The Aged Care Safety and Quality Commission’s Sector Performance Report for the quarter to June 2024 provided a year-in-review summary of the state of standards compliance within the aged care sector.
The report found that Quality Standard 8 (Organisational Governance) had the lowest rates of compliance throughout 2023-2024. What’s more, this standard had the greatest difference in compliance levels between residential services and home care, where the latter was assessed at only 70% compliance. The Commission has therefore signalled an increased focus on organisational governance, where they say some aged care providers are falling short.
The Commission’s findings echo conclusions of the Royal Commission into Aged Care Quality and Safety and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, which both found that boards and governing bodies often lack the knowledge and professional skills necessary to establish effective organisational governance systems.
Examples given included lack of:
- basic functional capabilities,
- fundamental gurantees of independence and transparency, and
- any representation of professionals in aged care delivery or experts in clinical care.
These findings prompted significant “provider governance” reforms to the Aged Care Act in late 2023, which included stricter requirements for governing bodies to appoint qualified and independent board members, including a minimum of one member with clinical expertise. The provider governance requirements will also form an important part of the new Aged Care Act. You can read more about these changes in our blog post Preparing for New Age Care Provider Governance Requirements which discussed the additional requirements for providers to form advisory bodies, maintain staff qualifications and clinical governance.
Governance in the Spotlight
Governance is the fundamental means by which an organisation ensures it has the right capabilities and processes to provide the care services that the community needs. For this reason, requirements for responsible organisational governance are a core component of virtually all community and health service standards across the country. Inadequate governance can contribute to weak organisational culture, inconsistent practices and processes, and a lack of accountability, and this can increase the potential for substandard care and incidences of abuse and neglect.
Quality governance begins with the board, whose members work together to establish the culture, values and strategy which allow the organisation to meet its goals and help those who need it most. The overall success of the organisation depends on conscientious board members with the right mix of skills and experience to oversee how the organisation is managed. This includes ensuring that it complies with its legal responsibilities and obligations, including all of the standards that apply to the services it delivers.
How SPP can help
Our Standards & Performance Pathways (SPP) platform has a deep pool of resources to help boards develop strong governance systems, to deliver best-practice care to the community. Here are just a few examples:
- Culture and Values
The governing body and organisation leaders are responsible for establishing the ethics, values and standards of behaviour which form the basis of the organisation’s culture.
Find our
Good Practice Guide: Purpose and Values in the Reading Room for a practical guide for developing a strong organisational culture. You can also find a range of useful templates to support your governance efforts including our Policy: Professional Ethics and Conduct, and Policy: Purpose and Values.- Independence, Accountability and Transparency
Each member of the governing body has a legal duty to act in good faith, and to make decisions in the best interests of the organisation. This means boards must take an active interest and adopt policies which prevent members from making improper use of their position, and be truthful, transparent and accountable when making decisions.
It is a responsibility under the Code of Conduct for Aged Care that key personnel (which includes governing members) let the organisation know if there are concerns about their suitability to meet expectations of transparency. This includes avoiding, reporting and managing conflicts of interest. Boards should seek to implement best-practice policies including majority independent membership and commit regular review to assess the effectiveness of their governance systems to maintain accountability.
You can read more in the Reading Room, with helpful resources including our Good Practice Guide: Accountability and our Policy: Role of Governing Body Members, and Policy: Conflicts of Interest.
- Risk and Incident Management
The governing body is responsible for implementing strategies to identify, assess and treat risks that face the organisation. This helps to support the organisation to make informed decisions about how to address uncertainty in the operating environment, and to avoid oversights which can lead to harm.
Part of this process involves active consultation and engagement with a range of stakeholders, particularly from people receiving care through structured feedback mechanisms. This should be regarded as an essential and ongoing process for leaders to understand how the organisation is going, and to address complaints about quality or safety through commitment to continuous improvement.
See our Good Practice Guide: Risk Management for an outline of useful resources, and our Policy: Client Feedback, and Policy: Complaints Management for practical information regarding gathering feedback, as well as our Policy: Partnering with Clients for an outline of approaches to incorporating service users into the service development and improvement process.
- Developing the right skills
Ensuring that members of the governing body have the right mix of skills, experience and expertise should be a key priority. Boards which lack vital professional knowledge and skills in aged care and clinical care, or otherwise overemphasise financial indicators of performance, can neglect indicators of safety and quality, allowing substandard care to go undetected and increasing the risk of incidences of serious harm. It is important that governing body members commit continuous effort towards development of professional skills and practical expertise relevant to effective organisational governance.
Organisations should put in place systems to make sure they are recruiting board members who are qualified, with valuable skills that will support effective governance. We discuss this within our Good Practice Guide: Board Recruitment. New members of a governing body should be actively supported throughout their orientation, so that their skills and experience can be focused on achieving organisational aims as quickly as possible. Take a look at our Board Orientation Kit for a detailed walk-through of how to introduce a new board member to your organisation’s processes and approach to its service delivery.
In the Reading Room you can find our Template: Board or Management Committee Skills Audit which provides a practical resource for identifying knowledge and skill gaps. Our resources, Info: Board or Management Committee – Skill Development, and Policy: Training and Development for Board Members can support the organisation to establish policies for training board members. The Aged Care Quality and Safety Commission also provides the Governing for Reform in Aged Care Program as a centre of excellence for improving skills in clinical and corporate governance.
- Regular supervision of key issues
It’s vital that boards implement a regular management reporting structure, including review and discussion of detailed KPIs of quality and safety. We also have some great resources to assist in this area. See our Board or Management Committee: Good Practice – Governance and Management for a good starting point, and our Board Meeting Template for a detailed standing list of matters to consider and report on at meetings.
Towards Best Practice in Board Governance
The outcome of the Royal Commissions and recent sector performance data reiterate that more must be done to improve the performance of governance systems. It is essential that the governing body ensures that an organisation’s culture and systems align with their missions and goals, as an ethical responsibility to ensure that people who are in need get the support they require.
Looking to improve your governance systems?
Sign up to SPP and let our Board Governance resources guide you towards continual improvement!
