If the investment in the Royal Commission is to bring about real and lasting change to the care of elderly Australians, much effort will be needed to ensure structural, cultural, capability and reputational changes are made and that those efforts result in better quality, compassionate care and improved outcomes.
Leaders from across the sector need new skills, mindsets and capacity to facilitate new ways of thinking and working to drive better outcomes and safe, compassionate, quality experiences for elderly Australians. This leadership responsibility requires government, public servants, policy makers, and regulators to question strategic and structural dimensions (purpose, standards, legislation, funding, commissioning, regulation, policy formulation, workforce shaping and skilling) and how they facilitate compassionate, quality care as a norm. It is also incumbent on sector leaders to play their role, making personal and organisational shifts to steward this important transformation of the sector.
Left out of sight and out of mind, ‘aged care services’ are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change.
Key takeaways from the final report
|Seven key points from the final report are outlined below.|
There is as much to “unlearn” in shaping the way forward as there is new learning and habit changing – shifting the assumptions underpinning current approaches is essential for true reform to be realised.
Create a compelling and aspirational vision of the nation’s promise to elderly Australians, coupled with practical tools to shift to a high performance (rather than minimum standards) focus.
The work of change must be leader led from across the aged care sector – more compassionate, curious and collective leadership practices and accountabilities need to be fostered and require urgent investment, this includes boards, executive teams, regulators, policy makers, front line leaders - all those charged with leadership roles.
Sector wide workforce capability and motivation is critical – the capability, integrity, compassion and resilience of the workforce and the value proposition for the profession are factors needing sector-wide attention, streamlining and consolidating learning and skilling at scale to lift quality and relevance of L&D for the national workforce.
More active experimentation with the potential of technology to revolutionise work and care.
Increase high quality opportunities for sector wide innovation, collaboration and learning and systematically identify high performers to mentor others.
Leverage the power of behavioural insights for cultural change.
The Australian aged care sector has been the subject of numerous major inquiries and reviews over the last two decades. The wealth of data and evidence that reform is needed is undeniable and the Royal Commission into Aged Care Quality and Safety has shown that little has changed, despite ongoing acceptance of the need for action.
The language of those charged with stewarding this system into a new era is peppered with a mixture of resolve to address the issues but also exasperation at the prospect of the scale and complexity of a pathway forward. Some of the greatest minds in policy, law and society have grappled with the seeming immovability of a deeply complex system.
A process of unlearning
|Improving the human experience of aged care for consumers and their families, providers and employees will require significant change.|
Cumbersome bureaucratic structures must morph into more dynamic systems, which are human centric and buoyed by motivated staff and communities.
There are several myths that must be exposed and unlearnt before we proceed down the path for change and reform. These include:
- Radical transformation is the answer
- Quality comes at a cost
- Point in time assessments, crisis responses, blame and shame can address a failed system
- A focus on minimum standards is the salve for a failing industry
- Focusing on serious incidents, complaints and errors will fix the problem
- More people and more resources will fix the problems we face
- Nobody wants to work in aged care, it’s a job of last resort
These flawed perspectives of the system need to be unlearnt and replaced with a new paradigm of what is possible to bring about real and enduring change.
Instead we could consider:
- Human systems require human centred interventions, shared purpose and a sense of urgency in order to adapt, learn and unlearn.
- It does not necessarily follow that better-quality care must cost more – the answer isn’t only in additional funding, but what you do with the funding that counts.
- Confidence, capability, shared purpose and focused effort can evolve a social system.
- Aspirational targets and recognition for high performance is inherently more motivating for changing culture and human behaviour.
- Focusing on positive choices, outcomes, capacity and core capabilities, ability, integrity and benevolence will nudge trustworthiness into the sector.
- Working and leading differently is going to be the key factor for change, in the context of potential adjustments to funding and resourcing models.
- Most people want to see our elderly Australians cared for well and many want a job that is meaningful, dignified and pays them adequately for their effort.
Applying a new lens
|If we are to embark on a path to “fix the system”, we need a new lens through which to view it.|
It has been stated that our aged care system is not built around the people it is supposed to help and support, but around funding mechanisms, rules, processes and procedures. This is a salient acknowledgement and at the heart of where the possibilities for focused reform lie. The current system ignores the fact that organisations are essentially social systems, comprising networks of relationships, cultures, human interactions and emotion.
A simple yet powerful frame to apply is to re-imagine aged care as human-centred with an emotional operating system that must be nurtured, cultivated and shaped to deliver the outcomes for whom it exists – our elderly Australians.
