TMP-GEN-0015 v14.0

LASA Q Conference

Let’s talk qualityRoss 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

• 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

Quality Agency

TMP-GEN-0015 v14.0

• 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…)

Quality Agency

TMP-GEN-0015 v14.0

• 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

Australian Aged Care Quality Act 2013

TMP-GEN-0015 v14.0

• 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

Advisory Council

TMP-GEN-0015 v14.0

The accreditation cycleDecision-makerassessment team report and recommendationapproved provider report other relevant information

APPLICATIONApproved provider applies for accreditation

Re-accreditation audit

Accreditation decision • met/not met• period of accreditation• arrangement for ongoing monitoring• required improvements

Continuous improvement

Ongoing monitoringAssessment contacts - announced / unannounced

Accreditation due to expire

TMP-GEN-0015 v14.0

• At least once every 3 years

• Site visit*

• Interim report

− Provider response

• Final report

− Met/not met

− Improvements

− Revise PCI – timetable to make improvements

Quality review process

TMP-GEN-0015 v14.0

• Premises of the approved provider

• 28 days’ notice (at least)

• Assess quality of care

• Meet AP daily re progress

*Site visits

TMP-GEN-0015 v14.0

• 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

Assessment contacts

TMP-GEN-0015 v14.0

• 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

Care recipients

TMP-GEN-0015 v14.0

How quality is seen…..

TMP-GEN-0015 v14.0

% 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

Industry Performance (residential)

TMP-GEN-0015 v14.0

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

Current

TMP-GEN-0015 v14.0

Response rate: 52%

TMP-GEN-0015 v14.0

Response rate: 52%

How you rate us

TMP-GEN-0015 v14.0

• Better Practice 2014

• “Choose your own adventure”

• One-day workshops

• Risk, Information, Complaints

• Understanding accreditation

• QUEST

• Quality Standard

Promoting high quality care

TMP-GEN-0015 v14.0

• Better Practice Awards

• QUEST for home care

• CALD workshop

• Industry needs analysis

• Residential and community/home care

Promoting high quality care

TMP-GEN-0015 v14.0

• >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)

Better understanding the care recipient experience (res. care)

TMP-GEN-0015 v14.0

• 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

SOFI2 – what is it

TMP-GEN-0015 v14.0

“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.”

Some CQC feedback

TMP-GEN-0015 v14.0

• 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

SOFI2 – Australian pilot

TMP-GEN-0015 v14.0

“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.”

What our SOFI-trained assessors said

TMP-GEN-0015 v14.0

• 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

Aged care managers

TMP-GEN-0015 v14.0

• 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

SCRQOL – a study

TMP-GEN-0015 v14.0

• Domains

• Personal cleanliness and comfort

• Safety

• Control over daily life

• Accommodation cleanliness and comfort

• Food and nutrition

• Occupation

• Social participation and involvement

• Dignity

SCRQOL

TMP-GEN-0015 v14.0

• 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)

Interviews and observations

TMP-GEN-0015 v14.0

• 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

Some findings and conclusions

TMP-GEN-0015 v14.0

• 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

Campbell (2007)

TMP-GEN-0015 v14.0

“Domains” of quality (based on stakeholders)

•Environment

•Services

•Interactions

•Personal

•Health

Campbell

TMP-GEN-0015 v14.0

• 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%

Campbell

TMP-GEN-0015 v14.0

• 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

The Georgia Quality Initiative

TMP-GEN-0015 v14.0

• 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

Measures

TMP-GEN-0015 v14.0

• 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

Georgia QI 2013 results

TMP-GEN-0015 v14.0

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

Quality

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.