south australia innovation hub trial...fall 08 evaluation of the south australia innovation hub...
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08Fall
Evaluation of the
South Australia Innovation Hub Trial
Prepared for the Department of Health September 2016
www.mpconsulting.com.au
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TableofContentsAcronymsandabbreviationsusedinthisdocument.....................................................................4
ExecutiveSummary......................................................................................................................5
Chapter1–TheSouthAustraliaInnovationHubTrial...................................................................7PartA–AbouttheSouthAustraliaInnovationHubTrial........................................................................7
ParticipantsintheHubTrial.......................................................................................................................8GovernanceoftheHubTrial.......................................................................................................................9
PartB–CommunitiesofPractice............................................................................................................9
Chapter2–EvaluationoftheHubTrial.......................................................................................11PartA–Purposeoftheevaluation.......................................................................................................11PartB–Conductoftheevaluation.......................................................................................................11
Questionnaires,interviewsanddocumentreview...................................................................................12Scopeandlimitationsoftheevaluation...................................................................................................12
Chapter3–HubTrialInitiatives...................................................................................................14PartA–Overview................................................................................................................................14PartB–Governance.............................................................................................................................14
Context.....................................................................................................................................................14ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................16
PartC–Continuousqualityimprovement–qualityoflife....................................................................19Context.....................................................................................................................................................19ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................22
PartD–Consumerengagement...........................................................................................................23Context.....................................................................................................................................................23ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................24
PartE–Complaintshandling................................................................................................................25Context.....................................................................................................................................................25ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................27
PartF–Financialreporting...................................................................................................................29Context.....................................................................................................................................................29ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................30
PartG–Extendedaccreditation...........................................................................................................30Context.....................................................................................................................................................30ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................32
PartH–ReducedACFIaudits...............................................................................................................32Context.....................................................................................................................................................32ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................33
PartI–CentreforLeadershipandExcellenceinAgeing........................................................................33Context.....................................................................................................................................................33ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................34
Chapter4–Summaryofoutcomesandlearnings........................................................................35PartA–CommunitiesofPracticeasamodelforcollaboration.............................................................35
CriticalsuccessfactorsforaCoP..............................................................................................................35RiskfactorsforaCoP................................................................................................................................38
PartB–AchievementofHubTrialobjectivesandaims........................................................................38Aim1:Betterpracticeconsumerengagementandgovernance..............................................................39Aim2:Innovation.....................................................................................................................................41Aim3:Moretargetedapproachtogovernmentregulatoryactivities.....................................................41Aim4:Opportunityformutualsharingandlearning...............................................................................43
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PartC–Challengesandlearnings.........................................................................................................43
Chapter5–ThefutureoftheSouthAustraliaInnovationHub.....................................................46
Bibliography................................................................................................................................47
AttachmentA–SummaryoftoolsusedinQoLFramework.........................................................51
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AcronymsandabbreviationsusedinthisdocumentACFA–AgedCareFinancingAuthorityACFI–AgedCareFundingInstrumentCDC–consumerdirectedcareCLEA–CentreforLeadershipandExcellenceinAgeingComplaintsScheme–AgedCareComplaintsSchemeCoP–communityofpracticeCoPs–communitiesofpracticeCOTA–CouncilontheAgeingAustraliaCOTASA–CouncilontheAgeingSouthAustraliaCQI–continuousqualityimprovementthedepartment–CommonwealthDepartmentofHealthHub–SouthAustraliaInnovationHubHubproviders–theSouthAustralianagedcareprovidersparticipatingintheHubHubTrialparticipants–allparticipantsoftheHubTrialincludinggovernment,agedcareprovidersandconsumerrepresentativesHubTrial–SouthAustraliaInnovationHubTrialQoL–qualityoflifeQualityAgency–AustralianAgedCareQualityAgency
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ExecutiveSummaryTheagedcaresectorisevolving,withfundamentalreformsbeingimplementedovera10-yearperiodtosupportconsumerdirectedcare,andensurethattheagedcaresystemissustainableandaffordable.Thereformstothesystemplaceconsumersatthecentreoftheircare,withasignificantfocusongivingpeoplegreaterchoiceandflexibility.Thechangesarealsointendedtoencouragebusinessestoinvestandgrow,andtoprovidediverseandrewardingcareeroptionsintheagedcaresector.Againstthisbackdrop,agroupofSouthAustralianagedcareproviders,motivatedtoinnovateasacollective,developedtheconceptofanInnovationHub.TheHubgaveprovidersanopportunitytocollaboratewithlike-mindedagedcareorganisationstoinnovateinareasofsharedinterestsuchasimprovinggovernanceandqualityoflifeforconsumers.ConsistentwiththeAustralianGovernment’sreformagenda,anddesiretoreduceredtape,a12-monthHubTrialwaslaunchedasajointinitiativeofgovernment,theSouthAustralianagedcareproviders,andtheCouncilontheAgeingAustralia,totrialarangeofinitiativestoimproveandsustainbetteroutcomesforolderAustralians.Thegovernmentagreedthat,forprovidersparticipatingintheHubTrial,therewouldbestreamlinedregulationintheareasofaccreditation,complaints,andAgedCareFundingInstrument(ACFI),alongwithopportunitiestoworkwithgovernmenttoinformbroaderagedcarepolicy.TheHubTrialadoptedacommunitiesofpracticemodelofcollaborationandsharedlearning,wherebygroupswereestablishedtoprogressinitiativesinareassuchas:governance;qualityoflife;consumerengagement;andcomplaintshandling.Followingthecompletionofthe12-monthHubTrial,mpconsultingwasengagedtoworkwithHubTrialparticipantstoidentifythekeybenefits,challenges,outcomesandlearningsfromtheHubTrial,alongwiththecriticalsuccessfactorsrelatingtoacommunityofpracticemodelofcollaboration.HubTrialparticipantsreportedsignificantbenefitsfrominvolvementintheHubTrialandcitednumerousexamplesofchangesthathadbeenmadetosupportbetteroutcomesforconsumers.Mostnotably,allHubprovidersreportedthat:
• theHubhadprovidedaninvaluableopportunitytoshareinformationinatrustingenvironment,
criticallyassesspractice,andlearnfromtheexperienceofothers.Thisreportidentifiessomeofthecriticalsuccessfactorsforacommunityofpracticethatcouldbeappliedbyotherprovidersseekingtobuildcapacityandinnovatecollectively;
• theyhadmadechangestotheirgovernancesystems,promptedbycomparativeanalysis,andinformedbyresearchintobestpractice.TheHubalsoproducedarangeofgovernanceandcomplaintsresourcesthatareavailableontheHubwebsite;and
• theyhadnotjustimprovedtheirmeasurementofqualityoflifeandconsumersatisfaction,buthadeachidentifiedwaystoaddressareasofdeficitandimprovequalityoflifeforconsumers.
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Fromgovernment’sperspective,theTrialalsodemonstratedthebenefitsofaco-designmodelinwhichtheregulatorandprovidersworktogether,andofferedanopportunitytoexploreconcepts,suchasearnedautonomy,thatwillinformbroaderpolicyinitiativesincludingthedevelopmentofaSingleQualityFrameworkforagedcare.mpconsultingsincerelythanksallstakeholdersfortheircontributiontothisevaluation.
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Chapter1–TheSouthAustraliaInnovationHubTrialPartA–AbouttheSouthAustraliaInnovationHubTrialTheSouthAustralianInnovationHub(theHub)wastheinitiativeofagroupofSouthAustralianagedcareproviders,motivatedtoformanindustrycommunitythatsharedapassionforworkingwitholderpeopletoimproveandsupportqualityoflife1.Aspartofthegovernment’sagendatoreduceredtape,MinisterAndrews(thethenMinisterforSocialServices)engagedwiththeSouthAustralianproviderstodiscussanddevelopideasforredtapereductioninagedcareregulation.Throughthisengagement,governmentandtheprovidersidentifiedanopportunitytotrialarangeofinitiativesthroughtheHub.TheSouthAustraliaInnovationHubTrial(theHubTrial)wasofficiallylaunchedbyMinisterAndrewson10October2014.TheHubTrialranfora12-monthperiod2andwasdesignedtoencourageinnovationbyprovidinganenvironmentinwhichtoexploretheeffectsofreducingregulationforprovidersthat:• satisfyregulatoryperformancecriteriaaround
accreditation,compliance,complaints,prudentialandtheACFI;and• agreetodevelopandimplementbetterpracticeapproachestogovernanceandconsumer
engagement.AtthecommencementoftheHubTrial,theparticipantsagreedtotheSouthAustraliaInnovationFramework(theFramework).TheFrameworkdetailedtheintentionsoftheHub,aswellasarangeofinitiativestobeincludedintheHubTrial.HubTrialparticipantsagreedthataniterativeapproachwouldbeusedtoallowadjustmentandrefinementofinitiativesasrequired.TheobjectivesandaimsoftheHubTrial,asdescribedintheFramework,wereasfollows:
TheobjectiveoftheHubistoimproveandsustainbetteroutcomesforolderAustraliansengagedwithagedcareservices.ThiswillbeachievedthroughdevelopinganearnedautonomyapproachforagedcareinsupportoftheGovernment’sderegulationandsocialpolicies.Anearnedautonomyapproachtoregulationoffers‘lightertouch’regulationtohigherperformingprovidersandaimsto:• Encourageproviderstopursuebetterpracticeinconsumerengagementandgovernance
andimproveservicedeliveryoutcomesforconsumers.
1SAInnovationHubPowerPointpresentation
2NotingthatHubproviderscontinuedtooperateastheSAInnovationHubbeyondthe12-monthTrialperiod.
“TheHubTrialprovidedanopportunityforproviderstoworkwithgovernmenttoidentify,developandtrialinnovativeapproachesthatsubstitutedreduced
governmentinterventionforgreaterrelianceoneffectivegovernanceactivityandpursuit
ofbetteroutcomesforconsumers”. DepartmentofHealth
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• Supportanexpansionininnovativemodelsofcareandservicesinlinewiththeincreasingdemandsofanageingpopulation.
• Facilitateamoretargetedapproachtogovernmentregulatoryactivitiestofocusthemonwheretheyareneededwhilstmaintainingsafeguardsforconsumers.
• Provideopportunityformutualsharing,learningandinnovationamongHubmembersandpartners.3
ThegovernmentagreedthatforprovidersparticipatingintheHubTrialtherewouldbe:• lessfrequentauditsandastreamlinedapproachtoassessmentofaccreditationstandardsby
theQualityAgency;
• agreaterfocusonresolutionofcomplaintsbytheprovider(minimisingtheinvolvementofthethenAgedCareComplaintsScheme(ComplaintsScheme));
• opportunitiestoworkwithAgedCareFinancingAuthoritytoimprovefinancialdatacollectionandreportingrequirements;and
• reducedACFIreviewswhereappropriate.ParticipantsintheHubTrialTheHubTrialinvolved:
• tenagedcareproviders4inSouthAustralia;
- AgedCareandHousingGroupIncorporated;- BarossaVillageIncorporated;- BoandikLodgeIncorporated;- HelpingHandAgedCare;- JamesBrownMemorialTrust;- MonreithAgedCare;- ResthavenIncorporated;- SaintHilarionIncorporated;- SouthernCrossCare(SA&NT)Incorporated;and- WambonePtyLtd;
• theDepartmentofHealth(thedepartment)(formerlytheDepartmentofSocialServices);• theCouncilontheAgeingAustralia(COTA);• theAustralianAgedCareQualityAgency(QualityAgency);and• theAgedCareFinancingAuthority(ACFA).
3SouthAustraliaInnovationHubFramework,DepartmentofSocialServices,June2015,p3
4AttheinceptionoftheHubTrial,10agedcareproviderswereinvolved.Thisnumberwaslaterreducedtoeightfollowingthewithdrawalofthetwoprivateproviders(WambonePtyLtdandMonreithAgedCare)duetoreasonsunrelatedtotheHubTrial.
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Intotal,theeightagedcareprovidersthatparticipatedintheHubTrialmanageapproximately60residentialagedcareservicesofdifferingsizelocatedinbothmetropolitanandregionalareas.ManyoftheprovidersalsomanagehomeorotheragedcareservicesbuttheseserviceswerenotincludedaspartoftheHubTrial.GovernanceoftheHubTrialTheHubTrialwassupportedandgovernedbytheSAInnovationHubWorkingGroup,whichwasestablishedtooversee,monitorandreviewtheHubTrialinitiatives5.TheroleoftheHubWorkingGroupincluded:• contributingtoarangeofnationalagedcareinitiatives;• contributingtothedevelopmentofinitiativesrelatedtoboardgovernanceandconsumer
engagementfornationalapplication;and• developingareportingmechanismincorporatingstatusupdatesbyHubTrialparticipantsand
formalfeedbacktothedepartmentontheearnedautonomycriteriaandtheinitiativesbeingtrialledintheHub.
TheHubWorkingGroupconsistedoffourrepresentativesoftheagedcareprovidersthatwereparticipantsintheHubTrial,arepresentativefromtheQualityAgency,representativesfromthedepartmentwithexperienceinagedcareregulation,arepresentativefromACFA,andaconsumerrepresentative.TheHubwasalsosupportedbyapart-timeofficer(theHubProgramDirector)basedinAdelaideandengagedforaperiodof24-months.TheHubProgramDirectorsupportedtheHubmembersby:coordinatingactivities;facilitatingcommunicationwithintheHubnetwork;andundertakingresearchtosupporttheinitiativesimplementedthroughtheHubTrial.TheHubProgramDirectorcontinuedtosupporttheactivitiesoftheHubprovidersfollowingtheconclusionoftheHubTrial.PartB–CommunitiesofPracticeOnewaythatparticipantsoftheHubTrialworkedtogethertoachievetheirobjectiveswasthroughcommunitiesofpractice(CoPs).Theterm‘communityofpractice’emergedthroughtheHubTrialasameansfordescribingthegroupsthatHubTrialparticipantsformedtocollaborateonspecificsubjectmattersofsharedinterest.EstablishingCoPsenabledHubTrialparticipantstoidentifyandfocusonarangeoftopicsofinterestandofrelevanceinthecurrentagedcarecontext.Themodelwasparticularlyvaluableinenablingproviderstoleverageoffexistingcapabilityandtobuildindustrycapacitymorebroadly.InadditiontothesubjectspecificCoPsthatwereformedaroundtheinitiativestrialledthroughtheHub,theHubproviders(asasubsetoftheHubTrialparticipants)alsooperatedasaCoP,withthesharedvisionofworkingwitholderpeopletoimproveandsupporttheirqualityoflife6.Asdiscussedbelow,thismodelofcollaborationbetweenHubprovidershascontinuedeventhoughtheHubTrialhasendedandgovernmentinvolvementhasceased.5SAInnovationHubWorkingGroup,TermsofReference,December2014
6www.sainnovationhub.orgviewed15April2016
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DuringtheHubTrial,eightCoPswereestablishedtofocusonstrategicandoperationalsubjectmatters.SomeoftheCoPsfloweddirectlyfromtheHubTrialinitiativesandotherswereformedontheinitiativeoftheHubproviders.TheCoPsincluded:• Governance;• Continuousqualityimprovement(CQI);• Accreditation;• Consumerengagement;• CDC;• Complaintshandling;• CentreforLeadershipandExcellenceinAgeing(CLEA);and• Financialreporting.TheCoPswereflexibleandadaptedoverthecourseoftheHubTrial,sometimesinresponsetogovernmentpolicyandinitiatives,sometimestoreflecttheareasofinterestandexpertisewithintheHubprovidergroup,andsometimesbecauseofthecloseconnectionsbetweenvarioussubjectmatterareas.SomeCoPsmerged,somechangedtheirnameoverthecourseoftheHubTrial(tobetterreflectthefocusofwork)andothersbecameinactiveasinitiativeswerecompleted.Chapter3thereforedescribestheworkoftheHubbasedonthesubjectmatteroftheinitiatives,ratherthanthenameoftherelevantCoP.
