A decision making model for complex assistive ...

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May 17, 2018 - Planning: consumers/care supports for time-off-work estimates ... •SUPPORT person-centred knowledge sharing for informed consumer-drive ...

A decision making model for complex assistive technology prescription: in four parts Assistive Technology Suppliers Australasian (ATSA) Expo 2018 th 17 May 2018: Melbourne

Dr Rachael Schmidt OT/PhD Email: [email protected]

Keywords: decision-making, person-centred, service transparency, stakeholder collaboration

learning objectives to 1.

2.

3.

4.

Enable decision making effectiveness through service transparency: a seven process service pathway; Evaluate decision making efficiency: understand major factors that influence decision-making facilitation/engagement and disengagement; Build trustworthy partnerships: strategy sharing to empower person-centred collaborative decision making; Develop effective clinical reasoning strategies: through critical service effectiveness and intervention satisfaction 2

1. Enable decision making effectiveness through service transparency: a seven process service pathway FIRST GOAL: ARTICULATE CLEAR AT SERVICE PATHWAY: service transparency Interactive, non-linear process of assessment & re-evaluation throughout process: match with person-centred goals/needs & aspirations SERVICE TRANSPARENCY: enables service allocation accordingly & clarity as to stakeholder contribution SERVICE/STAKEHOLDER RESOURCING: Clear service pathway enables service benchmarking by estimated time, cost, resources (funds/expertise: service benchmarking = robust AT service provision

Interactive, non-linear process of assessment-evaluation throughout process:

Dynamic

match with personcentred goals/needs & aspirations

Maintenance schedule

Maintenance 3 Schedule: formatted at prescription

2. Evaluate decision making efficiency: understand major influential factors of D-M facilitation/engagement/disengagement SECOND GOAL: IDENTIFY CASE COMPLEXITY EARLY: alert/allocate service resources accordingly CASE COMPLEXITY: Service resource need (expertise, team composition, additional time/resources & funding) AT OUTCOME PREDICTABILITY: est. standard/non-standard AT solutions = match AT resource/s access + anticipated outcome/expectations: are they realistic?

Primary service providers

Secondary or specialist seating service

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Australian Seating Service Benchmarking data provides service clarity A clear service pathway enables service allocation: • by service level (expertise) appropriate to case complexity • service resources (estimated hours per service step) • Propose stakeholder engagement/role

Why is service transparency important? Empowers all stakeholders: builds trust

Alert/anticipate service commitment role Planning: consumers/care supports for time-off-work estimates Funding timelines: hurdles/resourcing timelines Prior to service engagement

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Australian Seating Service Benchmarking (Schmidt 2015)

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3. Build trustworthy partnerships: strategy sharing to empower person-centred collaborative decision making THIRD GOAL: BUILD TRUSTWORTHY PARTNERSHIP: understand your stakeholder environment = enable collaborative, trustworthy service environment to inform stakeholder knowledge. ESTABLISH ALL STAKEHOLDER contribution & role/s EARLY WHO ARE THE ESSENTIAL & RELEVANT STAKEHOLDERS? ◊ Enable service ARTICULATE ‘space’ to ensure optimal stakeholder participation: Informed/knowledge depth for informed decisionmaking engagement ◊ Enable inclusive decision making by understanding real D-M support needs Vs reality: LoC LOCUS OF CONTROL (LOC): Who’s making AT-related decisions: consumer or advocate?

Who’s making the decisions?

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New publication Lange & Minkel (2018) Seating and Wheeled Mobility: a clinical resource guide. Slack Incorporated

Clear delineation of clinical roles depending on pathology: e.g. pressure injury management (Chisholm & Yip (2013)

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4. Develop effective clinical reasoning strategies: Critically evaluate service effectiveness & intervention satisfaction

FOURTH GOAL: FACILITATE CONSUMER-DRIVEN DECISION-MAKING (D-M) Understand AT Consumer/care provider’s accumulated AT & service experience EARLY SERVICE PROCESS TRANSPARENCY •CLARIFY stakeholder/team roles EARLY = align clear service pathway & complexity •SUPPORT person-centred knowledge sharing for informed consumer-drive choices

BUILD SERVICE RESLIENCE VIA SUPPORTING INEXPERIENCE: Robust collaborative AT Services actively support novice AT consumers/inexperienced prescribers to develop skill & confidence SUCESSFUL AT outcome = person-centred service experience focuses on best personal fitfor-purpose AT outcomes CLARIFY stakeholder roles

SUPPORT person-centred knowledge exchange INFORMED D-M CONFIDENCE

AT Outcome health Safety participation satisfaction

Fit-for-purpose

BUILD SERVICE RESLIENCE PEER MENTORING: SUPPORT INEXPERIENCE 9

Australian Resource:

Coyne (2016). 24hour Positioning (including Seating and Wheeled Mobility) Practice Guide for Occupational Therapists and Physiotherapists who Support People with Disability. Family & Community Services, NSW Govt. Electronically retrieved from:

https://www.adhc.nsw.gov.au/__data/assets/file/0009/348894/24_hour_Positio ning_Practice_Guide.pdf Practice Guide Contents: Overview: • 24hr Positioning Practice: literature review • Background & understanding factors impacting upon 24hr positioning in sitting, lying & standing • Providing 24hr servicing: service pathway & process 24 hrs positioning assistive technology: critique • Night-time equipment • Supported standing • Wheeled mobility & seating: manual & powered • Online AT procurement • Health & safety: pressure care management • Standards compliance • Airway safety • Best practice OT & Physiotherapy in 24hr positioning: assessment, prescription & evaluation

