NEWSLETTER For innovators in healthcare & beyond NOVEMBER 2014
Contents P. 1
Colonoscopy Service Improvement Project Sarah Mavrikis, Kerry Leaver, Jayne Sandford Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health
P. 6
CODE GREED: Protecting Our Frail Aged Char Weeks Innovation Leader Change Champions & Associates
Colonoscopy Service Improvement Project Southern Adelaide Local Health Network (SALHN)
P. 10 Valuing People: A web based organisational self-assessment tool Christine Pappon Valuing People Project Manager Alzheimer’s Australia P. 11 Kids Acute Liaison in Mental Health (KALM) Cassandra Hainsworth Registered Psychologist, The Department of Psychological Medicine, The Children’s Hospital at Westmead, NSW P. 13 The Accelerated Chest pain Risk Evaluation (ACRE) Project Wade Skoien ACRE Project, QLD P. 15 Standardised Surgical Set Ups Improve Efficiency and Cost Peter Stewart, FRACS, General Surgeon, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District P. 17 The Cunningham Dax Collection– Art & Mental Health Anna Zagala Acting Manager, Operations and Communications Officer Dax Centre, VIC P. 19 WORKSHOPS & IN-HOUSES P. 32 BLOG CORNER
With more than 500,000 procedures occurring each year, many Australians will require at least one colonoscopy during their lifetime. The often feared procedure is a crucial tool in the prevention and early detection of cancer and major health problems associated with the gastrointestinal tract. The demand for colonoscopy services is increasing and the provision of equitable and appropriate services complex, given that it is used as both a diagnostic tool, and a screening and surveillance tool. People often have to wait to receive the procedure, and given the important functions it’s vital that public hospitals are providing access in a consistent and appropriate manner.
Change Champions & Associates Newsletter - NOVEMBER 2014
(Continued p. 3.)
Call for abstracts & posters Respecting Our Loved Older One’s Wishes– 2 day seminar [p.5]
Scheduled courses 24 NOVEMBER 2014 (VIC), 08 DECEMBER 2014 (Auckland, NZ) Building Resilient Teams at Work [p. 19] with Kathryn McEwen 25 FEBRUARY 2015 (1/2 day workshop in Melbourne, VIC) Care Homes Programme [p. 4] with Pam O’Nions 26-27 FEBRUARY 2015 (2 day seminar in Melbourne, VIC) Respecting Our Loved Older One’s Wishes [p. 5] APRIL– MAY 2015 (travelling one-day workshop, to WA, QLD, NSW, VIC) Working effectively with clients experiencing family estrangement [p. 20] with Kylie Agllias
In-house workshops Workshops with Char Weeks [p. 21] [p. 22] [p. 23] [p. 24]
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. 25]
Board Appointments Master Class Workshops with Robyn Attoe
[p. 26] [p. 27]
Delirium and the Older Person Managing Behavioural and Psychological Symptoms of Dementia Workshops with Alice Rota- Bartelink
[p. 28] [p. 29] [p. 30]
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. 31]
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The Long Stay Patient
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Colonoscopy Service Improvement Project, continued from page 1. provision. Once implemented, BLIS will create a standard waiting list by site and this will enable a demand and capacity modelling exercise to be undertaken at a site, LHN and state level to understand the demand for scopes and the timeliness of procedure across the SA Health system. Important first steps have been to gain network-wide clinician support for the project and agreement on urgency categories for each of the procedures included. From 1 July 2014, each referring clinician has been assigning the urgency categories in line with the developed policy and protocol. SALHN’s key obstacle for implementing the first phase is In order to achieve this, SA Health initiated a statewide
that gastroenterology scopes are managed differently at
Colonoscopy Service Improvement Project in 2014, as a
each site, resulting in variations in patient management and
result of a recommendation from the Commonwealth
service structure: this is in part due to different funding
Government’s National Definitions for Elective Surgery
models at the sites. From a quality and safety perspective,
Urgency Categorisation Project. The recommendation
this creates an opportunity to deliver standardised best
proposed for the expansion of Elective Surgery urgency
practice across SALHN. The SALHN gastroenterology
categories and national reporting arrangements to include
services are keen to develop the concept of one service
medical procedures, such as gastroenterology scopes.
