LASA Q Conference
Let’s talk quality
Ross Bushrod
General Manager Accreditation
TMP-GEN-0015 v14.0
• What new, what’s not
• Governance
• Our processes
•
Residential
•
Home care
• Industry performance
• Promoting high quality care
• Better understanding the resident experience
TMP-GEN-0015 v14.0
Quality Agency
• Started operations 1 January 2014
• Australian Aged Care Quality Agency Act 2013
• Residential care accreditation transferred
• Responsible for home care review, 1 July 2014
• Existing staff, existing offices, existing contacts
• www.aacqa.gov.au
TMP-GEN-0015 v14.0
Quality Agency
• Accreditation processes unchanged
•
Quality Agency Principles 2013
• Accreditation Standards unchanged
•
Quality of Care Principles 1997
• Quality review process continues
•
Quality of Care Principles 1997
• Home care common standards (previously Community care…)
TMP-GEN-0015 v14.0
Australian Aged Care Quality Act 2013
• Accreditation of residential services
• Quality review of home care services (from 1 July)
• Advise Secretary of services not meeting Standards
• Promote high quality care
• Innovation in quality management, continuous improvement
• Provide information, education and training
• Other functions as specified by Minister
• Anything incidental/conducive to the above
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Advisory Council
• Appointed by Minister
• Chair and 6-10 members
−
Evaluation of quality management systems
−
Provision of aged care
−
Consumers
−
Geriatrics/gerontology/nursing
−
Public administration, management, law
−
Any other appropriate field of expertise
TMP-GEN-0015 v14.0
The accreditation cycle
APPLICATION
Approved provider
applies for accreditation
Re-accreditation
audit
Decision-maker
assessment team report
and recommendation
approved provider report
other relevant information
Accreditation due to
expire
Ongoing monitoring
Assessment contacts announced /
unannounced
Continuous
improvement
Accreditation decision
• met/not met
• period of accreditation
• arrangement for ongoing
monitoring
• required improvements
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Quality review process
• At least once every 3 years
• Site visit*
• Interim report
−
Provider response
• Final report
−
Met/not met
−
Improvements
−
Revise PCI – timetable to make improvements
TMP-GEN-0015 v14.0
*Site visits
• Premises of the approved provider
• 28 days’ notice (at least)
• Assess quality of care
• Meet AP daily re progress
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Assessment contacts
• Assess performance
• Assist continuous improvement
• Identify whether quality review required
• Information/education
• AP premises or “A site where home care is provided”


14 days’ notice
AP to tell care recipients
TMP-GEN-0015 v14.0
Care recipients
• Must be told of planned audits and quality reviews
• Must be given opportunity to talk to quality assessors/quality
reviewers
• Assessors/Reviewers must consider information by care recipients,
former care recipient, or representative
TMP-GEN-0015 v14.0
How quality is seen…..
TMP-GEN-0015 v14.0
Industry Performance (residential)
% of homes 44/44 as at last audit*
• Round one (2000) – 64 per cent
−
243 homes had 10 or more not met expected outcomes
• Round five (2012) – 95 per cent
−
26 homes had 10 or more not met
*Based on the last decision before 31 December every three years e.g. 2000, 2003, 2006, 2009,
2012.
• Governance is not a performance factor
TMP-GEN-0015 v14.0
Current
2,703 homes as at 31 January 2014
• 32 on timetables for improvement
• One home with 4+ not met
• Nil homes with 10+ not met
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How you rate us
100%
Overall Satisfaction
90%
80%
70%
65%
60%
50%
40%
26%
30%
20%
7%
10%
1%
0%
Fair
Poor
0%
Excellent
Very good
Good
Overall satisfaction rating
Response rate: 52%
TMP-GEN-0015 v14.0
How you rate us
100%
Allowing care staff to continue their
duties during the visit
90%
80%
70%
60%
53%
50%
36%
40%
30%
20%
8%
10%
1%
0%
Fair
Poor
0%
Excellent
Very good
Good
Rating
Response rate: 52%
TMP-GEN-0015 v14.0
Promoting high quality care
• Better Practice 2014
•
“Choose your own adventure”
• One-day workshops
•
Risk, Information, Complaints
• Understanding accreditation
• QUEST
• Quality Standard
TMP-GEN-0015 v14.0
Promoting high quality care
• Better Practice Awards
• QUEST for home care
• CALD workshop
• Industry needs analysis
•
Residential and community/home care
TMP-GEN-0015 v14.0
Better understanding the care
recipient experience (res. care)
• >10% sample on any visit
• 55,000 resident interviews pa
• Observation is part of the assessor toolkit
•
Resident responses, staff-resident interactions
•
Not all residents can reliably give information
• Short observational framework (SOFI2)
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SOFI2 – what is it
• Licensed from Bradford University
• Strictly controlled training and use
• UK Care Quality Commission
• Scottish Care Inspectorate
• Care and Social Services Inspectorate of
Wales
• Australian Aged Care Quality Agency
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Some CQC feedback
“Using the tool has given me greater insight into residents
experiences than any other methodology I have ever used.”
