The Aged Care RC Report in a 43-word blueprint (well, the quality and clinical governance bits, anyway...)

 Much has already been said about the Aged Care Royal Commission Report – released just a couple of weeks ago – with much more discussion to come, even before the government’s response in May.

 A lot of the media coverage has focused on the external levers: who’ll be in charge? How will it be funded? Where will the staff come from? How will they be trained? Etc, etc. All critical questions.

The chat in the sector is often about the potential for extra resources. Of course, no-one turns down extra resources! But…it’s how they’re used that determines the difference they make. Throwing five extra players onto the field in the middle of a match may make things worse. They need the right skills. They need to know the game plan, the structures and their role. They should be a good fit with their teammates. They have to be well-coached, with constructive feedback. Extra resources for a well organised and managed team is a dream. Extra resources for a chaotic team is just more chaos. So, how do we get our act together to make the most of - and cope with - everything that will flow from this report in the next few months? 

 Let's take a look at how we could do this with the quality and clinical governance components.

 Lots to like about this in the report.  Positive statements about the point of it all: ‘Our recommendations are directed to establishing an aged care system that will consistently deliver high quality aged care to older people in Australia, rather than merely meeting accreditation standards.’ The importance of a shared understanding of high-quality care is emphasised.  Strengthened board accountabilities for care quality are discussed. There are recommendations to support boards to enact their role in providing the governance, leadership and culture required for high-quality care. Evolved standards, guidance and training are mooted. The role of skilled and accountable staff in high-quality care is recognised, calling out the need for clear roles and responsibilities. More and better measures will be developed to paint a richer picture of point of care quality and guide improvement.

 So far, so good.

 The Gap

But – there’s a bridge to be built before these aspirations become reality. At this point, we have a list of recommendations. Building materials, if you like, for constructing sustained high-quality care. But the materials can’t fulfil their potential if we don’t have a blueprint for how to put them together to create a structure within which great care will flourish.

 Because it’s not just what we implement, it’s how we understand and value it that makes the difference between ticking more boxes and creating and sustaining high-quality care. How we position the system as a key component of achieving our strategic and operational aspirations and goals; how the system components relate to each other; how we lead and govern the system; and how we evaluate and improve it. And, most importantly, it's how we implement the system so it makes sense to managers and staff; and supports, rather than impedes, their ability to provide high-quality care with every consumer.

 My take on this will not be news to regular QNews readers! For over a decade I’ve been researching and experimenting with how to create this blueprint. The evidence – and experience – are both clear.  

 What is high-quality care? Well, it's this and this and this and...

First, we need a shared understanding of what high-quality care is, as the RC report notes. However, I counted roughly 16 dot points on this in the report. This is a common trap – either we don’t define it - or we define it with so many different words (that often mix ‘what’ and we’re trying to achieve and ‘how’ to achieve it) that we’re no closer to a shared understanding than when we started.

 The definition needs to be simple, clear and meaningful to staff, as they are the ones who create high-quality care – or don’t. It's not complicated - we know what we want if our care is in someone else’s hands; and, happily, this accords with the research on what consumers want from a care experience: ‘don’t harm me or make me worse; do the right thing by me to get the best possible outcome; make sure everyone is on the same page about my care and I don’t fall through the cracks; and underpin this by treating me with dignity and respect and as a partner in my care.’ In other words, make my care – or the care of someone I love - safe, effective, connected and personal. 

 These four words are goals for a high-quality care experience and encompass all the descriptors in the RC report. They're also easy for everyone – from the shop floor to the top floor – to keep in their head and pursue every day. These are not 'extra' requirements or more work. They're the basics of good care. As JD Rockefeller said 'the secret to success is to do the common things uncommonly well.'  That's what we're talking about. Every day. Consistency is the basis of success of all high performing organisations - in any sector. But it's tricky. Everyone can provide a high-quality care experience for some of the people, some of the time. But all of the people all of the time? - this requires specific knowledge and skills. Which brings us to...

