Exam Flashcards
What are some primary areas of influence in terms of Allied Health service development?
- Professional interests
- Tools and techniques available/advances in technology
- Current theories
- Literature and research
- Consumer need
- Fee schedules
- Government policy
- Identified consumer need
- Consumer demand
- Social/ Economic trends
What are some points on the history of Allied Health in Austraila
• Second world war - significant turning point for healthcare in Australia
• 1949-1984
• Public and private healthcare in different states – free healthcare
only to those deemed disadvantaged but differed state to state
• Expanded from hospital to community health and welfare
• GovernmentwasabletolegislateonIndigenousHealth–earlyfocus was on Indigenous communities involvement in healthcare
• Aged care provision funded by government
• 1975 – Allied health services first publicly funding - included in
Medical Benefits Scheme (optometry)
• 1984–IntroductionofMedicare
• 80s/90s - Preventative Health a focus
• 90s - Allied Health included on Medicare schedule (SARRAH, Enhanced Primary Health Care Package)Australia
• 1990s-2000s – more incentives from government to have private healthcare
• 2001 – Better Outcomes in Mental Health Care Program introduced
• 2004 – Allied Health and Dental Care Initiative (Chronic Disease Management) – MBS funding
• 2006 – Better Access to Mental Health – MBS funding
• 2008 – Helping Children With Autism initiative MBS funding
Australia
• 2011 – Better Start MBS funding (children with a disability) -greater funding for occupational therapy, physiotherapy, speech pathology, new items for audiologists
• National Disability Insurance Scheme 2016-2019 - turning point for allied health
• Community OT services – increased NGO’s and privatisation?
• Better start and Helping children with Autism - transition to NDIS
•Australian Government Hearing Services Program will be transitioned in part to the NDIS by 2019-20
What are some points on the history of Audiology service provision in Australia? IMPORTANT
• Early 1940s - childhood deafness due to Rubella
• Audiology emerged as a profession in the 1940s after World War II with servicemen and women returning with noise-induced hearing loss.
Research advances
• Acoustics technology advances also
• 1943/44 - Acoustic Research Laboratory (ARL)
• 1947 - Commonwealth Acoustic Laboratories (Norman Murray) - research function and a new service delivery function of providing hearing services to children and war veterans
• 1967 – change to National Health Act – provision of hearing aids to pensioners (as well as children who were included previously).
• 70s - University programs for Audiologists
• 1973 - Commonwealth Acoustic Laboratories renamed National Acoustic Laboratory– largest trainer and employer of audiologists until early 90s
• 1993 – Seniors Health Card
• 1993 - Australian Hearing Services (Australian Hearing)/National Acoustic Laboratory
• Recently – move towards more private organisations providing hearing (Upfold, 2008) tests/hearing aids
What do Allied Health Services have in common with one another?
- Working towards health and well-being of individuals, groups, communities, populations
- Specialist knowledge and skills derived from recognised body of learning research
- Education and training at a high level
- Ethical responsibilities and shared values
- Beneficence
- Non-maleficence
- Autonomy
- Privacy and confidentiality • Compassion
- Professional duty
- Justice
What are the three categories of the ICF?
- Body, function and structure
- Activities (limitation)
- Participation (Restriction)
Why do new service areas develop?
- Need in the community – e.g. increasing number of children with autism, increasing number of aged people, rising obesity and lifestyle risk factors, increasing chronic disease
- Other Professions require expertise – Lawyers, Medicine
- Development in knowledge or techniques – Sensory Integration,
- Technology available – computer access, Apps, communication devices, telehealth
- Legislation – Disability Discrimination Act – access to public premises and work, NDIS
- Focus of Health Policy – Aged care reform, NDIS Economic climate – funding for healthcare
What are some recent influences on health services? IMPORTANT
• Deinstitutionalisation • Integration • Early intervention • Preventive Health • ⇑consumer determinism • Freedomofinformation • Paying clients • Technology advances • ⇑knowledge • Development of Ax tools • Refinement of Interventions • EBP of interventions • Continuity of care • ⇑ funding for equip/mods • ICF • Generic positions • Private Health • NDIS
Upcoming challenges in healthcare?
• The ageing population;
- The burden of disease, in particular, chronic disease and mental illness;
- The increasing expectations within the community regarding the level of healthcare that they should be entitled to receive;
- Innovation in diagnosis identifying increasing numbers of people with specific diseases/conditions
- Innovation in interventions
- Inequities of access and health outcomes for certain populations within Australia
What do quality improvement and knowledge translation use
Action learning
What are the quality improvement 5 elements of success?
- Fostering and sustaining a culture of change and safety
- Developing an understanding of the problem
- Involving key stakeholders
- Testing change strategies
- Continuous monitoring of performance and reporting of findings to sustain the change
What is knowledge translation?
- Knowledge translation is the process of closing the gap between what the evidence demonstrates and what we actually practice
- (Closes the research/practice gap)
- Allied Health Professionals need to learn how to identify the evidence that warrants being put into routine practice, analyse their current practice with respect to that evidence, and change their practice behaviours as needed.
What are some challenges regarding knowledge translation?
- Health systems fail to use research evidence optimally
- Inefficient use of resources
- Political and societal pressure to use evidence in decision making
- Translating evidence into practice is complex – barriers exist
- Lack of financial incentive (funding)
- Access to research and equipment
- Standards in line with evidence?
- Individual practitioners – knowledge, attitude and skills appraising and using evidence
- Lack of time/resources
What is the knowledge translation framework?
