Case Studies & Profiles

Guardianship Program

Case study

New learning program sees guardianship matters fast tracked

“In the 6-month pilot of the guardianship education program, the number of days between lodging an application [with the tribunal] to date of discharge [for a patient] dropped from an average of 83 to just 27. The education program has helped people understand the new guardianship guidelines and get the process right.”

Formal training developed by HETI is upskilling health staff in new guardianship application guidelines, resulting in significant benefits to facilities and patients. Sue Steele-Smith, HETI Senior Program Officer from Allied Health, explains how the new blended learning package is helping to improve internal processes within hospitals and reduce hospital stays for patients.

In 2016 NSW Health identified an issue with the process of appointing guardians for people who were considered unable to make their own decisions. Limited understanding and awareness about guardianship matters was resulting in patients experiencing lengthy –  and costly – hospital stays, waiting on average 83 days before discharge from hospital, while waiting for a decision to be made through the guardianship process.

“This was not only costing the NSW health system in lost bed days, but patients were left in limbo not knowing where they would go and at an increased risk of complications associated with long term hospital stays,” Sue says.

With the goal of ensuring patients who do not need to be in hospital would be placed in the most suitable setting as quickly as possible, the NSW Whole of Health program, in collaboration with the Local Health Districts and Specialty Health Networks, developed new guardianship application guidelines. To support the effective implementation of the new guidelines, HETI was called on to develop and deliver a training package that would educate staff about the new guidelines.

“We created a two-stream training program to bring the new rules and guidelines to life,” explains Sue. “Our program focuses on assisting staff to understand their roles and responsibilities when making a guardianship application to the tribunal and gives them practical skills in writing guardianship applications.”

The program comprises an online module delivered through My Health Learning and a face-to-face ‘train-the-trainer’ style workshop. The online module uses case studies to explain when you need to think about guardianship and when you don’t.

Sue says with minimal formal training in this area in the past, the uptake of the learning package has been positive across all Local Health Districts and many disciplines. The real impact, however, has come from the results seen within facilities and by individuals.

"Most notably, there has been a massive drop in the average number of days it takes for guardianship decisions to be made – from 50 days previously to 16 days," Sue says, adding that the project's initial goal had been to reach an average length of 21 days through the implementation of the new guidelines and associated training package.

"The basic skills training has definitely had an impact. The education program has helped people understand the new guidelines and get the process right. One of the best outcomes is that staff are now only submitting applications for patients who really need to go before the tribunal. Previously, lack of understanding meant staff were putting in applications for patients who didn't need guardianship," Sue says.

The quality of applications going to the tribunal has also improved. Fewer applications are being resubmitted because of errors or incomplete information.

"Staff now have the confidence to know when they should apply for guardianship. They have increased confidence in their own capacity and increased confidence that what they write in their report is what the tribunal needs. It has also taught them that everyone is involved in guardianship matters and this shouldn't just fall on one person' shoulders."

For Sue however, the most positive outcome has been the impact on patients. With increased confidence and knowledge in this area, staff are now putting the patient's rights first, resulting in faster decision-making and appropriate care being provided in the most appropriate setting as quickly as possible.

Key benefits for participants

  • Increased confidence in guardianship matters
  • Increased knowledge about the guardianship process
  • Increased team work
  • Improved application writing
  • Ability to train other staff in guardianship guidelines

Key outcomes for patients

  • Shorter hospital stays for patients
  • Reduction in days taken to reach a decision
  • More hospital beds available

The programs