The Aged Care Standards and Accreditation Agency Ltd Continuous Improvement in Residential Aged Care

The Aged Care Standards and Accreditation Agency Ltd Overview Section One: An introduction to continuous improvement  What is continuous improvement?  Legislative background  Links between self-assessment, continuous improvement and strategic planning  Benefits

The Aged Care Standards and Accreditation Agency Ltd What is continuous improvement ? Continuous improvement:  Involves lifting performance in each of the four Accreditation Standards and the 44 expected outcomes  Is part of an overall quality system, focusing on systematic and integrated improvements with clearly defined objectives  Is evidence-based  Is a results-focused activity which can be demonstrated through outputs and outcomes  Ranges in scale from smaller programs to significant strategic initiatives

The Aged Care Standards and Accreditation Agency Ltd The Accreditation Standards Standard 1:  Management systems, staffing and organisational development Standard 2:  Health and personal care Standard 3:  Resident lifestyle Standard 4:  Physical environment and safe systems  9 expected outcomes  17 expected outcomes  10 expected outcomes  8 expected outcomes

The Aged Care Standards and Accreditation Agency Ltd Legal responsibilities of approved providers  The Accreditation Grant Principles 1999 specify: - that the residential care service complies with the Accreditation Standards and its other responsibilities under the Aged Care Act that a process of continuous improvement is undertaken, measured against the Accreditation Standards

The Aged Care Standards and Accreditation Agency Ltd Legal responsibilities of approved providers  That a “plan for continuous improvement” for the home must be submitted to the Agency  That the plan should include how the home will address any matters identified for improvement by the assessment team during site audit  That the plan be in a form approved by the Agency

The Aged Care Standards and Accreditation Agency Ltd The link between continuous improvement and strategic planning  Aims to raise the quality of service the home provides to residents  Strategic approach to the organisation’s vision, mission, values and objectives  A management plan including setting strategic goals, operational management and conduct of care and services

The Aged Care Standards and Accreditation Agency Ltd The link between continuous improvement, self-assessment and the accreditation process  The accreditation process is designed to assess homes’ performance against the Accreditation Standards  The accreditation process requires self-assessment against the 44 expected outcomes that make up the four Accreditation Standards  Homes must provide a “plan for continuous improvement” to the Agency  Informs the home’s management of the results achieved through improvement projects previously implemented

The Aged Care Standards and Accreditation Agency Ltd Self-assessment results  The self-assessment process against the 44 expected outcomes will lead to a range of possible improvements being identified by a home  These improvements may be: - to ensure compliance with an expected outcome or - to improve performance in an expected outcome where the home is already compliant

The Aged Care Standards and Accreditation Agency Ltd The link between self-assessment and continuous improvement Self Assessment Plan for Continuous Improvement Continuous Improvement Activities

The Aged Care Standards and Accreditation Agency Ltd Self-assessment results  A simple four-step model for self-assessment is described in the Agency’s updated education package Self- assessment for Residential Aged Care Services – available at

The Aged Care Standards and Accreditation Agency Ltd Benefits to be gained from continuous improvement  Residents’ needs better identified and met  Improvements in outcomes for residents and other stakeholders  More effective services  A cooperative approach to improvement which brings groups of stakeholders together  Greater efficiency in resource allocation

The Aged Care Standards and Accreditation Agency Ltd Overview Section Two: The principles of continuous improvement  Overview of the principles  Customer focus in detail  Case study

The Aged Care Standards and Accreditation Agency Ltd Principles of continuous improvement  Strategic planning and implementation  Clearly defined objectives and outcomes  Resident focused  Involvement of key stakeholders  Encouragement of innovation  Utilisation of a range of approaches and techniques  Regular monitoring and evaluation

The Aged Care Standards and Accreditation Agency Ltd Customer focus in detail This section looks at customers in greater detail, with a focus on residents in aged care homes

The Aged Care Standards and Accreditation Agency Ltd Resident input Input should:  Be structured so that the most information can be gathered in the best form  Be thought through carefully during development, including talking to residents about obtaining their input  Allow for documentation and collation of the results  Be reviewed regularly to assess whether it is actually providing useful information to enable improvements to be made, and  Include feedback to the people who provided input

The Aged Care Standards and Accreditation Agency Ltd Obtaining customer (resident) feedback  Surveys, questionnaires  Interviews  Focus groups  Suggestion schemes  Complaints monitoring  Resident meetings  One-on-one discussions  Care planning meetings

The Aged Care Standards and Accreditation Agency Ltd Customer (resident) feedback  Record it!  Use it!