delivered across three sites and a key enabler in achieving this is the consultative approach taken to engage all
SA Health is focussing a significant effort on improving the
stakeholders in the rationale for change and using their
delivery
expert knowledge to identify and resolve the barriers to
of
gastroenterology
services,
starting
with
colonoscopy. This will be achieved through the introduction
implementation.
of statewide arrangements for waiting list management, similar to those that have proven effective for elective
One other significant barrier is the multiple IT legacy
surgery services in South Australia.
systems in place. This means the LHN is unable to create one network-wide scope waiting list. The challenge will be
In June 2014, statewide policies and guidelines were
coming up with innovative ways of integrating the three
developed: most importantly, the introduction of standard
independent waiting lists to facilitate equitable access to
urgency categories for patient prioritisation. The project
network services for patients.
teams within each of South Australia’s Local Health Networks are tasked with their implementation. Let us now
The second phase of the project will use the service
focus specifically on the Southern Adelaide Local Health
modelling to inform future service planning and facilitate
Network (SALHN).
robust resource allocation decision making in the tight fiscal environment health is currently operating within.
The first phase is to implement a consistent and structured Booking List Information System (BLIS) for each of the three
SA Health’s commitment to improving patient outcomes is
hospitals
Centre,
demonstrated by this service improvement initiative, which
Repatriation General Hospital and Noarlunga Hospital. All
will ensure equitable and timely access to public
three sites are very different in terms of size and service
gastroenterology services for all South Australians.
within
SALHN;
Flinders
Sarah Mavrikis Project Officer Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health
3
Medical
Kerry Leaver Operations Manager Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health
Change Champions & Associates Newsletter - NOVEMBER 2014
Jayne Sandford Clinical Practice Improvement Officer Division of Surgery & Peri-Operative Medicine Flinders Medical Centre, SALHN SA Health
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 Keep an eye& out on the -website! 4 Change Champions Associates Newsletter NOVEMBER 2014 Visit www.changechampions.com.au
Abstracts & Posters due 15 November 2014 at midnight
Delivering integrated, consumer directed care where, when and how it’s needed. ON!
Olympic Park, Melbourne VIC, AUSTRALIA
ING SO M O C M A PROGR
INVITED KEYNOTE SPEAKERS
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Dr Régis 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) 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) Rod Quantock, Comedian, Dinner Speaker (confirmed) Dr David Skyes, General Manager, Learning and Development, Alzheimer's Australia VIC (confirmed)
EARLY DELEGATE REGISTRATIONS ARE NOW OPEN Visit www.changechampions.com.au
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D E E R G E D CO Protecting Our
Frail Aged Char Weeks Innovation Leader Change Champions & Associates
Staff, Patient and Visitor Safety in Healthcare Facilities
medical emergency like Arthur’s chest pain and loss of
An iced to the eyeballs hipster hurls obscenities while fist
aggression or violence.
consciousness. Code black signals a personal threat. In Victoria, there’s a code grey, called by a clinician to signal
punching moths in the cool night air, just missing a paramedic’s right temple. Elsewhere in a hospital
All of these codes stem from the recognition that the
emergency department, a ragged homeless woman,
safety of staff, patients and visitors is paramount. How
screams “I’ll cut you” as a medical team tries persuade
safe is a cognitively impaired nursing home resident when
her that she is safe from the demons rampaging through
one of their offspring whispers sweet nothings like, "Let
her mind. Nearby, a new arrival, Arthur, an ashen faced,
me take care of everything. You can trust me with all of
portly bloke who had been complaining of pain in his
your money. I'm not greedy like the others."
chest and shoulder tips, fades quietly out of life. And in a local nursing home, Jorge, has rammed his wheelchair into a nursing director’s shins during another attempted
Acute Hospital Episodes Connect Older People and Their Families to Frailty
breakout through the code locked glass doors because, “That bitch won’t get me a doctor”. Jorge has already
Too often, it’s an acute hospital episode, such as after a fall,
forgotten that his doctor has just left his side.
that first connects older people with not only their frailty, but the fragility of their physical and/or cognitive
These are all examples of behaviours, some far worse
independence.
