Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Enablers of sense-making and responding and their impact on the effectiveness of management accounting practices

Management accounting practices are expected to adapt and evolve with changing information requirements. The purpose of this study is to determine the factors that enable management accounting adaptability and effectiveness. This study identifies three factors that drive management accounting adaptability through their support of sense-making and responding. Specifically, it is examined how top management team knowledge, team-based structures, and information system flexibility affect management accounting adaptability. The hypotheses are tested using data collected from an online survey of Australian and New Zealand companies. The results support the proposed relationships. Also a positive association between management accounting adaptability and management accounting effectiveness was found. This empirical study contributes to the literature on management accounting change by determining a number of drivers that improve upon the agility of organizational management accounting practices.

Comparing the effect of inadequate documentation to the cost management and tendering processes in managing contractor and fixed lump sum contracts in Australia

Purpose of this paper This research aims to examine the effects of inadequate documentation to the cost management & tendering processes in Managing Contractor Contracts using Fixed Lump Sum as a benchmark. Design/methodology/approach A questionnaire survey was conducted with industry practitioners to solicit their views on documentation quality issues associated with the construction industry. This is followed by a series of semi-structured interviews with a purpose of validating survey findings. Findings and value The results showed that documentation quality remains a significant issue, contributing to the industries inefficiency and poor reputation. The level of satisfaction for individual attributes of documentation quality varies. Attributes that do appear to be affected by the choice of procurement method include coordination, build ability, efficiency, completeness and delivery time. Similarly the use and effectiveness of risk mitigation techniques appears to vary between the methods, based on a number of factors such as documentation completeness, early involvement, fast tracking etc. Originality/value of paper This research fills the gap of existing body of knowledge in terms of limited studies on the choice of a project procurement system has an influence on the documentation quality and the level of impact. Conclusions Ultimately research concludes that the entire project team including the client and designers should carefully consider the individual projects requirements and compare those to the trade-offs associated with documentation quality and the procurement method. While documentation quality is definitely an issue to be improved upon, by identifying the projects performance requirements a procurement method can be chosen to maximise the likelihood that those requirements will be met. This allows the aspects of documentation quality considered most important to the individual project to be managed appropriately.

Is member-rated project success influenced by leadership team emotional intelligence?

Large complex projects often fail spectacularly in terms of cost overruns and delays; witness the London Olympics and the Airbus A380. In this project, we studied the emotional intelligence (EI) of leadership teams involved in such projects. We collected our data from 370 employees in 40 project teams working on large Australian defense contracts. We asked leadership team members to complete a scale measuring their EI, and project team members to rate the success of the projects. We found it was not the mean score, but the highest EI score in the leadership team that predicted members’ project success ratings.

Translating Management Storylines: developing a visual strategy to communicate science to stakeholder community, a case for Mackay, QLD

This project developed a visual strategy and graphic outcomes to communicate the results of a scientific collaborative project to the Mackay community. During 2013 and 2014 a team from CSIRO engaged with the community in Mackay to collaboratively develop a set of strategies to improve the management of the Great Barrier Reef. The result of this work was a 300+ page scientific report that needed to be translated and summarised to the general community. The aim of this project was to strategically synthesise information contained in the report and to design and produce an outcome to be distributed to the participant community. By working with the CISRO researchers, an action toolkit was developed, with twelve cards and a booklet. Each card represented the story behind a certain local management issue and the actions that the participants suggested should be taken in order to improve management of The Reef. During the design synthesis it was identified that for all management issues there was a reference to the need to develop some sort of "educational campaign" to the area. That was then translated as an underlying action to support all other actions proposed in the toolkit.

Studying relationships in project management through social network analysis

Successful project management depends upon forming and maintaining relationships between and among project team members and stakeholder groups. The nature of these relationships and the patterns that they form affect communication, collaboration and resource flows. Networks affect us directly, and we use them to influence people and processes. Social Network Analysis (SNA) can be an extremely valuable research tool to better understand how critical social networks develop and influence work processes, particularly as projects become larger and more complex. This chapter introduces foundational network concepts, helps you determine if SNA could help you answer your research questions, and explains how to design and implement a social network study. At the end of this chapter, the reader can: understand foundational concepts about social networks; decide if SNA is an appropriate research methodology to address particular questions or problems; design and implement a basic social network study.