The Aged Care Standards and Accreditation Agency Ltd XYZ nursing home case study Resident focus Group exercise: - Read the case study supplied in the education package - Discuss the case study approaches to resident focus -As a team, look at and complete the exercise

The Aged Care Standards and Accreditation Agency Ltd Overview Section Three: Continuous improvement in detail  A cycle of continuous improvement  A simple model for continuous improvement activities  Identifying continuous improvement opportunities  Case studies  Evaluating the approach to continuous improvement

The Aged Care Standards and Accreditation Agency Ltd A cycle of continuous improvement The home’s approach to continuous improvement should:  Focus on improvement as opposed to maintenance of existing performance levels  Achieve demonstrable improvement in care and services  Be planned and systematic at all levels of the organisation, and  Involve measurement of results against the Accreditation Standards

The Aged Care Standards and Accreditation Agency Ltd A simple model for continuous improvement activities  The Agency uses a simple four-step model to manage continuous improvement activities.This is one model that could be used, there are many other models and systems to help homes improve  This model can be used at any level of the home: - Service wide level - Clinical care level - Support service level - Staff team level - Individual staff member level

The Aged Care Standards and Accreditation Agency Ltd A simple model for continuous improvement activities Step 1 Plan the improvement Step 2 Implement the improvement Step 3 Check how well the improvement has worked Step 4 Decide next steps

The Aged Care Standards and Accreditation Agency Ltd Step 1: Plan the improvement Step 2 Implement the improvement Step 3 Check how well the improvement has worked Step 4 Decide next steps Step 1 Plan the improvement

The Aged Care Standards and Accreditation Agency Ltd Step 1: Plan the improvement  This level of planning is more detailed than the “plan for continuous improvement”  It involves planning for individual activities  This occurs at specific team or staff levels, as opposed to involvement of the entire service

The Aged Care Standards and Accreditation Agency Ltd Step 1: Plan the improvement  Identify the expected outcome that the improvement relates to  The results expected to be achieved  The overall objective  The timeframe in which the result is to be achieved  The actual steps involved  Outputs/milestones to be achieved  Staff members involved in each step  Measurement of results/improvements

The Aged Care Standards and Accreditation Agency Ltd Step 2: Implement the improvement Step 1 Plan the improvement Step 3 Check how well the improvement has worked Step 4 Decide next steps Step 2 Implement the improvement

The Aged Care Standards and Accreditation Agency Ltd Step 2: Implement the improvement Now is the time to put the improvement in place!

The Aged Care Standards and Accreditation Agency Ltd Step 2: Implement the improvement As the staff go about making the changes indicated in their plan, thought can be given to:  Ensuring the involvement of the appropriate staff  Ensuring residents and staff are informed as appropriate  Ensuring that the steps are documented  Seeking feedback along the way As the improvements are implemented, you will start measuring those improvements. The results of the improvements will then help you to know if they have worked well or not.

The Aged Care Standards and Accreditation Agency Ltd A simple model for continuous improvement activities Step 1 Plan the improvement Step 2 Implement the improvement Step 4 Decide next steps Step 3 Check how well the improvement has worked

The Aged Care Standards and Accreditation Agency Ltd STEP 3: Check how well the improvement has worked This step is to evaluate how effective the improvement effort has been. This step can often be overlooked in the enthusiasm to improve and make a difference!

The Aged Care Standards and Accreditation Agency Ltd A simple model for continuous improvement activities Step 1 Plan the improvement Step 2 Implement the improvement Step 3 Check how well the improvement has worked Step 4 Decide next steps

The Aged Care Standards and Accreditation Agency Ltd STEP 4: Decide the next steps Possible situations at this stage:  The improvement activity has been successful – well done!  The improvement activity has been partially successful and staff need to make further improvements  The improvement activity has been unsuccessful and staff need to make further improvements

The Aged Care Standards and Accreditation Agency Ltd Identifying continuous improvement opportunities It is quite likely that a home could develop more improvement ideas than it can undertake all at once This means that you should prioritise and plan the continuous improvement activities you will be doing The identified improvements can be grouped in an order that is logical to your home –  According to Accreditation Standard  According to clinical or support care processes  According to responsibilities

The Aged Care Standards and Accreditation Agency Ltd Planning for continuous improvement As you prioritise improvement activities, you may be able to see links that can assist you. Several issues or expected outcomes could be addressed through one improvement activity. The “Results and processes in relation to the expected outcomes of the Accreditation Standards” handbook lists links between expected outcomes

The Aged Care Standards and Accreditation Agency Ltd Planning for continuous improvement  Identify desired/possible improvements - from self assessment - Agency required improvements  Prioritise and plan the improvements, considering: - resources - timeframes - responsibilities

The Aged Care Standards and Accreditation Agency Ltd Consider the following when prioritising improvements  Which are required to ensure compliance with the Accreditation Standards?  Which bring most benefit to residents?  Will some improvements have a positive impact on a number of expected outcomes?  Which are required from the Agency’s audit results?  What does your feedback tell you what residents, staff and managers are most supportive of?  Which are most likely to succeed?  Are there some ‘quick wins’?

The Aged Care Standards and Accreditation Agency Ltd Individual continuous improvement activities Once you have identified, prioritised and planned your improvements on your “plan for continuous improvement”, you will be ready to manage the individual improvement activities

The Aged Care Standards and Accreditation Agency Ltd XYZ nursing home case studies Group exercise: - Read the case studies supplied in the education package - Discuss the case study approaches to continuous improvement activities -As a team, look at the exercise for continuous improvement looking at Standards Three and Four for your nursing home

The Aged Care Standards and Accreditation Agency Ltd Evaluating and improving the approach to continuous improvement How an organisation goes about planning and managing continuous improvement activities can also benefit from evaluation and improvement  What was your home’s plan regarding continuous improvement?  What actually happened? Did the activities go as planned?  What were the results? Were they as planned? What was the benefit for residents? What benefits were gained by your home?  What can be done to further improve the home’s approach to continuous improvement?