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NEWSLETTER For innovators in healthcare & beyond FEBRUARY 2015

Contents P. 1

‘The Pitch’ innovation challenge Barbye Castillo Sydney Local Health District

P. 7

Engaging consumers to develop a cancer survivorship and wellness model of care in the ACT David Larkin PhD Canberra Region Cancer Centre Canberra Hospital & Health Service

P. 8

Being clear about death and dying Steve Offner UNSW Media

‘THE PITCH’ innovation challenge Sydney Local Health District encouraging & supporting innovation

P. 10 The Smile Mum Project, Wagga Wagga Jennifer Lang Murrumbidgee Local Health District P. 12 Squashed in the Middle by You Char Weeks Change Champions & Associates P. 16 Keeping older Australians on their feet Dr Anna Barker, Dr Darshini Ayton, Ms Sheral Rifat & Ms Margaret Brand Monash University P. 17 Setting out on Firmer Foundations Melissa Walshe & Jackie Jenkins Good Shepherd P. 18 One Disease Duneeshya Gunasekara 1disease

Sydney Local Health District embraces, encourages and supports a culture of innovation through its innovation challenge - The Pitch.

P. 19 Benefits of training and staff development for recreation staff in aged care Lauretta Kaldor Diversional Therapist, Workplace Trainer

The Pitch is a new initiative through which staff are able to pitch their innovative idea to a panel of experienced judges, giving them permission to change our system. The Pitch aims to invigorate a culture of innovation across the District and is open to all staff. It provides a sense of empowerment to all levels of the organisation by showcasing that the District is interested and excited by all ideas that aim to improve the system and patient experiences – no matter how big or small.

P. 20 C.R.A.T.- A constipation risk assessment tool Kimberley Zanik Broome Hospital, WACHS Kimberley

P. 24 WORKSHOPS & IN-HOUSES Change Champions & Associates Newsletter - FEBRUARY 2015 P. 38 RESOURCES

(Continued p. 3.)


www.changechampions.com.au

DOWNLOAD THE PDF PROGRAM ONLINE! http://tinyurl.com/programrespecting

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Respecting Our Loved Older One’s Wishes Delivering integrated, consumer directed care where, when and how it’s needed. 25-27 February 2015 Melbourne City Conference Centre 333 Swanston St Melbourne (Opposite the State Library), VIC, AUSTRALIA 2

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Respecting Our Loved Older One’s Wishes 25-27 February 2015

Invited Keynote Speakers Prof Chris Brook Chief Advisor, Innovation, Safety and Quality; and Health and Medical Commander Department of Health Victoria Dr RĂŠgis Blais Pan Canadian Home Safety Study, University of Montreal, Canada (confirmed) Carol Foster Locality Manager, Adults North, Nottingham Citycare Partnership, UK (confirmed) Prof Peter Gonski SouthCare, South East Sydney LHD, NSW (confirmed) Carolyn Gullery General Manager, Planning, Funding & Decision Support Canterbury & West Coast District Health Boards, NZ (confirmed) Tracy Haddock PEPS Manager, Bedfordshire Partnership For Excellence in Palliative Support (PEPS) Co-ordination Centre and Local Implementation Manager, Vitrucare End of Life Pilot St Johns Hospice, UK (confirmed) Prof Joseph E Ibrahim CRE-Patient Safety, Department of Epidemiology & Preventive Medicine & Prevention Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, VIC Department of Epidemiology & Preventive Medicine, The Alfred Centre, VIC Department of Forensic Medicine, Victorian Institute of Forensic Medicine (confirmed) Caroline Mulcahy CEO, Carers Victoria (confirmed) Rod Quantock Comedian, Dinner Speaker (confirmed) Dr John Rasa CEO, Networking Health Victoria, President Australian College of Health Service Management (confirmed) Dr David Skyes General Manager, Learning and Development, Alzheimer's Australia Vic (confirmed)

DOWNLOAD THE FULL PDF PROGRAM: Visit: http://tinyurl.com/programrespecting 3

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Upcoming seminars 25 FEBRUARY 2015 (1/2 day workshop in Melbourne, VIC) Care Homes Programme [p. 24] with Pam O’Nions 26-27 FEBRUARY 2015 (2 day seminar in Melbourne, VIC) Respecting Our Loved Older One’s Wishes [p. 2] Delivering integrated, consumer directed care where, when and how it’s needed APRIL– MAY 2015 (travelling one-day workshop, to WA, QLD, NSW, VIC) Working effectively with clients experiencing family estrangement [p. 26] with Kylie Agllias

Online courses Sustain Success On Line Resilience Course [p. 25] with Kathryn McEwen & Char Weeks

In-house workshops Workshops with Char Weeks [p. 27] [p. 28] [p. 29] [p. 30]

Manage Your Energy Not Your Time Moving Forward: Accepting and Embracing Resistance to Change The New Leaders Toolkit Managing Up (How to help your boss add value to your work) Workshops with David Schwarz

[p. 31]

Board Appointments Master Class Workshops with Robyn Attoe

[p. 32] [p. 33]

Delirium and the Older Person Managing Behavioural and Psychological Symptoms of Dementia Workshops with Alice Rota- Bartelink

[p. 34] [p. 35] [p. 36]

The ABC of BOC– Working with Older Adults with Complex Care Needs The Challenge of Long Term Alcohol Abuse in Older Adults The Service Providers Toolkit: Improving the Care of Older Homeless People Workshops with Julie Faoro

[p. 37]

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The Long Stay Patient

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(‘THE PITCH’ innovation challenge, continued from page 1) The District will invest $240,000 annually ($50,000 per

intake,

making

the

selection

process

difficult

and

quarter) on staff’s innovative ideas, highlighting its

competitive. The Kerry Packer Auditorium at Royal Prince

commitment to its core values – Collaboration, Openness,

Alfred Hospital opened its doors to the inaugural The Pitch

Respect and Empowerment (CORE). The Pitch removes the

event on Friday, 22nd August 2014. Over 120 staff joined

red tape and introduces a transparent process accessible to

the six pitchers who would stake their claim for a chance to

all staff. A one page online application form allows staff to

win the initial $50,000 to fund their innovative idea.

provide a brief description of their innovation; what the desired outcomes are; whose involvement will be required;

With excitement in the air, each presenter creatively

the timeframe and budget for the solution; and the

introduced their idea to the esteemed panel who were then

sponsorship acquired for the project. The Pitch process,

we able to ask questions at the end of each presentation.

screening and scoring tools (which are used by both the

Staff were invited to a cocktail-style experience while The

District’s Innovation Group and The Pitch panel) are also

Pitch panel members deliberated on the winning Pitch.

accessible to staff via the District’s Innovation web page providing staff with all the essentials for their pitch.

As difficult as it was for the panel, the winning pitch would be announced on the night. Two ideas were able to share in

Twenty-one applications were received in the August 2014

the winnings:

Pitch: Back to basics in Balmain’s front yard Brief Description: This innovation explores the establishment of a restorative and therapeutic garden for Balmain Hospital inpatients which will simulate normal every day activities and assist patients with a smooth transition to the community. Awarded: $33,000

Pitch: No time to pitch the tent – Catching up with best practice Brief Description: This innovation confronts issues with dysphagia (an impairment to swallow function) and its contribution to the development of aspiration pneumonia. It addresses such challenges by promoting objective assessments using key equipment which will improve the patient experience and reduce cost. Awarded: $16,683

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(‘THE PITCH’ innovation challenge, continued from page 5) The second The Pitch session was held at Concord Medical

innovative ideas to the esteemed panel. With much

Education Centre at Concord Repatriation General Hospital

excitement and some extra funds in the air, the panel

on Friday 21st November 2014. Staff from across the District

announced the winning pitches for the night:

supported its six key pitchers who presented their

Pitch: 'DEPROX' Strikes Back-The way forward in environmental decontamination Brief Description: This innovation introduces the Deprox System (Hygiene Solutions) which is an automated vapouring system that disinfects and systematically eradicates microorganisms. Awarded: $50, 000

Pitch: Fire Service – Training Centre Brief Description: This innovation explores the completion of structured training for clinical staff in regards to evacuation skills via a simulation fire training centre. Awarded: $40,000

Sydney Local Health District is looking forward to continuing its culture of innovation by supporting quarterly Pitches throughout 2015/16. For more information regarding The Pitch visit the Sydney Local Health District Innovation website at www.slhd.nsw.gov.au/ innovation or contact Sydney Local Health District Performance and Clinical Redesign Program Manager, Barbye Castillo via email barbye.castillo@sswahs.nsw.gov.au.

