1D - Communicate and Collaborate: Advancing health care outcomes
Tracks
Concurrent D
| Tuesday, September 17, 2024 |
| 1:30 PM - 3:00 PM |
| Hamersley |
Speaker
Mr Matthew Bacon
Senior Policy Officer
WA Department of Health
Look After Your Blood: the development of a blood-borne virus campaign
Abstract
What is the problem/issue that requires public health action? [Context and aim]
Amongst Aboriginal populations in WA, injecting drug use (IDU) is reported as the risk factor for the majority of hepatitis C notifications, and for some HIV notifications. This demonstrates the continuing need for the WA Department of Health (WA DoH) to raise awareness of the prevention, testing and treatment of blood-borne viruses (BBVs) amongst Aboriginal people.
What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]
WA DoH’s previous BBV campaign evaluation demonstrated good performance, with 40% of survey respondents recalling having seen the campaign and 20% noting they got tested for HIV and hepatitis C as a result of seeing the campaign. The previous campaigns success is largely attributed to three-quarters of respondents feeling the content was created by people who understand their community and their culture.
How has this been used in practice? [Translational outcomes]
Using strong stakeholder and consumer engagement has guided the key messages, approach, and concepts of the current campaign. Engagement occurred through focus groups, media consumption analysis and interviews conducted with people that had lived experience of BBVs. Key successes of engagement have been:
1. the partnership with both Aboriginal health services and peer-based drug user organisations which have facilitated relatable campaign scenarios
2. use of peoples lived experiences and assessed where opportunities for intervention could have occurred and exploring how a campaign could support achieve this
3. being able to address the shame as a barrier to BBV healthcare without contributing to the stigma that can be associated with drug use
4. identifying mediums to utilise that could have greatest reach with Aboriginal communities.
What actions should we take in the future to address the problem/issue? [Future actions]
The campaign launch is scheduled in June 2024. Preliminary feedback has highlighted the campaign materials are relevant and impactful. The campaign will be regularly monitored using media analytics. Analytics from the first campaign media buy will be presented at the conference.
Disclosure of Interest Statement:
The authors conducted this work have no conflicts of interest to declare.
Amongst Aboriginal populations in WA, injecting drug use (IDU) is reported as the risk factor for the majority of hepatitis C notifications, and for some HIV notifications. This demonstrates the continuing need for the WA Department of Health (WA DoH) to raise awareness of the prevention, testing and treatment of blood-borne viruses (BBVs) amongst Aboriginal people.
What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]
WA DoH’s previous BBV campaign evaluation demonstrated good performance, with 40% of survey respondents recalling having seen the campaign and 20% noting they got tested for HIV and hepatitis C as a result of seeing the campaign. The previous campaigns success is largely attributed to three-quarters of respondents feeling the content was created by people who understand their community and their culture.
How has this been used in practice? [Translational outcomes]
Using strong stakeholder and consumer engagement has guided the key messages, approach, and concepts of the current campaign. Engagement occurred through focus groups, media consumption analysis and interviews conducted with people that had lived experience of BBVs. Key successes of engagement have been:
1. the partnership with both Aboriginal health services and peer-based drug user organisations which have facilitated relatable campaign scenarios
2. use of peoples lived experiences and assessed where opportunities for intervention could have occurred and exploring how a campaign could support achieve this
3. being able to address the shame as a barrier to BBV healthcare without contributing to the stigma that can be associated with drug use
4. identifying mediums to utilise that could have greatest reach with Aboriginal communities.
What actions should we take in the future to address the problem/issue? [Future actions]
The campaign launch is scheduled in June 2024. Preliminary feedback has highlighted the campaign materials are relevant and impactful. The campaign will be regularly monitored using media analytics. Analytics from the first campaign media buy will be presented at the conference.
Disclosure of Interest Statement:
The authors conducted this work have no conflicts of interest to declare.
