The Royal Commission's final report calls for fundamental reform of the aged care system. RLDatix explores what this means for healthcare leaders and recommends a comprehensive quality and safety framework that protects and nurtures an increasingly ageing population
Australia’s changing demographics are significantly influencing the demand for and provision of aged care. People are living longer than ever before. It is projected that the number of Australians aged 85 years and over will increase from 515,700 in 2018–19 to more than 1.5 million by 2058. Meanwhile, there will be fewer people of working age available to pay taxes to fund the aged care system and to meet the growing demand for services. In 2019, there were 4.2 working age (15–64 years) people for every Australian aged 65 years or over. By 2058, this will have decreased to 3.1.
New report calls for fundamental reform
The final report from the Royal Commission into Aged Care Quality and Safety calls for the fundamental reform of the aged care system that to date, “has not provided the assurance of high quality and safe care that older people and the community reasonably expect.”
From a quality and safety perspective, the report reveals a number of failings including:
- No clear statement in the Aged Care Act of the basic responsibility of approved providers to ensure that the care provided to residents is safe and of high quality;
- Disconnected systems management, systems governance and regulatory functions;
- Difficulty in measuring and reporting quality;
- Poor collaboration between aged care providers and the healthcare system.
Starting afresh - Placing people at the centre of aged care
While acknowledging key areas for concern, the report envisions the foundations of a new aged care system that is people-centric. This encompasses common themes for reform that communities expect from their aged care system, namely “dignity and respect, control and choice, the importance of relationships and connections to communities and the desire for a good quality of life and ageing at home.”
Ensuring quality and safety is the driving imperative of the report and its final recommendations are directed towards establishing an aged care system that will “consistently deliver high quality aged care to older people in Australia, rather than merely meeting accreditation standards.”
There are 148 wide-ranging recommendations for change, but what do they mean for your organisation? In terms of quality and safety, focusing on these top 3 priorities will go a long way to enabling organisations to meet the recommendations:
- A new Serious Incident Response Scheme (SIRS) will require the reporting of a much wider range of incidents – SIRS is designed to help reduce the levels of neglect and abuse that are currently unacceptably high. In 2018–19, the number of alleged incidents in residential aged care is estimated at between 32,193 and 44,131, and the number of serious events could be as high as 2,520, or almost 50 per week. Expanding the scope of incidents reported will minimise regulatory oversight of abuse and neglect and upskill providers to better respond to incidents.
- Strong feedback mechanisms – an important means by which aged care providers can learn about day-to-day practices within their services. Feedback needs to come from everyone - people receiving aged care, their representatives, and staff - to improve delivery of care.
- Readily accessible data – A key issue for future research will be to ensure timely access to data. Long delays in securing access to data can adversely affect the ability to monitor trends in care quality. Minimum datasets must be based on common data standards so that they yield meaningful and reliable information.
9 steps to create a comprehensive quality and safety framework
Healthcare leaders can prepare for the findings and recommendations of the Royal Commission through proactive quality and safety planning:
- Recognise the importance of good governance – the impact of the COVID-19 pandemic has exacerbated the weaknesses and shortcomings in the aged care system, especially the reactive nature of its governance structure. Effective governance requires ongoing attention. Rather than react to adverse developments, the aim for healthcare leaders is to put in place a consistent set of quality and safety processes that actively drive improvements in aged care. These might include steps to measure and monitor progress, identify areas for improvement, address emerging issues and provide feedback to personnel enabling them to improve their performance.
- Establish the right quality standards – identify which characteristics of your organisation’s care environment contribute positively to, or alternatively place at risk, the safety, health, wellbeing and quality of life of people receiving care. The right standards can motivate staff to achieve – and ideally exceed - the expectations for quality, especially when communicated sensitively and integrated into a services contract that everyone understands and can promote widely and with confidence across the organisation.
- Reinvigorate quality measurement and reporting – take a comprehensive approach that entails three linked elements: indicators to measure quality, benchmarking for continuous improvement, and a star rating system for comparing the performance of your organisation against other providers. Collate the right data from all the right systems then consider which indicators really matter to your care environment. Consider going beyond the basics of pressure injuries, use of physical restraint and unplanned weight loss, and make benchmarking an essential component of quality measurement and reporting.
- Increase communication and collaboration - policy developments over recent decades have aimed to encourage competition between providers of aged care services in the expectation that competitive market forces would lead to innovation and improvements in quality and safety outcomes. This hasn’t necessarily been the case. Now is the time to improve communication and collaboration between the people working in the aged care system and the people working in the general healthcare system so that older people can enjoy joined-up care as they move between the two healthcare systems. Best-practice learning and knowledge-sharing will support an integrated aged care system. For example, staff at residential aged care facilities share updates of a resident’s health status, including medications and advance care directives with paramedics should residents be transferred to hospital.
