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

11.7 - Future directions

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A number of themes emerged from the interviews regarding how to ensure best practice is implemented and embedded within residential aged care – clinical leadership, learning and development, accessibility of resources and engagement of stakeholders.

Clinical leadership

A consistent theme from the interviews was the need to recognise, articulate and support clinical leadership. Having a professional identity was considered by almost half the respondents to being a critical first step to improve awareness, engagement, and leadership of clinical nurses – i.e. registered nurses – within aged care. This would include an articulation of the clinical skills needed to support residents requiring increasingly complex care with a broader set of managerial skills.

A number of respondents spoke of the need for a national approach to facilitating a clinical leadership profile within residential aged care. It was felt that the stakeholder consultation and advisory mechanisms currently employed by DoHA e.g. Ageing Consultative Committee, and Ageing Workforce Committee, provided an opportunity to identify priority areas for ongoing clinical skills enhancement, as well as being possible vehicles for dissemination of program findings, and advice regarding implementation issues. Fundamentally, however, the key message from respondents was the need for an ongoing focus by government into initiatives or mechanisms to support a viable and sustainable cohort of clinical leaders within the sector.

Learning and development

Some respondents pointed to the opportunities that the new national registration and accreditation scheme for health professionals provides, linking credentialing with professional support and advice, and the provision of educational opportunities. An example of such an initiative is the Royal College of Nursing, London, which is funded to coordinate and deliver a range of practice development initiatives, which are automatically linked to registration records, providing up to date records of who has done what in the sector. Such a development would assist in facilitating a community of practice amongst nurses working within leadership positions within the aged care sector. Suggested areas of focus include mentoring skills, Total Quality Management, strategic perspectives, clinical crisis response and reflective practice.

Clinical leadership needs to be underpinned by a sound learning and development framework which takes a holistic approach in recognition of the variety of factors (staffing, organisational, resourcing) that facilitate the embedding of evidence-based practice. A number of suggestions were made by respondents, including the provision of a learning and development levy by Government targeted at assisting staff to access academic qualifications or similarly credentialed educational opportunities. Suggestions included using the funding to assist new graduates pay off their HECS debt; payment of fees for staff to enrol in post-graduate courses; and providing subsidised access to clinical resources such as the Joanna Briggs Institute. These could be provided as an enhancement to the current suite of workforce initiatives available within residential aged care (see Section 9.1). There was general recognition of the investments which had been made by government in recent years to provide scholarships for staff working in aged care, and inducements for nurses to return to the workforce. However, there was some difference in perspective about the administration of these initiatives, whether they had targeted the right people, and whether the anticipated benefits had been realised.

One respondent suggested financial incentives (bonuses) for staff who have achieved additional qualifications. A number of the larger aged care providers (mainly not-for-profit) are trialling these approaches from within their own budgets; however all agree that there could be much greater benefits and uptake of educational opportunities if funding were made available across the sector.

Accessibility of resources

The importance of staff being able to access credible, contemporary best practice advice and information which was targeted to their needs was a recurring theme. There was general acknowledgement of the range of resources already available but that the variety of potential sources of information required some guidance to direct staff to appropriate resources in a timely fashion. The resources and outcomes of the EBPRAC program were acknowledged to be a significant resource which should be made more generally available.

Some respondents highlighted the need for a national approach to disseminating resources and continuing to make them available in the future. A particular concern was the additional cost required to ensure materials were current and to facilitate distribution. It was recognised that DoHA and the Aged Care Standards and Accreditation Agency both had roles in disseminating resources but many considered that this might not attract a sufficiently wide enough audience. In particular, it was felt that the roles of these two organisations were predominantly associated with funding and compliance, rather than enhancing best practice. There seemed to be general consensus that an information/resource portal/site would be best provided by a university or organisation which was recognised as having a track record in evidence-based research and professional development within the sector. Such a function would invariably require additional investment, to enable the responsible agency to collate information (developed under EBPRAC as well as from other sources), maintain its currency, and disseminate advice and developments across the sector in a timely and accessible manner.

Engagement with stakeholders

There was general recognition of the importance of an ongoing dialogue between elements of the sector (management, clinical staff, care staff) and policy makers to ensure future policy and program development occurs in a structured, effective and timely manner. A number of those interviewed were members of national committees currently convened by DoHA, however their level of awareness regarding the EBPRAC program was not better than most of the others interviewed. In the main, respondents felt that DoHA needed to consult with the sector about the major outcomes from EBPRAC, the implications for practice, and opportunities to promote, disseminate and implement findings. The inclusion of consumers in this process was also recognised as important.
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