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Chapter2–EvaluationoftheHubTrialPartA–PurposeoftheevaluationInMarch2016,thedepartmentengagedmpconsultingtoconductanindependentevaluationoftheHubTrial.Thepurposeofthisevaluationisto:• identifykeyactivitiesundertakenaspartoftheHubTrial;
• examinethebenefitsandchallengesoftheHubTrial;
• wherepossible,identifytheextenttowhichtheHubTrialachievedtheobjectivesandaims,
alongwithanylearningsforthefuture;and
• focusspecificallyonthecommunitiesofpractice(CoPs)(asakeyelementoftheHubTrial):- analysethegoalsandobjectivesoftheCoPsandtheprocessesforestablishingtheCoPsand
fordevelopingresources;- identifycriticalsuccessfactorsforimplementingasustainableCoP(suchasmeasuresof
success,clarityofrolesandresponsibilities,andorganisationalcharacteristics);- identifythechallengesandbenefitsofCoPparticipation;and- identifytheimpactsofCoPparticipation(bothpositiveandnegative).
Broadly,thegoalfortheevaluationwastoidentifyanddocumentthebenefitsandchallengesofparticipationfororganisationsinvolvedintheHubTrial,theoutcomesofinnovationfocusareas,andlessonsthatcanbelearnedforother‘communities’ofserviceproviderslookingtoestablishaninformationsharingmodelofcollaboration.WhilethisreportpredominatelyfocusesontheHubTrial,theworkoftheHub(intheformoftheagedcareprovidersthatparticipatedintheHubTrial)isongoing.Insomecases,initiativeslaunchedthroughtheHubTrialhavecontinuedafterthecloseofthe12-monthTrialperiod.Thisreportthereforeidentifiesbenefits,challenges,outcomesandlearningsoftheHubmorebroadly.PartB–ConductoftheevaluationTheevaluationoftheHubTrialinvolvedconsultationwitharangeofstakeholders,including:• thedepartment:
- theQualityReformBranch;- thePrudentialandApprovedProviderRegulationBranch;- theSouthAustralianRegionalOffice;
• theQualityAgency;• theAgedCareComplaintsCommissioner(andformerofficersoftheAgedCareComplaints
Scheme);• ACFA;• COTAandtheCouncilontheAgeingSouthAustralia(COTASA);• eachofthecurrentagedcareprovidermembersoftheHub:
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- AgedCareandHousingGroupIncorporated;- BarossaVillageIncorporated;- BoandikLodgeIncorporated;- HelpingHandAgedCare;- JamesBrownMemorialTrust;- ResthavenIncorporated;- SaintHilarionIncorporated;- SouthernCrossCare(SA&NT)Incorporated;and
• theProgramDirectorfortheHub.Consultationswereheldbyacombinationofteleconferences,writtenquestionnairesand/orface-to-facemeetings.Questionnaires,interviewsanddocumentreviewQuestionnairesformedthebasisforinterviewsinpersonandbyteleconference,andthebasisofwrittensubmissions.Questionnairesweretailoredtoeachstakeholderbutlargelyrelatedto:• objectivesoftheHubTrialandwhetherparticipantsconsideredthoseobjectivesweremet;• benefitsandchallengesofparticipatingintheHubTrial;• criticalsuccessfactorsfortheHub;• specificactivitiesandareasoffocusthatparticipantswereinvolvedin;and• keychangesthatHubprovidersimplementedasaresultofparticipationintheHub.ThedocumentsreviewedaspartofthisevaluationincludepapersandguidanceproducedbytheHubprovidergroup;mediaabouttheestablishmentoftheHubTrial;minutes;frameworkdocuments;andworkingpapersoftheHubWorkingGroupandCoPs.ThekeydocumentsreviewedaredetailedinthebibliographytothisReport.ScopeandlimitationsoftheevaluationTheevaluationwaslargelyqualitative,basedonconsultationswithstakeholdersandthereviewofdocuments.Thedepartmentconfirmedthatthiswasthepreferredapproach,noting:
• thattheevaluationapproachwasproportionatetothelengthandthenatureoftheHubTrial;
• someoftheHubTrialinitiativeshadonlybeenrecentlyimplementedorwerepartially
implemented,andasaconsequencetherewouldbelimiteddataabouttheoutcomesforconsumersandotherstakeholders;
• thattherewaslimitedbaselinedataavailabletoinformaquantitativeevaluationacrosstherangeofinitiativesimplementedbyparticipants;
• thattherelativelysmallsamplesizecouldcausechallengesforde-identifyinginformationinthe
evaluationreport;and
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• theevaluationinvolvedconsultationwithCOTA,astheconsumerrepresentativeinvolvedintheHubTrial,butdidnotincludedirectcontactwithconsumers.
TheevaluationthereforefocusesontheoutcomesreportedbyHubTrialparticipants,andtheinitiativesimplementedaspartoftheHubTrial,ratherthanonassessingtheoutcomesforconsumersofeachoftheinitiatives.
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Chapter3–HubTrialInitiativesPartA–OverviewThisChapterdescribesthekeyinitiativesprogressedthroughtheHubinrelationto:• governance;• CQI–qualityoflife(QoL);• consumerengagement;• complaintshandling;• financialreporting;• extendedaccreditation;• reducedACFIaudits;and• theproposedCentreforLeadershipandExcellenceinAgeing.PartB–GovernanceContextAtanearlymeetingoftheHubWorkingGroup,membersidentifiedthepotentialvalueandopportunityinexploring‘goodandbetter’governanceinthecontextofcontemporaryagedcare.BoththeWorkingGroupandHubprovidersattheboardandmanagementlevelagreedthatgoodgovernanceisacriticalelementtohighperformingorganisationsandsaweffectivegovernanceasthecornerstoneforsupportinghighqualitycareandQoLinagedcareserviceprovision.7TheAgedCareOrganisationBoardresponsibilitiesinitiativewasagreedtobyHubTrialparticipantsatthecommencementoftheTrial.Thepurposeoftheinitiativewastoimproveservicedeliveryoutcomesforconsumersbyensuringthatboardsprovidestrongleadershipinrelationtobetterpracticegovernanceandconsumerengagement.Theinitiativeidentified:
• anumberofoutcomesintendedtoinformfutureearnedautonomycriteriaandsupportthe
buildingofindustrycapacity,including:
- thedevelopmentofaprinciplebased,governanceframeworkforagedcare;- betterpracticeapproachestogovernanceandservicedeliveryoutcomesforconsumers
achievedthroughthedevelopmentofresourcestobeutilisedbytheboardsofHubproviders;and
- thedevelopmentandimplementationofconsumerengagementstrategiestosupporttheprovisionofhighqualitycare;and
• thatakeyobjectiveoftheHubTrialwastoensurethatboardsprovidestrongleadershipin
relationtoqualityoutcomesandorganisationalperformance.
7EffectiveGovernance:aframeworkforagedcare,June2015,p1
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InNovember2014,theHubTrialestablishedaGovernanceCoPtodevelopareferencepointandevidencebaseforeffectivegovernance8.LeadershipoftheCoPwassharedbytheQualityAgencyandHubproviders.TheGovernanceCoPmetonthreeoccasionsandalsoundertookanumberofconsultationswiththeHubTrialparticipantsfromDecember2014toJune2015tocapturearangeofideas,insights,experienceandexamplesfromHubprovidersandtheirBoards.Insummary,theCoP:• conductedinterviewswithHubprovidersinlate2014toexploreideasondefinitionsand
descriptionsofeffectivegovernanceandpracticesusedintheirorganisations;• conductedaliteraturesearchtoidentifygovernancemodelstobeusedinacomparative
analysiswithfourtheoriesselectedtogivetheoreticalcontextforthecomparativeanalysis;• selectedthreegovernancemodelsforcomparativeanalysis:CorporateGovernancePrinciples
andRecommendations(ASXCorporateGovernanceCouncil,2014);GoodGovernancePrinciplesandGuidanceforNot-for-ProfitOrganisations(AICD,2013);andGoodGovernance:AcodefortheVoluntaryandCommunitySector(TheCodeSteeringGroup,2011).Thesegovernancemodelswereselectedforanalysisonthebasisofcollectivelyrepresenting:
- theAustraliancontext(orpotentialtobeadaptedfor);- publiclylistedandnot-for-profitentities;- mandatoryandvoluntarymodels;- differentapproachestogovernanceissues;and- differentstructures,forexample,thenumberofprinciplesandhowtheissuesaregrouped;9
• criticallyanalysedarangeofresourcestoinformthedevelopmentofagovernanceframework;
• heldaseriesofthreeworkshopswithHubprovidersandtheirnominatedBoardmembers(with
theinitialworkshopfacilitatedbyagovernanceexpertandsubsequentworkshopsfacilitatedbytheQualityAgency):
- tofocusunderstandingusingaspecifiedmodelandtosecureagreementastolanguageand
concepts;- todeterminehowtheagreedmodelalignedwithcurrentexperienceandtoagreea
modifiedmodelfortheagedcarecontext;- toreviewtheemergingframeworkandagreeitsstructureandapproach;
• encouragedindividualboardconsultationsinwhichHubprovidersworkedwiththeirown
boardstotest,andgaininput,aboutcurrentexperienceandtheboard’sperspectiveonwhatdistinguisheshighperforminggovernance;and
8EffectiveGovernanceinagedcare:ProjectReport,June2015,pi9EffectiveGovernance:aframeworkforagedcare,June2015,p4
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• initiatedanumberofopportunitiesthroughouttheHubTrialperiodfortheboardsofHubproviderstomeet,networkandshareinformationandexperiences.
Thecomparativeanalyses,researchanddiscussionsamongstCoPmembersinformedthreekeydocumentsthatwerefinalisedbytheGovernanceCoPinJune2015andwerepublishedontheHubwebsite10.ExperienceofHubTrialparticipantsandoutcomesachievedBasedondiscussionswithHubprovidersandtheQualityAgency,providersgreatlybenefitedfromtheopportunitytoshareandlearninatrustingenvironment.Inparticular:• theprocessofdevelopingandtestingtheGovernanceFrameworkgaveHubprovidersthe
opportunityto‘stress-test’theirownsystemsandpolicies.Hubprovidersreported:- thevalueofhavingameasureagainstwhichtobenchmarkandconfirmexistingpractices;- somesignificantchangestoorganisationalpracticesbasedonthetestingofsystemsagainst
theGovernanceFramework(referdiscussionbelow);and- thevalueofthegovernanceresearchprojectininforminginternalreviewsandexternal
evaluations;
• anumberofprovidersimplementedchangestogovernancesystems,processesandBoardandstafftrainingtobetterreflectgoodgovernanceandtoincreasethefocusonconsumerengagementandQoL;- forexample,oneprovidermadesignificantchangestotheirOrganisationalPlanand
ContinuousQualityImprovementPlantoreflectbetter-focusedgoalsandoutcomesthathadbeendirectlyshapedbytheHubTrial;and
- anotherprovidermadechangestotheirstaffappraisalstofocusonstaffstrengthsandhelpencouragepositiveattitudes;
• Hubprovidersconsistentlynotedthatthe
corevalueofthedocumentsproducedbytheGovernanceCoPwasintheirspecificitytotheagedcarecontextandthattheyhadbeendraftedbyanagedcarecommunityofpractice(whiledrawingonliteratureandwidelyusedmodels);
10Referwww.sainnovationhub.org
“Theboardskillshaveimprovedsignificantlywiththefocusongovernance.Theinteraction
withotherboardshasbeenanexcellentlearningmethod.”
BoandikLodge
“Thecomparativeanalysishighlightedthathighperformancemanifestsfromthebehaviourandethicsofindividualboardmembers;supportedbyboardleadershipandculture.Asystemforgoodgovernancesetsthefoundationofstructures,expectationsandactivitiesonwhichhigh
performancecanbebuilt.Highperformanceofaboardreliesonachievingtherightbalanceofthediverseaspectsofwhataboarddoesandhowitoperates.Indoingsoahighfunctioningboardrequiresadaptationtoidentifyandachievetherightbalancetogovernandreflectanagedcare
provider’smission,contextandculture.”SAInnovationHub,GovernanceFramework
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• workshopsprovidedtheopportunityforcross-providerengagementandlearning,andgaveBoardmembersandmanagementtheopportunitytoengagewithsimilarorganisationsandtospeakopenlyaboutthecommonissuestheyface.Asdescribedinthecasestudybelow,thiswasparticularlyvaluableforsmallerprovidersthatdeliverservicesinaregionalorruralsetting.
Casestudy:BarossaVillageandBoandikLodge
BoththeBoardandExecutiveteamfromthetworuralandregionallybasedprovidersintheHub–BoandikLodge(MountGambier)andBarossaVillage(BarossaValley)metinMarch2015.BarossaVillageBoardmemberstravelledtoMountGambierwheretheyspentseveraldaysmeetingwiththeirBoandikLodgecounterparts.Participantsdiscussedarangeofissuesimpactingonagedcareboards,particularlyfromaruralandregionalperspective.Topicsdiscussedincluded:
• governanceincludingboardsub-committees,boardprocessesandreporting;• theboards’roleinoverseeingclinicalgovernanceandinpolicymaking;• strategicplanningprocesses;• riskmanagement;• issuesimpactingtheagedcaresectorandboardprioritiesfortheshorttomediumterm;• consumerengagement;• successionplanning;and• marketing.
Itwasagreedthattheissuesformetropolitanandruralboardsweregenerallythesame,however,withinsmallercommunitiesandsmallerorganisationsthedelineationbetweentherolesofBoardmembersandmanagementweresometimesblurredandtherewerechallengesrecruitingappropriatelyskilledBoardmembers.Onthepositiveside,therewasoftenahighlevelofconsumerengagementbetweenBoardmembersandthelocalcommunity.TheBoardmembersalso:• notedthattheongoingreformwithinthesector,whilstnecessary,hadcausedtheboardstoshifttheirfocustothe
shortterm(upto3years)whenstrategicallyboardsshouldbethinking5to10yearsahead;and• emphasisedtheimportanceofgovernancesupportingtheethicsandvaluesoftheorganisationincludinga
commitmenttothefuturesustainabilityofsmaller,locallyownedcommunityorganisations(wherelocalboardsareavoiceforthecommunityintermsofthetypeandqualityofservicesprovidedtoelderlyconsumers).
