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Perhaps the most powerful evidence heard at the Royal Commission into Aged Care Quality and Safety (aged care royal commission) were the firsthand accounts from care recipients and their families. Now, following the commission’s final report, two key themes relating to consumers have emerged. First, aged care providers must focus on continuous improvement and true quality systems if they are to achieve consistently great care for each person. This means moving well beyond minimum standards required by regulators, as well as embracing digital capabilities. Second, providers must apply a consumer-experience lens.
From strategy and governance to infrastructure and operations, providers must ensure that achieving the ideal experience of each person in their care, and their families, is at the heart of their organisation.
The 2020 Aged Care Experience Survey (a collaboration between PwC and Salesforce) showed aged care was the worst performing sector when it came to delivering on customer experience. Moreover, families and advocates of care recipients felt the aged care experience had changed for the worse in the past 12 months. While there is no doubt COVID-19 impacted this result, the downwards shift remains concerning.
So, how do aged care providers start to deliver quality care, with meaningful personalised experiences that will deliver a customer-centric approach?
While there are myriad inputs into quality care, four particular target areas are the foundations around which to transform your service delivery:
Consumers can expect to see greater transparency around providers’ operations as quality and safety recommendations, such as the introduction of a broader suite of quality indicators and performance reporting, kick in. It’s not just about operations, however, and providers are increasingly being expected to disclose information about their governance systems and controls to consumers. Here, expect to see providers leveraging technology to enable active monitoring and reporting of their control and compliance obligations.
The challenge for providers will be to continue to improve reporting to regulators and peak bodies but, at the same time, to throw open the doors to the public at large.
The Department of Health and the aged care royal commission have expanded the data published about providers (for example, the government’s My Aged Care website now offers a service compliance rating, assessing the performance of aged care homes nationally); however, provider-generated information about performance, particularly from a quality and safety perspective, is harder to come by in the public domain.
Reporting by providers is often inconsistent and rarely digital. Much of what’s reported relates to a single incident or complaint and less is published about the day-to-day processes and controls at a care home. But this information is critical to consumer confidence and trust. Customers want to see that a consistent standard of care is being delivered, and that a robust process is in place to ensure sustained learning and improvement when things do go wrong.
The 2020 Aged Care Experience Survey found decision makers ranked ‘transparency around care being provided and overall health status’ the third most important area that could be improved by aged care providers (after ‘cost of care’ and ‘skills and knowledge of staff’).
Only 63% of decision makers are satisfied with their level of visibility over their relatives’ care, daily and weekly schedule, wellbeing and other updates.
Providers reporting on processes and systems of control will not only benefit from a more sophisticated understanding of their operations but importantly they’ll bolster trust among their customers.
Adoption of digital communications skyrocketed in aged care during COVID-19, and we can expect the trend to continue. Tech is increasingly being harnessed as a communication vehicle, allowing aged care recipients to engage with family and friends. For consumers, the feeling of being socially connected to families and their community can lower anxiety and depression, help regulate their emotions, lead to higher self-esteem and empathy, and actually improve immune systems. Most of all, though, it means providers are meeting that most powerful human need – the need for connection.
Providers are also turning to digital for virtual health consultations. The aged care royal commission recognised that virtual health consultations are not just achievable, but also beneficial.
The challenge for providers is taking the great strides they’ve made in digital connectedness during COVID-19 and turning those into sustainable ways of working. Giving aged care consumers access to the digital world and, by extension, the virtual health world will require investment in devices or digital portals. Aged care providers should consider establishing virtual consulting rooms with digital connectivity to host virtual care consultations. Residential care providers should also be equipped to bring virtual consultations into the home for in-home services.
Connectedness means different things to different populations and for many older Aboriginal and Torres Strait Islander people, maintaining connectedness relates not only to other people, but also Country and culture. The Aboriginal Medical Services Alliance Northern Territory recommends that, where Aboriginal people can’t be cared for on Country, they should receive funding to take trips back to Country and to enable family to visit. Providers must understand the needs of the communities they care for to ensure all that the feeling of connectedness is a reality for everyone.
The 2020 Aged Care Experience survey found almost 40% of decision makers felt their relative’s aged care provider wasn’t engaging effectively with them as a key stakeholder.
The way we think about aged care is fundamentally shifting from simply delivering the minimum required standard of care, to really maximising quality of life.
Choice is now high on the agenda, as reflected in the aged care royal commission’s final report and the federal government’s response, with progress towards the allocation of places to consumers rather than providers. The royal commission recommended expanding the remit of aged care, so that services are more holistic. By broadening what’s covered under aged care – adding, for example, respite care and allied health, and encouraging greater interaction with primary care (all recommendations which have been accepted by the federal government) – the sector is moving towards a more consumer-centric approach.
