Articles

Senior man using a smartphone in an aged care home

New Business Models in Aged Care

Aged Care operators are pursuing new business models, out of necessity. This is in response to changes to the financial position and social expectations of the Baby Boomers generation.

A brief look into the new business models in Aged Care reveals the following trends:

  1. The move to ageing in place / multigenerational living, where two or more generations co-habit: a 2013 report cited by Choice stated that 27% of residents living together do so for “care arrangement and support”
  2. Designing for disability, including dementia, and their carers
  3. Vertical villages and the support of couples for whom age-related disease is occurring at different rates

Why is this happening?

  • These changes are in response to changing demographics of the population.
  • Fundamental economics show that Baby Boomers are asset-rich, but cash-poor
  • The shift in business model reflects the consumer-style expectations of people as they age and the availability of cash (or work) to fund their retirement

People born between 1946 and 1964, the Baby Boomers, are heading into retirement at a rate of about 10,000 a day.

“The
 Baby 
Boomers 
currently
 comprise
 25% 
of 
the
 population
 yet
 they
 own
 55% 
of 
the
 nation’s 
private
 wealth,” 
reports 
Mark
 McCrindle, a social researcher.
 “And
 in 
2020, when
 the 
oldest
 Boomers 
hit 
their 
mid
 70’s,
 we
 will
 witness 
the
 biggest
 intergenerational
 wealth
 transfer 
in 
history.”

This generation is one of the richest ever, estimated to peak at about $54 trillion in assets by 2030. Yet, in 2016 GoBankingRates published research conducted with 1,504 adults in the US over the age of 55 (4.3% margin of error): approximately 30% of the respondents age 55 and over claimed to have no retirement savings and less than half (46%) of the respondents had sufficient retirement funds.

The Center for Aging & Work at Boston College found a mismatch in the retirement expectations of older workers and their employers: their research suggested 64 percent of workers would like some kind of “phased retirement.” When Center researchers asked employers whether they accommodated such “phased retirement,” about half said they did for top workers, but only 10 to 20 percent offered it to all workers.

New Business Models

As such, operators are seeking alternate revenue sources through the provision of:

  • Access to onsite and offsite medical and health-related services
  • Offsite lifestyle retreats
  • Additional advancement services, such as onsite education, employment and volunteer advisory centres
  • Repurposing retail / mixed building developments, with some levels within the building now dedicated to aged care

Periop Partners offers a state-of-the-art platform and service design for medical and lifestyle care. We uniquely enable care coordination across multiple locations, mobile teams and virtual consultations. To see how we can assist your aged-care development, call 1300 799 438 to talk to our consultants.

Aged care nurse taking care of recovering elderly man

Scrutiny of Workforce Management in Aged Care Report

Workforce management came under scrutiny in the Senate’s report into the future of Australia’s aged care sector workforce, released on the 20th of June, 2017.

The Senates recommendations have raised questions regarding the compliance to oversee the management of such a diverse workforce.

The media has provided intense scrutiny into the education, incentives and remuneration of the aged care workforce. Also of particular concern to the senate committee was the management of the workforce, with the following relevant recommendations:

  1. Recommendation 4
    25 The committee recommends that, as part of the aged care workforce strategy, the aged care workforce strategy taskforce be required to include:… “mechanisms to rapidly address staff shortages and other factors impacting on the workloads and health and safety of aged care sector workers, with particular reference to the needs of regional and remote workers including provision of appropriate accommodation;” and
  2. Recommendation 6
    31 The committee recommends that the aged care workforce strategy include consideration of the role of informal carers and volunteers in the aged care sector, with particular focus on the impacts of both the introduction of consumer directed care and the projected ageing and reduction in these groups.
  3. Recommendation 7
    34 The committee recommends that the national aged care workforce strategy includes consideration of the role of medical and allied health professionals in aged care and addresses care and skill shortages through better use of available medical and allied health resources.
  4. Recommendation 8
    41 The committee recommends that the government examine the introduction of a minimum nursing requirement for aged care facilities in recognition that an increasing majority of people entering residential aged care have complex and greater needs now than the proportions entering aged care in the past, and that this trend will continue.

Why is this significant?

