south australia innovation hub trial...fall 08 evaluation of the south australia innovation hub...

08Fall

Evaluation of the

South Australia Innovation Hub Trial

Prepared for the Department of Health September 2016

www.mpconsulting.com.au

SAInnovationHubTrialEvaluationReport Page2of52

TableofContentsAcronymsandabbreviationsusedinthisdocument.....................................................................4

ExecutiveSummary......................................................................................................................5

Chapter1–TheSouthAustraliaInnovationHubTrial...................................................................7PartA–AbouttheSouthAustraliaInnovationHubTrial........................................................................7

ParticipantsintheHubTrial.......................................................................................................................8GovernanceoftheHubTrial.......................................................................................................................9

PartB–CommunitiesofPractice............................................................................................................9

Chapter2–EvaluationoftheHubTrial.......................................................................................11PartA–Purposeoftheevaluation.......................................................................................................11PartB–Conductoftheevaluation.......................................................................................................11

Questionnaires,interviewsanddocumentreview...................................................................................12Scopeandlimitationsoftheevaluation...................................................................................................12

Chapter3–HubTrialInitiatives...................................................................................................14PartA–Overview................................................................................................................................14PartB–Governance.............................................................................................................................14

Context.....................................................................................................................................................14ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................16

PartC–Continuousqualityimprovement–qualityoflife....................................................................19Context.....................................................................................................................................................19ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................22

PartD–Consumerengagement...........................................................................................................23Context.....................................................................................................................................................23ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................24

PartE–Complaintshandling................................................................................................................25Context.....................................................................................................................................................25ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................27

PartF–Financialreporting...................................................................................................................29Context.....................................................................................................................................................29ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................30

PartG–Extendedaccreditation...........................................................................................................30Context.....................................................................................................................................................30ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................32

PartH–ReducedACFIaudits...............................................................................................................32Context.....................................................................................................................................................32ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................33

PartI–CentreforLeadershipandExcellenceinAgeing........................................................................33Context.....................................................................................................................................................33ExperienceofHubTrialparticipantsandoutcomesachieved.................................................................34

Chapter4–Summaryofoutcomesandlearnings........................................................................35PartA–CommunitiesofPracticeasamodelforcollaboration.............................................................35

CriticalsuccessfactorsforaCoP..............................................................................................................35RiskfactorsforaCoP................................................................................................................................38

PartB–AchievementofHubTrialobjectivesandaims........................................................................38Aim1:Betterpracticeconsumerengagementandgovernance..............................................................39Aim2:Innovation.....................................................................................................................................41Aim3:Moretargetedapproachtogovernmentregulatoryactivities.....................................................41Aim4:Opportunityformutualsharingandlearning...............................................................................43

PartC–Challengesandlearnings.........................................................................................................43

Chapter5–ThefutureoftheSouthAustraliaInnovationHub.....................................................46

Bibliography................................................................................................................................47

AttachmentA–SummaryoftoolsusedinQoLFramework.........................................................51

AcronymsandabbreviationsusedinthisdocumentACFA–AgedCareFinancingAuthorityACFI–AgedCareFundingInstrumentCDC–consumerdirectedcareCLEA–CentreforLeadershipandExcellenceinAgeingComplaintsScheme–AgedCareComplaintsSchemeCoP–communityofpracticeCoPs–communitiesofpracticeCOTA–CouncilontheAgeingAustraliaCOTASA–CouncilontheAgeingSouthAustraliaCQI–continuousqualityimprovementthedepartment–CommonwealthDepartmentofHealthHub–SouthAustraliaInnovationHubHubproviders–theSouthAustralianagedcareprovidersparticipatingintheHubHubTrialparticipants–allparticipantsoftheHubTrialincludinggovernment,agedcareprovidersandconsumerrepresentativesHubTrial–SouthAustraliaInnovationHubTrialQoL–qualityoflifeQualityAgency–AustralianAgedCareQualityAgency

ExecutiveSummaryTheagedcaresectorisevolving,withfundamentalreformsbeingimplementedovera10-yearperiodtosupportconsumerdirectedcare,andensurethattheagedcaresystemissustainableandaffordable.Thereformstothesystemplaceconsumersatthecentreoftheircare,withasignificantfocusongivingpeoplegreaterchoiceandflexibility.Thechangesarealsointendedtoencouragebusinessestoinvestandgrow,andtoprovidediverseandrewardingcareeroptionsintheagedcaresector.Againstthisbackdrop,agroupofSouthAustralianagedcareproviders,motivatedtoinnovateasacollective,developedtheconceptofanInnovationHub.TheHubgaveprovidersanopportunitytocollaboratewithlike-mindedagedcareorganisationstoinnovateinareasofsharedinterestsuchasimprovinggovernanceandqualityoflifeforconsumers.ConsistentwiththeAustralianGovernment’sreformagenda,anddesiretoreduceredtape,a12-monthHubTrialwaslaunchedasajointinitiativeofgovernment,theSouthAustralianagedcareproviders,andtheCouncilontheAgeingAustralia,totrialarangeofinitiativestoimproveandsustainbetteroutcomesforolderAustralians.Thegovernmentagreedthat,forprovidersparticipatingintheHubTrial,therewouldbestreamlinedregulationintheareasofaccreditation,complaints,andAgedCareFundingInstrument(ACFI),alongwithopportunitiestoworkwithgovernmenttoinformbroaderagedcarepolicy.TheHubTrialadoptedacommunitiesofpracticemodelofcollaborationandsharedlearning,wherebygroupswereestablishedtoprogressinitiativesinareassuchas:governance;qualityoflife;consumerengagement;andcomplaintshandling.Followingthecompletionofthe12-monthHubTrial,mpconsultingwasengagedtoworkwithHubTrialparticipantstoidentifythekeybenefits,challenges,outcomesandlearningsfromtheHubTrial,alongwiththecriticalsuccessfactorsrelatingtoacommunityofpracticemodelofcollaboration.HubTrialparticipantsreportedsignificantbenefitsfrominvolvementintheHubTrialandcitednumerousexamplesofchangesthathadbeenmadetosupportbetteroutcomesforconsumers.Mostnotably,allHubprovidersreportedthat:

• theHubhadprovidedaninvaluableopportunitytoshareinformationinatrustingenvironment,

criticallyassesspractice,andlearnfromtheexperienceofothers.Thisreportidentifiessomeofthecriticalsuccessfactorsforacommunityofpracticethatcouldbeappliedbyotherprovidersseekingtobuildcapacityandinnovatecollectively;

• theyhadmadechangestotheirgovernancesystems,promptedbycomparativeanalysis,andinformedbyresearchintobestpractice.TheHubalsoproducedarangeofgovernanceandcomplaintsresourcesthatareavailableontheHubwebsite;and

• theyhadnotjustimprovedtheirmeasurementofqualityoflifeandconsumersatisfaction,buthadeachidentifiedwaystoaddressareasofdeficitandimprovequalityoflifeforconsumers.

