CHART - National Aged Care Conference, Canberra.

The Cooperative for Healthy Ageing Research and Teaching (CHART) at the University of Canberra held its inaugural National Aged CareConference on Friday, 19 April 2013.

The keynote speaker was Professor Lynn Chenoweth from the University of Technology Sydney.  Lynn is the Professor of Aged & Extended Care Nursing in the Faculty of Nursing, Midwifery and Health at UTS.  Professor Chenoweth spoke about creating caring cultures for older people within the health and residential aged care systems. 

The percentage of Australians aged over 65 has been increasing since the 1980s, and while some disease rates are falling, the prevalence of mental health and neurological conditions is rising.  This increase in neurodegenerative disorders is resulting in an increase in health spending, as these conditions are the most expensive to manage.  In fact, health care costs across all conditions are rising faster than general economic growth. 

There are challenges at the system, organisational and direct care levels which contribute to lack of safety, poor care coordination and care of chronic conditions, treatment errors and adequate transition care in hospital discharge.  Professor Chenoweth spoke about the need to have the right care, at the right time, in right place, with right provider – a concept that can be achieved through the philosophy of person-centred care.

 

An alignment with person centred care requires that staff are appropriate educated and trained, information is shared between all stakeholders, and that processes are regularly reviewed.  Professor Chenoweth then discussed three projects that demonstrated the benefits of person centred care – the CADRES Study, the EN-ABLE Project and the PerCEN Study.  These studies demonstrated that adoption of a person centred care model resulted in an increase in the quality of care and patient wellness scores, a decrease in patient agitation, fewer incidences of falls and injuries and a more positive emotional response to care.

This idea of adopting a more person-centred approach to the delivery of care was further developed by Fritz Quero, a PhD student at the University of Canberra who spoke about a project to introduce a homelike philosophy of care at a Calvary Retirement Community facility.  This model of care focuses on creating an environment which is able to incorporate the “rituals, routines and personal touches” that residents associated with their own homes into a residential aged care facility.

Fritz discussed the importance of language, and how the facility doesn’t have wings, but “households”, not dementia units, but “memory support households”.  The homelike philosophy of care is about deinstitutionalising residential aged care, promoting shared decision making and emphasising living well, rather than just waiting to die. 

Residents’ rooms and common areas in the Calvary facility were transformed by personal touches and household furniture.  Residents were able to choose the colour of paint on the walls, and the nurses’ station has been infused into the household – it blends into the living room, rather than being a separate area.  As Fritz discussed, implementation of this philosophy of care required consideration of the systems, procedures, and processes already in place.  In addition, it required consultation with the residents and training with staff to help them adapt to a new way of delivering care. 

While there have been some teething issues, such as the lack of understanding of the duty of care from non-clinical staff, and misunderstandings of clinical governance responsibilities, the majority of outcomes have been positive, as Fritz discussed.  Both clinical and non-clinical staff members understood and have become more involved in delivering this model of care.  Residents are more empowered, having been given the opportunity to participate in their own treatment and determine the timing of their care.  There has been a marked decrease in complaints, and an increase in satisfaction with overall care. 

The projects discussed by Lyn Chenoweth and Fritz Quero demonstrated the positive benefits, for both staff and consumers, that can be derived from a more respectful, person-centred approach to the delivery of care.  

Heather McGowan

HIP Project Officer

“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw

After more than six months working with HCCA’s Health Infrastructure Program team, conducting information sessions and engaging with the community, I recently had a chance to take a step back and reflect on some of the learnings that have been generated through this process.

One of the key concerns of many community groups that we’ve spoken to has been communication.  Most people have never even heard of the Health Infrastructure Program, much less know what the Program involves, and what kind of improvements, changes and restructuring that they will experience as part of it.  By delivering information sessions, we are slowly helping to inform the ACT community, but this kind of approach needs to be supported by a range of other communication techniques.

