Profound changes to the aged care workforce are needed now

As our aged care sector continues its journey of reform and change, providers are firmly focused on how to deliver better outcomes for those receiving care now and into the future.

A central element in achieving this goal is having an effective approach to tackling workforce challenges. It’s also the key to creating a positive organisational culture, controlling costs, and improving quality, safety, and day to day operations.

The aged care sector is facing pressure being exerted at all levels of the organisation. Externally, there’s the unfolding fallout from the Aged Care Royal Commission, ACFI funding pressures, and industrial pressure for fixed staff ratios. Looking internally, many providers have an ageing direct care workforce, an increasing proportion of casual/part-time staff, specific budget pressures, recruitment issues and high levels of unplanned leave and turnover.  On top of that, the introduction of the new Aged Care Quality Standards is unsettling for clinical leaders and front line teams, concerned about the pressures of meeting new levels of compliance and scrutiny. Cumulatively these pressures are playing out to create the perfect storm for workforce tensions. 

Many providers face the reality of having a very distracted management environment for the next few years while their teams deal with fast-moving issues coming from all directions. In working with our clients it’s clear that every workplace is different and each has its own specific issues. 

The aged care system is a complex ecosystem

Michael Roberts - Grant Thornton Consulting

"The aged care system is a complex ecosystem where different facilities, geographies, and teams can vary enormously in terms of workforce challenges. There’s no magic bullet but there are key actions providers can take to successfully navigate this complex landscape."

Understand the situation (you can’t fix what you can’t see)

Perhaps the most crucial element in the journey is making sense of the various moving parts. This takes a combination of active leadership presence, listening, observing and analysing and monitoring meaningful data. Complex human systems cannot be managed by remote control alone. The consequences of that approach are all too visible at the moment. The value delivered to residents and clients, and the organisations reputation is created by the actions and behaviours of front-line staff. 

It’s common to find that leaders and Boards of Aged Care providers need a much clearer picture around workforce issues than they currently have. It is not enough to periodically monitor average monthly KPIs – that is the equivalent of steering a car down the road by watching the rear view mirror.  We need a stronger focus and better tools to provide insights into team culture and workforce dynamics (variations in turnover, leave patterns, recruitment, skills, and performance etc). That also means having better information flow up, down, and across the organisation.

Solutions can’t be defined and refined until there’s a clear view of the landscape. Having better knowledge lets us see pressure points and respond quickly and appropriately. Strategies might include people management, reward and recognition, recruitment, technology, change management, performance management, training and coaching, roster and coverage changes – whatever it takes. 

We recently completed some work with a client which provided powerful insights to help them better understand and manage their workforce environment. You can read more about that here.

Nurture good people – focus on culture

Team culture plays a critical role in attracting and retaining good staff. Providers most likely to be successful are those who bring their stated culture and values to life, and where they are genuinely embraced and felt by everyone. These are teams that create a place that people want to be in, with high job satisfaction, and a workplace which staff happily recommend to others.

Front line leaders play a critical role in ensuring that their workplace is one where the organisational values are lived in reality. Insincerity or a lack of alignment with the personal values of the staff is a recipe for burnout or disengagement. In a 24/7 service this means ensuring consistency across all shifts.

Recruit wisely

We have worked with providers who have almost identical services and a similar resident profile that operate in the same region. One has a waiting list of eager people wanting to work there, while the other has chronic recruiting issues. Reasons of team and management culture, job flexibility, reputation, and local practices are all contributing factors. It’s also important to have an understanding of the reasons for people leaving the organisation. Good people may be lost to the organisation because of lack of flexibility, a mis-match between the lived experience and personal values, not getting enough shifts, or local leadership issues. You don’t know why if you don’t ask and people won’t tell you the truth if you don’t ask in the right way.

For those services where staff turnover is high or recruitment is problematic it’s a good time to understand the contributing factors to the problem and question whether the current process is working effectively. Is the current recruitment approach effective – particularly for those using outsourced on-line recruitment services? While this approach might deliver a large number of applications and resumes, it may not bring candidates with the right attitude, skills and fit for the job.

Utilising the personal and professional connections

Michael Roberts - Grant Thornton Consulting

"There is mounting evidence that utilising the personal and professional connections of your best people may be a much better source of future staff with the right organisational fit."

Obviously, steer away from hiring just anyone who can fill a vacant position – even as a casual team member. Lowering recruitment standards always has negative long-term consequences in terms of performance, quality and morale. It’s also the fastest way to demotivate or lose your good people.

Help teams understand the outcomes-based environment

We are in an era where the focus on service delivery and quality from regulators has never been higher. Teams need to be ready to handle the higher level of scrutiny around quality and safety of services. To demonstrate compliance with the new Aged Care standards, the quality and safety systems need to capture whether standards are actually being met and outcomes achieved.  We call it the “Show Me” test. It’s not enough to have a policy or procedure, the staff need to be able to understand and describe the requirements and help measure outcomes. This new level of scrutiny will impact all levels of the organisation and all staff need to understand what this means in terms of their role and how they work and relate with clients and families. The training and change management efforts needed in this area can be significant

Ensure that RN and EN roles can focus on areas that add value

It’s a fact that the proportion of RNs and ENs in residential care has significantly reduced over time.  Figures from Department of Health and Australian Institute of Health and Welfare show that from 2003-2016 Australian Residential care places increased by 48,000 at the same time as RN and EN positions decreased by 3,500. While there’s no blueprint for determining the right blend of staff it is clear we need to make best use of valuable RN and EN time. There is a lot of pressure for people in these important roles to spend more time on documentation and compliance management and this does not always make for a desirable clinical role. RN and EN roles are less satisfying and effective when they are reduced to just pushing a medication trolley or filling in forms. They need to be freed up to focus on working closely with residents, carers and care workers, GPs and others to improve resident’s lives and prevent and solve problems.

For aged care providers, getting the workforce right is a critical piece of the journey to achieving better care outcomes. Through gaining a deeper understanding of the issues and implementing clear, fair and flexible strategies, providers can find new ways to better manage the many complex and interlinked challenges and ultimately differentiate themselves to gain competitive advantage.

We share our Top 8 recommendations for providers to create ideal conditions for an effective aged care workforce. Click here to download our infographic.