Fromgovernment’sperspective,theTrialalsodemonstratedthebenefitsofaco-designmodelinwhichtheregulatorandprovidersworktogether,andofferedanopportunitytoexploreconcepts,suchasearnedautonomy,thatwillinformbroaderpolicyinitiativesincludingthedevelopmentofaSingleQualityFrameworkforagedcare.mpconsultingsincerelythanksallstakeholdersfortheircontributiontothisevaluation.

Chapter1–TheSouthAustraliaInnovationHubTrialPartA–AbouttheSouthAustraliaInnovationHubTrialTheSouthAustralianInnovationHub(theHub)wastheinitiativeofagroupofSouthAustralianagedcareproviders,motivatedtoformanindustrycommunitythatsharedapassionforworkingwitholderpeopletoimproveandsupportqualityoflife1.Aspartofthegovernment’sagendatoreduceredtape,MinisterAndrews(thethenMinisterforSocialServices)engagedwiththeSouthAustralianproviderstodiscussanddevelopideasforredtapereductioninagedcareregulation.Throughthisengagement,governmentandtheprovidersidentifiedanopportunitytotrialarangeofinitiativesthroughtheHub.TheSouthAustraliaInnovationHubTrial(theHubTrial)wasofficiallylaunchedbyMinisterAndrewson10October2014.TheHubTrialranfora12-monthperiod2andwasdesignedtoencourageinnovationbyprovidinganenvironmentinwhichtoexploretheeffectsofreducingregulationforprovidersthat:• satisfyregulatoryperformancecriteriaaround

accreditation,compliance,complaints,prudentialandtheACFI;and• agreetodevelopandimplementbetterpracticeapproachestogovernanceandconsumer

engagement.AtthecommencementoftheHubTrial,theparticipantsagreedtotheSouthAustraliaInnovationFramework(theFramework).TheFrameworkdetailedtheintentionsoftheHub,aswellasarangeofinitiativestobeincludedintheHubTrial.HubTrialparticipantsagreedthataniterativeapproachwouldbeusedtoallowadjustmentandrefinementofinitiativesasrequired.TheobjectivesandaimsoftheHubTrial,asdescribedintheFramework,wereasfollows:

TheobjectiveoftheHubistoimproveandsustainbetteroutcomesforolderAustraliansengagedwithagedcareservices.ThiswillbeachievedthroughdevelopinganearnedautonomyapproachforagedcareinsupportoftheGovernment’sderegulationandsocialpolicies.Anearnedautonomyapproachtoregulationoffers‘lightertouch’regulationtohigherperformingprovidersandaimsto:• Encourageproviderstopursuebetterpracticeinconsumerengagementandgovernance

andimproveservicedeliveryoutcomesforconsumers.

1SAInnovationHubPowerPointpresentation

2NotingthatHubproviderscontinuedtooperateastheSAInnovationHubbeyondthe12-monthTrialperiod.

“TheHubTrialprovidedanopportunityforproviderstoworkwithgovernmenttoidentify,developandtrialinnovativeapproachesthatsubstitutedreduced

governmentinterventionforgreaterrelianceoneffectivegovernanceactivityandpursuit

ofbetteroutcomesforconsumers”. DepartmentofHealth

• Supportanexpansionininnovativemodelsofcareandservicesinlinewiththeincreasingdemandsofanageingpopulation.

• Facilitateamoretargetedapproachtogovernmentregulatoryactivitiestofocusthemonwheretheyareneededwhilstmaintainingsafeguardsforconsumers.

• Provideopportunityformutualsharing,learningandinnovationamongHubmembersandpartners.3

ThegovernmentagreedthatforprovidersparticipatingintheHubTrialtherewouldbe:• lessfrequentauditsandastreamlinedapproachtoassessmentofaccreditationstandardsby

theQualityAgency;

• agreaterfocusonresolutionofcomplaintsbytheprovider(minimisingtheinvolvementofthethenAgedCareComplaintsScheme(ComplaintsScheme));

• opportunitiestoworkwithAgedCareFinancingAuthoritytoimprovefinancialdatacollectionandreportingrequirements;and

• reducedACFIreviewswhereappropriate.ParticipantsintheHubTrialTheHubTrialinvolved:

• tenagedcareproviders4inSouthAustralia;

- AgedCareandHousingGroupIncorporated;- BarossaVillageIncorporated;- BoandikLodgeIncorporated;- HelpingHandAgedCare;- JamesBrownMemorialTrust;- MonreithAgedCare;- ResthavenIncorporated;- SaintHilarionIncorporated;- SouthernCrossCare(SA&NT)Incorporated;and- WambonePtyLtd;

• theDepartmentofHealth(thedepartment)(formerlytheDepartmentofSocialServices);• theCouncilontheAgeingAustralia(COTA);• theAustralianAgedCareQualityAgency(QualityAgency);and• theAgedCareFinancingAuthority(ACFA).

3SouthAustraliaInnovationHubFramework,DepartmentofSocialServices,June2015,p3

4AttheinceptionoftheHubTrial,10agedcareproviderswereinvolved.Thisnumberwaslaterreducedtoeightfollowingthewithdrawalofthetwoprivateproviders(WambonePtyLtdandMonreithAgedCare)duetoreasonsunrelatedtotheHubTrial.