Ms Leah Flitcroft
Phd Candidate
Swinburne University Of Technology
Assessment of digital health station utilisation across different remoteness areas in Queensland
Abstract
Located in retail areas and free to use, digital health stations are kiosks that offer an affordable and accessible platform for people to monitor their blood pressure and weight. To date there has been no research to determine the differences in utilisation between urban, regional and remote areas. This study therefore aimed to provide a detailed analysis of the utilisation of digital health stations in Queensland, and the health outcomes for users, with a particular focus on the differences in utilisation across remoteness areas.
Data was collected from 83 SiSU wellness health stations installed across Queensland, for the period January 1, 2018, to May 18, 2023. A total of 427,802 health checks were conducted during this period, pertaining to 273,123 unique users. Multivariate analyses were conducted to identify differences in utilisation and outcomes for users according to sociodemographic and geographic characteristics.
Results reveal that a higher proportion of users were female, from the lowest and highest socio-economic quintiles, and younger, compared to the general Queensland population. There was a lower proportion of users from remote areas, which aligns with the current distribution of stations in Queensland. Users residing in remote areas travelled longer distances to access health stations, and were less likely to be repeat users. Those residing in major cities travelled the shortest distance to a health station, however people residing in inner regional areas were more likely to be repeat users. There was no significant difference in the number of checks per day for stations located in different remoteness areas, however due to low numbers for the one remote station in Queensland, remote areas were excluded from this analysis. There were significant decreases in blood pressure for those with high baseline scores, with more rapid improvements observed in those aged under 65 years. Improvements to baseline blood pressure were observed in all remoteness areas apart from those residing in remote areas.
These findings provide valuable insight into the differences in utilisation of digital health stations across difference demographic cohorts and remoteness areas, however highlight the need for further piloting and assessment of utilisation in remote areas in Queensland.
Data was collected from 83 SiSU wellness health stations installed across Queensland, for the period January 1, 2018, to May 18, 2023. A total of 427,802 health checks were conducted during this period, pertaining to 273,123 unique users. Multivariate analyses were conducted to identify differences in utilisation and outcomes for users according to sociodemographic and geographic characteristics.
Results reveal that a higher proportion of users were female, from the lowest and highest socio-economic quintiles, and younger, compared to the general Queensland population. There was a lower proportion of users from remote areas, which aligns with the current distribution of stations in Queensland. Users residing in remote areas travelled longer distances to access health stations, and were less likely to be repeat users. Those residing in major cities travelled the shortest distance to a health station, however people residing in inner regional areas were more likely to be repeat users. There was no significant difference in the number of checks per day for stations located in different remoteness areas, however due to low numbers for the one remote station in Queensland, remote areas were excluded from this analysis. There were significant decreases in blood pressure for those with high baseline scores, with more rapid improvements observed in those aged under 65 years. Improvements to baseline blood pressure were observed in all remoteness areas apart from those residing in remote areas.
These findings provide valuable insight into the differences in utilisation of digital health stations across difference demographic cohorts and remoteness areas, however highlight the need for further piloting and assessment of utilisation in remote areas in Queensland.
Dr Matthew Govorko
Know Workplace Cancer Senior Coordinator
Cancer Council Western Australia
Exhausted lungs: WA workers' experiences of workplace exposure to diesel engine exhaust
Abstract
CONTEXT:
Any worker can be exposed to diesel engine exhaust (DEE), a known carcinogen, if they work with or around diesel-powered engines. Each year, approximately 130 Australians develop lung cancer due to past exposure to DEE at work. To date, relatively little is known about workers’ awareness of the health effects of DEE exposure.
AIM:
This study sought to measure the experiences and attitudes towards workplace exposure to DEE among Western Australian (WA) workers.
METHODS:
In an online survey, WA workers from a range of industries described the use of diesel engines in their workplace. Respondents who used or worked close to diesel-powered engines reported actions that were taken to manage risks of workplace DEE exposure. Workers reported their awareness of the health effects of DEE.
