Saving lives in the morgue

Summary

Aim

To improve access to sustained information and to provide proactive support for families and individuals at risk of complex bereavement, by increasing social work counselling contacts.

Benefits

For individuals and families

• Bereaved people feel empowered and well informed to engage with a complex and disempowering medical and coronial system.
• Clients can normalise feelings of grief and loss, and integrate the death event into their lives.
• Clients will be adequately supported throughout the exposure to repeated trauma. This can help to reduce the long-term health, social and financial impacts of sudden and traumatic bereavement.
• Timely, proactive, relevant, and specialised support can reduce the risks associated with sudden bereavement, and assist people to relearn their world, rebuild their families, and to stay alive.
• Sustained and targeted support to minimise the incidence and impacts of repeated trauma, secondary losses, profound grief, and financial and other stressors. This can improve long-term health, social, and functional outcomes for bereaved individuals, families and communities.

For staff

• Staff have an improved level of work satisfaction, role diversity and reduced risk of exposure to vicarious trauma.

For the health system

• Families and individuals have improved mental and physical health outcomes, which reduces the burden on the health system.

Background

Families impacted by sudden and traumatic deaths are increasing every year. In NSW there has been an increase in reportable deaths by 18% over the previous three years, and an increase in suicide deaths by 26%. Every year approximately 6500 families will be exposed to the NSW Coronial system following the death of a loved-one .

The forensic medicine social work service is essential to the community of NSW. The service empowers families and individuals with information and emotional support to help them navigate the complex medical and legal system during a period of acute grief and bereavement.

Across NSW there was no consistent clinical or operational model to guide the provision of forensic medicine social work to the people of NSW. Each of the three services had different clinical models with no alignment of evidence-based service interventions. The operational model across the three sites was complex and unclear and there was inequitable staff access to professional supervision and peer support.

The impact of the variation in clinical care, operational governance and increasing service utilisation meant that:

• people accessing the service across NSW were not getting a clear and consistent service
• staff had poor job satisfaction and limited opportunities for role diversity
• aligned stakeholders had an unclear view of the pathways through the system.

Despite the growing need for forensic medicine social work services in NSW a clear, appropriately resourced and consistent service model was required to meet future demand and community and stakeholder needs.

Implementation

Through a focused effort, the project team conducted diagnostic activities to map:

• the current clinical care
• demand and capacity
• operational structures
• pathways
• the expressed needs of clients
• the issues of staff and aligned stakeholders.

The diagnostic activities were designed to include the voice of families, as well as staff and service stakeholders, to inform the design and direction of the service into the future.

Solutions were developed that would address the prioritised service issues, and a pilot of an enhanced service model was trialled. At the completion of the project a service model was documented with a well defined vision for the future enhanced model.

The final solutions included the following.

1. Defining and documenting the current service model and vision for future service enhancement.
2. Pilot an enhance service model including counselling services.
3. Create and implement a client communication plan.
4. Develop a healthy workplace strategy.

Status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.

Dates

Project planning began in December 2017, with the project team selected and enrolled in the February 2018 ACI redesign school.

Throughout 2018 planning, diagnostic and solution design phases were completed. Between December 2018 to March 2019 pilot testing of solutions was completed and evaluation was planned for April 2019.

The project will be completed in May 2019 with ongoing redesign work incorporated into the roles and responsibilities of the service team leaders and operational managers.

Implementation sites

The project has involved the social work services at the forensic medicine facilities in Newcastle, Wollongong and Sydney.

Partnerships

• Centre for Healthcare Redesign
• NSW Department of Justice
• NSW Police

Results

1. Designing and documenting the redesigned service model and vision for future service enhancement

The project aim, to define and document the redesigned service model, has been achieved. The draft is awaiting endorsement by the forensic medicine leadership team, planned for May 2019. The planning for implementation of the future service model will start in May 2019, and completion will depend on success of the business case.

2. Pilot an enhanced service model including counselling services

The pilot objective was to increase counselling contacts to people identified as being at-risk of complex grief. The pilot provided short-term counselling that increased client access to the forensic medicine social workers for at-risk clients. There were an additional 55 client counselling sessions delivered during the pilot.

The pilot was an opportunity to inform the vision for the future service model, to test the efficacy of providing counselling and identify the staff skill development required to implement planned activities. Staff reported an increase in job satisfaction and role diversity from trial participation.

3. Create and implement a client communication plan

The objective of the client communication plan was to improve the quality and access to appropriate service communication collaterals. A package of communication collaterals was developed for utilisation by the service. This included a new service brochure, website, client information sheets, communication letter templates and a remembrance postcard. The communication package will be released in May 2019, following the rebranding campaign by NSW Health Pathology.

4. Develop a healthy workplace strategy

The objective of the healthy workplace strategy was to implement strategies that proactively manage and reduce exposure to vicarious trauma in social workers. The strategy forms part of the future vision for the forensic medicine social work service and is included in the documented service model. Implementation of individual and group-based facilitated supervision is planned for 2019, along with implementation of a social work case review and debrief program.

Lessons Learnt

• When working with clinicians, managers and stakeholder groups it is important to recognise their expertise, experience and balance the project requirements with their capacity to participate.
• Clinicians participating in project activities were happy to contribute but this often competes with their busy workloads. It is helpful to be respectful of their time contribution and value their expertise.

Contacts