When compared to other health services the ACT Health Directorate is lagging behind in terms of communicating with Canberra’s citizens.  The Health Directorate’s website is out of date with some sections of the site still boasting about the display of sketch plans…in 2011! And the website still refers to “Your health – our priority”, a slogan that is no longer in use.  As it is, the Health Directorate website is not an effective tool for informing the public about this massive program of public works, and often a fundamental restructuring of how care is delivered. We are very keen to work with the Directorate to improve the level of information to the Canberra community.

There are lots of excellent examples of effective websites that the Health Directorate could emulate.  The Box Hill Hospital, the Fiona Stanley Hospital and the Royal North Shore Hospital websites all contain a variety of media about their (re)developments and health initiatives.  

Kerry Snell and I attended a Health Facilities Design and Development conference earlier this year and saw an interesting presentation about the New Bendigo Hospital.  For this project, the website is the main communication tool and offers members of the public project outlines, Models of Care and sketch plans.  This website receives 4200 hits per week.  However, there is a recognition that electronic communication alone is not enough, and accordingly four information sessions are held each year, with attendance figures ranging from 40-200 people. 

Communication isn’t just about the big picture stuff, either.  During redevelopment, restructure and relocation, it is so important to have effective communication and appropriate signage to facilitate consumer and staff movement around facilities.  At the Canberra Hospital, there is a great deal of development currently being undertaken.  However, services are still going on, so interim measures are taken.  Issues occur when people attempting to access these facilities are unfamiliar with new arrangements, or when signage is poor.  A key example of this is the Adult Mental Health Unit – despite the unit having been open for over a year, there are still signs which point to its former location. We've also heard reports from women accessing the Centenary Hospital for Women and Children that the entrance is difficult to locate.  The signage inside the Centenary Hospital is also inadequate - on a recent visit to the facility, I noticed at least 6 women walking around looking confused.  Luckily, there happened to be helpful staff members around who offered directions.

A sign pointing to the old mental health facility at the Canberra Hospital.

It’s time for the ACT Health Directorate to put a strong, flexible and effective communication strategy in place so that the Canberra community can be adequately informed about the program of works for which their tax dollars are paying.  Having such a strategy will also enable better access to services for consumers, who will be informed when parking or location arrangements change.  It will also reduce opportunities for distress when interim arrangements are employed – an informed consumer is (generally) a more understanding consumer.

Communication is key – capisce?

Heather McGowan

Health Infrastructure Program

Consumer Health Forum Workshops - Informed Consent & Quality Use of Medicines in Hospitals, March 2013

On the 25 and 26 of March, the Consumer Health Forum held two workshops; one on informed consent and the other on quality use of medicines in hospitals. Joanne Baumgartner, a HCCA member, attended on both days. Joanne completed this report to share with other consumers.

Workshop 1:  Informed Consent

This followed on from a previous workshop on Informed Financial Consent and discussion was focussed on the forms signed by consumers prior to their procedure or operation.

The general consensus was that patients/consumers need to be provided with substantially more information regarding

• The procedure itself;
• Who would conduct the procedure;
• The likely outcomes;
• Risks involved;
• Discharge and rehabilitation processes;
• Support options available, e.g. supported accommodation 

Consumers felt that these issues were not properly considered by health professionals and were rarely, if ever, discussed. In particular, rural consumers are often transferred to major city hospitals without their Informed Consent paperwork and are expected to simply accept whatever procedures were carried out at those hospitals. There was also no access to adequate post-discharge care in rural areas.

Treatment of mental health consumers was also an area of concern with regard to consent, as consumers felt that unnecessary force was being used too often with Involuntary Patients. This was considered to be an abuse of human rights. New procedures and protocols are required to ensure that all consumers are treated with dignity and respect.

Papers were presented by a range of health care professionals, including medical specialists and university researchers in the area as well as the Health Care Complaints Commissioner. These professionals agreed with consumers that more information needed to be provided to patients during the consent process. The suggestion was made that both consumers and clinicians could be required to check boxes indicating that sufficient information had been provided before signing off on a procedure.

