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The sustainable financing of protected areas (PA) is a worldwide challenge and a barrier to the effective management of over 15% of global land area (Protected Planet, 2021). The purpose of the paper is to outline one approach that has been used to address the challenge of the sustainable financing of the publicly managed terrestrial PA estate in New South Wales (NSW), Australia. Also, PA practitioners internationally may find the case study useful in addressing the challenge of insuf- ficient funding for PAs under their care and control. The paper provides the Theory of Change (ToC) as a mechanism for the sustainable financing of the PA estate in NSW, identifying six pathways to change: government support, institutional effectiveness, appropriate business model, strategic planning and innovation, communication and advocacy, and collaboration and partnerships. It demonstrates how the success of each pathway depends on a suite of enabling conditions that help to dismantle the impediments to the sustainable financing of the PA estate. The ToC is intended to guide actions to address the sustainable financing of the PA estate and to achieve the overall impact of the effective management of PAs with respect to conservation and other aligned objectives. The ToC presented in the paper is focused on NSW, however it considers policy and management implications and lessons from the case study that can be applied to PAs in an international context. [ABSTRACT FROM AUTHOR]

The national Closing the Gap reform provides a mandate for mainstream organisations to undergo structural transformation to better address the needs and concerns of Aboriginal and Torres Strait Islander communities. In the criminal justice sector, the reform resonates strongly with ongoing discussions about how both policy and practice can address the significant over‐representation of Aboriginal people across the criminal justice system. One way that structural transformation can occur is through the genuine involvement of Aboriginal knowledge holders and communities in policy development. This study illustrates how this might happen in relation to youth justice policy and programme design. Eighteen Aboriginal community members from a town in rural New South Wales participated in a series of interviews relevant to the Closing the Gap target. Qualitative content analysis was used to identify four key themes relevant to the development of justice policy: supporting cultural identity in a post‐colonial context; articulating strengths and resources which can be mobilised in the community; the centrality of poverty to offending; and responding to intergenerational trauma. The study illustrates how non‐Indigenous policymakers and practitioners might approach the task of engagement and consultation by identifying Aboriginal knowledge as a legitimate epistemic resource that they can draw upon to guide the ongoing development of evidence‐based policy and programmes. This study describes how an approach to community engagement using a culturally informed research methodology to develop a locally informed theory of change can guide youth justice policy. [ABSTRACT FROM AUTHOR]

A systemic and integral approach to 'organisational resilience' is important if infrastructure providers are going to advance business strategies which contribute to the sustainable development of their regions. What is required is an understanding of resilience which links the development of people as learning agents with sustainable professional practices at all levels of an organisation, including its external partners, its customers and its community. This can then drive business transformation which empowers both a sustainability and a commercial value creation logic. This paper contributes to type resilience discussion by exploring the conceptual space between the notion of learning for resilient agency and the technical resilience required for sustainability in infrastructure services. We do this through a case-study of a water utility in New South Wales, Australia, which has constructed an integral model of resilience as a 'working theory of change'. Particular attention is paid to the interface between the human systems and the technical systems as a critical 'missing link' in the resilience discourse. [ABSTRACT FROM AUTHOR]

The concept and practice of Social Impact and Social Impact assessment has developed and matured over the last decade. Despite this growth, confusion still exists with respect to definitions of social impact as well as which tools and frameworks are most appropriate. Central to the concept and practice of social impact is a focus on outcomes. This paper argues that a discernible albeit problematic pattern and approach has emerged in outcomes measurement within the social impact field. After briefly reviewing some of the key problems with how outcomes measurement is practised, it presents some recent approaches from the evaluation field that attempt to address some of these concerns before introducing a new approach to understanding and evaluating outcomes -Meaningful Evaluation (ME). A pilot Meaningful Evaluation of volunteer ethics teachers in the Primary Ethics program in NSW is used to illustrate the approach. ME combines the Map of Meaning (MoM) with insights from next generation evaluation approaches to understand and assess outcomes. Informed by appreciative inquiry perspectives, it provides a means to bridge the divide between positivist and interpretivist approaches in evaluation. Key to ME is the assumption that it is more likely that immediate outcomes lead to medium and long-term outcomes (changes in behaviour) that are sustainable and lead to impact if participants experience program interventions as 'meaningful'. Meaning is an important internal outcome that is essential if longer-term external outcomes are to occur. It also shifts the focus to capture unintended outcomes, key to developing holistic and systemic rather than linear and mechanistic Theories of Change. [ABSTRACT FROM AUTHOR]