An aged care workforce has diverse skills, which can be difficult to manage. Add to this, volunteers, carers and patients with different needs, levels of mobility and disability and medical requirements and you have a very complex scheduling problem. Any inefficiency of such a diverse workforce will add to the cost. Finally, the requirement of compliance, eg maintaining a team with a required (or enforced) skills profiles and ratios, behoves such a system to have the ability to track and create alerts – a workforce management “super-duper” interface.

Leading Aged Services Australia CEO, Sean Rooney cited the 2011 Productivity Commission Report, Caring for Older Australians, which highlighted ‘superficial attractions’ to mandatory staffing to care recipient ratios was a ‘blunt instrument’ that is unlikely to be an efficient way to improve care’. Like a domino, for a margins-based industry, it will have knock-on effects on quality and cost of care, and ultimately impact profitability.

 

What can be done?

Scheduling and correct coordination of the aged care workforce is of top priority.

Aged care providers should look for a system that allows proactive profiling and management of this style of workforce, across multiple locations and teams of healthcare issues. The autonomy for some elements can be distributed (eg patients request a visit from a particular type of provider, if part of their care package), whilst others can be centrally controlled (eg accreditation of the home-care staff).

It is very likely, given the focus on the complexity of chronic disease management, and the feedback from key organisations, that aged care teams will be physician led. The AMA continues to advocate to secure medical and nursing care for older Australians, particularly as the population ages.

As such, a detailed understanding of each worker’s skill set, documentation of past client contact, as well as a system to monitor and manage the location of the patient.

Finally, a rules based self-scheduling engine, accommodating volunteers, carers, staff and medical professionals, will allow aged care organisations to see whether they have all roles, functions and locations covered – and manage for the times when they are not.

In summary:

  • Anticipate the need to manage your aged care staff and workforce closely, with the ability to match the needs of the patients with the ability and past history of the staff, volunteer or medical team member
  • Begin to build a profile of your people’s skills sets, with a tool like Jobs for Periop Partners
  • Begin to automate management tasks and scheduling of locations and jobs: Mobiliyo can assist in this process
  • Ask us how MedicRooms.com can be used as an internal site to schedule care in your patients’ residences, or within a residential village.
  • A super-user platform that oversees all aspects of workforce management.

Want to find out how Jobs, Mobiliyo, MedicRooms and the Periop Partners platform can help you manage your aged care workforce? Call us on 1300 799 438 and ask to speak to one of our consultants.

How to Handle problems in Accreditation

How to Handle problems in Accreditation

Accreditation problems arise when from either paper record personnel issue. It is important that you recognise the hospital has all rights to accreditation and your ability to practice on hospital grounds sets your legal coverage but also determines your reputation within the hospital environment. Common problems in accreditation are:

  • Operating without being accredited
  • Not being accredited in time
  • Absence of key information
  • Lack of personnel who will vouch for you

To read the basics of accreditation, please visit the previous article:

Overcoming this problem with accreditation are really quite easy.

First, ensure that copies of your basic information are available both in print or digital format. It is important as you’ll be asked for these. Commonly, it is not necessary for them to be authorized unless the hospital has a policy for this. So call the Executive Administration office and check. If they request it, it is easy to go to your local police station or find a pharmacist or file a medical practitioner who will enable you to get it notarized.

Ensure that you have at least two references e.g. surgical references prior to commencing your accreditation process. It is important that you’re in the industry that is known by the hospital or have their own standing as surgeons who will vouch for your credibility as a surgical assistant. They are likely to be contacted by phone. It is unnecessary for them to ask a written reference, commonly the hospital have their own paperwork which they will send to the rooms in order to support your application. Their interest as a surgeon is to support your application, not only because it’s a nice thing to do but because your presence as a surgical assistant provides both medical, legal coverage as well as assistance to make the list go faster.

Finally, the other people you can appeal to are the people in the accreditation team themselves. They are often quite helpful and quite knowledgeable of the working of the team.They’re aware of the internal pressures include that your application has to be shown to the chief medical officer or director of the medical services prior to your being permitted to have accreditation on site. If you imagine that these people are incredibly busy and that coordination time, in order to review your application, cannot be done immediately. It is best that you leave, no less than 72 hours for them to actually consider your application. During holiday times, they may not be available, to review your application. Accreditation documentation can be scanned and emailed back to the office, it is best to follow this up with a courtesy phone call to let them know that this documentation has arrived to expedite its review by the medical doctors/ accreditation team. If you have any other questions, particularly with regards to the thought you might find useful in application/job, please see our other articles.