than depicted here, that our dedicated healthcare teams regularly endure while just doing their job. The reality is
Relatives, friends and extended families can be caught off
that
emotional,
guard emotionally as they struggle with the difficult to
psychological or self inflicted can become extremely
digest truth that their older loved one is losing their ability
unpredictable and potentially dangerous. The offspring of
to care for them self. Conflicting opinions, expressions of
our frail aged share that same potential when life appears
grief, ulterior motives, perhaps fuelled by lingering sibling
to suddenly go pear-shaped for their parents.
rivalries or estrangement, may be even more distressing to
people
in
pain,
be it
physical,
their frail parent than the harsh reality of their health To a certain extent, Australian health professionals are
predicament. How safe are our elderly when they are
supported by standardized codes for dealing with
frightened, confused and not in control of their offsprings'
emergencies. There’s code blue that alerts everyone to a
behaviours? (Continued p. 7.)
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ED Protecting Our Frail Aged, Continued from p. 6.
Some families huddle into an all for one, and one for all,
Healthcare facilities across the spectrum are full of stories
team. In these families nearly everyone is willing to do that
such as that about the son who refused to allow his mother
little bit extra to smooth the transition from hospital. Their
to be discharged from a hospital to a nursing home until
focus is on the care and wellbeing of their loved one. They
she, against her wishes, granted him a power of attorney.
seek to fully understand their loved one’s wishes and to
There is the anecdote of the son who appeared out of
actively encourage their participation in discussions of
nowhere to make regular appearances at his dying father’s
options and final decisions. In the ideal family, at least one
bedside.
trusted person might know the whereabouts of a will, any powers of attorney, enduring guardianships, medical
During many of these encounters, the son apparently would
guardianship, advance care plans, organ donations and
leap on any opportunity to demonise his father’s deliciously
decisions about who gets what and when. Such a high level
attractive second wife as an uncaring gold digger. As the
of organisation may well alleviate pressures, concerns and
father’s condition deteriorated, the son is said to have
fears about the future for all concerned.
removed an art collection and furniture from his father’s home, apparently in an effort to spare the valuables from
Their loved one can leave hospital on a new journey to a
the ensuing post mortem carve up. Stories abound of
place, perhaps to home, perhaps not, where they can
threats to stop visiting the older person if they don’t make
receive the care that they need and still be happy and as
financial contributions to shore up future appearances.
independent as their condition allows. It’s hard to find a convincing argument that these vulnerable But not every family is cordial, generous, caring and sharing.
patients and residents are actually safe, especially from their own families.
Harmful Effects of Family Conflict and Family Estrangement
It is probably as difficult for healthcare professionals as it is for patients and residents to sift fact from fiction when it
According to family conflict expert Dr Kylie Agllias*, there is
comes to perceptions and attributions of avaricious or
mounting evidence that family conflict and estrangement
malicious intent among family members. This is particularly
are far more common than families care to share. The
the case with pernicious family dysfunction, where
stigma and embarrassment attached to family conflict and
members may appear to be caring so as to make others
estrangement may be unbearably painful for some
seem comparatively less than caring. Emotions may run
members. Others, unable to cope with the embarrassment
high,
of appearing dysfunctional, will do anything to brush any
communication may remain just perfunctory. Distrust has
brand of disharmony under the carpet in the name of blood
the capacity to spread faster than you can spell ebola as
ties and kinship.
disaffected relatives focus on issues among kin rather than
motivations
may
appear
questionable
and
actually helping their loved one to optimise their version of Then, there are those families whose members are openly
a quality life
shameless about playing out the blame game, nurturing conflict,
pitting
one
against
another
and
feeding
If no tangible evidence to support claims of ill will exist, then
estrangement in the hospital ward, nursing home or
it can be difficult to discern that a relationship with an
anywhere else that facilitates an airing of how hard done by
elderly parent is abusive. That is why we need a Code
they are compared to everyone else.
Greed…
(Continued p.8) 7
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ED Protecting Our Frail Aged, Continued from p. 7.
