Majority of clinical staff support quality indicators, study finds

As Australia moves to a national system of quality indicators in aged care, new research into their use in Victoria finds the majority of senior clinicians see the benefits, but there are caveats to successful implementation.

As Australia moves to a national system of quality indicators in aged care, new research into their use in Victoria finds the majority of senior clinicians see the benefits, but there are caveats to successful implementation

Most senior clinical staff believe that the use of quality indicators in Victorian Government aged care facilities has led to “substantive benefits for resident care and contributed to a culture of quality.”

However, a small proportion of staff believed the program was of “little value and consumed precious resources.”

These are among the key findings of a qualitative study into the use of quality indicators in Victoria’s state-owned aged care facilities, based on site visits to 20 facilities and interviews with 56 senior clinicians and nurse managers.

The program of quality indicators has been in use across the Victorian Government’s 196 aged care facilities since 2006. The program involves the collection, reporting and benchmarking of data across five indicators: pressure ulcers, falls, physical restraints, medicines and unplanned weight loss.

The findings of the study, published on Monday in the Australian Health Review, come as the Federal Government develops a national voluntary quality indicators program for aged care (see below).

The qualitative research, which was the second part of a larger study, was conducted by a collaborative including Ballarat Health Services, Monash University, La Trobe University, the RDNS and the National University of Ireland, Galway.

The study found that staff reported the quality indicators had “a direct and positive influence on the quality of care at multiple levels within the organisation.” This included increased staff knowledge and engagement, strengthened clinical processes and improved timeliness of referrals.

“Quality indicator data used for internal benchmarking helped identify opportunities for care improvement and provided staff with objective evidence of change in practice,” it found.

Respondents reported improvements in resident care, in particular a reduction in the use of physical restraints and earlier identification of unplanned weight loss, according to the study.

Further, there were knock-on effects in related areas, the study found. “For example, staff involved in the [quality indicator] unplanned weight loss addressed structures and processes in their facilities leading to improvements in oral care, a more conducive environment for eating meals, engagement with the dietitian and addressing nutrition more generally for all residents.”

Drawbacks and caveats highlighted

However, the study also found some perceived negatives associated with Victoria’s quality indicators program, with increased workload the most frequently cited drawback.

Additional resources were required to implement data collection and reporting requirements, some respondents said.

“Duplication of data and effort between the QI program and other quality improvement or accreditation tasks contributed to this impression,” the study noted.

Training of staff was singled out as an important caveat for the successful implementation of a quality indicators program, with education for executives and board members highlighted as the most important.

Some respondents reported concerns around definitions and the clinical credibility of the quality indicators, with the indicators on physical restraint and medicines considered most problematic, the study noted.

The consistency of data collection and analysis both within and between facilities, and reporting data to the department, were also highlighted as key issues by some respondents.

“A significant barrier to implementation was a range of technical data collection issues,” the study noted. “The challenge is to ensure the introduction, acceptance and implementation of a standardised data collection tool that is simple and clear.”

National program in development

The Victorian study has delivered a timely message, as the Federal Government is currently developing a national voluntary quality indicators program for aged care.

Initially a pilot of three indicators in residential care, covering unplanned weight loss, pressure injuries and the use of physical restraint, will be conducted, with the results to be published on My Aged Care.

A quality of life measure to capture a consumer’s experience and home care indicators will also be developed. The national program is due to begin in January 2016.

However, there have already been warnings that public reporting of quality indicators could have perverse outcomes, and this needed to be considered as Australia adopted its quality indicators program.

As Australian Ageing Agenda reported, Dr Lee-Fay Low, an Associate Professor in Ageing and Health from the University of Sydney, said in February that publishing quality report cards in aged care can lead to greater cherry picking of clients and encourage providers to divert resources to areas under review.

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Tags: Australian Health Review, Ballarat Health Services, Dr Lee-Fay Low, la-trobe-university, monash-university, my-aged-care, rdns, slider, university-of-sydney,

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