Intotal,theeightagedcareprovidersthatparticipatedintheHubTrialmanageapproximately60residentialagedcareservicesofdifferingsizelocatedinbothmetropolitanandregionalareas.ManyoftheprovidersalsomanagehomeorotheragedcareservicesbuttheseserviceswerenotincludedaspartoftheHubTrial.GovernanceoftheHubTrialTheHubTrialwassupportedandgovernedbytheSAInnovationHubWorkingGroup,whichwasestablishedtooversee,monitorandreviewtheHubTrialinitiatives5.TheroleoftheHubWorkingGroupincluded:• contributingtoarangeofnationalagedcareinitiatives;• contributingtothedevelopmentofinitiativesrelatedtoboardgovernanceandconsumer

engagementfornationalapplication;and• developingareportingmechanismincorporatingstatusupdatesbyHubTrialparticipantsand

formalfeedbacktothedepartmentontheearnedautonomycriteriaandtheinitiativesbeingtrialledintheHub.

TheHubWorkingGroupconsistedoffourrepresentativesoftheagedcareprovidersthatwereparticipantsintheHubTrial,arepresentativefromtheQualityAgency,representativesfromthedepartmentwithexperienceinagedcareregulation,arepresentativefromACFA,andaconsumerrepresentative.TheHubwasalsosupportedbyapart-timeofficer(theHubProgramDirector)basedinAdelaideandengagedforaperiodof24-months.TheHubProgramDirectorsupportedtheHubmembersby:coordinatingactivities;facilitatingcommunicationwithintheHubnetwork;andundertakingresearchtosupporttheinitiativesimplementedthroughtheHubTrial.TheHubProgramDirectorcontinuedtosupporttheactivitiesoftheHubprovidersfollowingtheconclusionoftheHubTrial.PartB–CommunitiesofPracticeOnewaythatparticipantsoftheHubTrialworkedtogethertoachievetheirobjectiveswasthroughcommunitiesofpractice(CoPs).Theterm‘communityofpractice’emergedthroughtheHubTrialasameansfordescribingthegroupsthatHubTrialparticipantsformedtocollaborateonspecificsubjectmattersofsharedinterest.EstablishingCoPsenabledHubTrialparticipantstoidentifyandfocusonarangeoftopicsofinterestandofrelevanceinthecurrentagedcarecontext.Themodelwasparticularlyvaluableinenablingproviderstoleverageoffexistingcapabilityandtobuildindustrycapacitymorebroadly.InadditiontothesubjectspecificCoPsthatwereformedaroundtheinitiativestrialledthroughtheHub,theHubproviders(asasubsetoftheHubTrialparticipants)alsooperatedasaCoP,withthesharedvisionofworkingwitholderpeopletoimproveandsupporttheirqualityoflife6.Asdiscussedbelow,thismodelofcollaborationbetweenHubprovidershascontinuedeventhoughtheHubTrialhasendedandgovernmentinvolvementhasceased.5SAInnovationHubWorkingGroup,TermsofReference,December2014

6www.sainnovationhub.orgviewed15April2016

DuringtheHubTrial,eightCoPswereestablishedtofocusonstrategicandoperationalsubjectmatters.SomeoftheCoPsfloweddirectlyfromtheHubTrialinitiativesandotherswereformedontheinitiativeoftheHubproviders.TheCoPsincluded:• Governance;• Continuousqualityimprovement(CQI);• Accreditation;• Consumerengagement;• CDC;• Complaintshandling;• CentreforLeadershipandExcellenceinAgeing(CLEA);and• Financialreporting.TheCoPswereflexibleandadaptedoverthecourseoftheHubTrial,sometimesinresponsetogovernmentpolicyandinitiatives,sometimestoreflecttheareasofinterestandexpertisewithintheHubprovidergroup,andsometimesbecauseofthecloseconnectionsbetweenvarioussubjectmatterareas.SomeCoPsmerged,somechangedtheirnameoverthecourseoftheHubTrial(tobetterreflectthefocusofwork)andothersbecameinactiveasinitiativeswerecompleted.Chapter3thereforedescribestheworkoftheHubbasedonthesubjectmatteroftheinitiatives,ratherthanthenameoftherelevantCoP.

Chapter2–EvaluationoftheHubTrialPartA–PurposeoftheevaluationInMarch2016,thedepartmentengagedmpconsultingtoconductanindependentevaluationoftheHubTrial.Thepurposeofthisevaluationisto:• identifykeyactivitiesundertakenaspartoftheHubTrial;

• examinethebenefitsandchallengesoftheHubTrial;

• wherepossible,identifytheextenttowhichtheHubTrialachievedtheobjectivesandaims,

alongwithanylearningsforthefuture;and

• focusspecificallyonthecommunitiesofpractice(CoPs)(asakeyelementoftheHubTrial):- analysethegoalsandobjectivesoftheCoPsandtheprocessesforestablishingtheCoPsand

fordevelopingresources;- identifycriticalsuccessfactorsforimplementingasustainableCoP(suchasmeasuresof

success,clarityofrolesandresponsibilities,andorganisationalcharacteristics);- identifythechallengesandbenefitsofCoPparticipation;and- identifytheimpactsofCoPparticipation(bothpositiveandnegative).

