Working together to improve the care of older people: a new framework for collaboration.

AIM: This paper is a report of a study identifying the care issues experienced by older people in the acute setting that could be improved through a collaborative approach to action. BACKGROUND: Actively involving consumers in the governance of healthcare organizations is viewed positively, although there is less agreement on how to do this. Co-operative inquiry is a useful approach to involve consumers and clinicians in structured dialogue about understanding and changing care, whereas traditional quality improvement methodologies are often singular in their dimensions of change. METHOD: Using a co-operative inquiry approach, five workshops were facilitated over a 4-month period in 2008 with four volunteer older people, four clinicians and three facilitators (n=11). All participants were actively involved in generating ideas and actions using a range of facilitation techniques and data collection methods. FINDINGS: There was increased awareness, understanding and acceptance of clinicians' and consumers' experiences and expectations of care. The complexity behind changing so-called simple care (providing warm drinks, appetizing food), which were the key concerns for consumers, relied on the active management and broader transformation of the system, including teamwork, communication processes and organizational and individual values and beliefs. CONCLUSION: Consumers and clinicians put different emphasis on perspectives related to improving care of older people in the acute hospital setting. The disconnect between what consumers viewed as 'simple' organizational behaviours to change and what the clinicians viewed as complex, led to a recognition that the approach to organizational change needs to be reconceptualized.

Organisational challenges when enabling ease of access for the elderly around a large acute hospital campus.

This paper describes one of several projects undertaken in a large acute care hospital under the banner of 'TOPIC7' The Older Person and Improving Care. It was conducted between January and November 2008. Although driven by the Royal Adelaide Hospital Nursing Service it was undertaken within a multidisciplinary framework. Large city-based tertiary hospitals, nearly without exception, are usually large sprawling campuses having evolved over time from buildings designed and constructed for lower populations and less traffic issues. Parking facilities may or may not be available on-site. In addition, drop-off points are located on the peripheries of the campus at often congested areas. These elements present a particular challenge to the elderly patient. Aims The purpose of this project was twofold: first, to investigate the challenges faced by older people when making their way from access points such as drop-off points and car parks through to hospital departments and second, to review potential solutions. Methods The multidisciplinary project team used a variety of knowledge translation tools and strategies to focus on areas of concern in relation to access for the elderly. They conducted a series of audits to guide practice improvement activities. This led to a reconsideration of currently planned strategies and planning of new initiatives to improve access for the elderly. Results The project was able to define clearly and prioritise the many challenges facing the older person trying to negotiate their way into hospital buildings and the barriers to them successfully reaching their destination in a safe and timely manner. At the beginning of the project it was apparent that a specific solution (an electric courtesy buggy) was in the process of being implemented. This intervention was reviewed in terms of consumer support and implementation feasibility. As a result of the comprehensive audit process, the 'courtesy buggy' was determined to not be the ideal solution and an alternative solution (wheelchair bank) is now being planned for implementation. Conclusions This project highlighted the challenges of working within a large and complex organisation with multiple key stakeholders and the need for clear pathways that clinician groups can follow to avoid duplication of effort and potential implementation of suboptimal strategies.