“I now have graphic evidence to back up my judgment about the quality of
communication with residents.”
“The tool also really helped me focus on how disempowering poor
communication can be, and highlighted that some recent staff
training had not been successful.”
TMP-GEN-0015 v14.0
SOFI2 – Australian pilot
• Train-the-trainer, strict selection criteria
• Four-day program for trainers, delivered by Bradford
trainers
• Observation tool and manuals customised for the
Australian context, Quality Agency audit methodology
• Field pilot involving SOFI-trained trainers
TMP-GEN-0015 v14.0
What our SOFI-trained assessors said
“While not specifically assessing staff performance I am more aware
of how staff are interacting with residents and the potential impact
on the residents.”
“It enabled me to follow up on ‘quiet’ residents to ensure they were
receiving appropriate emotional support, choices and decisions and
activities and lifestyle.”
“I used SOFI2 in a dementia specific unit and it gave me a good
sense of normal interactions between residents and staff and the
environment in which the residents live.”
“The observation time reinforced my general impressions of good staff
interactions from earlier in the day.”
TMP-GEN-0015 v14.0
Aged care managers
• Generally positive, understood the purpose of the trial
• Is the tool available for use by aged care managers?
• How will it be reported?
• Time management
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SCRQOL – a study
•
Social Care-Related Quality of Life (SCRQOL) - An attempt to
measure and monitor the value of social care services
•
Personal Social Services Research Unit
•
•
University of Kent
•
London School of Economics
•
University of Manchester
www.pssru.ac.uk
TMP-GEN-0015 v14.0
SCRQOL
•
Domains
•
Personal cleanliness and comfort
•
Safety
•
Control over daily life
•
Accommodation cleanliness and comfort
•
Food and nutrition
•
Occupation
•
Social participation and involvement
•
Dignity
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Interviews and observations
• Staff interviews covered their perceptions of residents’
current SCRQOL and expected levels absent care
home
• Resident interviews focused on their experiences living
in the home, their views about staff and the help they
receive, and their current care needs
• Observations – usually two hours (4pm-6pm)
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Some findings and conclusions
• Needs in the most basic domains of peoples’ lives well
met overall, but not so well in areas such as social
participation, occupation and control
• Some divergence between regulators’ ratings of homes’
performance and SCRQOL scores
• Differences may reflect emphasis by homes and by the
regulator on management systems and processes and
resident health outcomes rather than social care factors
and quality of life
TMP-GEN-0015 v14.0
Campbell (2007)
• Aged care managers, staff
•
Quality of care = clinical outcomes
•
Quality of life = lifestyle, activities
• Residents, relatives
•
Quality of care = what’s acceptable
•
Quality of life = resident/family/community expectations
•
Balance/emphasis varies according to health status
Quality of care is the degree to which acceptable standards are met
Quality of life is the degree to which individual well-being meets personal
expectations
TMP-GEN-0015 v14.0
Campbell
“Domains” of quality (based on stakeholders)
• Environment
• Services
• Interactions
• Personal
• Health
TMP-GEN-0015 v14.0
Campbell
• Overall quality (v. good/excellent)
•
DON/Quality manager - 93%
•
Resident/family
- 70%
•
Care staff
- 63%
• Clinical quality (v.good/excellent)
•
DON/quality manager - 95%
•
Resident/family
- 67%
•
Care staff
- 73%
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The Georgia Quality Initiative
• Collaborative, involving governments, NGOs
(Alzheimers), public advocates, Georgia Health Care
Association
• Started in 2003, voluntary
• High participation rates
•
95% homes
•
70% residents
• Linked to incentive payments through Medicaid
TMP-GEN-0015 v14.0
Measures
•
Tracks “technical measures” as well as satisfaction scores
•
Technical data submitted monthly
•
Falls
•
Pressure sores
•
Pain management
•
Restraint
•
Catheter use
•
Unexpected weight gain/loss
•
Staff turnover
•
Staff satisfaction survey at least annually
•
Family satisfaction survey at least annually
TMP-GEN-0015 v14.0
Georgia QI 2013 results
• Residents/relatives
•
89% rated their home as excellent/good, willing to recommend
• Staff
•
75% rated their home excellent/good, willing to recommend
• Overall satisfaction score – 2013 vs 2004 (out of 100)
•
Families – 78 vs 71
•
Residents – 78 vs 75
•
Staff – 63 vs 59
TMP-GEN-0015 v14.0
Quality
Perceptions vary as to:• What it means ?
•
Quality of care
•
Quality of life
•
SCRQOL
• Its measurement?
•
Those in charge of the system
•
Those at the front line
•
Those the system is designed for
TMP-GEN-0015 v14.0
Thank you
TMP-GEN-0015 v14.0
Risk indicators
•
Change of management systems (incl. IT)
•
Change of key personnel
•
Change in business strategy/restructuring
•
Change of approved provider/ownership
•
Changes in processes, procedures not supported by appropriate training
•
Change in resident numbers or mix – sudden or gradual
•
Building programs
The problem is not the risk! Problems occur when risk is not
appropriately managed.
TMP-GEN-0015 v14.0