Table 5 Factors influencing the SHARE pilot disinvestment project
Positive | Negative |
|---|---|
External environment | |
▪ The project funders had significant impact on the project  - Political support for new technology ▪ The other health services in the consortium also had significant impact  - Collaboration with some of the other health services in writing pathway and documents and developing database and implementation strategies was helpful ▪ Manufacturer’s information was useful ▪ Manufacturer’s technical representative was helpful | ▪ The project funders had significant impact on the project  - Monash Health informed that they had to lead a consortium of health services in implementing the new technology, adding complexity to the original application  - Lack of consultation in choice of partner health services  - Requirements for data collection and reporting changed during the project ▪ The other health services in the consortium also had significant impact  - Slow and difficult to coordinate when working with other health services  - Lack of accountability in some of the other health services  - Lack of ‘buy-in’ from other health services through the entire process |
Organisational environment (Monash Health) | |
▪ Monash Health’s reputation as a leader will facilitate new technology support ▪ Monash Health encourages innovation ▪ Support from Centre for Clinical Effectiveness (CCE) ▪ Support from Clinical Program Directors ▪ Support from Finance Department and having someone who can translate the finance jargon ▪ Clinical Resource Nurse monthly meetings ▪ Nursing/Allied Health collaboration ▪ Although staff leave and secondments are difficult there can also be an advantage of working with replacement staff who become familiar with the project | ▪ Organisational processes appear to be changing regularly ▪ Lack of clarity around organisational structures and processes eg who to go to for what, when etc. ▪ Lack of communication eg machine delivered to a corridor on a Friday afternoon and left unsecured over the weekend. A component was lost and a new component had to be purchased. ▪ Relevant patient group and clinical expertise in this area located at site A and new machine is at site B. Patients usually scheduled for surgery at A will have to transfer to B. ▪ Sites have different cultures and processes and patients and staff will have to adapt ▪ Impact on other departments eg Sterilisation department has to learn new procedure ▪ Staff secondments and/or leave |
Identification process (VPACT application process for introduction of new TCP) | |
â–ª Proposed by potential adopters (nursing/allied health and surgeons) â–ª Support from CCE to provide supporting evidence â–ª Support from Clinical Information Management to provide supporting data | â–ª Application form is really long and a lot of work â–ª Lack of awareness of the workload prior to commencing work on application |
Prioritisation and decision-making process (SHARE process to determine disinvestment project) | |
â–ª VPACT funding and endorsement â–ª Clinical project team keen to access CCE expertise and support for project delivery | Â |
Rationale and motivation | |
â–ª To reduce harm, improve patient outcomes, improve service efficiency, save money | â–ª Emphasis on financial/economic outcomes |
Proposal for change | |
â–ª There is good evidence to support the new technology â–ª Data on patient group, burden of disease, impact of new technology provided in detail â–ª New technology does not cause long lasting/irreversible damage â–ª Easy to use â–ª Proposal for change is clear â–ª Relative advantage is clear: improved outcomes for both patients and health service â–ª Endorsed by clinical leaders, good local engagement, clinical champions â–ª Surgeons allowed to keep the theatre time and reduce their own waiting lists (rather than reallocating to other surgical specialties or closing theatres to realise savings) | â–ª Longer time to set up than other treatment options â–ª Lots of protective clothing which can be uncomfortable â–ª Mentally and physically tiring â–ª The whole process of change including administration, training, support, etc. is a lot of work |
Potential adopters (Nursing and Allied Health staff to undertake new procedure, surgeons to reduce old procedure, junior medical staff to refer patients appropriately | |
▪ Most surgeons happy to relinquish old procedure to allow them to undertake other procedures ▪ Surgeons involved in VPACT application have become an authority on the new technology ▪ Senior clinical staff read up on new technology as they don’t want to lose face ▪ Registrars (referrers) are supportive of/have an interest in new technologies ▪ General interest among staff ▪ Nursing/Allied Health team look professional, able to build credibility and trust with patients | ▪ One group of surgeons less likely to refer patients for new procedure, do not appreciate role of podiatrist in patient care, lack of understanding of treatment options ▪ Some surgeons/medical staff have issues with territorialism and ego |
Potential patients | |
â–ª Patients with chronic conditions are more open to trying new treatments | â–ª This group of patients are less likely to be comfortable travelling to different hospitals â–ª Lack of English language can be a problem |
Implementation plan | |
▪ Small training workshops with medical teams ▪ Support from CCE ▪ Support from Clinical Program Directors ▪ Maintenance of a booking system ▪ Quarterly meetings with all participating health services | ▪ Should have performed barriers and enablers analysis earlier in process ▪ Involvement of other hospitals with staff who are not dedicated/committed (eg disputes among doctors from another site) ▪ Having to repeat training every 3–6 months due to staff rotations ▪ Attrition of podiatrists and Clinical Nurse Consultants as they are often young women who leave or work part-time to have or care for children ▪ Keeping the team motivated is hard ▪ VPACT did not meet costs stipulated in application; fewer machines, limited consumables, etc. ▪ Lack of dedicated treatment room increases time for preparation and cleaning. Clinical time is small in comparison to set up/clean up time. Inadequate ventilation (aerosols are created with treatments) |
Evaluation plan | |
▪ Support from CCE in development of evaluation plan ▪ Having a person in charge of data entry | ▪ ‘Shifting the goal posts’ by VPACT regarding data collection and reporting |
Implementation and evaluation resources | |
▪ Other clinical staff voluntarily take up extra workload (both barrier and enabler) ▪ Support from CCE in design of a database, assistance with data entry and reporting ▪ Support from SHARE health economist in development of cost-comparison plan ▪ Monash Health ‘Scope of practice’ processes and documents were helpful | ▪ Inadequate funding for clinical staff to implement and evaluate change process ▪ Other clinical staff voluntarily take up extra workload (both barrier and enabler) ▪ Time needed to write up new scope of practice documents |