Introduction Timely assessment of swallowing disorders (dysphagia) by speech pathologists helps minimise patient risk, optimise quality of life, and limit healthcare costs. This study involved a multi-site implementation of a validated model for conducting adult clinical swallowing assessments via telepractice and examined its service outcomes, costs and consumer satisfaction. Methods Five hub-spoke telepractice services, encompassing 18 facilities were established across a public health service. Service implementation support, including training of the telepractice speech pathologists (T-SP) and healthcare support workers in each site, was facilitated by an experienced project officer. New referrals from spoke sites were managed by the hub T-SP as per published protocols for dysphagia assessments via telepractice. Data was collected on existing service models prior to implementation, and then patient demographics, referral information, session outcomes, costs and patient and T-SP satisfaction when using telepractice. Results The first 50 sessions were analysed. Referrals were predominantly for inpatients at spoke sites. Telepractice assessments were completed successfully, with only minor technical issues. Changes to patient management (i.e. food/fluid changes post assessment) to optimise safety or progress oral intake, was required for 64% of patients. Service and cost efficiencies were achieved with an average 2-day reduction in waiting time and an average cost benefit of $218 per session when using the telepractice service over standard care. High clinician and patient satisfaction was reported. Conclusion Telepractice services were successfully introduced across multiple sites, and achieved service and cost benefits with high consumer satisfaction.

Purpose While research has confirmed the feasibility and validity of delivering clinical swallowing evaluations (CSEs) via telepractice, challenges exist for clinical implementation. Using an implementation framework, strategies that supported implementation of CSE services via telepractice within 18 regional/rural sites across five health services were examined. Method A coordinated implementation strategy involving remote training and support was provided to 18 sites across five health services (five hub and spoke services) that had identified a need to implement CSEs via telepractice. Experiences of all 10 speech-language pathologists involved at the hub sites were examined via interviews 1 year post implementation. Interview content was coded using the Consolidated Framework for Implementation Research (CFIR) and constructs were rated for strength and direction of influence, using published CFIR coding conventions. Results Services were established and are ongoing at all sites. Although there were site-specific differences, 10 CFIR constructs were positive influencing factors at all five sites. The telepractice model was perceived to provide clear advantages for the service, and clinicians were motivated by positive patient response. Strategies used to support implementation, including having a well-organized implementation resource and an external facilitator who worked closely with the local champions, were highly valued. Two CFIR constructs, Structural Characteristics and Available Resources , were challenges for all sites. Conclusions A complex interplay of factors influenced service implementation at each site. A strong local commitment to improving patient care, and the assistance of targeted strategies to support local implementation were viewed as central to enabling implementation.

Summary This paper describes an approach to managing E&P assets through the operation of multidisciplinary business teams (MBT's). This approach can result in improved asset performance in terms of efficiency, motivation, and business results compared with more traditional matrix-style hierarchies. This paper also outlines certain critical success factors for the long-term success of MBT's and discusses some of the risks of MBT operation. Introduction Optimal development of E&P assets is often encumbered by the organizational structure and internal workings of the company(s) owning the assets. All too frequently, the management hierarchies of E and P companies are ill-equipped to focus on the range and diversity of opportunities offered to them in their asset base. This occurs primarily because the authority to make decisions frequently is several levels removed from the source of technical knowledge and the individuals in the best position to make decisions. Thus, people in a position to recognize opportunities to build value into a set of assets often face both communication difficulties and internal competition in persuading senior management to take positive action. Compare this with a situation where all the professional input needed for the enhancement of a given set of assets is incorporated into one core team, and this core team is vested with total management responsibility. This is the essence of the MBT philosophy. What Are MBT's? MBT's are groups of staff brought together to manage a defined set of resources. The types of resources or "assets" that are best managed by an MBT are those that are capable of being run as a stand-alone business; that have a defineable value, in terms of both book value and/or market value; and that can be enhanced through value-adding activities. The key assets of an E and P company are licenses for exploration and/or operation. Most licenses fulfill all the above criteria of suitability for MBT management. It is helpful to think of types of E and P licenses as distinct asset types: production assets, production assets under development, and exploration assets. These asset types can be run on a stand-alone business basis and have a value that can be enhanced. The processes of adding value will differ for processes of adding value will differ for producing acreage compared with wildcat acreage. Nonetheless, all can, individually or jointly, constitute the basis of an independent business unit.

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