Living with a wound that has not healed is an enormous challenge to a person’s mental and physical wellbeing. The ACI established the Chronic Wound Management Initiative as part of NSW Health’s Leading Better Value Care program to bring together clinicians, patients and carers, researchers and managers passionate about improving chronic wound care across the state.
Chronic wound management was chosen as a Leading Better Value Care initiative in 2018. Chronic wounds include skin tears, pressure injuries, autoimmune conditions, dermatological conditions, diabetic foot ulceration, compromised surgical wounds and leg ulcers. Chronic wound management spans inpatient, community, general practice and residential aged care settings. While pockets of excellent wound care exist in NSW, care can sometimes be fragmented and inconsistent.
In September 2019, the NSW Ministry of Health published the Leading Better Value Care, Standards for Wound Management. This set the scene for the ACI to launch the Chronic Wound Management Initiative and support the local health districts (LHDs) and specialty health networks (SNHs) to implement the standards.
The initiative aims to:
- improve the consistency and integration of care for people with chronic wounds
- promote holistic care to support wound healing
- strengthen communication and referral pathways in wound care.
The Chronic Wound Management Taskforce was convened to guide the initiative. The Taskforce includes a diverse range of health professionals, patients, carers, researchers and managers with wound expertise from regional, rural and metropolitan NSW. The 30-member Chronic Wound Taskforce is led by the following dedicated executive team of co-chairs:
- Paresh Dawda, General Practitioner, Co-Chair ACI GP Advisory Group
- Annie Walsh, Wounds Australia board member. Head of Department, Podiatry and High Risk Foot Services, Royal North Shore and Ryde Hospitals, Northern Sydney Local Health District
- Matthew Malone, Senior Clinical Lecturer/Faculty of Medicine and Health, The University of Sydney, South Western Sydney Local Health District
- Sue Monaro, Skin Integrity Improvement Facilitator, Clinical Governance Directorate, Northern Sydney Local Health District.
There was an enormous level of interest in the Taskforce and the ACI was inundated with nominations to join. A 400-member Chronic Wound Management Community of Interest was also established to harness and foster this interest.
Collaborating across the ACI and the health system
The Chronic Wound Management Initiative brings together expertise from across the health system. The following ACI clinical networks and teams are involved in the Taskforce that supports the initiative:
- Chronic Care Network
- Primary Healthcare Institute
- The Patient Reported Measures team
- The Clinical Implementation and Redesign Capability team.
Other NSW Health stakeholders involved, include:
- Local health districts
- Specialty health networks
- Clinical Excellence Commission
- Health Education and Training Institute
- Ministry of Health
- eHealth
- HealthShare.
Primary health networks, the residential aged care, disability services university and non-government organisation sectors are also represented.
Improving the delivery and quality of chronic wound care
To improve chronic wound care for patients, clinicians and the health system, the Chronic Wound Management Initiative is focused on:
- providing clinical expertise to help LHDs and health services understand their current practices, measure themselves against the Chronic Wound Standards and develop ongoing monitoring metrics
- developing evidence-informed organisational models for chronic wound management in different care settings
- supporting LHDs by developing and implementing statewide solutions for local use.
“Other priorities we’re exploring include identifying capability and education opportunities, standardising documentation and image capture solutions,” explains Annie Walsh, one of the initiative’s co-chairs.
“The initiative will also focus on increasing awareness of the patient and their family and carers’ experience, and highlighting Aboriginal perspectives and experiences. Ensuring that services we provide are culturally safe and mindful of Aboriginal and Torres Strait Islander people’s lived experience.”
Progress and achievements so far
Since it was established in early 2020, the initiative has been building and nurturing partnerships across the health system and has produced key documentation to support projects going forward.
“Bi-monthly Community of Interest meetings have given members from across NSW and different healthcare settings a regular opportunity to engage with each other, share ideas, provide advice and guidance, raise issues and discuss innovative local solutions that may be adopted or implemented statewide,” says Ms Walsh.
A Wound Care Clinical Priorities Brief has been published, and literature reviews completed to inform the organisational models, which are currently being drafted.
“Early on, the Taskforce highlighted that engagement with consumers, their carers and families would be vital to the success of the initiative and to ensure we build a model co-designed by consumers,” says Ms Walsh
“Consumer focus groups, led by the initiative’s patient and consumer representatives, have provided insight into the lived experience of having a chronic wound. These insights have contributed to an evidence compendium, containing an evidence review and patient and health professional experiential data.
“On a reflective note, the vital role that community and primary care play in treating people living with chronic wounds has been consistently highlighted as the Initiative has gathered momentum.”
What does this mean for clinicians and the community?
“Many patients with a chronic wound describe feeling debilitated, isolated from their friends and community, self-conscious, in pain and immobile – this significantly impacts their employment, relationships and daily life. The initiative recognises the immense physical, social, mental and financial toll an unhealed wound can have on someone’s life,” Ms Walsh explains.
“The initiative is working to improve the equity and equality of wound care provided across NSW, to ensure all patients can receive high quality evidenced based wound care – by the right person, in the right place and at the right time.
“This means improving integration of services in our own LDH/SHN and within other areas of healthcare, through strengthening communication and referral pathways.
“International evidence has shown that moving to this model of care results in improved wound healing outcomes and helps identify wounds early. Which is beneficial to consumers and clinicians."
What advice do you have for setting up and resourcing collaborative projects like this?
Anthea Temple, who is leading the ACI Wound Initiative Project Team that supports the initiative and Taskforce’s activities, describes an internal organisational collaborative model to resource and support the Initiative, and ensure the right expertise is contributed at the right time.
“We call it “the wound onion” – clinical networks and teams from across the ACI nominated to be part of three different layers to form the core project, support and advisory teams,” Ms Temple explains.
“The core project team leads the work, the support team moves in and out of the project team at various stages as appropriate. The advisory team receives regular updates and offers guidance throughout the program. It’s worked really well so far.”
What advice do you have for working with diverse stakeholders?
Ms Temple recommends booking in regular meetings and establishing a collaborative online portal, (using a tool like SharePoint) to provide one source of truth for stakeholders seeking information and the ability to collaborate online.
“It’s important to share information as much as possible; regular meetings and SharePoint has helped streamline this.
“Identifying your key stakeholders and building relationships with them is essential. Particularly local project leads and champions for the Initiative. Proactively engaging with, and learning from, exemplar sites enhances these relationships and contributes to the success of projects.”
“We’ve learnt a lot from our consumers and carer representatives, which is why it is so important to include them early on in the initiative.
“Also relying on and leveraging the strengths of your team, executive the various stakeholders help keep them engaged.
“And always remember that for continuous improvement, being perfect is the enemy of good.”
Find out more about the Chronic Wound Management Initiative or email the team at ACI-ChronicWounds@health.nsw.gov.au to join the Chronic Wound Management Community of Interest and access the SharePoint site.