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

8.5Summary

Those dissemination activities that were most likely to be used, followed up and considered most effective by projects appeared to be:

Presentation at a conference (national or state/territory or local)

Story in a magazine or newsletter (local, industry or professional)

Information provided on a website

Brochures, leaflets or posters in a health and community setting

Peer reviewed journal article

Project newsletter

The main purpose of dissemination activities was for awareness and understanding with relatively fewer activities aimed at promoting action.

9DISCUSSION

This report has detailed the overall impact and outcome of the latest round of EBPAC projects, and raises important insights into facilitating evidence-based practice within a complex and increasingly competitive aged care sector.

9.1What was achieved?

There is no doubt that the Australian Government has provided significant investment to improve the delivery of evidence-based practice for aged care residents. This latest round of EBPAC projects has involved several thousands of aged care workers nationally. It builds on the earlier EBPAC rounds which, at the time of writing that evaluation report, we noted was the ‘most comprehensive, coordinated approach to implementing evidence-base practice in residential aged care’ within Australia. The outcomes of these projects have been promoted widely through the Aged Care Quality Agency’s Better Practice conferences and through its website.⁶⁰ The residential aged care sector has subsequently been systematically equipped with resource kits and training and consultancy initiatives derived from five of the thirteen Rounds 1 and 2 projects:

Better Oral Health in residential aged care: 396 workshops were delivered nationally, with 4,885 people trained from 2,809 aged care homes, multi-purpose services and Indigenous flexible care services (2009-10)⁶¹

Dementia Dynamics Toolkit: distribution of free toolkits to all residential aged care facilities, supported by the delivery of 30 workshops nationally (2014-2015)⁶²

Designing for People with Dementia: national consultancy services of environmental design experts that provided on-site education, assessment and advice to aged and health care managers and architects (2013)⁶³

Palliative Approach Toolkit (RC1 in this latest funding round): provided 61 workshops nationally attended by 2,824 health professionals

Champions for Skin Integrity (RC2 in this latest funding round): provided 37 workshops nationally attended by 1,286 health professionals

Within this latest funding round, the reach has been extended to beyond residential aged care to include community care resulting in innovative, evidence-based models of service delivery being tested and evaluated. A more significant development, perhaps, has been the increasing recognition by the sector generally, and the Department in particular, of the need to address systemic factors that can facilitate the delivery of evidence-based practice. EBPAC Round 3 included funding for projects to explore leadership development and organisational change models (CL1, CL2, CC6 and RC3), and there appeared to be an increased number of projects explicitly using evidence based knowledge translation techniques to inform activities.

9.2Program objectives

The combination of both Round 3 EBPAC and ACSIHAG projects within the evaluation reflects the synergies that exist between each program. The overall objective of both programs has been to achieve practice and evidence-based improvements for people receiving aged care services, staff providing those services, the aged care system and the broader community. Table below provides a summary of how the objectives of the EBPAC and ACSIHAG programs were met, drawing on evidence from across the evaluation.

The fourth column of the table highlights the relevant sections of the report containing the evidence to support the conclusions about whether or not the objectives were met. Both programs sought to deliver impacts and outcomes at three levels – client and carer; staff and organisations; and the broader system – and consequently neatly align with the CHSD evaluation framework used. The approach taken to making a judgement about the programs’ success, however, has shifted from that used previously. As we noted in our evaluation plan, the diversity of projects means that applying one set of criteria such as ‘key success factors’ or principles of practice change’ that resulted from our earlier EBPAC evaluation did not make sense. Instead, our focus was to unpack the model of change used by each project to ensure the elements were in place to best support implementation of evidence based practice.

Table EBPAC objectives

EBPAC or ACSIHAG	Objective	Evidence to support achievement	Ref. (Section)	Objective met or not met
Improvements for recipients of aged care services
EBPAC	Improve clinical and personal care for recipients	All projects included application of evidence-based practice techniques and processes; however, there is limited evidence regarding client impact and outcomes	4.1	Objective met
ACSIHAG	Support activities that promote healthy and active ageing;	Social/leisure activities initiated and/or integrated into several projects; alignment of projects with CDC objectives.		Objective partially met
	Support activities that provide information and support to assist carers maintain their caring role;	Resources developed to assist carers support care and assess organisation culture.		Objective partially met
	Support to services providing aged care to Aboriginal and Torres Strait Islander people and people living in remote areas;	CDC and oral health resources developed; Oral health services and pathways		Objective met
	Support people from culturally and linguistically diverse (CALD) backgrounds.	Recreation activities initiated; CDC model clarified		Objective met
Improvements for staff
EBPAC	Provide opportunities for aged care and health workforce to enhance their knowledge and skills to support the uptake of evidence-based, person centred, aged care practice	Each project involved education and training to staff in new evidence based practice	4.2	Objective met
	Support staff to access and translate the best available evidence into everyday practice;	Staff provided with evidence-based resources		Objective met
ACSIHAG	Support activities that build the capacity of aged care services to deliver high quality care.	Education and training provided, resource packages developed and disseminated		Objective met
System improvements
EBPAC	Showcase innovative Australian evidence-based, person centred, aged care practice, including through encouraging partnerships between aged care providers, education and research organisations	Consortium approach to each project; Eight projects lead by / included research partners;	4.3	Objective met
	Widely disseminate and promote established, evidence-based, person centred aged care practice, including through encouraging partnerships between aged care providers, education and research organisations	Localised project activities limited the capacity for broader dissemination of many projects; partnerships expected to extend reach of dissemination.		Objective partially met
	Develop, maintain and promulgate resources that support evidence-based, person centred, aged care practice and inform ongoing development of, and assessment against, relevant standards	Initiatives aligned with strategic frameworks, competencies, and standards.		Objective met
	Contribute to development of the aged care evidence base through evaluation of projects that translate into everyday practice	Each project included evaluation activities, some more detailed than others.		Objective partially met
ACSIHAG	Respond to existing and emerging challenges, including dementia care.	Leadership development, organisational change and organisational assessment projects		Objective met