The Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE)

Malnutrition is recognised as a wicked problem that adversely influences morbidity, mortality, and treatment costs in approximately one in two hospital inpatients. 

This program applied a multiphase, mixed-methods approach to co-design, implement, evaluate, sustain and spread a locally tailorable, systematised, interdisciplinary malnutrition model of care across diverse settings between 2016 and 2021.  The implementation approach was considerate of key implementation and translation theories, models and frameworks; essentially the program built the reasons to change, involved relevant people in the change process, embedded change into current practice, and accounted for climate to support spread and sustainability

Phase I demonstrated that tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources.

Phase II finalised and published the SIMPLE model, explored additional barriers and enablers to sustainability and spread into new settings, and has implemented SIMPLE processes across many hospital and health service settings both in Australia and internationally

Research team 

Dr Jack Bell (lead, MRFF Translating Research into Practice Fellow), Dr Merrilyn Banks, Rhiannon Barnes, A/Prof Tracy Comans, Belinda Gavaghan, Jan Hill, Heather Keller, Alita Rushton, and Dr Adrienne Young.

Funding Sources

• 2018 MRFF Translating Research into Practice Fellowships - Next Generation Clinical Researchers Program (administered by HMNS)
• Allied Health Professions Office, Queensland;
• Australian Centre Health Services Innovation, AusHSI

Outputs

• The SIMPLE model, toolkit and core dataset. This model was tested and adapted to fit across 15+ hospital settings in Queensland. Adoption and reach evaluation demonstrated tailored implementation in 40 wards in 12 hospitals, in >1500 patients in the absence of additional clinical funding or resources. Mixed methods process data, for example identification of lower value care disinvestments and alternative higher value healthcare reinvestments, and barriers and enablers to delegation have been articulated, applied to transform care, and published.
• Several publications including
  • a book chapter, which has been downloaded more than 14,000 times (as of February 2022).
  • an edited book: Geirsdóttir, Ólöf G. and Bell, Jack J. ed.(2021). Interdisciplinary nutritional management and care for older adults : an evidence-based practical guide for nurses. Perspectives in Nursing Management and Care for Older Adults, Cham: Springer International Publishing, and a book chapter: Geirsdóttir, Ólöf G., Hertz, Karen, Santy-Tomlinson, Julie, Johansen, Antony, and Bell, Jack J. (2021). Overview of nutrition care in geriatrics and orthogeriatrics. Interdisciplinary nutritional management and care for older adults : an evidence-based practical guide for nurses. Cham: Springer International Publishing.3-18
  • several journal articles including:
    •  Bell, Jack J., Young, Adrienne, Hill, Jan, Banks, Merrilyn, Comans, Tracy, Barnes, Rhiannon, and Keller, Heather H. (2018). Rationale and developmental methodology for the SIMPLE approach: A Systematised, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation in hospitals. Nutrition and Dietetics 75 (2) 226-234
    • Bell, Jack J., Young, Adrienne M., Hill, Jan M., Banks, Merrilyn D., Comans, Tracy A., Barnes, Rhiannon, and Keller, Heather H. (2021). Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation delivers improved hospital nutrition care processes and patient reported experiences – an implementation study. Nutrition and Dietetics 78 (5) 466-475

Impact

The SIMPLE program has demonstrated sustained improvements in audited nutrition care, patient reported experience measures, healthcare value, and healthcare outcomes in more than 40 wards in 12 hospitals, in >1500 patients in the absence of additional clinical funding or resources. This program has scaled and spread SIMPLE into 17 sites across Queensland as of October 2021.

Evidence of organic uptake internationally has been supported by international presentations and workshops across the UK, Europe, South East Asia, and North America. SIMPLE has directly informed clinical guidelines, policy, procedure and clinical task instructions guiding care in > 100 public Queensland hospitals, and into the Fragility Fracture Network Global Clinical Toolkit that is transforming nutrition care internationally in hip fracture. 

A further recent example of global uptake of knowledge and social impact is the recent release of the new textbook, ‘Interdisciplinary Nutritional Management and Care for Older Adults, An Evidence-Based Practical Guide for Nurses’ which is founded on the SIMPLE approach (63K downloads; Altmetric score 57, as of March 2022). Although only released in September 2021, this book is already influencing care processes across diverse healthcare settings and is included as a key resource within the Fragility Fracture Network 5-year strategy.