Why a Toolkit on Working Together?

What is the evidence that working together in partnership between services helps improve palliative care and advance care planning for older people?

This toolkit has utilised the findings of the Decision Assist Palliative Aged Care Linkages project evaluation. An extensive systematic literature review was conducted and identified seven strategies for successful linkage between organisations:

The Linkages project trialled the implementation of these strategies in more than 30 sites across Australia, and positive changes to palliative care and advance care planning of older persons were widely reported. To assist with understanding the potential benefits of partnerships when providing palliative care for older people, see the real life case studies of how services like yours have implemented strategies to improve the collaboration between aged care and palliative care services.

As you work your way through this Toolkit, we recommend that you consider how each of these strategies might bring about the changes you seek in your care of older persons near the end of life.

It’s important to be clear about the terms we use in the care given to older persons at the end of life. Palliative Care Australia has introduced the following definitions to describe commonly used terms and these relate to this Toolkit.

Consider these practice areas within your organisation. Do you need to make changes in the way these are addressed?

1. Advance care planning
2. Recognising end-of-life care
3. Assessing palliative care needs
4. Providing palliative care
5. Working together
6. Responding to deterioration
7. Managing dying
8. Bereavement

These are areas that you can effect change in through successful and sustainable partnerships when providing palliative care and advance care planning for older people.  Depending on your particular settings of care, a number of ELDAC Toolkits may address these particular areas.

The Toolkit provides you with resources and links to other sites where you can find out more about working together to improve palliative care and advance care planning for older persons. Ideally, it can be used in conjunction with other ELDAC Toolkits although it can be used as a stand-alone resource.

The ELDAC Working Together Toolkit has been created to help middle and upper level managers create partnerships between aged, primary and palliative care services. It takes you through the processes to establish and implement effective and sustainable partnerships between service providers.

Before you begin to work your way through this Toolkit, we recommend that you take a little time to understand the fundamental principles and practices of partnership development. The elements of the Working Together Toolkit are underpinned by elements of the partnering cycle. Many elements of partnering will be familiar already. You can see that the cycle is made up of four segments, each with its own components that step you through the information you need to establish and implement effective and sustainable partnerships between service providers.

Remember, whilst every partnership is unique, there is a great deal of similarity in how organisations work together in partnerships. The cycle shown here provides some guidance but does not represent a clear cut process – your path through these segments will rarely follow a linear path.

We do recommend, though, that you follow the steps within the Working Together Toolkit to systematically build the collaborations with others to achieve a successful and sustainable partnership when providing palliative care and advance care planning for older people.  These steps are not necessarily linear – for example, strategies for evaluation and sustainability do not come at the end of this process; rather they are integrated throughout the whole process.