Shane Crowe, Department of Health, Victoria - Piloting and Implementation of the Health Assistant...
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Health Assistant (Nursing) implementation in Victoria
Shane Crowe Senior Project Coordinator Department of Health Victoria
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Victorian context
• ‘Nurse/Patient Ratios’ determines staffing levels in public hospital settings
• No provision in the Victorian Public Sector Nurses and Midwives Agreement for AINs – this remains the case in the current agreement
• 2 initial pilots undertaken in 2009 at Austin Health and Bendigo Health
• AIN role called Health Assistant (Nursing) in Victoria
• Traditionally strong opposition by ANMF to the introduction of AINs in any setting
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Key principles of Health Assistant (Nursing) role
Within Victoria:
• Work as part of the ward team
• Complements existing roles
• Work under the supervision of the registered nurse
• Bound by enterprise agreement (nurse/patient ratios) – not replacing nurses
• Support the highly skilled nurses with appropriately trained staff
• Focused on activities of daily living and other related duties – role clarity
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Initial Pilots
Methodology utilised by Austin Health:
• Executive sponsorship
• Project officer to oversee implementation
• Dedicated clinical support
• Recruitment and selection process
• Pilot wards – 2 per ward and part of ward team
• TAFE partner - Cert III in Health Service Assistant – with focus on acute care
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Initial Pilots
Stakeholder engagement
• Early engagement with NUMs
• Local ward working groups
• Comprehensive communication strategy with all stakeholders, including nursing staff across all sites and all shifts
• Education of nursing staff around supervision and delegation
• Support for nursing staff on how to work with new role and integrate into the team.
• Engagement and consultation with industrial groups and staff
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External Evaluation – Initial Pilots
Independent external evaluation undertaken by PwC demonstrated:
Efficiency:
• A reduction in agency costs across the pilot wards
• A reduction in specialling costs by 30% over the 12 month pilot (362 hours)
• Austin Health pilot demonstrated that role is almost cost neutral
Effectiveness:
• A positive impact on the nurses’ time to provide patient care
• A sense of the role enabling the team to provide the “care our patients deserve”
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External Evaluation – Initial Pilots
• A positive impact on staff morale on the pilot wards
• Feel valued and that their employer cares
Sustainability: • Reduction in workload and stress levels for nurses, may lead
to improved retention
Feasibility: • Evaluation found the role/model to be appropriate for
consideration of future workforce reform and feasible for broader roll out to other suitable hospitals and wards across the State
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Nurses’ comments
• “I get more time to assess patient and able to provide more acute care”
• “Able to administer meds and IV antis on time, follow up doctors orders sooner”
• “Feel less pressured – able to really concentrate on patient assessment”
• “More time to focus on medications, vital signs and general overall well-being”
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Consumer/patient feedback
• Clear communication of roles and responsibilities of all staff
• Patients commented that they had increased access to assistance with personal care needs
• 48% drop in patient complaints on pilot wards following introduction of HAN role in first 12 months
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Number of Patient Complaints Pilot Wards - Pre and Post HAN Implementation
Pre-HAN Patient Complaints (pilot wards)
Post-HAN Patient Compliants (pilot wards)
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Alternate entry pathway into nursing
• A number of the HAN’s from initial pilot have been inspired to continue their learning
Ongoing education
Undertaking RN degree
Undertaking EN diploma
Undertaking other healthcare undergraduate course Undertaking non-healthcare undergraduate course
No further study post-Cert III
• At Austin Health 25% from initial pilot are currently studying Nursing Degrees or Diplomas
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Initial Pilots – Key Learning
• Dedicated clinical support vital for both trainees and nurses
• Communication strategy with all nursing staff
• Delegation and supervision education vital
• Complement the role of the nursing staff – not replacing nursing staff – ratios
• Consultation with stakeholders, particularly the ward staff
• Part of ward team – nursing culture
• Executive leadership +++++
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Subsequent Projects
• In 2011 Austin Health independently introduced HANs into all of their acute inpatient wards
• Based on success of initial pilots, in 2013 the Department of Health Victoria supported additional implementation projects:
Acute care:
• Barwon Health
• Eastern Health
• Monash Health
Sub-acute care:
• Austin Health all wards
• Monash Health – 1 sub-acute ward.
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Implementation Guide
• As role is still new to Victoria, robust implementation is vital.
• Initial pilots and subsequent projects have demonstrated that implementation methodology is sound.
• Learning gained from pilots, projects and literature has been consolidated into an implementation guide.