Aim To report a programme theory for pre-natal home visiting by nurses in the context of a sustained nurse home visiting programme by exploring pre- and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes. Background Studies have shown sustained nurse home visiting commencing pre-natally to be effective. Few studies have explored the processes by which pre-natal activities by nurses contribute to achieving effective outcomes. Design Process evaluation. Methods Process and outcome data from a randomized controlled trial of sustained nurse home visiting in an area of socioeconomic disadvantage in Western Sydney between 2005-2008 were collated. The pre-natal intervention focused on improving transition to parenting by supporting mothers through pregnancy. Health and service use outcome data were analysed for 208 women (111 intervention; 97 comparison receiving usual care). Five nurses delivering the intervention completed checklists detailing activities undertaken. Results Nurses provided information, psychosocial support, and health promoting activities for families. Intervention mothers had a higher rate of unassisted vaginal births than the general population. Compared with comparison mothers, intervention mothers at 4-6 weeks postnatally reported better general health and felt significantly more enabled to cope with and understand their baby and to care for themselves and their baby. Conclusion Comprehensive support, in a context of enabling client-nurse relationships and continuity of carer are the ways by which antenatal nurse home visiting achieves benefits for women and infants, having an impact on both clinical outcomes such as rates of normal vaginal delivery and maternal service engagement. [ABSTRACT FROM AUTHOR]

Introduction: The NSW Agency for Clinical Innovation (ACI) recently completed an e-enabled proof-of-concept Patient Reported Measures (PRMs) program. The PRM program was co-designed from inception, solution design, implementation and evaluation with consumers, clinicians and managers across care settings in NSW. The PRM program focused on measuring what matters most to people living with chronic and complex conditions and providing real-time reports to care providers to improve care coordination, care planning, shared decision making and importantly support people (patients/carers) to be partners in their healthcare. Description: The PRM Program held several workshops, established a community of practice, and worked alongside stakeholders across care settings to truly co-design, test, refine, implement, evaluate an e-enabled PRM program that measured what mattered most to a person, irrespective of their condition - focusing on holistic care, with PRM reports available in real-time. This enabled clinicians to view what mattered most to those they were treating, and often uncover key areas of concern they previously didn't know about. Aim and theory of change: The overall aim of the program is to enable people to provide direct and timely feedback to healthcare providers about what matters most to them - the theory of change is through completing PRMs electronically, the reports are available in real-time to care providers who can then spend more time during consults focusing on what matters most and tailoring care and treatment - time is maximised and enables a broader holistic approach Targeted population and stakeholders: People living with chronic and complex conditions, across care settings for the initial proof-of-concept PRM program, focusing on integrated care (across care settings - hospital, community, general practice). Stakeholders including anyone with an interest in PRMs (clinicians, managers, executives, consumers, carers) and those interested in finding out the key challenges and enablers of committing to a true co-design process to implement, evaluate and build a robust system to collect PRMs electronically. Timeline: Proof-of-concept program is complete and evaluation finished in 2017. The further codesign of the new PRM IT solution and program is set to be complete late 2018, with implementation occurring early 2019 across care settings. Highlights (innovation, Impact and outcomes): Innovative resources to support and build capacity and capability of care providers. Innovative approach to co-design and partnership. Positive impact and outcomes of patients involved in proof-of-concept. Increased uptake (as evidence by request for assistance and implementation), evaluation will be discussed. Comments on sustainability: Due to the true co-design approach and robustness of the program, it is proven to be sustainable and scalable Comments on transferability: Transferable across jurisdictions/countries. Have already provided advice to many other Australian and international partners on our program Conclusions (comprising key findings): The PRM program transformed care delivery and through the proof-of-concept evaluation ACI is in the final stages of co-designing a robust e-enabled platform capable of integrating with electronic medical records and patient portal views to enhance integrated care with a focus on what matters most to patients (or their carers). [ABSTRACT FROM AUTHOR]

Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. The NSW Government's Integrated Care Strategy funding enabled the establishment of an integrated care initiative called Healthy Homes and Neighbourhoods (HHAN). The Initiative was designed as a population-based, family-centered, care-coordination network that functioned across agencies to assist vulnerable families to navigate the health and social-care system, to keep themselves and their children safe, and in doing so, promote social cohesiveness. The evaluation framework is described. Methods: Since integrated care initiatives are an example of complex interventions in health and social care, we underpinned this programme of development, research and evaluation by the critical realist metatheory of science and the NSW Health Monitoring and Evaluation Framework, using the UK Medical Research Council (MRC) Framework for evaluating complex interventions.1 We adapted the iterative approach of development, feasibility/piloting, evaluation and implementation of the MRC framework to include critical realist, participatory, continuous and theory driven elements. Discussion: Both the 2008 UK Medical Research Council framework for evaluating complex interventions, and our previously reported critical realist methodology, provided the tools to enable an iterative approach to development, design, testing and continuous evaluation. The philosophical paradigms underpinning each approach are different. Both the NSW Health and MRC frameworks were developed from in the "logical positivist" inductive and deductive reasoning traditions with a strong focus on activities and outcomes but little emphasis on process. That weakness was been recognised and the MRC subsequently endorsed advice on process evaluation for complex interventions which accommodated the realist approach incorporated here. Conclusion: Integrated care initiatives are examples of complex interventions in health and social care. The interventions are multi-layered and operationalization is strongly influenced by both historical and current context. This aspect alone makes it imperative that the methodology used is post-positive and takes ontologically stratified context into account. The NSW Health Monitoring and Evaluation Framework did not make provision for assessment of context or mechanism of effect. We describe here a multilevel approach including a continuous improvement approach through constant comparison and triangulation of mixed method findings. Utilising the MRC framework for evaluating complex interventions within a critical realist methodology, enabled us to study both mechanisms of effect and context. Lessons learned: Evaluation of integrated care interventions will require a pluralist approach to methodology. It is possible to design evaluation approaches that allow study of context, mechanism, reach and efficacy in a complex layered design as used for integrated care initiatives. Limitations: The approach utilised was contrained by the requirements of the policy and funding organisation. We did not fully explore the application of Theory of Change and complexity science within the MRC framework. Suggestions for future research: We recommend that further theoretical and applied research be undertaken to advance the methods and tools available for evaluation of complex multi-layered integrated care initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Primary health is the cornerstone of a strong and efficient health system. High performing primary care that is accessible, comprehensive, co-ordinated and continuous, and achieved through contemporary models of care offers the potential to enhance integration, improve patient outcomes and experience, and sustainability. Primary Health Networks are building capacity and capability for general practice to achieve this based on a model known as Patient Centred Medical Home (PCMH). The Australian Government is commencing the roll out of 'Health Care Homes' using elements of PCMH and alternative payment structures. To optimise the impact of these primary care reforms requires a supportive and collaborative approach from the broader health system. Practice Change: The NSW Agency for Clinical Innovation (ACI) is supporting services to develop localised integration networks - "Healthcare Neighbourhoods". Neighbourhoods will operate with the general practice or Aboriginal medical service as the hub and include health and social care services. Neighbourhoods support the practice through engagement with care coordination, shared care planning, effective communication, data sharing, and a team-based approach to care. Aim and Theory of Change: The Healthcare Neighbourhood aims to build a shared purpose for integration and care outcomes, clarify roles and responsibilities, and support collaboration with general practice. It refocusses the health system from operating in silos to integrated implementation with primary care as the hub. ACI will deliver a capability program that builds awareness and knowledge, encourages connections and information sharing, provides tools and resources, and supports implementation of healthcare neighbourhoods. It constitutes a significant component of a change and adoption strategy for a more integrated health economy. Targeted Population: Key beneficiaries are people with chronic and/or complex conditions. The intervention will take place at the meso and micro system. Timeline: Trial sites will commence in October 2017 across three Local Health Districts and Primary Health Networks and will run until June 2018. Highlights: A 'Navigating the Healthcare Neighbourhood' website has been launched, bringing together information about PCMH including; definitions, animations and videos, articles, case studies, patient stories, and other resources. Five local events with international experts in PCMH and integrated care have been held. These have been attended by over 200 health professionals from across NSW. Forthcoming: Podcasts with international patient-centred medical home experts Dr Kirsten Meisinger and Dr Nwando Olayiwola will be released shortly. Sustainability: This work is aligned with macro level policy change at Federal and State Government level. The project seeks to establish shared vision and understanding across the health system and explore local opportunities for change and collaboration. Transferability: Our work provides a high-level structure, resources and tools to build healthcare neighbourhoods, which can be tailored to meet local needs and resources. [ABSTRACT FROM AUTHOR]