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Engaging consumers to develop a cancer survivorship and wellness model of care in the ACT David Larkin PhD Clinical Cancer Research Nurse Canberra Region Cancer Centre Division of Cancer, Ambulatory and Community Health Support Canberra Hospital & Health Service Although survival rates for many cancers have improved

distributed in both paper and electronic format to consumers

significantly, more people are living with the consequences of

(people who have had a diagnosis of cancer and their carers)

a cancer diagnosis and its associated treatment. The ACT has

and clinicians involved in the treatment and follow up of this

the best cancer survival rates in Australia (AIHW, 2012).

patient group. Selection criteria were identified to reflect the

Survivorship is a new area of the cancer care pathway. Cancer

unique population groups serviced by the CRCC. The survey

survivorship can refer to a number of different timeframes in

was designed to determine how the local consumers and

the cancer patient trajectory. In the past, the term ‘cancer

service providers define survivorship; to enquire about the

survivor’ was used to describe someone cured of their cancer.

physical emotional and practical support needs of cancer

This usually meant someone who was free of disease for 5-10

consumers; and to examine coordination of resources and

years after treatment. Nowadays , however, survivorship

support from a clinician perspective.

means different things to different people. There are a number of emotional, physical, practical and social challenges that

108 patients, 31 carers and 72 clinicians have completed the

cancer survivors may face during or after finishing cancer

survey. Results overwhelmingly demonstrate that respondents

treatment, including late effects of cancer treatment and the

understand survivorship to be living with cancer, beyond

fear of cancer returning . The main elements of effective

diagnosis and treatment. Consumers and carers indicated they

survivorship care include care after treatment, cancer

would like ongoing psychosocial support during and following

surveillance,

treatment. They also desired better communication and

prevention

of

cancer

recurrence,

the

management of late effects and overall wellbeing.

collaboration with their GP and other health professionals and felt this could be achieved with the use of a summary

The Canberra Region Cancer Centre (CRCC), commenced

treatment plan. This plan, outlining treatment details,

operation in 2014, integrating most Canberra Hospital and

recommendations and other planned health interventions,

Health Services Cancer Services into one location. It is now the

could be available from diagnosis, and updated during and

primary adult tertiary referral hub for cancer diagnosis and

after treatment. Clinicians indicated they would like a greater

treatment in the ACT and South East New South Wales region,

understanding of resources and support available to patients.

servicing a population in excess of 500,000 people. A significant part of the vision to provide this population with

In light of the results from the surveys, the Model of Care will

integrated and contextually appropriate cancer care involves

place emphasis on survivorship as living well with cancer,

implementing a Cancer Survivorship Model of Care for within

beyond diagnosis and treatment. Work is now underway to

the region. This project aimed to engage and consult with local

examine this in detail and determine how this will frame

consumers and service providers to help inform priorities in

patient care and support. Development of a Model of Care

establishing a model of care.

that enhances the wellbeing approaches important in survivorship provided to patients and carers has commenced.

The researchers devised survey tools based on current issues in cancer survivorship research. These tools have been widely

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For more info please contact david.larkin@act.gov.au


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This article first appeared on the UNSW Newsroom on 22 January 2015 at http://newsroom.unsw.edu.au/news/health/being-clear-about-death-and-dying Published with permission.

Being clear about death and dying

UNSW researchers have developed an assessment tool that helps doctors and caregivers more accurately identify elderly patients whose death is imminent and unavoidable at the time of hospital admission. The CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) tool identifies patients who are likely to die within a threemonth period. Elderly people with chronic, age-related illness commonly endure repeated admissions to hospital in the last months of life and may be subject to distressing, expensive and futile medical procedures. The new tool provides more certainty in prognosis and enables an end-of-life care plan to be developed that best meets patients’ needs. A paper describing the assessment procedure is published today in the BMJ Supportive & Palliative Care. “Most terminally ill people want to die at home, but in fact three quarters end up dying in acute hospitals, often after intrusive, expensive and ultimately pointless medical procedures,” says Dr Magnolia Cardona-Morrell, who led the research at UNSW Medicine’s Simpson Centre for Health Services Research, alongside UNSW professor of intensive care Ken Hillman*. 8

Change Champions & Associates Newsletter - FEBRUARY 2015

“Current acute hospital systems often fail to recognise or cater to the needs of people for whom death is imminent and unavoidable. They are geared for aggressive treatment and emergency resuscitation, not peaceful, harm-free transitions,” Dr Cardona-Morrell says. “Elderly people who are dying need to be protected from heroic but intrusive live-saving hospital interventions that often only prolong suffering rather than enhance quality of remaining life.” CriSTAL consists of a 29-item screening list that can be completed by a nurse or a doctor before hospital admission and takes account of factors such as vital signs, cognitive impairment, recent hospitalisations, measures of frailty and the presence of active disease such as cancer or chronic kidney or liver disease. The process is informed by an extensive review of the strengths and weaknesses of medical literature that attempts to “diagnose dying” or devise an end-of-life assessment tool for clinical use. Most of the existing tools rely on clinical judgment or subjective assessments and value judgments. Others are unacceptably inaccurate. (Continued next page)


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(Being clear about death and dying, continued from page 8) The authors say developing a more objective and accurate way of identifying patients near the end of life is crucial to prevent inappropriate hospital admission and unnecessary treatments. “It can be difficult to reach a decision that balances the rights of patients to die with dignity and the expectations of families about satisfactory end-of-life care, while considering the limitations of health resources,” they write. “Delaying unavoidable death through aggressive and expensive interventions may not influence patient outcome; may compromise the bereavement process for families; and cause frustration for health professionals.” Dr Cardona-Morrell says the research is not about dictating the withdrawal of treatment, but about minimising uncertainty and establishing objective criteria for imminent death. “It’s about coming to terms with the fact that death from old age and multiple chronic conditions is part of a natural process and that medicine cannot work miracles. And it’s about ensuring that people at the end of their lives have the best possible care and support, in line with their wishes,” she says.

Professor Hillman emphasises that “the management of elderly frail patients at the end of life in acute hospitals is one of the greatest challenges facing health care. Most patients and their carers do not wish to be admitted to a hospital at the end of their life and this is a major contributor to the unsustainable costs of health care.” CrisTAL will be trialled in selected hospital emergency departments in Sydney this year. It will include communication training for medical staff, so they can ably and comfortably discuss with dying patients and their carers the limitations of medical treatment and the most appropriate place and process of dying. The paper, “Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)” is an Open Access publication. The research was funded by a grant from the National Health and Medical Research Council of Australia. *Professor Hillman is a well-known advocate for reform in end of life care and has written books and articles on the subject. Media contact: Steve Offner, UNSW Media, 02 9385 1583 or 0424 580 208 s.offner@unsw.edu.au

2015 Productive Series

Conference Join us in September 2015 in Sydney NSW for the 2nd Productive Series conference. Those who came to Melbourne last year left excited, inspired and full of good ideas to take back to their health service. 2015 promises to be even better with overseas keynote speakers and presentations from teams around Australia and New Zealand that are improving services for patients using the Productive programs. Mark September 2015 in your diary and join us in Sydney, NSW. Register your interest now info@changechampions.com.au 9

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DAT E CL AIME R


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The Smile Mum Project, Wagga Wagga Jennifer Lang Oral Health Promotions Officer Murrumbidgee Local Health District Jennifer.Lang@gsahs.health.nsw.gov.au

Good oral health enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment. While oral diseases are common, they are largely preventable through water fluoridation and individual practices, such as brushing twice a day with fluoride toothpaste and regular preventive dental care. However, poor oral health during pregnancy can impact on the health outcomes of mother and baby, increasing the chances of infants developing early dental caries (tooth decay) and associated with adverse pregnancy outcomes, such as preterm and low birth-weight babies. Dental caries is one of the most common diseases in childhood. A particularly damaging form, early childhood caries, can begin at a very young age when developing primary (baby) teeth are especially vulnerable. Severe dental decay undermines the quality of life of young children through pain and problems with sleeping, eating and behaviour. There is evidence suggesting good oral health in infancy and early childhood contributes to better general health in adulthood. Murrumbidgee Local Health District (MLHD) Wagga Wagga Oral Health Service established a partnership with MLHD Midwifery and Clinical Redesign and Charles Sturt University Oral Health Clinic to form the Smile Mum Project Team. The Agency for Clinical Innovation Methodology for Change resources guided the development of a priority program for eligible pregnant women to receive subsidised dental care. (Continued next page) 10

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(The Smile Mum Project, Wagga Wagga, continued from page 10)

Oral health staff, midwives and pregnant women were involved in the consultation, diagnosing the problem and developing solutions to create an innovative model of care. The Smile Mum Project eligibility criteria is limited to participants under 25 years of age and holders of Commonwealth Government concession cards. The Smile Mum Project enabled oral health information and a direct referral process to be provided to local midwives. Prioritised pregnant women received subsidised dental care and preventive advice at Charles Sturt University Oral Health Clinic and Wagga Wagga Base Hospital Dental Clinic. Over a six month period:  86 referrals were received.  37 women completed a full course of dental care  20 women in the process of treatment. Feedback from patients and clinicians indicated that the Smile Mum Project is improving maternal oral health, reducing the risk of infants developing early dental decay and positively influencing the oral health behaviours and attitudes of the women and their children. The Smile Mum Wagga Wagga program has provided a patient centred clinical pathway Model of Care to improve oral health outcomes of rural disadvantaged and low socioeconomic patients. Project supported by Centre for Oral Health Strategy NSW For further information please email: Jennifer.Lang@gsahs.health.nsw.gov.au

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Change Champions & Associates Newsletter - FEBRUARY 2015

Smile Mum Project team members (Back L-R): Anna Bromham, CSU Bachelor of Oral Health student, Jennifer Lang, MLHD Oral Health Promotion Officer, Shirley O’Brien, and MLHD Adolescent Pregnancy Support Midwife. Seated: Smile Mum participant Samantha Buckley. Missing from the photo are team members: Joanne McLennan, MLHD Oral Health Services Team Leader and Senior Dental Therapist, Leanne Beasley, Project Coordinator from MLHD Oral Health Services, Bronwyn Paton from MLHD Clinical Redesign.


