Determining readiness for a reablement approach to care in Australia: Development of a pre-employment questionnaire.

Reablement is described as a goal directed intervention with a view to maintain or improve the independence of clients through "doing with, rather than doing for". As a relatively new concept in care, lack of specific skills in reablement is not uncommon, however, intrinsic values aligned with reablement are beneficial to organisations providing care and support to clients. The aim of this study is to develop a pre-employment questionnaire to assess readiness for a reablement approach to care as a step towards developing a reablement culture across organisations. A questionnaire based on activities of daily living (ADL), developed by the research team in consultation with a local community-based care organisation, was completed by 166 staff members at a community-based care organisation in Tasmania across several timepoints during and following reablement education sessions in 2018. The scores from these questionnaires were utilised to develop a questionnaire appropriate for determining readiness for reablement prior to employment within the organisation. Over a period of twelve months, a total of 407 Reablement Readiness Questionnaires were submitted by staff, indicating high levels of willingness to engage in reablement prior to and following the education sessions. Exploratory factor analyses were performed, and the construct validity and internal consistency of the emerging factors were assessed. An exploratory factor analysis indicated that ADL, in relation to reablement, consist of three dimensions-Lifestyle, My body and Connecting. The corresponding questions were subsequently built into an online questionnaire for pre-employment use. This questionnaire also has potential benefit in recruitment of staff to other community service organisations, to ascertain their readiness for reablement prior to beginning a variety of different roles within client care and support.

Staff experiences of a reablement approach to care for older people in a regional Australian community: A qualitative study.

Reablement is described as a person-centred, goal-directed intervention with a view to regain, maintain or improve the independence of older clients. Although evidence to support the use of reablement as a multidisciplinary, home-based intervention for community-dwelling older adults is increasing, there is limited knowledge about what it means for care staff who provide client-based services. This study, which was nested in a larger program evaluation, used a descriptive qualitative approach to explore direct care staff and care coordinator experiences of translating a reablement training program into practice for older people in a regional Australian community. Two months after the training program four focus groups were conducted with 13 care coordinators to assimilate staff experiences with development of care plans, systems, processes and practices of reablement. In addition, four direct care staff took part in individual interviews, which centred on eliciting their experience using the reablement approach with clients. Results from the care coordinator focus groups and the direct care staff interviews highlight the importance of reablement staff training and the involvement of staff in the development and delivery of a reablement approach to client-centred care. A number of organisational and client-centred challenges such as communication, functional partnerships, staff education and resourcing are also uncovered in this research into the development of a reablement-focused care service in a regional setting. Overall there is support for the dominating discourse around healthy ageing and the policy approach of ageing in place to support wellness.

Organizational Support in Healthcare Redesign Education: A Mixed-Methods Exploratory Study of Expert Coach and Executive Sponsor Experiences.

Healthcare organizations must continue to improve services to meet the rising demand and patient expectations. For this to occur, the health workforce needs to have knowledge and skills to design, implement, and evaluate service improvement interventions. Studies have shown that effective training in health service improvement and redesign combines didactic education with experiential project-based learning and on-the-ground coaching. Project-based learning requires organizational support and oversight, generally through executive sponsorship. A mixed-methods approach, comprising online surveys and semi-structured interviews, was used to explore the experiences of expert coaches and executive sponsors as key facilitators of workplace-based projects undertaken during an Australian postgraduate healthcare redesign course. Fifteen (54%) expert coaches and 37 (20%) executive sponsors completed the online survey. Ten expert coaches and six executive sponsors participated in interviews. The survey data revealed overall positive experiences for coaches and mixed experiences for sponsors. Interview participants expressed a sense of fulfillment that came from working with project teams to deliver a successful project and educational outcomes. However, concerns were raised about adequate resourcing, organizational recognition, competing priorities, and the skills required to effectively coach and sponsor. Expert coaches and executive sponsors sometimes felt under-valued and may benefit from cohort-tailored and evidence-based professional development.

Increasing interest of students from under-represented groups in medicine-A systematised review.

