A whole-of-health system approach to improving care of frail older persons
Elizabeth Whiting
A B C * , Ian A. Scott B D , Laureen Hines E , Tamara Ward E , Ellen Burkett D E , Erin Cranitch E F , Alison Mudge B G , Elizabeth Reymond D , Andrea Taylor H I , Ruth E. Hubbard B D and On behalf of the Frail Older Persons’ Collaborative Program
A The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Qld 4032, Australia.
B University of Queensland, St Lucia, Brisbane, Qld 4067, Australia.
C Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.
D Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
E Queensland Health Clinical Excellence Queensland Healthcare Improvement Unit, Royal Brisbane and Women’s Hospital, Level 2, 15 Butterfield Street, Herston, Qld 4006, Australia.
F Redland Hospital Emergency Department, Weipinn Street, Cleveland, Qld 4163, Australia.
G Department of Internal Medicine, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4029, Australia.
H School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Qld, Australia.
I Sunshine Coast Hospital and Health Service, Birtinya, Qld, Australia.
Australian Health Review 46(5) 629-634 https://doi.org/10.1071/AH22170
Submitted: 30 September 2021 Accepted: 26 August 2022 Published: 30 September 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons’ Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities. Locally developed, evidence-based interventions were selected by workshop participants for each priority area: a Residential Aged Care Facility acute care Support Service (RaSS); improved early identification and management of frail older persons presenting to hospital emergency departments (GEDI); optimisation of inpatient care (Eat Walk Engage); and enhancement of advance care planning. These interventions have been implemented across metropolitan and regional areas, and their impact is currently being evaluated through process measures and system-level outcomes. In this narrative paper, we conceptualise the healthcare organisation as a complex adaptive system to explain some of the difficulties in achieving change within a diverse and dynamic healthcare environment. The Frail Older Persons’ Collaborative Program demonstrates that translating research into practice and effecting change can occur rapidly and at scale if clinician commitment, high-level leadership, and adequate resources are forthcoming.
Keywords: advance care planning, education, frail elderly, frailty, health services for the elderly, hospital emergency services, implementation science, inpatients, nursing homes, systems theory.
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