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.
My work own started as the development of a suite of key performance indicators – KPIs – but I soon recognised that there are indeed many measures that can be adopted, that so often in our aged care programs are not made transparent to many (any) stakeholders.
For me, performance indicators are like the set of Ten Words, or Ten Commandments from the Judaeo-Christian Scripture. We can treat commandments as rules like a to-do list that we check off, or a series of tick boxes. Alternatively, we can regard them as principles that can change us, our attitudes, and response to others, and positively improve our services. For example, there is a story in Matthew’s Gospel where a young man asks Jesus what good things he must do to earn eternal life. Jesus asks the young man if he has kept several of the commandments. When the young man says that he has obeyed these things since he was a young boy and asks what else must he do, Jesus gently confronts him by suggesting that he must now sell everything he has, give it to the poor, and follow Him (Jesus). The checklist of performance against the commandments was not enough. What Jesus really wanted – the principle – was the change of heart (sell everything and give it to the poor) and follow Him (Jesus – the improvement) that consequentially would earn the desired outcome.
Do you seek a better outcome in your provision of aged care services? Just like a mirror, a broader regard of performance indicators can assist us. They can reveal to us, feed back to us, what we need to change so that we can improve to reach a new or changed goal, a performance outcome whether or not regulated, or a strategic objective.
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Performance indicators should not be regarded as a mere checklist but rather a mirror against we can check in to measure our commitment to our people, our purpose, and our performance.
The myriad of performance indicators I have gathered do well and truly surpass the regulated minimum. They are also aimed at reflecting our commitment to people, purpose and performance so that we can change and improve the care and services to our residents/clients and other valuable stakeholders; and improve our relationships with our staff, engage better with families and friends so that we can build stronger community.
The performance indicator library is broken down into six domains as follows:
- Domain 1 – Quality and safety of care;
- Domain 2 – Quality of life;
- Domain 3 – Leadership;
- Domain 4 – Economic performance;
- Domain 5 – Quality of assets, equipment and supplies; and
- Domain 6 – Governance.
I am currently negotiating with a software firm how this library of performance indicators can be built into an existing software platform or be crafted into a simple application complete with database to ensure capacity for ongoing collection and reporting of data.
And by the way, this library of indicators is not to suggest that any one organisation must use every indicator, For example, if you are not engaged in a capital development program you may find no use at all for Domain 5. Some of these indicators are a simple binary Yes/No recording. Others, for example, how many Board meetings does each Board Member attend is a simple count, but when used with other indicators does ensure governance performance is being monitored. And many of these indicators will not be new to you and you are likely already recording them in your existing systems.
Please contact me if you want to learn more.
Nice chatting
Wayne
[1] Gillian E Caughey et al, ‘International and National Quality and Safety Indicators for Aged Care – a Report for the Royal Commission into Aged Care Quality and Safety’ (Research Paper 8, The Registry of Senior Australians (ROSA), 2020) <https://agedcare.royalcommission.gov.au/sites/default/files/2020-08/research_paper_8_-_international_and_national_quality_and_safety_indicators_for_aged_care.pdf>
[2] Department of Health, ‘National Aged Care Mandatory Quality Indicator Program’ (Australian Government Department of Health, 2019) <https://www.health.gov.au/initiatives-and-programs/national-aged-care-mandatory-quality-indicator-program>
[3] Ageing and Aged Care Branch Quality Improvement Unit, ‘Quality indicators in public sector residential aged care services’ (Victorian Department of Health & Human Services, 2015) <www.health.vic.gov.au/agedcare/publications/resourcemanual>
[4] European Centre for Social Welfare Policy and Research, ‘Measuring Progress: Indicators for care homes’ (Progress, The EU programme for employment and social solidarity, 2010)
[5] Gillian E Caughey et al, above n 1, ii.