How can rural and remote clinicians implement national health reform in their community? Written by Karen Butler MPH, CCRN1.

Re-orienting health services towards more holistic care requires a focus on population health outcomes whilst optimising the health of individuals. The overarching theme is to reorientate health services towards more holistic care using comprehensive primary health care strategies to prevent the impending non-communicable disease disaster caused by the world wide ageing population.

Re-orienting health services towards more holistic care requires a focus on population health outcomes whilst optimising the health of individuals. The broader healthy lifestyle opportunities need to be incorporated with health promotion, illness prevention, diagnosis, treatment, care and rehabilitation for effective service provision.

Critical success factors for comprehensive chronic disease prevention & management strategies.

 Address the human side of change empathetically and systematically.  Change starts from the top and begins on day 1 with managers ‘walking the walk and talking the talk’ in a diplomatic and tactful way.  Remembering the most change often happens at the ‘coal face’ or the ‘front line’.  Confront reality, demonstrate faith and craft a vision. Confronting reality is akin to evaluating and communicating where we are now; demonstrating faith is where we want to be regardless of difficulty and crafting a vision is where we are going and how we are going to get there.  Create ownership; not just buy- in; through camaraderie, financial compensation and other incentives.  Practice targeted over communication and spread the word in interesting ways that are easily understood by all and check for understanding. Speak from the heart with commitment and dedication.  Explicitly address culture and attack the cultural centre with diplomatic communication to the ring leaders to recruit them to support the changes.  Expect and prepare for the unexpected. Preparation should include education and training resources in appropriate media to allow effective group and individual presentations.  Assess the cultural landscape early, manage risks and keep perspective through surveillance of people’s reactions to ensure ‘fires are extinguished early’ to prevent spread of malicious resistance in the workplace.  Speak to the individual as well as the institution as without the individuals there would be no institution. Support the people and manage the opponents to the change via appropriate channels. Encourage all team members to actively participate in the change process.

Strategic direction of the health service. Infrastructure. KPIs, TQM. OHS, incident reporting. Safety management system. Infection control. Referral processes. Programs, protocols, guidelines. Performance mgt. Communication processes. Workplace wellness programs.

Comprehensive PHC. Healthy lifestyle & wellness programs. Health promotion & prevention. Community education. Screening & MBS screening items. Early detection & early intervention. Self management, health optimisation & action plans. Early chronic disease management programs & prevention of deterioration. All DoHA & national programs training. Case management & palliative care. Education for carers. Supporting people living in the community. Emergency response procedures, emergency alert contacts training. Telephone consults & telemedicine. Life Script & motivational interviewing. Referral processes & services available. Complex chronic disease rehabilitation.

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