The Value of a Code Greed
The effective implementation of Code Greed, rests on the frail older person being able to provide a family history, by
Code Greed is very loosely based on the “Richardson
name, by relationship and emotional connection, including
Principle” that if there is a horse by the name of Self
those estranged, self distanced, incarcerated or just living
Interest running in a race, then back it. While not
overseas.
condoning gambling, visitor behaviours that reek of self interest sit at the heart of the need for a Code Greed. If
The next challenge for health professionals is to
Code Greed were to be adopted, it might be emerald
triangulate the family history and relationships between
green, the colour of envy. It is possible that convenience
relatives to ascertain the family dynamics and alert them
and self interest may offer in part, an explanation for the
to potentially difficult encounters. For example, when
sometimes dismal visitor turn outs for residents in many
there is friction between siblings that is obviously
of our aged care facilities. As an aside, it’s hard to miss
disturbing for the resident or patient, one might be
the selfless devotion of some offspring of some nursing
refused visitation while the other is present.
home residents. Code Greed would exist essentially to protect the frail aged
Protect Yourself Plan Your Own Transition to Frailty
from coercion, manipulation, unreasonable sense of entitlement and any other subtle or overt form of financial, legal, psychological or physical threat from a visitor, and especially, visitors named Relative. Code Greed would be patient or resident centred. It should be respectful of every patient or resident's right to be treated with dignity. It should support the patient or resident to have their expressed wishes heard and actioned as reasonable. Code Greed might also be clinically led. Code Greed could be called, for example, when any health professional:
hears or sees a patient or resident showing signs of sudden or unexplained onset distress before, while or after being visited
overhears repeated conversations that focus on the denigration or belittlement of another family member
overhears any visitor applying even the most subtle pressure to give them money or sign any documents
observes tension or arguments between patient or resident and visitor eg “Go. I don’t want you here.”
What people seem to consider late is that frailty is one of life’s milestones, just like that first milk tooth pushing through pink gums and that rolling stumble into your first steps. There are a million and one books available on all of those life stages from conception to cremation. But who talks about frailty as a life stage. Some how frailty is thrown in with all the other diseases that go hand in hand with ageing. Sure people talk about whether they will or won’t wish to go to a nursing home but very few people plan out their options for frailty, like they would their family, career or retirement. How often have you heard teenagers declare, “When I am 18, I am going to do what I like!” But when you have arrived at 85, it’s a little hard to stomach someone you hardly know telling you that you can no longer do what you like. Being forced to accept your limitations and the limits of your edition surely opens a whole new mass of emotions, that may be played out as rebelliously, angrily, defiantly or acceptingly as you might have at 17 years and 11 months. (Continued p. 9.)
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ED Protecting Our Frail Aged, Continued from p. 8.
So why don’t we plan for frailty? Do we believe it won’t
For the good of their own health and wellbeing, older
happen to us? Do we see our frailty inching towards us as it
people need to remain in control of living their lives,
lumbers across distant hills and valleys like a rusty stage
including their dependence on others. For many, though, it
coach with four lame horses? Maybe we just have blind spot
becomes a time fraught with grief, fear and a swirling
in our frailty hemisphere. Or are we simply naïve enough to
washing machine of bleeding emotions. Worse, it is often
think that when our time comes, our best interests will rise
compounded by opinions thrust upon them by everyone
first and foremost above all else, because “we have our
who thinks they know better about where they should go
family if nothing else”?
and who should take care of them and how. No wonder many frail older people feel worthless, unloved and become
Why not offer us frailty checks at 50 years of age when the
depressed. It’s hard for many people come to terms with
Government sends us that anniversary invitation for bowel
such a harsh reality that they are no longer able to care for
cancer screening. How about at our 60th birthday, when we
themselves.
receive our first Seniors card? Or maybe, we could receive a trip to our general practitioner for a reflex hammer to the knee, a memory test and a blood test when we announce our retirement from paid work. Older adults should consider writing a plan for their very
Char Weeks Innovation Leader Change Champions & Associates www.changechampions.com.au
own transition towards frailty way, way before they need transitional care from hospital to wherever. To ensure that
*Dr Kylie Agllias' renowned Master Class, Dealing Effectively with
their wishes including alternate or fall back plans in the
Clients Experiencing Family Estrangement will be held in capital
event of emergency, are crystal clear, the personal
cities in Australia in May 2015. Registrations open at
transition plan to frailty would, ideally, be discussed and
http://www.changechampions.com.au
shared with family members.
