary hospital.  Literature in the wider ED research demonstrates that there are identifiable reasons on the impact of these presentations. This innovative study is the first known study to identify populations and causes for these presentations and level of social worker (SW) intervention.

Methods:

461 patients were coded, based on their triage notes, into ten categories.  A retrospective chart audit was completed for patients who met the inclusion criteria to identify triggers for presentation and the SW interventions that were provided. 10% of the charts were peer reviewed.

Results:

37 patients charts were reviewed, which resulted in 415 presentations to the ED. Despite the high indicators of psychosocial dysfunction/concerns only 6% of presentations resulted in a referral to SW. The primary reason SW were referred was for discharge planning/youth homelessness. SW were rarely engaged for significantly distressed or anxious parents even though this is a key indicator for representation.

Conclusions:

There are four identified themes that require further examination in the ED that potentially could change presentations and reduction of resources in the ED.  Medical processes/procedures, vulnerable populations, mental health issues and parental coping and anxiety were the themes contributing to high intensity users presenting to the ED.


Biography:

Jaime O’donovan is a Senior Social Worker at the Lady Cilento Children’s Hospital

A systematic review of assessment tools and factors used to predict discharge from acute general medical wards

Ms Aruska D’Souza1,2, Associate Professor Catherine Said1,3, Ms Melanie Tomkins2,3, Ms Nina Leggett2,3, Ms Jacqueline Kay2, Dr Catherine Granger1,2

1University of Melbourne, Parkville, Australia, 2Melbourne Health, Parkville, Australia, 3Western Health, Sunshine, Australia

Background: Timely discharge has potential to improve quality of care and reduce length of stay. This systematic review aimed to identify assessment tools (containing multiple items) and factors (single items) associated with discharge destination (home, subacute or residential care) in general medical inpatients.

Method: Protocol registered a priori on PROSPERO (CRD42017064209).  Five electronic databases were searched. Studies were eligible for inclusion if they were: a prospective or retrospective quantitative study design, with a minimum of 20 adult acute general medical inpatients and published in English. Outcomes of interests were assessment tools or patient factors with statistical correlations with discharge destination. Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively.

Results: Twenty-three studies were included. Within included studies, tools and factors spanned ‘cognitive’, ‘functional’, ‘mobility’, ‘medical’, ‘social’ and ‘other’ domains. Fifteen tools associated with discharge were identified; 13 were associated with discharge to residential care, 11 with discharge home and 2 with subacute. The most commonly researched tools were the Mental Status Questionnaire/Short Portable Mental Status Questionnaire, the Mini-Mental State Examination, the Barthel Index, the Katz Index and the Lawton ADL Index (each investigated in two studies). Thirty-nine factors associated with discharge were identified; 28 were associated with discharge home, 15 with subacute and 23 with residential care. The most commonly researched factors were age and patient/carer’s wishes about returning home (each investigated in eight studies).

Discussion: The large number of tools and factors found, as well as their distribution across several domains, exemplifies the complexities of discharge planning. There is no single tool that best predicts discharge destination for this complex cohort. Further research is needed to determine the psychometric properties of the tools identified as well as additional predictors of subacute care.


Biography:

Ms D’Souza is a senior physiotherapist who graduated from La Trobe University in 2010 and has worked in the public health system for over eight years. She currently works at the Royal Melbourne Hospital. Ms D’Souza was the successful recipient of the Mary Elizabeth Watson Early Career Fellowship in Allied Health and commence a PhD part time at the University of Melbourne. Her PhD topic aims to investigate discharge from acute general medical wards. She is the lead researcher in a systematic review, two observational studies and a qualitative study. Ms D’Souza was successful in a poster presentation at the 2017 national Australian Physiotherapy Association conference and a table top discussion at the 2018 Australian Association of Gerontology conference.

Can Care Coordination reduce Hospital Admission in at-risk patients: The HealthLinks Project Evaluation at Peninsula Health

Miss Rebecca Kwok-yee Pang1,2, Prof  Velandai Srikanth1,2, Mrs Belinda Berry1, Mr Faisal Husain1, Dr Gary Braun1, Mrs Erin Magee1, Dr Nadine E Andrew1,2

1Peninsula Health, Frankston, Australia, 2Monash University, Frankston, Australia

Unwarranted hospital readmissions, particularly among people with chronic complex conditions, add to the cost of health care. It is therefore important to devise ways to reduce the risk of readmissions in this group.