Previous article ‘Accreditation and Working in a New Hospital’.

Theatre Courtesy

Theatre Courtesy

Portrait Of Female Doctor With Patient In Background

You’re new to theater and it’s all bright and shiny and the last time you were there, you were in med school and you stepped back accidentally and brushed against something blue (but it’s all blue…!) and then “the whole set up was contaminated…”!!!

Relax. You’ll go a long way if you have good Theatre Manners.

It’s important that you don’t let courtesy overwhelm sterility – keep the mask on, avoid shaking hands anywhere near the setup and if you really must bring your bag into theatre, make sure you set it down away in the established “doctors area” (look for cues e.g: large empty table, computer not on, chairs amassing in the corner that the table is in).

The first rule of Theatre is that there is a hierarchy. If you truly believe that the surgeon is at the top of that hierarchy, be prepared for a very cold and bumpy ride. No, the person in charge is the scrub sister (she or he is the one scrubbed) and in general, it’s best you address them first and introduce yourself – name (drop the “doctor” stuff, you’re not the surgeon) and your role (assistant / medical student/trainee coming in to watch – though hopefully by then, you know this!!). Be polite and wait for her attention – her clock is set by when the surgeon wants to start and she doesn’t want to keep him or her waiting!

Be courteous to the new scout team too, introduce yourself to them next. They don’t know your style but will be quickly sizing you up. Ensure that the team has your glove size and your preferences. If you’re particularly junior or new, introduce yourself to everyone. No one expects – or would tolerate – your arrogance in a theater. Check with them, or the anesthetist if the patient is due to have a catheter (or other preparatory activities) pre-operatively – particularly if it’s due to be done by you!

Ensure the patient knows who you are. Patient interaction will be covered in another post. Suffice to say, morally, ethically and legally, a patient should know who has been in or near their body.

In the theater before surgery, ensure that you’re helpfully present but out of the way when things look like they’re ticking along fine. A good example is willing to do things that get the theater going – eg roll the patient (if you’ve had the correct training), check the consent (pending hospital regulations). Respect the fact that this team has probably worked together for longer with the surgeon than you have, so let them lead. Make sure you know the name of the anesthetist and theater tech so if you or the surgeon need assistance on the repositioning of equipment it sounds more like a request, than a rude command.

It’s important that you be proactive but not demanding. If you need a wet pack, calmly hold out your hand and clearly ask, “may I have a wet pack please” or “wet pack please” – if there’s any question as to why you need it, indicate or gesticulate as to why it’s important at that stage of the operation for you to have access to the instrument or support tool you’re asking for (eg Kerrison punch -> wet pack in the hand of the assistant on the same side as the punch).

Never grab!!! Yes, it makes more sense for you to take the instrument from the surgeon and the scrub team to find the next instrument the surgeon has asked for – but some scrub teams have been trained to take everything and give everything to ensure the count is correct. Be mindful of how your cleaning or placing of the instruments feels to the other party – some don’t realize their exuberant grabbing midair throws the surgeon off her aim and she has to recalibrate to target the same area again. This is easy, but after a while, exhausting. Best you just don’t do it.

Be kinesthetically aware – that is, assess your relative body position – are you blocking the flow between a surgeon and scrub nurse (there should be a clear path – lest there be scalpels in hands or arms)? Leave enough time if it a new specialty in order for you to do things as part of the team and to register yourself to the new hospital. Enjoy and see this is a new opportunity to get your name out there and you’re experiencing something new and interesting, it may lead to a new specialty opening up for you for greater appreciation to the existing one.

Don’t lean on the patient. It’s a sad fact that patients (and medical staff, to be honest :)) are becoming laterally-challenged, but a great amount of what we do surgically is about relative anatomy. Any force you onto the patient, or worse, onto the struts or supports holding the patient endangers the safety of the patient. There are terrible stories of Neurosurgical residents leaning on the headframe or the Mayo table believing it to be secure, only to have loosened the supports – doing great harm to the patients as a result.

If you’re tired, stretch when possible (keep sterile) and review your position. More tips in a future post.

At the end of the case, thank the team. Help them to take the patient off the table (see above re: training) and if they have lost an item of their count, stay til it’s found. It’s also good form but not necessary for you to wait till the patient is awake. However, if the surgeon says it’s ok to go – head on off!