Adverse effects of androgen-deprivation therapy in prostate cancer and their management

Objective To provide an up-to-date summary of current literature on the management of adverse effects of androgen-deprivation therapy (ADT). Patients and Methods All relevant medical literature on men with prostate cancer treated with ADT from 2005 to 2014, and older relevant papers, were reviewed. Recent health advisory statements from the Australian government, societies and advocacy groups have been incorporated to the document. Results There are numerous adverse effects of ADT that require pro-active prevention and treatment. Ranging from cardiovascular disease, diabetes and osteoporosis, to depression, cognitive decline and sexual dysfunction, the range of adverse effects is wide. Baseline assessment, monitoring, prevention and consultation from a multidisciplinary team are important in minimising the harm from ADT. Conclusions This review provides a series of practical recommendations to assist with managing the adverse effects of ADT.

Job-related diversity and team performance: An empirical analysis of the US music industry

A significant amount of research has been carried out to investigate the existing bonds between team characteristics and team outcomes in contexts of social creativity. Specifically, how work group diversity affects its performance is of great relevance but unfortunately, there is no clear understanding of the diversity-performance relationship. Therefore, to improve our understanding of this phenomenon, it would be worthwhile to investigate further empirical settings. For this reason, we decided to study the music industry that, to our knowledge, has never been chosen as empirical setting for the application of the theoretical constructs linked to the topic of team diversity and performance. Our research aims at analyze the US music industry to study the relationship between job-related characteristics of team diversity and team performances.

Ambidextrous leadership and team innovation

Purpose The purpose of this paper is to report the first empirical test of the recently proposed ambidexterity theory of leadership for innovation (Rosing et al., 2011). This theory proposes that the interaction between two complementary leadership behaviors – opening and closing – predicts team innovation, such that team innovation is highest when both opening and closing leadership behaviors are high. Design/methodology/approach Multi-source survey data came from 33 team leaders of architectural and interior design firms and 90 of their employees. Findings Results supported the interaction hypothesis, even after controlling for leaders’ transformational leadership behavior and general team success. Research limitations/implications The relatively small sample size and the cross-sectional design are potential limitations of the study. The findings provide initial support for the central hypothesis of the ambidexterity theory of leadership for innovation. Practical implications The results suggest that organizations could train team leaders’ ambidextrous leadership behaviors to increase team innovation. Social implications Identifying ways to facilitate organizational innovation is important, as it contributes to employment and company growth as well as individual and societal well-being. Originality/value This multi-source study contributes to the literatures on leadership and innovation in organizations by showing that ambidextrous leadership behaviors predict team innovation above and beyond transformational leadership behavior.

Lernen im Team: Zusammenhänge zwischen Personen- und Teammerkmalen und der Leistung von Multiplikatoren [Learning in teams: Relationships between individual and team characteristics and the performance of multipliers]

The continuous mutual transfer of knowledge and skills within work teams is increasingly important for organizational practice. According to the situational and experience-based approaches of applied learning research, certain individual and social prerequisites have to be met for successful learning in teams. In a field study at an automobile production site, it was investigated which personal characteristics of multipliers and which characteristics of teams are related to the performance of multipliers in 31 teams with 291 coworkers. Using multi-level analyses (HLM), the amount of variance explained by the predictor variables in teaching success of multipliers and learning success of coworkers was examined. Results showed that multipliers' conscientiousness and team cohesion were related to teaching success of multipliers; extraversion and team cohesion were related to the learning success of coworkers. In closing, the scientific and practical implications for the investigation and promotion of work-based learning processes in teams are discussed.

Prevention and management of foot problems in diabetes: A summary guidance for daily practice 2015, based on the IWGDF Guidance Documents

In this 'Summary Guidance for Daily Practice', we describe the basic principles of prevention and management of foot problems in persons with diabetes. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015. There are five key elements that underpin prevention of foot problems: (1) identification of the at-risk foot; (2) regular inspection and examination of the at-risk foot; (3) education of patient, family and healthcare providers; (4) routine wearing of appropriate footwear, and; (5) treatment of pre-ulcerative signs. Healthcare providers should follow a standardized and consistent strategy for evaluating a foot wound, as this will guide further evaluation and therapy. The following items must be addressed: type, cause, site and depth, and signs of infection. There are seven key elements that underpin ulcer treatment: (1) relief of pressure and protection of the ulcer; (2) restoration of skin perfusion; (3) treatment of infection; (4) metabolic control and treatment of co-morbidity; (5) local wound care; (6) education for patient and relatives, and; (7) prevention of recurrence. Finally, successful efforts to prevent and manage foot problems in diabetes depend upon a well-organized team, using a holistic approach in which the ulcer is seen as a sign of multi-organ disease, and integrating the various disciplines involved.