BarossaVillagealsoenjoyedtheopportunitytovisitandinspecteachoftheoperationalsitesmanagedbyBoandikLodgeandafuturevisitbytheteamfromBoandikLodgetoBarossaVillagehasbeenplanned.GovernancechangeswithinproviderorganisationsEachHubprovideridentifiedchangesthathadbeenmadetotheirgovernancearrangements,systemsandprocessesasadirectresultoftheHubTrial.Thisincludedchangestostrategicplans,identificationofskillsgapsandchangestoreportinglinesandstructures.WhiletheimpactofthegovernanceprojectvariedacrossHubproviders,allprovidersagreedthattheHubwasanopportunitytoconnectboardsandtorepositionwhatwerequitediverseapproachestogovernance.Providersgaveexamples,includingthattheincreasedengagementofBoardmembersacrossorganisationsgeneratedsignificantdiscussionandpromptedself-examinationofBoardpractices.Forexample:• someBoardsreconsideredtheirstructureandmeansforrenewal;
- WhilesomeBoardshadstrictrotationalpoliciesembeddedintheirgovernanceframeworks,othershadminimalturnover.DiscussionsamongstBoardmembershighlightedthebenefits
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andchallengeswitheachapproachand,inatleastonecase,aBoardwasproposingtoadjustitsapproachbasedonitslearningsthroughtheHub.
• someBoardmemberswerepromptedtoattendAustralianInstituteofCompanyDirectors
(AICD)training,andoneorganisationimplementedinternalandexternaltrainingforBoardmembers,particularlyaroundgoodgovernance;
• oneBoarddedicatedasessiontocriticallyreviewingitsgovernanceagainsttheGovernanceFrameworkgeneratedbytheHub,andtoidentifyingareasofshortfall.Asaresult,anewGovernanceStrategicPlanwasdeveloped(withKPIsandtimeframes)andaskillsmatrixwasdevelopedtoidentifyskillstobedevelopedbyBoardmembersandothers;
• oneBoardchangeditscommitteestructuretoincreasethefocusonconsumerengagementandensuredirectprovisionofadvicefromconsumers,theirfamiliesandcarerstotheBoard;and
• basedondiscussionswithotherBoards,oneBoardre-considereditsstrategicfocusandhowit
mightbroadenitsmembershipinreadinessfortheimplementationofnewhealthandagedcareinitiativessuchashealthcarehomes.
WhilebuildingcapacityoftheBoardsisanongoingventure,HubprovidersidentifiedthattheirBoardshavepickeduponideasgeneratedthroughtheHub.HubprovidersnotedthatBoardmemberswillcontinuetoattendgovernanceworkshopsdeliveredthroughtheHubandtheHubprovidersarecommittedtocontinuingtobringBoardmemberstogethertofurtherestablishandstrengthentheconnectionstheyhaveforged.BroaderapplicationofgovernanceworkEarlyintheHubTrial,participantsexpressedinterestindevelopingandtriallinggovernanceinitiativesthatcouldberolledoutnationallytoassistboardsofagedcareorganisations(bothfor-profitandnot-for-profit)toadoptbetterpracticeapproachestogovernance.TheresourcesdevelopedbytheGovernanceCoP,includingtheEffectiveGovernance:aframeworkforagedcare,providebenchmarkingtoolsthatarenowavailabletoprovidersoutsideoftheHub.Tosupportuseoftheresourcesbyotheragedcareproviders:
• Hubprovidershavepublishedthegovernancedocumentsdeveloped;• thedepartmenthascreatedalinkfromitswebpagetotheHub’swebpagewherethe
governancedocumentscanbeaccessed;• theprojecthasbeenpromotedintheAgedCareProviderNewslettergeneratedbythe
department;and• theQualityAgencyhasmadethegovernanceresourcesaccessiblefromitswebsiteandhas
promotedtheresourcesatBetterPracticeConferences.ThedepartmenthasalsoadvisedthattheworkoftheGovernanceCoPwillinformthedevelopmentoftheSingleQualityFrameworkincludingthedevelopmentofnewend-to-endagedcarequalitystandards.
SAInnovationHubTrialEvaluationReport Page19of52
PartC–Continuousqualityimprovement–qualityoflifeContextInlinewiththeobjectiveoftheHubTrialtoimproveandsustainbetteroutcomesforolderAustralians,akeyfocusoftheHubwasimplementinginitiativestobettermeasureandimprovequalityoflifeandwellbeingforconsumers.IntheearlystagesoftheHubthiswasreferredtoasfocusingoncontinuousqualityimprovement(CQI)andaCoPwasformedtofocusonthisissue.However,overthecourseoftheHubTrialtheCoPevolvedasHubprovidersbecameincreasinglyfocusedonqualityoflife(andimprovingoutcomesforconsumer)ratherthanoncontinuousqualityimprovementmoregenerally.TheCQICoPcontinueditsworkaftertheTrialandtheHubprovidersmadesignificantgroundinrelationtoqualityoflifeinitiativesandultimatelyproducedtheHubQualityofLifeFramework11.IndevelopingtheQoLFramework,theCoP:• undertooksomeworkdefiningQoLandthefocusfortheFramework.TheCoPagreedthatthe
FrameworkneededtodomorethansimplyprovideindicatorsforQoL.ItneededtoformamorecomprehensivesystemformeasuringQoLandalsotargetingactionstowardsimprovingQoL;
• researchedarangeoftoolsandsystems.TheCoPfocusedontoolsthatwerevalidated,easytouse,andwouldberelevanttoresidential,communityandretirementliving.TheCoPagreedthateachHubprovidercouldhavethechoiceofwhichtoolstoutilisetomeasureQoLbutanytoolsselectedshouldbeadoptedintheirentiretyratherthanadapted(asanymodificationcouldcompromiserobustnessandvalidity);
• agreedontheappropriateaudiencetobeincludedinmeasuringqualityoflife.Onthispoint,theCoPdecidedthatthebestoutcomefortheconsumerwouldbetoincludefamilymembersandstaffamongstthosesurveyed.ResearchundertakenbytheCoPshowedthatemployeeengagement,recipientco-designandhealthenvironmentheavilyinteractedwiththeconsumerexperienceofQoLandwereallfactorsthathadthepotentialtobeinfluencedbytheprovider12;and
• agreedthattheQoLworkshouldfocusontheidealoutcomesforconsumersandsomeofthe
factorswithinthecontroloftheproviderthatcaninfluencethissothatproviderscanadjusttheireffortstobetterfocusonQoLforeachindividual.
TheCoPalsoengagedexpertsintheconsumerengagementfieldtoinformthevariousmethodsofconsumerengagement,measuresofsatisfaction,benchmarkingandanalysis.ThisincludedamarketintelligenceorganisationandtheSAHealthandMedicalResearchInstitute
11TheSAInnovationHub:QualityofLifeFramework(aspresentedbyFrankNaso,WellnessDirection,StHilarionAgedCareInc)(unpublished)12JamesBrownMemorialTrust,Writtenquestionnaireresponse
SAInnovationHubTrialEvaluationReport Page20of52
QualityofLifeFrameworkThedesignmethodologyfortheQoLFrameworkisbasedonsimple‘toplineandbenchmarkingtools’,andanassociated‘deepdive’toolkittofurtherinvestigatespecificareas,shouldthetoplinetoolidentifyapotentialdeficit.Theintentwasthatsimpletoolswouldbeusedinthefirstinstance(toencourageuptakebylargeandsmallproviders)andresourcescouldthenbetargetedonthoseareasofneed,asidentifiedthroughthetoplinetool(maximisingefficiency).13TheCoPselectedthreetoolsastoplineandbenchmarkingtoolstomeasureandcomparebroadareasofwellbeingandqualityoflife.Applicationofthetoplinetoolsenabledcomparisonbetweenservicelocations.Afurthertwotoolswereselectedasoptional“deepdive”toolstofurtherinvestigateanyissuesorpotentialproblemsidentifiedthroughthetoplinetoolsandtoproviderecommendationsforaction.Toplineandbenchmarkingtools Deepdiveandoptionaltools1. Personalwellbeingindex(cognitive)
(PWI)2. QualityofLife–AD(QoLAD)
(cognitiveimpairment)3. NetPromoterScore(NPS)
1. WorldHealthOrganisationQualityofLife(WHOQoL)
2. CIMPACT
*seesummaryoftoolsatAttachmentAOncethedraftQoLFrameworkwasdeveloped,anumberofHubproviderstrialledthevarioustoolsacrosssomeoralloftheirservices.Someprovidershosted‘trialsites’,inwhichathree-daytrialofthetoolswasundertakenwithconsumersandstaff,opentootherHubproviderstoobserve.Results,outcomesandfeedbackobtainedthroughthisprocesswereprovidedtotheCQICoPtofurtherinformthedevelopmentoftheQoLFramework.Forexample,relativelyearlyintheHubTrial,theCoPidentifiedthatthePWItoolwouldnotmeettheneedsofpeoplewithcognitiveimpairmentormilddementia.Inresponse,theCoPidentifiedQoLADasacompaniontooltobettercaterforthoseneedsandtoenabletheQoLframeworktoextendtoasmanyconsumersaspossible.Anumberofprovidersalsonotedthatbytriallingthetools,thishadpromptedthemtothinkdifferentlyaboutQoLandtheactionsthatcouldbetakentoimproveQoL.Thisisevidencedinsomeofthecasestudiesbelow.
13JamesBrownMemorialTrust,CaseStudy:HubQualityofLifeFramework–atoolforinnovation
“TheFrameworkstartedbylookingatqualityinagedcareandanattempttodefineit.ThisprogressedtoafocusonQualityofLifeasthis
appearedtobepoorlyrepresentedinthemethodscurrentlyinuse…Thistextureofgaps
andpossibilitiesstartedformingintoaframeworkaswelookedatQualityofLifeand
thefactthatwedidnotactuallywantanindicator,ratherwewantedasystemtomeasureandtargettowardsimproving
QualityofLife.” JamesBrownMemorialTrust
SAInnovationHubTrialEvaluationReport Page21of52
Casestudy:MeasuringQoLatBoandikLodgeAspartoftheQoLinitiative,BoandikLodgetrialledthePWI,QoLADandDEMQOL.ThePWIwasalsotrialledwithcommunitycarerecipientsandthoseinindependentlivingservicesmanagedbyBoandikLodge(toensurerelevanceacrosscaretypes).BoandikLodgealsotrialledawellbeingandresilienceprogramprovidedbytheSouthAustralianHealthandMedicalResearchInstitute.Asaresultofthetrial,BoandikLodge:• hasdecidedtousethePWIandQoLADonanongoingbasiswitheveryconsumer(residentialandcommunitycare)
andallnewclients.Thetoolsarere-appliedevery6months;• hastrainedstaffintheuseofthePWIandQoLAD;and• isusingtheresultsofthePWIandQoLADtodeveloplifeplanswithconsumers,andtoidentifyconsumersthat
wouldbenefitfrominvolvementinthePerma+wellbeingandresiliencetrainingprogram.TheChiefExecutiveOfficerofBoandikidentifiedthat,attimes,theresultsofthesurveyscanbechallenging,particularlyforthoseintheorganisationwithaspecificfocusontheprovisionofclinicalcare.Staffwere,however,veryreceptivetotheuseofthetools(andchangestopracticethatflowedfromtheresults)becauseitalignedstronglywithCDCandalsobetterhighlightedwhatwouldmostbenefiteachindividualconsumer.Casestudy:TrialatSaintHilarionInlateSeptember2015,SaintHilariontrialledbothNPSandCIMPACTattheirFulhamsiteoverthecourseofthreedays.ThetrialwasprecededbytrainingforkeySaintHilarionstaff.Followingthetrial,advicewasalsosoughtfromconsumers,familiesandstaffaboutthetrialandareasforimprovement.Thetrialhighlightedanumberofadjustmentsthatwouldbemadetotheapplicationofthetools.Forexample,SaintHilarionidentifiedthat:• theywouldundertakemoreface-to-facesurveys.Whilethisapproachistimeconsuming,SaintHilarionconsidered
thatface-to-facesurveysgivesrisetomorevaluableinformation;• someofthequestionsaskedbystaffcouldbebetterfocused;and• therewouldbevalueinhavingallthreetoolstranslatedintoItalian.Staffattheservicereportedthatthetrialhad:• heightenedconsciousnessofQoLandhadinfluencedhowtheythoughtaboutprovidingcare;• encouragedthemtothinkaboutcreatingahomeratherthanapplyingahealthcaremodel;• shiftedthinkingawayfromamedicaldeficitmodel;and• focusedtheirattentiononactivitythatismeaningfulfortheconsumer.Aswasnotedbyonestaffmember“Bytriallingandusingthesequalityoflifetools,staffandconsumershavegainedabetterunderstandingofpeople’sneeds.Goingthroughthisprocessofco-productionmeansit'samoreequitableprocess,andconsumersfeelinvolvedindecisionsbeingmade.Whatwe'vealsofoundusingthistoolisindividualneedsarebeinghighlightedandaddressed,andstaffhaveimprovedtheiremotionalintelligenceinrelationtoconsumerneeds”.InparallelwiththeHubTrial,SaintHilarionalsotrialledtheCommunityWestStepForward–TogetherInitiativewhichfocusedontriallingco-productionwithawellnessandenablementfocus.“Theprocesshashelpedustoseethewholeperson,includingtheiraspirations,andstaffandconsumersfeelmoreconnectedasaresult”.
