Table 1

Characteristics of the innovation teams in case A and case B

Case characteristicsCase A: implementing a mental health screening toolCase B: improving screening for dementia and delirium
The interventionThe intervention was underscored by a recommendation within a national evidence‐based guideline concerning perinatal mental health screening with referral for follow‐up management.7
The focus of the intervention was the integration of routine mental health screening into antenatal care for refugee women.
The intervention involved implementing a complex multidimensional perinatal mental health‐status assessment using an online tool (translated into different languages for patient use) with follow‐up services provided where appropriate.
The outcomes of the application of the screening tool were then linked to a referral pathway in community care.
The intervention was underpinned by the Australian National Accreditation Healthcare Standards for ‘best practice’ (National Safety and Quality Health Service Standards).8
The intervention aimed to embed screening into routine care intended to support patient‐centred management strategies for acute episodes of dementia or delirium.
The intervention was complex and multidimensional and involved several elements including a delirium screening tool, a patient familiarisation tool, a patient‐centred strategy aid to facilitate compassionate and effective care, an online clinician education course and intensive practical coaching for target clinicians from a cognition specialist. Implementation was based on the Confused Hospitalised Older Persons Program,18 with some local modification.
Innovation team delivering the interventionThe innovation team was led from within the Centre and the approach developed was consistent with identified best practice in translational research to achieve impact.19 For example, the intervention was triggered through identification by researchers of an evidence—practice gap and pervasive patient need. This identification drew on research indicating that perinatal depression and perinatal anxiety affects up to 20% of all women in pregnancy during the first 12 months post birth with debilitating effects on women, children and families (deidentified published paper). In seeking to address this gap, Centre researchers partnered with clinicians within hospital P and implementation and innovation experts to address the issue. In addition, extensive input was actively sought from diverse stakeholders including patients and community, academics, technical experts and clinicians.
The composition of the innovation team reflected this ethos with members with appropriate skills and expertise drawn from a clinical research background (senior research fellows, PhD scholars, front-line clinicians (nurse managers and midwives, maternal child health clinician, psychologist, service manager and obstetrician from service P) as well as a general practitioner. This cross‐ disciplinary team was managed through a governance framework that included all key internal and external stakeholders.
The innovation team was located and embedded within hospital P and comprised members of the innovation function (project officer and innovation facilitator), senior clinical service directors (medical and allied health directors), doctors (medical consultants from general medicine and geriatric), other specialists (cognition consultant, neuropsychologists, education specialists and communication experts) and nursing and management staff (nurse and service managers).
IEP traits—subject positionPeripheral position.Central position.
Process and context of delivering the interventionThe targets for the innovation were clinical team managers and front‐line clinicians delivering care in a perinatal setting within hospital P.
The trigger for the project was the lack of mental health screening undertaken in this setting, as per outlined as a recommendation within the national guideline and pervasive patient need.
The delivery of the intervention was undertaken in one maternity clinic at one site.
From the outset, the refugee community was engaged by the innovation team and involved in the codesign of the intervention. This ‘bottom‐up’ approach was also evident in the team’s lateral approach to building support with departmental heads and target clinicians. Sustainability and scale‐up was 'designed‐in’ from the beginning but not enacted until the intervention was proven effective in practice.
In general, the intended outcomes of the intervention were regarded by the team, project sponsors and stakeholders as being achieved.
The target clinicians for the innovation were clinical managers and front‐line clinicians delivering care to patients at risk of developing delirium and/or dementia. They were located in a highly complex general medical and subacute setting across all sites of hospital P.
This intervention was triggered by a serious adverse event within hospital P which drew attention to pervasive patient need and prompted a strong senior clinician desire to improve care practices. At the same time, an internal audit indicated that there were inconsistencies within hospital P between established national standards of care and clinical practice on the front line.
The intervention satisfied many of the ‘critical success factors’ associated with innovation initiatives.3 For example, strong support from the senior executive drove the innovation initiative which also provided a clear ‘top-down’ imprimatur which was maintained through active monitoring of progress from a senior level. Similarly, the intervention sought input from a wide range of stakeholders (eg, patients, academics, technical and educational experts and clinicians) who provided inputs in the development of the screening tool and during the implementation process.
Implementation was carefully phased in three stages lasting 3 months across eight target wards. This enabled the innovation team to focus its resources on training and coaching staff, while daily and weekly evaluation allowed progress to be measured and learning to be captured to inform subsequent phases and assist the intervention to spread and scale.
Outcomes of the interventionThe intervention ultimately proved successful and the screening tool, assessment process and associated referral pathway for care were reported to be acceptable and feasible for health professionals in a project evaluation. From the perspective of patients involved, screening for mental health in pregnancy using a digital platform was also found to be acceptable and feasible (deidentified published papers).Initially, internal reports and quality assurance data indicated strong outcomes from the intervention with early shifts in clinical practice and screening rates as the initial implementation phases were completed. However, by the time our research finished at the end of the third phase of implementation, the picture had changed. At this point, measures of intended outcomes after 18–24 months (eg, in terms of delirium and dementia risk screening rates and associated use of tools to improve patient‐centred care) indicated a reduction in the use of tools and a decline in screening rates by target clinicians.
  • IEP, institutional entrepreneurship.