Department of Health

Improving childhood asthma management in Melbourne's inner west

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The Improving childhood asthma management – inner west program (ICAM) aimed to deliver rapid and targeted projects to improve key aspects of the local asthma care system that would improve the health and wellbeing for children with asthma in the inner-west.

The program took an innovative and collaborative ‘system thinking’ approach, initiating meaningful and local improvements in a limited timeframe.

  • Duration: Length 3min 50 sec

  • Transcript

    A Systems Thinking Approach to Improving Childhood Asthma Management in the inner west of Melbourne “Artwork © Guy Downes”

    Victorian Department of Health

    It’s complex

    (Voiceover)

    We all know that managing a chronic health condition is complex.

    Take children with asthma.

    They and their families encounter…

    …GPs and nurses

    …Pharmacists and specialists

    …Sometimes, ambulances and hospitals.

    (beat)

    There are forms, checklists…

    …appointments to book… and, get to!

    There’s the rest of a child’s life…

    …school, sport, friends and community - their homes and local environment

    …which can all affect a child’s asthma symptoms, or how they’re perceived or managed.

    better together

    (Voiceover)

    So, when we set out to improve the management of childhood asthma in Melbourne’s inner west…

    …we discovered a lot of great, committed people - with expertise and experience - trying to do the same

    …but, entangled in this complex system, they didn’t always know about, or understand, each other’s work…

    …and, often, things were disconnected and confusing for children with asthma and their families.

    (…Even for the services and professionals themselves!)

    (beat)

    We realised…

    …we didn’t need to invent new things

    …we needed to work together, to make all this work better!

    (Voiceover)

    We chose… a systems thinking approach.

    You see, the asthma care system – like all complex systems - is made up of many parts. All affecting each other.

    We know how some of the parts work together

    …but usually we don’t consider all the forces at work

    …forces that could help, or hinder us, in reaching our goals.

    (beat)

    So we all gathered together to map this system

    …and started to see ourselves as part of a larger whole.

    (beat)

    We identified lots of small changes that – together - could have big impacts.

    “we” did

    (Voiceover)

    And we put these changes into action.

    (beat)

    We’ve been working with local schools, GPs and communities - to elevate Asthma Action Plans to their rightful place…

    …not seen as ‘paperwork’, but used as a valuable asthma management tool.

    Making things clearer for clinicians…

    …with more straightforward guidance on childhood asthma management.

    Integrating services and information…

    …so people get the right care, at the right time, in the right place.

    We’ve been creating local resources…

    …that build local knowledge in our communities.

    We’re boosting awareness, skills and confidence…

    …to empower children, families, and communities, to take charge of asthma.

    And, a strong and diverse community of practice is keeping the momentum going - and the change-makers connected!

    it works

    (Voiceover)

    It allowed us to forge connections

    …re-imagine organisational boundaries

    …experiment, modify, learn, adapt, and communicate

    (…without fearing failure, or laying blame).

    It enabled us to create ripples of improvement…

    …benefitting children with asthma, their families, and the people supporting them across the asthma care system… in the inner west, and perhaps beyond.

    (beat)

    That’s where you come in.

    You’re invited to learn more about the ICAM program, and how you can build on this work

    …or, how you can use systems thinking to make the impact of your work bigger too!

    Our system approach

    • The asthma care system involves a wide range of stakeholders such as:

      • GPs
      • local hospitals
      • schools
      • pharmacies
      • sporting and community bodies.

      Consistent, joined-up support and care are required to help families successfully navigate the asthma care system in order to receive the right care, at the right time from the right person. The ICAM program set out move the system towards this state.

      Characteristics of our systems approach were:

      • Investigating the underlying problems including listening to lived local experiences
      • Continuously involving stakeholders to ensure multiple-perspectives where understood
      • Supporting deep collaboration and integration between six concurrent projects
      • Using a causal loop diagram to understand the interrelationships and identify impactful interventions
      • Co-developing multiple rapid interventions to nudge the whole system towards the desired state
      • Encouraging and fostering co-design and collaboration during implementation to forge sustainable relationships
      • Using storytelling as part of our evaluation

    Funding and context

    • The funding:

    • The context:

      A needs analysis of the inner west revealed that, when seeking diagnosis or support manage a child’s asthma, families and carers can encounter a range of challenges and barriers that come with accessing and navigating the asthma care system.

    The ICAM program and 6 projects

    • The program involved the development and coordination of 6 separate projects led and delivered by key partner organisations involved in asthma care to:

      • Improve the use and understanding of asthma action plans. This will help improve management of a child’s asthma, whether at home, school or in the health care setting. This project was led by Asthma AustraliaExternal Link .
      • Develop high-quality, streamlined clinical practice guidelines for childhood asthma. This project was led by the Royal Children’s Hospital, MelbourneExternal Link .
      • Develop and promote integrated care pathways. These will provide improved communication about patient care between health providers and support services. This project was led by Safer Care VictoriaExternal Link .
      • Establish a community of practice that works together to improve childhood asthma. This project was also led by Safer Care VictoriaExternal Link and supported by the North Western Melbourne Primary Health NetworkExternal Link .
      • Design and deliver an education package to inner west asthma care providers. Content is locally tailored and based on best-practice asthma care. This project was led by National Asthma Council, AustraliaExternal Link .
      • Improve asthma self-management. This includes addressing barriers at the system level, and increasing skills and confidence at the individual level. This included the development of a children's picture book, video stories from local young people, in-language community information sessions and codesign of resources. This project was led by cohealthExternal Link .

    Resources and partners

    Next steps

    As of 1 July 2023, this project will move into the ICAM Sustained phase led by Safer Care Victoria, where current networks will continue to facilitate ongoing improvement work in the Inner West Melbourne suburbs.

    This work will then be evaluated as part of a research project with the Murdoch Children’s Research Institute funded by Asthma Australia, with expected completion in December 2026.

    Updates will be published on the Safer Care Victoria ICAMExternal Link page.

    For enquiries contact icam@health.vic.gov.au

    Reviewed 11 September 2023

    Health.vic.gov.au

    Contact us

    Environmental Heath Policy and Risk Management Unit

    50 Lonsdale Street, Melbourne, VIC 3000
    Phone 1300 761 874
    environmental.healthunit@health.vic.gov.au
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