This article can be republished if author and source are clearly acknowledged.
Respecting Our Loved Older One’s Wishes: Delivering integrated, consumer directed care where, when and how it’s needed. 26-27 February 2015, Melbourne VIC Health, community and aged care professionals are frequently faced with the dilemma of how to care for older people while respecting their wishes and preserving their mobility and independence. Increasingly, when offered a choice, many older people prefer to remain in their home for the remainder of their life. Yet, in the context of the whole family, the availability and myriad of services and service providers, somehow enacting that decision sometimes comes with a whirlpool of complexities. This practical two day seminar is designed to examine changes in the way that healthcare is delivered to older Australians with a particular focus on person and family centred models of service and care delivery.
EARLY REGOS ARE OPEN! Visit www.changechampions.com.au 9
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Valuing People: a web based organisational self-assessment tool Christine Pappon Valuing People Project Manager Alzheimer’s Australia
What is the resource?
staff, managers, consumers and families/carers to develop
The concept of person centred care is not new, however many organisations struggle with implementing person centred models of service and care delivery. Alzheimer’s Australia has
a current organisational picture
The development of this national resource was informed by industry leaders through a Consortium, consumers and
It supports community aged care providers to implement organisational change strategies to facilitate best practice,
developed the Valuing People resource to support community aged care providers move towards more personalised services.
The self-assessment process captures the perspectives of
person-centred support.
The analysis of the feedback and associated report is generated online so as to minimise the workload for organisations undertaking the self-assessment
academic experts through advisory committees and a change management consultant. It has been supported by both local
Why is this important?
and international literature on person centred care and has
Alzheimer’s Australia recognised the need to support
been independently evaluated.
community organisations to move towards personalised services that are underpinned by dignity and respect for all.
Two major pilots provided the opportunity to test the resource
Valuing People is premised on the belief that organisations can
with a range of consumers, staff and organisational
only be person centred if all aspects of the organisation adopt
representatives and reinforced that the self-assessment
a person centred approach.
highlights areas of both strength and need for improvement for community aged care providers.
For those organisations that have already developed a service model that seeks to promote person centred care, Valuing
This 3 year project sought to improve the quality of
People is not intended to replace it. Rather it will support you
community-based support services by developing an evidence-
to determine how well these principles are being applied
based Person-Centred Community Support Framework and
across your service initiatives.
Organisational Self-Assessment Tool. The result is a resource that is unique for a number of key reasons:
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Change Champions & Associates Newsletter - NOVEMBER 2014
For more information contact: Christine Pappon Valuing People Project Manager Christine.Pappon@alzheimers.org.au
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Kids Acute Liaison in Mental Health (KALM) Cassandra Hainsworth Registered Psychologist, The Department of Psychological Medicine, The Children’s Hospital at Westmead, NSW
Background: The KALM project was conducted in the Emergency Department at the Children’s Hospital Westmead as part of the NSW Agency for Clinical Innovation (ACI) and the Centre for Healthcare Redesign (CHR) Diploma program. In partnership, Psychological Medicine and the Emergency Department (ED) conducted the KALM project because of the issues below: Mental health (MH) presentations to the ED at the Children’s Hospital at Westmead have increased exponentially (120%) since 2010, with research suggesting that this figure will continue to increase in the future. The increase of mental health presentation has impacted on achieving the National Emergency Access Target (NEAT) (4-hour rule) while maintaining quality of care. There is also a change in when patients are presenting to the ED. Weekend presentations are up by 48% from 2011. There is also an increase in morning and night presentations. With limited CNC coverage due to staff shortages, the current practice is that psychiatrist registrars are called in for all mental health presentations after hours. This puts pressure on the mental health budget. The nature of mental health presentations to the Emergency Department (ED) has also changed, with self-harm and suicidal ideation making up 50% of all mental health presentations in 2012 compared to 20% in 2002.
(Continued p.12) 11
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Kids Acute Liaison in Mental Health (KALM), Continued from p. 11.
The aim of the study: To measurably improve the model of care for children and adolescents presenting to The Children’s Hospital at Westmead Emergency Department requiring urgent mental health care. The KALM project established a clear pathway and guideline for all mental health presentations. The pathway aimed to improve collaboration between the Emergency Department and Psychological Medicine, ensuring patient care was always the prime focus. It also helped eliminate lengthy delays for patients which in turn improved the National Emergency Access Targets (NEAT).