Previous Article: ‘Preparing for a List‘.

Preparing for a List

Preparing for a List

The best way to prepare for a new type of operation is to observe one beforehand.

In this on-demand age, there are numerous online visual and text-based ways of preparing for a list – if you can’t get your hands on a copy of Zollinger’s, try these strategies:
Obtain a list from a practice manager by requesting one day in advance so that you can be prepared for the list beforehand

Go to YouTube and search for that operation
Trap for young players: there are often multiple ways to approach an operation – however, at least being aware of positioning and “what comes next” will stand you in better stead to anticipate the surgeon
Skip the “cartoon” ones or the ones obviously created for a general public audience. Narrow down on the ones created by the surgeons themselves

Occasionally the surgical specialty bodies will have published a collection of their presentations or videos for the education of their trainees

Reference any notes that might be out there including surgical assisting notes on how to assist a surgeon in that procedure.

Revise the anatomy and be aware of major structures that are important to protect during the operation.

Be familiar with the instruments in that specialty
This can be completed with a simple Google search or a deeper review of the instruments via the medical device company’s website.
PDF/Booklets are often available for download.

Finally, if you’re going to assist a surgeon long term, it helps to keep notes on how they like the setup and what order they may do things. These notes ensure that you keep their method fresh in your mind and that it’s easy for you to adapt between surgeons.

Previous article Apps that can Help your Surgical Assisting Business’.

Accreditation and Working in a New Hospital

Accreditation and Working in a New Hospital

Smiling doctor with an operating room at the background

This article is aimed for those surgical assistants starting out who may not be familiar with the procedures that private hospitals have in approving you to work with them – and how they differ from hospital to hospital. Public hospitals may have different procedures from private hospitals, so if you’re commencing work at a public hospital, it’s best you consult their administration or HR department to find out their accreditation procedures.

Surgical assistants may be called upon to work in different hospitals. This opportunity to increase their footprint is a great opportunity to see how different hospitals work and which style of teams you enjoy. Often, I’ve changed private hospitals in response to the surgeons’ new preference of where they’re consulting. Surgical Assistants may also choose to register at a number of new hospitals pre-emptively in order to ensure that they are “ready-to-go” when a surgeon calls upon them.

It is usually straightforward to request to work at a new private hospital. The most important thing to remember is that private hospitals control all levels of those who are allowed to operate within their walls regardless if they are an employee or not. It’s their prerogative and this process of being permitted onsite to operate is called “accreditation”.

The best way to find out what a hospital’s accreditation procedure is to ring the executive office, explain that you’re a doctor and ask to speak to someone from the accreditation team. Please know that depending on the size and the procedure of the hospital, accreditation may be granted between 24 to 60 hours, that is five days or a business week prior to your list.

The basic information requirements for the accreditation process are usually the following:

  • Your AHPRA number
  • Medical graduation certificate
  • Current indemnity insurance

It is important for you to have this on hand, either printed copies or available for download to demonstrate, few hospitals allow you to do temporary accreditation on site. They do not have the right or grounds to ask you for:

  • Your religion
  • Your sexual preferences
  • Your political persuasion
  • A payment for accreditation

Some private hospitals may require you to know an existing surgeon within their hospital. When you are just starting out, it’s best that you reach out to your seniors (consultants or even fellows) who are supportive and who will state that you are of good standing personally and professionally. So, should you accept the list, part of your responsibility is to ensure that you are accredited in time.

If you have problems with accreditation, please see our article on ‘How to handle problems in accreditation’.

Previous article ‘Preparing for a List in Another Specialty‘.

Preparing for a List in Another Specialty

Preparing for a List in Another Specialty

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At this time of the year, we’re often asked to assist in specialties in which we may not have our core skill set.

It’s common for an assistant to be contacted urgently by a practice manager who has “received your name from such-and-such” in order to assist in their surgeon’s unexpected, ad-hoc list.

Before saying yes, consider the following:

  1. Is will accept this list add significantly to your time? (after all, it’s the holiday season for your loved ones too)
  2. Surgical Assistant who say yes during Christmas and other low availability times are often remembered fondly by practice managers when they update their lists and call schedules.
  3. It is really great way to get to know your surgeons and have your name established in that particular specialty. This is particularly important if you are a junior unaccredited registrar wanting to move into that specialty, or you’re interested in the types of lists that specialty offers.