RESEARCH FINDINGS:
Of the 1,199 survey respondents, 384 workers used or worked close to diesel-powered engines at least occasionally. Actions taken to manage risks associated with DEE included switching off engines when not in use, only using engines outdoors, and using emission control devices. More than one in ten workers (14%) reported that no actions were taken to manage risks associated with DEE. Two in five workers (42%) had not received any training or information about DEE safety measures or health risks. Nearly three quarters (71%) of workers who used or worked close to diesel engines were not aware of any health effects associated with DEE.
TRANSLATIONAL OUTCOMES:
Findings are being used to inform and support policy and advocacy efforts calling for increased awareness, stronger compliance and enforcement activity, and improved government regulation.
FUTURE ACTIONS:
Work health and safety regulators, industry, and peak health groups need to improve health risk communication targeting relevant industries to raise awareness of the health risks and control measures associated with DEE exposure.
Any worker can be exposed to diesel engine exhaust (DEE), a known carcinogen, if they work with or around diesel-powered engines. Each year, approximately 130 Australians develop lung cancer due to past exposure to DEE at work. To date, relatively little is known about workers’ awareness of the health effects of DEE exposure.
AIM:
This study sought to measure the experiences and attitudes towards workplace exposure to DEE among Western Australian (WA) workers.
METHODS:
In an online survey, WA workers from a range of industries described the use of diesel engines in their workplace. Respondents who used or worked close to diesel-powered engines reported actions that were taken to manage risks of workplace DEE exposure. Workers reported their awareness of the health effects of DEE.
RESEARCH FINDINGS:
Of the 1,199 survey respondents, 384 workers used or worked close to diesel-powered engines at least occasionally. Actions taken to manage risks associated with DEE included switching off engines when not in use, only using engines outdoors, and using emission control devices. More than one in ten workers (14%) reported that no actions were taken to manage risks associated with DEE. Two in five workers (42%) had not received any training or information about DEE safety measures or health risks. Nearly three quarters (71%) of workers who used or worked close to diesel engines were not aware of any health effects associated with DEE.
TRANSLATIONAL OUTCOMES:
Findings are being used to inform and support policy and advocacy efforts calling for increased awareness, stronger compliance and enforcement activity, and improved government regulation.
FUTURE ACTIONS:
Work health and safety regulators, industry, and peak health groups need to improve health risk communication targeting relevant industries to raise awareness of the health risks and control measures associated with DEE exposure.
Miss Ellie Kotkis
Research Assistant
Royal Perth Hospital
E-volution of Case Report Forms: Digitization's Impact on a Clinical Toxicology Database
Abstract
Context and Aim
Traditionally, hospital-based research studies have relied on paper-based case report forms (CRFs) for patient enrolment, compromising recruitment and data quality. The State Toxicology Alert Reporting System (STARS) is a secure online clinical toxicology database hosted by the Western Australian (WA) Department of Health. In August 2023, STARS transitioned from paper-based CRFs to digitised CRFs accessible via QR codes. This study compared the completion of electronic CRFs to previously used paper-based CRFs within STARS.
Methods and Analysis
Enrolment into STARS requires a blood sample, a laboratory form, and a completed CRF. Since November 2020, Emergency Department (ED) clinicians across five WA EDs have been educated on patient eligibility and data collection requirements. In August 2023, the paper-based CRFs transitioned to an electronic format with updated educational materials, including posters and lanyard cards.
CRF completeness was defined as the proportion of cases with a created CRF divided by all cases with a blood sample laboratory form identifying STARS enrolment. Both systems were assessed over six months pre- and post-August 2023. Completeness was compared using two-proportion z-tests.
In the six months of paper-based CRFs, 196 of 302 (64.9%) enrolled patients had a completed CRF. In the six months post-digitization, 249 of 291 (85.6%) CRFs were completed. The proportion of completed forms with electronic CRFs was significantly higher than paper-based CRFs (P<.0001).
