Working Together - Act – Sustaining
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Act – Sustaining

The “Act” module focusses on sustaining the service partnership and the improvements that have been achieved in the provision of palliative care and advance care planning for older people in your care.  Sustainability is about maintaining the partnership and the change or improvement that has been implemented, continuing to build on it 14 and not letting old processes return. 15

If the improvement hasn’t been successful, analyse what can be done differently

and go through the PDCA cycle again with an amended plan.

If the improvement has been successful, continue on with the activities discussed in this module.

https://www.agedcarequality.gov.au/providers/residential-aged-care/copy_of_processes/continuous-improvement

After working through this module, you will have an understanding of:

  • Methods to embed and maintain the improvements in the provision of palliative care and advance care planning for older people in your care
  • Methods to spread the improvements achieved and to increase the impact of their implementation within your service
  • How you might celebrate the successes and share the story of working together with other care service providers

Key organisational elements required to sustain improvement

  • Supportive management structure – leadership;
  • Resources and capacity;
  • Robust, transparent feedback systems – communication;
  • Shared sense of the systems to be improved – shared vision;
  • Well defined roles and responsibilities;
  • Improvement culture and staff engagement; and
  • Formal capacity-building programs. 9 15

This section looks at how to embed and maintain the improvements that have been made in the provision of palliative care and advance care planning for the older persons in your care.

Embed your improvement

You can give the improvements you’ve made the best chance of ongoing success by:

  • Ensuring all staff involved are informed of new processes;
  • Updating relevant policies and procedures;
  • Including new processes in staff orientation and ongoing education;
  • Communication with all care service partners and staff involved;
  • Ensuring the partnership survives the departure of individuals and enables newcomers to catch up quickly by succession planning;
  • Forming a working group (if not already done so). Please refer to Residential Aged Care & Home Care What can my organisation do Toolkits - Action 1 Form a Palliative Care and Advance Care Planning Working Group;
  • Ongoing evaluation and reporting;
  • Maintaining staff engagement; and
  • Empowering Champions 7 15

Identify and empower palliative care and advance care planning champions

Identify and empower champions who are strong advocates and deeply committed to the successes of working together to improve palliative care and advance care planning for older people. 

They may help to navigate roadblocks to the partnership’s success, act as a resource for other staff, assist with improvement activities, build motivation and encourage participation 2 16. (Please refer to Residential Aged Care & Home Care What can my organisation do Toolkits - Action 2 Identify Palliative Care and Advance Care Planning Champions;)

Continuing on

Maintaining the improvements in the provision of palliative care for older people, and the momentum of the partnership successes are the priority now. Consider these issues:

  • The partnership continues, but may require some adjustments. 17
  • Inviting new service partners to work together to achieve the best possible palliative care and advance care planning for older persons in your care.
  • Periodic review/evaluation as per the partnership agreement
  • Communication planning and leadership remain vital
  • Continue ongoing embedding processes
  • Building resilience and improvement culture – while mentioned briefly below, this will be expanded upon in future updates of the online Toolkit content.

Resilience is an individual’s ability to cope under pressure and to adjust to adversity. 18 19

Resilient people have strong resources, support networks and skills to help manage stress and conflict. 20  They contribute to creating a resilient culture and organisation.

“Taking action to foster resilience will help to build positive workplace cultures that support high-quality, person-centred care and support” 19(page 3)

Practical considerations to support resilience. Managerial support and strong leadership; transparent, open communication; listening skills; encourage respectful supportive teams and networks; reward and encourage achievements; Human Resource policies (work hours, leave etc.); encourage and support physical and mental health wellbeing including methods to manage stress. 18 21

You can find extra reading (1304kb pdf) on these issues.

This section looks at how to spread and increase the scale of the improvements that have been made in the provision of palliative care and advance care planning for the older persons in your care.  Initially you may have introduced the improvement process into one area of your service only, once success has been established, increase the scale and spread, by introducing the improvement through more areas of your service. 6

Spread:  “Actively disseminating best practice and knowledge about every intervention and implementing each intervention in every available care setting. 14page 3

Scale:    increasing the impact of the improvement

http://www.effectivepartnering.org/factor/context-reach-impact/scaling/

Develop a plan for upscaling and spread

The Institute for Healthcare Improvement (IHI) Framework for Spread discusses considerations prior to initiating a spread plan and how to develop the plan.  It also contains Checklists for Spread including leadership, communication and knowledge transfer:

  • Preparing for Spread – it is never too early!
  • Establishing an aim for Spread – addresses the “who, what and where” of spread
  • Developing an initial plan – addresses the “how” of spread
  • Executing and refining the plan

More guidance on developing a plan for spread 22 is available online.

Lessons learned

It is important to identify and document learnings along the way as they will inform the story of working together for the best possible palliative care for older people in your care.  Periodic review meetings can be attached to improvement milestones to support continuous learning and identify lessons learned. 23 You may consider attaching “lessons learned” as a permanent agenda item for your working together meetings.

Consider what is going well?  Have there been any roadblocks or risks identified? What can be improved?  Keep a record of the learnings you identify along the way. 24

Communicating your story

Following the establishment of your successes in improving palliative care and advance care planning for older people, spread the word! 7 This is the opportunity to acknowledge and celebrate achievements and to tell your story.  Sharing the story of the partnership may also encourage other care providers to work together 6; assist with increasing scale and spread of the improvement in palliative care services for older people; keep care service partners and staff engaged; spread key learnings and maintain momentum.

Give some thought to these points:

  • What were the lessons learned from improving the palliative care for older people in your care?
  • Who to share your story with – consider your audience 7
  • How to share your story – communication options

View a sample Communication Checklist (136kb pdf) (This interactive pdf can be completed online, downloaded and printed for your organisation’s records.)

 

It is important to consider how to share the information in the most appropriate way for the intended audience. For example, an external funder may expect a formal report, the public (your local community and aged care/palliative care providers) will appreciate a story with personal dimension and policy makers (Commonwealth and State health departments) might require statistics 7.

You may choose to use one of the following approaches to share your story:

  • Write up and share Annual or Final Report. (440kb pdf) (This interactive pdf can be completed online, downloaded and printed for your organisation’s records.)
  • Write up your story as a Case Study. (441kb pdf) (This interactive pdf can be completed online, downloaded and printed for your organisation’s records.)

Examples of successful partnerships between aged and palliative care service providers is available online.

If you didn’t get to the videos earlier in this Toolkit, they will show you real life examples of successful partnerships between aged and palliative care service providers.

Page updated 23 January 2019