Introduction: The health sector is activity focused; it is counted, valued and bought. Is this sustainable and should alternative constructs be considered? This case study from Integrated Care on the Central Coast of NSW, Australia outlines the journey of building an Outcomes Based Commissioning Framework to support vulnerable older people. Practice Change Implemented: The approach applied new thinking around funding outcomes to develop an innovative funding to drive improved care. Aim and theory of change: The aim is to deliver care coordination for vulnerable population group, engage community based providers and pilot an alternative funding model. Targeted population and stakeholders: The project encompassed needs assessment and predictive risk stratification for a population at risk of hospitalisation in the next twelvemonths and experiencing health and socioeconomic disadvantage. Timeline: Twelve-months. Highlights: The project brought together essential components of care - identifying a population at future risk, collaboratively designing new models of care through care design, assessing the local community's capability to support the vulnerable and creating outcome based payment and contracting models. An outcome focus was developed through reducing hospitalisations and this provided the basis for an alternative funding model. The model focused on care and ensured funding was available where care was required (at the hospital to pay for bed days or to pay providers for supporting people in their community). This shifted the focus and reimbursement from service activity to delivering on patient outcomes. Sustainability and Transferability: This approach, drawing on existing funding, has potential to be sustainable into the future and challenges traditional funding of care. Transferability could be country wide, and the outcomes approach has implications in integrated care in all settings. It expands significantly on international outcome models by increasing payments to providers that successfully support patients to avoid unnecessary hospitalisations. Hybrid models of activity based and outcomes based funding have potential into the future of health funding. Conclusions: Potentially this care model is agreeable to providers, sits within existing health budgets, is transparent and allows care to follow the patient. Discussion: An alternative care model has been trialed within an Outcomes Based Commissioning Framework. It incorporates new approaches to considering funding, engaging the market and fundamentally challenging the traditional approach to core business. Lessons Learned: This new way of thinking challenges both the system and the people that work in it. It is a journey of change and needs support and guidance along the way. Political scrutiny adds an extra dimension to work of this type and the right stakeholders must be engaged. A number of secondary outcomes have emerged including: Development of new contracts and KPIs Improving links between clinical and financial performance staff Establishing frameworks for care coordinators and general practitioners to work closer together. [ABSTRACT FROM AUTHOR]

Introduction: The NSW Integrated Care Strategy involves implementing innovative, locally led models of integrated care across the State to transform the NSW healthcare system. The Agency for Clinical Innovation's Patient Reported Measures (PRMs) Program is an important enabler of this strategy. The PRMs Program aims to enable patients to provide direct, timely feedback in order to drive improvement and integration of health care across NSW. Short description of practice change implemented: The PRMs Program enables the collection and use of Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs). The program has used a collaborative co-design approach working with a range of consumers and clinicians throughout each phase. The program is currently working with 11 proof of concept sites (geographical areas) from rural, regional and metropolitan NSW and has facilitated the development of strong partnerships between the acute, community and primary health care services. The program has significantly built capability and capacity of the health care system to transform how care is delivered and how people think about patient outcomes using a range of resources. Aim and theory of change: A formative evaluation of the program was completed to assess the short-term and intermediate outcomes and identify the barriers and enablers of embedding PRMs into routine clinical practice. Targeted population and stakeholders: The targeted population for the program was people living with complex and long term conditions. The PRMs Program has worked with a variety of consumers, clinicians and managers from the proof of concept sites across a range of different settings. Timeline: The Integrated care strategy commenced in 2014 and will run over six years. The PRMs Program commenced late 2014 initially with four proof of concept sites and, due to heavy demand for support and broadening of the program, the program has expanded to 11 proof of concept areas which comprises 81 sites. Highlights (innovation, Impact and outcomes): The PRMs Program formative evaluation identified that having a genuine co-design approach (working from the start with consumers and clinicians) of the program was identified as a key strength of the program as was the co mmitment to travelling out to visit the sites to localise implementation and the education and training was well received. There was early evidence that care planning changed following completion of PROMs and that PRM data has been used to monitor quality and refine service delivery. There was also early evidence that care was more patient-centred, more responsible to patient's needs, clinical practices improved, service delivery more effective and added to reduction in unplanned hospital admissions. Conclusions (comprising key findings): PRMs Program demonstrates how the use of co-design and technology can be used to improve the integration of care and change the way care is delivered to ensure that we really hear what matters most to patients. The results of the program evaluation will be shared and will highlight the enablers and barriers to embedding PRMs into routine clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The current health care system has been characterised as overly focused on treating illness rather than promoting health, and driven by the care provider rather than the consumer. In order to begin to shift this approach to care design and delivery we must work with consumers, enabling them to understand and manage their health needs. The NSW Agency for Clinical Innovation (ACI) Chronic Care Network has sponsored the development of a Consumer Enablement Framework in partnership with consumers, the NSW Ministry of Health, other NSW Health Pillar agencies, Health Consumers NSW, Local Health Districts and Primary Health Networks. Practice Change The Framework aims to Provide easy access to evidence and identify approaches that strengthen a person's capacity and motivation to manage their healthcare Provide tools and resources to support an organisational culture and environment that optimises enablement, health and equity. Aim and theory of change: Enablement in health describes the confidence, skills, and knowledge people use to manage their own health and wellbeing. Enablement is also influenced by the way health services are delivered and the environment they live in. Increasing a person's involvement in their own care can foster better health, offer opportunities for selfmanagement, and avoid unnecessary treatments. Targeted Population: The Framework can be accessed by everyone, however, it has been written for healthcare providers, and staff within community and social organisations. Timeline: A draft Framework will be circulated for feedback in September 2017, with the final Framework due in February 2018. Implementation opportunities will be available in 2018 for interested clinicians, organisations and services. Highlights: We engaged more than 300 consumers, families and clinicians in the design and development of the Framework. Consultation occurred from the beginning and at multiple points throughout the process and a prototype was used to share and test ideas. Use of an iterative process with multiple rounds of prototype cycles created state-wide buy-in, sharpened our thinking and ensured we designed and developed a valuable and practical Framework. Transferability: Due to the extensive consultation undertaken, the Framework is expected to be relevant and applicable to both NSW Health and Primary Care. Conclusions: Development of the Framework for Consumer Enablement has required explicit recognition of the multiple components of enablement and the interaction this has with individual's strengths and weaknesses. This is a person centred approach to the management of health and wellbeing in which the principle aim of healthcare providers is to build upon and develop a person's strengths, resilience and health literacy. The Framework aims to bridge the gap between choice and people's ability to integrate care of their health with the demands of life. [ABSTRACT FROM AUTHOR]

