Quality Framework for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program

2 The Quality Framework

Up to Office of Aged Care Quality and Compliance (OACQC)

prev page| TOC |next page

2.1 Introduction

The establishment of a culturally appropriate Quality Framework for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program is one of a group of measures by the Government to support access to quality aged care services for people from Aboriginal and Torres Strait Islander communities.

The Quality Framework includes a set of Standards and a process for monitoring achievements against the Standards, designed to assist service providers to continuously improve their services.

2.2 The Quality Standards

The Standards were developed based on input from consultations, a literature review and the pilot of the Draft Quality Framework. The literature highlighted that Standards should:

• be simple in intent, achievable and few in number
• be measurable
• encourage continuous quality improvement.

Themes that were consistently emphasised during the consultations were the importance of:

• culture: of each person cared for, their families and the community
• risk management: the need to minimise risk for the people cared for and for staff, while respecting the needs and wishes of all stakeholders
• the relationships of flexible aged care services: with the people they care for and their families, the community, other providers and government.

2.3 The Structure of the Quality Standards

The Standards include two overarching principles:

Cultural Safety: Cultural safety is about recognising, respecting and nurturing the unique cultural identity of Aboriginal and Torres Strait Islander people and meeting their needs, expectations and rights.

The Standards take into account the importance of culture to service providers and people receiving a care service. Each service provider and the communities they support have unique and diverse cultural needs.

The concept of culture and cultural safety has been identified as an important component in improving health care with, and for, Aboriginal and Torres Strait Islander people.

Culture is distinctive to a region. Cultural needs and issues may be specific to the individual, their group, or be related to whether they are male or female. Managing a culturally safe environment is a continuous process, as needs and issues may be different for each person.

Respect for their region’s culture is very important to service providers. Services need to identify the needs and issues of each person they care for, and have a process to manage and deliver this care. This ensures that:

• individuals receive care that is culturally appropriate and is respectful of him or her, and his or her family and home
• no one is offended or insulted
• service users feel comfortable and safe.

As service providers and their communities have unique and diverse cultural needs, the Standards do not focus on what represents culturally appropriate and culturally safe care. Instead, there is emphasis throughout the Standards on the issues that must be considered in assessment, planning and service delivery, in order to identify what each service user considers to be culturally appropriate and culturally safe care. Top of page

The Standards include specific requirements which will Guide and assist a service provider in gathering and then acting upon this information. This begins at assessment with hearing the person’s life story and carries through to how information is communicated, the way, and by whom, their service is delivered and the environment in which the service is delivered.

Continuous Quality Improvement: CQI is about always working to improve services and outcomes for people. It means looking for better ways to do things.

These two principles are recognised throughout the Standards and are integral to the Quality Framework.

Figure 2.1 is a visual representation of the two overarching principles. That is, the dotted lines that frame and create linkages within the picture represent Cultural Safety and Continuous Quality Improvement as key elements of the Standards.

Within the picture the two Standards are represented in two large circles:

• Care Delivery and Information – is about the steps involved in directly providing care to people.
• Management and Accountability – is about support systems and processes.

For each standard there are a number of Expected Outcomes that are represented in the small circles and joined by the lines representing the overarching principles; these state the results to be achieved.

Table 2.1 sets out the full version of the Quality Standards, Expected Outcomes and Guide to requirements.

Figure 2.1: Picture of Quality Standards

Figure 2.1 is a picture of the Quality Standards Structure which illustrates how the Quality Standards work together as an interconnected hierarchy of overarching principles, standards, expected outcomes and guiding requirements.

Table 2.1: Standards, Expected Outcomes, Guide to requirements

1. Care Delivery and Information Each service user has access to and receives quality aged care services that meet their needs and respects their dignity and individuality. This is achieved through assessment, planning and regular review of each service user’s needs, in consultation with them and their nominated representative/family member/people. Each service user is fully informed about service choices and their rights and responsibilities as a service user. This information is provided in a format appropriate to their needs and communicated in a way that is culturally acceptable to each service user.	1.1 Assessment Each service user is supported to actively participate in an assessment of their care needs. The assessment is conducted by appropriately experienced staff and considers: eligibility, priority of access, independence, physical, social, emotional and cultural care needs and clinical care needs, where applicable and with the agreement of the service user. Guide to requirements: The assessment includes each service user’s: life story medical history functional, cognitive and sensory status nutritional status/needs personal care needs special care needs clinical risk factors. and where applicable: assessment of the resident’s ability to smoke safely, including the need for, and level of, supervision
	1.2 Care Planning Each service user has a documented care plan that addresses their identified care needs and preferences. This includes a cultural support plan which describes how assessed needs and service user preferences will be met in a culturally safe way. The care/cultural support plan includes strategies to maintain privacy and dignity, individual interests, customs and beliefs, independence and family connectedness. Guide to requirements: The care plan addresses: all assessed needs and preferences of the service user. what action is to be taken to meet assessed needs and preferences of the service user in a culturally safe and respectful way. who is responsible for what care (including family members and/or other providers). when and where care is to be received (ensuring a culturally safe environment).
	1.3 Review Each service user is monitored to ensure: service delivery occurs as planned, their needs are regularly reassessed and the care plan is updated in consultation with the service user to reflect any change in needs and service user preferences. Guide to requirements: The care plan addresses: occurs at least six monthly and where service user needs change identifies progress against planned goals/actions results in any change in needs and preferences being documented in the care plan.