Humans, history shows us, do not ‘transform’ - just as human systems do not. They adapt and evolve - often iteratively and sometimes painstakingly over time.
Evolving and adapting the aged care system through a human centred lens will require a purposive, multi-faceted set of activities that bring humans to the centre, improving the outcomes and shaping new practices – person by person, facility by facility. Accelerating the pace of change will require united and collective efforts at all levels of the system fuelled by a will to deliver on a new promise.
|This adaptation in aged care can be considered through five inter-dependent lenses:|
Collective leadership is at the heart of building an adaptive, purpose driven system.
At present, responsibility for aged care rests with the Commonwealth as the primary funder and regulator and the role of delivering services in aged care is diffused across for profit and not for profit providers as well as some state and territory and local governments. The complexity of the system contributes to problems such as inertia for improvement, inadvertent perverse incentives, shifting blame when things go wrong (and they do) and a dilution of accountability for quality, compassionate care.
The Carnell Patterson Review1 has shown that regulatory mechanisms do not consistently provide assurance of quality that the community needs and expects. As we cannot rely on regulation alone to bring about wholesale change, the activation and mobilisation of collections of local leaders and influencers is needed to shape and steer the system into a better future.
Senior leaders, boards, facility leaders all need to step in to lead ethically, responsibly and adaptively to create cultures and conditions for compassionate, empathetic, quality care.
Strategic leadership is also needed in the policy and regulatory arena – what we mean by strategic leadership here is the application of three key capabilities: future focus; imagination; and purpose-driven action.
A visible public commitment by key leaders across the sector to a charter for quality, compassionate care and to reforming the sector, putting our ageing citizens at the centre of all decisions would be a good (if symbolic) start to build shared purpose and collective accountability.
“This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more”
Aged Care Royal Commission, Foreword, Interim Report
Trust in the aged care sector has been deeply diminished, fuelled by recent events and the stories of poor conditions, mistreatment, inadequate staffing and training and of course, unnecessary deaths.
Trust is difficult to gain and easy to lose. The challenge is made yet more difficult in this case, by tackling the work of re-building the sector in the context of shame, media scrutiny as well as shifts in consumer expectations and care ethics.
Efforts to rebuild trust in aged care is a challenge for individual facilities to rise to as well as larger multi-site providers. Equally the policy and regulatory settings need to consider how the cycles of reviews and piecemeal reforms have themselves diminished trust, and focus instead on incentivising integrity, facilitating capability uplift and rewarding compassionate care.
A potential focus point, may be the development of a transparent and strength-based system that incorporates aspirational measures, recognising, publicising and elevating the most trustworthy facilities, publishing the features that make them trustworthy and funding them to mentor and coach other facilities to institute similar improvements.
The current focus on compliance to minimum standards by providers does not support sector wide capacity building nor encourage improvements beyond minimum benchmarks.
If we are to entrust our mothers, fathers, grandfathers and grandmothers to institutions, having confidence in their wellbeing and quality of life, there must be an investment to substantially lift the pride in the profession of caring for our national treasures – our elderly Australians – and this includes a substantial effort in lifting quality of care skills and the capability of the workforce. This starts by reinstating the status of aged care as a noble profession, and not just a job of last resort. A goal that is achieved by re-imagining the working (and caring) environment, shaping new roles, investing in workplace culture (creating workplaces where people want to come to work) and investing genuinely and intelligently in the wellbeing, skills and reputation of the workforce
Skilling the aged care workforce is worthy of an entire investigation in its own right but there is value in considering an overhaul to build a truly integrated, national, user-centred workforce development and learning platform to ensure quality, relevance and appropriateness of learning options and qualifications. The aged care workforce deserves contemporary learning approaches that build confidence, trust and pride in their chosen profession and that tie all investment in capability building to a shared philosophy and purpose – high quality, compassionate and capable care.
Investment in technological workforce adjuncts will also play a substantial role, freeing the human workforce to focus on the delivery of compassionate care and extending the reach of scarce medically qualified staff members.
- virtual supervisors for incidents or medical requirements
- virtual 3D in the moment training for employees
- technologies for the management, recording and administering of medications
- robotics to support risky activities like lifting and turning bed ridden patients
- smart wearables that use artificial intelligence and are less invasive and less dependent on wearer abilities
- technologies to encourage mobility and activity to stave off decline in physical fitness
- virtual colleges where elderly Australians can enrol in programs to stimulate their mind and continue to engage their active brain.