• Aims to support and guide health services in planning, implementing and evaluating the HAN role.
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Implementation Guide
Provides guidance on:
• Establishing governance arrangements • Role and scope of activities • Assessing needs and capacities of workplaces • Establishing delegation and supervision arrangements • Recruitment, orientation and employment • Education and training options • Reviewing project outcomes
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Supporting a team approach
• It is well established that good teamwork is an important part of providing high-quality care, with tangible benefits to patients, staff and health services.
• The guide supports integration of health assistants (nursing) as part of the nursing team.
• Role works with registered staff to support and facilitate the provision of the highest standards of patient care.
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Example of shared aspects of care
Different roles within the nursing team share various aspects of care to fulfil the clinical care requirements of the patients under their care.
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Role and scope of activities
• Work under clearly defined parameters, with a mixture of direct patient care and other activities that support the nursing team.
• Position descriptions and duty lists established, ensuring role clarity. Examples given in appendices of guideline.
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Indicative Duty List
Hygiene Communica.on Mouth clean Answering call bells including “staff assist” Basic eye care Clerical (answering and transferring calls) Brushing hair Communica>on conduit (Verbal and wri@en) Showering Report unexpected events Shaving A@end handover
Sponging Report to Team Leader Toile.ng Documenta.on Changing incon>nence pad Fluid balance Chart (oral input and urine output) Replacing bo@le/commode Food Chart Emptying IDC Bowel Chart Emptying and delivering urinal pans Weight Manual Handling Maintenance Transfer/siNng out of bed Restock supplies
Changing tubing/suc>on equipment Mobilising pa>ents Nutri>on Emergency response Feeding pa>ents/assis>ng oral nutri>onal needs Other Du.es
Environment Assis>ng with deceased pa>ents Maintain safe pa>ent environment Escor>ng to appointments where appropriate Assist with flowers/vases Packing and unpacking pa>ent belongings Making beds (not on admission or discharge) Weighing pa>ents
Pre-‐opera>ve shaves
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Getting Started
To establish the role, the document provides guidance on:
• Establishing project governance
• Project management and resourcing
• Assessing need for role and capacity
• Project planning
• Establishing role governance
• Developing a communication strategy – Austin Health case study outlined.
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Change Management
New to most health services in Victoria, so an effective change management essential to support everyone through the change process, including: • A clear reason for the change and a shared vision • Consistent messaging – clear communication • Executive support • Consultation and involving stakeholders • Set objectives and congratulate team when it is
achieved • Gaining people’s commitment
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Delegation and supervision
• Must be a clear and shared understanding of the:
o role that the HAN plays within the team.
o skills and competencies that a HAN will be expected to demonstrate
• Establishing an effective delegation and supervision framework is essential.
• Document provides guidance on:
o Delegation – delegator and delegatee
o Supervision – direct and indirect
o HAN specific case scenarios outlined
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Delegation and supervision
• These projects and other work has highlighted the need to support a heightened awareness and education of delegation and supervision principles.
• New Delegation and Supervision guidelines for Victorian nurses and midwives just released.
• Seeks to reinforce the NMBA publications around decision making, by making practical recommendations and a framework.
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Recruitment, education and evaluation
Recruitment: • Recruitment of right staff essential to this new role • All projects have demonstrated large untapped pool of people
interested in working in health at this level • Document provides guidance on selection, induction and
management arrangements Education: • Currently mainly traineeship based • Outlines traineeship requirements, competency assessment
and where to find out about potential incentives • Specifies the Certificate III (HLT32512) course core and
recommended units for Victorian public health services • Provision of appropriate support
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Measuring outcomes and impact
Evaluation: • Implementation Guide outlines the evaluation framework
utilised for these projects within Victoria. • Victorian Innovation and Reform Impact Assessment
Framework evaluates the efficiency, effectiveness and sustainability of initiatives.
• External independent evaluation of subsequent projects currently underway.
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Resources and further reading
• Implementation guide: http://docs.health.vic.gov.au/docs/doc/Health-assistant-nursing-implementation-guide
• Delegation and supervision guideline for Victorian nurses and midwives: http://docs.health.vic.gov.au/docs/doc/Delegation-and-supervision-guidelines-for-Victorian-nurses-and-midwives
• PwC external evaluation of HAN role and implementation: http://docs.health.vic.gov.au/docs/doc/Evaluation-of-three-Better-Skills-Best-Care-pilot-projects
• Contact: [email protected]