Top of page

1. Care Delivery and Information Each service user has access to and receives quality aged care services that meet their needs and respects their dignity and individuality. This is achieved through assessment, planning and regular review of each service user’s needs, in consultation with them and their nominated representative/family member/people. Each service user is fully informed about service choices and their rights and responsibilities as a service user. This information is provided in a format appropriate to their needs and communicated in a way that is culturally acceptable to each service user.

1.4 Clinical Care Each service user’s clinical care needs are met. Guide to requirements: Each staff member works within their scope of practice. Clinical care needs include, as applicable: special care needs safe and effective management and administration of medication effective assessment, treatment and management of pain access to specialised palliative care services access to other specialist health care/allied health services functional care cognitive care sensory care nutritional care personal care. Note: The requirements within this outcome may have limited applicability, or not be applicable to some organisations.

1.5 Information Each prospective service user is fully informed about service choices and their rights and responsibilities as a service user. Guide to requirements: information about available services and eligibility to receive services is clearly documented. This information is communicated in a manner that is appropriate in format and culturally acceptable to each prospective service user to support choice and decision making each service user is offered a service agreement by the service provider which sets out the terms and conditions of the service/s to be received and the service user’s rights and responsibilities1 the service provider ensures that the content of the service agreement is fully explained to each service user (and/or their representative) in a culturally acceptable way prior to entering into the agreement a process is in place to enable service users to be represented by an advocate of their choice.

Top of page

2: Management and Accountability The service provider has implemented systems and processes which ensure the organisation is well managed and services are continually improved. This results in the delivery of culturally safe, quality services that are responsive to the needs of each service user, their representatives, staff and other stakeholders.

2.1: Governance The service provider has clear and effective governance processes in place. Guide to requirements: Board/Committee members have appropriate skills, knowledge and experience to carry out their role Board/Committee members have an understanding of, and promote culturally safe service delivery the roles and responsibilities of the Board/Committee are documented meeting minutes and other records evidence that the Board/Committee carry out their roles and meet their responsibilities planning occurs to set strategic directions and promote the delivery of culturally safe quality aged care services the service actively engages with and consults the community about the services available and reflects this in service planning.

2.2: Management Systems The service provider has clear and effective management systems and practices in place. Guide to requirements: the service provider understands and complies with the funding agreement, including the service provider guidelines the service provider understands and complies with regulatory and relevant legislative requirements management and staff accountabilities and delegations are documented, relevant to their roles service planning and development occurs and aligns with the organisation’s strategic directions financial, human and physical resources are allocated and used in ways that support quality care services that are delivered in a culturally safe and comfortable environment information management systems are in place to ensure the service users’ right to privacy, dignity and confidentiality in relation to the use of and collection of personal information information management systems are in place to ensure the safe and secure storage of documents and records, and enable effective use of information to meet the needs of each service user, staff, management and regulatory bodies a process to manage positive feedback, complaints and allegations is in place which is effective, accessible, and culturally acceptable to stakeholders the service provider works in partnership with other organisations to maximise access to services and/or enhance service delivery a continuous quality improvement program is in place to monitor and improve: the care and services provided to service users, and the management systems and practices of the service provider.

Top of page

2: Management and Accountability The service provider has implemented systems and processes which ensure the organisation is well managed and services are continually improved. This results in the delivery of culturally safe, quality services that are responsive to the needs of each service user, their representatives, staff and other stakeholders.

2.3: Risk Management A risk management framework is in place to ensure the safety of service users, staff and other stakeholders, and that quality care services are delivered. Guide to requirements: effective financial management processes are in place to ensure the service is, and remains, financially viable. Financial risks are identified and managed in an appropriate manner an asset management program is in place purchased goods and services are of a standard that ensure the delivery of quality aged care services procedures are in place for the management of emergencies including natural disasters effective infection control procedures are implemented procedures are in place to identify and address potential risks associated with: the physical environment chemicals or dangerous goods laundry services kitchen and food handling cleaning fire equipment open fire supervision Procedures are in place to identify and manage risk related to service delivery.

2.4: Human Resources Effective staff recruitment and retention ensure that service users’ needs are met. Guide to requirements: recruitment and retention processes ensure sufficient staffing levels are maintained at all times for the delivery of safe services services are provided by appropriately skilled staff that have an understanding of the cultural needs of the key stakeholders, including service users all staff and volunteers have a current police check that complies with the funding agreement staff and volunteers are provided with training and development activities relevant to their role an effective performance appraisal process is implemented for staff and volunteers.

prev page| TOC |next page