Results: The results of the study have been extremely positive, with key improvements already resulting in significant benefits including:
Close collaboration between the Emergency and Psychological Medicine Departments in the assessment and treatment of mental health patients in the ED. This work is now shared equally by the two departments, resulting in better care and less delays for patients presenting with mental health issues.
Improvement in Psychological Medicine response time to ED consultation and attendance, meeting the KPIs set for the project.
By the end of the eight week initial trial, the pathway was followed 89% of the time.
When the pathway was followed the NEAT target was achieved 100% of the time over the last three weeks of the trial.
The ED medical staff conducted a brief HEADSS/MSE assessment on all mental health patients by the end of the trial as per the KALM pathway guideline.
60% reduction in the cost of overtime for Psychiatry Registrars.
Acknowledgements: Expert support from all the members of the KALM working party and steering committee:- Alison Lee, Prof David Bennett, A/Prof David Dossetor, Tim Hoffmann, Dr Mary McCaskill, Leonnie Dawson, Alan Gardo, Earle Durheim, Sangita Jaipuriar, Karen Munro, Andrea Worth, Dr Adrian Bonsall, Dr Vanessa Crawford, Dr Chandra Ayer, Marny Thomas and the Official Visitors.
For more info, please email Cassandra.hainsworth@health.nsw.gov.au
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The Accelerated Chest pain Risk Evaluation (ACRE) Project: Clinical Redesign to Achieve NEAT Compliance Wade Skoien ACRE Project, QLD Each year in Australia an estimated 500 000 patients present to hospital Emergency Departments (EDs) with possible cardiac chest pain. Up to 85% are eventually diagnosed with non cardiac causes, but require either extended ED stays or admission for diagnostic workup. Current risk stratification guidelines dictate protocols that prohibit compliance to the National Emergency Access Targets (NEAT), which state that by 2015, 90% of patients presenting to a public hospital ED will need to leave the ED or be admitted to hospital within 4 hours. The ACRE Project was designed to shorten the traditional cycle of evidence – guideline – clinical practice. Recent high level evidence - demonstrated in the ADAPT trial, has shown that the risk stratification of patients with possible acute coronary syndrome (ACS) can be safely fast tracked using accelerated diagnostic protocols (ADPs). This clinical redesign project and the implementation of the protocol aim to:
Improve in National Emergency Access Targets (NEAT) across QLD for patients presenting with possible cardiac chest pain
Improve patient journeys by reducing unnecessary time in hospital awaiting tests
Identify a group of low intermediate risk patients that can be safely, accelerated and discharged allowing resources to be allocated to higher risk patients
Reduce the percentage of admissions in the possible cardiac chest pain cohort (Continued p. 14.)
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The Accelerated Chest pain Risk Evaluation (ACRE) Project: Continued from p. 13. A successful pilot study at Nambour General Hospital (NGH) was achieved in 2012-2013. The existing chest pain guidelines at NGH ED were modified to incorporate a pathway termed SLIC (Short Low Intermediate risk Chest pain). Patients directed along this pathway were discharged from the ED after 0 and 2 hour serial ECG and Troponin testing, for an outpatient exercise stress test and then followed up by phone at 30 days to monitor outcomes and safety. Throughout the pilot study, 1762 patients presented to NGH with chest pain. Approximately 19% of the ‘possible cardiac chest pain’ presentations (i.e. excluding the confirmed ACS and clear non cardiac chest pain presentations) were designated as SLIC patients, which matched the results of the ADAPT trial. This represented 214 patients that were suitable for early discharge and outpatient follow up, thus avoiding admission. The average ED LOS for the SLIC patients was less than 180 minutes, well under the 240 minutes required to meet NEAT. This also contributed to reduced ED LOS overall, for all chest pain presentations. Comparing the most recent 6 months of the pilot study to the six months immediately before implementation of ACRE, the average ED LOS for all chest pain presentations had fallen from 425 to 344 minutes, an average reduction of 81 minutes. Following the success of the pilot study, a grant from the Queensland Government Health Innovation Fund (HIF) was awarded for statewide rollout of the project, supported by the Queensland Health Clinical Access and Redesign Unit (CARU). The accelerated diagnostic protocol has now been implemented in a further eight major sites throughout Queensland, with a number more currently in the planning stages of implementation. Early data from a number of our current sites have shown that the protocol is achieving the aims outlined above. We are confident that this trend will be replicated in all sites when data becomes available. For further information about the ACRE Project, visit: http://www.health.qld.gov.au/caru/html/acre.asp Figure – Average ED LOS at NGH for All chest pain, SLIC and non-SLIC patients from July 2012 to January 2013.
