Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report
9.2 - Likely consequences of not addressing continuing community needs or problems
- Key Messages
- Executive Summary
- About This Report
1 - Introduction- 2 - Evidence, Changes in Practice and the EBPRAC Program
- 3 - Program Delivery/Implementation
- 4 - Program Impact
- 5 - Capacity Building
- 6 - Generalisability
- 7 - Sustainability
- 8 - Dissemination
9 - Appropriateness- 10 - Cost Implications for Government and Aged Care Providers
- 11 - Perceptions of High-Level Stakeholders
- 12 - Discussion and Conclusions
- 13 - Recommendations
- References
- Appendices 1 to 6
- Appendices 7 to 12
- Appendices 13 to 17
Aged care providers will continue to need a workforce which has contemporary clinical skills to underpin effective care delivery. Therefore, there is a high likelihood of the need for ongoing investment and focus of effort (by government and/or the sector) to facilitate access to and application of evidence-based practice. Programs such as EBPRAC have a role to play in enabling the sector to meet the needs of an older and increasingly diverse population.
The experience of the EBPRAC program has confirmed that the key success factors identified in the literature review undertaken at the commencement of the evaluation are a useful mechanism for ‘framing’ the implementation of evidence-based practice in residential aged care (see Section 3.11). Stakeholders highlighted the importance of leadership, the main elements of which have been identified (in a systematic review funded by DoHA) as inspiration, transformation, direction, trust, empowerment, creativity, innovation and motivation (Jeon, Glasgow et al. 2010). Research in New South Wales indicates that the change management aspects of a facility manager’s role have been ‘largely ignored or taken for granted’ and that there are many ways in which facility managers can be supported in managing change (Shanley 2005).
The lessons learnt from the EBPRAC program about the importance of leadership indicate that any future initiatives to improve clinical practice, whether the rationale is based on implementation of evidence-based practice or not, should be underpinned by a systemic approach to developing the particular skill sets and attributes that aged care clinical managers require. Without a focused effort on developing clinical leadership there will continue to be limits to the extent to which evidence-based practice is initiated, implemented and sustained, within individual facilities and across the sector.
The interviews with high level stakeholders (see Section 11) identified particular barriers to the sustainability of evidence-based practice – reduced numbers of qualified staff; a culture of ‘compliance’ which inhibits innovation; limited opportunities for staff to participate in education and training; and variable access to information technology. There was also recognition of the need for a national approach to dissemination of evidence-based resources. Evidence-based practice does not happen in isolation from these broader considerations.
These challenges have been recognised by the Australian Government, which has commissioned the Productivity Commission to undertake a review of the aged care sector. The mandate of the review includes ‘social, clinical and institutional aspects of aged care’, consideration of ‘options for reforming the funding and regulatory arrangements’ and ‘transitioning … to a new system that ensures continuity of care’ (Productivity Commission 2010, pp 2-3). These foundational aspects of residential aged care need to be addressed if the education delivered, resources developed and systems implemented under EBPRAC are to be sustained and applied to the sector more generally.
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