High workload, inadequate staffing, unexpected events and conflicting demands lead to difficult prioritisation decisions for residential aged care staff and potentially substandard care for residents, a Macquarie University study has found.

The study, published in Qualitative Health Research this month, aimed to explore which situations forced staff to make difficult prioritisation decisions, known as prioritisation dilemmas, and the influences of prioritisation decision-making.

The study involved a prioritisation activity, questionnaire and interviews with 32 nurses, managers, personal care assistants, lifestyle officers and pastoral care staff from five aged care facilities in New South Wales and Queensland managed by a single provider.

Lead researcher Dr Kristiana Ludlow said prioritisation can potentially result in substandard care if lower priority tasks are delayed or left undone.

“Prioritisation can cause lower priority tasks to become missed and our study shows minimising these situations where staff are faced with these dilemmas is important,” Dr Ludlow told Australian Ageing Agenda.

She said they found that high workload and inadequate staffing both caused prioritisation dilemmas for aged care staff.

Dr Kristiana Ludlow

“[Staff] were busy, there was a lack of time and this often led to psychosocial aspects of care, such as having conversations with residents being neglected [or had their care] delayed,” said Dr Ludlow, an honorary postdoctoral fellow at the Australian Institute of Health Innovation at Macquarie University

Unexpected events and competing demands such as when staff need to attend to multiple residents at the same time, and inadequate staffing were other factors of prioritising dilemmas, she said.

“[Staff] would be faced with this dilemma where they would have to decide, who gets seen first and who gets, I guess, where that care gets delayed?”

The study also identified seven factors that influence staff prioritisation decision-making including how staff perceive their role or responsibility.

“Staff would prioritise cared based on what they thought their duties were, and what was central to their role. But unfortunately, this often led to task focused care, and therefore more social or interpersonal aspects of care would often be neglected,” Dr Ludlow said.

The other influences identified include urgency of the situation, the anticipation of consequences, perceived peer support and teamwork, residents’ care needs, finding a balance of safety and independence, and person-centred care and quality of life.

“We found that participants tried to prioritise care in a way that promoted person centred care and that was important to them. But it wasn’t always possible to do this because they were dealing with limited resources,” she said.

“Other factors such as urgency would influence [staff] more. That was the conflict we found where staff were saying that person-centred aspects of care were often delayed or neglected, but it was still important to them.”

Dr Ludlow said an understanding of staff prioritisation dilemmas and influences on staff prioritisation decision making help managers support their staff and reduce instances of missed care.

“To reduce these dilemmas, you need improvements in resources and support, particularly increased staffing levels,” she said.

This research is part of a larger study looking at the priorities of aged care residents and family members.

Dr Ludlow said she hoped to bring these three perspectives together to compare prioritisations across the groups.

Access the study here.

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1 Comment

  1. In any workplace ‘the ship is only as good as the Captain’.
    The Captain is often the owner of the business or someone who is responsible to successfully manage operations.
    Leaders need to be qualified to provide only the best management skills and therefore lead and ultimately be responsible for all daily procedures.
    Aged Care is a service industry.
    Professional management in any industry need to be qualified, vigilant at all times, to constantly supervise staff, assist and encourage their employees and when necessary be ‘hands on’, lead by example, while providing advice, training and support.
    Successful managers often ensure they are regularly engaged at the ‘coal face’ and as a result they observe all business operations and honestly note and report their findings both good and bad…
    Sitting behind a desk is also a necessary part of management duties but efficient managers arrive on the floor (when least expected) and have the experience to know when and where they can best assist while displaying the skills to effectively prioritise and therefore obtain the best outcomes for their clients, staff and the overall business. To complement their skills they also rely on their experience and common sense.
    The Aged Care Royal Commission has identified negligence and the Captain’s of Industry are all responsible.

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