Consulting
It has been a while since I have written – almost two years. And what a two years it has been!
Given the amount of media coverage on both sides of the approaching federal referendum on an Indigenous Voice to Parliament, in mid-January I sat down and wrote an essay on how, as a regular church goer, I might consider my voice in this significant time in Australia’s history.
If you are interested to read it, the essay is here.
I am looking forward, with timidity, to reading and reviewing the final report from the Royal Commission into Aged Care Quality and Safety.
As you might recall, I retired on 1 November 2019 on grounds of ill following an almost 40 year career in aged care management and leadership, and three Chief Executive Officer positions totaling more than twenty years.
In my view, whilst the funding is the highest it has ever been, the care provided within that funding is at least as poor as that provided in the mid 1980s which prompted the (Senator) Giles review into nursing homes. In my view, based on a competent clinical assessment of their health and multiple morbidities with which most seniors approach care services for support, our current aged care system, whether for residential and/or home based care, is unable to guarantee that each care recipient will receive the care they need, let alone want.
The aged care sector needs MORE:
Mine is a long list, but I think not unreasonable. And I have likely omitted to mention some that I should have included.
My own work on minimum staffing requirements (here) back in 2018 suggests about an additional $6 billion to have a workforce sufficient in number and training to appropriately care for our most frail if elders. Today many residential aged care services do not even have a registered nurse on duty 24 X 7, with perhaps only one or two staff for 100 or more residents. In my view this is a shameful outcome of what has been, in hindsight, some thirty-five years of failure of what promised to be an innovative Aged Care Act in Australia.
There is going to be tough times ahead for all involved and the final report/s are likely going to make for difficult reading. But they must be both read and acted upon.
The question is, will the Australia Government have the appetite and conviction to introduce rights based changes in care for our elderly. Or will older Australians face an uncertain future with respect to their care needs in later life?
UPDATED to include responses to questions I asked of the Australian Government Department of Health’s COVID-19 Vaccine Team
Its been a little while and I haven’t been that well.
I wrote an essay on the weekend of 12, 13, and 14 February 2021 about use of vaccines by Christians (and more generally, people of faith). The essay focuses on how we might best respond to some of the new COVID vaccines that have a development and indeed a testing basis in foetal cell lines, descendant from decades old aborted human foetal cells.
This can be a complex area of morality and bioethics for people of faith. The essay is not a short read, but I do hope you find it both informative and helpful for yourself, and perhaps even your own faith community. If you appreciate the work, please feel free to share and discuss within your community.
Oh, and there is a couple of questions to which I could not (yet) give a more complete response. I have asked the Australian Government’s COVID resource team to provide a considered view. I hope that they come through on this.
The essay is here.
Take care all – nice chatting.
I read with interest this week the eighth Research Paper[1] from the Royal Commission into Aged Care Quality and Safety. It is about comparison and review of a plethora of quality indicator systems across numerous local and international jurisdictions in the residential aged care sector. That specific document can be found at this web link https://agedcare.royalcommission.gov.au/sites/default/files/2020-08/research_paper_8_-_international_and_national_quality_and_safety_indicators_for_aged_care.pdf.
Contemporaneously I have been compiling a library of similar indicators that I believe will be useful in our overall aged care sector. There are some differences between my work, the report provided to the Royal Commission, the Australian Government’s mandatory reportable quality indicators,[2] indicators used by the Victorian Government in its State managed residential aged care facilities,[3] and an international source of over 90 indicators[4] that I have used. The main differences are that where most of those other sources focus on quality of care and safety, and quality of life indicators, I have also built in indicators around, quality of assets, equipment, and supplies, and organisational governance.
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This is not to suggest that my library of currently 194 indicators is complete. On the contrary, the ROSA report prepared for the Royal Commission “A total of 305 quality and safety indicators for residential aged care were identified”.[5] At some point a limit is reached as to what quantity is manageable to be measured, recorded; and if made mandatory, reported.
