Research Project Report - University of Tasmania · Research Project Report “Implementing self...

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March 2011 1 Research Project Report “Implementing self management into chronic disease care: Mapping an organisational and systems approach through the North West Area Health Service, Tasmania” Maree Gleeson- University of Tasmania Rural Clinical School Sharon Griffiths Department of Health & Human Services Population Health Background The NWAHS is incorporating strategies to encourage an organisational and systems change to the management of chronic disease. By incorporating strategies to encourage a ‚self management‛ approach to health and disease management the NWAHS is endeavouring to facilitate the way in which health professionals work to ensure that the client is at the centre of decision making for their health care. An important aspect of this process is the role that senior managers play in leading this change. Their understanding and perceived level of organisational support will play an important role in executing these changes. The study will utilise the ‚Navigating self management manual: A practical approach to implementation for Australian health care agencies‛ (2007 DOHA) document which emphasises the important role that organisational leaders play in facilitating this shift and outlines the strategies required to ensure success. It is anticipated that results from this study will assist in providing feedback to managers, senior executives of the Service and general staff to illuminate the areas of change that need to be addressed. It will also provide valuable base line data on perceived organisational status against which to measure future changes. In turn this information will allow for reflection on strategies that are important in contributing to organisation and systems changes in relation to chronic disease self management. Aims: To determine perceptions of senior managers and selected key staff to the preparedness of the North West Area Health Service (NWAHS) in implementing a chronic disease self management approach to health care. To gain an understanding of the perceived enablers and barriers to facilitate implementing self management into chronic disease care. To ascertain the views that managers have toward the implementation of the DHHS Strategic Directions which reflect the principles of chronic disease self management principles. To map the processes undertaken by the NWAHS in implementing chronic disease self management into the organisation.

Transcript of Research Project Report - University of Tasmania · Research Project Report “Implementing self...

Page 1: Research Project Report - University of Tasmania · Research Project Report “Implementing self management into chronic disease care: Mapping an organisational and systems approach

March 2011 1

Research Project Report

“Implementing self management into chronic disease care: Mapping an

organisational and systems approach through the North West Area Health Service,

Tasmania”

Maree Gleeson- University of Tasmania Rural Clinical School

Sharon Griffiths – Department of Health & Human Services Population Health

Background

The NWAHS is incorporating strategies to encourage an organisational and systems

change to the management of chronic disease. By incorporating strategies to

encourage a ‚self management‛ approach to health and disease management the

NWAHS is endeavouring to facilitate the way in which health professionals work to

ensure that the client is at the centre of decision making for their health care. An

important aspect of this process is the role that senior managers play in leading this

change. Their understanding and perceived level of organisational support will play

an important role in executing these changes. The study will utilise the ‚Navigating

self management manual: A practical approach to implementation for Australian

health care agencies‛ (2007 DOHA) document which emphasises the important role

that organisational leaders play in facilitating this shift and outlines the strategies

required to ensure success.

It is anticipated that results from this study will assist in providing feedback to

managers, senior executives of the Service and general staff to illuminate the areas of

change that need to be addressed. It will also provide valuable base line data on

perceived organisational status against which to measure future changes. In turn

this information will allow for reflection on strategies that are important in

contributing to organisation and systems changes in relation to chronic disease self

management.

Aims:

To determine perceptions of senior managers and selected key staff to the

preparedness of the North West Area Health Service (NWAHS) in

implementing a chronic disease self management approach to health care.

To gain an understanding of the perceived enablers and barriers to facilitate

implementing self management into chronic disease care.

To ascertain the views that managers have toward the implementation of the

DHHS Strategic Directions which reflect the principles of chronic disease self

management principles.

To map the processes undertaken by the NWAHS in implementing chronic

disease self management into the organisation.

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Participants

Participants of the research will be selected from the DHHS North West Area Health

Service. These groups include:

Phase 1:

- All managers invited to attend the ‚Embedding Chronic Conditions Self

Management into Systems and Organisations‛ workshop being organised by

DHHS Population Health.

Phase 2:

- Volunteers from the senior management group and key staff at the NWAHS.

The above groups have been chosen because they represent most closely the cohort

of staff that have been deemed to be important in influencing and managing

organisational and systems change in chronic disease self management as purported

by the ‚Navigating self management manual: A practical approach to

implementation for Australian health care agencies‛ (2007 DOHA).

Their view of the organisations preparedness for change and the enablers and

barriers to execute the strategy are important variables to consider for future

development of health services.

Because of the nature of the research there is no control group, however there is a

possibility that the research will be repeated in the future and data from this project

used as baseline to measure change over time.

Brief outline of methodology:

Phase 1: An anonymous survey (developed on SurveyMonkey) was sent to senior

managers and key staff involved in strategic planning of chronic disease care from

the NWAHS. The survey was based on the principles of chronic disease

management as indicated in the ‚Navigating self management manual: A practical

approach to implementation for Australian health care agencies‛ (2007 DOHA).

