Evidence, Standards and Outcomes: Taking a leadership role in palliative care Tieman JJ, Rawlings D, Mills S, Banfield M PCWA 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 Aging All work with Palliative Care Services to improve Service quality STANDARDS NSAP: 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

OUTCOMES PCOC: Palliative Care Outcomes Collaborative Utilises standardised validated clinical assessment tools to benchmark and measure outcomes in palliative care EVIDENCE CareSearch: Australia’s Palliative Care knowledge base Latest 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 Assessment PCOC: Palliative Care Outcomes Collaboration Outcomes can be used as an evidence source for your NSAP Self Assessment CareSearch Provides 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 Report NSAP Results & Key Improvement Areas CareSearch Evidence PCOCCareSearch NSAP PCOCNSAPCareSearch Quality Improvement Action Plan

Working Together Change Framework Is there a problem? What is causing the problem? Is there evidence about what to do? Does your plan address the issues? Were you able to implement your plan? Have you reviewed what you did?

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.