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The Sustainability Through Empowerment Project

Sydney Children's Hospital Network
Project Added:
4 March 2016
Last updated:
8 April 2016

The Sustainability Through Empowerment Project (STEP)


The endocrine department at Sydney Children’s Hospital Randwick implemented education strategies for clinicians and families, to increase awareness of alternative support options.


To reduce the number of preventable and inappropriate phone calls from families of children with diabetes to the after-hours on call service, by 80% within 18 months.


  • Reduces unnecessary hospital presentations and improves patient safety.
  • Reduces the number of preventable and inappropriate calls to the after-hours phone service.
  • Empowers families to manage their child’s diabetes independently.
  • Improves diabetes care through better education and support.
  • Enhances job satisfaction and rostering of Junior Medical Officers (JMOs)
  • Provides diabetes educators with quality improvement and clinical practice improvement credentials.


An after-hours phone service for families of children with diabetes was established by SCHN over 20 years ago, to provide clinical advice in emergency situations. It was designed to improve the safety of children with diabetes and prevent unnecessary presentations to the emergency department.

Over time, the increasing volume of calls – many of which were preventable or inappropriate – has caused the sustainability of the service to be under threat. For example, the service often received calls about patient numbers, technology support for insulin pumps and information about models of care. These calls not only prevented emergency calls from getting through, but also encouraged dependence on the service. The volume of calls also impacted the work-life balance and rostering schedules of JMOs, which also made the service unsustainable without change.

The objective of the project was to first understand why there was a high proportion of preventable and inappropriate calls to the service, then implement interventions that reduced these types of calls.


  • A two-week audit of diabetes services was undertaken to identify the problem. This included interviews with local and national diabetes services, to understand their model of care, approach and challenges. Consumer consultation was also undertaken.
  • Project team meetings took place to review the audit data, using brainstorming and affinity diagrams, multi-voting and weighted voting tools.
  • The following challenges were identified as a result of the audit:
    • there were inadequate written resources for ‘predictable’ problems
    • the model of care encouraged dependence
    • there was a lack of time to develop resources that provided reassurance
    • there was a lack of time to help patients and their families become independent
    • there was a lack of recognition that the after-hours on call service was only for emergencies.
  • Educators and doctors were provided with coaching and new phone scripts, to redirect inappropriate calls and empower families to manage problems independently.
  • A pre-clinic questionnaire was developed, to address common problems and educate families about clinic consultations and the after-hours phone service.
  • Wallet-sized cards will be developed in collaboration with Medtronic Australia, to trouble-shoot technical problems like pump trouble, disconnect doses and travel (currently in development).
  • An indexed resource folder will be developed for families and distributed by the clinic coordinator. The folder contains new resources and provides better access to existing resources, to educate families and reduce dependence on the after-hours phone service.

Project status

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

Key dates

  • May 2015 – February 2016.

Implementation sites

  • Endocrine Department, Sydney Children’s Hospital Randwick


  • Medtronic Australia


  • Between 23 May and 11 October 2015, inappropriate and preventable phone calls were reduced, following implementation of the coaching and new phone scripts.
  • A full audit will be undertaken in June 2016, following implementation of the indexed resource folder and wallet-sized cards solutions.

Lessons learnt

  • We enjoyed the benefits of creating standardised systems and processes, which had a positive flow-on effect to the motivation and satisfaction of the diabetes team.
  • We learned that implementing this project took double the time we expected and had staffing issues which also impacted our project timeline.


Dr Kristen Neville
Senior Staff Specialist Endocrinologist
Sydney Children’s Hospital Network
Phone: 02 9382 1456

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