Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report
11.6 - Clinical indicators
- 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
There was general consensus that EBPRAC provided the potential for the development of a coherent set of clinical indicators for the sector. A number of respondents pointed out that the clinical areas covered under EBPRAC are consistent with the indicators already available, e.g. the Draft Quality Indicator Set included as Appendix C in the report Evaluation of the impact of accreditation on the delivery of quality of care and quality of life to residents in Australian Government subsidised residential aged care homes – final report (Commonwealth of Australia 2007). In addition, one major provider indicated the use of a commercially available audit program that encompasses the 4 standards and 44 outcomes detailed in the aged care accreditation standards (available at https://www.movingonaudits.com.au).
As noted in Section 9.3, the clinical issues addressed in existing materials are generally the areas which cause most complaints and/or incidents within health and aged care settings. While this is recognised as a valid approach to identifying the key issues to be measured, some respondents argued that it reinforces the ‘compliance mentality’ i.e. these are the things you must do to ensure you are doing ‘no harm’ to residents. To that extent, the focus continues to be on harm prevention, rather than health and well-being optimisation.
Some respondents highlighted the need to move beyond this ‘duty of care’ approach to look at more positive indicators, to measure ‘how do we know we are doing well?’ There was a sense that the sector needed to move to an ‘excellence in clinical practice’ mentality, however it was also acknowledged that this would require a ‘massive cultural shift’ within the sector, including at the government, research and service provider levels. One industry representative commented that the current EBPRAC topics were ‘too narrowly focused’ and indicators were needed regarding issues such as the social needs of residents, supports required for the role of the registered nurses in residential aged care, as well as clinical indicators for community care.
Clinical indicators were generally held to be positive drivers of change, in particular if they incorporated some of these more positive and broader definitions. There was recognition, however, that there were a number of ‘underlying pre-requisites’ within organisations such as having the relevant systems in place to collect data and support improved practice, as well as a culture that embraced a total quality management approach. The question remains as to who is responsible for establishing and driving the clinical indicators which reflect more contemporary and enabling care practices. It was pointed out that a number of organisations had been contracted in recent years to develop clinical indicators for the sector, but these had not been widely circulated. It was also felt that the data already being collected – by DoHA and the Aged Care Standards and Accreditation Agency – were not well utilised in determining potential indicators for the sector. There was some consensus regarding the process by which the indicators should be developed; a number of respondents highlighting the importance of having a collaborative approach, which included government, providers and academics. However, none of the respondents mentioned the role consumers (residents and their families) might play in this process.
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