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Standardised Surgical Set Ups Improve Efficiency and Cost Peter Stewart, FRACS, General Surgeon, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District The John Hunter Hospital in Newcastle, NSW is the tertiary hospital for the Hunter New England Local Health District (HNELHD), with approximately 550 laparoscopic appendicectomy and cholecystectomy operations performed annually. HoPreviously, each of the thirteen surgeons in our Acute General Surgery Unit had an individual preference card for both laparoscopic appendicectomy and laparoscopic cholecystectomy. Furthermore, due to operating theatre case load and a 24 hour surgeon roster, one third of appendicectomy and two thirds of cholecystectomy patients had their operation booked by one surgeon but were operated on by another. This caused confusion, with incorrect or unavailable equipment in the operating theatre leading to time delays, frustration and excess cost due to opened but unused equipment.
Phase I: What was happening
The standardised set up card and kits were introduced into clinical practice in May 2013.
To define the pre-existing situation, cost analysis per case and per annum was performed. Researchers observed op-
Phase III- Description of change
erations to determine the frequency of opened but unused items, and variation of equipment from the preference
Implementation of standardised set ups and equipment
card. Staff time and motion was assessed by recording the
resulted in
number of scout nurse excursions to the equipment supply area for items not on the preference card. Qualitative costs
Reduced cost
were assessed by conducting a survey of operating theatre
Improved efficiency
nursing staff that assessed satisfaction regarding equip-
Improved staff satisfaction
ment variability. The standardised kits resulted in a total annual cost reducThe optimal solution to this issue was to standardise the
tion of over $78,000. The kits also reduced the variations
set up cards and equipment for laparoscopic appendicecto-
from the preference card, or opened but unused items
my and cholecystectomy operations.
from 75% of cases to 37.5%. Post implementation analysis identified most of these variations to be due to a single
Phase II- Implementing change
equipment issue, which was easily rectified. Staff efficiency has improved. Nursing staff excursions to central supplies
All thirteen surgeons collaborated in the development of an agreed list of essential single use items for each operation. Two industry suppliers were invited to prepare the required equipment, and the most competitive price for the preferred items to be purchased as a kit was negotiated by an independent medical administrator.
for additional equipment occurred more than five times per case prior to the implementation of the standardised set ups, reduced to around once per case since implementation. Satisfaction surveys demonstrated the kits have received overwhelming support from both nursing staff and surgeons. (Continued p. 16.)
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Standardised Surgical Set Ups Improve Efficiency and Cost, Continued from p. 15.
A Laparoscopic Cholecystectomy kit as it is supplied and stored (above); the contents of a Laparoscopic Cholecystectomy kit (below). The items encircled yellow are supplied in all kits and so purchased at a discount rate, but only opened on an ‘as needed’ basis. If not used they can be used for another operation.
Have the kits been beneficial to our theatre?
