1. Gill Lewin Silver Chain, Perth, WA Curtin University of Technology, Perth, WA Examples of Evaluations that have influenced Community Care Practice and Policy

2. Silver Chain Health + Aged Care Provider 100+ years old 3000+ staff and 650 volunteers Wide range of community services e.g. Home hospital, palliative care, allied health, home nursing, personal care, home help, remote nursing Over 40,000 clients visited each year Nearly 1,500,000 home visits each year

3. 1 st Evaluation Purpose Does the introduction of evidence based practice: Risk assessment Risk and ulcer management Documentation Accompanied by: Knowledge and understanding Equipment availability Reduce Pressure Ulcer prevalence?

4. Evaluation Design 1.Baseline Measurement: Prevalence and Work Practices 2.Implementation of Guidelines 3.Follow-up Measurement: Prevalence and Work Practices

5. Prevalence Survey Results

6. Appropriate Current Equipment?

7. Reinforcement Strategies Identification of cases where new processes not followed Feedback sessions with staff Monthly management reports identifying staff not following process Equipment roadshows

8. Prevalence Survey Results

9. Appropriate Current Equipment? 63% 75% 91%

10. Performance monitoring

11. 2007 Further Evaluation Home notes audit Comparison of home notes data with Client information management data Equipment assessment Focus Groups with staff

12. 2007/8 Findings Ownership lost, key staff had left Independent researcher reduced monitoring Lack of management accountability No ongoing feedback to staff, reports not easy to use Deficits in staff knowledge and understanding Some duplication in documentation Some processes seen as not working/burdensome Increase in both incidence and prevalence verified, processes not being reliably followed

13. Recommendations Increase focus so PURA part of everyday Increase accountability at all levels Incorporate audit of PURA processes into regular home notes audits Include PURA on agenda for all team meetings Implement refresher courses for staff

14. Organisational response Board sponsored scoping project Reconvening of Pressure Ulcer Risk Group Top down accountability - KPI reported to Board - GMs report to CEO - Managers report to GMs - Team Leaders report to Managers End to end process on Comcare Mobile PURA process part of internal Quality audit Refresher courses implemented

15. Ulcer Monitoring Supplementary evaluation and recommendations

16. Reflections Barriers: Lack of ownership “Buck passing” Lack of feedback to staff Processes not streamlined Changing organisational priorities Enablers: Reliable data and reports Research team reports to Board Increased organisational focus on accountability Clinical KPIs focus of external accreditation agencies Technology Organisational commitment to evidence-based practice

17. 2 nd Evaluation Purpose Does participation in a short term restorative program prior to receiving home care: Reduce the demand for services? Result in better outcomes for older people requesting home care?

18. HIPstory 1999Home Independence Program (HIP) developed 2000 Pilot Study 2001Operational trial in small area 2002Controlled Trial 2004Implemented across metro 2005Randomised Controlled Trial (RCT) 2010RCT completed 2011Evaluation ongoing

19. HIP Results HIP has been shown to: Reduce the demand for homecare by approximately 2/3rds Improve participants’ self confidence, everyday functioning and well being more than standard home care Significantly reduce presentations to ED and use of aged care services over the next two years as compared to standard home care Result in lower home and other aged care costs over the next two years as compared to standard home care

20. Strategies Used to Influence Policy Disseminated results widely: - Conference/workshop presentations - Industry media stories - HIP Manual - Journal articles - Said “yes” to all invitations to speak about it Identified international supporting evidence Harnessed opportunities to influence opinion leaders Directly lobbied policy makers: - Asked to present to DOHA - Wrote/participated in writing many submissions to PC inquiry “Went on about it” to EVERYONE ALL THE TIME

21. Success! Productivity Commission Inquiry Report: Caring for Older Australians Recommendation 9.2 “An intensive reablement service should be introduced to give greater focus on independence, rehabilitation and restorative care..”

22. Reflections Barriers: System disincentives Ageism Time to build evidence base Enablers: Organisational “whole of sector” focus Encouragement to disseminate International evidence State adoption of enabling policies Other agency adoption of restorative models/approaches Opportunities to engage with policy makers Consistency with Government thinking “Its Time”

23. Contact Details For information about research at Silver Chain: www.silverchain.org.au/research/ or to contact me: glewin@silverchain.org.au