SAInnovationHubTrialEvaluationReport Page22of52
ExperienceofHubTrialparticipantsandoutcomesachievedAllHubTrialparticipantsacknowledgedthesignificantworkundertaken,andoutcomesachieved,inrelationtoQoL.ThetrialoftheQoLtoolsconductedbytheHubprovidersreturnedthefollowinginformation:• bothsmallandlargeprovidersfoundthetoolseasytouse;• consumersfoundthequestionseasytounderstandand
relevant;and• resultsidentifiedareasforimprovement,and
interventionswereimplementedaccordingly.Oneproviderreportedthatbytestingtoolsattheirdifferentservicesites,theywereabletoundertakeanappreciativeenquirythatenabledthemtocompareresults,andworkmorestrategicallywithprojectstaffonlifestyleprogramsacrossitsservices.Casestudy:ApplicationofQoLmethodologyatJamesBrownMemorialTrustTheQoLmethodologyhasbeenappliedacrossJamesBrownMemorialTrust’soperations,withthePWImeasurementincorporatedintheTrust’sannualsurvey.CIMPACTisbeingusedinresponsetolowerthanbenchmarkPWIoutcomesinaspecificareaasadeepdiveserviceevaluationtooltodriveimprovement.TheoutcomesarebeingusedtoactivelytargetandevaluateprojectsintheTrust’sAnnualCQIPlan.AdoptingtheQoLmethodology,andhavingthetoolstomeasureandtargetQoL,hasinformedthedevelopmentofinnovativemodelsofcareandarangeofdevelopmentprojectstargetingspecificaspectsofQoL.Forexample,specificprojectshavebeenimplementedtoaddress‘achievementinlife’results.TheapplicationoftheFrameworkhasnoticeablyshiftedtheTrust’sstrategyandabilitytoperceiveandtargetQoL.Thedatagatheredwillsupportanalysisofthesetargetedprojects.BasedondiscussionswithHubproviders:• mostprovidersgaveexamplesofhow
theapplicationofbetterpracticemethodologiesdevelopedbytheCoPwasinformingservicedevelopmentanddelivery,andtheoutcomesforconsumers;
• dataarebeingcollectedusingqualityoflifetools,insomecases,forthefirsttime,thatwillenablequantitativeevaluationtotakeplace;
• thequalityoflifemeasurestrialledundertheQoLFrameworkregularlyextendedbeyondaHub
provider’sresidentialcareservicestoalsoincludeitshomecareservices;and• staffatserviceshadtheopportunitytolearnanewwayoflookingatagedcare,inrelationto
carerecipients.Providersreportedthat,insomecases,theresultswereconfrontingandstaffwerechallengedtoshifttheirthinking.
“Themembersoftheworkinggroupcollaboratedandsharedbothknowledgeandresourcestoplan,develop,testandevaluatetheframework.The
collectiveknowledgebaseallowedrapidprogresstowardstheobjectiveofinitiallydeveloping
indicatorsforQualityofLifeandastheprojectdevelopedbuildingaframeworktoenable
providerstoactivelyimproveQualityofLife.” JamesBrownMemorialTrust
“DuringtheperiodoftheHub,individualHubprovidershave
extendedtheirunderstandingoftheuseofmetricsin
understandingthequalityoflifeofconsumerswithintheirservices.Thisisanareaof
increasingfocusrelativetothespecificstandardsthatthecaresystemestablishesovertime.”
ResthavenInc.
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NationalAgedCareQualityIndicatorProgramHubworkontheQoLFrameworkcommencedinadvanceoftheNationalAgedCareQualityIndicatorProgram.However,HubproviderscontributedadviceinrelationtotheNationalProgram.ThevoluntaryNationalProgramwaslaunchedon1January2016andencouragesproviderstocollectinformationandreportagainstthefollowingthreequalityindicators(withthepotentialforindicatorstobefurtherexpandedwithadvicefromanexpertpanelandinconsultationwithindustry):pressureinjuries;useofphysicalrestraint;andunplannedweightloss.
TheNationalProgramwillalsoconsiderexpandingtheinformationavailableaboutQoLlifeintheAustralianagedcaresetting.Consumerexperienceandqualityoflifetoolshavebeenassessedfortheirsuitabilityinresidentialagedcare.Toolsthatwerefoundtobeapplicable,feasibleanduser-friendlyforconsumersandprovidershavebeenpiloted.ThroughtheNationalProgramserviceproviderswillbeabletocomparetheirresultswithanationaldatasetgainedfromtheconsistentapproachtomeasuringqualityoutcomes.PartD–ConsumerengagementContextTheHub’sfocusonconsumerengagementwascloselyconnectedwiththeworkinrelationtogovernanceandproviderparticipationintheHubTrialincludedacommitmenttobothgovernanceandconsumerengagement.IntheinitialstagesoftheimplementationoftheHubTrial,aconsumerengagementstrategywaspreparedbytheQualityAgencyandcirculatedtoHubTrialparticipants.Insummary,thestrategyincluded:• anapproachforHubproviderstodevelopaconsumerengagementstrategy:
- toinvolveconsumersinassessingwhatalreadyworksandwhy,andplanningwhatcould
workbetter;and- todevelopwithconsumers,astrategywithanevaluationplanprovidingperformance
indicatorsforsuccess;
• consumerengagementdrivers(e.g.communityandconsumerexpectations,demandfor‘individualchoice’withinmodelsofcareandqualitypracticesthatbestpromoteQoL,independence,socialandeconomicparticipation);
• abroadframeworkforinitiatingandsustainingconstructiveconsumerrelationships;
• questionstosupportevaluationandmonitoringofthestrategy;and
• informationaboutmechanismsforincreasingconsumerengagement.COTAalsoledaconsumerengagementCoPthatfocusedon:
SAInnovationHubTrialEvaluationReport Page24of52
• providingworkshopsforHubproviders.WorkshopsincludedpresentationsfromCOTAandavisitingexpertfromtheUnitedKingdomspecialisinginpersonalbudgetsandsystemsofself-directedsupport.SomeHubparticipantsalsoworkedwithCOTASAinrelationtoconsumerengagementandcomplaints.COTASAnotedthisworkisongoing,withconsumerworkshops(focusedonimprovingco-design)planned;and
• discussingexamplesoftoolsthatcouldbeusedtoobjectivelymeasurethequalityofconsumerengagement.ThisincludedtheOwlRatingmodel,aninitiativeoftheNRMAinpartnershipwithCOTAandGallup(aglobalresearchcompany)14.
MembersoftheconsumerengagementCoPnotedthattheemphasiswaslargelyonsharinginsightsandinformationaroundmodels,principlesandopportunitiesforimprovedconsumerengagement.ThisCoPalsoconsideredhowaconsumerengagementstrategycouldgiveanorganisation’sBoardvisibilityofthedepth,breadthandmeasureofconsumersatisfactiontobetterinformco-productionmodelsofengagement15.Hubprovidersnotedthatsomeoftheworkthathadbeenplannedinrelationtoconsumerengagementandco-productiondidnotprogressasoriginallyintended,asitwasovertakenbyothereventsandinitiativessuchastheStepForwardTogetherpilot.ThisisajointinitiativeofCommunityWestInc.andCOTA(fundedbythethenDepartmentofSocialServices)tohelpagedcareservicesmovebeyondconsultingtoco-producing16.ThedepartmentalsoreportedthatconsumerengagementwouldalsobeafocusoftheworkdevelopingtheSingleQualityFramework.ExperienceofHubTrialparticipantsandoutcomesachievedWhilesomechangesweremadewithinindividualorganisationstoenhanceconsumerengagementandCDC,thetimingandscopeofthisevaluationdidnotenablemeasurementofoutcomesforconsumers.FeedbackfromHubTrialparticipantswasvariedinrelationtotheconsumerengagementinitiatives:• somefeltthattheconsumerengagementworkoftheHubwasessentiallyanopportunityto
alignandvalidateworkthatproviderswerealreadyundertakinginthisspace;
14OwlRatingsaredisplayedontheLivingWellNavigatorwebsiteandindependentlyrateretirementlivingoptionstohelpconsumerstonavigateretirementlivingandagedcare,includingknowinghowtochoosethebestserviceproviderfromapersonalperspective.
15Thisisanewwayofworkingwithconsumersofagedcareservicestoco-designservicedelivery.Theserviceproviderworkswithconsumersasequalpartnersinthedesignprocesstoensurethattheserviceofferedisrelevanttotheconsumerandmeetstheirneeds.16https://www.communitywest.com.au/explore/exploring-co-design-with-catalyst/step-forward-together-projectviewed30May2016
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• someprovidershadusedtheopportunitypresentedbytheHubtore-visitandimprovetheirconsumerengagementmechanisms;
- Forexample,onelargeprovidernotedthattheyhad,forsometime,hadaconsumerand
carerengagementcommitteebutthecommitteehadnotbeendirectlyfeedingintotheBoard.TheHubhadpromptedthemtoconsiderhowbetterconnectionscouldbemadebetweenconsumers,carersandtheBoard.ChangesweremadesothatrepresentativesfromtheconsumersandcarersengagementcommitteewouldattendtheBoardsub-committeemeetingstoprovidedirectfeedbackinrelationtoconsumeroutcomes.
• anumberofprovidersnotedthecloselinkagesbetweentheworkongovernance,QoL,
complaintsandconsumerengagement.Inparticular,providersnotedthatconsumerengagement(andmeasurementofquality)needstobeattheheartofallagedcareserviceplanninganddelivery,andthisnecessarilyinfluencesthegovernanceofproviderorganisations;and
• anumberofHubTrialparticipantsfeltthattheTrialhighlightedthepotentialformuchdeeper
consumerengagement,co-designandco-productionbetweenprovidersandconsumers.SomenotedthattheyhadhopedthattheHubproviderswouldmakefurtherprogress(beyondtheHubTrial),particularlyaroundco-productionandCDCintheresidentialcarecontext;
- Forexample,someHubprovidersfeltstronglythatCDCinresidentialcarewasanatural
extensionofCDCinhomecare,butitrequiredconsiderationofsomecomplexissuesincludinganyfundingramifications.Tothisend,theCDCinResidentialCareWorkingGroup(whichlatermorphedintoacombinedCDCandconsumerengagementCoP)undertookaSWOTanalysisofasinglecarefundingregime.TheCoPsubsequentlyadvocatedforasingleassessment,approvalandfundingregime(acrossallcaretypes).ThiswasalsorecommendedbytheAgedCareRoadmap,preparedbytheAgedCareSectorCommittee.
PartE–ComplaintshandlingContextAspartofthelightertouchregulationinitiativestrialledthroughtheHub,providersweregiventheopportunitytodemonstratetheeffectivenessoftheircomplaintshandlingmechanisms.ItwasalsointendedthatdecreasedinterventionbytheComplaintsSchemeinprovideroperationswouldreduceregulatoryburden.ThekeyoutcomessoughtbytheComplaintsManagementinitiativewere:
• improvedservicedeliveryoutcomesforconsumersachievedthroughHubprovidershaving
effectiveinternalcomplaintshandling;
• appropriateandresponsivegovernancetorespondtoemergingissuespriortocomplaintsbeingraised;and
• complaintsmechanismsthatareintegratedintotheprovider’soverallqualitysystems.
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InrelationtocomplaintsraisedaboutHubparticipantservicesduringtheHubTrial:
• theSchemecontinuedtoresolvecomplaintsviaearlyresolution,whereverpossibleand
appropriate;
• complaintsthatwouldtypicallybehandledthroughafullSchemeresolutionprocesswerereferredtotheproviderforresolutionwithinanagreedtimeframe(exceptwhereamajororsignificantrisktocarerecipientswasidentified);
• ifthecomplaintposedamajororsignificantrisktoacarerecipient,theproviderneededtosatisfytheSchemethatithadappropriatestrategiesinplacetomitigatetheriskpriortotheSchemereferringthemattertotheproviderforresolution;
• theSchemecoulddecidenottoreferacomplainttotheproviderwherethecomplainanthadraisedconcernsaboutthemattersbeingresolvedbytheprovider;and
• oncetheproviderhadresolvedthecomplaint,orhadexhausteditsefforts,itadvisedtheScheme(nowrittenreportrequired).TheSchemetestedthecomplainant’ssatisfactionthatthecomplaintwasresolvedand,ifsatisfied,closedthecase.Ifthecomplainantwasnotsatisfied,theSchemewouldconsiderwhetherfurtherinvolvementwaswarranted.
WithintheHub,acomplaintsCoPwasformedtodevelopacomplaintsfeedbackframeworkbasedonbestpractice(withprocessesmappedanddocumented)whichcouldbeusedtoguideindustrypractice.Toprogressthiswork,theCoP:
• circulatedaquestionnairetoHubprovidersseekinginformationabouteachproviders’
mechanismsforcollectingandreportingoncomplaintsandcomplaintsdata;and
• undertookareviewofrelevantresourcesrelatingtogoodcomplaintshandlingincludingdocumentspublishedbytheAustralianNationalAuditOffice,theCommonwealthOmbudsman,theSouthAustralianDepartmentofEducationandChildDevelopment,theVictorianHealthServicesReviewCouncil,andthe(then)AgedCareCommissioner.
Followingthecollectionofthisinformation(andrelativelyearlyintheprocess),theComplaintsCoPidentifiedthattherewaslittlevalueincomparingprocessesanddevelopingadetailedproceduralframeworkfordealingwithcomplaints(notingthatprovidershavearangeofdifferentprocesses,butitwastheoutcomesthatmattered).Instead,itwasagreedthattheworkoftheCoPshouldfocusontheprinciplesunderpinningeffectivecomplaintshandlingmechanisms.Drawingonbestpracticemodelsandadvicefromthe(then)AgedCareCommissioner,theComplaintsCoPdevelopedatwo-pagedocumententitledComplaintsManagement–GuidingPrinciples.Thedocumentdetailedfourguidingprinciplesforcomplaintshandlingfocusedon:
• Culture–anopenandlearningorganisationalcultureisfundamentaltoapositiveconsumer
experience.Thisincludesopenness,honestyandacknowledgementwiththewholeprocesscommencingwith,andcentredon,theconsumer’spointofview.
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• People–toensurethatconsumersenjoytheirexperience,providerswillensurethattheirpeopleareeducatedandexperiencedtoberesponsiveandinclusive.Consumersshouldfeelheardandunderstoodastheprovidersworktowardsresolvingconcerns.
• Process–providerswillhaveanopenandtransparentprocessforhandlingcomplaints.Thiswillsupportproviderstoberesponsiveandflexibleastheyresolveproblems.
• Analysis–providerswilllearnandgrowfromconsumers’feedbackbyapplyingwhattheylearntoimprovetheirservicesforthebenefitofothersinthefuture.
TheComplaintsManagement–GuidingPrincipleshasbeenpublishedontheHubwebsite.ExperienceofHubTrialparticipantsandoutcomesachievedAsnotedabove,thereweretwomainHubTrialinitiativesrelatingtocomplaints:
• thedevelopmentofcomplaintsprinciples(developedontheinitiativeofthecomplaintsCoP);
and
• changestothewaythattheComplaintsSchemehandledcomplaintsregardingservicesmanagedbyHubprovidersduringtheperiodofthetrial.
DevelopmentofcomplaintsprinciplesInrelationtothefirst,mostHubprovidersnotedthattheprincipleshadenabledthemtotesttheirownsystemandthat,inmostcases,providersreportedthattheirassessmentoftheircomplaintshandlingprocessesagainsttheprinciplesconfirmedthattheyhadreasonablecomplaintshandlingsystems.SomeHubprovidersnoted:• thevalueofmeetingwiththe(then)AgedCareCommissionerandthefactthatithadshifted
theirfocusfromaprocessorientationtofocusingmoreoncultureandpeopleasbeingcriticalforgoodcomplaintsmanagementandimprovementoftheexperience(andoutcomes)forconsumers;and
• thatthedevelopmentofthecomplaintsprinciplesandthereferralofmorecomplaintstoprovidersforresolutionhad“sharpenedourresponsiveness[inmanagingcomplaints]”.