%
Nursing staff survey following implementation of the standardised set up cards and kits
The standardised kits were subsequently introduced to another hospital in the HNELHD, and would be applicable to other high volume units. Through engagement of all staff involved, opportunities were identified to extend this concept to other surgical specialties with similar issues such as Obstetrics and Cardiothoracic Surgery. This innovation project has improved efficiency, staff satisfaction and cost for our hospital, and resources released can be used in other ways. Dr Peter Stewart drpeterstewart@gmail.com Or Dr Peter Pockney Peter.Pockney@hnehealth.nsw.gov.au 16
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Some of the equipment in use during a laparoscopic cholecystectomy
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The Cunningham Dax Collection Art & Mental Health Anna Zagala Acting Manager, Operations and Communications Officer Dax Centre, VIC
Kopi mourning caps – clay head ware used by northern Victoria’s Indigenous communities for thousands of years as part of mourning rituals – played an important role in a recent professional development workshop held at The Dax Centre last month. The Kopi mourning cap represents loss, sorrow and grief. When in mourning, Aboriginal women would cut off their hair, weave a net of emu sinew and place it on their head. Afterwards they would cover the sinew with several layers of gypsum, a white river clay, forming the Kopi. Women wore the Kopi from two weeks to six months depending on their relationship to the deceased. At the end of the mourning period the Kopi was taken off and placed on the grave of their loved one. The Dax Centre hosted a two-day experiential art therapy workshop on this Indigenous mourning ritual as part of a two-year project researching the role of art in promoting healing and emotional wellbeing in Aboriginal communities. The workshop – facilitated by artists Maree Clarke and Robyne Latham and professional art therapist Kate Richards – invited participants to learn about the history of Kopi caps and hear about the revitalisation of this cultural practice and to explore their own experience of grief and loss. Seventeen participants from a variety of backgrounds: occupational therapy, art therapy and indigenous health, worked in pairs to make and decorate their own Kopi caps using clay, feathers, paint and found objects. In addition to creating caps, attendants also took part in facilitated group reflection. For many it was a powerful experience. Located on the grounds of the University of Melbourne, The Dax Centre is a multi-faceted not-for-profit organisation that promotes mental health and wellbeing through art. At the heart of The Dax Centre is the Cunningham Dax Collection, a collection of over 15,000 artworks created by people with an experience of mental illness or psychological trauma. (Continued p. 18) 17
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The Cunningham Dax Collection, Continued from p. 17.
The Collection is named after its founder Dr Eric Cunningham Dax. Dr Eric Cunningham Dax was a pioneering psychiatrist who helped reform the mental health system in Australia. He started community-based services such as Lifeline – a world’s first at the time. Dr Dax strongly believed in the value of art and creativity, and initiated art programs for patients in institutions as far back as the 1940s. In the 1980s when psychiatric institutions were closed down Dr Dax began to salvage thousands of artworks from skip bins. Recent acquisitions include artwork by survivors of the Holocaust and their children, by children from war-torn Kosovo and East Timor, and by survivors of the Black Saturday Bushfires in 2009. Staff works closely with artists and communities who contribute their work and life stories to this Collection. The Dax Centre uses this Collection as the centrepiece of exhibitions, education programs for students at all levels and for the community at large and professional development. Those in Melbourne between now and late February can catch the new exhibition Raw Emotion: Contemporary and Historic Works from the Cunningham Dax Collection. For more information visit: www.daxcentre.org or http://healingways.daxcentre.org/
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BUILDING RESILIENT TEAMS AT WORK A Full Day Workshop for Leaders and Leadership Teams The most valuable assets in any organisation are their people. Today’s executives and leaders appreciate the need to be on top of their game all of the time; regardless of the pressures they face from an ever changing environment. They are expected to be able to support their teams through a myriad of challenges while maintaining a positive work environment. This practical workshop is for the emotionally intelligent: those who understand that RESILIENCE is a key characteristic of a healthy, productive and sustainable team.
Who Should Attend Executives, managers and team leaders from any government or professional or industry sector. Delegates are welcome to bring case studies for discussion in strictest confidence.
2014
DATES
24 Nov 2014– Melbourne, VIC 08 Dec 2014– Auckland, NZ 19
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KATHRYN MCEWEN is an organisational psychologist, company director and executive coach. Join her for this stimulating workshop, purposely designed to provide you with the strategies and tools you need to build resilience at work.
For more info, or to register online please visit:
WWW.CHANGECHAMPIONS.COM.AU
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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 20
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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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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
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The New Leaders Toolkit Full day workshop with Char Weeks
A Practical Workshop on the Stuff That’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. It’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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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 ‘board ready’ and onto the board you want.
www.changechampions.com.au 25
Change Champions & Associates Newsletter - NOVEMBER 2014
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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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 ‌
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 29
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
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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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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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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 people’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:
http://charweeks.hubpages.com/ 32
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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
GAICD, GCCM, BMC, CHE, BA
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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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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? We’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 Diane Vatinel at: info@changechampions.com.au
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