Broadly,thegoalfortheevaluationwastoidentifyanddocumentthebenefitsandchallengesofparticipationfororganisationsinvolvedintheHubTrial,theoutcomesofinnovationfocusareas,andlessonsthatcanbelearnedforother‘communities’ofserviceproviderslookingtoestablishaninformationsharingmodelofcollaboration.WhilethisreportpredominatelyfocusesontheHubTrial,theworkoftheHub(intheformoftheagedcareprovidersthatparticipatedintheHubTrial)isongoing.Insomecases,initiativeslaunchedthroughtheHubTrialhavecontinuedafterthecloseofthe12-monthTrialperiod.Thisreportthereforeidentifiesbenefits,challenges,outcomesandlearningsoftheHubmorebroadly.PartB–ConductoftheevaluationTheevaluationoftheHubTrialinvolvedconsultationwitharangeofstakeholders,including:• thedepartment:

- theQualityReformBranch;- thePrudentialandApprovedProviderRegulationBranch;- theSouthAustralianRegionalOffice;

• theQualityAgency;• theAgedCareComplaintsCommissioner(andformerofficersoftheAgedCareComplaints

Scheme);• ACFA;• COTAandtheCouncilontheAgeingSouthAustralia(COTASA);• eachofthecurrentagedcareprovidermembersoftheHub:

- AgedCareandHousingGroupIncorporated;- BarossaVillageIncorporated;- BoandikLodgeIncorporated;- HelpingHandAgedCare;- JamesBrownMemorialTrust;- ResthavenIncorporated;- SaintHilarionIncorporated;- SouthernCrossCare(SA&NT)Incorporated;and

• theProgramDirectorfortheHub.Consultationswereheldbyacombinationofteleconferences,writtenquestionnairesand/orface-to-facemeetings.Questionnaires,interviewsanddocumentreviewQuestionnairesformedthebasisforinterviewsinpersonandbyteleconference,andthebasisofwrittensubmissions.Questionnairesweretailoredtoeachstakeholderbutlargelyrelatedto:• objectivesoftheHubTrialandwhetherparticipantsconsideredthoseobjectivesweremet;• benefitsandchallengesofparticipatingintheHubTrial;• criticalsuccessfactorsfortheHub;• specificactivitiesandareasoffocusthatparticipantswereinvolvedin;and• keychangesthatHubprovidersimplementedasaresultofparticipationintheHub.ThedocumentsreviewedaspartofthisevaluationincludepapersandguidanceproducedbytheHubprovidergroup;mediaabouttheestablishmentoftheHubTrial;minutes;frameworkdocuments;andworkingpapersoftheHubWorkingGroupandCoPs.ThekeydocumentsreviewedaredetailedinthebibliographytothisReport.ScopeandlimitationsoftheevaluationTheevaluationwaslargelyqualitative,basedonconsultationswithstakeholdersandthereviewofdocuments.Thedepartmentconfirmedthatthiswasthepreferredapproach,noting:

• thattheevaluationapproachwasproportionatetothelengthandthenatureoftheHubTrial;

• someoftheHubTrialinitiativeshadonlybeenrecentlyimplementedorwerepartially

implemented,andasaconsequencetherewouldbelimiteddataabouttheoutcomesforconsumersandotherstakeholders;

• thattherewaslimitedbaselinedataavailabletoinformaquantitativeevaluationacrosstherangeofinitiativesimplementedbyparticipants;

• thattherelativelysmallsamplesizecouldcausechallengesforde-identifyinginformationinthe

evaluationreport;and

• theevaluationinvolvedconsultationwithCOTA,astheconsumerrepresentativeinvolvedintheHubTrial,butdidnotincludedirectcontactwithconsumers.

TheevaluationthereforefocusesontheoutcomesreportedbyHubTrialparticipants,andtheinitiativesimplementedaspartoftheHubTrial,ratherthanonassessingtheoutcomesforconsumersofeachoftheinitiatives.

Chapter3–HubTrialInitiativesPartA–OverviewThisChapterdescribesthekeyinitiativesprogressedthroughtheHubinrelationto:• governance;• CQI–qualityoflife(QoL);• consumerengagement;• complaintshandling;• financialreporting;• extendedaccreditation;• reducedACFIaudits;and• theproposedCentreforLeadershipandExcellenceinAgeing.PartB–GovernanceContextAtanearlymeetingoftheHubWorkingGroup,membersidentifiedthepotentialvalueandopportunityinexploring‘goodandbetter’governanceinthecontextofcontemporaryagedcare.BoththeWorkingGroupandHubprovidersattheboardandmanagementlevelagreedthatgoodgovernanceisacriticalelementtohighperformingorganisationsandsaweffectivegovernanceasthecornerstoneforsupportinghighqualitycareandQoLinagedcareserviceprovision.7TheAgedCareOrganisationBoardresponsibilitiesinitiativewasagreedtobyHubTrialparticipantsatthecommencementoftheTrial.Thepurposeoftheinitiativewastoimproveservicedeliveryoutcomesforconsumersbyensuringthatboardsprovidestrongleadershipinrelationtobetterpracticegovernanceandconsumerengagement.Theinitiativeidentified:

• anumberofoutcomesintendedtoinformfutureearnedautonomycriteriaandsupportthe

buildingofindustrycapacity,including:

- thedevelopmentofaprinciplebased,governanceframeworkforagedcare;- betterpracticeapproachestogovernanceandservicedeliveryoutcomesforconsumers

achievedthroughthedevelopmentofresourcestobeutilisedbytheboardsofHubproviders;and

- thedevelopmentandimplementationofconsumerengagementstrategiestosupporttheprovisionofhighqualitycare;and

• thatakeyobjectiveoftheHubTrialwastoensurethatboardsprovidestrongleadershipin

relationtoqualityoutcomesandorganisationalperformance.

7EffectiveGovernance:aframeworkforagedcare,June2015,p1

InNovember2014,theHubTrialestablishedaGovernanceCoPtodevelopareferencepointandevidencebaseforeffectivegovernance8.LeadershipoftheCoPwassharedbytheQualityAgencyandHubproviders.TheGovernanceCoPmetonthreeoccasionsandalsoundertookanumberofconsultationswiththeHubTrialparticipantsfromDecember2014toJune2015tocapturearangeofideas,insights,experienceandexamplesfromHubprovidersandtheirBoards.Insummary,theCoP:• conductedinterviewswithHubprovidersinlate2014toexploreideasondefinitionsand

descriptionsofeffectivegovernanceandpracticesusedintheirorganisations;• conductedaliteraturesearchtoidentifygovernancemodelstobeusedinacomparative

analysiswithfourtheoriesselectedtogivetheoreticalcontextforthecomparativeanalysis;• selectedthreegovernancemodelsforcomparativeanalysis:CorporateGovernancePrinciples

andRecommendations(ASXCorporateGovernanceCouncil,2014);GoodGovernancePrinciplesandGuidanceforNot-for-ProfitOrganisations(AICD,2013);andGoodGovernance:AcodefortheVoluntaryandCommunitySector(TheCodeSteeringGroup,2011).Thesegovernancemodelswereselectedforanalysisonthebasisofcollectivelyrepresenting:

