Change in dementia care starts at the coalface

A new project is equipping health professionals to become change agents within their organisations to improve dementia care and support for carers, write Dr Kate Laver and Monica Cations.

 The 2016 release of the Clinical Practice Guidelines and Principles of Care for People with Dementia in Australia provided a guide for health professionals about how best to assess, diagnose, prevent, and care for people with dementia. They suggest treatments and services that should be offered to all people with dementia and their carers from the point of diagnosis.

Among these, three recommended treatments were considered priorities for action:

1. All people with dementia should be encouraged to exercise

   

2. People with dementia should be offered evidence-based occupational therapy interventions that include education, goal setting, and strategies for carers
3. Family carers of people with dementia must be offered support services including access to respite.

Evidence tells us that these interventions have a significantly positive impact on people with dementia and their carers, including delaying functional decline and improving wellbeing.

While many health professionals working in community dementia care are aware of the gaps in their practice, they may not know how to fill these gaps or have resources to address the issues. A new research project hosted by Flinders University, in collaboration with Griffith University and the University of Sydney, takes aim at this challenge with an innovative approach that centres health professionals as their own agents of change.

The Agents of Change project will bring together 30 health professionals from around Australia to participate in a national quality collaborative over 18 months. Collaboratives will connect health professionals keen to improve their dementia care practice with one of the target recommendations. It will provide an opportunity to work together with other clinicians to discuss challenges and identify solutions for these.

Each member of the collaborative will receive specialised training in quality improvement, learn techniques to translate research evidence into their practice, and be supported to maintain that change over time. With the guidance of a team of clinical, consumer, and implementation experts, health professionals will develop and enact a unique plan of action. A plan might involve establishing a new referral pathway, incorporating a new therapy into their practice, setting up a new service, or any other change that improves their practice. Here’s an example.

A community care package coordinator becomes an Agent of Change. She feels that encouraging clients with dementia to exercise is very important but doesn’t know how to support them to do this. With the help of the project experts, she sets up a walking group run by volunteers within her organisation and refers her clients to it whenever she can. She brainstorms with experts and other clinicians in her collaborative when problems arise. 

This approach will address known barriers to changing practice. It is light touch and acknowledges that clinicians are best placed to decide how improvements can be made in their own service context. It embeds change into existing services and healthcare systems, rather than introducing new and mismatched programs. Health professionals will have access to a network of experts and other clinicians with whom they can brainstorm ideas and share successes.

The project is not limited to any one profession in particular, but is designed to be beneficial for all health professionals with scope to improve their services for people with dementia and their carers. In this way, the project will capitalise on the variety of health professionals who have contact with people with dementia, no matter the context. It is delivered entirely online so is accessible across the country.

Suitable clinicians may work in primary health care, community care, day therapy, hospitals, or any other organisation supporting people with dementia living in the community. Participation will fulfil a year of continuing professional development requirements in most professions for the clinicians, and they will receive a $1,000 stipend to be used toward the costs of presenting their plan at a relevant professional meeting or conference.

We will assess how people with dementia benefit from the improved services and whether the plans translate to changes in behaviour and wellbeing. We will also explore the experiences of the clinicians, and gather their feedback about the facilitators and barriers to change that they encounter.

We hope that by empowering clinicians to become their own agents of change, this project will foster sustainable changes in practice with wide-reaching benefits for people living with dementia and their carers.

Dr Kate Laver and Monica Cations are research fellows at Flinders University. Kate Laver is the lead investigator on the Agents of Change project and Monica Cations is the project coordinator. For more information contact Monica Cations.

This article appears in the current Summer edition of Community Care Review magazine.

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