The Community Health Risk Factor Management Research Project Influence of Health Care Organisation

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The Community Health Risk Factor Management
Research ProjectInfluence of Health Care
Organisation
Rachel Laws on behalf of the Community Health
SNAP Project Team
Funded by the NSW Department of Health
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Community Health Risk Factor Management Research
Project

• Feasibility study to develop and test models of
  risk factor management in community health
  services (CHS)
• Aim To increase capacity of CHS to address SNAP
  risk factors as part of routine work
• Two AHS involved SESIAHS and HNEAHS
• Three community Health Teams
• Funded by NSW Health, managed by CPHCE, UNSW

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Project Overview
Lessons for dissemination
Needs Assessment Planning/ diagnosing
Evaluation / Reflection Appropriateness of
models Factors influencing implementation
sustainability Change in practice
Model Development Action planning
Implementation of models Action Taking
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• Capacity to address Lifestyle Risk Factors

• Organisational
• Development
• Assessment process
• Record systems
• Audit and feedback sessions

• Workforce Development
• Clinician training
• Discussion at team meetings

• Resource Allocation
• Client resources
• Clinician Guidelines
• Referral directory
• Some new referral services

• Partnerships
• Referral services
• Division of GPs
• Population health

• Leadership
• Organisational / team leader support

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Factors Influencing Practice
Wider Community
Service/Organisational Factors
Clinician Factors Knowledge Confidence Attitudes
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The Pushes and Pulls of the System

• Increasing focus on post acute care
• ..increased focus on provision of post acute
  care, well that
• certainly is a key challenge I think because
  while we are trying to
• do projects like this, a lot of prime
  intervention, we arehaving to
• take more things over from hospitals so the
  acuity is going up so
• its a real balancing act between the two I
  think (manager).
• the only thing I can think of that would affect
  us being able to do the
• risk factor management properly would be changes
  in our work
• environment where the workload is so busy.. the
  hospital system
• people are being discharged a lot quicker than
  what they
• wouldve been 10 years agowe will be getting
  more
• acute and sicker people. (clinician)

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Organisational Congruence

• Fit with team and organisational priorities
• I think that one of the things is that the risk
  factor management
• project actually enhances our own service
  delivery plan. We have
• chronic disease prevention and early intervention
  as one of the five
• priority health areas ..so it fits really well
  into what we do, into our
• core business (team 3).
• Weve not had that formal framework to say our
  community nurses
• should..as part of their core business.. talk to
  their clients around
• Risk factors. We know all those things are
  important. we havent
• articulated thats what we want that workforce to
  do (team 2).

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Sustainability - Need for System Level Approach

• Incorporate into orientation program and job
  description for new staff
• Systematic approach to provision of risk factor
  training and resources
• Systematic approach to assessing, recording and
  reporting on risk factor activities
• Linkages to GP, DGP, Population Health and
  Referral Services
• Ensuring health promotion remains part of the
  broader community nursing model
• Wider organisational support (outside of CHS) is
  required to provide the resources and impetus to
  drive system level

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Sustainability - Need for System Level Approach

• Well I think there has to be strong leadership
  from NSW
• Health if its going to be core business because
  its one of the
• many competing priorities in the state and things
  like,
• emergency departments, triagetimes are being too
  long and
• waiting times have been too long and surgery and
  babies and
• cancer, theyre all the real groovy things that
  always get all the
• attention ..somehow that has to be changed around
  so that
• this is up there (Manager).

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Next Steps

• Efficacy trial of SNAP interventions in community
  nursing services
• To Commence in 2009

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Acknowledgement

• NSW Health Participating Area Health Services
• Community Health SNAP Project Team
• Laws R, Powell Davies G, Williams A, Eames-Brown
  R, Amoroso C, Harris MF, Hughes J, Kehoe P,
  Harper M, Gorrick P, Fuller S, Angus N, Greatz R,
  Senuik S, Jacobs S, Roe K, Gilkes S
• More Information r.laws_at_unsw.edu.a
• Ph 93851488, www.cphce.unsw.edu.au