PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...

ACTION:The intention is for this information to be used by the Evaluation Committee to: 1) assess therelevance of the research to the evaluation; and 2) stimulate discussion on the most expeditiousprocess for information uptake. Either collated responses or initial findings can to be presented to theEvaluation Committee.Draft list of collated responses on supports and barriers to theimplementation of PCDSThemes Barriers SupportsWorkforce Insufficient numbers of service providersConstraints placed on dedicated chronic diseasepositionsIncreasing workload in remote health servicesNo agreed benchmarks for staffing levelsPerson dependent servicesHigh staff turn over that erodes community trust andengagementEmploying the wrong personalities to key positionsShortage of skills and a mismatch between evidencefor public health and the attributes and skills of theworkforce.Aboriginal people are under represented in thehealth workforce. This is a problem for two reasons:1) it is difficult for non-Aboriginal people to look atimproving health from an Aboriginal perspective; 2)employing Aboriginal people is part of the solution toreducing the disadvantage facing Aboriginal people.There were extra demands placed on Aboriginalpeople, and insufficient support, and inadequatetraining. And there are inequitable power differentialamong different professions in health services.TrainingFundingRelationshipsLeadershipandmanagementCommitmentsand cultureMedicare not developed with remote Aboriginalcommunities in mindPerverse incentives in MedicareMultiple and confusing funding sources and avenues.Funding for PCDS used to support Departmentalhealth servicesNeed to improve relationships between:Commonwealth/State; Policy/Operational; Healthservices and patients; Health services andcommunities; And across sectors i.e. education, localgovernment.Unclear and contested roles and responsibilitiesImplementation hinges on engagement of clinicmanagers.Quality improvement processes are needed tosupport implementation.Dominate focus on acute care rather than bettermanagementEmphasis on treatment at the exclusion of primarypreventionTendency to support vertical (programs focused ondisease or stage of life) rather than horizontalapproach (building capacity e.g. quality improvementsystems, number of staff, training, etc.)Sufficient numbers of staffDedicated chronic disease positionsRight mix of values and attributesamong staffAppropriate mix of skillsTeam work and collegialityStaff recruitmentFunding seen as the most enablingsupport.And acts as a catalyst for othersupports such as workforce.Funding is seen as an indicator ofinstitutional will.Stakeholder participationCommunity engagementLeadership as a vehicle for changeand therefore an important supportfor implementation of health policy.Leadership exists within keyindividuals and groups.Symbolic commitment i.e. formalrecognition and endorsement of PCDSHealth professions dedicated toaddressing chronic diseaseACCHS dedicated to communityengagementAppendix 5: How Policy is Implemented – Evaluation of the NT Preventable Chronic Disease Strategy 2007 130