Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

10.1 - Cost implications for government

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Based on data provided by each project the inputs for the program have been quantified, both in terms of expenditure and in terms of full-time equivalent staff. However, there are some key issues that need to be considered:

• Inputs for the program included a significant component for evaluation.
• The projects were relatively short-term in nature. In addition they started from a situation in which there was effectively no existing program. Therefore there were significant ‘establishment’ costs involved (e.g. recruiting staff, establishing relationships, developing materials, ensuring project staff themselves were well trained). Over a longer time frame the proportion of costs related to these initial ‘establishment costs’ would be significantly reduced.
• Governance costs are also likely to be significant for projects of this nature initially, but are likely to diminish over time.

Projects were asked to estimate costs across four phases, distinguished by the purpose of the expenditure – project governance, project establishment, project implementation and project evaluation. The results are summarised in Table 24. There are some, mostly minor, differences between the total amounts for each project in this table and the budget for each project in Table 1 at the beginning of this report.

Table 24 Estimated project expenditure by purpose of expenditure

Project No.	Expenditure by phase of project ($)				Total
	Governance	Establishment	Implementation	Evaluation
1	193,558	33,060	726,573	107,485	1,060,676
2	90,865	62,000	271,310	357,890	782,065
3	153,240	33,275	808,045	107,220	1,101,780
4	1,300	31,000	1,139,940	123,000	1,295,240
5	166,588	48,671	195,554	96,647	507,460
6	130,785	41,816	427,299	64,979	664,879
7	-	20,000	435,341	260,784	716,125
8	97,500	13,500	507,253	137,100	755,353
9	95,288	125,165	381,464	271,563	873,480
10	173,239	115,065	879,583	210,363	1,378,250
11	242,991	45,094	288,670	104,764	681,520
12	248,173	27,847	475,707	138,146	889,873
13	29,856	111,636	846,353	166,155	1,154,000
Total	1,623,383	708,129	7,383,092	2,146,097	11,860,701
% of total	14%	6%	62%	18%	100%

To allow for the different amounts of money allocated to each project the same data is presented in Table 25 as percentages to give an indication of how each project allocated expenditure in proportion to the size of their budget.

The data in Table 24 and Table 25 should be treated with some caution as the amounts are estimates only. For example, it is very difficult in some cases to separate out expenditure on implementation from expenditure on evaluation when a particular activity (e.g. baseline auditing) may have been used both for evaluation and implementation (by feeding the results back to facility staff to inform goal setting and action plans). What is notable is the very high cost of evaluation for three projects (31%, 36% and 46%) which skews the average amount of money devoted to evaluation (18%). The median cost was 15%.

Table 25 Percentage of project expenditure by purpose of expenditure

Project no.	Expenditure by phase of project ($)				Total
	Governance	Establishment	Implementation	Evaluation
1	18%	3%	69%	10%	100%
2	12%	8%	35%	46%	100%
3	14%	3%	73%	10%	100%
4	0%	2%	88%	9%	100%
5	33%	10%	39%	19%	100%
6	20%	6%	64%	10%	100%
7	0%	3%	61%	36%	100%
8.	13%	2%	67%	18%	100%
9.	11%	14%	44%	31%	100%
10	13%	8%	64%	15%	100%
11	36%	7%	42%	15%	100%
12	28%	3%	53%	16%	100%
13	3%	10%	73%	14%	100%
Total	14%	6%	62%	18%	100%

Table 26 summarises the expenditure, across all projects, of both salary expenditure and other expenditure devoted to implementation. For the purposes of data collection ‘other implementation expenditure’ consisted of three expenditure categories: payments to participating facilities, travel costs and other operating expenses. Implementation activities cost an average of $59,000 per participating facility across the whole program. This gives an indication of what a differently structured program might cost, one where governance and establishment costs were borne by facilities (which might be quite low depending on the nature of the project) and there was no evaluation.

Table 26 Implementation expenditure per facility

Expenditure item	Average cost
Salary expenditure on implementation per facility	$36,000
Other implementation expenditure per facility	$23,000
Total implementation expenditures per facility	$59,000

Each lead organisation was asked to identify how much time was spent by each person employed on their project on the four project phases. The time spent on implementation activities was also estimated for each staff member (see Section 3.3.2 for details). The most time consuming aspect of implementation was the time spent establishing, organising and delivering the various education programs undertaken by each project which represented 12.9% of total project staff time. Details of the education and training are included in Section 5.1. The data were linked to data about project costs to arrive at a salary cost for training staff. Details of the number of staff trained and the salary cost of doing so are included in Table 27. On-the-job training was generally conducted 1:1.

Table 27 Numbers of staff trained and training costs

Form of staff training	Total trained	Average salary cost per staff member trained
Staff trained through training workshops	4,767	$103
Staff trained through academic detailing	1,333	$163
Staff trained through other on-the-job training	1,119	$322

The data in Table 27 provides an indication of the sort of trade off that needs to be made when deciding how education should be provided. As indicated elsewhere in this report the literature generally supports 1:1 and small group education as being more effective than larger ‘workshop’ style education (Forsetlund, Bjorndal et al. 2009) but this needs to balanced against the additional cost, as indicated in Table 27. It is difficult to judge whether the mixed outcomes achieved by the various education and training programs in the EBPRAC program (see Section 4.4) are consistent with the findings from the literature but there is a general sense that staff prefer more individualised, small group, education.

Another important cost in the program has been the cost of identifying, working with and supporting local facilitators (e.g. champions, link nurses) in the 10 projects which adopted this approach to change management. The 177 facility-based champions trained as part of the EBPRAC program cost an average of $2,197 in salaries and wages for project staff. No attempt has been made to allow for the different periods of time each week that these facilitators were employed in the role. As with all the other data that relies on estimates of how people have spent their time this cost is an estimate only.

Travel costs varied from a low of 2% to a high of 10% of total costs, averaging 7% across all projects, a total of approximately $640,000. Not surprisingly, the lead organisations with the lowest travel costs (2% and 3%) were located in Melbourne with all their participating facilities in close proximity.
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