- theAustraliancontext(orpotentialtobeadaptedfor);- publiclylistedandnot-for-profitentities;- mandatoryandvoluntarymodels;- differentapproachestogovernanceissues;and- differentstructures,forexample,thenumberofprinciplesandhowtheissuesaregrouped;9

• criticallyanalysedarangeofresourcestoinformthedevelopmentofagovernanceframework;

• heldaseriesofthreeworkshopswithHubprovidersandtheirnominatedBoardmembers(with

theinitialworkshopfacilitatedbyagovernanceexpertandsubsequentworkshopsfacilitatedbytheQualityAgency):

- tofocusunderstandingusingaspecifiedmodelandtosecureagreementastolanguageand

concepts;- todeterminehowtheagreedmodelalignedwithcurrentexperienceandtoagreea

modifiedmodelfortheagedcarecontext;- toreviewtheemergingframeworkandagreeitsstructureandapproach;

• encouragedindividualboardconsultationsinwhichHubprovidersworkedwiththeirown

boardstotest,andgaininput,aboutcurrentexperienceandtheboard’sperspectiveonwhatdistinguisheshighperforminggovernance;and

8EffectiveGovernanceinagedcare:ProjectReport,June2015,pi9EffectiveGovernance:aframeworkforagedcare,June2015,p4

• initiatedanumberofopportunitiesthroughouttheHubTrialperiodfortheboardsofHubproviderstomeet,networkandshareinformationandexperiences.

Thecomparativeanalyses,researchanddiscussionsamongstCoPmembersinformedthreekeydocumentsthatwerefinalisedbytheGovernanceCoPinJune2015andwerepublishedontheHubwebsite10.ExperienceofHubTrialparticipantsandoutcomesachievedBasedondiscussionswithHubprovidersandtheQualityAgency,providersgreatlybenefitedfromtheopportunitytoshareandlearninatrustingenvironment.Inparticular:• theprocessofdevelopingandtestingtheGovernanceFrameworkgaveHubprovidersthe

opportunityto‘stress-test’theirownsystemsandpolicies.Hubprovidersreported:- thevalueofhavingameasureagainstwhichtobenchmarkandconfirmexistingpractices;- somesignificantchangestoorganisationalpracticesbasedonthetestingofsystemsagainst

theGovernanceFramework(referdiscussionbelow);and- thevalueofthegovernanceresearchprojectininforminginternalreviewsandexternal

evaluations;

• anumberofprovidersimplementedchangestogovernancesystems,processesandBoardandstafftrainingtobetterreflectgoodgovernanceandtoincreasethefocusonconsumerengagementandQoL;- forexample,oneprovidermadesignificantchangestotheirOrganisationalPlanand

ContinuousQualityImprovementPlantoreflectbetter-focusedgoalsandoutcomesthathadbeendirectlyshapedbytheHubTrial;and

- anotherprovidermadechangestotheirstaffappraisalstofocusonstaffstrengthsandhelpencouragepositiveattitudes;

• Hubprovidersconsistentlynotedthatthe

corevalueofthedocumentsproducedbytheGovernanceCoPwasintheirspecificitytotheagedcarecontextandthattheyhadbeendraftedbyanagedcarecommunityofpractice(whiledrawingonliteratureandwidelyusedmodels);

10Referwww.sainnovationhub.org

“Theboardskillshaveimprovedsignificantlywiththefocusongovernance.Theinteraction

withotherboardshasbeenanexcellentlearningmethod.”

BoandikLodge

“Thecomparativeanalysishighlightedthathighperformancemanifestsfromthebehaviourandethicsofindividualboardmembers;supportedbyboardleadershipandculture.Asystemforgoodgovernancesetsthefoundationofstructures,expectationsandactivitiesonwhichhigh

performancecanbebuilt.Highperformanceofaboardreliesonachievingtherightbalanceofthediverseaspectsofwhataboarddoesandhowitoperates.Indoingsoahighfunctioningboardrequiresadaptationtoidentifyandachievetherightbalancetogovernandreflectanagedcare

provider’smission,contextandculture.”SAInnovationHub,GovernanceFramework

• workshopsprovidedtheopportunityforcross-providerengagementandlearning,andgaveBoardmembersandmanagementtheopportunitytoengagewithsimilarorganisationsandtospeakopenlyaboutthecommonissuestheyface.Asdescribedinthecasestudybelow,thiswasparticularlyvaluableforsmallerprovidersthatdeliverservicesinaregionalorruralsetting.

Casestudy:BarossaVillageandBoandikLodge

BoththeBoardandExecutiveteamfromthetworuralandregionallybasedprovidersintheHub–BoandikLodge(MountGambier)andBarossaVillage(BarossaValley)metinMarch2015.BarossaVillageBoardmemberstravelledtoMountGambierwheretheyspentseveraldaysmeetingwiththeirBoandikLodgecounterparts.Participantsdiscussedarangeofissuesimpactingonagedcareboards,particularlyfromaruralandregionalperspective.Topicsdiscussedincluded:

• governanceincludingboardsub-committees,boardprocessesandreporting;• theboards’roleinoverseeingclinicalgovernanceandinpolicymaking;• strategicplanningprocesses;• riskmanagement;• issuesimpactingtheagedcaresectorandboardprioritiesfortheshorttomediumterm;• consumerengagement;• successionplanning;and• marketing.

Itwasagreedthattheissuesformetropolitanandruralboardsweregenerallythesame,however,withinsmallercommunitiesandsmallerorganisationsthedelineationbetweentherolesofBoardmembersandmanagementweresometimesblurredandtherewerechallengesrecruitingappropriatelyskilledBoardmembers.Onthepositiveside,therewasoftenahighlevelofconsumerengagementbetweenBoardmembersandthelocalcommunity.TheBoardmembersalso:• notedthattheongoingreformwithinthesector,whilstnecessary,hadcausedtheboardstoshifttheirfocustothe

shortterm(upto3years)whenstrategicallyboardsshouldbethinking5to10yearsahead;and• emphasisedtheimportanceofgovernancesupportingtheethicsandvaluesoftheorganisationincludinga

commitmenttothefuturesustainabilityofsmaller,locallyownedcommunityorganisations(wherelocalboardsareavoiceforthecommunityintermsofthetypeandqualityofservicesprovidedtoelderlyconsumers).