Workshop 2: Quality Use of Medicines in Hospitals

This workshop specifically focussed on the lack of continuity of care and poor record keeping with regard to prescriptions in hospitals. The gaps between the emergency department and inpatient wards as well as poor communication on discharge were discussed. Consumers identified one of the main issues to be that many consumers, especially the elderly, did not have adequate knowledge or understanding of their medications to keep track of their own prescriptions.

A study has found that patients experienced fewer adverse effects from medications when they were able to keep them in a cabinet drawer by their bed and able to follow their medication regime on their own. However, consumers are rarely afforded this level of trust by clinicians with regard to administering their own medications.

Consumers also agreed that the use of generic medications is often confusing in hospitals, as it is hard for them to check whether they are being given the correct medicine and dosage. A hospital pharmacist explained to the group that hospitals were now using generic medications to save money, making it unlikely that consumers would receive the medications that they were used to at home. In this case, hospital staff need to ensure that consumers are told which medication is which to help them keep track of what they are taking.

Five ‘Rights’ for Quality Use of Medicines were identified as follows:

·         Right Patient

·         Right Drug

·         Right Dose

·         Right Route

·         Right Time

The workshop attendees agreed that all consumers have the right to receive information regarding their medications in an understandable format, rather than the many pages of unrelated information that is currently provided.

Joanne Baumgartner
HCCA Member and Consumer Representative 

Health Activism & the Knowledge Society: Engaging Consumer/Citizens in Shaping Health

We are partnering with the University of Canberra to complete a research into the effects of health care consumer and citizen engagement in health policy.

Assoc Prof Anni Dugdale competed interviews with key informants in November and December last year and is working through documentary evidence.  The preliminary findings will be shared at a conference in April.

The two day conference presents opportunities for consumers and policy makers to hear about the role on the consumer movement and citizen engagement in development our health system.  There will be a number of local and national speakers and a number of interactive sessions to identify future directions.

Questions include:

•  What does it mean for health consumer organisations to partner with governments, health professionals, and others to engage citizen participation in health policy and health system design and governance? 

• How are health activists (and their organisations) negotiating the advantages and the pitfalls of being inside the tent (when they are), without losing their integrity and independence as health activists, or their vision for broader agendas that cross the boundaries between government departments? 

The details of the conference is on the UCAN website.  Numbers are limited so we suggest you register soon.

Health Activism & the Knowledge Society: Engaging Consumer/Citizens in Shaping Health 
Thu 4 April 2013 to Fri 5 April 2013 
Clive Price Suite, Building 1, Level C, University of Canberra
Speakers include Celia Roberts, Evelyne de Leeuw, Helen Meekosha, Sophie Hill, Anni Dugdale, and Catherine Settle.  

To register, click on this link.

It promises to be a very interesting couple of days. 

Darlene Cox
Executive Director

 

The Australian Health Care Reform Alliance

The Australian Health Care Reform Alliance, AHCRA, is a coalition of peak health groups working towards a better health system for Australia’s future, stating its vision as:

'a health system that assists individuals to be healthy and delivers compassionate and quality health care to all'.

The Federal Government has embarked on a major health reform initiative, involving making significant changes to the ways in which health care is funded and delivered. AHCRA supports the overall goals of health reform and is working to ensure that the reform measures deliver a fairer, more efficient and sustainable health system.

On 30 January 2013 the AHCRA Executive convened a one day workshop to discuss planning for the year ahead. HCCA is a member of AHCRA and Sue Andrews and Russell McGowan attended the meeting. What follows is a summary of AHCRA’s work in monitoring progress of the Federal Government’s health reform agenda to date. It is based on a report prepared by Dr Tony McBride which framed the day’s discussions and informed consideration of work for the upcoming election year.