“We have uncovered an aged care system that is characterised by an absence of innovation and by rigid conformity.”
Aged Care Royal Commission, Foreword, Interim Report
The Royal Commission gives us pause to question what we understand to be the aged care sector and how it has evolved over time. It is a rare opportunity to deeply consider the underlying assumptions that are driving service models and care delivery. Arguably a key assumption that appears to underpin current approaches is that at best, providers can help our loved ones to die well, rather than to live excellently.
How a provider conceives of its purpose and role drives the organisational culture, and consequently, determines how people are treated and supported. Re-visiting the purpose and ‘why’ of Aged Care is necessary to define the promise and benefits to all stakeholders and opens space for new innovations.
Breakthrough innovations in aged care may be instigated by expanding our thinking from purely a “healthcare” paradigm. Looking overseas, at parallel industries and in isolated cases here in Australia, we can see numerous examples of innovation in care being provided to individuals, which focus on improving quality of life for example, of those with dementia rather than locking them away to suffer inevitable decline.
Supporting more innovative aged care will require government to embrace a more active role in stimulating the sector, investing in wellbeing initiatives that are founded in a principle of dignity and that aim to improve quality of life over time. It also requires public servants and sector leaders to operate with an innovation mindset – to foster and experiment with new models and modalities.
Fostering cultures where experimentation is the norm, with the people at the centre, is another role for leaders at all levels of aged care. Equipping leaders with the skills, mindsets and capacity to shape compassionate innovation cultures is a critical step that requires investment immediately.
A starting point here is the investment in new forums that foster collective leadership to engage leaders in shaping and steering their organisations and the sector towards new cultures, engaging employees in identifying and designing innovations and new ways of working and caring. Bringing sector leaders together, in for example 'insights events' where sector leaders, public servants, international and local academics and practitioners come together with the express intent of exploring and shaping innovations for the sector.
The development of new leadership mindsets, skillsets and capacity within provider organisations including individual facilities (shifting from “managing a facility” to “leading a compassionate care team”) can be a focus and will nudge change at the national and local level. There is much written on the value of focusing on compassion as a core shared value for high performing, interdependent teams.
Leadership effort focused on innovation and quality care needs to be a priority at all levels of the system to ensure innovation can emerge.
“We have been alarmed to find that many people die while waiting for a Home Care Package. The Australian Department of Health, which oversees the system, has no mechanism to follow up …”
Aged Care Royal Commission, Foreword, Interim Report
Our social environment and surroundings are powerful influencers of the choices we make, the behaviours we exhibit and the values that we uphold. A pathway for considering pragmatic reform across the sector lies in establishing the settings for each person in the chain to make positive choices to deliver positive outcomes.
Behavioural insights bring huge possibilities for movement here. Recognising that every moment in the life of an older Australian matters, and all those charged with their care and the preservation of their dignity are making choices daily, hourly, minute by minute. Focusing effort toward influencing these choices can have a significant impact on individual and collective outcomes.
As a service, aged care is an integral part of our social support system and, as such, it must aim to be the best service that an inventive, clever and compassionate country can provide.
|The work of reimagining the aged care system begins by believing the system can reform itself, it can be better.|
It relies on those charged with leading and stewarding reform to be inspired to take on the task at hand and then rolling up the collective sleeves of those in and around the sector and getting on with the work of reform.
Our suggestions focus on relationships not transactions:
- Start with leaders – find them, invest in them, support them to collectively do the heavy lifting of cultural change at the local level, collectively at the national and state-wide level and within their spheres of influence.
- Focus on the future, sector-wide purpose – Create a compelling and aspirational vision of our future promise to elderly Australians, build new and compelling narratives for how things could be and shift away from shame and blame as tools to drive change.
- Re-imagine the workforce – the capability, integrity, compassion and resilience of the workforce, the value proposition for the profession. Invest in the potential of technology to revolutionise work in aged care, reinvent learning and skilling system-wide.
- Invest in action now and for the future – through local collective and individual action, the big ideas, the innovations and the technology, by provoking and allowing space for ongoing experimentation, mentoring, learning and unlearning.
Starting small and thinking big is what older Australians deserve. The good news is that empathy, compassion and benevolence are not scarce resources especially if we consciously create social systems where these abilities can thrive.
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1. Review of National Aged Care Quality Regulatory Processes (2017). Kate Carnell and Ron Paterson. Available at: https://www.health.gov.au/sites/default/files/review-of-national-aged-care-quality-regulatory-processes-report.pdf (2.1MB)