10 Declare personal involvement

Four Decision-Making (D-M) components to selecting complex assistive technology AIM: SERVICE PROCESS TRANSPARENCY STAKEHOLDER COLLABORATION

INFORMED CONFIDENT DECISION MAKERS

Successful AT Outcome

PARTICIPATION SATISFACTION

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Schmidt ATSA EXPO Melbourne 2018

REDUCE SERVICE RELIANCE

AT Outcome

Conclusion:

health Safety participation satisfaction

With informed decision-making knowledge – Service providers –  can articulate evidence-based strategies  to collaboratively facilitate and empower person-directed decision making - with relevant stakeholders –  to advocate appropriate 24hr posture and wheelchair-seating solutions according to individual needs/aspirations; AT consumers and participants  can ideate (to anticipate) what appropriate 24hr posture and wheelchair-seating solutions should look like/be according to their specific individual needs/aspirations  to advocate services and technology access to meet their personal goals and aspirations Does the AT satisfy ‘Fit-for-purpose’  meaningful participation/engagement 12

Participant’s handout Email: [email protected]

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A decision making model for complex assistive technology prescription: in four parts ATSA Expo Melbourne 17th May

2018

AIM: SERVICE PROCESS TRANSPARENCY STAKEHOLDER COLLABORATION

Dr Rachael Schmidt OT/PhD Melbourne; Email: [email protected]

INFORMED CONFIDENT DECISION MAKERS

Successful AT Outcome

PARTICIPATION SATISFACTION

REDUCE SERVICE RELIANCE

1. Enable decision making effectiveness through service transparency: a seven process service pathway FIRST GOAL: ARTICULATE CLEAR AT SERVICE PATHWAY: service transparency Interactive, non-linear process of assessment & re-evaluation throughout process: match with person-centred goals/needs & aspirations SERVICE TRANSPARENCY: enables service allocation accordingly & clarity as to stakeholder contribution SERVICE/STAKEHOLDER RESOURCING: Clear service pathway enables service benchmarking by estimated time, cost, resources (funds/expertise: service benchmarking = robust AT service provision.

Seven Seating Service Steps Seven Seating Service Steps : Interactive, non-linear process of assessment & reevaluation throughout process: match with personcentred goals/needs & aspirations

2. Evaluate D-M efficiency: understand major influential factors of decision-making facilitation/engagement & disengagement SECOND GOAL: IDENTIFY CASE COMPLEXITY EARLY: alert/allocate service resources accordingly CASE COMPLEXITY: Service resource need (expertise, team composition, additional time/resources & funding) AT OUTCOME PREDICTABILITY: est. standard/non-standard AT solutions = match AT resource/s access + anticipated outcome/expectations: are they realistic?

Maintenance schedule

Location to timely service support

Informed maintenance schedule for optimal AT performance

3. Build trustworthy partnerships: strategy sharing to empower person-centred collaborative decision making THIRD GOAL: BUILD TRUSTWORTHY PARTNERSHIP: understand your stakeholder environment = enable collaborative, trustworthy service environment to inform stakeholder knowledge. ESTABLISH ALL STAKEHOLDER contribution & role/s EARLY WHO ARE THE ESSENTIAL & RELEVANT STAKEHOLDERS? ◊ Enable service ARTICULATE ‘space’ to ensure optimal stakeholder participation: Informed/knowledge depth for informed decision-making engagement ◊ Enable inclusive decision making by understanding real D-M support needs Vs reality: LoC LOCUS OF CONTROL (LOC): Who’s making AT-related decisions: consumer or advocate?

Specify stakeholder/team roles early

4. Develop effective clinical reasoning strategies: through critical service effectiveness and intervention satisfaction FOURTH GOAL: FACILITATE CONSUMER-DRIVEN DECISION-MAKING (D-M) Understand AT Consumer/care provider’s accumulated AT & service experience EARLY •CLARIFY stakeholder roles = to clear service pathway + establish complexity early •SUPPORT person-centred knowledge sharing for informed consumer-drive choices SUPPORT INEXPERIENCE: Robust collaborative AT Services actively support novice AT consumers/inexperienced prescribers to develop skill & confidence SUCESSFUL AT outcome = person-centred service experience focuses on best personal fitfor-purpose AT outcomes

Schmidt ATSA EXPO Melbourne 2018

APPLICATION: informed decision-makers

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Australian Seating Service Benchmarking data provide WCseating service transparency A clear service pathway enables service allocation of estimated hours by either: • primary level of service; • secondary level service (shaded) according to; • identifies stakeholder role/engagement per service step/s. Service transparency informs & empowers stakeholders to anticipate their service commitment (role expectation, time/service resources, time-off-work as AT consumer/family-support agent) & funding prior to service engagement

Australian Seating Service Benchmarking (Schmidt 2015)

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