Health services showed great innovation and creativity in how they went about promoting and educating on this concept ... of person centred care ... and working towards it being embedded in usual clinical practice.
When most of us think of hospital, we think of a place you go to get better – either because you’re very sick or injured. Historically, this has been the main role of the hospital – the treatment of acute disease and trauma – but it is no longer the case.
As the population ages and the nature of healthcare changes, hospital admissions are increasingly about treating chronic conditions, often at the times when they flare up. This has meant a significant shift in approach for hospitals and clinicians. Some have taken longer to realise this change, and some have been resistant to accepting it, but others have seen these changes as an opportunity to create new ways of providing services and new models of care that meet the needs of this predominantly older hospital population.
This philosophy is what underpinned the Council of Australian Governments Long Stay Older Patients Initiative (COAG LSOP) in Victoria. The COAG LSOP ran initially from 2006 to 2010, and was then extended to 2013. In Victoria, the program has been implemented by the Department of Health and Human Services (DHHS) as Improving Care for Older People (ICOP), building on work that had been ongoing since the development of the 2003 policy of the same name. In the second stage, from 2010 to 2013, 35 public health services across the state participated in the initiative, including all metropolitan health services. These health services implemented a huge range of innovations and changes to improve the care of older people in hospital.
Health services were funded to make changes in a range of areas. They were asked to make improvements to the physical environment that would facilitate better outcomes for older people. One of the most popular improvements was purchasing clocks for patient rooms, especially those showing date and day as well as time. In fact over a thousand clocks were bought! Other improvements included improving chairs and signage, buying pressure care equipment like cushions and heel wedges, through to creating garden areas for older patients and patients with dementia.
Policy development was another focus of the program, namely including ICOP principles for minimising functional decline into policies and clinical guidelines. In fact almost all participating hospitals had developed and implemented an organisation wide policy on minimising functional decline by the end of the initiative.
Health services were also asked to provide professional development to improve their workforce’s ability to best care for older people. A range of education programs were delivered, ranging from lunchtime seminars to vocational qualifications.
Of course, all this policy and knowledge has to be translated into practice, and embedding the evidence into models of care was perhaps the biggest focus of the program. The ways health services went about this, the areas on which they focused and the approaches taken were greatly varied – many examples of innovation can be found within these case studies. All have contributed to our knowledge of what works in minimising functional decline and what can be implemented to improve care for older people.
Underpinning all this work was the principle of person centred practice, which is putting the patient at the centre of their care. Health services showed great innovation and creativity in how they went about promoting and educating on this concept and working towards it being embedded in usual clinical practice.
Implementing such culture change needs leadership to be successful. As Chief Executive of Eastern Health, Alan Lilly has prioritised the patient experience. His recognition that older people are the major users of the health service – he estimates that people over 70 make up at least 40 per cent of their patients – puts their experience front and centre. Using patient feedback to work out priorities for changes has led to improvement like the roll out of staff name badges that can be easily seen by patients and visitors.
Eastern Health now compiles a list of the top 12 priorities for the year, from the patients’ perspective. Ultimately, what comes out as being most important to patients is communication and feeling listened to by staff, says Alan.
Sue Race, Divisional Director of Subacute and Aged Care Services at Western Health (WH), has championed the principles of ICOP since working on the original policy Improving care for older people: a policy for health servies in 2003. She finds it particularly rewarding to have seen a culture shift occur within Western Health during that period, so that the ICOP principles are now embedded into everyday practice across the organisation. She says that having the principles embedded into the clinical governance structure at WH has been essential.
Eastern Health's CEO says they now compile a list of the top 12 priorities for the year, from the patients' perspective. Ultimately, what comes out as being most important to patients is communication and feeling listened to by staff.
Kate Mangion, Manager Communications and Partnerships, division of Subacute and Aged Care Services at WH, who worked on the ICOP project, agrees. “There’s high level governance and really high level support [for this work], and I think it’s great that now we’re seeing so many different people involved in leading all this work,” she says.
This new way of working is spreading through health services as more and more clinicians who were involved in the program champion its ongoing importance. Kate Allen, Nurse Unit Manager of the Geritatric Evaluation Management ward at St Vincent’s Hospital Melbourne worked on the ICOP project there. She says that there are people who worked on the project in positions throughout the organisation. “We all approach our work with our headspace changed,” she says, “and this approach influences others and the message keeps spreading.”
Nicole Doran, Manager Ageing and Complex Care at DHHS, has played a key role in overseeing the implementation over the past decade. Nicole is proud of Victoria’s role in leading the way in best care, and says “these implementation case studies are just some of the many good news stories across the State.” She also stresses that this has only been possible because of the commitment and collaboration of health services, DHHS, the National Ageing Research Institute and a host of experts in their field, to improve outcomes for older people.
Indeed Best care for older people everywhere: The toolkit, affectionately known throughout health services as The toolkit, and the Improving the environment for older people: An audit tool are two tangible resources developed during this period to support health services make evidence based changes.Nicole’s hope is that The toolkit, now in its third edition as this new web based resource Older people in hospital, will retain the existing audience and attract a new audience, not only within Australia, but also internationally. As she says, “that alone is a legacy in itself.”