OBJECTIVE: Community engagement activities are the entry point to a "pipeline" of activity aimed at supporting under-represented students and nurturing their interest in medical careers following graduation. This review aimed to describe the range of activities medical schools undertake to encourage and support rural students or other targeted under-represented populations to apply to medical school, and the reported outcomes. The overarching aim was to identify which programs prior to application into medicine are most effective. DESIGN: A systematised review. SETTING: Medical Education articles published January 2000 to May 2018. PARTICIPANTS: Population groups under-represented in medicine, including rural students. INTERVENTIONS: Programs delivered to participants prior to application to medical school. MAIN OUTCOME MEASURES: Reach, format and duration of programs, number of participants applying and completing medical school. RESULTS: A search of several databases identified 2688 articles. After filtering for relevance, 1271 articles were considered for the final review. Of the 155 full-text articles assessed, 133 were excluded as they did not meet the eligibility criteria. A further three articles were added on review of references. Nine reviewers conducted data abstraction from 25 articles. CONCLUSION: There is a need for improved evidence to define the best ways to support under-represented groups in medicine. Important features appear to be targeting interested students and supporting their attainment of entry requirements. Successful programs might be those which enhance a student intake representative of the population.

Challenges of delivering evidence-based stroke services for rural areas in Australia.

OBJECTIVE: The aim of this paper was to use current stroke care guidelines to identify and discuss current stroke care challenges in rural Australian health care and potential solutions for delivery of evidence-based practice. DESIGN AND SETTING: A review of national guidelines since 2002 for organised stroke care was undertaken to determine best practice for delivering primary stroke care. We then employed a narrative literature review strategy looking at relevant articles, based on keywords, outlining current stroke service availability in Australia, highlighting the challenges of implementing evidence-based stroke care in rural areas in Australia based on the current guidelines. RESULTS: Delivery of evidence-based stroke care in rural Australia is fraught with challenges. Although national best-practice guidelines for stroke care are well established, the recommendations made in these guidelines do not always reflect the resource availability in rural Australia. Redesigning processes and utilising available resources, such as telemedicine or local clinical pathways, can achieve an evidence-based standard; however, ultimately better resourcing of these areas is required. CONCLUSION: Evidence-based stroke care, aligned with current national standards is the key to providing adequate stroke services in rural Australia. Improved health service resourcing and better utilisation of currently available resources are options for achieving elements of evidence-based stroke care. IMPLICATIONS FOR PUBLIC HEALTH: Availability of adequate services for stroke patients directly impacts public health as it determines health outcomes for these patients. Indirect implications for public health include the effects on health professionals and the general public.

Medication Error Rate in Transition of Care: General Practitioner (GP) Referrals to a Regional Emergency Department.

Medication errors have a significant impact on patient outcomes, increase healthcare costs, and are a common cause of preventable morbidity. This single-site, observational, diagnostic accuracy study aimed to quantify medication discrepancies in transition of care from primary care to the emergency department (ED) over a 12-month period. Medication lists in General Practitioner (GP) referrals to a regional ED were examined against a Best Possible Medication History (BPMH) performed by a hospital pharmacist. One hundred and forty-three patients (25%) with computer-generated GP referrals to ED who were subsequently admitted to hospital had a BPMH taken; 135 (94%) of these had at least one medication discrepancy identified with a discrepancy rate of 67.18 discrepancies per 100 medications. Improving medication reconciliation in the community may reduce the burden associated with preventable medication errors. Whether this is achieved by more frequent GP-led medication review or community-based pharmacist medication review may depend on the community and available resources.

Learning in Practice: Collaboration Is the Way to Improve Health System Outcomes.

Evidence suggests that it is challenging for universities to develop workplace-relevant content and curricula by themselves, and this can lead to suboptimal educational outcomes. This paper examines the development, implementation, and evaluation of Australia's first tertiary graduate course in healthcare redesign, a partnership initiative between industry and university. The course not only provides students with an understanding of person-centered sustainable healthcare but also the skills and confidence to design, implement, and evaluate interventions to improve health service delivery. Increasing students' application of new knowledge has been through work-integrated learning, a pedagogy that essentially integrates theory with the practice of workplace application within a purposely designed curriculum. The specific aim of this study was to examine the outcomes of the course after two years, utilizing an anonymous online survey of graduates. Sixty-two graduates (48%) completed the survey. Kirkpatrick's four-level evaluation model was used to analyze the data. The analysis revealed high satisfaction levels in relation to the course content and delivery. Through successful completion of the innovative course, students had increased their knowledge of health system redesign methods and, importantly, the ability to translate that knowledge into everyday practice. Graduates of the clinical redesign course reported that they had been able to transfer their skills and knowledge to others in the workplace and lead further improvement projects.