For AHCRA, the health system’s underlying principles should be based on:

• Equitable access
• Equitable outcomes
• Primary Health Care
• Community engagement and consumer participation
• Workforce
• Efficiency

Using six criteria developed from these principles AHCRA undertook an analysis of how new policies and funding mechanisms/initiatives would:

• create positive permanent changes to what health care was provided (not just more of the same)
• increase effective preventive effort/early intervention and better integrated multi-disciplinary primary health care
• improve equitable access to health care, especially primary health care
• ensure stronger consumer, carer and community engagement in both care and planning 
• increase efficiency of use of resources and workforce
• create a more rational split of responsibilities between governments.

These were applied to the areas of health reform: hospitals funding, primary health care, aged care, mental health, dental care, health prevention, eHealth and workforce issues.

Whilst the analysis reflected a broad-brush assessment of each initiative, what emerged was a ready shorthand summary of progress. However, noting this qualification, it indicates that:

• Most of the initiatives are permanent (as much as one can say) in nature (e.g. not short-term funding, or trials)
• Less than a third are aimed at increasing a focus on prevention or early intervention
• Less than a half are aimed at addressing inequities
• Few address increasing the involvement or centrality of consumers or community in the system
• About a half seem to be addressing efficiency
• About a third seek to clarify funding/policy/service delivery responsibilities
• Some key disadvantaged groups, especially those typically hidden such as people with an intellectual disability, are not identified as requiring specific strategies.
• Overall this amounts to a picture of disjointed incrementalism with some progress but a disappointing level of action on some of the most important issues to AHCRA members
• There is still a long way to go on the long and winding road.

Overall, the reforms appear to be moving in some of the right directions although overall modest in nature and patchy. Positives of the reform process and other Federal Government initiatives in the last three years include: 

• The recent national dental package, with its reform of at least the child and adolescent system, is a significant gain, and creates some of the building blocks required for a future universal system
• Greater funding into innovative areas of mental health provision
• Establishment of Medicare Locals (MLs) as supports for and change agents for reform and improvement in primary health care. In particular their population health planning will create shared understandings of the local system (currently not available) and a platform to address the gaps identified. The MLs also offer new opportunities for community engagement.
• Other initiatives offer the opportunities for a more nationally consistent system, and one where the efficiencies gained in some states can be spread across the remainder (e.g. in hospital care pricing).
• And although not strictly part of the reform process, the Federal Government’s legislation for tobacco plain packaging was a major gain.

However, for many initiatives there is too little implementation progress so far to measure what has been achieved. The vast majority of health consumers would have noticed little impact so far, so judgement on many reforms may have to wait a year or two to be valid. And for some, implementation will need to be closely monitored to ensure that the anticipated benefits are achieved.

However there is also a range of important gaps and system flaws that have not been adequately addressed or even recognised at all. So in some key areas there has been no or little progress, including prevention (whose share of the national health budget is going backwards)^[1], consumer participation and moving towards consumer-focussed services, and action to meet the needs of some identified vulnerable population groups, including people with intellectual disabilities.

The fee-for-service model remains unscathed despite its many drawbacks including constraining innovation. In other areas there has been only very modest progress (e.g. in increasing the equity of the system, so for example mal-distribution of services and professionals remains chronic in many parts of Australia and out-of-pocket expenses for consumers continue to rise, hitting the poor hardest). There has also been some action in workforce, for example to improve the availability of allied health professionals in rural areas, but it falls far short of the need (and has been exacerbated by the wholesale slashing of allied posts by at least one State Government).

Two key challenges present themselves for AHCRA and its members. The first is to continue to advocate for the gaps to be addressed, albeit in an environment where the appetite of the major parties for significant reform appears sated. The second is to identify opportunities to influence the effective implementation of the current reform agenda, especially those addressing equity, the strengthening of prevention and primary health care and reducing demand on hospitals, so that such reforms achieve the maximum possible benefit to the community.

For more information about AHCRA see www.healthreform.org.au or contact HCCA.

Sue Andrews

HCCA President

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[1]Australian Institute of Health and Welfare 2012. Health expenditure Australia 2010–11. Health and Welfare Expenditure series no. 47. Cat. no. HWE 56. Canberra.^↩