Aged Care – once in a decade chance to make a difference. Can we seize the opportunity?

So now we have a Royal Commission into Aged Care.

The reasons are not because the quality of aged care is uniformly bad, but it is accepted that the worst practices can be improved in some areas by identifying poor providers. I’m sure the rest of the time will be spent discussing changes to policy, funding and threats of punishment.

If only outcome improvement was that simple.

Aged Care Services are complex organisations and very, very personal. We will hear horror stories that none of us will be proud of before the Royal Commission is finished. And then when another year starts we will all be left with the same management issues (and some new ones) and somehow the inevitable extra money in an election year will have disappeared.

So how will the quality somehow be better if there is more money?

Acute health service budgets have risen by a lot more than inflation but still there is no correlation to safety or quality so why should it work in Aged Care?

Regulation from above, legislated inspection, fear of sanctions and the blunt tool of standards and policy compliance won’t work any better at a system level than they ever have before.

Even with a shot of extra money we all know that improvement still cannot be inspected in from the outside.

So we should ponder, how we got to this point and how it needs to be different.

I have a strong view that we don’t manage health services properly and if we all could just improve this aspect it would flow through to better outcomes for those we care for. I think this is a once in a decade opportunity before us right now.

We must recognise that complaint and incident systems will never tell us the full truth and they are just one type of measure.

We need to find new ways to understand and improve the experience of care.

We need continuous measures of all critical issues linked to an agreed learning approach.

We need to stop worrying about getting an improvement method “right’ when any practical and continuous improvement method can work well in intelligent hands.

We still rely on others to inspect us and give us reports rather than develop our own skills and insights.

We don’t connect the staff who do the work with the joy of intrinsic motivation and excellence.

We use BI tools to report on anything, by anything, without deciding first what we really need to know rather than just what we have.

We manage by cost when we know good quality costs less because we don’t know how to measure the value of quality.

We end up not knowing what is actually being done in our names.

Actually, most decisions we now desperately need to make are the ones we haven’t been making which is why we are in the current situation.

Unfortunately, we usually don’t start by deciding what decisions we actually need to make. We usually don’t think about how much uncertainty we need to resolve. We usually start at the wrong place and say what information do we have and think it’s a beginning.

We need to go back to our purpose and start again with clearer thinking about how excellence should look and feel – even if we don’t know how to measure it to start with and gradually implement the systems, information and governance needed from there as we learn new methods.

It will still need those relentless, thankless tasks of measuring, managing, learning, testing and improving. It is hard, often frustrating, but it is worthy work.

There is nothing like a crisis to get us to think differently. And this is a crisis that absolutely needs us all to step up and respond.

Dr Chris Farmer

Clinical Director, Metrixcare