Providers must prioritise choice and consumer preferences by providing more personalised services. From food options at care homes, through to tailored allied health programs, aged care consumers are being empowered to make decisions about the services they receive and the ways they are delivered. From an operational perspective, providers need to consider how to collect, store and respond to these preferences, as well as what tools to use to deliver them consistently.
Again, there are still significant shortfalls in the industry. Our research showed 45% of respondents felt their aged care provider didn’t deliver customised and personalised care, while almost half (48%) felt their provider wasn’t using technology to enable a more independent lifestyle.
For providers seeking to put choice and personalisation at the heart of their services, a human-centred design approach will enable this.
For instance, a service blueprint that includes ‘moments that matter’ KPIs, as well as service delivery ‘pain points’, can direct efforts (and budgets) for maximum gain.
To this end, the National Aboriginal Community Controlled Health Organisation has called for a focus on the social, cultural and emotional wellbeing of care recipients, reinforcing the fact that aged care is about much more than just the physical needs of care clients.
One of the main themes in our commentary on the aged care royal commission’s interim report (2019) was the need for improved access within the aged care system. This was echoed in the aged care royal commission’s final report, which devoted a large number of recommendations to the issue of access. This has been taken up by the federal government, allocating $272.5 million to enhanced assistance for consumers to access and navigate the aged care system.
By access we mean:
In short, access means removing barriers to entry so that aged care is available to all. We believe there’s more to do when it comes to giving consumers access to the healthcare they need.
Increasingly, access to information and services is provided by government agencies and the commercial sector via digital channels. Providers should increase their accessibility by providing digital options for aged care recipients and their circle of care, which can be delivered in an increasingly cost-effective manner.
However, our research shows Australian aged care access is still not up to scratch – digital or otherwise. The 2020 Aged Care Experience survey found many aged care consumers and their families report a poor experience when it comes to finding a provider that meets their care requirements.
More than a third (42%) of decision makers rated their satisfaction with the experience of looking for a provider as six out of ten or less.
Those surveyed said it was ‘very difficult to traverse around the system’, that it was ‘very stressful because it was so expensive and it was hard to compare’, and that there’s ‘not enough information on what services you can or cannot get’. These challenges were exacerbated by language barriers, so providers and government must ensure interpreters are available to improve access to care.
Creating a shift to a person-centred organisation and prioritising the customer experience needn’t cost the earth. In fact, when structured the right way, a person-centred transformation can be cost effective, while providing huge impacts for aged care customers and staff.
Increasingly, organisations are delivering transformation projects in bite-sized pieces that produce tangible results at every stage of the project. This gives organisations the ability to evaluate the success of each investment before moving on to the next one.
For the aged care sector, this means projects that make an immediate difference to the lives of aged care recipients and their families, as well as to staff members. So where can you start?
Formulate your consumer vision.
Unlike your company’s vision, mission and value statement, this is where you gather yourself and those people who access and use your service, to agree on a standalone statement describing your vision for each person that you're accountable and responsible to care for. The ‘people we care for’ vision is referred to in decision making at all levels, such as committee meetings, planned projects, care provision, etc. to ensure people are placed first at all times. Someone should always be asking the question: will this benefit those we care for?
Create a service blueprint to define how you will serve consumers and support staff
By defining how you will deliver services, and address the key challenges of transparency, connectedness, choice and access, you can engage and rally the organisation to the cause. When staff understand the type of organisation you are trying to create, they can embrace the transition to a person-centred approach. A service blueprint is an excellent tool to articulate these themes in a simple to understand and collaborative way.
Prioritise projects for maximum impact (don’t try and solve everything at once)
Use your consumer vision as a tool to question, validate and prioritise each of your current and future projects, ensuring the safety and quality of care is the end goal with an improved person-centred experience. Communicate projects and obtain input from consumers, staff, family and community as your priority list may be very different from theirs.
Is there a focus on creating meaningful change to improve a person’s experience of your service?
True transformation in aged care empowers people, measures the whole experience - including individual outcomes - while maintaining a people-centric culture. It means driving quality of life and placing the safety, health and wellbeing of each person at the forefront, always.
It provides an opportunity to improve the whole care experience at every interaction through digitally enabled insights that are delivered accurately and in a timely period.
PwC’s Aged Care Transformed framework can help you to deliver purposeful, person-centred care, so you can deliver high quality, safe experiences with outcomes founded upon a structured approach that measures against expectations.
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