The first part of the survey consisted of 23 items (Appendix 1) combining questions

answerable on a 5 point Likert scale with an additional ‘not sure’ option and open

ended responses. It explored attitudes towards the variables that impact on

systems and organisational change and how this relates to the NWAHS. The second

part of the survey consists of a 5 item 5 point Likert scale with an additional ‘not

sure’ option and open ended responses. These questions related to the strategic

directions of the Tasmanian Health Plan and how the NWAHS aligned with these

principles.

Phase 2: This involved interviews with 7 managers/key staff who identified their

willingness to partake. The semi structured interviews included 8 key questions

(Appendix 2) to collect qualitative complimentary data.

Phase 3: This related to a mapping exercise of education, training and organisational

activities relevant to facilitating systems change related to chronic disease self

management. This will take place following discussion with NWAHS CEO

regarding Phase 1 and 2 of the research.

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Results - Phase 1

Chart 1: This chart shows that more than half of the participants indicated that the

NWAHS provides leadership investment (at the top level) at least somewhat or quite

well with an average score of 2.6 (or below) out of 5 on the Likert scale

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Chart 2: This chart indicates that more than half of the participants perceived the

NWAHS as taking a system approach somewhat or not at all with an average score

of 2.6 (or below) out of 5 on the Likert scale

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Chart 3: This chart indicates that more than half of the participants perceived the

NWAHS to provide training ‚not at all’ or ‚somewhat‛ with an average score of 2

(or below) out of 5 on the Likert scale

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Chart 4: This chart indicates that most participants perceived the NWAHS as

empowering action through working groups ‚not at all‛ or ‚somewhat‛ with an

average score of 2.7 (or below) out of 5 on the Likert Scale

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Chart 5: This chart indicates that most participants perceived the NWAHS as not

embedding chronic disease self management into strategic service planning with an

average response rate of 2 out of 5 on the Likert scale

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Chart 6: This chart indicates that most participants perceived the NWAHS as not

taking a regional approach to support chronic disease self management with an

average score of 2 (or below) out of 5 on the Likert Scale

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Chart 7: This chart indicates that most participants perceived the NWAHS using an

evidence base ‚somewhat‛ or ‚not at all‛ to support chronic disease self

management with an average score of 2.6 (or below) out of 5 on the Likert Scale

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Chart 8: This chart indicates that most participants perceived the NWAHS as either

not engaging General Practice or not being aware of engaging General Practice to

support chronic disease self management with an average score of 2.3 (or below) out

of 5 on the Likert Scale

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Chart 9: This chart indicates that just over half of the participants that responded

perceived the NWAHS as meeting the strategic objective of supporting individuals,

families and communities to have more control over what matters to them.

Chart 10: This chart indicates that more than half of the participants that responded

perceived that the NWAHS as only ‚somewhat‛ or ‚not at all‛ fulfilling the strategic

objective of promoting health and wellbeing and intervening early when needed

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Chart 11: This chart indicates that most participants that responded perceived that

the NWAHS was fulfilling the strategic objective of developing responsive,

accessible and sustainable services

Chart 12: This chart indicates that just over half of the participants that responded

perceived that the NWAHS was fulfilling the strategic objective of creating

collaborative partnerships to support the development of healthier communities.

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Chart 13: This chart indicates that just over half of the participants that responded

perceived that the NWAHS was fulfilling the strategic objective of shaping our

workforce to be capable of meeting changing needs and future requirements

Results – Phase 2

Themes from CDSM Research

CDSM Framework:

1. Leadership investment (at the top level)

2. Taking a systems approach

3. Invest in training

4. Empowering action through working groups

5. Strategic plans, work plans and position descriptions

6. A regional approach

7. Use an evidence base

8. Engage General Practice

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CDSM

Frame-

work

Themes / Comments Quotes

2, 3, 5 A range of training offered and

undertaken by interested health

professionals in various units and

departments / small pockets. However

with no strategic plan in how to

implement this further (deeper and

wider – in a more integrated way in

care but also across units and for

patients).

‚…but I actually want to start looking at how

[training] works from practical level and I think

once you’ve got that it’s better to see where

you’ve got to go from a leadership perspective

and how you can get people there‛

1, 2 There is strategic intent but no long

term planning for strategic direction,

some of this is due to competing

demands for example the Tasmanian

Health Plan, delivery of clinical

services, health reform, separation of

primary health from acute care

services.

