By Nicole Micallef
Martin Chadwick caused a sensation, inspiring 200 allied health professionals from across Tasmania to be agents of change – to be; better self advocates, more visible, more efficient, the solution to more effective health care delivery. After all, as allied health professional we are there on the front line. In this article, I reflect on the keynote address delivered at the 1st Tasmanian Allied Health Symposium (14th November 2013 in Hobart) from the perspective of a dietitian.
Martin Chadwick may not be a household name but he is on LinkedIn. A quick search reveals a smiling, friendly looking Director of Allied Health from the Counties Manukau District Health Board, New Zealand. This geographical area, near Auckland, has a very similar population profile to Tasmania. Their current population is estimated to be about ½ million people and is socio economically disadvantaged, aging, and is more likely to suffer from a chronic condition/s than their New Zealand counterparts. These factors are known to increase the demands on health services. Through his ability to express the common ground between the Counties Manukau and Tasmanian populations, Martin connected with me and thus gained my complete attention for the duration of his presentation (if you know me personally, you will know this is not easy to do.)
He illustrated his discussion about the complexity of the health system with a photo of a Mandelbrot set. A Mandelbrot set is a mathematical factual; a shape of great beauty that displays self-similarity at various scales. No matter how much you zoom in or zoom out on a Mandelbrot set the complexity doesn’t change. So, in relation to our working environment, the issues faced by each dietitian are the same as those faced by our health organisations, which are the same challenges the Dietitians Association of Australia will be dealing with at the national level. All these groups are trying to find the solutions to manage changing and increasing health service demands.
The good news is that dietitians can be part of the solution. As you are well aware, better nutrition combined with physical and mental activity is known to prevent the development of many chronic conditions and/or their associated complications. To find the solutions Martin suggests that we step back and ask ourselves: What are the systems we use routinely? What are the simple rules behind these systems? What can we learn from this?
As a dietitian working in the speciality area of cystic fibrosis, I am particularly excited about a future where interdisciplinary teams will drive nutrition innovation collectively. For this to happen though, dietitians will need to become comfortable with our competencies and creditentials being less important than teaming and problem solving. Some of the other areas for change that dietitians need to be open to include: the need for more adaptable generalists over specialists, technology transforming nutrition counselling and education, and the food industry continuing to alter public health priorities. The American Academy of Nutrition and Dietetics has recently published the results of their ‘future scan’ study 2012-2022 in a series of papers, very insightful reads if anyone is interested in knowing what future changes are predicted to drive the dietetics workforce (Journal of Academy of Nutrition and Dietetics 2012, Volume 112, Issue 3 Supplement.)
However, the right thing to do is often the hardest to do.
Why is it so hard? To being to answer this question Martin takes us on a brief journey with Captain Cook. I am no history expert and I have not checked the authenticity of this story (If my husband is reading this I hope he forgives me for any historical errors.) Cook could be said to have completed one of the first randomised controlled trials, one of his ships had lime juice on board and the other didn’t. On the ship where the crew was made to drink lime juice, scurvy was all but eliminated. How long did it take for lime juice to become a standard practice of the British Navy? 150 years! How long does it take for evidence based medicine to be translated to practice? On average, 15 years!
Why is it so hard to do what we know is right to do? The definition of evidence based practice is constantly evolving. According to Martin, the original genesis of the concept combined three key components – best available evidence, clinical experience and patient experience. I am sure that most dietitians would answer that evidence based practice is just the literature. Unfortunately, in many areas of dietetics there is not a huge volume of literature to guide our practice. In these situations we need to remember that our collective experience counts and the patient has expertise too.
What do we do about these evidence gaps? Yes, we continue to conduct research to fill them but we also need to change our focus! After Martin’s presentation, I realised that instead of simply being dietitians that we need to expand to also become implementation scientists and self-promoters. There is even a journal dedicated to implementation (Implementation Science). Do you really think that medical and nursing colleagues have all the answers? They don’t, they are just much better at evaluating everyday practice and selling their messages than we are. Dietitians need to be better self advocates; we need to be more visible.
So, do you have a 20-30 second elevator speech? If not, you should. A good website to help you develop your elevator speech is www.mindtools.com/pages/article/elevator-picth.html. As a profession, we need to sell the message that we are the nutrition experts, we have unique roles and skills, and, that our practices do result in better patient outcomes – every opportunity we get.
An ageing population means caring for older people who are likely to have chronic conditions, some induced and exacerbated by lifestyle factors. The effective management of chronic conditions truly requires an interdisciplinary approach. We as dietitians have the training and expertise to play a decisive role in direct treatment of these individuals and mentoring of other disciplines involved. Just like Martin did with the Tasmanian allied health professionals, I would like to leave you with some questions to think about:
-What is our vision for dietetics as a group?
-What outcomes should we choose as a profession?
-What can we do differently?
Feel free to email me ([email protected]) your answers to these questions. You never know, I may be tempted to write another article based on your collective responses for the Dietitian Connection newsletter.