You have now identified the need for a GEDI service in your ED by reviewing clinical and client outcome data. Now, it is important that goals of implementation as well as both the barriers and risks are also identified. This needs to be achieved during the engagement phase.
Identify and communicate the benefits
It is important that the future benefits of the GEDI implementation (and the continued identification of emerging benefits once implemented) are identified to move towards set goals. This can also assist in effectively engaging and motivating key clinical stakeholders (for example, ED staff, hospital management, RACF senior nursing staff and local GPs). Communicating the benefits to key stakeholders provides relevance to the need for GEDI and provides reasons to continue to engage with the GEDI team. This can be achieved through meetings, in-service or through broader case examples, e.g. through PHN facilitated meetings with local GPs, educational sessions.
Identify and communicate risks
Implementing a new model of care is challenging. Working with multiple stakeholders from different sectors of community health and the acute sectors brings complexity to the issues that can arise.
Perform and document risk assessment during the pre-implementation phase. Consider: Financial, organisational and clinical risk. Your organisation should have an approach to risk that is organisation wide. Risk needs to be addressed in presenting a business case. View GEDI implementation checklist for of the key points to address prior to implementation.
Work to do
Queensland Health Related Policies
Engage with ED and hospital executive
The original GEDI service began with an ED physician holding the geriatric portfolio and a CN with clinical background in geriatrics building the intervention. In your organisation, the driver for implementation may be different. Regardless, the clinician interested in establishing this model will need to engage with both the ED and hospital management to effectively communicate the need for a GEDI service. Supporting evidence, such as information from the GEDI evaluative research project (Craswell, Marsden, Taylor, & Wallis, 2016; Marsden, Taylor, Wallis, Craswell, Broadbent, Barnett… Glenwright (2017) and Wallis, M., Marsden, E., Taylor, A., Craswell, A., Broadbent, M., Barnett, A., Nguyen, K., Johnston, C., Glenwright, A., Crilly, J (2018) and a literature search for similar or alternative models of health service delivery being implemented around Australia and globally may be useful.
Reading
Examples of other supporting evidence are:
- supporting the provision of additional clinical resources within RACFs, promotion of Advance Care Directives and End of Life Pathways for palliative care (Arendts & Howard, 2010)
- rapid access to review of older adult patients and comprehensive geriatric assessment, in the ED (Wright, Tan, Iliffe, & Lee, 2014)
- enhanced education in gerontology care (Aldeen, Courtney, Lindquist, Dresden, & Gravenor, 2014; Castilho-Weinert, Sibele Yoko Mattozo, Bittencourt Guimãraes, Gonçalves, Zanini, Cavalcanti, . . . Ximendes 2014; Conroy, Ansari, Williams, Laithwaite, Teasdale, Dawson, . . . Banerjee 2014; Conway, Dilworth, Hullick, Hewitt, Turner & Higgins 2015; Silvester, Mohammed, Harriman, Girolami, & Downes, 2014).
It will also be important at this stage to identify where potential funding might be accessed. View an example calculation to determine your staffing requirements for a GEDI service and a list of suggested equipment for purchasing.
Identify key stakeholders
Stakeholders are important to ensure your implementation of a GEDI service is effective. Stakeholders may include but are not limited to: ED nursing staff, senior ED medical staff, QAS, Geriatricians, ED and hospital executive. Clinicians will be using this model but it is important that they are assisted in understanding the benefits of the system, support the need for this change and they are willing to engage with the model once it is implemented.
This can be a key challenge and requires specific attention. Identifying stakeholders, the key opinion leaders in the ED, is critical to finding support for the intervention to assist in making the implementation successful. Sometimes it will be hard to identify who will be positive (or negative) towards the GEDI model. Inside the ED, everyone will be involved particularly the Nurse Unit Manager (NUM), primary ED nurses, ED physicians and medical teams, administrative officers, triage, and of course the patients.
Think about stakeholders outside the ED such as the business managers, Geriatricians, Allied Health professionals, the Ambulance service, the Director of Nursing and other NUMS i.e. from geriatric wards. Identify how implementation of a GEDI service will affect all stakeholders and communicate this.
Example benefits for GEDI for example Health Service stakeholders
| Stakeholder | Example benefit |
|---|---|
| CEO, HHS Executive |
|
| NUM of ED |
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| ED MD |
|
| Geriatricians |
|
| Allied Health |
|
Methods for engaging stakeholders
- Include opportunistic face to face conversations
- GEDI team representation at other decision making meetings within the HHS
- Determine what each stakeholder can gain from the implementation
- Develop a specific GEDI forum and invite key stakeholders
- Regular meetings with stakeholders – present goals and small steps to success
- Regular reports delivered in the mode most preferable to each stakeholder
- Provide documentation about the GEDI model and evidence for its efficacy
- GEDI model presentations
- GEDI team education sessions for ED staff
- Engage individual clinicians by allocating specific tasks such as: vertical engagement with senior staff
- Be creative - provide incentives for attendance to key meetings, e.g. cater for events
- Invite stakeholders to join a clinical advisory group.
Communicate the need for GEDI and the potential benefits for older people
- Engage with this toolkit
- Read summary of data from The Silver Book (Cook, Oliver, & Burns, 2012) or Geriatric Emergency Department Guidelines (American College of Emergency Physicians, 2013)
- Review other websites recommended
Meetings
GEDI ED physician and CNC to organise meetings with other key stakeholders, e.g., Community Discharge Liaison Department head, Geriatric Services Medical lead, ED senior management team.
Examples of engagement activities for key stakeholders
| Example Stakeholders | Example Activities |
|---|---|
| Director of ED | Advocate for a GEDI service in executive meetings; Engage with nursing management to build joint commitment to the need for GEDI Assist in developing documentation for GEDI protocols; Meetings; Support for project grant applications |
| Nursing Director for your ED ED Nursing Unit Manager |
Advocate for a GEDI service in executive meetings; Engage with medical management to build joint commitment to the need for a GEDI service; Recognise the staffing needs for the GEDI model and facilitate recruitment and training Assist in developing documentation for GEDI protocols; Meetings; Endorse project grant applications |
| Hospital CEO/COO/ Administrator | Endorse the GEDI team at executive and State level; Access for review of policy and procedure for the GEDI model; Consider ongoing monitoring of consistency of middle management support. |
| Inpatient geriatricians, general physicians and sub-specialty teams | Attendance at meetings – inform and involve regarding the GEDI model to facilitate acceptance and requirements; Provide GEDI team access to case conferencing; Access for direct GEDI referral |
| Hospital senior accountant/finance | Developing budget proposals related to GEDI rollout and ongoing service provision; Advocating for GEDI expenditure at executive level; Monitoring budgetary performance; |
| Hospital quality and safety representative | Assist team in accessing appropriate risk management policy and performing risk management assessment |
| ED clinical staff | Attendance at education sessions; Engage with the GEDI team in workplace; Provide feedback |
| Community health services manager | Facilitate communication pathways between hospital and community services |