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Squashed in the Middle by You Putting the Juice into Middle Management Char Weeks

Orange in the Middle Picture yourself as a pulp perfect navel orange, lazing in the afternoon warmth of an early Sunraysia spring. It’s a good life. Every orange in every tree in your orchard is on message to ripen as evenly as you can. There’s no pressure except for the odd nudge here and there from a branch hopping wagtail. Each developing orange is equally nurtured with a careful balance of water. Each is protected from birds, bats, fruit flies and two legged poaching varmints by a vigilant avuncular orchardist. Each receives a word of encouragement, an approving nod or a proud smile from their avuncular orchardist. All you have to do is deliver the juice. It can’t get much easier than that. In the bigger picture of oranges and juice, unnatural predators, those fiercely competitive supermarket giants despatch B Triples that rumble like earth tremor aftershocks toward your orchard. Your tree branches vibrate through the trunk and into the tree’s roots. Suddenly, your stem loses the better half of its hold on its twig. You are left swinging in mid air, not sure what is going on. You are not quite ready to drop your vitamin filled goodness and the thought of being plucked out of the cosy protection of your tree fills you with trepidation. The big B Triple driver from the city pulls out his clip board and pen and financially and emotionally squeezes the orchardist for more and more oranges for less and less return. Panicked about the future sustainability of their livelihood, the orchardist tractors through their inherited rows of citrus trees, churns the ground willy nilly with growth enhancers so as to keep up with big city demand. Careless backpackers snatch half ripened fruit for the cash on offer. Perfect as you, you become one of the first to be backpacker plucked from the tree. You find yourself slam dunked into 12

Change Champions & Associates Newsletter - FEBRUARY 2015

Innovation Leader Change Champions & Associates the murky depths of a canvas bag with other oranges of similar calibre and a swage of leafy debris. Confusion reigns. Then, you are all tossed into the wash, conveyed through grading, boxing and finally labelled, “Premium Juicer”. When all the cartons are packed and stacked, you are trucked off to some mystery city supermarket conglomerate. It’s not exactly the ideal career progression; to be crushed between the citrus producer and the KPI driven supermarket executive. There you are powerless, in the dark, not sure what you can and can’t do and with others determining your fate. But that is what happens to many middle managers, even to those with tertiary qualifications in management.

Premium Oranges Can Survive With Their Juice Intact Every day middle managers seesaw between the demands of those above and those arising in their teams. It takes balance and emotional intelligence to manage competing pressures while continually making adjustments to maintain stability, productivity, positivity and your own sanity. You are working in a landscape that, by necessity or design, is constantly changing, perhaps only subtly. Some adapt more easily than others. That’s life. Some emerging middle managers will feel squashed in between the top and bottom plates of a manual vice juice extractor. Without resilience and support, pulp, juice, pith and skin could be squashed out and sprayed everywhere but in the catch cup. (Continued next page)


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(Squashed in the Middle by You, continued from page 12)

There is a plethora of leadership and management development courses on offer, delivered by all manner of institutions. There appears little evidence between having an EMBA and being a great manager as there is the converse i.e. having no qualifications while becoming a brilliant manager. What appears to be widely agreed is that organisations commit to provide development opportunities, some lavish, for executives. They willingly invest as necessary in training for the front line. But, very little attention is dedicated to delivering training that addresses the expressed immediate needs of those in the middle. Most of what they need to learn is not in the book. Their questions often start with, “What do I do if...”. And the answer isn’t always on the Internet. In fact, sometimes it lies within and just needs a little help to surface. Many middle managers learn from their own manager. And while some of those managers provide wonderful guidance, there are others who deserve a magnifying mirror to facilitate a little self reflection. No wonder some middle managers burn out and retreat to the comfort zone of the front line. Could middle management be the litmus test for career progression and the acid test of resilience? There are fewer executives on the rungs above you and competition for promotion is often fierce. Those ambitious few who cope best and show greatest ability are those who are most likely to be promoted or poached. That is not to detract from the courage and tenacity of the career middle manager.

Putting the Juice into Middle Management Let’s now look at some practical strategies for surviving middle management.

“Choice” is an important word. We all always have choices. Many new middle managers commence their role by coming in early, staying back late and, can you believe, showing up for work on weekends to make up for what they may perceive as conscious incompetence. Mathematically, it doesn’t work to accept a promotion with a salary boost and then volunteer your time in the same organisation. If you are one of those people, check your salary now by dividing the hours you usually work in an average week and see how it looks. Some of you may discover that, in real terms, you are actually earning less now than before you were promoted. Staying back may make you look dedicated but it also makes you highly visible. Everyone who comes into work after you and leaves before you sees that you are still there. That makes other people feel guilty and creates a source of wash basin gossip. Worse, it sets an unhealthy precedent for all of your direct reports. And it’s VERY unhealthy, not just for you, but for the organisation as a whole. Some of you will say that working extra time is expected from managers. Your manager does it and they expect the same from you. Check your contract. If it’s written into your contract that you are required to donate additional hours...well, whoopsy. Perhaps it would have been better if you had checked the fine print first. But, all of that following the old culture is phooey if you want happy staff, happy organisation and a successful organisation. You are not your job. You have a life and if you don’t have a life, create one. Set your working hours. Leave a little flexibility for anything that is genuinely urgent. And spend the rest of your time on healthy body, healthy mind activities.

1. PUT YOUR OWN WELLBEING FIRST This is not about becoming self obsessed about your ability/ inability or letting your ego run riot about your promotion from the open plan work benches to a cupboard office. Just like anything you take on for the first time, tandem parachuting, driving lessons, getting married, it is reasonable to feel a little anxious. If you feel that you might become a runaway bride/groom, choose to not take the middle management role until you feel ready.

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(Continued next page)


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(Squashed in the Middle by You, continued from page 13) 2. GET CLEAR ABOUT WHAT IS EXPECTED FROM YOU AND WHAT YOU EXPECT FROM OTHERS Middle management is about matching demands and expectations from above and with your team. Your job exists to help your organisation, via your senior managers, to translate strategy into action. As a middle manager, you are the bridge between the big picture and the detail. You are the conveyor of information to and from senior managers and to and from your team. It makes sense then to have some idea about what your actually boss does, to whom they report, their KPI’s and challenges, and broadly, how they like to work. More importantly, try to get a handle on their communication style and preferences. This will help you to see where and how you fit with their role and to understand their priorities and pressure points. By the way, whether you approve or otherwise of your boss’s communication style, people will always do what people do. Try not to be judgemental. No one is perfect, not even you. One good choice is to learn to anticipate your boss’s behaviour and adapt your own behaviour to become appropriately accommodating. That will help to free you to be able to propel yourself forward and may be even share with your boss some of your skills, knowledge, emotional intelligence etc. that you have and they haven’t that inspired them to hire you in the first place. Once you have clarified priorities and deliverables with your boss, take the time to learn about the people in your team. Who are they? What makes them tick at work? How do they things are going or could be improved? What are their future career plans? Discuss your own role, communication style etc as you did with you own boss. Let your team know who you are and what makes you tick. What leadership/management style do they consider motivating? Who do they admire as a leader and manager and why? It is amazing how many people still think that the best way to motivate their people is to cut them down, in the belief that it will inspire them to do better. They are the managers whose communication commences with what you did wrong, with or without mention of what you did right. Or the first answer is always, “No” or if you are lucky, it’s “No, but...” 14

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And they wonder why you are shocked when you hear via someone else that they have a high opinion of your work. Please. A better way to motivate your people is to see the good in them and treat them with respect and courtesy. Saying please, thank you, well done and treating them with respect also helps. Sharing information always helps to dispel concerns. You are aiming to create a continuous improvement team where individuals respond to constructive feedback and feel confident about their ability. As a team, your internal mission is to “do it better”. 3. KEEP MOULD AT BAY When things aren’t working quite the way you had hoped, open up a calm, constructive conversation early. Avoid the blame game. Sentences that commence with “You did...”, “You said...” or “You told me...” demonstrate a culture of blame and abdication from responsibility. Going off your rocker in anger erodes trust and confidence among your team members and gives them a license to talk about your bad behaviour. Blaming and shaming serve only to build anger, resentment and apathy in your team; none of which are conducive to a high achieving, collaborative workplace. It’s inexcusable to imitate anyone else’s blame game behaviour toward your own team. If it happens to you and you are brave, it might worth nudging your boss in the direction of your priority to find ways to solve the problem, rather than bear the brunt of what went wrong. They may glare at you or come back with an unwelcome retort. But some people just have to have the last word. So let them. Taking a proactive approach to dealing with issues with your boss or your team helps to keep you on the front foot. The stability and predictability in your own behaviour helps to build everyone’s confidence and resilience. Waiting for mould to bloom before drawing attention to it is tantamount to letting management happen to you. In the absence of information and/or direction, people find ways to speculate. Before you know it, a tiny solvable problem transforms into an emotive bonfire. You have a choice to be brave and close down the wash basin clap trap that sometimes has only the flimsiest relationship with the truth. (Continued next page)


