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Governance of Clinical Care in Aged Care Part 1 | Governance Evaluator
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Top risks identified by Aged Care boards in 2018. Risk 4: Governance of Clinical Care – Part 1
This month we commence our two-part investigation into Governance of Clinical Care; the issues uncovered in our research, as well as tips and resources for ensuring your board is leading a culture that supports the delivery of safe & quality aged care.
What is Governance of Clinical Care?
The Australian Commission on Safety and Quality in Healthcare’s NSQHS Standards apply to healthcare, community and aged care organisations in Australia, regardless of their location or size. The Standards brought rise to the National Clinical Governance Framework, which states that the governance of clinical care involves a complex set of leadership behaviours, policies, procedures, and monitoring and improvement mechanisms that are directed towards ensuring good clinical outcomes.
Effective governance of clinical care must also take into account the imperatives of the Aged Care Quality Standards (2018), including Consumer-Directed Care.
Both Standards are incorporated in the Governance of Clinical Care module themes of the Governance Evaluator board evaluation. Due to their complexity and importance, the findings that relate to each theme will be examined in depth across two reports:
Governance of Clinical Care Part 1 will explore:
Staff who deliver safe care
Governance of Clinical Care Part 2 will explore:
The aged care industry is undergoing an important revolution with the increasing involvement of patients and recipients of care as consumers.
A report by the Institute for Health and Ageing and the Australian Catholic University, Older and Wiser: Putting the Consumer’s Voice at the Centre of Residential Aged Care states that “the advent of Consumer-Directed Care (CDC) in Australian Residential Aged Care Facilities (RACFs) will require a revolutionary change in the service delivery mindset” (p7:2017). This commences the process leading to a change in status from ‘care recipient’ to ‘consumer’ and to being encouraged and supported to having a consumer voice which is at the centre of service delivery planning, design, delivery and evaluation.
Genuinely engaging with consumers in the planning, design, delivery and evaluation of care can improve the decision-making of organisations, the behaviour of care delivery staff, and the experience of consumers, their families and carers, and may lead to more appropriate care.
Q: Does the Board partner with consumers?
Fig 1: 2018 evaluation findings for genuinely partnering with consumers
Only 39% of boards are satisfied that their directors all understand the increasing shift toward the paradigm of consumers-as-partners being genuinely embedded within the care framework and have actively and successfully embraced the level of engagement needed to bring these changes to fruition.
Top Tips for Genuinely Partnering with Consumers
Understand who your consumers are. This will depend on the services your organisation provides.
Have a plan for consumer engagement that has more than one strategy for genuine engagement.
Lead a culture for continuous review and development – it is not sufficient to just ‘hear the voice’, it is also essential to maintain the connection with consumers and others through the planning, implementation and review stages. Key to true engagement is to always return to acknowledge the input and what has occurred as a result.
Aged care is complex due to the agedness, frailty, vulnerability and often cognitive impairment of the consumer and often the consumer’s voice comes from many sources, such as loved ones, family, carers and others. This necessitates a variety of strategies for hearing the consumer voice in relation to consent, choice and dignity of care. Effective aged care boards have in place processes such as:
A resident/consumer engagement plan that identifies the consumers and their definition of vulnerability
A consumer engagement plan with clear reporting structures for boards, residents/ consumers and identified others
Residents committees who report to the quality committee or the board
Annual meetings with large groups of consumers and their family/carers to hear and make sense of multiple voices
Satisfaction surveys that produce well-trended and benchmarked reports
Contact Kellie O’Callaghan (O’Callaghan + Co), an expert in bringing the voice of the consumer to the table
Older and Wiser: Putting the Consumer’s Voice at the Centre of Residential Aged Care. Read here.
The Victorian Healthcare Experience https://results.vhes.com.au/
People Matters Survey https://vpsc.vic.gov.au/data-and-research/people-matter-survey/
Governance Manual – 8.3 Terms of Reference for a Consumer Advisory Committee
Governance TV – Kellie O’Callaghan – Effective Stakeholder Engagement; how to plan, measure and assess
Governing Safety & Quality
Governing safety and quality is about ensuring that the organisation delivers safe, high-quality care to its consumers in accordance with the principles of Consumer-Directed Care resulting in an enhanced quality of life as measured by validated instruments.
Safe, quality care is the core business of aged care organisations and this is a key focus of the board. The board is accountable for the quality of care delivered in, and by, the organisation and its staff. The board is responsible for ongoing continuous review and development of quality and safety. This requires the board to frequently review, evaluate and amend based on consumer and staff feedback about quality and safety, thereby continually improving all aspects of the business.
Q: Is the Board governing safety and quality?
Fig 2: 2018 evaluation findings for Governing Safety & Quality
58% of boards are satisfied that their strategic and organisation quality and safety plans reflect the importance of safe, quality aged care; the leadership of the safety and quality committee is skilled, knowledgeable and committed; and that all directors have an appropriate level of understanding of the safety and quality of services provided to enable them to govern effectively.
Top Tips for Governing Safety & Quality
In your strategic planning process, ensure that ‘provision of safe and quality services to your community’ is the vision and mission
Demonstrate and develop leadership, experience and skills for relevant board subcommittees such as the quality and/or clinical governance subcommittees, by:
Gaining a strong understanding of the corporate and sector skills and experiences of directors and ensuring directors who have strong or significant aged care sector and clinical governance skills and experience are leading the quality/clinical governance committee
Ensuring all directors are well inducted into the safety and quality and risks of the organisation
Investing in upskilling directors who don’t have strong sector/clinical governance skills
LASA, the national peak body representing and supporting providers of age services across residential care, home care and retirement living, has a useful range of reports and policy documents on their website: https://lasa.asn.au/about-lasa/
Governance Evaluator Development & Skills Matrix for aged care boards – click here for a demonstration
Governance TV – Dr Liz Mullins – What I learnt at Djerriwarrh Health Services
A manifestation of the organisation’s commitment to safe, quality care is that staff work, and are enabled to work, in a manner which minimises the risk of harm to consumers and themselves and that maximises the likelihood of safe, quality care outcomes.
The Single Aged Care Quality Framework Standards requires organisations to monitor the performance of staff with responsibility for consumer care, as underperformance represents a significant risk to consumer care, to the organisation, and undermines community confidence in the sector.
Q: Is the Board sure that staff are appropriate for the delivery of safe care?
Fig 3: 2018 evaluation findings for staff who deliver safe care
76% of boards are satisfied that there are appropriate and effective controls in place to ensure that all staff understand and are aligned with the principles of Consumer-Directed Care; are supported with professional development and are appropriately skilled, experienced and credentialled to provide quality care whilst working within a defined scope of practice.
Top Tips for boards to ensure staff who deliver safe care
Understand your duty of care for staff by ensuring management are held to account for compliance with relevant Occupational Health and Safety Laws and sustaining a workplace culture that values staff, their professionalism and wellbeing
Receive high-quality information/reports about care delivery and other staff performance so that you are assured about the safety of the workplace and the ability of staff to perform their duties effectively
Emphasise to management the importance of, and hold management accountable for, employing appropriately skilled, credentialed staff
Encourage and support continuing professional development, staff education and training as a critical component of ensuring the delivery of safe and quality care
Credentialing health practitioners and defining their scope of clinical practice: A guide for managers and practitioners, which can be accessed here
Governance Evaluator TV – Managing clinical risk, ensuring quality and safety (Effective Clinical Governance)
Resources Manual – 4E Staff engagement and accountability
Aged CareGovernance
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