Continue reading “Strategic Planning Insights #4 – Performance Indicators”Toward the end of my previous essay I indicated that I would focus on KPIs in this Blog Piece. I will get to that next time – I feel it important to make some commentary on the impact that COVID-19 is having on the services of our aged care colleagues in Victoria. This week saw a specific focus by the Royal Commission into Aged Care Quality and Safety on the management of, and planning for, COVID-19 outbreaks in New South Wales and Victoria. The following dot points are some of a tweet thread I made on Saturday morning summarising my take on the week’s evidence:
Committing to the formation of strategy, developing that strategy and communicating it are significant responsibilities of any board.
How best can the developed strategy be measured, reviewed, and managed?
I will leave the measurement of strategy performance for the third in this series of short essays. This short essay focuses on the board’s management of its strategy through the Chief Executive (howsoever titled).
There is nothing that quite replaces the annual board get-away for deep, focused strategic thinking about its role, its responsibilities, and the organisation in which its fiscal duties and fiduciary responsibilities are invested. These can be richly rewarding times, and if well facilitated, can bring long term, positive momentum to the board and senior management, with a renewed focus on organisationally important things to be achieved. But if your board’s last strategic thinking and planning session was, say, in November 2019, you know now that the world has almost completely changed within one calendar quarter.
Your board no doubt meets several times each year. But do you meet to drive an Agenda to get the business done or are you meeting to drive a transformational and winning organisational culture? There is a world of difference between these two outcomes. Without detracting from the value of still getting away for an annual, thorough review of strategy, there are useful alternatives that make more frequently inclusive focus on strategy at regular “any time”[1] board meetings, and more formally on a periodic basis throughout any given year. Whether conscious or unconscious, you and your board drive the culture of the organisation in how you use the opportunities of your governance meetings.
Essentially there can be three types of meetings in which strategy can be given a dedicated place on your board agenda for its appropriate diligent review:
The Greek word σκέφτομαι (skéftomai – thinking) has the sense of contemplation, that is, more than just thinking as in this familiar image below.[1] More like thinking with care or weighing up the impact of thoughts. From this word we get the word skéfto.
Over the years I have been on boards where strategy, its measurement and monitoring have been left to the CEO to lead; and where strategy was not a matter that was on the board agenda in regular (monthly) meetings.
I encourage us all to seriously think about how we can amend agendas to include strategy as a priority item on each board meeting.
Boards can learn how to ask questions of the executive team and management around matters rolled into their Strategic Plan. For example, if you have ten overarching objectives in your current strategic planning document, and your board meets ten or eleven times each year, you could consider a well thought out sixty minutes of discussion around each of these high level objectives at each Board meeting, and the entire Plan would be discussed throughout the year. To provide time for input from the CEO and executive team, even if the Board were to conduct that review of each item in the Plan over a two month period, the entire plan could be thoroughly discussed and re-invigorated every two years. This does not detract of course from the value of a formal annual Strategic Planning review.
However, too often we lay responsibility (blame) at the feet of the CEO and executive team if strategy is not achieved or seems to waver along the path the organisation sets. This is most unfair if the board itself is not taking care of the primary responsibilities of monitoring and oversight of the organisation’s strategy and strategic plan for which it is responsible.
In his well-known text on governance, Tricker describes the basic board functions[2] working through management as:
Just the other day on 15 June 2020 we honoured World Elder Abuse Awareness Day, a day that highlights elder abuse in all of the forms it manifests itself.
Australia has had its own recent and continuing struggles with prevention of spread of COVID-19, and I feel proud to be both an Australian and supporter of most of our aged care providers in how they have managed well in these complex times. As we know, our experience has not been shared with numerous other western nations.
Just one week ago, the Kaiser Family Foundation (“KFF”) released the following summary of data around prevalence and mortality rates due to COVID-19 in USA long term care facilities – for ease of discussion, let’s call them all nursing homes. Remembering that the population of the United States of America is about 13 times that of Australia:
14 June 2020
At the start of May 2020, I proposed a way in which the (residential) aged care sector might reconsider its apparent very widespread lockdown of facilities and prevention of family members visiting with loved ones in care. Various alternates of “window visits” etc had been quite successfully trialled by some providers, but they fail, for example, where a residential care facility is in a multi storey complex, with all residential living contained at above ground floor level.
There is no doubt that aged care providers have been caught in a bind with the onset of the COVID-19 pandemic. Can they have visitors at all, or on a very strict basis? What is the best guidance? Hospitals have become focused on well controlled prevention strategies – so much so that emergency department traffic has significantly slowed during this pandemic, and only now beginning to return to normal frenetic activity.