Empowerment climate, supervisory support for creativity and work role performance in new product development settings: A team level investigation

This thesis is an examination of how organisational context variables affect the performance of new product development (NPD) teams. Specifically, the extent to how team empowerment climate and supervisory support for creativity impact NPD team performance. Moreover, this thesis is a step forward in the ongoing development of work role performance theory by examining Griffin et al.'s (2007) work role performance model in the context of NPD teams. This thesis addresses the lack of research exploring work role performance dimensions in NPD teams and the extent to which a team empowerment climate and supervisory support for creativity impact NPDs performance.

Knowledge management research in the construction industry: a review

Purpose: Knowledge management (KM) is important to the knowledge-intensive construction industry. The diversified and changing nature of works in this field warrants us to stocktake, identify changes and map out KM research framework for future exploration. Design/methodology/approach: The study involves three aspects. First, three stages of KM research in construction were distinguished in terms of the time distribution of 217 target publications. Major topics in the stages were extracted for understanding the changes of research emphasis from evolutionary perspective. Second, the past works were summed up in a three-dimensional research framework in terms of management organization, managerial methodology and approach, and managerial objective. Finally, potential research orientations in the future were predicted to expand the existing research framework. Findings: It was found that (1) KM research has significantly blossomed in the last two decades with a great potential; (2) major topics of KM were changing in terms of technology, technique, organization, attribute of knowledge and research objectives; (3) past KM studies centred around management organization, managerial methodology and approach, and managerial objective thus a three-dimensional research framework was proposed; (4) within the research framework, team-level, project-level and firm-level KM were studied to achieve project, organizational and competitive objectives by integrated methodologies of information technology, social technique and KM process tool; and (5) nine potential research orientations were predicted corresponding to the three dimensions. Finally, an expanded research framework was proposed to encourage and guide future research works in this field. Research limitations/implications: The paper only focused on the construction industry. The findings need further exploration in order to discover any possible missing important research works which were not published in English or not included in the time period. Originality/value: The paper formed a systematic framework of KM research in construction and predicted the potential research orientations. It provides much value for the researchers who want to understand the past and the future of global KM research in the construction industry.

Building economic capability to improve the management of marine resources in Australia: Final report

FRDC project 2008/306 Building economic capability to improve the management of marine resources in Australia was developed and approved in response to the widespread recognition and acknowledgement of the importance of incorporating economic considerations into marine management in Australia and of the persistent undersupply of suitably trained and qualified individuals capable of providing this input. The need to address this shortfall received broad based support and following widespread stakeholder consultation and building on previous unsuccessful State-based initiatives, a collaborative, cross-jurisdictional cross-institutional capability building model was developed. The resulting project sits within the People Development Program as part of FRDC’s ‘investment in RD&E to develop the capabilities of the people to whom the industry entrusts its future’, and has addressed its objectives largely through three core activities: 1. The Fisheries Economics Graduate Research Training Program which provides research training in fisheries/marine economics through enrolment in postgraduate higher degree studies at the three participating Universities; 2. The Fisheries Economics Professional Training Program which aims to improve the economic literacy of non-economist marine sector stakeholders and was implemented in collaboration with the Seafood Cooperative Research Centre through the Future Harvest Masterclass in Fisheries Economics; and, 3. The Australian Fisheries Economics Network (FishEcon) which aims to strengthen research in the area of fisheries economics by creating a forum in which fisheries economists, fisheries managers and Ph.D. students can share research ideas and results, as well as news of upcoming research opportunities and events. These activities were undertaken by a core Project team, comprising economic researchers and teachers from each of the four participating institutions (namely the University of Tasmania, the University of Adelaide, Queensland University of Technology and the Commonwealth Scientific and Industrial Research Organisation), spanning three States and the Commonwealth. The Project team reported to and was guided by a project Steering Committee. Commensurate with the long term nature of the project objectives and some of its activities the project was extended (without additional resources) in 2012 to 30th June 2015.

Sport scandal and sponsorship decisions: Team identification matters

We conducted an experiment to investigate the impact of sport scandal on consumer attitudes toward a range of sport stakeholders. We examined the effects of fans’ social identity (fan of scandalized team vs. fan of rival team), scandal severity (single perpetrator vs. multiple perpetrators) and the sponsor brand’s response to the scandal (sponsorship retention vs. termination) on consumers’ attitudes toward the implicated team, the scandal perpetrators, the sport, and sponsor brand. We find evidence of differential reactions to scandal reflecting social identity, such that fans support their own team despite increased scandal severity but negatively judge a rival team’s transgressions. Results suggest that where fans are concerned, sponsors may be better served to continue with a sponsorship following scandal than to terminate, even for some forms of severe scandal. However, termination may receive more positive evaluation from rival team fans; hence continuation of sponsorship needs to accompany a tempered approach.