Moving towards best practice service delivery in aged care

The Aged Care Quality Standards are an important part of an organisation’s quality and compliance benchmarking. However, for providers looking to go beyond their baseline obligations, SPP hosts a number of best practice self-assessments for aged care. These guidelines and standards are designed to complement your ACQS compliance, and provide further guidance across targeted areas of service delivery and governance.

Aged Care – Clinical Governance

The Aged Care Quality and Safety Commission has developed guidance on clinical governance in aged care to assist aged care providers to develop and review their clinical governance framework.

We’ve made digesting that guidance easier for providers.  By working through our Aged Care – Clinical Governance self-assessment module, you can identify key issues that need to be addressed in a clinical governance framework, as well as identify gaps and opportunities for improvement.

Aged Care Diversity Framework

The Aged Care Diversity Framework was developed by the Australian Department of Health and Aged Care. The Aged Care Diversity Framework includes four Diversity Action Plans which are designed to help providers address barriers faced by different groups, being all diverse older people, older Aboriginal and Torres Strait Islander peoples, older CALD people, and LGBTI elders.

We have a self-assessment module for each of the Action Plans, which allows providers to work through three different levels, according to what is most relevant to their organisation: foundational actions, next steps and leading the way.

Inclusive Service Standards

The Inclusive Service Standards were developed by the Centre for Cultural Diversity in Ageing to assist aged care providers in the development and the delivery of inclusive services to all consumers. 

They provide a framework for services to adapt and improve their services and organisational practices so they are welcoming, safe and accessible.

Meeting the performance measures listed in this assessment provides evidence that an organisation has embedded an inclusive, non-discriminatory approach to its delivery of care and services.  

Dementia Australia Quality Care Recommendations

Dementia Australia’s Quality Care Recommendations have been developed by people living with dementia, their families and carers in the context of the new Aged Care Quality Standards. Each of the eight Standards has a dementia-specific recommendation on how that Standard needs to be met when providing any aged care service to a person living with dementia, their families, carers and advocates. 

This module provides organisations with further insight and direction on each of the Aged Care Quality Standards, through the lens of dementia-friendly care.

National Guidelines for Spiritual Care in Aged Care

The National Guidelines for Spiritual Care in Aged Care were developed by Meaningful Ageing Australia, who state:

Spirituality is integral to quality of life and well-being, and should be accessible to all older people in a way that is meaningful to their beliefs, culture and circumstances.

The Guidelines are designed specifically for offering spiritual care and support to older people living in residential aged care, or receiving care and support through home care packages. They are intended to support organisations to embed spirituality into key systems and processes with the goal that all older people (and their loved ones) are offered best-practice in spiritual care.

ACSA Wellness and Reablement Roadmap

The Wellness and Reablement Roadmap was developed by ACSA to help CHSP providers to self-assess their progress in integrating wellness and reablement principles into core service delivery. 

Taking a wellness and reablement approach to service design and delivery enables service providers to focus on outcomes for individuals rather than service outputs.

The Wellness and Reablement Roadmap provides a framework for discussions at all levels within an organisation to help providers identify “what they are doing well” and “what actions need to be taken to improve performance” in progressing, managing and measuring wellness and reablement.

Want to learn more?

Our modules for the standards and guidelines detailed above are available in SPP under the Aged Care – towards best practice drop-down header. They can be accessed and progressed at any time, at your own pace, as relevant to the needs of your organisation. You can automatically generate a quality improvement plan for each specific module you follow.

Access best practice
self-assessments in SPP.

Is your aged care board equipped to govern successfully?

Quality services arise from good leadership. As an aged care provider, your governing body plays an integral role in promoting a culture of safe, inclusive and quality care and services, and overseeing your organisation’s operations.

Responsibilities

Under the Aged Care Quality Standards, the governing body is accountable for the delivery of safe and high quality care and services to all consumers in the organisation’s care. 

Each member of the governing body must be satisfied that the organisation has in place the culture, strategies, policies, practices and behaviours to ensure delivery of care and services to that standard.