BarossaVillagealsoenjoyedtheopportunitytovisitandinspecteachoftheoperationalsitesmanagedbyBoandikLodgeandafuturevisitbytheteamfromBoandikLodgetoBarossaVillagehasbeenplanned.GovernancechangeswithinproviderorganisationsEachHubprovideridentifiedchangesthathadbeenmadetotheirgovernancearrangements,systemsandprocessesasadirectresultoftheHubTrial.Thisincludedchangestostrategicplans,identificationofskillsgapsandchangestoreportinglinesandstructures.WhiletheimpactofthegovernanceprojectvariedacrossHubproviders,allprovidersagreedthattheHubwasanopportunitytoconnectboardsandtorepositionwhatwerequitediverseapproachestogovernance.Providersgaveexamples,includingthattheincreasedengagementofBoardmembersacrossorganisationsgeneratedsignificantdiscussionandpromptedself-examinationofBoardpractices.Forexample:• someBoardsreconsideredtheirstructureandmeansforrenewal;

- WhilesomeBoardshadstrictrotationalpoliciesembeddedintheirgovernanceframeworks,othershadminimalturnover.DiscussionsamongstBoardmembershighlightedthebenefits

andchallengeswitheachapproachand,inatleastonecase,aBoardwasproposingtoadjustitsapproachbasedonitslearningsthroughtheHub.

• someBoardmemberswerepromptedtoattendAustralianInstituteofCompanyDirectors

(AICD)training,andoneorganisationimplementedinternalandexternaltrainingforBoardmembers,particularlyaroundgoodgovernance;

• oneBoarddedicatedasessiontocriticallyreviewingitsgovernanceagainsttheGovernanceFrameworkgeneratedbytheHub,andtoidentifyingareasofshortfall.Asaresult,anewGovernanceStrategicPlanwasdeveloped(withKPIsandtimeframes)andaskillsmatrixwasdevelopedtoidentifyskillstobedevelopedbyBoardmembersandothers;

• oneBoardchangeditscommitteestructuretoincreasethefocusonconsumerengagementandensuredirectprovisionofadvicefromconsumers,theirfamiliesandcarerstotheBoard;and

• basedondiscussionswithotherBoards,oneBoardre-considereditsstrategicfocusandhowit

mightbroadenitsmembershipinreadinessfortheimplementationofnewhealthandagedcareinitiativessuchashealthcarehomes.

WhilebuildingcapacityoftheBoardsisanongoingventure,HubprovidersidentifiedthattheirBoardshavepickeduponideasgeneratedthroughtheHub.HubprovidersnotedthatBoardmemberswillcontinuetoattendgovernanceworkshopsdeliveredthroughtheHubandtheHubprovidersarecommittedtocontinuingtobringBoardmemberstogethertofurtherestablishandstrengthentheconnectionstheyhaveforged.BroaderapplicationofgovernanceworkEarlyintheHubTrial,participantsexpressedinterestindevelopingandtriallinggovernanceinitiativesthatcouldberolledoutnationallytoassistboardsofagedcareorganisations(bothfor-profitandnot-for-profit)toadoptbetterpracticeapproachestogovernance.TheresourcesdevelopedbytheGovernanceCoP,includingtheEffectiveGovernance:aframeworkforagedcare,providebenchmarkingtoolsthatarenowavailabletoprovidersoutsideoftheHub.Tosupportuseoftheresourcesbyotheragedcareproviders:

• Hubprovidershavepublishedthegovernancedocumentsdeveloped;• thedepartmenthascreatedalinkfromitswebpagetotheHub’swebpagewherethe

governancedocumentscanbeaccessed;• theprojecthasbeenpromotedintheAgedCareProviderNewslettergeneratedbythe

department;and• theQualityAgencyhasmadethegovernanceresourcesaccessiblefromitswebsiteandhas

promotedtheresourcesatBetterPracticeConferences.ThedepartmenthasalsoadvisedthattheworkoftheGovernanceCoPwillinformthedevelopmentoftheSingleQualityFrameworkincludingthedevelopmentofnewend-to-endagedcarequalitystandards.

PartC–Continuousqualityimprovement–qualityoflifeContextInlinewiththeobjectiveoftheHubTrialtoimproveandsustainbetteroutcomesforolderAustralians,akeyfocusoftheHubwasimplementinginitiativestobettermeasureandimprovequalityoflifeandwellbeingforconsumers.IntheearlystagesoftheHubthiswasreferredtoasfocusingoncontinuousqualityimprovement(CQI)andaCoPwasformedtofocusonthisissue.However,overthecourseoftheHubTrialtheCoPevolvedasHubprovidersbecameincreasinglyfocusedonqualityoflife(andimprovingoutcomesforconsumer)ratherthanoncontinuousqualityimprovementmoregenerally.TheCQICoPcontinueditsworkaftertheTrialandtheHubprovidersmadesignificantgroundinrelationtoqualityoflifeinitiativesandultimatelyproducedtheHubQualityofLifeFramework11.IndevelopingtheQoLFramework,theCoP:• undertooksomeworkdefiningQoLandthefocusfortheFramework.TheCoPagreedthatthe

FrameworkneededtodomorethansimplyprovideindicatorsforQoL.ItneededtoformamorecomprehensivesystemformeasuringQoLandalsotargetingactionstowardsimprovingQoL;

• researchedarangeoftoolsandsystems.TheCoPfocusedontoolsthatwerevalidated,easytouse,andwouldberelevanttoresidential,communityandretirementliving.TheCoPagreedthateachHubprovidercouldhavethechoiceofwhichtoolstoutilisetomeasureQoLbutanytoolsselectedshouldbeadoptedintheirentiretyratherthanadapted(asanymodificationcouldcompromiserobustnessandvalidity);

• agreedontheappropriateaudiencetobeincludedinmeasuringqualityoflife.Onthispoint,theCoPdecidedthatthebestoutcomefortheconsumerwouldbetoincludefamilymembersandstaffamongstthosesurveyed.ResearchundertakenbytheCoPshowedthatemployeeengagement,recipientco-designandhealthenvironmentheavilyinteractedwiththeconsumerexperienceofQoLandwereallfactorsthathadthepotentialtobeinfluencedbytheprovider12;and

• agreedthattheQoLworkshouldfocusontheidealoutcomesforconsumersandsomeofthe

factorswithinthecontroloftheproviderthatcaninfluencethissothatproviderscanadjusttheireffortstobetterfocusonQoLforeachindividual.