IMPORTANT
KNOW FOR EXAM: WEEK ONE SLIDE 44
What is action learning?
Action Learning is a process that involves a small group (called a set) working on real problems, taking action, and learning as individuals, as a team, and as an organization.
It helps organizations develop creative, flexible and successful strategies to pressing problems.
What is the action learning circle?
IMPORTANT
SLIDE 47 WEEK ONE
Plan -> Do -> observe -> reflect (in a circle)
What is the difference between action learning and traditional learning?
Traditional learning: • Individual-focused • Learning about others • Input-based • Past- orientated • Passive • Theoretical • Low risk
Action learning: • Group-based • Learning self and others • Output/result-based • Present/future-oriented • Active • Practical • High risk
Other important differences …
- In Action Learning, the relationship between theory and practice is reversed. Theory is created through action, reflection and dialogue rather than learned before practice is attempted.
- Lack of any defined ‘curriculum’ or pre-determined course of learning. What is learned may not be what was already intended.
- Action learning changes the power relationship between learner and facilitator and organisation. No one is entirely in charge. Accountability sits with the learner.
What can action learning be used for?
- Improve quality of practice
- Translate evidence (knowledge) into practice
- Identify where services need to develop (needs analyses)
- Develop personal skills and knowledge to meet the changing and ongoing needs of consumers
- Understand how the profession needs to develop to support practice
How to health professionals develop the quality of their skills and service provision?
- Attend in-services and workshops
- Monitor client performance &satisfaction
- Regularly review literature and research
- Develop protocols to ensure consistent practice
- Reflect in action
- Reflect on action
- Benchmark against other therapists & services
- Review and develop best practice guidelines
- Use outcome measures routinely
- Other means?
What is Quality Improvement?
- Involves defining quality, and continuously measuring outcomes against standards & then taking corrective action when problems are identified
- As systematic, data-guided activities designed to bring about immediate improvement in health care delivery in particular settings
What is Knowledge Translation?
Knowledge translation is the process of closing the gap between what the evidence demonstrates and what we actually practice
What is Action learning?
A systematic way to approach quality within an organisation
Continuous Quality Improvement – Focuses on development of both the organisation & the individual
Learning from concrete ‘real world’ experience, critical reflection, group discussion, trial & error
Continuous process of learning and reflection supported by colleagues with an intention of getting things done
Learning from concrete experience/action & critical reflection on that experience
Spiral of cycles
Focus on “real” problems: complex with no clear solution
What are the two aspects of action learning?
- growth & development of people & organizations
* finding solutions to problems
Why does action learning align well with allied health?
• Concerned with real problems facing people
• Use of clinical reasoning
• Applying theories and evidence to specific situations
• Understanding of the service recipients’ experience
• Concern with the consequences of actions in a given
context
• Thinking critically and resolving ethical dilemmas
what can be done vs what should be done
How does Action learning work?
A cycle / A series of cycles • Identify a need / Establishing a goal • Developing a plan • Acting • Observing • Reflecting • Brainstorming solutions to problems • Revising the plan • Taking further action on the revised plan
PLAN, ACT, OBSERVE, REFLECT
What are the characteristics of Action learning?
- real-life situations
- learner driven
- social process (often involves teamwork)
- takes time (to reflect & problem solve)
- encourages people to find their own solutions • anticipated and unanticipated learning
What is one of the most important aspects of action learning?
to constantly refine your understanding of the problem to ensure the suitability and quality of the solution
What is the process for developing a project outcome?
- Identify, describe & understand the need or problem
2. Identify, describe & understand the goal
How do you identify, describe and understand the need or problem?
• What problem or need is the project aiming to address?
• What information do you need to gather in order to develop a thorough
understanding of the need or problem?
•Who are the Stakeholders?/How do they define the problem?
• What contextual factors are impacting on the issue and the way it is viewed or defined?
• How has the issue been viewed to date?
•Has the issue always been present/acknowledged?Why?/Whynot?
• Why is it being identified as a problem now?
• How have contextual factors influenced how this issue has been seen?
What are some strategies for analysing problems?
- 5 Whys - developed by Sakichi Toyoda and later used within Toyota Motor Corporation
- Fishbone – Professor Ishikawa • The Why-Why diagram
What is the 5 whys technique?
e.g.
Increasing numbers of people with chronic diseases are being readmitted to hospital. (the problem)
• Why? – they are unwell. (1st why)
• Why? – condition unstable. (2nd why)
• Why? – medication level not adequate. (3rd why)
• Why? – medications missed or condition worsened. (4th why)
• Why? – clients are not able to continuously monitor and manage their health . (fifth why, root cause)
What are the limitations of the 5 Whys technique?
- Tendency for investigators to stop at symptoms rather than going on to lower level root causes.
- Inability to go beyond the investigator’s current knowledge - can’t find causes that they don’t already know
- Lack of support to help the investigator to ask the right “why” questions.
- Results aren’t repeatable - different people using 5 Whys come up with different causes for the same problem.
How do you draw a fishbone diagram? KNOW FOR EXAM
See slide 27 week 2
How is a Why-Why diagram different to a fishbone diagram?
Takes it a step further and looks at solutions
How do you identify, describe and understand the goal?
• How do people think the problem/issue can be addressed? • What does each stakeholder think should happen?
• How will the context define what can happen?
Understand the context: Services don’t occur in a vacuum
Practice is influenced by interaction between
• Broad socio-political context
• Organisational context & culture
• The lens of the person defining the problem/developing a solution
• Needs & expectations of consumers of the service
• Skills, abilities & interests of the service providers