Challenges for non-executives

But boards are usually (and should be!) composed of non-executive directors, who very often will be fulfilling their role on a voluntary basis.  On any one board there may be directors with varying levels of knowledge about the specific requirements of the Aged Care Quality Standards.  Directors may be located remotely from the provider and, especially over the last 18 months with COVID, opportunities for face to face on site meetings has been extremely limited.

And yet, individually, each director shares the responsibility to oversee that their provider delivers safe, quality and compliant care.

Problems highlighted by the Royal Commission

The importance of strong governance in aged care was a central finding of the recent Royal Commission into Aged Care Quality and Safety. In their Final Report, Commissioners Pagone and Briggs were blunt in their assessment of the failures of some aged care providers’ governing bodies:

“Provider governance and management directly impact on all aspects of aged care. Deficiencies in the governance and leadership of some approved providers have resulted in shortfalls in the quality and safety of care. Some boards and governing bodies lack professional knowledge about the delivery of aged care, including clinical expertise. There is a risk that they may focus on financial risks and performance, without a commensurate focus on the quality and safety of care.”

The Commissioners spoke unambiguously of the duty held by governing body members:

“Accountability begins and ends with the leaders of an organisation, the board and senior management. If boards and governing bodies do not have the knowledge or skills to understand the care that is being delivered, they are unable to ensure that this care is high quality and safe. The values and behaviour of people in these senior positions have a significant impact on workplace culture and the quality of care that is delivered.”

It is clear that scrutiny of aged care provider governing bodies will be a focus of the Aged Care Quality and Safety Commission – now and into the future. Already, government has begun legislating for greater accountability and responsibilities for governing bodies, with the recent Aged Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill 2021 signalling strengthened governance arrangements from March 2022.

Now, more than ever, providers must ensure that their governing bodies are highly informed, involved, and are advocates for quality and safety in the aged care sector.

Our solution: the Board Governance Toolkit

In response to the findings of the Royal Commission, and requests from our customers, we have developed the Board Governance Toolkit.

Our new Board Governance Toolkit addresses all of the requirements in the Aged Care Quality Standards for oversight of the organisation’s provision of quality and safe care and services, and oversight of management and staff.

For each requirement, we ask a series of questions that walk directors through the necessary avenues of enquiry, so that they understand their obligations and are guided to ask the right questions and receive the correct and relevant information from management. Directors also have the opportunity to comment on how their organisation is meeting that requirement, or how it could improve.

Our Toolkit helps each individual board member to:

  • Understand their ACQS responsibilities
  • Record their assessment of organisational performance
  • Engage effectively with senior management
  • Identify gaps and areas for improvement
  • Regularly review progress and update priorities

Our Toolkit facilitates regular review and continuous quality improvement.  As part of regular quality improvement processes, governing body members should revisit the Toolkit and update their comments, for review and discussion at board level on a regular basis.

Click here to view our Board Governance Toolkit flyer.

Seeking guidance for your board?

Access the Board Governance Toolkit on SPP.

Royal Commission Series: new governance standard

Over the past few weeks, we have been highlighting a number of the Royal Commission’s recommendations, as well as updating you on resources that can help you implement best practices.

Our focus today is on Recommendation 90: New governance standard.

The Royal Commission’s executive summary of its final report emphasised the need to ensure high standards of governance within aged care providers:

“Provider governance and management directly impact on all aspects of aged care. Deficiencies in the governance and leadership of some approved providers have resulted in shortfalls in the quality and safety of care.

“Governance arrangements provide for the systems by which an organisation is controlled and operates, and the mechanisms by which the organisation and its people are held to account. They are set by the leaders of an organisation, in particular the board or governing body. They are implemented by executive leaders and workers who report to those executive leaders. They involve everyone in an organisation.”

In the Royal Commission’s view, the existing governance requirements under the Aged Care Quality Standards “do not provide a sufficiently strong basis for the governance and leadership of aged care providers.”

