Quality Standards confusion: Why staff need more than a memo

The Aged Care Quality Standards were introduced to define what good care looks like, holding providers to account so they deliver safe, high quality care that meets the needs and preferences of older people.

The incoming Strengthened Quality Standards – to be introduced from July 1 alongside the new Aged Care Act – are a significant shake-up of the eight current Standards. With Standard 1: The person at the centre, the following six Standards encapsulate the idea of person-centred care:

• Standard 2: The organisation
• Standard 3: Care and services
• Standard 4: The environment
• Standard 5: Clinical care
• Standard 6: Food and nutrition 
• Standard 7: The residential community

However, despite their impending introduction, Hello Leaders found that many staff on the floor remain in the dark about Quality Standard changes. Almost two-thirds of aged care workers who responded to our poll stated they do not understand the Strengthened Quality Standards and have not received any training or information about them.

While some in leadership positions would argue staff on the floor do not need to know everything about Quality Standards, a strong understanding of these regulatory elements can help them evaluate their own actions.

Thrive Aged Care Consultants Director Kathy Kirby is a leadership expert and experienced Registered Nurse in her own right. She consults and supports aged care providers to take a proactive approach and invest in the development and well-being of staff.

She told Hello Leaders it’s common for aged care providers to communicate, plan and implement change at a high level while forgetting to include the broader workforce. 

“[Providers] do the work but fail to engage, involve and share the WHY with our most important asset – our workforce. Then, we expect them to just get on with the HOW – the changes that are being implemented and to do so immediately and successfully,” Ms Kirby explained.

“That approach just isn’t going to work. For change to be effective and sustained, we need to bring people on the journey.

“We continue to notice that despite personal carers being a large cohort of our workforce, we still fail to provide them with adequate education. Education is a key component of the Strengthened Standards and it is an area that in my opinion, we have lots of opportunity to improve.”

A sense of urgency

The rapid pace of change has created a seemingly endless sense of urgency in aged care. At first it was residential aged care that bore the brunt, with home care now involved heavily through Support at Home and Quality Indicator expansion. 

Both Ms Kirby and her fellow Thrive Director Kate Lamont – an Occupational Therapist by trade and policy expert – know that leaders in the thick of aged care are overwhelmed by it all. However, they have noticed a shift in attitudes this year. 

“We are definitely seeing a stronger focus this year on getting prepared for the changes and I think, a sense of excitement about how these changes might look in practice but this comes alongside apprehension for those providers who are due for an assessment soon after 1 July,” Ms Lamont added.

Thrive is confident the Strengthened Standards will be clearer to understand, offering providers and their staff more explicit guidance on what is expected. Shifts in approach are still required to ensure compliance – and hopefully more than just that.

“These are the minimum expectations to meet and we should always be striving to do better. They are enhancing what we should have already been doing but with clearer outcomes,” Ms Kirby said. 

“There are certainly areas where you can see there is a strong focus, such as dementia care. Dementia is mentioned specifically throughout almost every standard and has explicit requirements. This is very different to the current standards. 

“Another area of focus is identifying frailty and shifting to an approach of ‘reablement’, maintenance of function and independence. This is certainly going to be a big shift for providers to consider how they currently assess for frailty and what programs/approaches they take to encourage reablement. This is another area where there is likely to be process changes as well as a change in approach.”

These changes ultimately do place some pressure on providers to ensure staff are educated about the why – why is it a focus – and the how – how is that shift going to occur. Ms Kirby said without that education, changes will not be implemented effectively. 

Communication and support

With only four months until the Strengthened Quality Standards take effect – alongside a raft of other changes – the pool of information aged care providers are wading through is deep. 

As a result, key details can often be shared in what Ms Kirby labelled a ‘tick and flick’ exercise: one meeting or education session with staff can leave management feeling as though they’ve communicated effectively. 

Yet this is where a message can be misunderstood and the ‘how’ and ‘why’ remains irrelevant to workers in the home or community. Ms Kirby used continence care as an example. 

“Continence care is an area of focus aged care providers generally think they do well. As a consultant I can confidently say that as a sector we don’t. Go and ask your staff about how they provide quality, individualised continence care and see how many can answer you,” she said.

“Just because you have an assessment in place with ‘toileting times’ for a resident doesn’t mean staff understand the WHY behind completing that assessment, WHY certain continence aids should be used or HOW that care plan is supposed to be implemented for that resident. Don’t make assumptions based on your own knowledge – use the data around you to get the complete picture.”

A clear communication strategy for change is therefore important to ensure messages are shared, received and reinforced. 

“Don’t panic. Take a breath. What we tend to do with big changes like these standards decide we need to start from scratch and so we decide that we need to change everything and we don’t,” Ms Lamont advised.

“We have a philosophy, KISNSB: Keep It Simple, we’re NOT Stupid… we’re just Busy!”

And with that philosophy in mind, Ms Kirby and Ms Lamont have shared their tips so everyone can avoid the panic and effectively implement the Strengthened Quality Standards.

• Start by identifying what you already do well, celebrate with staff and leave those areas alone.
• Develop a priority list and an action plan. Look at the new areas of focus that have been introduced where you may not be confident and focus your attention. Starting points can include frailty and reablement, trauma informed care, dementia care, food and nutrition, mental health and continence.
• Communicate and engage with your team. Use this as an opportunity to check in with staff to see if they truly feel confident around things like dementia care or continence care or if more education is needed. Is there a high rate of SIRS or OVA? Are there staffing issues? This is the data that needs to be collected and checked to know the full story as ‘training without outcomes, is training that isn’t working’. 
• Invest in support for your leaders. With many new leaders in the sector, support is essential so they feel confident in their role. Take the time to train and mentor leaders across nursing, facility management, clinical care and quality management. This includes focusing on skills linked to people management, communication, quality improvement and change management.
• Invest in education. Do not just choose educational options that purely tick a box. Invest in programs that lead to change and improve knowledge and skill in your entire workforce. 
• Get curious! Ask questions, become educated and if something doesn’t make sense, ask WHY. Staff can be involved in this exciting change by asking managers questions, querying processes, and sharing ideas and feedback. 

More information on the existing and Strengthened Quality Standards is available here, while the Department of Health and Aged Care released an updated support document this month. Thrive Aged Care Consultants also hosted a webinar recently outlining the key changes.