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(Squashed in the Middle by You, continued from page 14) When management happens to you, the juicer is extracting from you from top and bottom simultaneously. Your personal resilience may become compromised. That is concerning when it flows onto your team and then you take it home to your family. Take a look at this video by Kathryn McEwen if you are thinking about your resilience https:// www.youtube.com/watch?v=Rg_x1dy9KCU 4. WHAT IF YOU THINK THE TOP ORANGE IS A HALF MANDARIN? There are some middle managers who feel frustrated when they believe that their boss is inept, less intelligent or just sitting it out for a retirement in a job they believe they should have. As frustrated as you may feel, you have a choice to act professionally by keeping your toxic lips sealed. If you spray cynical comments about your boss over your team like pesticide, you are setting a new low in behaviour precedents. You can choose to help your boss to learn just in a similar way that they have a responsibility to help you to learn. And you can decide to demonstrate more broadly that you are ready to step up to the next level by supporting your boss so that you ALL look good. 5. YOU NEED YOUR JUICE TO MANAGE UNPOPULAR CHANGES FROM THE TOP All too often middle managers are directed from way above to deliver to their teams messages for unpopular change. For even the most experienced middle manager, this can be confronting, especially when they don’t agree with or understand the changes or what is actually changing remains a mystery. Remember, that it’s the role of the top echelon to envision and strategise. Sometimes, in the very early stages, the executive has little idea how vision and strategy will translate into implementation, action and outcomes. Often times, team members, perhaps, mistakenly interpret that management keeps them in the dark. “They don’t tell us anything”, is a frequent catch cry. Sometimes, executive can’t tell you because they neither know yet nor have assessed organisational readiness. It’s that simple. 15

Change Champions & Associates Newsletter - FEBRUARY 2015

If you are a middle manager who has been asked to share information about change, here are a few tips that might help you through:

 ask your boss to help you to craft some key messages about what it is, how it will benefit the organisation and the team and what is the likely impact on the team.

 be clear that you and your team are keen to be involved in the consultation process. After all, no one knows more about what you and your team do than you and your team.

 be open about not having all of the answers but be willing to commit to keep the communication lines open

 share what you know when you know you can share information

 if there is no update, that in itself is information for sharing with your team. This will help to dispel any “They know but they are just not telling us” twitter

 avoid saying or even giving an air of knowing what is going on but not being in a position to reveal. You can lose trust by creating a power differential in your team if you have the temerity to make statements like, “I know but I can’t say right now.” Remember, no one likes surprise parties.

 keep in mind that a good change strategy has flexibility and the change may need to change to make it more workable. So its best not to present information from above as set in stone until it’s actually set in stone. Otherwise, you will hear and perhaps say, “It keeps changing and we don’t know what is going on.” Of course, it keeps changing. It’s on the top echelon’s head to get it right and they will do whatever it takes to get it right.

 invite questions and discussion among the team members while discouraging cynicism and speculation, especially your own.

 make yourself available for your team member’s personal concerns about the change, especially if it impacts their job or their personal circumstances. Remember, that you may be delivering the message that change is coming, but you are not an orange parked on head of William Tell’s son. Finally, be confident, believe in yourself and remember your career comprises many journeys each with a beginning and an end. Middle management offers its own series of journeys. It’s not a destination. Enjoy those journeys. This article can be republished if author and source are clearly acknowledged.


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Keeping older Australians on their feet The RESPOND project Respond to the first fall to prevent the second Dr Anna Barker, Dr Darshini Ayton, Ms Sheral Rifat & Ms Margaret Brand Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University

Falls are one of the leading causes for presentation to hospital

multi-centre randomised controlled trial to test an innovative

Emergency Departments (ED). More than 83,000 Australians

post ED discharge program designed to reduce secondary falls

aged 65 and over were hospitalised following a fall in 2010.

in older people—The RESPOND project. This program aims to

More than 50 per cent of these fallers experience a second fall

address the lack of perceived personal relevance by adopting a

within the next six months. However, less than 30 per cent of

patient-centred approach that encourages older adults to get

fallers

involved in the decision making process.

discharged

from

the

ED

access

the

services

recommended by hospital staff. The RESPOND program connects patients with evidence based Recent studies suggest that older Australians are

falls-prevention strategies and improves their knowledge and

reluctant to participate in fall prevention activities.

ability to navigate the complex healthcare system. The

Almost 3 in 4 fallers are unwilling to attend exercise

intervention provides ongoing coaching and telephone

classes, more than half are hesitant to discontinue using

support to assist individuals to participate in self-selected falls

psychotropic medications and more than a third are

prevention activities; assistance in the identification of barriers

reluctant to have a home safety assessment.

and facilitators to achieving goals; and positive reinforcement when patient selected goals are achieved and sustained.

Research suggests that the lack of participation in proven fall prevention activities are due to the stigma associated with

Further information on the RESPOND project can be found

programs targeted toward ‘older adults,’ an individual’s under-

here.

estimation of the risk of falling and the perception that a program is not personally relevant.

The Falls and Bone Health team host educational seminars annually.

The RESPOND project To ensure you remain up to date on the latest research Researchers from Monash University, and health partners

findings, join our mailing list by emailing your interest to

across Victoria, NSW and Western Australia, are leading a

respond.depm@monash.edu.

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Change Champions & Associates Newsletter - FEBRUARY 2015


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Setting out on Firmer Foundations Empowering women experiencing economic abuse Melissa Walshe Senior Practitioner Firmer Foundations Good Shepherd

“Why doesn’t she just leave?” It is a comment most of us have heard in relation to women living with family violence. The reasons why women stay in violent relationships are many and varied, but an innovative pilot program from community services organisation Good Shepherd Australia New Zealand aims to address one of the known factors trapping women in abusive relationships: lack of financial independence. As part of the organisation’s aim to create an emotionally, economically and physically safe world for women, the Firmer Foundations program supports women to gain confidence, skills and knowledge to build a secure financial future. Research has shown that women who are financially independent are less vulnerable to financial stress and have greater resources to leave situations of family violence. This includes women having access to their own money, having equal decision making power about family finances and the ability for them to earn a reasonable income. Many people think of family violence as physical, verbal or emotional abuse. Economic abuse is also another, less understood form of family violence that can have devastating consequences for those affected. Economic abuse can happen to anyone regardless of their socioeconomic or ethnic background. Signs that financial abuse may be occurring include women having no bank account of their own, being unable to provide for their needs or those of the children and debts incurred in her name without her approval or knowledge. Economic abuse is a crime in most parts of Australia. Withholding money, controlling spending and making all the financial decisions are some of the ways financial abuse is carried out. The Firmer Foundations program helps to empower women in these areas, providing them with the awareness and skills needed to minimise their risk.

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Change Champions & Associates Newsletter - FEBRUARY 2015

Jackie Jenkins Financial Capability Worker Firmer Foundations Good Shepherd Women in Australia earn 17.6 per cent less than men and taking time out of the paid workforce to care for family further reduces their access to financial security. Traditional ideas about men as breadwinners, and of financial matters being a male domain, also contribute to a lack of money management skills and confidence for many women. One in three women experiences family violence during their life, and it is the leading contributor to death, disability and illness in Victorian women aged 15 to 44 years (Vic Health 2004). Mitigating this pervasive problem through building women’s financial confidence is vital. Good Shepherd Australia New Zealand aims to disrupt the intergenerational cycle of disadvantage with a focus on women and girls. The Firmer Foundations program offers women information and resources about money management, either individually or in group sessions. It is an opportunity for women to talk about money, learn from each other and be assisted with employment, education or training options. Firmer Foundations is for any woman living in the Mornington Peninsula Shire or Greater Western Melbourne areas. They can be working, unemployed, single, partnered, separated, with or without children or other care responsibilities and may be on any type or level of income or no income. For more information phone 03 5971 9444 or email firmerfoundationspeninsula@goodshepvic.org.au or 03 8312 8800 or email firmerfoundationswest@goodshepvic.org.au.


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One Disease Duneeshya Gunasekara Communications Coordinator www.1disease.org

For a nation which calls itself the “Lucky Country”, it’s a little secret that life is far from lucky for our Indigenous Australians, who can expect to live 10-20 years less than other Australians. One contributor to this life expectancy gap can be attributed to a small microscopic bug known as scabies. Scabies is a highly contagious skin disease. According to The World Health Organization, as many as 130 million people are affected by scabies at any one time with the majority these people living in developing countries where overcrowding and poverty coexist. Shockingly, in the Northern Territory (NT) of Australia, one of the richest countries in the world, 7 in 10 Indigenous kids are affected by scabies at least once before they can celebrate their first birthday, and 1 in 3 kids under the age of 5 are affected by scabies at any one time. These children can require sedatives to help them sleep at night and painful antibiotic injections for infections from scabies sores. The severe form of scabies, known as crusted scabies (CS) causes significant skin disfigurement and these individuals often suffer in silence and shame, receiving little ongoing care and become the ‘super spreaders’ of scabies in the community. Furthermore, historically crusted scabies patients had a 50% mortality rate over 5 years. One Disease is a non-profit organization that believes no Australian should die of a preventable disease and is aiming to help close the Indigenous health gap disadvantage. Our mission is to eliminate disease from remote Indigenous communities with the first on our hit list being scabies. We work in partnership with Indigenous communities in the NT to (i) identify crusted scabies patients and ensure they receive the appropriate treatment in a culturally respectful manner and (ii) assist local clinics with conducting skin screenings to diagnose and treat simple scabies. 18