OneprovideralsonotedthatthecomplaintsprinciplesdevelopedthroughtheCoPhadbeenintegratedintotheirstafftrainingprogram,andgeneratedagreaterfocusonthecreationofacustomerserviceculture.ChangestothehandlingofcomplaintsmadethroughtheComplaintsSchemeThereweremixedresponsesfromHubprovidersinrelationtothechangestotheComplaintsSchemeaspartoftheHubTrial.Mostprovidersconsideredthattherehadbeenalackofclarity
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regardingthechangestotheComplaintsScheme’sarrangementsfordealingwithcomplaintsrelatingtoHubservices.Someexpressedconcernthattherehadnotbeenagreaterreductionintheregulatoryburdenassociatedwithcomplaintsrequirements,andthattheComplaintsSchemehadcontinuedtodealwithsomecomplaints(whereastheexpectationofsomeHubprovidershadbeenthatproviderswoulddealwithallcomplaintsinthefirstinstance).Likewise,ComplaintsSchemestaffacknowledgedthatnotallprovidersorallcomplaintsofficershadconsistentlyunderstoodthecircumstancesinwhichmatterswould,andwouldnot,bereferredforresolutionbyHubproviders.Someoftheuncertaintyaroundtheagreedprocesses,mayhavecontributedtotheearlycommunicationsissues.ConsultationwiththecurrentAgedCareComplaintsCommissionerandotherHubmembersindicatedthat:• thenumberofcomplaintsresolvedatearlyresolutiondecreasedduringthecourseofthetrial;
- Consistentwiththechangesmadethroughthecomplaintsinitiative,thisdecreasemaybe
explainedduetoanincreaseincomplaintsbeingreferredforproviderresolution(asopposedtobeingaddressedbytheComplaintsSchemethroughearlyresolution).
• overathirdoftheHubprovidercomplaintshandledthroughearlyresolutiontookmorethan22
daystoresolve(whichwasslightlyhigherthanthestateaverageforthesameperiod);- Theextendedtimeframesforresolutionmayrelatetoaninitiallackofclarityregardingthe
roleoftheComplaintsSchemecomparedtothatoftheHubproviders.• 13ofthe44complaintsreceivedwithrespecttoHubprovidersduringtheperiodoftheHub
TrialwereresolvedbyComplaintsSchemeinvestigationratherthanearlyresolutionorapprovedproviderresolution.Themainreasonsthatmatterswerenotreferredtoprovidersforresolution(orwerereferredbacktotheComplaintsSchemeafteraproviderresolutionprocess)were:
- somecasescommencedbeforetheHubTrialandrequiredfurtherclarificationfollowing
traditionalresolutionprocesses;- insomecases,complainantsweredissatisfiedwiththeprovider’sprocessandsoughtthe
involvementoftheComplaintsScheme.COTAalsonotedthatsomeconsumershadexpressedconcernthat,bybeinginvolvedwithHubproviders,theyfeltthattheyhadlosttheiropportunitytoseekresolutionoftheircomplaintsbyanindependentparty;
- thecomplainant’sdissatisfactionwiththeoutcomesachievedbytheproviderthroughproviderresolution;or
- thecomplainantnotagreeingtobeinvolvedinaHubresolutionprocess.Hubmemberfeedbackonthisinitiativesuggeststhatproviderresolutioncanbeeffectivewhenusedintherightcircumstances.Itdoes,however,dependonthewillingnessofthecomplainanttobeinvolvedandtheprovider’sprocesses,experienceandreadinesstoresolvecomplaints.InsomecircumstancestheindependentinputoftheComplaintsScheme(nowtheAgedCareComplaintsCommissioner)isnecessarytoresolveissues,includingwheretheremayberiskstocarerecipientsorwherethecomplainantortheproviderseekstheinvolvementofanindependentperson.
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InparallelwiththeHubTrialcomplaintsinitiative,changeswerealsomadetotheComplaintsScheme,withresponsibilityfortheresolutionofallcomplaintsbeingtransferredtotheAgedCareComplaintsCommissionerfrom1January2016.DiscussionswiththeAgedCareComplaintsCommissionerconfirmedthat:• oneoftheprioritiesoftheAgedCareComplaintsCommissioneristoresolvecomplaintsas
quicklyaspossibleintheinterestsofthecarerecipient.TheAgedCareComplaintsCommissioneralsoacknowledgesandsupportstheimportanceofmaintainingstrongrelationshipsbetweenproviders,consumersandtheirfamiliesandworkingtoempowerbothconsumersandserviceproviderstodealwithmostconcernsdirectlythemselves;and
• theAgedCareComplaintsCommissionerwillcontinuetopromotethebenefitsofresolutionattheproviderlevelforbothcarerecipientsandtheprovider.TheAgedCareComplaintsCommissionerhasadvisedthatshealsointendstocontinuetotakeaproportionateapproachtocomplaintsmanagement,basedonrisk,andlimittheburdenonbothprovidersandcomplainantstoresolveissues.
PartF–FinancialreportingContextAspartoftheHubTrial(andasidentifiedintheSAInnovationHubFramework),theACFAconsultedwithHubTrialparticipantsonreforms(flaggedforpossibleimplementationin2014-2015)toreduceredtapeinproviderfinancialreporting.Aspartoftheconsultation,theACFAbriefedHubparticipantsonrecommendationsithadmadetogovernmentonoptionstoimprovethecollectionoffinancialdatafromagedcareproviders,includingoptionstorationalisefinancialreporting.Inthereportprovidedtogovernment,Improvingthecollectionoffinancialdatafromagedcareproviders(September2014),theACFArecommended:
• theadoptionofasingleComprehensiveFinancialReport(CFR)toreplacetheexistingGPFR,the
AnnualPrudentialComplianceStatement(APCS)andSurveyofAgedCareHomes(SACH)forresidentialagedcare,andtheexistingfinancialreport(FAR)forhomecare;
• thatoncetheCFRwasinplaceandtheminimumdatasetwasagreed,theadoptionofStandardBusinessReporting(SBR)asthemechanismfortransferringdatabetweenprovidersandthedepartment;
• collectionofincomeandexpenditureinformationatthefacilityorservicelevel;and
• wherefinancialdataoutsideoftheminimumdatasetneedstobecollected,thiswillbecollectedusingarepresentativesampleofprovidersratherthanthecurrentCensuscollection(100percentofproviders)approach.
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AshortdiscussionpaperwasdevelopedbyHubprovidersinNovember2014providingcommentsontheACFArecommendations.Thedepartmentthenissuedadiscussionpaper,includingadraftformCFR,andsoughtcommentsbyFebruary2015.ItwasproposedthattheCFRwouldreplacethecurrentannualobligationsfor:aGPFR;APCS,FARandSACH.Hubparticipantswereinvitedtomakesubmissionstothedepartment,alongwithallotherproviders.ExperienceofHubTrialparticipantsandoutcomesachievedIndiscussionswithHubproviders,anumberofprovidersexpresseddisappointmentthattheyhadnotbeenmorecloselyinvolvedinthedevelopmentandtriallingoftheCFR.IndiscussionswithACFAandthedepartment,however,bothacknowledgedthatconsultationontheCFRneededtobesignificantlywiderthantheHub(i.e.withadiverserangeofprovidersacrossAustralia)andthatthetrialoftheCFRwasopentoallprovidersincludingHubproviders.HubprovidersalsonotedthatatthecommencementoftheHubtheyhadhopedthattherewouldbemoresharingoffinancialinformation(withintheHub)includingdiscussionsaboutthebestwaytoimprovefinancialaccountabilityandreporting,butoutcomeswerenotachievedinthisparticulararea.Onreflection,Hubprovidersnotedthatthiswasanambitiousagendaandthatitmayhavebeenunrealistictoexpectproviderstosharedetailedfinancialinformation,particularlyearlyintheHubTrial,beforetrusthadbuilt.SomeHubTrialparticipantsconsideredthatthetrustamongstparticipantswassufficientlydevelopedthatthisworkcouldnowproceed,butotherscontinuedtonotethattherewouldbelimitsontheextenttowhichproviderswouldbecomfortablesharinghighlyconfidentialandcommerciallysensitiveinformationwithothers.HubprovidersacknowledgedthatthiswasavaluablelearningintermsofareasthatarechallengingtodiscussopenlythroughaCoPmodel.PartG–ExtendedaccreditationContextOneelementofearnedautonomytrialledthroughtheHubwaslessfrequentauditsandastreamlinedapproachtoassessmentoftheAccreditationStandardsbytheQualityAgency.AsdescribedintheSouthAustraliaInnovationHubFramework,theHubtrialledthreeinitiativesrelatingtoaccreditation:• anextendedaccreditationperiodofuptofiveyears(describedinmoredetailbelow);• astreamlinedaccreditationprocessforcorporate-levelassessmentofStandard1;and• reducedduplicationofassessmentacrosstheAccreditationStandards.ThepurposeoftheinitiativewastofacilitategreaterautonomyofHubprovidersinmanagingtheirservicesandensuringthathighstandardsofcareandservicesaremaintained.Thedesiredoutcomesoftheinitiativeincluded:
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• thatqualityofcareismaintained(throughcontinuedcompliancewiththeAccreditationStandardsandcontinuousimprovement);and
• reducedgovernmentinterventioninprovideroperationsandthereforedecreasedregulatoryburden.
Otherfeaturesofaccreditationinitiativeincluded:• thattheQualityAgencywouldconductanunannouncedvisitatleastonceayearforeach
service;• thatHubproviderswouldimplementconsumerengagementstrategiestomeetconsumer
expectationsoftransparencyandaccountabilityforqualityofcare;• corporate-levelassessment(inrelationtohowtheprovideraddressedexpectedoutcomesin
Standard1)wouldinvolveconsultationwiththeproviderastoanychangesmadesincethelastassessment.Anyassessmentattheservicelevelwouldseektovalidatetheapplicationofthecorporatepoliciesandprocesses;and
• whenundertakingasiteauditorreviewaudit,theQualityAgencywouldconductassessmentagainstanyexpectedoutcomesthatareduplicatedacrosstheAccreditationStandardsasthoughtheywereconsolidated.
Newprocesseswerealsotrialledinrelationtoproviderself-assessmentagainstStandard1(Managementsystems,staffingandorganisationaldevelopment),withoutcomesgiventoQualityAgencyassessorstodemonstrateimpactattheservicelevel.IntheearlystagesoftheHubTrialanaccreditationsub-groupwasformedtoshareandreflectonaccreditationexperiences.However,inMarch2015,theHubprovidersdecideditwasappropriatefortheaccreditationsub-grouptomergewiththeCQICoPgiventherelatednatureoftheworkthatthetwogroupswereundertaking.ThemajorityofHubprovidersreportedanincreasedfocusonqualityoutcomesduringtheHubTrial.DifferentmodelsforensuringCQIwereadoptedbyHubproviders.SomeleveragedofftherelationshipsthattheyhadformedintheHubandestablishedaprocessofpeerreview(includingforreviewofhomecareservices).AnotherproviderdescribedhowitvoluntarilyappliedtheQualityImprovementCouncil(QIC)HealthandCommunityStandardsinitsorganisationasawaytofocuscontinuousimprovementandidentifyqualityimprovementpriorities.Anotherprovidernotedthattheywereintendingtoinviteanexternalevaluatortoreviewtheirservices.Casestudy:BarossaVillageandBoandikLodgeHomeCarePeerReview
InMarch2016,theGeneralManager(HomeCareServices)andQualityCoordinatorofBarossaVillageattendedBoandikLodgeinMountGambiertoworkwithBoandikLodge’sCommunityCareTeamonapeerreviewoftheHomeCareStandards.
ThepeerreviewwasaprocessinwhichcolleaguesintheagedcareindustrycouldprovidefeedbackonBoandikLodge’sperformanceagainsttheHomeCareStandards.ThepeerreviewwasanopportunityforBoandikLodgetogainanindependentopiniononitspreparednessforitsupcomingmid-yearqualityreviewsitevisitbytheQualityAgency.
Thevisitalsoenabledtheorganisationstoshareinformationandsuggestionsastocontinuousimprovementofservicesandprocesses.Forexample,duringthevisitBarossaVillageprovidedsamplesoftheirconsumers’individualisedperson-centredcareplans.TheseplanshavesinceinformedBoandikLodge’sapproachtocareplanpresentation.The
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organisationshavealsosharedsampleassessmentformsandapproachestoconsumerassessment,sothatimprovementsinthisareacanbeconsidered.
Thepeerreviewthathasnowbeenestablishedbetweentheorganisationswillcontinue.LaterintheyearrepresentativesfromBoandikLodgecommunitycareteamwillvisitBarossaVillagetoundertakeapeerreviewinadvanceofitsreviewbytheQualityAgency.ExperienceofHubTrialparticipantsandoutcomesachievedBasedondiscussionswithHubproviders,mostreportedthattheincreasedaccreditationperiodwasthemostobviousadvantageresultingfromearnedautonomy.Hubprovidersdescribedthevariousimpactsofextendedaccreditationattheirservicestoinclude:• theheightenedsenseofresponsibilitytoensurethatstandardscontinuedtobemetthrough
theextendedaccreditationcycle;• theimportanceofnot‘restingontheirlaurels’andtomaintainthefocusonqualityoutcomes;• theriskofreputationaldamageifcompliancewiththestandardswasinquestion,particularly
havingbeenaccreditedforfiveyears;and• thebroaderresponsibilitytodemonstratethepositiveeffectsofanextendedaccreditation
periodsothattheinitiativehadthepotentialtobenefitprovidersoutsidetheHub.AnumberofHubprovidersadvisedthat,basedonaccreditationprocessescarriedoutinearly2015,streamlininghadnotbeenevidenced,andthenewcorporate-levelassessmenthadeitherresultedinnosignificantchange,orhadinfactincreasedthetimecommitment.BasedondiscussionswithHubTrialparticipants,theaccreditationinitiativewasbeneficialinthatitopeneduppathwaysforpeerreviewandencouragedorganisationstoinvestinCQIsystemstoensurethatthestandardscontinuedtobemetthroughoutanextendedaccreditationperiod.SomeoftheconceptstestedduringtheHubTrialregardingaccreditationarealsobeingprogressednationally,includingthedepartment’scurrentworkwiththesectortoco-designaSingleQualityFrameworkthatwillbebasedonproportionate,targetedregulation.PartH–ReducedACFIauditsContextThepurposeoftheinitiativewastofacilitategreaterautonomyofproviderswithrespecttoACFIreviewswhilemitigatingCommonwealthbudgetaryrisk.
Aspartoftheinitiative,Hubproviderswouldbeguaranteedasix-monthperiodbeforeanACFIreviewwasundertakenataHubserviceunlessareviewinthepreviousthreeyearshadidentifiedconcernswiththeaccuracyofclaiming.Thereviewswouldalsobelimitedto10%ofconsumers.Itwasagreedthatafterthefirstsixmonths,reviewscouldbeundertakenbythedepartment,butagainlimitedto10%andnomorefrequentlythansixmonthly(unlessconcernswereidentified).Itwasalsoagreedthatthedepartmentcouldundertakemorefrequentreviewsandcomplianceaction,inlinewithnormalpractices,ifconcernswereidentified.
