Good Life Club ProjectGood Life Club Project

System change to System change to embed self-embed self-

management.management.

Jill KellyJill Kelly

Today….Today….

Briefly describe project model Briefly describe project model

Description of Transition Phase of Description of Transition Phase of programprogram

Highlight learningsHighlight learnings

3 year Demonstration Project3 year Demonstration Project Telephone coaching by Allied Health Telephone coaching by Allied Health

Practitioners & general practice nursesPractitioners & general practice nurses

Promotion of Multi-disciplinary care Promotion of Multi-disciplinary care planning/self-management planplanning/self-management plan

Client Website Client Website www.goodlifeclub.infowww.goodlifeclub.info

Club activitiesClub activities

Client newsletter Client newsletter

& email newsletter& email newsletter

Transition Phase – 2 yearsTransition Phase – 2 years

Action Plans to embed CDSMAction Plans to embed CDSM Organisational supportOrganisational support Train the Trainers Flinders Uni modelTrain the Trainers Flinders Uni model Regional Practitioners networkRegional Practitioners network Stanford course leaderStanford course leader

trainingtraining

Central Administration, Co-ordination and Development Leadership for capacity building initiatives Source of expertise in chronic Condition self-management Central marketing role Promoting chronic Condition self-management to GPs & other health providers Facilitating skills training for Allied Health Practitioners and volunteers Evaluation & dissemination of evidence and results Financial administration Engaging other stakeholders eg. Dept of Veteran Affairs, Council of the Ageing

Embedding Telephone coaching for chronic Condition in partner agencies

Flexible models of delivery in fitting with structure of organisation.

Support for the organisational change management process

PDSA $

GLC Club activities

Integrate more fully with existing activities in community. Activities

“Branded" as GLC "endorsed" to create a common identity across community

Facilitate training at Regional level

Stanford model

Flinders Uni model

Health Coaching

Building capacity in general practice

e.g. chronic illness clinics & coaching for PN’s.Pilot initiatives to match current chronic condition initiatives e.g MBS items

Organisational capacity building

.skills training for AHP

Change management support

Regional Practitioners Group

SUSTAINABILITY “PROJECTS”SUSTAINABILITY “PROJECTS” Trialled different models of coachingTrialled different models of coaching Barriers and facilitators identifiedBarriers and facilitators identified

FacilitatorsFacilitators Supportive and proactive managementSupportive and proactive management Consultant approachConsultant approach Organisational and health professional behaviour Organisational and health professional behaviour

change supportedchange supported Regional Practitioners Group – at team leader Regional Practitioners Group – at team leader

levellevel PDSA cyclesPDSA cycles

Sustainability ProjectsSustainability Projects Follow-up telephone coaching 4 months Follow-up telephone coaching 4 months

post diabetes education grouppost diabetes education group Using the Wagner Assessment in Chronic Using the Wagner Assessment in Chronic

Illness Care toolIllness Care tool Division – establish self-management in 2 Division – establish self-management in 2

Asthma Clinics in general practiceAsthma Clinics in general practice Establish Volunteers in Chinese Good Life Establish Volunteers in Chinese Good Life

Club Club Trial Flinders Uni CDSM tool in SRSTrial Flinders Uni CDSM tool in SRS Action planning in Diabetes Education Action planning in Diabetes Education

groupgroup Acute sector – planned to establish use of Acute sector – planned to establish use of

Flinders Uni toolsFlinders Uni tools

What worked…What worked… Small $ grants for Action PlansSmall $ grants for Action Plans PDSA cyclesPDSA cycles Regional practitioner group – at Team Leader levelRegional practitioner group – at Team Leader level Training – Stanford, health coaching/motivational Training – Stanford, health coaching/motivational

interviewing interviewing Good Life Club TrademarkedGood Life Club Trademarked Promoting evaluation – HEI-QPromoting evaluation – HEI-Q $ support to Chinese Health Foundation of Australia $ support to Chinese Health Foundation of Australia Consultant/leader at regional levelConsultant/leader at regional level Regional Practitioners Group – at Team Leader LevelRegional Practitioners Group – at Team Leader Level

What didn’t work….What didn’t work….

Difficult engaging some Difficult engaging some Managers/Team leadersManagers/Team leaders

Engaging acute health/HARPEngaging acute health/HARP Flinders model implementationFlinders model implementation Difficult to plan for sustainabilityDifficult to plan for sustainability Context – no DHS policy or $ for CDMContext – no DHS policy or $ for CDM Lacked broader principles & Lacked broader principles &

elements of Wagner model of CDMelements of Wagner model of CDM

What’s happening now…What’s happening now…

Two resources being developed:Two resources being developed:

1.1. Development of a practical guide to Development of a practical guide to implementing self-management and implementing self-management and chronic disease systemschronic disease systems

2.2. Research and develop an Information Research and develop an Information Package on nurse-led chronic disease Package on nurse-led chronic disease clinics in General Practiceclinics in General Practice

More InformationMore Information www.goodlifeclub.infowww.goodlifeclub.info

(see Health Professionals/Resources)(see Health Professionals/Resources)

Australian Journal of Primary Health Australian Journal of Primary Health

Vol. 9 2&3 2003Vol. 9 2&3 2003