Introduction: Nationally, palliative care separations have increased by 51% over a decade, and demand is projected to rise by 4.6% yearly. Community-based palliative care is 50%-300% less expensive than hospital-based care, yet whilst 74% of Australians wish to die at home only 16% actually do. Unplanned admissions occur due to lack of after-hours care, inadequate symptom management and poorly coordinated care and many patients have not made their wishes for care explicit through completion of an Advance Care Directive (ACD). General Practitioners (GPs) should play a central role as community palliative care delivery by GPs reduces hospitalisations and increases home deaths. Barriers to involvement by GPs include unwillingness to provide after-hours care, and lack of knowledge, confidence and experience in palliative medicine. Methods: A quasi-experimental design utilising an intervention and control group based on neighbouring rural Community Nursing Areas (CNA) was used. Participants were referred by general practices and specialists. Change implemented: The project was a collaboration between the state Northern NSW Local Health District, the regional primary care organisation (then known as North Coast NSW Medicare local) and the then Regional GP training organisation. Patients in the interventaion CNA received standard care from community nurses plus the trial General Practice Registrar (GPR) service. The GPR services will be described. Aim and theory of change: The aim was 1)to increase the proportion of patients who died at home (as wished) and proportion with an ACD, and 2) reduce the number of hospital admissions and bed-days per 100 patient-days. We also aimed to develop enduring palliative care skills and experience in the GP workforce. Targeted population and stakeholders Palliative care patients in a rural town and surrounds. 99 intervention and 92 controls. The design, funding and governance was shared across the 3 collaborating organisations. Timeline: The program ran over a two year period from 2013-15. Highlights: Controls were twice as likely to have eight or more bed-days than the intervention group (OR 2.089 (95%CI 1.100 - 3.967); p=0.024) per 100 days. After adjusting for age and residence in an RACF, analysis showed that controls were ~three times more likely to have two or more admissions than the intervention group (OR 3.12 (95%CI 1.72 - 5.92); p < 0.001) per 100 days. There was a substantial improvement in ACD completions compared to those in the control area. Sustainability and transferability: The registrar gained supervised experience in palliative care to carry into their GP careers. Subsequent General Practice Registrar positions in palliative care have been developed in this and neighbouring health districts. Conclusions: This pilot provides preliminary evidence that a GPR palliative care facilitator can significantly reduce rural palliative care patients' hospital admissions and inpatient days. It is a model that can be replicated and sustained. [ABSTRACT FROM AUTHOR]