Change Champions & Associates Newsletter - FEBRUARY 2015

We believe the disease can only be eliminated when people are empowered to take care of their health. For this reason, we employ and up-skill local Indigenous workforce to conduct community education at schools, mothers groups and via door to door visits to problem households. One Disease’s nurses conduct education sessions at local clinics and have written clinical guidelines for diagnosis & treatment of scabies and crusted scabies. Furthermore, One Disease is the only organization in the world that is designing a clinical registry of CS patients to ensure contact tracing could be done to effectively identify and treat everyone affected by this disease. Since the organization’s inception in 2011, One Disease have been invited to work in 28 communities across the NT. We have identified 65 individuals with crusted scabies who are on personalized care plans and in one community have seen a 76% reduction in the number of days a CS patient spends in hospital and a 100% reduction in patients reporting skin condition impacting their ability to work. In 2013, One Disease was able to register the medication, ivermectin, with the Australian Therapeutic Goods Administration for the use of scabies and findings on CS and the need to identify and treat these super spreaders was recognized and published in the peer reviewed and highly respected Medical Journal of Australia (MJA). To find our more about what it’s like to live with crusted scabies, you can watch the story of one of our patients, Stephen Maymuru- http://1disease.org/healthy-skin/storiesfrom-our-communities/stevens-story/ To find out more about our One Disease, please visit www.1disease.org


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Benefits of training and staff development for recreation staff in aged care One of the most important marketing tools aged care facilities use today focuses on recreation opportunities within the facility. Future customers (or their families) are more than likely to be critical if recreation as advertised is not up to their expectations. This puts an added pressure on the facility to provide an excellent leisure program. However the level of educational background of people employed as leisure staff in aged care, varies greatly in all states. It is really important that leisure staff be upskilled to do a job that is really essential in aged care homes.

By

participating in practical workshops leisure, staff really appreciates seeing the value of a good leisure program. As the impact of person-centred care and consumer directed

Lauretta Kaldor Diversional Therapist, workplace trainer & supplier of resources for leisure staff aged care slkaldor@bigpond.net.au www.laurettakaldor.com.au

care changes from the medical model, all staff will be involved in the leisure and lifestyle of each client at a facility. No longer will it be OK for leisure staff to just be expected to mind the clients while task orientated care staff and nurses get on with their routines. Leisure staff must evolve into facilitators to help all care staff find ways to engage residents in activities (can be individual or group) as part of a team. As a majority of

Topics for staff development that may be useful are:  How to use the life story of each resident to plan what activities will engage that resident  How we might involve the residents in planning social programs and outings to suit their needs and preferences?

residents in aged care homes are living with dementia, leisure

 What creative activities can be adapted so that people who

staff needs to know what activities will engage their residents

have challenges to leisure can enjoy creating art, craft or

regardless of their cognitive issues and work with care staff to produce excellent resident lifestyle outcomes.

writing?  How can families assist to provide individual activities that will make their visits valuable?

Therefore leisure staff needs the practical skills and education

 How to use current technology e.g. Laptop, iPad etc. to

and come up with ideas that will enhance their clients’

connect people, provide sensory enhancement and joy to

lifestyle and help to foster well-being (as opposed to ill-

people whose ability to engage in leisure is challenged.  Practical ways to use reminiscing as an enjoyable activity

being).

with older people. They need to know how to help care staff (e.g. when residents show distressed reactions) as part of a team to improve overall well-being of such residents.

In- house workplace leisure training or staff development for all staff (or just leisure staff) might be one way of upskilling all to improve their understanding of what leisure is all about.

For more information, please contact Lauretta at: slkaldor@bigpond.net.au 19

Change Champions & Associates Newsletter - FEBRUARY 2015


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A constipation risk assessment tool Kimberley Zanik Clinical Nurse, Medical Surgical Unit Broome Hospital, WACHS Kimberley AIM: To reduce the risk of developing constipation while in the acute care setting through utilisation of a constipation risk assessment tool. A constipation risk assessment tool has been designed and trialled in Broome Regional Hospital as a result of research, evidence based practise and observation that constipation in the acute care hospital setting is poorly managed by health professionals. There is a distinct knowledge deficit into the risk factors of constipation development and best treatment modalities. An ingrained culture exists that bowel management is a nursing duty despite the need for medical collaboration regarding pharmacological intervention and physiological considerations. The disconnect and under recognition of constipation and management strategies is linked to a shift in nursing culture away from basic care towards policy and procedure. By having a standardised assessment tool available with clear guidelines for the healthcare team, consistent evidence based care can be delivered. The burden of hospital induced constipation on individuals includes discomfort, pain, headache, confusion, electrolyte imbalance, embarrassment, investigations, and potentially severe medical complications. The direct and indirect costs of constipation on the healthcare system can be widespread including increased staffing, drug therapy, imaging, and intervention. Untreated constipation in the acute care setting can culminate in increased length of hospital stay, cost of care and places extra burden on an already pressured healthcare system. The Constipation Risk Assessment Tool is an integrated tool used collaboratively by doctors and nurses to assess an individual’s risk of developing constipation while in the acute care setting. The Tool identifies risk factors for an individual developing constipation while hospitalised and places pharmacological interventions pre-emptively in place. By reducing the incidence of constipation there are significant cost savings for the healthcare facility as well as reducing length of stays, and improving quality and health outcomes for patients. 20

The Constipation Risk Assessment Tool was initially introduced into Broome Regional Hospital as a trial document for a period of three months from June-August 2013. During this time the tool was utilised by nursing and medical staff for all admissions onto the medical- surgical, maternity and mental health units. The roll out of the tool was coupled with formal education sessions, informal feedback sessions, a self directed learning package and regular written updates. Much of the education and reinforcement came via face to face interaction with the author. After the trial, feedback was gained on the tool and minor alterations made to make the tool more user friendly. A pre and post implementation audit was conducted. As an outcome of the significant improvement in results the tool is now a standard admission document on the medical -surgical ward at Broome Regional Hospital. Prior to the introduction of the Tool only 8 percent of patients had bowel activity documented and 58 percent of patients had no documentation for the entire admission. Post implementation showed a significant improvement with 76 percent of patients having bowel activity documented on the Constipation Risk Assessment Bowel Chart. The risk assessment component showed a completion rate of 64 percent total and 26 percent partial completion. The roll out of the tool has been a challenge like most change and quality improvement initiatives. Time and resource constraints by the author have further slowed the roll out process with implementation in the maternity and mental health units at a standstill. However the positive results from the initial audit cannot be ignored. The change noticed on the ward environment with regards to bowel documentation, aperient prescriptions and nurse initiation has been refreshing. Seeing nurses empowered to take charge of bowel care confidently is evidence enough to continue to fuel the change and quality improvement process. My journey with the Constipation Risk Assessment Tool has been long but enjoyable and my passion towards improving patient outcomes through bowel care continues to drive my vision for change in practise. A COPY OF THE TOOL IS INCLUDED ON THE NEXT 2 PAGES

Change Champions & Associates Newsletter - FEBRUARY 2015


Surname

UMRN / MRN

Given Name

DOB

______________ Hospital / Health Service Kimberley Region

Constipation Risk Assessment Tool

Gender

Address

Post Code

Ward: _______________________________

Telephone

Doctor: ______________________________

Prior to Diagnosis

Question

Will patient need a bedpan or bedside commode?

Consider the environment and cultural consideration of the patient. Can they get to the toilet? Is it private?

Do they have adequate time to evacuate their bowels?

Patient usually uses bowels (times day/ week)

Are they likely to inform you of problems with their bowels or constipation?

Stool is usually a (rate 1-7) on Bristol stool scale

Do they understand what you are asking?

Encourage fluid intake, mobility, fibre and correct position for bowel evacuation.

Uses frames, sticks or standby assistance Restricted to bed / chair

0

Assessment Completed By (Please Print Name & Designation) Date:

1 0 1 2 3

Less activity than normal for patient

3

Bristol Stool Scale provided overleaf

Independent

No

Patient last used bowels (date prior to submission)

Mobility

Yes

Diet No change in regular diet and fluid intake Reduced nutritional intake Reduced fluid intake Needs assistance to eat and drink

SUBTOTAL

2 0 1 2 3

SUBTOTAL

Haemorrhoids, anal fissures and rectoceles, perianal abscess Gynaecological conditions, surgery and pregnancy Neuromuscular and neurological

3

Consider spinal chord injury, motor neuron, multiple sclerosis, chord compression, parkinson’s and stroke

2

Diabetes Abdominal conditions and surgery

2

Cholecystectomy, appendectomy

2 2 3 3 3

Psychiatric illness, learning disability or dementia Post operative Chronic constipation Cancer Peritoneal dialysis, haemodialysis / electrolyte imbalance

SUBTOTAL

4

Patient Symptoms

Yes

No

3 2 3

0 0 0

Patient believes they are currently constipated Patient has a history of constipation Patient usually uses laxatives

SUBTOTAL

Medications Opioids NSAIDS Antiemetic Calcium channel blockers Iron supplements Anticonvulsants

4 2 2 2 2 2

Antidepressants Antipsychotics Antiparkinsons Antispasmodic Polypharmacy

SUBTOTAL Document Developer: Kimberley Zanik, CN General Ward, Broome Hospital VERSION DATED 31 OCTOBER 2013 (WACHS Manager, Health Record Forms)

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Change Champions & Associates Newsletter - FEBRUARY 2015

5 2 2 2 2 2

Results Low Risk <8 Moderate 8 - 14

High >14

TOTAL SCORE   

PRN BD two tablets of Coloxyl and Senna (Coloxyl only if pregnant) PRN Movicol one sachet BD

Coloxyl and Senna two tablets BD regular and Movicol one sachet BD regular

Coloxyl and Senna two tablets BD regular and Movicol two sachets BD regular Consider STAT doses of other aperients eg microlax enema

*Consider rectal preparations such as suppositories and enemas only if faeces is evident in the rectum through examination or as requested by the Medical Officer

MRK 155

Orthopaedic

CONSTIPATION RISK ASSESSMENT TOOL

3 2 2 2

Illness


______________ Hospital / Health Service Kimberley Region

Constipation Risk Assessment Tool

Surname

UMRN / MRN

Given Name

DOB

Address

Gender

Post Code

Ward: _______________________________

Telephone

Doctor: ______________________________

Date

Time

Bowels Opened

Bristol Scale

Amount (S)mall, (M)edium, (L)arge

Was Laxative used In last 24 hours?

