Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

6.2Community projects

Five projects (CC1, CC2, CC3, CC4 and CC5) took a multi-level approach aimed at improving client outcomes. The evidence from the diffusion of innovations literature is that certain characteristics of innovations can influence whether they will be taken up and implemented elsewhere: relative advantage (the degree to which the innovation is better than what is in place already); compatibility (the innovation is compatible with the values and perceived needs of the adopting organisation); complexity (the innovation is relatively simple); trialability (the innovation can be ‘tried out’ before full adoption); observability (the benefits of the innovation are visible); adaptability (the innovation can be adapted for local use); risk (the innovation is perceived as low risk).³³

Based on these seven ‘characteristics of innovations’, there are some favourable indications that the innovations developed and implemented by the five projects have the potential to be adopted more broadly:

Relative Advantage: the innovations align with consumer directed care reforms.

Compatibility: the innovations are compatible with the needs and values of aged care.

Complexity: each project involved small changes in service provision to clients and, in general, the resources developed by each of the five projects were simple to use.

Trialability: the innovations lend themselves to being ‘tried out’ on a relatively modest scale.

Observability: each of the five projects resulted in examples of staff ‘seeing the benefits’ of the changes that were occurring.

Adaptability: the innovations can be adapted for local use, which may require adapting training materials to suit the learning needs of staff.

Risk: the innovations are low risk.

There is one issue which limits the generalisability of the findings from the five projects, concerning complexity. Although the practice changes implemented by each project were relatively small in scale that does not mean that implementing those changes successfully is easy, as demonstrated both in this round and the earlier rounds of the program. The findings from the evaluation indicate that several factors are likely to influence the ability of other organisations to adopt and implement these innovations. Staff will need the ability to engage with clients and understand the change being proposed; there will need to be support from managers, peers or someone in a designated position to facilitate the changes; and staff will need some way of working out how to incorporate the practice changes in the work they are doing already.

Without the relative advantage provided by supporting the implementation of CDC, there would be limited incentive for organisations to implement the project outcomes. For example, there are no demonstrated improvements in client outcomes mostly because of the poor reporting of client outcomes by a couple of projects. Furthermore, none of the projects demonstrated the cost effectiveness of what was implemented.

Specific comments about the generalisability of each project, including relative advantage, are summarised in Table .

Table Generalisability – community projects

Project	Comments about generalisability
CC1	The client education resources are suitable for those who are fluent in English and have no cognitive impairment. These materials require revision before widespread dissemination can be contemplated. There is some evidence of a favourable impact on clients but both the leg ulcer and skin awareness programs require further work to improve effectiveness. The use of DVDs for client education ensures consistency in the information provided to clients and lends itself to wider implementation, but requires ongoing funding to purchase (and replace) DVDs and DVD players.
CC2	There is some evidence of a favourable impact on clients but no evidence of an increase in client activity. With its focus on incorporating social and recreational goals in care planning, this project potentially fits well with the broader agenda of consumer-directed care (CDC); similarly, by aiming to increase client activity the model aligns to the wellness and re-enablement focus of aged care reforms As long as local conditions are favourable (e.g. resources to support the change in practice, support from local management) the principle underpinning LEAP has wide applicability. LEAP champions were an important feature of this project and would require funding if this component of the model was employed elsewhere.
CC3	The project demonstrated a positive impact on client mood but was focused on a particular client group (elderly people with a Chinese background). The model is potentially generalisable to other groups with a culturally or linguistically diverse background but is relatively resource intensive, particular the time taken to produce CDs and song books. CDs now represent ‘old’ technology – adoption of this model in other settings might benefit from the use of MP3 players. Care needs to be taken to ensure that the copyright of performers is not infringed, which can be partly overcome by employing a music therapist (music therapists can copy music). The model enables services to be more client focussed, thereby potentially fitting well with the broader agenda of CDC.
CC4	Clients perceived an improvement in the quality of case management. Of the three groups targeted by this project (Greek, indigenous, rural/remote), Greek clients benefited the most. This suggests that the intervention may be more suitable for some groups than for others. With its aim of increasing client involvement in decision-making about their own care, this project fits well with the broader agenda of CDC. The model relies on clients’ willingness to allocate part of their ‘care budget’ to pay for case management, which may limit uptake of the model more broadly.
CC5	The project final report includes no evidence to support the claim of improvements in client outcomes. The clients enrolled in this project were given priority access to dental care. The extent to which this access to dental care contributed to the overall results achieved by this project is not known but is likely to be considerable. Similar results may not be achieved elsewhere without the same priority access to dental treatment. There was a strong emphasis in this project on facilitation, primarily from the project team but with the support of a local staff member dedicated to work half-time (0.5 FTE) in this role. Without this level of support, similar results are unlikely to be achieved elsewhere.