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|University of Auckland, New Zealand|
|Keynote: J Palliat Care Med|
|Health services are seeking to assist older people to stay functional and at home for as long as possible. However, community care for older people with complex health needs raises issues about co-ordination, risk aversion and societal expectations of safety. Safety is less important to older people than a sense of control. New Zealand research uncovered older people were dissatisfied with home based services. They thought they were insufficiently involved in decision-making, cultural differences were insufficiently respected, and they had little control over their everyday lives a balanced scorecard was established to enable benchmarking of success factors critical to the successful support of older people living in the community. Benchmarking can assist learning by ‘communities of practice’ by identifying what works well. A recursive innovation, action research approach involving twenty focus groups across three District Health Boards informed the initial implementation of the INTOUCH benchmarking system with five District Health Boards. Data from performance measurement is used to triangulate the personal and social worlds of the stakeholders. Transparency helps quality improvement. The recursive dialogue encouraged by INTOUCH supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders. Incorporating the consumer perspective within the balanced scorecard means older people are included in the service design and delivery. Implementation fidelity is a major issue in contemporary health projects so an evidence-based systematic model that engages all stakeholders into an agreed approach provides leaders with a management control mechanism that is useable in this twenty-first century world in which people work in networks and alliances.|
Stephen Jacobs is a senior lecturer in the School of Nursing, the Faculty of Medical and Health Sciences, The University of Auckland lecturing of Health Services for Older People and Leadership and Management for Quality Healthcare. He is also co-director of the Institute of Healthy Ageing coordinating five research streams: workforce, mental health, best practice, community, and rehabilitation. He researches in two key areas: community dementia services and the adaptive leadership and empowerment of nurses. His PhD was in Medicine, researched quality control of home support services for older people. From 2000 till November 2006 he was Senior Advisor in the Health of Older People in the New Zealand Ministry of Health Prior to that, he was for five years Manager, Services for Older People, Wesley Wellington Mission, managing a community service, a home care service, two rest homes, and two continuing care hospitals.
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