Progressive roll-out is being achieved in the installation and activation of the Model of Care (MoC) adopted from the Institute for Urban Indigenous Health (IUIH) in south-east Queensland. Whilst Galangoor Duwalami is driving the change management processes internally, Nhulundu Wooribah and Bidgerdii are the first two Service sites using a CQ RAICCHO ‘Spearhead’ to implement the transitions.
All Member Services have received an induction into the Model of Care. In the first instance, a presentation was provided to the CQ RAICCHO Board, which provided a comprehensive overview of the Model and its various underpinning elements. This was provided by senior IUIH managers who developed and led implementation of the Model in the 13 clinics in south-east Queensland. Follow-up on-site presentations have been progressively conducted with individual CQ RAICCHO Member Services, and both doctors and Practice Managers have come to SEQ for orientations to see the Model of Care in practice in ‘showcase’ clinics.
Bidgerdii and Nhulundu, agreed to establish with CQ RAICCHO individual Joint Management Committees (JMCs) as a steering committee responsible for providing strategic input toward and oversight of the installation process in their respective Services.Both JMCs are now in operation and the implementation has commenced with the support of a full-time CQ RAICCHO ‘Spearhead’ position.
Spearheads are specialists in primary health care, deployed on the ground to support new and existing Services in implementing the Model of Care. They are responsible for leading, instigating and reporting on change and reform processes.
The Spearhead plays an active role in supporting both management and clinical/programs staff to achieve required change and adjustment. For the duration of the implementation and transition period, they work in the clinic supporting, assisting and driving reform of required systems and processes to enable achievement of optimum primary health care delivery and business performance.
Initial steps and measures conducted particularly revolve around the completion of extensive mapping and profiling exercises, which document the current status and performance of the Service across different areas of functionality (i.e. clinical governance, staff structure, current services). These early steps and measures enable formation of a blueprint for action that supports service enhancement and reform in line with the Model of Care. A resulting Implementation Plan is formed from this process, which with JMC endorsement, sets the scene for key actions and measures to be undertaken within a specified timeframe. Examples of action items articulated in the Plan include clinical governance, workforce composition and staff training, team-based roll-out of the cycle of care, as well as a range of enabling systems and processes.
The Spearhead also provides a mentoring role. Spearheads are clinical leaders who are available to support, assist and advise staff as they adjust to implementation of the Model of Care and the necessary measures that it promotes.
The Spearhead commenced work in Bidgerdii and Nhulundu Wooribah in January 2014. Key action steps that have been undertaken include:
- Support in conducting a comprehensive mapping exercise, that identifies distribution of both existing and prospective Indigenous clients, to understand where geographical gaps in service delivery exist, that will in turn inform community engagement work (principally conducted by the Community Liaison Officer) and thus generate scope for greater service utilisation by the Service’s local catchment population;
- Education sessions on the Model of Care of how it sits within the Service, and the functionality of the Model of Care with sessions on job role descriptors and where their roles sit within the model.
- Work to map and profile current workforce structure, for the purpose of identifying how this compares to the requirements of the Model of Care, so as to advise staffing configuration, to in turn inform change management arrangements and workforce adjustment;
- Undertaking current staff skills assessment to identify areas of need in skills development, work efficiencies, and understanding of the concepts and workings of the Model of Care, and identification of the skills and qualifications mix amongst staff, for future training, which support the objective continuous quality improvement and professional development of staff;
- Introduction of clinical governance systems and processes that enhance both clinical and business efficiencies; and introducing appointments books for all clinical team members to alleviate wait times and ensure optimisation of MBS items;
- Working with staff at both an individual and group level to ensure everyone knows and understands the Model of Care, its approach and team basis;
- Introduction of the cycle of care in to the clinics. The cycle of care is based on a best practice approach to comprehensive primary health care and places an emphasis on optimum utilisation of MBS items that address the most significant illnesses and chronic conditions of Indigenous persons, particularly those with complex care needs;
- Education on and introduction of staff incentive schemes, which promote a climate of team work and unified action;
- Identifying under-efficiencies in MBS items and utilising these in target settings and improvement in chronic disease management initiatives;
- Promoting an all of Organisation approach to ownership of the Model of Care and incorporating inter team referral from all sections and aligning ‘Deadly Choices’ to service delivery.
- Supporting clinic staff to increase knowledge and understanding of how to make the most effective use of their Service’s health information system, and working with staff to ensure they input correct and pertinent data into systems to capture accurate information. The objective is to enhance the quality of data produced by and available within the Service. This enables a more accurate, timely and definitive picture of service performance and client need, which can in turn be used for future service planning.