Yes

No

1 2 3 4 5 6 7

S

M

L

Yes

No

Yes

No

1 2 3 4 5 6 7

S

M

L

Yes

No

Yes

No

1 2 3 4 5 6 7

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Comments

Yes No S M L Yes No 1 about 2 3 4 5 6 7 Constipation For more information the Risk Assessment Tool, Yes No S M L Yes No 1 2 3 4 5 6 7 Please contact Kimberley Zanik atS Kim.Zanik@health.wa.gov.au Yes No M L Yes No 1 2 3 4 5 6 7

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The Communiqué is returning! The newsletter written by clinicians for clinicians about lessons learned from deaths investigated by the Coroners’ Court. After a five-year hiatus in publication Professor Joseph E Ibrahim and Dr Nicola Cunningham are delighted to announce the return of the Communiqué, an electronic, quarterly educational newsletter, that uses a narrative case-study approach to report lessons learned from deaths in acute health care settings investigated by the Coroners’ Court. Our return to production is made possible through Victorian Managed Insurance Authority and Monash University who are supporting the return of the Communiqué as an educational resource for medical practitioners and health professionals with a focus on patient safety in acute health care settings. The first issue of the Clinical Communiqué examines the National Standards while pulling together three clinical cases from our past issues. We do this to introduce ourselves to the newcomers; hail our return to past subscribers; and trial our new layout and presentation – in modern IT parlance, perform ‘an alpha test of product’. The first issue is now available and we present cases about: Medication and Safety “Knowing what the right hand is doing”); Clinical Handover - “Hard to swallow”; and Recognising and Responding to Clinical Deterioration in Acute Health Care “Measuring pain and sedation”. Subscription is free register at: http://www.vifmcommuniques.org/subscribe/

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Change Champions & Associates Newsletter - FEBRUARY 2015


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Change Champions & Associates presents:

1/2 DAY WORKSHOP WITH PAM O’NIONS 25 February 2015, Melbourne VIC

Background There is a growing appetite for improvement across the aged care sector coupled with increased demand from residents, relatives, commissioners and regulators. This makes it essential to share best practice and support improvement initiatives… and to do so now. The Care Homes Programme is designed to help care homes strengthen communications with the wider health and care community and improve resident, relative and staff experience. It is divided into two parts: Wellbeing and Connect. Care Homes Wellbeing focuses on improving resident, relative and staff experience by creating better communication channels within care homes. Care Homes Connect focuses on strengthening external relationships by creating more effective communications between care homes and the wider health and care community

Facilitator name: Pam O’Nions RN BSc MNsg GDipED DipBus Doctoral Candidate Senior Consultant, Qualitas Consortium Objectives: The focus of this interactive workshop will be to introduce you to the Care Homes Programme to find ways that help the aged care facilities to better engage with staff, residents & relatives and enhance communications between the different groups. Learning Outcomes: At the completion of the workshop the learner will have been introduced to the Care Homes Programme structure and tools to:    

empower staff to make the improvements that residents and relatives want improve safety through better communication improve efficiency to release more time caring for residents improve relationships between aged care, local community and the wider health and social care system

To register your interest email: info@changechampions.com.au Download the PDFNewsletter flyer- FEBRUARY online. Change Champions & Associates 2015 Visit www.changechampions.com.au

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If you are under the pump and not sure that you are managing as well as you could, this online program, Sustain Success, will help you to build your resilience at work and beyond. Best of all its easy! There is no need to ask your manager for permission for time off to attend a course. No need to feel embarrassed about your capacity to cope. No need to consider withdrawing or watering down decision making because you feel that your ability and your confidence are living on different planets. Developed by revered, organisational psychologist, Kathryn McEwen, here's an opportunity to reflect on the way work pressure impacts on the way you function at work and beyond. You can complete the program, in your own time and at your own pace. Better, you will be supported by a Resilience at Work accredited coach. This is not a one size fits all program. One 75 minute individualised coaching session is included in the program but for an additional fee you may book additional sessions. Coaching sessions are held face to face in Victoria and by telephone or skype elsewhere.

Change Champions & Associates Newsletter - FEBRUARY 2015

Resources

Sustain Success provides:  An assessment of your current personal resilience levels  An evidence-based model to use to develop resilience in the workplace  Specific strategies to maintain personal strengths and address gaps in relation to resilience  Individualised practical coaching to:  Support focused reflection and action  Develop practical strategies for dealing with challenges in the work place and beyond

   

    

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Insight into personal work resilience levels Understanding of the components proven to build resilience at work A customised and coach-supported plan to build or maintain resilience in your current job Increased capacity to work in a sustainable way, both physically and psychologically

6 Activities each including Activity Sheets and videos Completion of the Resilience at Work (RAW) Scale RAW score results sent to your RAW accredited coach 75 minute strictly confidential coaching session to develop strategies going forward Each participant will receive a certificate of attendance upon completion


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Working effectively with people experiencing

family estrangement A practical approach for health & welfare professionals

Full Day Workshop with Kylie Agllias 24 27 29 01

April 2015– Perth, WA April 2015– Brisbane QLD April 2015– Sydney, NSW May 2015– Melbourne, VIC

or as an in-house at your organisation 26

Make an inquiry for your facility! www.changechampions.com.au

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Change Champions & Associates presents a brand new workshop

Manage Your Energy Rather Than Your Time 3 Hour Workshop with Char Weeks

If you are over trying to manage your time so that you can do everything on your wish list on time all the time, this workshop might be for you. Join Char Weeks for this practical and inspiring workshop which could change the way you do everything. Book this in-house workshop today! Email info@changechampions.com.au for more details

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Make an inquiry for your facility! www.changechampions.com.au

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Moving Forward Accepting and Embracing Resistance to Change

This master class will enable you to: EXPLORE reasons for and sources of resistance to change both more broadly and in the context of your role as a change agent, leader, implementer or recipient

LEARN strategies for anticipating, addressing and managing resistance to change and any unintended consequences

DISCUSS ways to build dynamic coalitions for sustainable change

MANAGE the messages, manage people and networks, develop competencies, find comfort zones

Who is this workshop for? New leaders and project managers from any industry or public sector who are keen to develop their skills in Change Management

DELGATES ARE TO BRING: 1. Organisational chart with names of position holders de-identified 2. Project proposal or implementation strategy or a change resistance issue (real or hypothetical)

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BOOK THIS IN-HOUSE WORKSHOP email info@changechampions.com.au for expressions of interest

Make an inquiry for your facility! www.changechampions.com.au

Change Champions & Associates Newsletter - FEBRUARY 2015


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Resources

The New Leaders Toolkit Full day workshop with Char Weeks

A Practical Workshop on the Stuff Thatâ&#x20AC;&#x2122;s Not in the Book This full day workshop is suitable for emerging, acting, tired, frustrated or continuously improving managers of just about any project, program, facility, department, group or organisation. Itâ&#x20AC;&#x2122;s about building your confidence and sharing tips for dealing with some of those tricky challenges that come with the territory.

For in-house expressions of interest Email: info@changechampions.com.au www.changechampions.com.au

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MANAGING UP (How to help your boss add value to your work) Ever bounced into your boss’ office to eagerly report on project progress, only to be met with a quizzical stare? Ever been stopped mid-sentence by a boss who has no idea what you are talking about? Ever been asked to cut to the chase when you thought you were actually giving a brief summary? Did their eyes glaze over half way through a perhaps long winded explanation? Feel a bit anxious when going into a meeting with your boss?

Understand the broader context in which your boss works and what is important to them as a leader and manager.

Here is a 3 hour

workshop that will help

expertise to enhance each others’ roles, to build trust, respect and capability.

you to make those meetings with your boss a much more

Identify strategies to ensure that you and your boss are on the same page in update meetings and that you are more clear

mutually rewarding experience

Better understand how to tap into your boss’ skills and

about what to do when you get back to your desk. 