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ExperienceofHubTrialparticipantsandoutcomesachievedWhentheinitiativewasfirstimplementeditwasanticipatedthatanyevaluationwouldconsider:
• whethertherehadbeenachangeinCommonwealthbudgetaryrisk(basedonanassessmentof
claimingactivity);and• costsavingstoHubprovidersduetoreducedregulatoryburden.ChangesinCommonwealthbudgetaryriskAspartoftheevaluation,mpconsultingwasprovidedwithdataontheoutcomesofACFIreviewsofHubproviders.Giventheconfidentialnatureofthesereviews(andthereviewoutcomes),thisreportcannotdescribethereviewoutcomesonaprovider-by-providerbasis.However,thedepartmentadvisedthattherateofinaccurateclaimingforHubproviderswasnotmateriallydifferenttoprovidersnationally.ToimprovethenationalaccuracyofACFIclaimingandstrengthencompliance,thegovernmentannouncedanumberofmeasuresaimedatprotectingtheintegrityofACFI.CostsavingstoHubprovidersHubprovidersdidnotcollectinformationaboutthecostsavingsassociatedwithindividualmeasuresthatformedpartoftheHubTrial.SomeprovidersnotedthatduringtheHubTrialtherehadbeenastreamliningofACFIprocessesorreducedACFIreviews;othersdidnotidentifyasignificantdecreaseineffort.ThismaybereflectiveoftheshortperiodoftheHubTrialandthefactthatthenatureoftargeted,risk-basedACFIauditsmeansthatnotallHubservicesweresubjecttoanACFIauditduringtheperiodoftheTrial.ThedepartmentadvisedthattheHubinitiativehasassistedthedepartmenttorefineitsACFIreviewapproachtoensurethatitistailoredandflexibleinanongoingefforttoreducetheadministrativeburdenforapprovedprovidersfoundtohavebeenclaimingaccurately.Thismayinvolvefewerfuturereviewsforaresidentialagedcareservicewhereitisconsideredtobeatlowerriskofsubmittinginaccurateclaims.However,wherethereisevidencethatapprovedprovidershavenotmadetheirclaimsappropriately,thedepartmenthasadvisedthatitwillcontinuetotakeactiontocorrecttheclaimoraddressthenon-compliance.PartI–CentreforLeadershipandExcellenceinAgeingContextThroughtheirengagementintheHub(and,inparticular,theworkundertakeninrelationtogovernanceandQoL),Hubprovidersidentifiedthattherewaspotentialtodevelopandenhanceleadershipintheagedcaresector.ACoPwasthereforeformedlateintheHubTrialperiod,attheinitiativeofHubproviders,todevelopideasaround:• leadershipandworkforce;
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• buildingthecapacityofpeoplewhoareabletoleadagedcarebusinessesandtoconfrontstrategicchallengesintheagedcaresector;and
• theestablishmentofaleadershipcentrewhichcouldoperateindependentlyoftheHub.Toprogressthiswork,Hubproviderssummarisedtheirorganisations’currentapproachtoleadershiptraining,undertookaneedsanalysisandidentifiedprioritiesforagedcareeducation.HubprovidersalsocompletedabriefsurveytoidentifyforeachoftheHuborganisations:• thetopthreetofiveareasofinterestinthecontextofpositioningtheorganisationsforgrowth
inacomplexandrapidlychangingenvironment(forexample,consumerengagement,leadership,changemanagementandworkforcedevelopment);
• thetypesofprogramsthattheorganisationwouldbenefitfrom(forexample,peermentoring,leadershipdevelopmentprograms,mentoringandcoaching);and
• thegroupsofpeopleinanorganisationwhowouldbenefitfromanagedcareacademyconcept.Followingtheresultsofthesurvey,andcommencinginMay2015,theCentreforLeadershipandExcellenceinAgeing(CLEA)CoPhas:• determinedthescopeofworkandtheadvantagesandopportunitiesforaCoPsuchastheHub;
• discussedlocalandinternationalmodels,examplesandprogramgoals,andpotentialpartners
(suchasTAFE,universities);• workedwithalocallybasedleadershipconsultant;and
• engagedwithProfessorJulienneMeyer,ExecutiveDirectorofMyHomeLife(aUK-wide
initiativetopromoteQoLforthoseliving,dying,visitingandworkingincarehomesforolderpeople)andProfessorofNursingCareforOlderAdultatCityUniversity,Londontodrawoninternationalmodelsandlearnings,andtodiscusshowtheHubcouldcollaboratewithMyHomeLife.
ExperienceofHubTrialparticipantsandoutcomesachievedTheCLEAconcepthascontinuedtoevolvebeyondtheperiodoftheHubTrialtothepointthataDraftBusinessPlanwasproducedinMarch2016.TheCLEADraftBusinessPlanincludesthegoals,values,strategicdirectionofCLEA,andkeyprioritiesforthefirstthreeyears.Atthetimeofthisevaluation,HubprovidersacknowledgedthatCLEAwasstilldevelopingasaconceptandthatfinaldecisionshadnotyetbeenmaderegardingthefocus,structureandmembershipofCLEA.MostprovidersagreedthatthepotentialvalueofCLEAwasthatitprovidedleadershipsupportbutwithafocusonagedcare,ratherthanbeingagenericleadershipcourse.ProvidersalsoreferencedtheappliednatureoftheCLEAapproachasapointofdifferencecomparedtomanyotherleadershipdevelopmentsolutions.
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Chapter4–SummaryofoutcomesandlearningsPartA–CommunitiesofPracticeasamodelforcollaborationAsdescribedinChapter1,theHubTrialwasbasedontheCoPmodelofcollaborationandsharedlearning.Adoptingthismodelprovedparticularlyvaluableinenablingproviderstoleverageoffexistingcapability,experienceandthediversityofHubmembership.CriticalsuccessfactorsforaCoPAspartoftheevaluation,mpconsultinghasbeenaskedtoidentifysomeofthecriticalsuccessfactorsforaCoPthatmayberelevanttoothersseekingtoestablishCoPs.Basedonmpconsulting’sanalysisandthefeedbackfromHubTrialparticipants,criticalsuccessfactorsforaCoPmodelofengagementincludethefollowing.• AnappropriatelysizedCoP.
- Membershiphastobeconducivetogenuineengagementandthereforehasanaturallimit.- AsnotedbyoneHubTrialparticipant,“Thislooselyequatestohowmanypeoplecansit
aroundatableandcontribute”.
• Strikingabalancebetweendiversityofmembershipandcommonpurposeandvision.- AcriticalsuccessfactorfortheHubwashavingrepresentationfromsmallerandlarger
organisations,regionalprovidersandurbanprovidersandprovidersfocusingontheneedsofdifferentconsumers(culturallyandlinguisticallydiverseconsumers,consumerswithdementiaetc.).
- DiversitymeantthatthediscussionswithintheHubwerebroad(informedbydifferentperspectives)andthematerialsproducedbytheHubwererelevanttoawiderangeofproviders.
- WorkingwithawiderangeofprovidershelpedHubTrialparticipantstothinkaboutthingsdifferentlyandavoidassumingthatthewaytheycurrentlyoperatedwastheonlyway(oreventheoptimalway).
- HubprovidersconsistentlynotedthattheHubcouldnothaveworkedunlessallprovidershadacommonsetofvalues.Someofthesharedvaluesincludedthedesirefor:astrongnot-for-profitsector;equityofaccess;andanimprovedfocusonQoLforconsumers.
- Thesecommonvaluesmeantthatprovidersweremorewillingtohelpeachotherandshareresources(whichwascriticaltotheoperationoftheHub).AnumberofHubprovidersqueriedwhethertheHubcouldhaveoperatedinthesamewayifprivateproviderscontinuedtobeinvolvedintheHub(asdiscussedinmoredetailbelow).
• ExecutiveandBoardcommitmenttotheCoP.
- EachoftheHubprovidersnotedtheimportanceoftheirExecutiveteamsandBoardhavingacommitmenttotheHubandtheirCEO’sbeingrepresentedontheHubWorkingGroup.
- ThismeantthatadequateresourceswerededicatedtotheHubandthattherewassupportfortriallingnewinitiativesastheywereidentifiedthroughtheHub.
- SomeHubprovidersalsoemphasisedtheimportanceofagoodinsidechampiontocommunicateandnegotiatechangeswithintheorganisation.
TheSAInnovationHub:ACommunityofPracticeinaction
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• Willingnesstodedicatesignificanttimeand
resources.- AllHubTrialparticipantsreportedthesignificant
timeandeffortdedicatedtoHubinitiatives.WhileallHubprovidersconsideredthattheinvestmentwasworthit,theyallacknowledgedthatunlesstheBoardandExecutiveoftheorganisationhadcommittedtotheHubandsawbenefitandvalueintheCoP,itwouldnothavecontinued.
- Thecapacityforseniorstafftoinvestasignificantamountoftimeawayfromtheday-to-dayneedsoftheorganisationisalsoseenasacriticalsuccessfactor.
• Trustbetweenmembers.
- Trustiscriticalforinformationsharing,butittakestimeandefforttobuild.- AllHubprovidersexpressedadegreeofsurpriseandsatisfactionaboutthelevelofsharing
thatwasactuallypossible,oncetrusthadbeenestablished.- Hubprovidersalsonotedthattherearealwayslikelytobeboundariesintermsofthe
informationthatcompetitorsarewillingtoshare.ThiswasevidencedwiththeearlyworkoftheHubrelatingtofinancialreporting.AsnotedinChapter3,thisinitiativedidnotprogressasintendedpartlyduetoareluctancebyproviderstosharehighlysensitivecommercialinformationearlyintheHubTrialandbeforetrusthadbeenfullyestablished.
- ACoPneedstobeanenvironmentinwhichitissafetoexploreideas,talkaboutmistakesanddifferentwaysofdoingthingsandcontinuetolearn.
• Authenticengagementandwillingnesstoshare.- MembersofaCoPhavetobewillingtoengageandtheremustbeclearrulesof
engagement.HubprovidersidentifiedthatinrelationtotheHub,“successwasduetoeveryonehavingavoiceandtheircontributionbeingconsideredanddiscussed…Everypersonhadtheopportunitytocontributeandwasencouragedtocontribute”17.
• Capacitytodrawontheexpertise,experience
andpassionofawiderangeofstaffwithintheorganisationsrepresentedintheHub.- Bycombiningexperienceandevidenceof
bestpractice,theHubprovidedsignificantopportunitiesforproviderstobuildexpertise
• Establishmentofsubject-specificCoPsto
pursueparticularinitiatives.- TheHubitselfoperatedasaCoP,butitalso
createdanumberofworkinggroupsor
17BoandikLodge,responsetoquestionnaire
“Thecommunityofpracticeapproachtakenallowedsharingofexistingknowledgeandalsoamuchmoreeffectivecollaborativeapproachtoresearchingandidentifyingnew
solutions.Thisapproachhasallowedverysignificantadvancesinashort
periodoftime,anoutcomeunachievableforanyindividualparticipantprovider.”
JamesBrownMemorialTrust
“TheexperienceoftheHubmembersworkingtogetherhasreinforcedtheideathatagroupoflike-mindedproviderswithsimilargoalsand
aspirationsaroundachievingbetteroutcomesforconsumerscan
overcomeperceivedboundariessuchascompetition,intellectualproperty
anddatasharing.”ACHGroup
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smallerCoPstoprogressparticularinitiatives.- Ingeneral,thefocusofthesubject-specificCoPswasagreedbytheHubWorkingGroupand
membershipwasself-directedbasedontheinterestofstaffoftheHubproviders.Thekeytothesuccessofthesesubject-specificCoPsincluded:o Theinvolvementofabroadrangeofindividualswithintheorganisation.Thisminimised
theriskof‘burnout’orlackofcapacitybyasmallnumberofindividuals(includingthoserepresentedontheHubWorkingGroup).
o Thecapacitytodrawonexternalresearchandexpertise.Eachofthesubject-specificCoPsinformedtheirworkthroughreviewofresearchandevidenceandbyinvolvingexpertswherenecessary.Thisprovidedanevidencebasefortheinitiativesandhelpedbuildsupportfortheiradoption.
• Anadaptable,flexibleandresponsiveapproach.
- ThroughouttheHubTrial,CoPmembersrevisitedtheroleofthesubject-specificCoPstodeterminewhatwasachievable,andmostvaluabletoallparticipants.ThismeantthattheinitiativesandprioritiesoftheCoPschanged.
- Fromthedepartment’sperspective,akeybenefitoftheHubwasitsabilitytoevolveandshiftfocusinresponsetochangesingovernmentpolicyandinitiatives.Forexample,thefocuswithintheHubTrialshiftedinresponsetothedepartmentwishingtopursueissuesandinitiativesraisedthroughtheHubonanationalbasis(e.g.todevelopaSingleQualityFrameworkforagedcare).Whilethesereformswerepursuednationally,theHubTrialplayedasignificantroleindrawingthedepartment’sattentiontotheimplicationsoftheissues.
• Effectivegovernanceandprojectsupport.
- TheHubbenefitedfrom:strongleadership;regular,focusedmeetings;thecloseinvolvementofgovernment,particularlyintheinitialstagesofimplementationwhendeterminingdirection,focusandoutcomes;andastrongprojectofficertosupporttheworkoftheHub.Theprojectofficerwasresponsibleforawiderangeofactivitythatincludedresearch,developmentofpapersandsuggestionsforstrategicdirection.ManyoftheHubmembersnotedthattheassistanceoftheprojectofficerwasacriticalsuccessfactorfortheHub,enablingactionstobeprogressedinatimelyandeffectivewayandmitigatingtheriskofalossofmomentumparticularlybetweenmeetings.
• Geographicalproximityofmembers.
- WhileprovidersacknowledgedthataCoPcouldoperateeffectivelydespitemembersnotbeingphysicallyproximate,itwasalsofeltthatbeingabletomeetregularlyface-to-facewasintegraltobuildingrelationshipsandtrust(particularlyearlyinthelifeoftheCoP)andtofacilitatingsharedideasandlearnings.
- Oneprovideralsonotedthatasharedgeographycreatedcommonalityoflanguageandpurposetohaveprovidersinvestedinthesuccessofthesameregion.
Overall,theCoPmodelofengagementwashighlysuccessfulinsupportingHubTrialparticipantstoprogressinitiatives,share
“TheCoPwasanintegralpartoftheprojectmethodologyandinvolvedafocusonsharedlearningandcapacitybuildingaswellasproductionoftheprojectdeliverables.”