The HealthLinks pilot project was conducted as a Department of Health and Human Services initiative. HealthLinks algorithm, developed by CSIRO, was made available to health services whereby a score ≥ 9 indicated high-risk of readmission. Peninsula Health adopted this criteria, coupled with care-coordination to patients aged between 51-91 years admitted to hospital between May and November 2017. Identified patients received care coordination by a nurse, multidisciplinary team interventions and follow-up, via regular telephone calls for 30 days after hospital discharge.

A pilot retrospective matched cohort study was performed. Patients, who received care coordination, were matched with five controls (patients who did not receive care coordination) on HealthLinks score, age, and sex. Descriptive analyses were used to compare groups; survival analysis was used in the primary outcome analyses. Primary outcomes were time to first readmission at 30, 60 and 90 days. The primary cause of readmissions was also described.

Sixty-five people received HealthLinks interventions (mean age 79 years, 46% male, median HealthLinks score 12) and 319 matched controls (mean age 78 years, 49% male, median HealthLinks score 12) were identified. There was a 22% reduction in readmission risk (Hazard Ratio 0.78, 0.42-1.45, p=0.44) within 30 days, no difference at 60 days and a 21% increased risk at 90 days (HR 1.21, 0.81-1.82, p=0.35) post discharge. Results were not statistically significant.

Results were underpowered due to small sample size. However, there were clinically important signals suggesting that care coordination in first 30-days may reduce time to readmission in at-risk patients, and the absence of this coordination may increase readmission risk. Verification in an adequately powered randomised trial is needed.

Acknowledgement: all co-authors and the Community Care team.


Biography:

Rebecca is a pharmacist at Peninsula Health where she has worked in a variety of areas. Rebecca is the senior pharmacist for Community Care and is currently undertaking PhD with Peninsula Clinical School, Monash University. She works with a multidisciplinary team to support clients who reside in the community and residential aged care facilities, with the view of preventing unnecessary hospital admissions.

Recent initiatives have included researching the multidisciplinary integrated health approach between hospital and community in preventing clinical deteriorations and unnecessary hospital admissions and providing safer care and program redesign.

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.

Organising orientation adds value to allied health workforce planning across four hospital and community settings

Mr Mian Wang1

1NSW Health, Westmead, Australia

Background

High turnover of allied health professions is costly. On-boarding costs have risen from $56,000 in 2015 to $120,000 in 2017. Succession planning is often poorly timed and lacking sustainable strategies for retention. Organising Physiotherapy INduction Interactions and Orientation for New Staff (OPINIONS) is an initiative reviewing the induction of new staff. An evaluation of the initiative’s effectiveness will be presented.

Method

A single site retrospective observational study investigated four hospital and community settings. Four focus groups of senior allied health professions scaffold local action areas using results from a cultural competency framework rating scale. Groups were followed up by a clinical educator for 12 months through local group coaching.  Data analysis reflected on staff turnover, costs of new staff on-boarding, days to fill positions, and unplanned leave for 12 months following the initiative. A descriptive analysis of staff engagement was measured through staff surveys.

Results

Preliminary data revealed a reduction in staff turnover from 11 to 9% between 2017 and 2018 whilst recruitment costs reduced for new staff. Staff engagement improved in the first three months of the initiative. All staff reported on the importance of prioritising staff well-being following the initiative. Unplanned leave reduced by 0.31 days per fortnight. Time taken to induct rotational staff increased but total days to induct new staff reduced by 21 days. Days to fill positions reduced from 91 to 77.

Discussion

This study reviews the outcomes of the OPINIONS initiative wherein effective collaboration between allied health clinical seniors and managers. As on-boarding costs continue to rise, service managers should consider building on local and timely recruitment and retention strategies for allied health clinicians as an investment into their workforce. Further research into the initiative can build capacity in improving outcomes for workforce planning, developing enabling leaders and facilitating sustainable allied health workplace cultures.


Biography:

Mr Mian Wang is a senior physiotherapist at Westmead Hospital. Mian educates, coaches and mentors allied health professionals and their students. Mian has an interest in translational research as he delivers value-based care in the community and acute aged care settings. Mian collaborates with multidisciplinary teams across Western Sydney Local Health District to facilitate a positive, data-driven and meaningful workplace learning culture.

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.

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