Table 3 Essential Component: Organisational Context
Organisational Context | Key Components | Source | Quotes from Australian Evaluation of Dementia Key Worker Models |
|---|---|---|---|
Model Design | ● Clear model design with desired outcomes documented ● Continual support; not time-limited ● Support across the continuum ● Flexible entry and exit criteria ● Encouragement and promotion of early intervention ● Continuity of care ● Flexible mode of support and frequency of contact ● Multi-disciplinary dementia support teams with a range of professions | Systematic Review, EWRG, Australian Evaluation | “For me I see it as an ongoing thing if something arises we would certainly have them as a client again we can absolutely justify it as we know working with people with dementia can be a long term thing.” [Key Worker One] “[Key worker] was available 24/7 basically. We felt sort of really comforted by the fact that we had that security... dementia is 24/7.” [Consumer Nine] “You need to do things early and think about all the things ahead of time and I’m so glad that we did make that connection really before we desperately needed it. Because if you reach that desperation point and you’re highly anxious and stressed, then it’s harder to make that connection. I don’t know how people would be able to manage that situation if they left it until it was the crisis point.” [Consumer Four] “In an ideal world you would have a multidisciplinary team because then it would be a really quality service: social worker, occupational therapist, psychologist, registered nurse” [Organisation Manager Three] |
Quality Assurance | ● Formal evaluation ● Consumer feedback: follow-up with all people receiving and withdrawing from the service ● Regular auditing | EWRG, Australian Evaluation | “[Evaluation] that is what we need to do. What we can provide is what we have in terms of feedback from carers, the referrals, assessments, case management of these patients that is all we have at this stage but I think it does need a more thorough evaluation to justify the funding.” [Organisation Manager Two] |
Inter-professional and Inter-Sectoral Collaboration | ● Strong links with other dementia, services and organisations ● Integrated approach to care; not working in silos or isolation ● Investments in a strong provider network | Systematic Review, EWRG, Australian Evaluation | “The aspect is to have that good capacity for interagency communication and building working relationships with other organisations that are relevant to the client group.” [Organisation Manager Twelve] “We’ve got our key result areas that are in- service sector collaboration and capacity building. An example of that would be, [key worker] and I went and did a two-and-a-half-hour training session at a disability service provider, because they had a person with younger onset dementia... they brought us in to help them build capacity amongst their staff” [Key Worker Eighteen] |
Infrastructure Support | ● Support for staff well-being, skill development and performance ● Monitoring caseloads and workloads closely and frequently | Australian Evaluation | “I definitely, in the past, have not been burnt out but been close to it. Just due to the high number of clients that I do have. That’s 53 clients but that’s also their carer and their families as well. So you’re dealing with 53 families that have such complex relationships as well, it’s easy for a worker to burn out.” [Key Worker Fourteen] “I mean I just don’t know how [key worker] juggles what they have to do in the time...I just think that when there’s so few it’s really hard to know how much you can expect from them because it’s unrealistic.” [Consumer Two] |
Resources | ● Physical resources: maps of services; vehicles (pool cars, reimbursement for travel); computers; phones; electronic databases ● Managerial support ● Professional development (case conferencing, mentoring, education, training, conferences, ongoing study opportunities, shadowing opportunities) ● Clinical support ● Access to technology (Skype; video conferencing) | Australian Evaluation | “They have to have a case conferencing system; but you really need a multidisciplinary team.” [Organisation Manager One] “Each team gets a consultation with the neuropsychology unit...we tease out the specifics of it, so we can come up with some strategies or make sure that what we’re doing we’re on the right track... and get somebody who’s external to us, look at us, tell us how are we doing here, and what do you know that we don’t that we might be able to work with.” [Key Worker Eighteen] |