AustralianAgedCareQualityAgency
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learnings,testideas,buildtrustedrelationshipsandachieveoutcomes.Importantly,themodelwasnotdependentontheearnedautonomyinitiatives,andisamodelofcollaborationthatcouldbeappliedbyotherprovidersseekingtobuildcapabilityandinnovatecollectively.RiskfactorsforaCoPHubprovidersalsoidentifiedsomeoftherisksinherentinaCoPmodelincluding:• theriskofchangestokeypersonnel;• thechallengeofcommunicationbetweenmeetings;• schedulingmeetingsduringpeakperiodsofactivityacrossthesectorandforindividual
organisations;• thefactthatprovidersarenotalwaysstartingfromthesamepointandmaynotalways‘beas
one’intermsofprioritiesoroutcomessought;and• thedifferingfinancialandresourcecapacityofproviders.
PartB–AchievementofHubTrialobjectivesandaimsAsnotedinChapter1,theobjectiveoftheHubwasto:
…improveandsustainbetteroutcomesforolderAustraliansengagedwithagedcareservices.ThiswillbeachievedthroughdevelopinganearnedautonomyapproachforagedcareinsupportoftheGovernment’sderegulationandsocialpolicies…thataimsto:• Encourageproviderstopursuebetterpracticeinconsumerengagementandgovernance
andimproveservicedeliveryoutcomesforconsumers.• Supportanexpansionininnovativemodelsofcareandservicesinlinewiththeincreasing
demandsofanageingpopulation.• FacilitateamoretargetedapproachtoGovernmentregulatoryactivitiestofocusthemon
wheretheyareneededwhilstmaintainingsafeguardsforconsumers.• Provideopportunityformutualsharing,learningandinnovationamongHubmembersand
partners.While12monthsisnotasufficientperiodtoeffectivelyevaluatewhethertherehavebeensustainedbetteroutcomesforolderAustraliansasaresultoftheHubTrial,therehavebeenachievementsagainsteachofthemainaimsoftheHubTrial.Someoftheseachievementshavebeenabletobeindependentlyverifiedbympconsultingandothershavenot.Forexample,HubprovidersreportedthatoneofthebenefitsoftheHubTrialwasthedevelopmentofstaffcapabilityinareascriticaltoimprovingqualityoflifeforconsumers.Thiscannotbeindependentlyverifiedwithinthescopeofthisevaluation.ThisPartthereforesummarisesthekeyoutcomesoftheHubTrialbasedonmpconsulting’sanalysisofthedocuments,anddiscussionswithHubTrialparticipants,includingself-reportingofbenefitsandoutcomes.
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Aim1:BetterpracticeconsumerengagementandgovernanceTheHubTrialaimedtoimprovegovernanceandconsumerengagementandtopositivelyinfluenceservicedeliveryoutcomesforconsumers.Basedonouranalysis,thethreemainwaysthattheHubTrialachievedoutcomesinrelationtoconsumerengagementandgovernancewere:• improvedproviderunderstandingandappreciationofqualityoflife;• strengtheningofgovernance(includingBoardcapacity);and• developmentofBoardandstaffcapability.Qualityoflife• Forthefirsttime,anumberofprovidersparticipatingintheHubTrialhaveadoptedtoolsfor
measuringqualityoflife,amechanismforexploringareasofconcerninmoredetail(revealedthroughthetoplinetools)andapathwayformakingimprovements.
• Thiswaspossible,inpart,throughahighlyeffectiveCoP.FivefeaturesofahighlyeffectiveCoPprocessinclude:usinganevidencebase;sharedlearnings;consideringthebroadercontext;actionlearning;flexibility;andanoutcomesfocus.ThedevelopmentoftheQoLframeworkreflectseachofthesefeature.
- Evidence–Theframeworkwasinformedby
researchandevidence(includingexternaladvicewhereneeded).- Sharedlearnings–ProviderssharedexperiencesandresourceswithothersabouttheQoL
frameworkstheyhadimplemented.- Considerationofbroadercontext–Considerationwasgiventorelatedgovernment
initiativesincludingthequalitytoolsbeingtrialledbythedepartment(throughKPMG)andaconsciousdecisionwasmadetopursuealternativeindicatorsthatfocusmoredirectlyonwellbeing,QoLandsatisfaction.
- Actionlearning–Theframeworkwastrialledbyanumberofprovidersbeforebeingimplemented.Resultofthetrialswereanalysedandadaptationsmade,beforetheframeworkwasappliedmorebroadly.
- Flexibilityenablingwideapplication–Eachproviderwasabletoselectwhichtoolstousebasedontheircircumstance.TheCoPworkedtoensurethattheframeworkhadvalueforallprovidersfromsmallsinglelocationprovidersthroughtolargeproviderswiththeresourcestoimplementsignificantqualityimprovementinitiatives.
- Outcomesfocus–Eachprovideridentifiedareaswhereimprovementscouldbemadeandimplementedchangesincluding:stafftraining;careplanning;lifegoalsettingforresidents;andintroductionofnewactivitiesthatweremeaningfultoindividualconsumers.Toenablebenchmarking,someHubprovidershavealsocommencedsharingindicatoroutcomeswitheachother.
“Ourclientshavebenefitedthroughmoreeffectivegovernance,focusonqualityoflife,reviewofcomplaintsprocesses,researchintoconsumerdirectedresidentialcare,sharingof
resourcesandinformation.” BoandikLodge
“TheinvolvementintheHubassistedResthaven’sstafftoembraceandbechallengedbyanimprovedconsumerfocus
nowandinthefuture.” ResthavenInc.
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• EventhoseprovidersthatalreadyhadsystemsinplacetomeasureQoL,reportedthatthey
benefitedfromparticipationintheHubandtheworkoftheCoP.Forexample,oneprovidernotedthatpriortotheirinvolvementintheCoP,theirfeedbackandengagementprocesshadbeenlimitedtoa‘satisfaction’styleaudit.DrawingontheworkoftheCoP,theproviderhadremodelledtheirapproachtoincorporateanappreciativeinquirybasedformatfocusingonQoL.
StrengthenedgovernanceAllprovidersreportedthatasignificantachievementoftheHubwas:• thebetterengagementofBoardmembersonissuesofgovernanceandstrategicagedcare
priorities(includingCDCandQoL);
• theincreasedfocusofBoardsongoodgovernancewithflow-througheffectstotherestoftheorganisation;and
• thestrengtheningofBoardcapacity.EachproviderhasadifferentBoardstructureanddifferentgovernancearrangements.However,eachproviderinterviewednotedthatchangeshadbeenmadeattheBoardlevelasaresultoftheHub(referChapter3).DevelopmentofBoardandstaffcapabilityHubprovidersconsistentlynotedthatoneofthebenefitsoftheHubwasthedevelopmentofitsBoardandworkforce.InadditiontostrengthenedgovernanceandBoardcapacity,providersnotedthat:• staffgreatlybenefitedfrombeinginvolved
inCoPs,leadingworkareasofinterestandexperienceandbeingexposedtonewideasthroughregulardiscussionswithstaffofotherproviders;
• membershipoftheHub(andthevariousinitiatives)promptedanumberofstafftoundertakefurtherprofessionaldevelopmentandtraining.Forexample,completionoftheAICDDirectorsCourseandcompletionoftraininginrelationtoQoLandcontinuousimprovementtools;
• theHubbroughtCEO-levelattentiontothetopicsbeingexploredthroughtheHubinitiativesandencouragedadeparturefromthe‘that'sjustthewaywedothings’mentalitywithinorganisations.Asonestaffmembernoted“TheHubhasreallymademethinkatamuchmorestrategiclevelratherthanintheday-to-daydetail.”
“Ihaveobservedgrowthintheteammembersdevelopmentally…
Irecognisethatthispilothasclearlyshiftedthelevelofthinkingabouttheindustry,consumerandhowtheproviderswork
together.Fromthefirstmeetingtowherewearenowthereisaverymarkeddifferenceintheinterpersonalinteractionsandincreased
empathyforthevariouspositionsandplayers.Ithasbuiltnetworks,developedindividualsandcontributedadiversityof
perspectivethatcreatesagreaterthansumeffect.”
HubProgramDirector
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Aim2:InnovationTheHubprovidedanopportunityformemberstocollaborativelydevelopandtestinnovativeapproachesinareasidentifiedasaprioritybyindustryandgovernment.Italsoprovidedanopportunityinwhichtotrialthebenefitsofaco-designmodelinwhichtheregulatorandprovidersworktogether.TheopportunitytoleveragecollectiveHubmemberexpertiseandtodevelopacrossmultipleareasinsucharapidwaywasparticularlysignificantforsmalltomediumHubproviderswithlimiteddevelopmentresources.AnumberofprovidersnotedthattheHubTrialpromptedthemto‘thinkoutsidethebox’.Asaresult,anumberofactivitiesweretrialledorimplementedthatwerebeyondthescopeoftheHubTrial.Examplesofactivitiesthatprovidershaveinitiatedinclude:• atrialofoptionsforinnovationinfoodservices,
includinggreaterinvolvementofinterestedconsumersinfoodproductionandpreparation;
• atrialofaresidentimpactsurvey,examininghowtheapproachoftheorganisationimpactsthelifeofeachconsumersurveyed;
• apeerreview,wherebytwoprovidersassessedeachother’sperformanceagainsttheHomeCareStandardsinpreparationforaqualityreviewbytheQualityAgency,resultinginrefinementofsomepracticesandimplementationofimprovementsinrelationtoassessmentandpersonalisedcareplanning;
• considerationofhowtobeststructuretheworkforceinordertofocusmoreonthecontinuumofcareandthetransitionofconsumersfromindependentretirementliving,throughhomecareandresidentialcare;
• implementationofheathyageingtraining(deliveredbyanotherHubprovider).
Aim3:MoretargetedapproachtogovernmentregulatoryactivitiesAsnotedinthepreviousChapter,therewerechangesingovernmentregulationinthreemainareas:extendedaccreditation;reducedACFIreviews;andchangestocomplaintsprocessestoincreasethefocusonproviderresolution.
“Theaccelerated,lowerriskdevelopmentopportunityofferedbyHubparticipationisthemostvaluableaspectfortheTrust,withveryreallimitsondevelopmentalresourcesavailabletousasasmallerprovider.ByleveragingtheHubworkinggroupstheTrusthasbeenabletocovermoreground,fasterandatlowerriskthanifwehadattemptedtodosoourselves.”
JamesBrownMemorialTrust
“TheSingleQualityFrameworkwillfocusonconsumerexperienceto
supportaconsumer-driven,market-basedagedcaresystem,encouragedeliveryofhigherqualitycareandreduceredtapeforagedcare
providers.TheFrameworkisbeingco-designedwithconsumergroups,representativesfromtheindustry,expertsinstandardsdevelopment
andagedcareregulationandapublicconsultationprocess.”DepartmentofHealth
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Basedondiscussionswiththedepartment,someoftheinitiativesandconceptsinitiallyprogressedintheHubTrialarenowbeingaddressedatanationallevel.InadditiontotheNationalAgedCareQualityIndicatorProgrammerandACFIreforms(e.g.moreriskbasedACFIauditingwithreducedadministrativeburdenonservicesthatmakeaccurateclaims),thisalsoincludesdevelopmentaSingleQualityFrameworkforagedcare.GovernmentisworkingwiththesectornationallytocreateaSingleQualityFrameworkbasedonproportionate,targetedregulationtodeliverhighqualityoutcomesforconsumersandproportionaterisk-basedregulationforagedcareproviders.Inrelationtoextendedaccreditation,mostprovidersnotedthebenefitof5-yearaccreditation.Theynotedthecostsavings,thebenefitofshiftingawayfromacompliancefocus,andthereducedpressureonstaffthatcanbeassociatedwithasitevisit.ItisworthnotingthatanumberofHubprovidersstatedtheywouldimplementothermeasurestoensurethattheycontinuedtomeettherequiredstandardsincludingexternalreview,peerreviewandmoreregularinternalreview.InrelationtoACFIaudits,therewerefewerauditsundertakenbutthereislimitedvalueinassessingtheoutcomesofeachoftheseaudits.InthecontextofbroaderGovernmentpolicychanges,theconceptofearnedautonomythatunderpinnedtheHubTrialhasinformedthedepartment’scurrentfocusonmoreriskbasedACFIauditingwithreducedadministrativeburdenonservicesthatmakeaccurateclaims.Inrelationtocomplaints,theHubTrialdemonstrated:• thevalueoftheAgedCareComplaintsCommissionerprovidingeducationtoprovidersabout
effectivecomplaintshandlings;and• thatreferringagreaternumberofcomplaintstoprovidersforlocalresolution:
- isnotalwaysappropriate,includingwhenthisisnottheoutcomesoughtbythecomplainant;
- doesnotalwaysreducethetimeframeforresolution;and- isonlyeffectivewhenthereisclarityofrolesandresponsibilitiesandwhentheproviderhas
astronginternalcomplaintsprocessandgoodcommunicationwiththeAgedCareComplaintsCommissioner.
ThedepartmentandtheQualityAgencyalsoadvisedthattheHubTrialpromptedthemtoconsiderarangeofissuesinrelationtomoretargetedapproachestogovernmentregulationandthevalueofproportionateregulationmodels,including:
• considerationofthevariousregulatoryleversavailabletoachievethedesiredaims,andthe
risks,costsandbenefitsforconsumers,providers,thesectorandgovernmentassociatedwitheachlever;
• thedifficultiesassociatedwithaccuratelydetermininglevelsofproviderperformanceandeligibilityforlightertouchregulation;
• theimpactonpublicconfidenceofearnedautonomyapproaches;and• theneedtomonitortheeffectivenessofanyearnedautonomyapproach.
SAInnovationHubTrialEvaluationReport Page43of52
Aim4:OpportunityformutualsharingandlearningCasestudy:DevelopmentofregionalCoPDuringthegovernanceproject,anumberoftheHubprovidersmirroredtheCoPprocessesinrelationtosharedlearningsandgoodpracticegovernancebymentoringandworkingwithotherprovidersintheirregions.Throughthisprocess,afewHubprovidersestablishedaregionalCoPthatincludedsupportforlocalIndigenousagedcareproviders.Drawingonstrategies,examplesandtoolsusedintheGovernanceFramework,thisregionalCoPsupportedcapacitybuildingandgoodpracticeingovernanceforregionalproviders.ClearlyoneofthekeybenefitsoftheHubwastheopportunityforproviderstoopenlyandsafelyshareinformationandlearningswitheachotherandwithgovernment.Hubprovidersappreciatedtheopportunityto:• beinvolvedinadiscussionaboutagedcareandto
contributelocally,andtotheagedcaresectormorebroadly;and
• tobuildrelationshipswithgovernmentoutsideofthenormalinteractions,andtoinformagedcarepolicy.