Translational Outcomes
Electronic CRFs improve completeness, streamline data entry, and improve research quality, particularly in resource-poor settings. Additionally, they facilitate real-time data monitoring and automated error-checking, further improving data quality.
Future Actions
Comprehensive ongoing training sessions for ED staff and a feedback loop for continuous system improvement are essential for enhancing processes within STARS and reducing administrative burden. Regular checkpoints to gather feedback from ED staff will prioritise their suggestions, ensuring ongoing refinement and fostering a user-friendly, efficient environment.
Traditionally, hospital-based research studies have relied on paper-based case report forms (CRFs) for patient enrolment, compromising recruitment and data quality. The State Toxicology Alert Reporting System (STARS) is a secure online clinical toxicology database hosted by the Western Australian (WA) Department of Health. In August 2023, STARS transitioned from paper-based CRFs to digitised CRFs accessible via QR codes. This study compared the completion of electronic CRFs to previously used paper-based CRFs within STARS.
Methods and Analysis
Enrolment into STARS requires a blood sample, a laboratory form, and a completed CRF. Since November 2020, Emergency Department (ED) clinicians across five WA EDs have been educated on patient eligibility and data collection requirements. In August 2023, the paper-based CRFs transitioned to an electronic format with updated educational materials, including posters and lanyard cards.
CRF completeness was defined as the proportion of cases with a created CRF divided by all cases with a blood sample laboratory form identifying STARS enrolment. Both systems were assessed over six months pre- and post-August 2023. Completeness was compared using two-proportion z-tests.
In the six months of paper-based CRFs, 196 of 302 (64.9%) enrolled patients had a completed CRF. In the six months post-digitization, 249 of 291 (85.6%) CRFs were completed. The proportion of completed forms with electronic CRFs was significantly higher than paper-based CRFs (P<.0001).
Translational Outcomes
Electronic CRFs improve completeness, streamline data entry, and improve research quality, particularly in resource-poor settings. Additionally, they facilitate real-time data monitoring and automated error-checking, further improving data quality.
Future Actions
Comprehensive ongoing training sessions for ED staff and a feedback loop for continuous system improvement are essential for enhancing processes within STARS and reducing administrative burden. Regular checkpoints to gather feedback from ED staff will prioritise their suggestions, ensuring ongoing refinement and fostering a user-friendly, efficient environment.
Ms Alicia Machalias
Project Officer
Cancer Council Australia
The crucial role of physical activity in cancer prevention
Abstract
Context and aim
Emerging evidence shows that physical inactivity is associated with an elevated susceptibility to developing 13 different types of cancer, including colon, endometrial, head and neck, gastric and liver cancers.1 The National Preventive Health Strategy adopts a comprehensive approach to address physical inactivity across the entire population in alignment with the Australian evidence-based guidelines on physical activity and sedentary behaviour. 2 Prioritising investment in physical activity promotion may facilitate a reduction in the site-specific cancer burden associated with sedentary behaviour.1
Methods and analysis
Cancer Council Australia recently developed the Physical Inactivity and Cancer policy to present comprehensive, evidence-informed policy initiatives to create supportive environments for Australians to increase participation in physical activity with a focus on mitigating risk of associated cancers and other chronic diseases.
Cancer Council Australia conducted an evidence review and engaged key experts in physical activity and cancer prevention to assist with the development of evidence-informed recommendations to mobilise national action for the promotion of physical activity among Australians. This includes increasing awareness of the link between physical inactivity and increased cancer risk and prompting action to create supportive environments for Australians to participate in regular physical activity.
Translational outcomes
Successfully combatting physical inactivity requires coordinated action across various levels including within the individual, interpersonal, community and policy, and societal domains. Four overarching priority areas were identified: 1) Infrastructure and policy development which alter the physical environment and foster active transportation; 2) Promotion of Australia’s physical activity and sedentary behaviour guidelines for all ages; 3) Enhancing and updating national data collection on physical activity among children; 4) Promotion of intersectoral engagement and strategic partnerships for comprehensive physical activity promotion.