Both in hospitals, and in longer term care settings the notion of visits – human touch – in these pandemic times has been a much debated phenomenon. As a species, humanity craves touch contact with those dear to us – particularly when we are ill and so frail that we are facing death, no matter how imminent. This certainly affects the older person in care, as well as family and friends who wish to provide the touch of comfort as much as the words of caring love, concern, and, in a final sense, farewell to this life.
Continue reading “A Simple Plan – and a Request to Support an Australian Icon”I am not sure how you have been managing your time during these past seven weeks. Because I am now “semi-retired”, I have taken the opportunity to read and refresh my earlier learnings over the past almost forty years on leadership, management, and strategy, while focusing on completing some studies in executive and leadership coaching.
What has struck me is that in this time of turbulent change, particularly in human services delivery right now where the impact of COVID-19 is taking its toll, is that many theories about leadership, management, strategy, and human resources management, actually have not changed, and likely do not need to. Sometimes the “old” fundamentals are as reliable as granite …
In his now famous, and dated article, Henry Mintzberg defined as a plan, ploy, pattern, position or perspective (Mintzberg, 1987, The Strategy Concept I: Five Ps For Strategy). Mintzberg described:
Continue reading “How Is Your Organisational Strategy Shaping Up for the 2020-21 Year and Beyond?”Stop the world – I want to get off is the title of a musical created in the 1960s.
Some 55 years later as we become globally enmeshed in a pandemic the like of which none of us has experienced before, one could be forgiven for wanting to shout those words from the roof tops.
I don’t need to remind you of the enormity of the task ahead of every organisation in every industry sector – particularly those in a sector I am so fond of and have given over half of my career to. I won’t belabour the size of the task ahead of you. But I do want to ask the rhetorical questions in this group – are we doing enough in our aged care sector to make an impact?
For providers – if you could get hold of adequate supplies of personal protective clothing and equipment, are you considering gloving, gowning, and masking all your front-line care staff? Are you having a skilled Registered Nurse meet and greet every visitor and taking a temperature prior to allowing a visitor, contractor, family member, Aged Care Quality and Safety Commission staff member enter the facility?
For the Australian government – Department of Health and Aged Care Quality and Safety Commission – have you increased the ACFI rate per resident per day, or introduced a coronavirus supplement to cover the cost of additional medical supplies, staffing supplies, and loss of revenue when facilities empty due to untimely death of residents? Have you considered the financial risk and impact of failure of the RAD scheme?
Why these specific questions?
Continue reading “COVID-19 – What more needs to be done in our aged care system?”6 January 2020
No matter where and how we are involved in our Australian aged care sector, 2019 was a tough year. The sector ended 2019 with one word ringing in our ears – Neglect – being the title of the Interim Report from the Royal Commission into Aged Care Quality and Safety. What a tough end to 2019!
How do we emerge from 2019 into a brighter and stronger 2020 given that the Royal Commission continues to march on? How do we turn Neglect into respect and rise above the negative views of all that 2019 revealed about our sector?
I suggest that we should at least consider the following seven factors:
Continue reading “Welcome to 2020”
This piece was published as ‘The Bones are Bare’ on Australian Ageing Agenda.
I have been back working in the aged care sector for almost twelve months now – first on an interim basis with Baptistcare here in Perth, and for the past four months or so as Chief Executive with Braemar Presbyterian Care in WA.
One of the most common questions on my return to the sector is about the amount of change there has been in “aged care” since I left the sector back at the end of 2010.
One could say that the change has been enormous, with refundable accommodation deposits now part of residential aged care, and significant changes having been made to funding around client centred care in the community aged care sector.
On the other hand, one could quite calmly suggest that no great change has happened. After all, since I first entered the aged care sector back in 1982, we have had at least some fifteen (perhaps closer to twenty) Australian Government Ministers with responsibility for aged care services over the past thirty years. In that same period, we have had at least three major changes to the funding regimes that providers live with daily.
Chatfield is Vice President of the National Cartoonists’ Society, a past President of the Australian Cartoonists’ Association and currently works from his studio in Manhattan.
Jason is also a professional stand-up comedian. You can find his Comedy Website here.