The Commission's recommendations

Recommendation 90 sets out a proposal for more robust governance requirements to be introduced, to drive improvements to the aged care system.  Key components of the recommendation include requirements that providers:

  • Have governing body members who possess the appropriate mix of skills, experience and knowledge of governance responsibilities, to ensure the delivery of safe and high-quality care by the provider;
  • Have a care governance committee, to monitor and ensure accountability for the quality of all care provided;
  • Seek and receive regular feedback from consumers, their representatives and staff, on the quality and safety of the services they deliver, and ways in which the services could be improved;
  • Have an integrated complaints management system, including regular reporting to the governing body about complaints, any patterns, and underlying reasons for the complaints;
  • Have effective risk management practices in place covering care risks and also financial and other organisation risks;
  • Give particular consideration to ensuring continuity of care in the event of default by contractors or subcontractors; and
  • Have a governing body representative provide an annual attestation that the governing body has satisfied itself that the provider has structures, systems and processes in place to deliver safe and high-quality care.

How can BNG help?

SPP’s existing self-assessment for the Aged Care Quality Standards is an excellent way for providers to better understand the core components of a comprehensive approach to governance.

The self-assessment goes well beyond just listing the requirements of the standards.  It guides providers through the core approaches and processes they should implement in order to achieve best practice across their organisation, and in the area of governance it includes detailed, educative, best practice modules covering topics such as:

  • Organisational structure and accountabilities; governing body recruitment, induction and training; and reporting;
  • Clinical governance;
  • Risk management systems;
  • Financial controls and management; and
  • Performance monitoring and evaluation, and quality improvement.

It also includes modules on client and community feedback and complaints.

All of the modules include downloadable resources such as policy templates, to help providers develop their own policies and procedures.

Towards Best Practice: Clinical Governance self-assessment

We also have a separate self-assessment for Clinical Governance, which is based on guidance from the Aged Care Quality and Safety Commission. It addresses clinical governance at a more granular level and details the processes that should be in place for a clinical governance framework. The self-assessment outlines the roles and responsibilities of all individuals involved in care including the governing body, senior executive team, operational manager, the workforce, health practitioners and consumers.

Resources

We have many resources which will assist providers to implement a comprehensive approach to governance across their organisation, including a whole resource topic on “Governance and Management”.  You can find this section in the Reading Room under the heading “SPP Resources by Topic”.

You can also search for other resources using the search bar in the Reading Room. A number of our resources address Recommendation 90, including information sheets and policies covering:

  • Client Feedback;
  • Quality Management and Continuous Quality Improvement;
  • Complaints Management; and
  • Risk Management.

While the governance requirements are yet to be formally implemented, your organisation can get ahead by working through our self-assessments and implementing best practice policies and procedures across the organisation.  

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You can access these governance resources and many more in the SPP platform. 

Clinical governance

The Aged Care Quality Standards and the National Safety and Quality Health Service Standards include requirements for organisations to have a clinical governance framework, as well as policies to address infection control, antimicrobial stewardship and open disclosure processes.

It is a mandatory requirement for all Australian hospitals and day procedure services to be assessed through an independent accreditation process to determine whether they are in compliance with the National Safety and Quality Health Service Standards.

What is clinical governance?

The set of relationships and responsibilities between a health service organisation and its relevant stakeholders to guarantee good outcomes and continuously strive to improve clinical care for clients.

At its core, effective clinical governance fosters a culture within an organisation in which healthcare professionals of all levels routinely question: ‘Am I doing it right? How can I do better?’.

Purpose of clinical governance

The purpose of clinical governance is to ensure that everyone is accountable to clients and the community for delivering good clinical outcomes and meeting clinical indicators. It is an all-encompassing framework, and also includes infection prevention, antimicrobial stewardship and waste management.

Six key components of the Clinical Governance Framework

  1. Governance, leaderships and culture
  2. Partnering with clients
  3. Roles and responsibilities
  4. Client safety and quality improvement systems
  5. Clinical performance and effectiveness
  6. Safe environment for the delivery of care

Policies related to Clinical Governance can be found in the SPP Reading Room:

  • Info Sheet: Clinical Governance
  • Policy: Clinical Governance
  • Policy: Open Disclosure
  • Policy: Infection Prevention and Control
  • Policy: Antimicrobial Stewardship
  • Policy: Waste Management