swancare stress audit: final report

SwanCareStress audit:

By Dr Niki Ellis16 May 2007

Final report

Research questions

What is the organisational health ofSwanCare and Waminda in particular?What are the factors which are risks andopportunities for organisational health inWaminda?What are the priority areas forimprovement?What are suggestions for improvementidentified so far?What is the action plan?

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Research questions

6 years of change for SwanCare inresponse to Governmentrequirements for raised standards inaged careChange successful – eg organisationis growing, workers comp premiumdecreased, resident satisfactionincreased

Policy environment at SwanCarePolicy environment at SwanCare

However further empowerment anddevelopment of staff is a key goal forCEO – building trust betweenmanagement and seen to be critical


We have to engage staff and establishtrust so that we can work together toachieve

‘’

Commonwealth funding policy means that carershave low payThey can go and work at Coles or Kmart and getmore money for a lot less stress

– Admissions Co-ordinator,Waminda

Aged care not a popular sector for health workers


Workforce shortage major people managementissue:

’‘

SwanCare’s strategy is to be an employer of choice


future aged care worker initiative

above award salariestraining and developmentopportunitiesflexible work arrangementsprograms to support staff

employee assistance program (EAP)

health promotion (Take 30)

financial management

Workers comp premium 400-500K 160KWorkers comp premium 400-500K 160K

2001-03 2004-06

No. Stress Incidents 0 2

No. Stress Claims 3 0

No. Stress Incidents 0 2

Estimates by Risk Manager

OHS Indicators

2001-03 2004-06

What is the organisational healthof SwanCare?


No. Stress Claims 3 0

Absenteeism in SwanCare



0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Total

hours of

sick leave

05/ 06 06/ 07

time

Extrapolated from 10 mths

9370 9505

Referrals to EAP SwanCare

0

1

2

3

4

5

6

7

8

No. of

referrals

Jan-Jun 2005 Jul-Dec 2005 Jan-Jun 2006

time

4

7

5



Staff turnover in SwanCare

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

%

Staff

turnover

2005 2006

time

27%

33%



Most agreementConfidentiality of payrollUnderstand how to completetime sheetTraining and developmentopportunitiesEffort made to give preferredhours and shifts/work andhome balance

Least agreementSpeed of payroll responseto queriesManagement dealeffectively with poorperformersRewards and recognition

Employee opinion poll on HR and payroll 2005



Staff turnover in SwanCare

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

%

Staff

turnover

2005 2006 2006

time Guesstimate by Manager

15%

27%

33%SwanCare overall Waminda

What is the organisational healthof Waminda?


Absenteeism in SwanCare

Extrapolated from 10 mths

$0.00

$20,000.00

$40,000.00

$60,000.00

$80,000.00

$100,000.00

$120,000.00

$140,000.00

$160,000.00

Total

salary cost

of sick leave

05/06 06/07

time

66%

$60 584

$152 828

$92 244

Waminda

SwanCare overall



NB some ofthis increasedue tosignificantsalaryincreases overthis period



Resident satisfaction - overall rating of Waminda

0%

10%

20%

30%

40%

50%

60%

%

excellent

scores

2004 2005 2006

time Source: Resident satisfactionsurveys for Waminda 2004-2006

59%

39%36%



Resident satisfaction - overall care by staff

0%

10%

20%

30%

40%

50%

60%

%

excellent

scores

2004 2005 2006

time

54%

32%

Source: Resident satisfactionsurveys for Waminda 2004-2006

53%



Resident satisfaction - staff attitude to residents

0%

10%

20%

30%

40%

50%

60%

70%

%

excellent

scores

2004 2005 2006

time

55%63%

45%




Resident satisfaction - personal care

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

%

excellent

scores

2004 2005 2006

time

35%32%

48%




Relationships with staffVariety of workOverall very satisfied with their work

What carers like most aboutworking at Waminda

Caring for the elderly‘I enjoy working with the elderly, it is interesting andrewarding and I help make their life better’Relationships with residents

Based on focus group with carers andinterviews with middle managers



‘Stress’, ‘workload too high’, ‘not enough time’, 14residents and 6 hoursExacerbated by unplanned absencesPaperwork – but considered new computer programwas making this easier; and could see the benefits ofincreased documentationPaperwork

What carers like least aboutworking at Waminda

Based on focus group with carers, andinterviews with middle managers

Organisational health ofWaminda?

Organisational health ofWaminda?