Future actions
The promotion of physical activity should intersect across multiple levels of influence to effectively support physical activity participation among Australians for the purpose of cancer and chronic disease prevention.
References
1Ellis, L., Milne, R. L., Moore, M. M., Bigby, K. J., Sinclair, C., Brenner, D. R., Moore, S. C., Matthews, C. E., Bassett, J. K., & Lynch, B. M. (2023). Estimating cancers attributable to physical inactivity in Australia. Journal of science and medicine in sport, S1440-2440(23)00514-5. Advance online publication.
2Department of Health. (2021). National preventive health research strategy. Obesity Research & Clinical Practice, 7, e115. https://doi.org/10.1016/j.orcp.2013.12.706
Emerging evidence shows that physical inactivity is associated with an elevated susceptibility to developing 13 different types of cancer, including colon, endometrial, head and neck, gastric and liver cancers.1 The National Preventive Health Strategy adopts a comprehensive approach to address physical inactivity across the entire population in alignment with the Australian evidence-based guidelines on physical activity and sedentary behaviour. 2 Prioritising investment in physical activity promotion may facilitate a reduction in the site-specific cancer burden associated with sedentary behaviour.1
Methods and analysis
Cancer Council Australia recently developed the Physical Inactivity and Cancer policy to present comprehensive, evidence-informed policy initiatives to create supportive environments for Australians to increase participation in physical activity with a focus on mitigating risk of associated cancers and other chronic diseases.
Cancer Council Australia conducted an evidence review and engaged key experts in physical activity and cancer prevention to assist with the development of evidence-informed recommendations to mobilise national action for the promotion of physical activity among Australians. This includes increasing awareness of the link between physical inactivity and increased cancer risk and prompting action to create supportive environments for Australians to participate in regular physical activity.
Translational outcomes
Successfully combatting physical inactivity requires coordinated action across various levels including within the individual, interpersonal, community and policy, and societal domains. Four overarching priority areas were identified: 1) Infrastructure and policy development which alter the physical environment and foster active transportation; 2) Promotion of Australia’s physical activity and sedentary behaviour guidelines for all ages; 3) Enhancing and updating national data collection on physical activity among children; 4) Promotion of intersectoral engagement and strategic partnerships for comprehensive physical activity promotion.
Future actions
The promotion of physical activity should intersect across multiple levels of influence to effectively support physical activity participation among Australians for the purpose of cancer and chronic disease prevention.
References
1Ellis, L., Milne, R. L., Moore, M. M., Bigby, K. J., Sinclair, C., Brenner, D. R., Moore, S. C., Matthews, C. E., Bassett, J. K., & Lynch, B. M. (2023). Estimating cancers attributable to physical inactivity in Australia. Journal of science and medicine in sport, S1440-2440(23)00514-5. Advance online publication.
2Department of Health. (2021). National preventive health research strategy. Obesity Research & Clinical Practice, 7, e115. https://doi.org/10.1016/j.orcp.2013.12.706
Dr Becky White
Adjunct Research Associate
Curtin University
Developing an infodemic management toolkit for immunization: An iterative consultation process
Abstract
Context and aim
An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights.
Methods and analysis/research findings
In 2023, WHO and UNICEF released guidance on ‘how to build an infodemic insights report in 6 steps’. This report gives general guidance and a more specific document, with practical and specific tools in standalone short focus areas that are immunization specific, was developed to guide infodemic managers or those working on vaccine demand and acceptance and by vaccination field workers. The toolkit is intended for work on vaccines across the life course. Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels.
Translational outcomes
The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives.
Future actions
The importance of the infodemic and management of misinformation is well recognised as a public health concern, both in Australia, and internationally. Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox. For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake and manage vaccine-related events. Future work can determine how this can apply to other health issues.
An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights.
