Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

11.4 - Knowledge management

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Knowledge transfer

Some respondents expressed clear views about the nature of knowledge management and transfer, in particular the advantages and disadvantages of particular approaches. At the core of most of this was the need for organisational leadership and support in regards to learning and development, and of the need for a culture of continuous improvement. Two large providers were actively involved in developing links with academic institutions in the development of learning and development packages and/or post-graduate curricula. One talked of this being a ‘marrying of both systems’ which ensured the organisational values and approaches were ‘embedding within courses as well as into the workplace’.

A common theme was the importance of mentoring. As one respondent noted:
education and group learning is one way, but the best way to transfer evidence-based practice is mentoring; working with staff it becomes embedded within the organisation.
One respondent who had been intimately involved in an EBPRAC project spoke of the realisation, as the project went on, of the need to
work alongside staff … while we did some general education, we did a lot more one-on-one education or around the bed with a few staff.
This close working with staff was important as ‘people take a while to build confidence … they initially think you are coming in and checking on them’ but ‘once the relationship is established’ they readily engage with the topic at hand.

A number of respondents also encouraged the use of reflective practice, action research or Plan-Do-Study-Act cycles with the aim of providing staff with skills that are generalisable to different problems/contexts.

The capacity of staff to acquire new knowledge and apply it in their day to day practices was a recurring concern raised by respondents. Issues such as variability in health literacy, staffing profiles and numbers, as well as heavy workloads and time pressures were the major impediments identified. While it was acknowledged that the majority of staff working in aged care had a personal commitment to providing quality care, their ability to provide this was often hindered by the ‘realities of day to day pressures’ which limit the opportunity for reflective practice, developing and embedding new approaches and systems, and maintaining currency with the latest research and/or clinical guidelines.

Two respondents cited examples of EBPRAC projects they had been involved in, which included additional funding for staff backfill to enable staff to attend training within work time. They both found, however, that this was rarely taken up due to the fact that there simply was not the workforce available to undertake the backfilling. Many group training activities were either attended by staff in their own time, or else a change of approach was required and project staff undertook more one-to-one or small group experiential learning at the bedside, when opportunities arose. Again, a number of respondents indicated that the capacity of smaller organisations or stand-alone facilities to participate in training or embed new practices would be limited due to such infrastructure issues.

A number of respondents identified changes within their local facility or organisation which enabled them to embed the changed practices arising from participation in EBPRAC. This was particularly evident in the responses of those involved in leading large aged care organisations, where the ‘head office’ had a keen interest in EBPRAC activities being undertaken at local sites. Respondents from one organisation commented on their intent to ‘leverage off the project to impact into organisational procedures and practices’, and a desire to ‘codify the processes so we can use this across the organisation more broadly’. This suggests that there is greater scope for spread of outcomes and embedding changed practices and processes that arise from local project activities when the facilities involved are part of a larger organisation or provider group, due to the existing infrastructure and systems in organisations of this scale.

Accessing knowledge

Many respondents agreed that the resources produced under EBPRAC have the potential to make a significant contribution to the training and information available to the sector. However, there were two key issues which limit the realisation of this potential – variable access to information technology and the diffuse information sources available. Some pointed out that while there may be good intentions to embed evidence-based practice the reality for many smaller, stand-alone facilities is one of limited access to resources such as information technology (computers, internet) and skilled staff. As one respondent noted:
Some would say yes it (evidence-based practice) is a high priority, but some days it’s a priority just to have someone with some skills on the floor.
A small number of respondents acknowledged the role of peak bodies and industry/academic groups, including the Joanna Briggs Institute in enhancing evidence-based practice. Several indicated their active membership of the Joanna Briggs Institute, including supporting staff on the clinical fellowship programs. Others noted that there were two factors which limited the ability of the Joanna Briggs Institute to influence the sector more generally - the cost associated with accessing its information and the narrow research approach used to identify best practice.
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