TheCoPalsoengagedexpertsintheconsumerengagementfieldtoinformthevariousmethodsofconsumerengagement,measuresofsatisfaction,benchmarkingandanalysis.ThisincludedamarketintelligenceorganisationandtheSAHealthandMedicalResearchInstitute

11TheSAInnovationHub:QualityofLifeFramework(aspresentedbyFrankNaso,WellnessDirection,StHilarionAgedCareInc)(unpublished)12JamesBrownMemorialTrust,Writtenquestionnaireresponse

QualityofLifeFrameworkThedesignmethodologyfortheQoLFrameworkisbasedonsimple‘toplineandbenchmarkingtools’,andanassociated‘deepdive’toolkittofurtherinvestigatespecificareas,shouldthetoplinetoolidentifyapotentialdeficit.Theintentwasthatsimpletoolswouldbeusedinthefirstinstance(toencourageuptakebylargeandsmallproviders)andresourcescouldthenbetargetedonthoseareasofneed,asidentifiedthroughthetoplinetool(maximisingefficiency).13TheCoPselectedthreetoolsastoplineandbenchmarkingtoolstomeasureandcomparebroadareasofwellbeingandqualityoflife.Applicationofthetoplinetoolsenabledcomparisonbetweenservicelocations.Afurthertwotoolswereselectedasoptional“deepdive”toolstofurtherinvestigateanyissuesorpotentialproblemsidentifiedthroughthetoplinetoolsandtoproviderecommendationsforaction.Toplineandbenchmarkingtools Deepdiveandoptionaltools1. Personalwellbeingindex(cognitive)

(PWI)2. QualityofLife–AD(QoLAD)

(cognitiveimpairment)3. NetPromoterScore(NPS)

1. WorldHealthOrganisationQualityofLife(WHOQoL)

2. CIMPACT

*seesummaryoftoolsatAttachmentAOncethedraftQoLFrameworkwasdeveloped,anumberofHubproviderstrialledthevarioustoolsacrosssomeoralloftheirservices.Someprovidershosted‘trialsites’,inwhichathree-daytrialofthetoolswasundertakenwithconsumersandstaff,opentootherHubproviderstoobserve.Results,outcomesandfeedbackobtainedthroughthisprocesswereprovidedtotheCQICoPtofurtherinformthedevelopmentoftheQoLFramework.Forexample,relativelyearlyintheHubTrial,theCoPidentifiedthatthePWItoolwouldnotmeettheneedsofpeoplewithcognitiveimpairmentormilddementia.Inresponse,theCoPidentifiedQoLADasacompaniontooltobettercaterforthoseneedsandtoenabletheQoLframeworktoextendtoasmanyconsumersaspossible.Anumberofprovidersalsonotedthatbytriallingthetools,thishadpromptedthemtothinkdifferentlyaboutQoLandtheactionsthatcouldbetakentoimproveQoL.Thisisevidencedinsomeofthecasestudiesbelow.

13JamesBrownMemorialTrust,CaseStudy:HubQualityofLifeFramework–atoolforinnovation

“TheFrameworkstartedbylookingatqualityinagedcareandanattempttodefineit.ThisprogressedtoafocusonQualityofLifeasthis

appearedtobepoorlyrepresentedinthemethodscurrentlyinuse…Thistextureofgaps

andpossibilitiesstartedformingintoaframeworkaswelookedatQualityofLifeand

thefactthatwedidnotactuallywantanindicator,ratherwewantedasystemtomeasureandtargettowardsimproving

QualityofLife.” JamesBrownMemorialTrust

Casestudy:MeasuringQoLatBoandikLodgeAspartoftheQoLinitiative,BoandikLodgetrialledthePWI,QoLADandDEMQOL.ThePWIwasalsotrialledwithcommunitycarerecipientsandthoseinindependentlivingservicesmanagedbyBoandikLodge(toensurerelevanceacrosscaretypes).BoandikLodgealsotrialledawellbeingandresilienceprogramprovidedbytheSouthAustralianHealthandMedicalResearchInstitute.Asaresultofthetrial,BoandikLodge:• hasdecidedtousethePWIandQoLADonanongoingbasiswitheveryconsumer(residentialandcommunitycare)

andallnewclients.Thetoolsarere-appliedevery6months;• hastrainedstaffintheuseofthePWIandQoLAD;and• isusingtheresultsofthePWIandQoLADtodeveloplifeplanswithconsumers,andtoidentifyconsumersthat

wouldbenefitfrominvolvementinthePerma+wellbeingandresiliencetrainingprogram.TheChiefExecutiveOfficerofBoandikidentifiedthat,attimes,theresultsofthesurveyscanbechallenging,particularlyforthoseintheorganisationwithaspecificfocusontheprovisionofclinicalcare.Staffwere,however,veryreceptivetotheuseofthetools(andchangestopracticethatflowedfromtheresults)becauseitalignedstronglywithCDCandalsobetterhighlightedwhatwouldmostbenefiteachindividualconsumer.Casestudy:TrialatSaintHilarionInlateSeptember2015,SaintHilariontrialledbothNPSandCIMPACTattheirFulhamsiteoverthecourseofthreedays.ThetrialwasprecededbytrainingforkeySaintHilarionstaff.Followingthetrial,advicewasalsosoughtfromconsumers,familiesandstaffaboutthetrialandareasforimprovement.Thetrialhighlightedanumberofadjustmentsthatwouldbemadetotheapplicationofthetools.Forexample,SaintHilarionidentifiedthat:• theywouldundertakemoreface-to-facesurveys.Whilethisapproachistimeconsuming,SaintHilarionconsidered