TheHubTrialdemonstratedcollaborationandpartnershipbetweenthegovernment,industryandregulators.Thecloseconsultationofthesepartieswascriticaltoestablishing,settingthedirectionfor,andmonitoringtheoutcomesoftheHubTrial.Providersalsoacknowledgethat,tovaryingdegreesdependingonthenatureoftheworkbeingundertaken,theHubprovidedanopportunityforthepoolingofresources.Whilenotanexplicitinitiative,thisby-productofthepositiveandtrustingrelationshipsdevelopedintheHubhasthepotentialforcostsavingsandefficiencies.Forexample,smallerorganisationswithintheHubweregivenaccesstoanumberofpoliciesandproceduresthatthelargerorganisationshaddeveloped,testedandsubsequentlyimplemented.Thisenabledsmallerproviderstodrawonwell-developedpracticestoinformtheirownpoliciesandprocedures,whilestillretainingautonomy.PartC–ChallengesandlearningsThepreviousPartsummarisessomeofthestrengthsoftheCoPasamodelforcollaborationandsomeoftheachievementsoftheHub.Aspartoftheevaluation,HubTrialparticipantswerealsoaskedfortheiradviceabouthowtheywoulddothingsdifferently,andwhatlearningstheywouldpassontoothersinterestedintheHubCoPmodel.Someofthemattersraisedincludedthefollowing:• theimportanceofbuildingtrustwithinthemembershipoftheHub;
“Localcommunities,localorganisations,localboards,local
people,localiseddecisionmaking…Thistrialprovidesuswithanopportunitytoworksidebysidewithsomeofthelarge,betterresourced,
providersandtotrialhownewinitiativesinbestpracticeand
improvedservicescanbeappliedwithinsmallerorganisationsandwithinrural/regionalproviders.”
BarossaVillage
SAInnovationHubTrialEvaluationReport Page44of52
- ProvidersobservedthatwhilethequalityofrelationshipsderivedfromtheHubareoneofthesignificantbenefits,itdidtaketimeforindustrycompetitorstoestablishtrust.Providersfeltthefinancialreportinginitiativecouldhavebeenmoresuccessfulifitstartedoncerelationshipshadbeenbuilt,whenpeopleweremoreinclinedtosharesensitiveinformation.
• thedifferentstrengthsandlimitationsofsmallerandlargerorganisations;
- AnumberofthesmallerandregionalprovidersemphasisedthevalueofbeingintheHub
andthesignificantbenefitsfromreceivingresourcesfromlargerproviders.TheyalsoidentifiedsomeofthechallengeswithdedicatingstaffresourcestotheHubandwithtraveltomeetings.
- Ontheotherhand,smallerorganisationsareabletoadoptnewapproachesmorequickly,whereasaslargerorganisationscantakelongertotrialorimplementinnovations.
• thechallengeposedbymultiplechangesinthe
governmentandthedepartmentthroughouttheperiodoftheHubTrial.Providersnotedthatthelackofcontinuityhadanimpactonthestrengthofrelationshipsandnetworks,andreducedtheopportunitytoexplorestrategicandnewpolicyopportunitieswiththedepartment;
• whether,iftheHubTrial,andinparticulartheearnedautonomyinitiatives,weremorebroadly
applied,therewouldbesimilaroutcomes;
• theHubTrialperiodof12monthslimitedthedegreetowhichtheeffectivenessoftheHubinitiatives,particularlyforconsumers,couldbedetermined;
• someaspectsoftheHubTrialwouldhavebenefitedfromgreaterclarity;
- Forexample,providersfeltthatthecomplaintsinitiativewasnotwellcommunicated
throughtheComplaintsSchemeandthatthiscreatedsomeinitialdifficultiesinengagingwiththedepartment.
- ThedepartmentidentifiedthattheHubTrialwouldhavebenefitedfromgreaterleadtimetoplaninitiatives,establishprocesses,trainstaffandco-designwiththesector.Including,thattheearlierfinalisationofkeydocuments(suchasthecomplaintsinitiative)couldhaveimprovedclarity.
• theinvestmentoftimeandresourcesintheHubrequiredsignificantenergyandcommitmentbyindustryandgovernment(althoughproviderslargelyacknowledgedthatforthemthereturnwasfargreaterthantheoutlay);
• thechallengesinestablishingtheHubTrial;
- HubmemberswereawarethatmanyotherprovidersmayhavelikedtobepartoftheHubandwouldalsohavemettherequirementsforearnedautonomy.However,thenatureof
“Smallerservicesaremorenimbleandadaptableoncetheyhaveadirection.Largergroupsmayhavemoreestablishedandentrenchedsystems,makingtheirchangeelementsmorecomplex.”
ResthavenInc.
SAInnovationHubTrialEvaluationReport Page45of52
theTrialrequiredamanageablenumberofparticipantsandtherewasvalueidentifiedinlocalisingtheTrialsite.
OtherfactorsthatwerenotexpresslyraisedbyHubmembersbutbecameevidentthroughtheevaluationoftheHubTrialincludethefollowing:• theobjectivesandaimsoftheTrialwerebroadlyexpressedand,inmostcases,notabletobe
effectivelyevaluatedafter12months.Nevertheless,asanumberoftheHubTrialinitiativesinformedbroaderagedcareinitiatives,thedepartmentconsideredthatitwasusefulfortheTrialtobeevaluatedatthistimetoinformtheseinitiatives;
• giventhe12-monthperiodoftheHubTrial,theTrialinitiativeshadlimitedtimetobeembeddedinpracticeandproducemeasurableoutcomesforconsumers;
• therewaslimitedpre-andpost-evaluationdatainrelationtoarangeofinitiativesincludedin
theHubTrial;and• whiletheconceptofearnedautonomyforhigherperformingproviderswasinitiallyastrong
driverfortheHubTrial,therehasbeenlimiteddevelopmentandtestingoftheconceptwithintheHub.OneofthelearningsfromtheHubisthedifficultyinidentifyingdifferentiatorsofperformancewithintheexistingregulatoryandpolicysettings.
- Forexample,whenover95%ofagedcareservicescomplywiththeAccreditationStandards
andtheexpectedoutcomesaremeasuredonamet/notmetbasis,itisdifficult(withinthecurrentqualityassessmentframework)todistinguishstrongerperformingorganisationsfromothers.Similarly,therearechallengesincomparingorganisationsbasedoncomplaintsandACFIinformationbecauseofthecommerciallysensitivenatureoftheinformationandthefactthatitisnotroutinelypublishedbythedepartment.
- Thedepartmentalsonotedthechallengeofmaintainingpublicconfidenceinrobustgovernmentoversightinaderegulationcontext.ThisconcernwasreflectedincommunityreactionandmediareportingintheinitialstagesoftheHubTrial.
SAInnovationHubTrialEvaluationReport Page46of52
Chapter5–ThefutureoftheSouthAustraliaInnovationHubBasedondiscussionswithHubproviders,theyintendtocontinuetomeetregularlyandarecommittedtothecontinuationoftheHub.Hubprovidersexpressedinterestincontinuingwithanumberofexistinginitiativesandalsoexpandingintonewareas.ProvidersalsoacknowledgedthatspecificCoPsformedwithintheHubwillchangeovertimeasexistinginitiativesareaddressedandnewinitiativesaredeveloped.OngoingHubactivitiesinclude:
• QoLtrialsthatarebothunderwaycurrently,andplannedatanumberofHubservices;
• governanceworkshopsandongoingnetworkingopportunitiesfortheboardsofHubproviders;and
• consumerengagementandco-designworkshopswithCOTASA.Inaddition,Hubmembersarealsoconsidering:• theestablishmentofCLEA;and• focusingonareasofinterest,suchasCDCinthe
residentialcarecontext,strategiesforhospitalavoidance,andongoingopportunitiestoinnovate.
InconsideringthefutureroleofgovernmentintheHub,providersexpressedarangeofviews.Ontheonehand,providersacknowledgedtheimportanceofnetworkswithgovernmentthatenabletheformingofapartnership,ratherthanarelationshipoffunderandregulator.Forothers,theroleofgovernmentisnotcriticaltothesuccess,orthebenefits,ofbeinginvolvedintheHub.Rather,thefutureoftheHubispredicatedonthemotivationandintentofHubmemberstoworktogether.AllHubprovidersidentifiedthatthebenefitsoftheHubaresomewhatstaged,inthatrelationshipswillcontinuetodevelopandoutcomesforconsumersachievedintime.Forthatreason,HubmembersbelievethatthevalueoftheHubwillcontinuetoberealisedintothefuture.
“TheSAHubprovidershaveagreedtocontinuetogetherwithrenewedagreedpurposeoverthenexttwo-yearperiod…Thereisrenewedandcontinuedfocusongovernance,
consumerengagement,continuousqualityimprovementandextendingthedevelopmentoftheLeadership
andExcellenceinitiative.”SAHubProviderGroup
“…theconceptofearnedautonomyintheHubTrialincludedconsiderationof
opportunityforredtapereductionintheagedcareregulatoryenvironment.WhileredtapereductionwasnotultimatelyafocusoftheHubTrial,HubprovidersaffirmandacknowledgethebroaderGovernmentintenttoreduceredtape,andthecontinuedimportanceofthisintentioninfutureagedcarereforms.”
SAHubProviderGroup
SAInnovationHubTrialEvaluationReport Page47of52
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SAInnovationHubTrialEvaluationReport Page51of52
AttachmentA–SummaryoftoolsusedinQoLFrameworkPersonalWellbeingIndex(cognitive)(PWI)ThePWIhasbeendevelopedtomeasurethesubjectivedimensionofQoL.ThePWIdistinguishesbetweentheobjectiveandsubjectivedimensionsoflifequality,tomeasuresubjectivewellbeing.ThePersonalWellbeingIndexassessesacrosssevendomains–health,personalrelationships,safety,standardofliving,whatyouareachievinginlife,feelingpartofacommunity,andfuturesecurity.QualityofLife-ADMeasure(QOL-AD)TheQOL-ADisabrief,13-itemmeasuredesignedtoobtainaratingofapatient’sQoLfromboththepatientandthecaregiver.Itwasdevelopedforindividualswithdementia,basedonpatient,caregiver,andexpertinput,tomaximizeconstructvalidity,andtoensurethatthemeasurefocusesonQoLdomainsthoughttobeimportantincognitivelyimpairedolderadults.Itusessimpleandstraightforwardlanguageandresponsesandincludesassessmentsoftheindividual'sphysicalhealth,energy,mood,livingsituation,memory,marriage,family,friends,selfasawhole,abilitytodochoresaroundthehouse,abilitytodothingsforfun,moneyandlifeasawhole.Caregiverscompletethemeasureasaquestionnaireabouttheconsumer’sQoL,whileconsumerscompleteitininterviewformatabouttheirownQoL.Themeasureconsistsof13items,ratedonafour-pointscale-patientandcaregiverreportscanbeevaluatedseparatelyand/orcombinedintoasinglescoreifdesired.Itgenerallytakescaregiversabout5minutestocompletethemeasureabouttheirpatients;forpatients,theinterviewtakesabout10to15minutes.NetPromoterScore(NPS)NPSisacustomerloyaltymetricbasedontheperspectivethateverycompany’scustomerscanbeplacedwithinthreetypes:• “Promoter”customersareenthusiasticandloyal,whocontinuallybuyfromthecompanyand
‘promote’thecompanytotheirfriendsandfamily.
• “Passive”customersarehappybutcaneasilybetemptedtoleavebyanattractivecompetitordeal.Passivecustomersmaybecomepromotersifyouimproveyourproduct,serviceorcustomerexperience.
• “Detractor”customersareunhappy,feelmistreatedandtheirexperienceisgoingtoreducetheamountofwhichtheypurchasefromyou.Detractorcustomersalsohaveanincreasedlikelihoodofswitchingtoacompetitoraswellaswarningpotentialcustomerstostayawayfromyourcompany.
Respondentsareaskedtoanswerbyusinga0to10scale,where5isneutral.Customerswhogivearatingof9or10areconsideredPromoters.Customerswhogivearatingof7or8arepassivecustomersandwhilsttheyarenotdissatisfied,theydonotfactorintotheNPSscore.Lastly,anycustomerswhoprovidearatingof6orlowerareconsidereddetractors.TheNetPromoterScoreiscalculatedbysubtractingthepercentageofdetractorsfrompromoterstogetanoverallNPSresult.
SAInnovationHubTrialEvaluationReport Page52of52
WorldHealthOrganisationQualityofLife(WHOQOL)TheWHOQOLisaQoLassessmentdevelopedtohavecross-culturalapplication.WHO,withtheaidof15collaboratingcentersaroundtheworld,developedtwoinstrumentsformeasuringQoL(theWHOQOL-100andtheWHOQOL-BREF),thatcanbeusedinavarietyofculturalsettingswhilstallowingtheresultsfromdifferentpopulationsandcountriestobecompared.ThecoreWHOQOLinstrumentscanassessQoLinavarietyofsituationsandpopulationgroups.WHOdefinesQoLasindividuals’perceptionoftheirpositioninlifeinthecontextofthecultureandvaluesystemsinwhichtheyliveandinrelationtotheirgoals,expectations,standardsandconcerns.Itisabroadrangingconceptaffectedinacomplexwaybytheperson'sphysicalhealth,psychologicalstate,levelofindependence,socialrelationships,personalbeliefsandtheirrelationshiptosalientfeaturesoftheirenvironment.TheWHOQOL-100assesses100items,stemmingfromthesixbroaddomainsofQoL-physicalhealth,psychological,levelofindependence,socialrelationships,environmentandspirituality/religion/personalbeliefs.Allitemsareratedonafive-pointscale(1-5).CIMPACTTheACHGroupdevelopedtheCustomerImpactStatement(CIMPACT)tomeasuretheimpactofACHGroupservicesonthelivesofolderpeople.Itaimstohelpservicestoprovidehighqualitysupportsthataregearedtowardthepromotionandmaintenanceofmeaningfulandpurposefullives.TheCIMPACTreview:• examinesservicesandwhat‘goodpractice’meansfromtheperspectiveofthosewhouse
them;• supportsthedevelopmentandrefinementofprograms;• providesfeedbacktostaffonhowwelltheservicesaremeetingtheneedsofpeopleand
contributingtotheirgrowthanddevelopment;and• contributestoacultureofcontinuousimprovement.TheCIMPACTprocesshasbeendesignedtoseekinformationabouthowprogramsareworkingtowardsdesiredimpactsthroughreviewingasetofqualitydimensionsthatarethoughttobemostlikely(basedonavailableevidence)toachievethoseimpacts.These25dimensionsaregroupedinto5keyareas:• Rightrelationshipswithpeople;• Respectuniqueness,workwithstrengthsandaddressneeds;• Supportcontributionandcommunityengagementthroughvaluedsocialroles;• Supportindependence,wellness,learningandgrowth;and• Presenceofrelevant,intentionalsafeguards.TheCIMPACTprocessisbasedonaninternalpeerreviewprocess.ItusesAppreciativeInquirytechniquestoincreasetheengagementofstaffintheprocessbyfocusingonwhatworks.Italsodrawsonpeoplefromacrosstheorganisationtoparticipateinthereviews,thusgainingacommonunderstandingacrosstheorganisationofwhatisconsideredtoconstitutequalityservices.