Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Implementation of Behaviour Response Teams (BRT) has affirmed that educating and empowering staff positively changes culture and enables delivery of exceptional care to our most vulnerable and misunderstood patients.
Dates: February 2025 - January 2026
Implementation sites: Bundaberg Hospital
Partnerships: Cognitive Impairment Committee, DSA, Integrated Care, Acute Care, Residential Aged Care Facilities, GP Clinics
Aim
To strengthen workforce knowledge, culture and capability, to improve care for those significantly affected by behavioural change due to dementia or disability- Families, carers, loved ones and the person themselves.
Outcomes
- Since inception in late January 2025, over 450 consumers and their families have benefited from BRT.
- Whilst supporting these individual patients BRT has proactively increased the capacity of WBHHS workforce with recognisable sustained culture change.
- Cultural shift from a “behaviour removal” mindset towards contextualising changed behaviours showing enhanced staff understanding of behaviour as an expression of unmet needs.
- Increased use of meaningful engagement activities that reduce distress and limit the impact of changed behaviours including reduced occupational violence.
- Enhanced staff understanding of changed behaviour and detailed behavioural reporting, with use of Pittsburgh Agitation Scale (PAS) data to support safe transitions to discharge destinations.
Background
WBHHS encompasses the Wide Bay and North Burnett catchment. 25% of the population in Wide Bay is aged over 65 years which is 12.8% greater than Queensland (WBHHS health service plan). In Bundaberg in 2026 there are an estimated 2,600 people living with dementia. In 2054, it is expected there will be 4,859 people living with dementia (87% increase). Similarly on the Fraser Coast there are currently an estimated 3,204 people living with dementia, with an expected 5,896 people living with dementia in 2054 (84% increase) (Dementia Australia, 2023).
Clearly a proactive, considered approach for quality care provision relevant to the needs of this population is essential. Across the WBHHS, individuals living with dementia and cognitive impairment with changed behaviours frequently encounter barriers to receiving safe, appropriate, and person‑-centred care. Staff commonly reported feeling underprepared to respond to behavioural expressions, and organisational expectations did not always align with the service’s capability or with contemporary evidence‑based dementia care. Early referrals to BRT were often accompanied by an implicit expectation that the team would “remove” or “resolve” behaviours to expedite discharge. This reflected a broader cultural challenge in which behavioural expressions were conceptualised as problems to eliminate rather than as meaningful communication of unmet needs, consistent with the frameworks described by Cunningham, Macfarlane and Healy (2024). BRT recognises that behaviour is shaped by the interaction between the person, their environment, and the care context. Just as patients communicate distress, discomfort, or unmet psychosocial needs through behavioural expression, staff also communicate through their actions, requests, and frustrations.
By informally assessing “staff unmet needs,” the team sought to understand the drivers behind staff responses - including uncertainty, fear, time pressures, or gaps in knowledge. This reflective, human‑centred approach became a catalyst for cultural change and aligned with contemporary models emphasising relational care, emotional intelligence, and the importance of staff capability in reducing changed behaviours. Initial analysis revealed a disconnect between organisational expectations and the workforce’s readiness to deliver quality dementia care.
Patient flow challenges added significant pressure. Individuals with (additional/ increased) behavioural needs often experienced delayed discharge or difficulty securing Residential Aged Care Facility (RACF) placement. BRT enhances transparency with RACFs by providing detailed behavioural reports, Behaviour Support Plan (BSP) strategies, and Pittsburgh Agitation Scale (PAS) data to support safe and sustainable transitions. This improves confidence among receiving facilities and reduces placement barriers. In the community, BRT contributes to hospital avoidance by offering consultation, tailored strategies, and follow‑-up to monitor changes and adjust care plans accordingly. This ensures that individuals receive care in the most appropriate setting and reduces unnecessary admissions.
Methods
BRT employed a consultation‑driven quality improvement methodology informed by Plan–Do–Study–Act (PDSA) cycles, human factors principles, and contemporary approaches to dementia care. Consistent with the frameworks described by Cunningham, Macfarlane and Healy (2024), BRT prioritised understanding behavioural expressions as communication and emphasised capability building across the workforce. The methodology centred on identifying gaps in staff knowledge, confidence, and cultural attitudes, and then designing targeted interventions to strengthen person‑-centred dementia care across WBHHS.
Cultural change became BRT core business. Through point‑of‑care education and modelling of best practice, staff were encouraged to challenge assumptions, destigmatise cognitive impairment, and adopt inclusive, person‑centred language. BRT supported engagement activities which reduced distress and demonstrated the therapeutic value of meaningful occupation (Cunningham et al, 2024). Theoretical principles underpinning BRT’s function include human factors principles and Safety‑II approaches that emphasise learning from what
goes well, rather than focusing on deficits. BRT highlighted staff strengths and reinforced the message that clinicians already possess the capacity to deliver high-quality dementia care. Hence, articulating that the “magic” was not in BRT itself but in enabling staff to recognise and apply their existing capability.
- Concept Development and Problem Identification Structured brainstorming and thematic analysis identified key messages that would resonate with staff and support cultural change. “From Referral to Recov-based interpretations of behaviour. Ward observations, referral patterns, and discussions with clinical care teams informed the identification of systemic barriers and workforce learning needs. Positive practice stories were incorporated to reinforce learning and highlight effective care.
- Development of a Comprehensive Education Program A multi-layered education suite was designed to build staff
capability in understanding cognitive impairment, behavioural drivers, and person‑centred strategies. Education emphasised critical thinking, behavioural formulation, empathy calibration, and reflective practice. Sessions were interactive, grounded in real
clinical scenarios, and aligned with evidence-based principles for responding to changed behaviour. - Implementation and Evolution of the Model Implementation progressed through three phases:
- Phase 1: Foundational education delivered through orientation and ward‑based sessions.
- Phase 2: Increased BRT presence, modelling best practice and supporting staff in real time.
- Phase 3: Embedding a transdisciplinary team (TDT) model across facilities, with education sustaining long‑term cultural change.
- Strengthening Patient Flow and Discharge Planning To address delays in discharge and placement, the BRT enhanced communication with RACF by providing detailed behavioural reports, Behaviour Support Plan (BSP) strategies, and PAS data. The team facilitated safe transitions to community or residential care, supported Advance Care Planning discussions, and engaged families to ensure continuity of person‑centred strategies.
- Enhancing engagement and Independence Clinical staff collaborated to deliver meaningful engagement activities which reduced distress and modelled evidence‑-based approaches to address changed behaviour.
- Continuous Feedback and Adaptation Education content and delivery were refined through ongoing staff feedback.
Discussion
This study has shown the value of the guideline sanctioned move in our protocol from IVHC to IVMP in the treatment of ASUC. The use of protocols is commonplace in the management of this high stake condition and exist in many hospitals around the state and country. A change is relatively easy to implement and in keeping with good practice.
In summary, IVMP and IVHC remain central to the acute management of ASUC, with the additional evidence suggested by this study there is little difference in colectomy rate, response to therapy and requirement for advanced therapy. Their pharmacological distinctions
– less hypokaleamia, reduced nursing interactions and reduced inpatient stay suggests that IVMP is the more appropriate option in our setting, but definitive comparative evidence is lacking.
While the use of steroids for ASUC may become less relevant in the future, leading study designs have yet to stray from their use. Therefore, further investigation with blinded randomised controlled trial to confirm our findings would still have merit.
References
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Key contact
Sarah Weiss
Clinical Nurse Consultant
Behaviour Response Team
Bundaberg Hospital
Wide Bay Hospital and Health Service