The Royal Commission into Aged Care Quality and Safety (Royal Commission) has been the most wide-ranging inquiry into Australia’s aged care system in 40 years.

The Commission sought testimony from thousands of Australians, with the final report describing aged care as a sector ‘which fails to meet the needs of older, vulnerable citizens.’

Although the sector is challenged by funding and operational complexities, the Report depicted a sector that had lost public confidence and trust as a result of an inability to adapt and respond to shifting community attitudes about the value of older Australians and expectations of higher standards of care.

It is undeniable that Australia faces the challenge of an ageing population. Continued demographic growth will only further stress the essential aged care industry from both an infrastructure and skilled workforce perspective. However, the aged care sector is too critical to be allowed to fail to meet the needs of older Australians and their families.

Trust is foundational to the longevity of the aged care industry in Australia. In order to move forward, the sector needs to respond in a way that moves beyond meeting minimum regulatory compliance to meet community and stakeholder expectations and take proactive steps towards re-establishing trust.


What is trust?

Competance, shared value and integrity.

Aged care is now facing one of its most vulnerable periods post the Royal Commission, after having had the entirety of the sector under a period of intense public scrutiny. This has brought significant perceived and actual reputational challenges for the sector individual and collectively. However, these significant reputational challenges bring an opportunity to consciously transform the sector in a way that builds trustworthiness.

Trust requires the presence and alignment of three characteristics: competence (the ability to deliver quality services), shared value (a positive orientation to older Australians and their families that goes beyond profitability) and integrity (adherence to accepted ethical and moral values).

If any one of these is absent, trust will be undermined. Trust requires the alignment of both perceptions and substance. As KPMG’s Designing Organisational Trust Report (2019) shows, a healthy organisational culture creates the underlying substance of trustworthiness.

However, trust is a perception held by stakeholders: employees, consumers and families, communities, suppliers, regulators and policy makers. A good reputation is achieved by proactively communicating, engaging on and demonstrating underlying trustworthiness.



KPMG Pillars of Trust framework

Organisations should also consider culture and reputation in the context of a clear purpose. 

Thinking only about reputation in isolation can lead to inauthenticity because it may not be built on the substance of trustworthiness achieved through a healthy culture.

Thinking only about culture in isolation can lead to myopia, because stakeholders fail to perceive trustworthiness that may be created. And without a clear purpose, an organisation can become rudderless.


Purpose, reputation and culture

Challenges for the aged care sector in delivering trust across the drivers of purpose, reputation and culture.

Purpose

Three key factors drive purpose:

  • Promise: a clear articulation and common understanding of why the organisation exists.
  • Strategy: a roadmap to achieve your promise.
  • Leadership alignment: a shared logic and collective view to shape and steer the organisation.

In the case of aged care, there has often been a misalignment on the promise providers can, and have been able, to deliver.

While families increasingly expect facilities to be designed to accommodate all their family members care and support, and consider their individual needs, the current system has been largely built around funding mechanisms, regulation and processes and procedures, rather than older Australian’s needs and requirements.

An opportunity exists to drive a very powerful, passionate, and people-centred purpose that cultivates relationships, not transactional approaches to care.

Reputation

A good reputation is built through:

  • Clear communication.
  • Doing what you say you’ll do.
  • Effective and two-way engagement with all older Australians and their families.

The Royal Commission found a lack of two-way communication and engagement with critical stakeholders including older Australians, their families, carers and the wider community.

Inadequate access to, and integration with, the broader health care system means communication must be simpler, more reliable and easily comparable in order to navigate a complex and heavily differentiated system. The final report of the Royal Commission focused on providing care that is respectful of, and responsive to, the preferences, needs and values of the individual older Australian. For providers, this means seeking out and understanding what is important to older Australians, fostering trust, establishing mutual respect and working together to share decisions and plan care.

Culture

To date, the aged care sector has tended to rely on standards and regulation to drive compliance, supported by policies and procedures. This approach has been a factor in many of the sector’s reputational and cultural challenges.

When it comes to delivering care, all staff, including front line care workers should be equipped with appropriate training and behaviours to help them exercise judgment in the best interests of their consumers rather than just complying with standards and regulations.

Whilst standardisation is important for consistency, care workers need to be equipped with the right decision-making frameworks (and skills), to empower them to make the best decisions.

Decision-making frameworks, when supported by meaningful values can be used by care workers as a guide to inform their everyday behaviours and resolve dilemmas. They’re the ‘how’ behind the achieving the purpose.

Implementing these behavioural changes is challenging and takes significant education, with a focus on behavioural insights to drive change, and positive reinforcement to get right. It is impossible to mandate through compliance and accreditation alone.

Using a ‘stick’ makes people error avoidant and focused on doing things right (transactional) rather than doing the right thing (relational).


Evolve workplace cultures

Seven important drivers of culture.

KPMG’s culture framework contains seven drivers of culture (see image above). Each contributes to a better understanding of ‘the way things are done around here’. All seven are important but leadership is the most important and has the most significant impact.

Without clear leadership alignment across the sector, opportunities for inaction, blame shifting and diluting responsibility have been created. If aged care leaders aren’t aligned on purpose, cultural aspiration and effort required to achieve it, cultural change efforts falter.


The way forward

A four-step transformation to become trustworthy and resilient to future transgressions.

To achieve genuine and sustained improvement to trust in the aged care sector, providers must shift their focus beyond compliance to the much harder, but more productive action, around defining a consumer-centred purpose and a culture that supports more consumer and family-centred communications and engagement.

This means the aged care sector must deliver consistent evidence of the organisation’s renewed trustworthiness (demonstration) to convince older Australians and their families that the risk of trust violations can be reliably prevented (communications and engagement).

Listen

Reflect on the final findings of the Royal Commission in the context of individual organisations. It should also involve regular engagement with important stakeholders such as families, consumers and employees to identify the underlying issues and opportunities for improvement.

Assess

Develop a strategy by defining a program of change that goes beyond meeting new compliance requirements. Regulation defines what an organisation ‘can do’, the reform process must also address what an organisation ‘should do’ which requires consideration of purpose as well as behavioural and operational culture.

Transform

Redesign the organisational model to balance purpose, culture and reputation. Develop and implement a plan focused on these key areas.

Communicate

Ensure clear and effective engagement with older Australians and their families to further embed trustworthiness. Establish a listening and feedback process into stakeholder engagement activities, covering consumers, their families and employees, and communicate identified successes and learnings.

An example may be the development of a transparent and strength-based system that incorporates aspirational measures, recognising, publicising and elevating the most trustworthy facilities, and publishing the features that make them trustworthy.


How KPMG can help

Enabling a holistic approach.

To start to make changes we must first change the lens through which we look at some of these problems. Reputation, culture and strategy is one way of achieving this. It is a challenge worthy of our times. Older Australians deserve a system that is dignified, humane and trustworthy.

KPMG’s trust framework enables a holistic approach to the development of a trustworthy aged care system by helping providers to see workforce and workplace sustainability challenges through an integrated view.


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KPMG aged care insights

Insights related to aged care in Australia and the Aged Care Royal Commission.