Methods and analysis/research findings
In 2023, WHO and UNICEF released guidance on ‘how to build an infodemic insights report in 6 steps’. This report gives general guidance and a more specific document, with practical and specific tools in standalone short focus areas that are immunization specific, was developed to guide infodemic managers or those working on vaccine demand and acceptance and by vaccination field workers. The toolkit is intended for work on vaccines across the life course. Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels.
Translational outcomes
The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives.
Future actions
The importance of the infodemic and management of misinformation is well recognised as a public health concern, both in Australia, and internationally. Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox. For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake and manage vaccine-related events. Future work can determine how this can apply to other health issues.
Dr Becky White
Adjunct Research Associate
Curtin University
Informing infodemic management capacity building with a robust and adaptable capability tool
Abstract
Context and aim
Infodemic management competencies and indicators have been included in key WHO pandemic preparedness documents and guidance such as the Preparedness and Resilience for Emerging Threats (PRET) initiative, the Health Emergency preparedness and response (HEPR) framework and in the WHO benchmarks for strengthening health emergency capacities. Training and capacity building is needed to strengthen infodemic management skills and capacity, and a tool to define capabilities and inform training needs was needed.
Methods and analysis/research findings
An adaptable tool was developed and piloted to measure infodemic management capacity to inform training and capacity building needs. The tool was informed by previous work and adapted to cover a wide set of capabilities, informed by the WHO competency framework for the infodemic workforce. The tool was developed to cover the breadth of infodemic management work practice and structural support and included: who is conducting infodemic management work; structures in place to support; main activities; health topics focus areas; partnerships with other organisations; social listening and infodemic insights generation; as well as challenges, opportunities and training needs.
Translational outcomes
The capability tool was piloted in March – May 2024 to inform regional and country level trainings. The tool can be adapted to the specific situation, with a full survey able to be disseminated via an online survey platform, as well as a modified interview guide for key informants or settings where that is more appropriate. The ability to adapt to specific settings is important to ensure the results are as useful and tailored as possible. Infodemic management is a new field in public health and the tool provided useful assessment of infodemic management capabilities to inform capacity building needs.
Future actions
The importance of the infodemic and management of misinformation is now well recognised as a public health concern, both in Australia, and internationally. Training and capacity building is needed broadly and these are new skills for many health professionals. Targeted and informed training programs are important for upskilling the workforce, and tools that assess capabilities in robust and standardised ways using documents such as the competency framework are vital.
Infodemic management competencies and indicators have been included in key WHO pandemic preparedness documents and guidance such as the Preparedness and Resilience for Emerging Threats (PRET) initiative, the Health Emergency preparedness and response (HEPR) framework and in the WHO benchmarks for strengthening health emergency capacities. Training and capacity building is needed to strengthen infodemic management skills and capacity, and a tool to define capabilities and inform training needs was needed.
Methods and analysis/research findings
An adaptable tool was developed and piloted to measure infodemic management capacity to inform training and capacity building needs. The tool was informed by previous work and adapted to cover a wide set of capabilities, informed by the WHO competency framework for the infodemic workforce. The tool was developed to cover the breadth of infodemic management work practice and structural support and included: who is conducting infodemic management work; structures in place to support; main activities; health topics focus areas; partnerships with other organisations; social listening and infodemic insights generation; as well as challenges, opportunities and training needs.
Translational outcomes
The capability tool was piloted in March – May 2024 to inform regional and country level trainings. The tool can be adapted to the specific situation, with a full survey able to be disseminated via an online survey platform, as well as a modified interview guide for key informants or settings where that is more appropriate. The ability to adapt to specific settings is important to ensure the results are as useful and tailored as possible. Infodemic management is a new field in public health and the tool provided useful assessment of infodemic management capabilities to inform capacity building needs.
Future actions
The importance of the infodemic and management of misinformation is now well recognised as a public health concern, both in Australia, and internationally. Training and capacity building is needed broadly and these are new skills for many health professionals. Targeted and informed training programs are important for upskilling the workforce, and tools that assess capabilities in robust and standardised ways using documents such as the competency framework are vital.
