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

11.5 - Receptive context for change

Up to Publications

prev page| TOC |next page

Respondents identified a number of areas where there was a ‘disconnect’ between the culture of those working in aged care and that of its regulators. One example cited was the inherent ‘tension between providing a home-like environment and the need to provide good clinical care’. While the aspirations of ‘home-like’ were generally agreed, it was noted that this can be difficult to maintain in situations where residents need high level clinical care, and occupational health and safety concerns of staff need to be managed.

Another example was DoHA ‘pushing the importance of having a good care plan’ which was translated by some staff as being a ‘requirement’. Many of the EBPRAC projects involved the introduction of including new assessment, monitoring and care planning processes. It was noted that these may be perceived by some staff as additional paperwork to fill in to ensure they ‘pass’ accreditation, and avoid sanctions. Several respondents noted that this was indicative of sectors within the industry that continued to have a ‘siege’ mentality, and who viewed accreditation as a ‘stultifying, rather than entrepreneurial or invigorating process’. A reframing of these regulatory requirements was required to move these groups from a ‘compliance focus’ to a ‘continuous improvement approach’ which, as one respondent noted, would be ‘not only evidence-based practice but evidence-generating’.

All respondents highlighted the role of leadership, particularly clinical leadership, as being critical to ensuring evidence-based practice is implemented and sustained. As one respondent noted
Evidence based practice needs to be embedded into an organisation’s culture … leadership is absolutely critical.
A number of respondents pointed out the relative decline in the number of registered nurses in aged care which has impacted on the uptake of evidence-based care, and its sustainability. One nursing profession representative commented that the increasing reliance on enrolled nurses was worrying, as they did not have the ‘overall clinical expertise’ necessary to anticipate, prevent, assess, and manage the range of clinical issues with which an aged care resident could present. Similarly, a number of registered nurses interviewed who were employed in administrative, research and program management roles commented about the lack of support for those in clinical leadership positions within an organisation by those who control operational aspects, including budgets and staffing

A small number indicated a preference to see ‘national benchmarks’ or mandated staffing levels, particularly in relation to registered nurses in aged care, in recognition of the increased clinical complexity of residents within the sector. Not all agreed, however, as some felt that there were opportunities to better equip and support clinical leaders to utilise and develop their skills, through re-allocation of some of the more time-consuming administrative and management functions they currently undertake.

Structural features to facilitate evidence-based practice were evident in a number of ways, including having evidence-based practice, often in combination with person-centred care, articulated at a strategic level and underpinning different aspects of an overall service model and procedures. As one respondent noted, consumer-centric cultures ‘have the support from management … you won’t get it in places where there is not good leadership’. Two large aged care organisations interviewed provided details of the clinical governance/leadership committees they had instituted, which were responsible for liaising with the broader sector to identify contemporary, evidence-based practices, and disseminating findings across the organisation. It was noted that such committees were in a position to influence resources, strategy and processes of the organisation to facilitate and underpin new initiatives.

The education and training agendas of organisations were used to reinforce these concepts, often through linking with tertiary organisations or offering credits towards post-graduate study. Again, these were generally larger organisations which had the critical mass to drive such initiatives. One organisation went further, embedding evidence-based practice and person-centred care within staff position descriptions and performance appraisals. Another provided financial incentives for staff to demonstrate their commitment to and promotion of evidence-based practice and person-centred care. There was also a strong view amongst respondents of the importance of engagement with all levels of an organisation in any future evidence-based practice initiatives. One-off training initiatives directed at specific classes of staff were considered insufficient to engender changed care practices which are sustainable.

While respondents strongly acknowledged the calibre and skills of many aged care clinical managers and leaders within the sector, there was a sense that those outside the sector did not appreciate the range and complexity of skills they possess e.g. those working in the acute sector and/or clinical specialties. The lack of a ‘professional identity’ which enables them to articulate their skills also impacts on their ability to advocate on issues which affect their practice, including the implementation of evidence-based research outcomes. It was noted that initiatives have been established in recent years, such as a mentor development program provided by a peak body, practice development programs within some of the larger organisations, and the formation of the Nurses in Management Aged Care group. However, these are all membership/provider driven, and have no systemic, guaranteed ongoing support or external recognition. Greater focus of effort to develop, resource and sustain clinical leaders was considered necessary to provide a receptive context for evidence-based care to be provided within the sector.
Top of page

prev page| TOC |next page