Evidence, Standards and Outcomes: Taking a leadership role in palliative care

Tieman JJ, Rawlings D, Mills S, Banfield MPCWA Conference, October 2012

Overview of session

•Quality Issues: Drivers, evidence, approaches

•Working Together: CareSearch, NSAP, PCOC

•Six Questions

Drivers for change•Health care variability

• Not receiving recommended care• Fragmented care

•Demand issues• Increased demand• Changing patterns of need

•Dynamic evidence base•Costs and resources•Health information technology

QI and Evidence•EBM/EBP: Evidence to inform quality care•Evidence as content in QI processes•Value add between EBM and QI•Emerging evidence of value of QI•QI processes as a source of new evidence

Working Together Partnership•CareSearch, NSAP, PCOC

•MOU signed in 2010…common interest, informed by different but aligned perspectives, in improving palliative care in Australia by upskilling palliative care services, facilitating quality improvement and encouraging the use of evidence in practice.

Working Together: NSAP, PCOC, CareSearch

All programs funded by Department of Health and AgingAll work with Palliative Care Services to improve Service quality

STANDARDSNSAP: National Standards Assessment Program• Services complete a self assessment snapshot

every 2 years against the standards• Create and implement a quality improvement

action plan, based on these results

OUTCOMESPCOC: Palliative Care Outcomes CollaborativeUtilises standardised validated clinical assessment tools to benchmark and measure outcomes in palliative care

EVIDENCECareSearch: Australia’s Palliative Care knowledge baseLatest resources and evidence

Working Together Projects•Integration of current activities•Identification of services •Working Together Change Framework

• WTCF Workshops• WTCF Study

•Change Management Hub:• Tools registry• QI searches

How do we work together?

Evidence Sources for NSAP Self AssessmentPCOC: Palliative Care Outcomes Collaboration

Outcomes can be used as an evidence source for your NSAP Self Assessment

CareSearchProvides links to quality tools which can be used for

NSAP Self Assessment

Quality Improvement Results and latest evidence for development of a Quality Improvement Action Plan

PCOC ReportNSAP Results & Key Improvement Areas

CareSearch Evidence

PCOC CareSearch

NSAP

PCOC NSAP CareSearch

Quality Improvement Action Plan

Working Together Change Framework

Question 1:

•Think about how you know there is a problem. Describe the problem for others.Be specific about the problem.

•Outline how big a problem it is and how it affects your work and your patients.

•You also need to consider whether it is a problem that you can solve.

Is there a problem?

Question 2: •Do some analysis on possible causes

• Service characteristics• Patient population• Feedback from patients/staff

•Check to see if there are reports or articles on similar problems

•Speak with other services about whether similar issues

What is causing the problem?

Question 3:•Check for evidence on the specific issue.Find out if there is evidence for new or different approaches.

•Find out if there are tools or measures you could use.

•Review what is effective in change management. Think if some of these strategies could be used in your plan.

Is there evidence

about what to do?

Question 4:•Check your plan indicates• Who• What• By when

•Make sure your plan is suitable for your service.

•Identify and include measures that can be used to show if things are changing

Does your plan address the issues?

Question 5:•Monitor what is happening as you implement the plan.

•You may need to vary your plan. Things change.People change. New information may emerge.

•Keep a note of why something changed and what you did in response.

Were you able to

implement your plan?

Question 6:•Review everything that happened.Just because you did something does not mean that what you wanted to, or expected to, happen actually did happen.

•Determine if the problem has been solved. Think about whether a different approach is needed.

Have you reviewed what you

did?

WTCF Workshop Evaluation•Ethics received for evaluation study

• Post-workshop questionnaire• Follow up survey (8 weeks)

•Objectives• To determine Workshop participants’ responses to the

Working Together Change Framework• To evaluate the effectiveness of the Workshop content and

format• To determine if participation in the Workshop led to

change activity in the service

Using the Working Together Group•Services can identify quality improvement opportunities through PCOC, NSAP processes

•Evidence summaries on priority areas available through CareSearch

•Workshops and projects to build knowledge and expertise in QI

CareSearch, NSAP and PCOC are funded by the Australian

Government Department of Health and Ageing.