Quality and safety in aged care: the challenge of transparency

The challenge
Six actions fo providers
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Quality and safety at the forefront of aged care

The Commissioners placed quality and safety at the centre of the Royal Commission's vision and focus, and many matters relating to quality were raised in hearings and through submissions.

Amongst these were a range of issues relating to the transparency of quality and safety performance. Simply put, it is difficult to determine whether any given service provider is providing care which is safe and of high quality. This lack of transparency has implications for both providers themselves, as well as older Australians and their families trying to make decisions about care.

The lack of transparency presents several challenges. For providers, it makes it difficult to understand their own safety and quality performance. Services that are excelling may not be recognised, while others that are performing poorly may not be held to account. Because performance data is not shared, services are limited in their ability to benchmark their own performance against others. For consumers and their families, the lack of transparency presents a barrier to identifying services about which they can be confident of the quality of care. In turn, it makes decisions about what services they wish to access and from whom, more difficult.

Most services assert that they provide care which is of good quality, however it is difficult to determine if in fact this is the case.

The challenge

Some key issues identified over the course of the Royal Commission which contribute to the lack of transparency include:

Limitations in the utility of accreditation reports:

Accreditation reports are one form of information about the quality of care provided by a service, however they provide very limited insight about quality, indicating only whether certain requirements are met. These reports do not discriminate between services that are providing outstanding care and those which are just meeting the minimum requirements.

Limited breadth and reach of the aged care quality indicator program:

The aged care quality indicator program is another form of information about quality, but it is limited. Only three indicators – unexplained weight loss, falls and use of restraints – are mandatory, and these are only for residential aged care services1. There are no mandatory quality indicators for other aged care programs, such as home care services.

Lack of available data about breaches or poor performance:

Information about individual services’ poor performance – as evidenced by matters such as complaints for example – is not published by entities to whom these matters are reported.

Where quality and safety information is available, it is difficult to find and interpret:

There is no central repository of quality and safety information enabling the comparison of quality and safety performance between providers or services. Some providers may choose to present information about the quality of their services, such as on their website, but there is no requirement to do so. Further, where quality performance is shared publicly, comparison is often difficult because it is not usually reported in a consistent way.

What can providers do?

Here are six actions providers can take to increase the transparency about the safety and quality of the care they provide. A range of recommendations were also made by the Commissioners in their final report, which align with these actions.

Become a learning organisation:

Providers should invest in developing a culture of openness which values and seeks to understand their own quality and safety performance and continually improve. This should be made a priority by including it in their vision, purpose or strategic objectives. Providers should ensure their leaders endorse this approach and demonstrate openness in the way they communicate about quality and safety, including how they respond when areas for improvement are identified. In turn, providers should also support workers to also adopt a learning mindset to all aspects of service delivery.
Get ready for an expanded national quality indicator program:

Providers should become familiar with the program and where it is heading. They can choose to be early adopters and start collecting data on new indicators before they become mandatory. This will give providers early data and information that they can use to identify areas for improvement.
Ensure quality measures include consumer reported indicators:

Providers should consider different ways to understand their consumers’ experiences. This means moving beyond net promoter scores to understanding how consumers perceive the interactions they have with services. Every consumer should be asked for feedback about their experiences of care routinely, using validated tools. This should be supported by other sources of information including interviews, focus groups, and family and carer journey mapping. Providers should not wait for complaints, and instead, be proactive and systematic about collecting information to understand whether consumers are meeting their goals, have good experiences of care, and services are contributing to them achieving their best possible quality of life.
Collaborate:

Providers should consider working together with others. This might mean sharing lessons learned about identifying measures of quality, interpreting these measures, or how providers can meaningfully report on this information to their important stakeholders. Collaboration will help providers accelerate their own path to performing well.
Report publicly:

Providers should think about ways in which they can share their safety and quality performance information with their consumers – both those who use services now, as well as those who may do so in the future. This will demonstrate providers’ commitment to being open, and help gain public trust.
Get consumers involved:

Providers should identify different ways in which they can get the input of consumers to their safety and quality reporting, for example using consumer advisory committees or boards. Providers should find out what matters to their consumers in the area of quality and safety and use this to help determine what they want to know (i.e. what should be measured), as well as how they want this information to be presented so that it is clear and easily understood.

Collecting, analysing and responding to information about their safety and quality performance should be an integral part of any provider’s operations. It helps those in governance roles understand how the organisation is performing and, when shared, can support all workers to take action where necessary to ensure care provided is safe and high quality. Above all, when providers are transparent about their safety and quality performance with the public, it helps support older Australians and their families make decisions about where they want to access care.

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