After accepting a list in a different specialty, there are some ways that you can prepare in order that you can arrive and perform to your best abilities. Consider the following:

1.) When a surgeon is operating with a different team, it could be stressful – if not to the surgeon, then to other members of the team until they’re sure of what you can do.

2.) Often the surgical team will anticipate that you’ll be slower than the usual assistant and they might not have work with a different assistant for a very long time.

3.) Regard your lack of familiarity with an operation as a potential source of risk in the operation (eg unprotected nerves, pulled vessels and dropped implants…). There are steps that you can do in order to reduce this risks in the future (see our article “Preparing for a List”).

4.) You may need more time in order to prepare for this particular specialty. In some specialties, it’s ok to turn up 15 minutes before the operation; in other specialties (and theaters), you expect that you’re there at least half an hour before the operation to assist with films, patient transfer, IDC insertion and general theater preparation of the patient.

Remember general theater courtesy: if it’s a new specialty and a new theater and a new hospital to you and a new surgeon then it’s like starting from the beginning. Read our article “Theatre Courtesy” if you need a refresh!

patient education software tablet

Periop Partners Builds Platforms for On-demand Patient Education

We build patient education platforms to help patients and health providers overcome challenges in the communication and comprehension around complex medical processes.

Challenges for a Patient:

  • Going to the doctor for a diagnosis (“crunch-time”) is scary
  • Fear can stop any calm, clear and rational thinking
  • Stress can impair recall and comprehension of information

… yet at their most vulnerable, they are expected to make rational health, financial and lifestyle decisions.

Challenges for a Health Providers:

  • As educators and deep learners in a particular area, you address the same kinds of questions from patient to patient
  • You commonly have to repeat yourself
  • Patients and family members require similar information at different periods of the care journey

… so we developed a Clinical Support and Education Platform

Why a Patient Education Platform?

An innovative Neurosurgeon asked us to develop a patient education multimedia solution, to help him communicate with his patients and their loved ones. He wanted the solution to be engaging but also efficient.

We interviewed the health provider and the patient community extensively.

Their requirements, their challenges and their requests have been uniform:

Give me an online platform where we can get information anytime that my doctors (or health personnel) have assessed to be safe and satisfactory, and that I can share that with my support people?

Click here to read more about the result: Clinical Support and Education Platform

Patient experience

One of the main findings of the patient experience research has been that there is no “one size fits all” approach to improving experience and that what works really well in one setting might not work so well in another.

There are however, some key factors and themes that are important to consider, such as the need for an experience programme to be embraced by leaders throughout your health system, the role of staff experience, the power of stories and the need to make the experience strategy central to your core organisational vision, strategy, quality reporting and service improvement work.
Patients and referrers look for authority figures in times of uncertainty. Almost as a reflex, they will look for a physician’s reputation or a word-of-mouth recommendation with an online search. Who you are and how they find you matters.

To view the collection of articles and advice from Periop Partners, visit our Facebook page.

Clinical Support and Education Platform

Our Clinical Support and Education Platform is currently under limited release for select clients in the health industry.

Why a Clinical Support and Education Platform?

Working with clinicians and interest groups, their request has been universal.

Give me an online platform where we can get information anytime that my doctors (or health personnel) have assessed to be safe and satisfactory, and that I can share that with my support people?

the brief for the Clinical Support and Education Platform

What does it do?

The resulting Clinical Support and Education Platform performs:

  1. Online multimedia education and clinical information
  2. Day-to-day or event-based support for professionals, patients and their support community
  3. On-demand and longitudinal timed reminders

Consequently, to support the adoption of this unique platform, we have developed:

  • a rapid content development platform
  • role-specific access to information
  • analytics and link tracking
  • sharing and collaboration features
  • whitelabelled front end (ie, your company branded)

What’s the benefit?

Clinicians engage in focused conversations addressing specific concerns, leading to better communication with patients.

Patients and their support community access curated, customised information at any time.

Especially in the Clinical trials arena, stakes are high: a failure to obtain informed consent or follow protocol could lead to the decimation of the project.

You’ve built the first one for one surgeon. Now you’re looking to expand it. Who are you looking for?

Groups who are running a Clinical trial, an Education project in healthcare, or run an interest group: if the efficient and tracked distribution of health information is important to you and your project, please contact us to discuss further.

Currently under limited release