Build confidence in presenting information to your busy boss to elicit a considered, timely and appropriate response.

www.changechampions.com.au

IN HOUSE WORKSHOPS

Email your expression of interest to: info@changechampions.com.au

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Change Champions & Associates Newsletter - FEBRUARY 2015


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Board Appointments Master Class

All you need to know to get the board position you want. More and more professionals are looking to share their expertise, and add to their own credibility, as Non Executive Directors (NEDs) on Boards and other Committees of Management. But, landing that first Board position is not so easy, especially when you are pitting your skills and experience with others who are equally talented and passionate about the same cause, company or industry NEDs often describe finding their first directorship as an arduous and time consuming process. More experienced NEDs suggest finding subsequent board roles can be equally difficult. Not starting your board vacancy search early enough, relying on existing or stale networks and not fully understanding the complexities of how board appointments are made can cripple your chances of being appointed to a Board. Addressing these issues is why our Board Appointment Seminars are so popular. Each half day seminar, led by David Schwarz (an experienced nonexecutive director, international head-hunter, board recruiter and the MD of Board Direction), is designed to practically demystify the board appointment process. It will also provide you the skills and assistance you require to get â&#x20AC;&#x2DC;board readyâ&#x20AC;&#x2122; and onto the board you want.

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Change Champions & Associates Newsletter - FEBRUARY 2015

With David Schwarz

For in house bookings email: info@changechampions.com.au


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Delirium

And the older person

“You would have to be half mad to dream me up.”

-Lewis Carroll, Alice in Wonderland

Full day workshop with Robyn Attoe For in-house bookings, email

info@changechampions.com.au “Delirium in older hospitalised people is often overlooked or misdiagnosed due to limited staff knowledge of delirium features or a perception that all cognitive impairment is due to dementia” (Australian Government Department of Health and Ageing). Delirium is a serious medical problem which results in increased length of stay in hospital, premature institutionalisation, morbidity and mortality in the elderly. Needless to say the cost to the healthcare system is enormous! This practical workshop by recognised dementia behaviour expert, Robyn Attoe, is designed to assist anyone working with older people:  to recognise the delirious patient early  improve knowledge about delirium management

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Change Champions & Associates Newsletter - FEBRUARY 2015


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Managing Behavioural & Psychological Symptoms of Dementia One day workshop with Robyn Attoe

Up to 90 % of people who have dementia will experience behavioural and or psychological symptoms during the course of their illness .

FOR IN HOUSE BOOKINGS, PLEASE EMAIL info@changechampions.com.au for expressions of interest

OUTLINE 1.

Discuss the different types of dementia, the changes to the brain and the behaviours staff may see in each type of dementia

2.

How to communicate effectively with the person with dementia (PWD)

3.

How the environment impacts on behaviour and how staff can modify the environment to reduce BPSD

4.

Discuss and define Psychological Symptoms of dementia and how to manage them

5.

How staff can assist in the transition from home to hospital or residential care by identifying the needs of the PWD and then providing a detailed strengths based care plan for the PWD

6.

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Discussion of case studies and more â&#x20AC;Ś

Make an inquiry for your facility! www.changechampions.com.au

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Need some practical tools to help you unravel and prioritise those complexities to deliver the best outcomes for your clients?

The ABC of BOC Working with Older Adults with Complex Health Care Needs Who Display Behaviours of Concern Join recognised expert, Dr Alice Rota Bartelink, in this full-day practical case-study workshop.

Workshop Content This practical case study day offers a vibrant, supportive, but strictly confidential forum for professionals who are: 

Uncertain about where to start unraveling complexities in caring for older adults who display behaviours of concern

Keen to understand the implications of behaviours of concern e.g. the impact and flow-on effect on staff, patients, clients, residents etc.

Interested in discovering tools and techniques to be able to more effectively identify and prioritise the management of behaviours of concern displayed by clients

Recognise the need to be able to measure the success of behaviour interventions and management plans

FOR IN HOUSE BOOKINGS,PLEASE EMAIL info@changechampions.com.au for expressions of interest

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The Challenge of Long Term Alcohol Abuse in Older Adults A practical in-house master class with Alice Rota-Bartelink on managing older clients living with Alcohol Related Brain Injury (ARBI)

Workshop Outline 

Introduction

Alcohol & Alcoholism

Symptoms

Alcohol and the Ageing Body

Comorbidity

Alcohol and the Brain

The Role of a Neuropsychologist

Treatment

Managing Challenging Behaviour

Aggressive Behaviour

Self Care Practices - Staff

Case Profile

Conclusion

Download the PDF flyer from our website www.changechampions.com.au and fill out the expressions of interest form 35

Master Class Aim To facilitate the transfer of skills and knowledge gained through evaluative research into the provision of appropriate support to clients living with alcohol related brain injury (ARBI) this presentation will provide education on the effects of long-term alcohol abuse on an older person and advice on strategies to assist service providers with managing behaviours of concern among older clients living with ARBI.

“This Master Class aims to improve the life quality of this often forgotten and neglected group of people by providing participants with an understanding of their unique set of care needs and imparting the skills required to enhance the delivery of effective care and support.” - Alice Rota-Bartelink

Make an inquiry for your facility! www.changechampions.com.au

Change Champions & Associates Newsletter - FEBRUARY 2015


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The Service Providers Toolkit: Improving the Care of Older Homeless People In-house master class with Alice Rota -Bartelink

Homeless and the Aged 

Introducing Nigel: Case profile

Defining homelessness – primary, secondary and tertiary

IN-HOUSE WORKSHOP

Characteristics of an aged homeless population

Advocating for the older homeless person

This workshop is available as an

Navigating complex service systems

in-house at your organisation.

Understanding life roles and the significance of

Download the PDF flyer from

engaging in meaningful activities

our website to read more info

Facing the challenge of “behaviours of unmet need”

and to fill out the expressions

The Service Providers Toolkit

of interest form.

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Change Champions & Associates Newsletter - FEBRUARY 2015


Contents

The

Articles

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Long Stay Patient

A workshop with Julie Faoro Many of you will have met Joan. She is a 74 year old widow who was living independently at home prior to presenting at your hospital ED in an altered conscious state. On assessment and investigation, layers of medical issues appear and need unravelling. Moving on, our Joan is still in hospital after 154 days. She's frustrated and bored. There is no agreed discharge plan and Joan just wants to go home. Your team are reluctant to discharge Joan because they are yet to be convinced that all her layers of issues have been resolved. These sorts of long stays are preventable. And this workshop with serve as a valuable investment for your hospital in preventing these long stays. Is this your patient? Could you do with some help to free up her bed?

Learning Objectives

Ideal audience: ANUM's, discharge planner, case manager, care co-ordinators, performance analysts and anyone else who genuinely cares about Joan and her need to live out her days independently and in her own home.

To identify patients that may benefit from the application of the long stay model prior to consuming excessive bed days

To learn how to engage all stakeholders in the implementation of the long stay program

IN HOUSE WORKSHOP ONLY!

To develop knowledge and skill in the application of the tools and methodology related to the long stay program model

Please email info@changechampions.com.au for expressions of interest

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Australian & NZ RESOURCES Limitation of care orders: Making an informed choice Dementia Training Study Centres Professor Joseph E Ibrahim MBBS, Grad Cert HE, PhD, FRACP, FAFPHM This education resource was developed by Professor Ibrahim to raise awareness of the important issues around limitation of care orders and cardiopulmonary resuscitation in persons with dementia, a sensitive and often contentious matter. People with dementia deserve the same opportunities as everyone else to be involved in making decisions about their treatment and lives and care should be exercised by others when presuming a certain quality of life for the person living with dementia. PDF available upon request, email info@changechampions.com.au

VIDEO: Driving with Dementia Professor Joseph E Ibrahim MBBS, Grad Cert HE, PhD, FRACP, FAFPHM This animated video addresses the myriad of complex issues involved in assessing whether a person with dementia is fit to drive. We hope that it will engage the audience and generate discussion amongst the general public and health professionals to help us all be better informed. https://www.youtube.com/watch?v=4F9z8mPhcTw&feature=youtu.be

VIDEO: To Resuscitate or Not? Professor Joseph E Ibrahim MBBS, Grad Cert HE, PhD, FRACP, FAFPHM Prof Joe wants your help. He's sitting having a tea when the ward bell sounds - a patient has collapsed in the hallway... his patient! Prof rushes to the scene to find that the person who has collapsed is Mr Rupert Jones, a man with dementia. The ICU doctor wants to know how bad his dementia is and whether or not they should stand down the code blue. Should they resuscitate Mr Jones? https://www.youtube.com/watch?v=4ps03E-NCaI

Anaesthesia Perioperative Care Clinician Storybook ACI- NSW Agency for Clinical Innovation The Anaesthesia Perioperative Care Network (APCN) interviewed people to find out about their experiences with surgery and general anaesthesia. The APCN is sharing these experiences with you in order to foster better conversations between patients, carers and clinicians. The ability to communicate effectively is a core skill for understanding and engaging with patients, for negotiating appropriate treatment, for ensuring health care practices are safe, and to encourage patients to be actively involved in their care and recovery. This storybook uses storyboards to share some of the key issues confronting people who undergo general anaesthesia and offers questions to enable health care providers to reflect on their current attitudes and practices. Ideally, it will encourage more person centred approaches to health care delivery. http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/247049/Anaesthesia-Perioperative-Care-ClinicianStorybook.pdf

Victorian Chemotherapy Service Redesign Project (VCSRP) Peter MacCallum Cancer Centre Key Messages and Executive Summary http://www.nemics.org.au/icms_docs/187330_VCSRP_Key_Messages_and_Executive_Summary_11th_April_2014.pdf