- Strengthen accountability and transparency – both form the foundations of good governance. Healthcare leaders might consider checking that their organisations are willing and able to provide ready access to information about their staffing and operations to enable proper scrutiny. Reinforce accountability and transparency with clear guidelines on how to publish regular quality and safety reports to key stakeholders internally and externally.
- Introduce feedback mechanisms – to learn more about the quality and safety of the day-to-day care services your organisation provides along with ideas for improving the delivery of those services. If possible, allocate dedicated resources to collating and analysing feedback and implement mechanisms that encourage engagement with residents, their families, their advocates and staff – all year round.
- Focus on improving complaints handling - a complaint can be a window into the quality and safety of care, providing an opportunity to improve the care of an individual, address systemic issues and remedy the consequences of poor care before things go badly wrong. Set targets but be realistic. The Aged Care Quality and Safety Commission traditionally aimed to resolve 80% of complaints within 60 days but it met this objective for 75% of complaints in 2019–20, meaning that one-quarter of the complaints were not resolved within the targeted timeframe. The Commission’s targets are a guideline but can help provide a starting point within your own organisation.
- Continuously monitor quality and safety - to identify risks and areas where care could be improved in a timely and effective way. To achieve this, organisations can draw on many different sources of information from previous inspections, historic complaints and serious incident reporting to prudential regulation and financial oversight. In future, regulators will be expected to assess whether providers are being ‘active, imaginative and flexible’ in ensuring the quality and safety of the care they provide in addition to assessing their compliance with the usual quality standards. Healthcare leaders are also warned to expect more unannounced visits by regulators. Always be prepared with updated information, documents and hard evidence.
- Embed a strong safety culture – this is especially important when the Royal Commission is recommending a rights-based approach to aged care. The new suggested approach covers human rights for people seeking aged care, for people already receiving aged care as well as for family or friends who are providing informal care and their rights to enjoy time off and respite.
Healthcare leaders might by guided by the five principles of FREDA (Fairness, Respect, Equality, Dignity and Autonomy) . These form the basis of all international human rights treaties and are today used by many healthcare organisations to form a human-rights based approach to clinical practice.
Blend strategy with data-driven technology
While producing the final report, the Royal Commission received a number of submissions supporting implementation of standardised data collection and the ‘collect once, use many times’ principle. However, to use data many times, the original collection must be high quality and reliable and this is not always straightforward when different government agencies do not share common data standards and systems.
Fortunately, the latest cloud-based technology is designed to overcome data silos that impede data flow. When evaluating the marketplace, healthcare leaders can rely on the following to create an effective data-driven quality and safety framework:
- One integrated platform - that combines advanced quality and safety reporting, governance, risk and compliance tools to provide a single view of data – and quality activities – across the entire organisation.
- Easy access to dynamic data– from multiple sources makes it possible for all stakeholders to report on and gain control of their care environment in real-time.
- Powerful Business Intelligence (BI) – the latest BI capabilities analyse unlimited volumes of data, turning it into powerful business insights to quickly detect patterns and spot emerging trends that impact quality and safety.
- Integrated data for integrated care - customisable and flexible, the latest cloud solutions make it possible to drill down into minute details to accurately measure, maintain and benchmark quality across multiple-site organisations and beyond.
- Specialist feedback modules – offer the capacity to seek feedback from people receiving care, families, their advocates and staff to support a virtuous circle of continuous improvement.
- Speak a common language - an important task for aged care data management is to establish a ‘common language’ that everyone understands whether they work in aged care, general healthcare or disability services. One integrated quality and safety solution also allows a common classification of language across multiple organisations to aid consistency of processes and clarity when reporting to national regulators such as The Aged Care Quality and Safety Commissioner in Australia.
- Adopt an industry-leading solution – the best technology partners are able to demonstrate their ability to support game-changing initiatives like SIRS. Ask vendors to show how their technology is used to trigger a SIRS question, assign priorities, assess the potential impact of SIRS incidents and then provide a properly recorded, end-to-end audit trail of SIRs activities.
RLDatix has already started adapting its software to support the recommendations in this report. By blending strategy with data-driven technology, care organisations are able to raise the bar for quality and safety.
Contact us now for more details about how we can support your organisation on its Resident Safety journey or visit www.rldatix.com