Worry after hoursSleeplessnessFatigue ‘physically and mentally draining’ ‘not muchleft’Negative impact on immune system – susceptible tominor illnessDepressionFeeling of not wanting to come to work ‘You wakeup and think I can’t face that place today andwonder how many we do not have today’Irritability at home

Impact on staff of high workload

Based on focus group with carers

What are the factors which are risks andopportunities for organisational health?What are the factors which are risks andopportunities for organisational health?

Job security

Workload

Job control

Scheduling

Job content

Social environment

Physical environment

Not relevant

---

++ (regular meetings, CI, but quite regimented)

++ (fair and flexible, but want longer shifts)

+++ (‘reason people do the job’)

++ (can be too much)

- (heat, physical work)

Based on workplace inspection, focus group with carers, interviews with Waminda co-ordinators

Organisational health indicator- way work is organised

Relevance to carers at Waminda

Rating of +++ is max positive impact - - - is max negative impact

What are the factors which are risks andopportunities for organisational health?What are the factors which are risks andopportunities for organisational health?Organisational health indicator – way people are managed

Relevance to carers at Waminda

Based on workplace inspection, focus group with carers, interviews with Waminda co-ordinators

RoleRelationships

Change management

Training and development/careerpathway

++++/- (PDPs &local supervisors/managergood, but lack of acknowledgement‘thankless job’)

- (senior management ‘removed’)

+ (training opportunities valued, but donot have time, and think that jobopportunities once developed are rare)

Rating of +++ is max positive impact - - - is max negative impact

What are the factors which are risks andopportunities for organisational health?What are the factors which are risks andopportunities for organisational health?

Overall good alignment between senior management, middlemanagement and carers on quality of working life factorsPerception of lack of recognition not mentioned bymanagement (although obvious in EOP)Lack of trust by carers towards to senior management possiblyunderestimated by managementFor carers normal workload, and workload exacerbated byunplanned absence is given overwhelming priority as astressorStressors associated with dealing with residents given greateremphasis by all managers than carersStressors outside work given greater emphasis by managers

Based on focus group with carers, interviews with Wamindamanagers and senior managers at SwanCare

Differences of view between management and carer

Attitude of carers to existing health andwell-being program

Attitude of carers to existing health andwell-being program

Take 30 Did not recognise title, but when explained‘content beneficial but don’t have time, itmakes it stressful’

Based on focus group with carers

Neutral response ‘low attendance’,difficult with shiftworkers

Social events

Most had taken up salary sacrifice toobtain tax benefit and valued this

Financial managementassistance

EAP ‘Good to know it is there’

Future aged care workerproject

Knew of it but not seen asrelevant

What are the priority areas forimprovement?


Employ more people – carers recogniserestrictions due to Commonwealth Governmentfunding policy but consider circumstances inlow dependency are not fair, especially asresidents are increasingly of higher dependency

Suggestions from carers:



Suggestions from carers:Carers have a say in recruitment –

Make shifts longer – staff may not have towork 6 days, may make shifts attractivefor agency and casual staff



Suggestions from managers:

Better funding

Work smarter

Eg role extension, role enhancementincluding in relation to externalorganisations, eg primary care and hospitals

Improve physical environment



Develop a stronger policy focus on improving quality of working life forcurrent staffIdentify KPIs related to staff well-being to complement indicators onresident well-being - ? Absenteeism, staff turnover, quality indicatorsdirectly related to carer performance

SwanCare

Reduce unplanned absences - ? by expanding casual poolImprove productivity

Working Smarter program (? Extend future aged care worker initiative, orundertake through continuous improvement (CI) program)Take up carer idea of reviewing shift design

Gather evidence to substantiate indications that current workloads forcarers in low dependancy facilities are too high and may be impacting onphysical, mental and social health of carers and hence quality of service toresidents (survey, pilot in Waminda, extend to other areas in SwanCare)

Waminda

ConclusionsPeople management a high priority in SwanCare – aims to be an employerof choice now and in the futureSubstantial achievements in the past 6 years; strong management teamExternal challenges – funding, reluctance of health workers to chooseaged careInternal challenges

aged care is currently benefiting from the goodwill of carers towards residents –however there are early signs in Waminda that this is not likely to be sustainablerelationship between facility floor and senior management outside Wamindastaff well-being program operates at secondary prevention level (not primaryprevention) for occupational stress? lack of traction for aged care worker in the future initiative

A more explicit focus on the quality of working life of current staff (theirmost pressing work issue) may assist to strengthen relationships anddevelop skills which could then be applied to the aged care worker projectThis Stressbuster initiative could be built upon to obtain more evidence tosupport the view that the Commonwealth funding formula for lowdependency care is inadequate

Conclusions

swancare stress audit: final report

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