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Australian & NZ RESOURCES The Right to Refuse: Examining Forced Marriage in Australia A joint project of Good Shepherd Youth & Family Service, Domestic Violence Victoria and Good Shepherd Australia New Zealand McGuire, Magdalena, Social Policy Researcher Good Shepherd Youth & Family Service This project drew on The Right to Refuse forum (a cross-sectoral forum on forced marriage which was held by the research partners) and the literature to devise some key findings about forced marriage. http://www.goodshepvic.org.au/Assets/Files/Right_to_Refuse_final_report.pdf

Acute Coronary Syndromes Clinical Care Standard Australian Commission for Safety and Quality in Healthcare This resource provides guidance to clinicians and health service managers on delivering appropriate acute coronary syndromes care. http://www.safetyandquality.gov.au/our-work/clinical-care-standards/acute-coronary-syndromes-clinical-care-standard/

Preventing Falls for Older Farmers Australian Centre for Agricultural Health and Safety This guide has been developed with the help of farmers aged over 55 years to help you identify your own risk of falling and to take steps to prevent falling on the farm. Risks can include individual risks as well as risks in the farm workplace. Individual risks are specific to you and may be increased by health problems, your medications, and poor balance, limited flexibility and reduced muscle strength. Risks in the farm workplace will vary according to the type of farm and type of work being undertaken. Section 1 provides a falls risk checklist to help you identify your individual risk for falls, as well as a test of balance and strength to assess your falls risk. Section 2 helps you plan a way to prevent falling on the farm including practical exercises you can do to build strength and balance, simple things you can do on the farm to reduce the risk of falls and also provides a personal action plan to help you reduce your risk of falls. Section 3 adds ideas to the â&#x20AC;&#x153;Great Idea Bankâ&#x20AC;? of older farmers for making farm work easier and safer. http://www.aghealth.org.au/tinymce_fm/uploaded/falls_resource.pdf

Smartphone Speeds Up Ed to Ward Bed Transition Nursing Review NZ, December 2014 Vol 14 (6) Whangarei nurse PETER WOODS outlines how using a smartphone cut out the 'middleman' and got ED patients more quickly allocated a ward bed. http://www.nursingreview.co.nz/issue/december-2014-vol-14-6/smartphone-speeds-up-ed-to-ward-bed-transition/ #.VMr5q2iUdlr

Antimicrobial Stewardship Clinical Care Standard Australian Commission for Safety and Quality in Healthcare The Commission, in collaboration with consumers, clinicians, researchers and health organisations, has developed the Antimicrobial Stewardship Clinical Care Standard and resources to guide and support its implementation. This resource provides guidance to clinicians and health service managers on delivering appropriate care when prescribing antibiotics http://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard/

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International RESOURCES System leadershipLessons and learning from AQuA's Integrated Care Discovery Communities The Kings Fund, UK This paper seeks to identify the skills, knowledge and behaviours required of new system leaders and to learn from systems attempting to combine strong organisational leadership with collaborative system-level leadership approaches. The paper draws on three years' development work with leaders in health care systems in north-west England, undertaken by the Advancing Quality Alliance (AQuA) and The King's Fund which has adopted a 'discovery' approach to developing integrated care and the leadership capabilities supporting it. http://www.kingsfund.org.uk/publications/system-leadership

Making our health and care systems fit for an ageing population The Kings Fund, UK Within each component of care, the report sets out the goal the system should aim for, presents key evidence about works, gives examples of local innovations, and some pointers to major reviews and relevant guidance. It argues that if the health and care systems can get services right for our older population – those with the highest complexity, activity, spend, variability, and use of multiple services – they should be easier to get it right for other service users. The twin challenges of demography and funding demand no less. http://www.kingsfund.org.uk/publications/making-our-health-and-care-systems-fit-ageing-population

Japan’s Fureai Kippu Time-Banking in Elderly Care: Origins, Development, Challenges And Impact International Journal of Community Currency Research Mayumi Hayashi, King’s College London Japan’s Fureai Kippu (‘Ticket for a Caring Relationship’) refers to mutual support networks of members of all ages, targeted at providing care for older people through exchanges of time credits, sometimes supplemented by cash payments (‘timebanking’). This has attracted increasing attention as a potential contribution to the ‘Big Society’ with an ageing population. However, despite its pioneering role and scale, relatively little is known about the details and outcomes of Fureai Kippu, and meanwhile simplistic and optimistic generalisations predominate. This article, using historical analysis and empirical evidence, seeks to address these gaps by examining the origins of Fureai Kippu, its early expansion, post-2000 slowdown and responses. It considers the practical contributions and varied beneLits potentially offered by the system, along with its operational difLiculties. The conclusion is that Fureai Kippu is so complex that not only is evaluation difLicult but also no universal panacea can be expected from it. https://ijccr.files.wordpress.com/2012/08/ijccr-2012-hayashi.pdf

Preparing Tomorrow’s Leaders Today: Investing in Capacity Building for Nursing Health Services Research NHSRU (Nursing Health Services Research Unit), Canada This report provides an evaluation of the Undergraduate Student Research Internship Program (USRIP) and demonstrates how the program achieves its intended outcomes and how government investment contributes to health research capacity. Document analysis was used, which included financial records, publications and a review of annual reports dating back to the inception of the Nursing Health Services Research Unit. In addition, the McMaster University Research Internship Program Survey was sent to former student research interns. Quantitative and qualitative analysis of survey responses was conducted. Information obtained from all sources was plotted on a logic framework (Cooke, 2005; Cooke & Sarre, 2009). http://nhsru.com/publications/preparing-tomorrows-leaders-today-investing-in-capacity-building-for-nursing-healthservices-research/

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Corner Kylie Agllias Kylie Agllias (Ph.D.) is a social work academic with a practice background in family counselling, domestic violence, homeless youth and women in corrections. Kylie's world renown research in family estrangement commenced in 2007 and is ongoing with different populations. She continues to publish widely on this topic, with publications including an entry in the Encyclopedia of Social Work and highly ranked journals including Qualitative Health Research and Affilia. She provides evidence based estrangement workshops and master classes to health and welfare professionals and interest groups.Char Weeks is in internationally certified Executive Master Coach, a graduate of the Australian Institute of Company Directors. She has formal qualifications in change management from the Australian School of Business (formerly the Australian Graduate School of Management) and has studied business management at the Australian Institute of Management. Kylie blogs about Family Conflict on the Psychology Today website. To read her articles, simply visit:

http://www.psychologytoday.com/blog/family-conflict

Char Weeks Char Weeks is an internationally certified Executive Master Coach, a graduate of the Australian Institute of Company Directors. She has formal qualifications in change management from the Australian School of Business (formerly the Australian Graduate School of Management) and has studied business management at the Australian Institute of Management. Char has a passion for change management and health care service reform and is a strong advocate for older peopleâ&#x20AC;&#x2122;s health and well being. She is the full time carer for her 86 year old mother, Alison. Writing provides a luxurious vacation from the more mundane aspects of daily life for Char. In 2010, she published her first book, Handy Hints for the Novice Conference Presenter" which sold in 9 countries. Char blogs about a variety of topics including aged care, mental health and change management at:

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Change Champions & Associates Newsletter - FEBRUARY 2015


Feel like you’ve bitten off more than you can chew? STRICTLY CONFIDENTIAL We offer a comprehensive, practical

Coaching for Emerging Leaders, Program and Project Managers

service that aims to put you back in the driving seat at work. These are just some of the skills and services on offer:

Improve your effectiveness at work, build a sustainable, positive team culture that drives innovation and productivity

With Char Weeks Executive Master Coach

Identify and build on your strengths as a leader

Learn practical skills to develop your emotional intelligence at work

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Appointments available between

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Learn how to manage your energy rather than your time Learn how to support your manager to bring out the best in both of you Build your resilience at work with RAW scale assessment

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Book your appointment

Receive confidential advice about complex change management issues

Access the support you need to help you and your team survive turbulent times

Phone 0467 635 150, or email info@changechampions.com.au 42

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Develop your presentation skills or simply rehearse that all important presentation and receive constructive feedback. NB: Some services are suitable for tertiary students.


PO Box 302 Kew, Victoria 3101 AUSTRALIA E: info@changechampions.com.au W: www.changechampions.com.au

Change Champions & Associates invites you to contribute to this publication! Are you or your organisation working on a new project or initiative? Weâ&#x20AC;&#x2122;d love to hear about it! Please send us a 1 page article highlighting the major aspects of the initiative you are part of. Email articles, suggestions and advertising enquiries to info@changechampions.com.au

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Don’t forget to download a copy of the program! http://tinyurl.com/programrespecting

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Respecting Our Loved Older One’s Wishes Delivering integrated, consumer directed care where, when and how it’s needed. 25-27 February 2015 Melbourne City Conference Centre 333 Swanston St Melbourne (Opposite the State Library), VIC, AUSTRALIA 44

Change Champions & Associates Newsletter - FEBRUARY 2015

Change Champions & Associates Newsletter FEBRUARY 2015  

Newsletter for Innovators in Healthcare and Beyond

Change Champions & Associates Newsletter FEBRUARY 2015  

Newsletter for Innovators in Healthcare and Beyond

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