‚….all talks about moving forward for chronic

disease but at this stage, as I said, it’s just tiny

little steps that we see any improvement‛

‚…. From the top down we’ve got to have more

of a drive, you know its like the chronic disease

framework that’s come out and the fact that

we’re just about to go through this

implementation phase of it and yet I don’t feel

like it’s really being drive down from the top‛

‚…the approach is so much *about+ problem

solve, get the person out‛

‚…I think primary health is a much easier setting

where people are going into their homes or you

know there’s longer appointments in the

community setting rather than, you know

eighteen patients a day that we see here, well,

we’ve got to get them out as quickly as possible‛

‚….I guess probably due to the time constraints

for us [acute setting] that was quite

difficult…when we actually go to the clients

house that is probably more of an in depth

assessment to see how we can manage that [their

chronic disease] in conjunction with them and

their families‛

1,2,3,4,5,

6 There needs to be a change in culture

around using language that is

consistent with chronic disease self

management within the area health

services (across disciplines).

‚…I don’t think there’s a collective team

approach… I don’t see doctors, nurses and allied

health professionals talking in a chronic disease

type of way or, but I do see it in pockets‛

‚…I suppose it’s developing that culture, so

having it as a language that we use, we’re

familiar with it, we all understand it and are

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working towards it so that’s really to me

developing leadership in others because we’re

all, I suppose wanting to speak the same

language and move forward in the same way‛

‚…we have not got the doctors on board, and in

terms of if we are going to roll out this strategy

the doctors, if they continue to work in the

medical model, and the same for nursing staff as

well, we’re going to be, banging our heads

against a brick wall‛

1,3,5 Gap between strategic intent and

strategic implementation for example

increasing capacity of managers in

relation to having the skill level to re-

direct their operational plans, position

descriptions and funding. This is

variable.

‚So I think it’s got to be led from the top and it’s

go to be a consistent message right across the

whole service and it’s got to be an ongoing

message that’s driven over and over because

you’re talking about a change in culture‛

‚…I don’t think we are setting jobs up in a

strategic way…you know we’re still setting them

up under a medical model‛

7 People are aware of the importance of

evidence base but it needs to be in the

Tasmanian context. There are variable

opportunities to collect data under the

current system (some can, some can’t)

there is no strategic intent or direction

to collect data or to utilise it.

Documentation of what is being done

with individual clients but there is no

consistent approach to collecting this

information.

‚…one of the things I sort of thought about after

the workshops is that we are not really assessing

or formally wiring down the things…at each

point that they are contacting the hospital for

example, we’re not really assessing or writing

down what we are doing for their chronic

conditions‛

4 Some participants were involved in

working groups and found this very

valuable, those who weren’t thought it

was very necessary as a vehicle to

progress CDSM forward consistently.

‚…I have been part of a fabulous little concept

*working group+ …the self management focus

forum…I thought that this was a really great

concept and I would love to see that continue‛

‚…we *the unit+ all have that same philosophy…

we have regular staff meetings and certainly this

[CDSM] has been a topical issue in our staff

meetings and how we actually go employing

what we’ve learnt on a daily basis… how we

change what we do…you know we talk about

that and how we’re actually going to put the

changes into place‛ 8 There was very little evidence to

support an awareness of general

practice integration.

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Discussion

This project opened the way for discussions with the local health service relating to

the preparedness of the organisation to support health professionals to practice

within a chronic disease self management framework. Health professionals in the

study reported a good understanding of approaches to chronic disease self

management and the importance of how this could facilitate change within the area

health service.

Of particular interest were the identified barriers of implementing a CDSM

framework across all levels of the service. This related mostly to a perception of

competing priorities between service delivery and not having the time to spend with

acute care patients in a more person centred/decision making approach. The culture

of a medical model of care was identified as an impediment to infiltrating all layers

of the health system especially in the area of acute care service. This was translated

in perceptions of the health service having ‚pockets‛ of focused CDSM approaches

to care.

Where these ‚pockets‛ existed it was evident that a number of staff in these areas

had been able to participate in CDSM training (a key focus of the CCP&SM Team

was to provide CDSM training opportunities to health professionals from the period

2007 to 2010). However, whilst a number of training initiatives have been made

available to staff feedback indicated there had not been enough investment made in

training or how the outcomes of training would be translated into practice.

Whilst participants reported evidence of strategic intent from the health service there

was no visible long term plan or direction to implement a CDSM approach.

Recommendations

Complete the Discussion component of this report (Phase 1 and 2 of the

project) following meeting with CEO, NWAHS.

Provide written report (Phase 1 and 2) to the NWAHS Executive.

Disseminate information through appropriate forums.

Phase 3 suggestions:

Upon recommendation from the NWAHS undertake further investigation of

staff perceptions of embedding CDSM into systems / organisation for example

increasing the cohort to include a larger target population or focusing in on a

work unit.

Mapping exercise of education, training and organisational activities that are

relevant to facilitating systems change related to chronic disease self

management.

Focus on the Stanford Chronic Disease Self Management Program: undertake

a further investigation of the perceptions of Stanford Leaders, Managers and

peers in the preparedness of the North West Area Health Service to embed

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the Stanford Chronic Disease Self Management Program as part of Chronic

Disease Management processes.

NWAHS ability to implement the Stanford Program within existing

work practices (with a focus on leadership/organisational capacity)