 Who creates the care experience?

Second, we focus on how those four goals are created with consumers. The temptation here is to rush to standards and compliance – but standards and compliance alone never created anything. People create the consumer experience. If we’d taken even half the time that’s been wasted over the years on whether some small thing was documented properly, and instead spent it on developing competent managers and staff, we may not be where we find ourselves today (and I’m a Health Info Manager - I get the importance of documentation.)

 Designing systems that may or may not be fit for purpose, and then shoe-horning staff into them and hoping we'll get high-quality care as a result, is a time-honored approach to quality in human services. I know. I did it for many years. Probably time we accepted that this experiment has failed.

 The report says a lot about staff, as it should. When it comes to the crunch about what staff need to be, to create high-quality care - we can distil the RC report words to five: clear, competent, compassionate, responsible, supported.  (My strategic quality system model, developed a few years ago, has a slightly different take - Skilled, Accountable, Focused, Empathic, Resilient - but you get the idea.)

 It's not rocket science. Staff need to be clear about what high-quality care is and their role in it. Competent to achieve it. Compassionate in their caring. Responsible for their actions. Supported to provide high-quality care through skilful management and development. Think it would make a difference to care if everyone woke up tomorrow like this?  You bet it would. Not just different - transformed. I understand the challenge of this and I can’t wave a wand and make it happen - or I would. But these characteristics can be built over time, with focused and committed leadership - which brings us to the third piece of the blueprint…

 How do they do it?

Governance and systems. Obviously important – but as our servants, not our masters. And only as good as they support staff to be – and feel – clear, competent, compassionate, responsible and supported, so they can provide safe, effective, connected and personal care with every consumer. This is where boards and executives come in. If they decide to support staff with great governance for great care, as a strategic and business priority, it will happen. Simple as that. If they decide it's someone else's problem, they'll be wondering in 12 months why their care is no better, despite the government hustle. And why they're staring down the barrel of yet more non-compliance.

 Of course, there are many systems required to support good governance. I count around 40 within my own CG model.  But if we lift our eyes to the next level up, we can encompass these – and the RC report – in four pillars, using twelve words: Consumer Partnerships, Leadership and Culture, Positive People and Practice, Pursuing High Performance.  Your clinical governance framework may use different pillars. That's fine. The ingredients will be the same. It's the same cake, differently sliced. 

 A blueprint

There's our 43-word blueprint for high-quality care: Safe, effective, connected and personal care with every consumer, created by staff who are clear, competent, compassionate, responsible and supported by great governance from boards and executives, comprising systems for Consumer Partnerships, Leadership and Culture, Positive People and Practice and Pursuing High Performance.

 By now you may be shaking your fist at the screen shouting ‘that’s over-simplified!’ Perhaps. But what’s the alternative - over-complicated? Of course, the detail of how each of these 43 words contributes to high-quality care is critical. The way we implement makes the difference between just more stuff and fit for purpose.  But before we decide on our internal furnishings, we must get our design right - and build the structure so it’s strong and effective. And the good thing? All of this is supported by years of research into what makes a high-performing human service organisation. We know what to do. We just have to do it. Nothing new is going to be discovered in the next 12 months for how to do this within your organisation. You can get started right now.

The aged care providers who grab the opportunity to design their whole of organisation blueprint for high-quality care will find that they’re well-positioned to put the RC ‘materials’ - that are eventually supported by the government - to best use, and will build a high performing organisation that supports consistently high-quality care. Not only will their consumers and families thank them, but their staff will be happier. The good ones will want to stay and word will get around that this is a great place to work, attracting more good people. As a bonus, they might even find that they're reducing their costs, as consistently great care reduces re-work and adverse events and streamlines processes. 

 Those who don’t are destined to spend the next few years tacking various materials together as they come down the line; not sure what to do with the three leftover screws, and wondering why the rain still gets in and consumers and staff are still getting wet.

 We have a once-in-a-generation opportunity to build something great. What would you like to be able to say you did with that opportunity in three years' time?