Aged care risks losing intent of reforms if focus is on ‘implementation not outcomes’

PROFILE: It’s critical that aged care facilities shift from focusing on tasks if they are to truly adopt more person-centred and consumer directed approaches, Di Adamson tells Australian Ageing Agenda.

PROFILE: It’s critical that aged care facilities shift from focusing on tasks if they are to truly adopt more person-centred and consumer directed approaches, Di Adamson tells Australian Ageing Agenda. 

Di Adamson
Di Adamson

Sometimes all it takes is one small change and the culture in an aged care facility can be transformed, says Di Adamson.

For 15 years, Adamson has been working with frontline managers in residential care to “create environments where people love coming to work.”

She points to one manager who introduced a “learning circle” at the end of shifts.

“The nurses and care workers would get together to talk about what they learned that day; what triggers in a resident they identified, what they did to make a difference in someone’s life, and what they could share around that.”

The sessions weren’t about clinical handover, Adamson hastens to add, but rather an opportunity to reflect on the personal insights staff had gained that shift.

The manager reported that, over time, the interpersonal, communication and problem solving skills of the staff had dramatically improved, says Adamson.

Involving staff is key

Underpinning Adamson’s approach is the belief that frontline staff, from senior nurses to care workers, need to be authentically engaged in the change management process – whether it’s getting their input to how a facility will adopt reablement to rolling out a new model of care.

“I truly believe that when staff have the opportunity to contribute at this level and to think like this they are perfectly capable of it,” she says.

And it should start right at the recruitment stage, Adamson argues.

“Typically someone comes for an interview and they are given a list of tasks they’ll have to perform and we ask about their experience and capability.

“But we should also be talking to them about the depth of the role: that they will be walking with people on the last journey of their life. We should be asking how they feel about that, how they feel about our organisational values and how they can make a difference to our residents’ lives.”

The focus must be on engaging people in the true meaning of their work, yet aged care has typically been defined by completing tasks, Adamson argues.

She says:

“Everywere I go I hear managers complain that their frontline staff are ‘too focussed on tasks’ and won’t get behind their person-centred approach. But the managers have been walking around for years handing out the tasks – they hold staff accountable based on the completion of tasks.”

This needs to change at management level, says Adamson.

“We can’t just expect the people on the floor to do it differently if management isn’t doing it differently,” she says.

Focus on tasks at our peril

In fact, Adamson argues that the shift away from focusing on tasks is critical if facilities are to truly adopt more person-centred and consumer directed approaches, as envisaged under the reforms.

“That’s going to be our greatest risk; that we lose the intent of these changes when we become focused on the process and implementation rather than on the result in terms of outcomes for the resident.”

But she acknowledges that for many facility managers, just keeping on top of the latest changes is a huge challenge.

“Until they have a day to step outside their daily practice, to look back in with a different view, it’s an absolute struggle.

“Yet once the managers shift, once they speak differently and give staff the opportunity to shift as well, then it’s quite remarkable what can be achieved,” she says.

The full profile on Di Adamson appears in the current issue of AAA magazine (Nov-Dec). Click here to subscribe

Tags: culture change, di-adamson, education, reforms, training,

3 thoughts on “Aged care risks losing intent of reforms if focus is on ‘implementation not outcomes’

  1. The challenges are certainly there on how we deliver person orientated care rather than task orientated care. Many see the barriers as the recent $1.8 Billion slashed from the Aged Care budget. The continued struggle for facilities to find and obtain staff in an area that is paid poorly. The culture towards older people, seen as a burden on society not valued and respected as the contributors to our countries, communities and lives (the people who have put us here today). Di I totally agree with your points with the interview process and sourcing people’s views on the depth of the role. I think there needs to be more added into education. Yes we have the task proportion, what if we bought in Consumers with stories and experiences. We have an era of consumer participation sweeping across the health sector with the philosophy “we do it best when we do it together”. The focus or core is person centred care. How do we sweep this philosophy across education and include it …but not just words in a manual. Staff inclusion, input and participation in residential facilities is also vital. Many go unsupported and go to work with the best intentions but can’t make any forward steps when not enough staff and not supported from a higher level. Task orientation has existed for many years. It is certainly time for culture change. It is going to take a lot of work, but yes needs to come from the top. Great article to read Di, have shared this on. Maria Berry (EBA Vic Representative /Advocate)

  2. I agree with much of what Di states, she is an excellent mentor and educator in this field.

    However there is a lived experience of being a care worker that many of today’s “leaders”, managers and consultants in the game do not understand. That experience is “walking the talk” going on the floor and do the actual work, meet the regulatory requirements, standards, legislation’s, timelines, paperwork and any other onion layer we can throw at the low paid care workers. Then comes the cultures, the diversity, the transaction leadership and the mandatory rules and reg (WHS).

    Including the daily routines , requests, person centered needs and that of the what is expected by the organisation and the family.All this for the lowest of pays and the least of thanks. Oh, can we add the behaviours, the emotions and the death and dying.

    The education needs to change with our future leaders, empowerment of person centered care comes when we truly value the work that our carers do and them as individuals in the team.
    Mastering and acknowledging autonomy in care work is extremely important. Enabling carers to master their own emotional intelligence at work, empowering their decision making process and providing them with registered nurses to mentor and guide the care.

    I could go on for ever, but in the end we have to acknowledge that what we ask and what we expect, is not what we get because its not what we do. Innovation is a great starting point in today’s care sector…..not by changing the names of programs and philosophies, rather embedding the skills in the teams and allowing those skills to be applied and then performanced managed.

    Paulatim.

  3. Let’s be clear; we don’t do person centered care.

    Many say they do, but unless they roster at least one carer for every four residents and can serve you a hot breakfast at 11am, they’re not. Anyone working on the floor knows the term is just spin for the marketing brochures.

    Care staff are task-oriented because that’s what the job entails…a series of tasks! Aged care’s devotion to cutting staff levels, trimming roster hours and loading the untrained with preposterous responsibility will ensure the focus stays on tasks.

    Of course, dinosaur practices that see everyone dragged off to the shower every day, progress notes written for every resident on every shift and every minor action recorded in hopelessly inefficient care software also enslave carers with additional tasks that MUST be completed.

    There’s wisdom in Ms Adamson’s message; unfortunately, our profit-driven model of residential care relegates it to utopian ideology. Even implementing a cleverly simple idea like the ‘learning circle’ is a challenging prospect when most rosters don’t provide any overlap across shifts.

    Drew has alluded to the huge burden we already place on our carers…just how much more do you want for $19/hour? Maybe we need an engagement loading?

    We’re stuck with a task-based culture until the right skill mix and staff numbers afford us the luxury of moving beyond it.

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