thatface-to-facesurveysgivesrisetomorevaluableinformation;• someofthequestionsaskedbystaffcouldbebetterfocused;and• therewouldbevalueinhavingallthreetoolstranslatedintoItalian.Staffattheservicereportedthatthetrialhad:• heightenedconsciousnessofQoLandhadinfluencedhowtheythoughtaboutprovidingcare;• encouragedthemtothinkaboutcreatingahomeratherthanapplyingahealthcaremodel;• shiftedthinkingawayfromamedicaldeficitmodel;and• focusedtheirattentiononactivitythatismeaningfulfortheconsumer.Aswasnotedbyonestaffmember“Bytriallingandusingthesequalityoflifetools,staffandconsumershavegainedabetterunderstandingofpeople’sneeds.Goingthroughthisprocessofco-productionmeansit'samoreequitableprocess,andconsumersfeelinvolvedindecisionsbeingmade.Whatwe'vealsofoundusingthistoolisindividualneedsarebeinghighlightedandaddressed,andstaffhaveimprovedtheiremotionalintelligenceinrelationtoconsumerneeds”.InparallelwiththeHubTrial,SaintHilarionalsotrialledtheCommunityWestStepForward–TogetherInitiativewhichfocusedontriallingco-productionwithawellnessandenablementfocus.“Theprocesshashelpedustoseethewholeperson,includingtheiraspirations,andstaffandconsumersfeelmoreconnectedasaresult”.

ExperienceofHubTrialparticipantsandoutcomesachievedAllHubTrialparticipantsacknowledgedthesignificantworkundertaken,andoutcomesachieved,inrelationtoQoL.ThetrialoftheQoLtoolsconductedbytheHubprovidersreturnedthefollowinginformation:• bothsmallandlargeprovidersfoundthetoolseasytouse;• consumersfoundthequestionseasytounderstandand

relevant;and• resultsidentifiedareasforimprovement,and

interventionswereimplementedaccordingly.Oneproviderreportedthatbytestingtoolsattheirdifferentservicesites,theywereabletoundertakeanappreciativeenquirythatenabledthemtocompareresults,andworkmorestrategicallywithprojectstaffonlifestyleprogramsacrossitsservices.Casestudy:ApplicationofQoLmethodologyatJamesBrownMemorialTrustTheQoLmethodologyhasbeenappliedacrossJamesBrownMemorialTrust’soperations,withthePWImeasurementincorporatedintheTrust’sannualsurvey.CIMPACTisbeingusedinresponsetolowerthanbenchmarkPWIoutcomesinaspecificareaasadeepdiveserviceevaluationtooltodriveimprovement.TheoutcomesarebeingusedtoactivelytargetandevaluateprojectsintheTrust’sAnnualCQIPlan.AdoptingtheQoLmethodology,andhavingthetoolstomeasureandtargetQoL,hasinformedthedevelopmentofinnovativemodelsofcareandarangeofdevelopmentprojectstargetingspecificaspectsofQoL.Forexample,specificprojectshavebeenimplementedtoaddress‘achievementinlife’results.TheapplicationoftheFrameworkhasnoticeablyshiftedtheTrust’sstrategyandabilitytoperceiveandtargetQoL.Thedatagatheredwillsupportanalysisofthesetargetedprojects.BasedondiscussionswithHubproviders:• mostprovidersgaveexamplesofhow

theapplicationofbetterpracticemethodologiesdevelopedbytheCoPwasinformingservicedevelopmentanddelivery,andtheoutcomesforconsumers;

• dataarebeingcollectedusingqualityoflifetools,insomecases,forthefirsttime,thatwillenablequantitativeevaluationtotakeplace;

• thequalityoflifemeasurestrialledundertheQoLFrameworkregularlyextendedbeyondaHub

provider’sresidentialcareservicestoalsoincludeitshomecareservices;and• staffatserviceshadtheopportunitytolearnanewwayoflookingatagedcare,inrelationto

carerecipients.Providersreportedthat,insomecases,theresultswereconfrontingandstaffwerechallengedtoshifttheirthinking.

“Themembersoftheworkinggroupcollaboratedandsharedbothknowledgeandresourcestoplan,develop,testandevaluatetheframework.The

collectiveknowledgebaseallowedrapidprogresstowardstheobjectiveofinitiallydeveloping

indicatorsforQualityofLifeandastheprojectdevelopedbuildingaframeworktoenable

providerstoactivelyimproveQualityofLife.” JamesBrownMemorialTrust

“DuringtheperiodoftheHub,individualHubprovidershave

extendedtheirunderstandingoftheuseofmetricsin

understandingthequalityoflifeofconsumerswithintheirservices.Thisisanareaof

increasingfocusrelativetothespecificstandardsthatthecaresystemestablishesovertime.”

ResthavenInc.

NationalAgedCareQualityIndicatorProgramHubworkontheQoLFrameworkcommencedinadvanceoftheNationalAgedCareQualityIndicatorProgram.However,HubproviderscontributedadviceinrelationtotheNationalProgram.ThevoluntaryNationalProgramwaslaunchedon1January2016andencouragesproviderstocollectinformationandreportagainstthefollowingthreequalityindicators(withthepotentialforindicatorstobefurtherexpandedwithadvicefromanexpertpanelandinconsultationwithindustry):pressureinjuries;useofphysicalrestraint;andunplannedweightloss.

TheNationalProgramwillalsoconsiderexpandingtheinformationavailableaboutQoLlifeintheAustralianagedcaresetting.Consumerexperienceandqualityoflifetoolshavebeenassessedfortheirsuitabilityinresidentialagedcare.Toolsthatwerefoundtobeapplicable,feasibleanduser-friendlyforconsumersandprovidershavebeenpiloted.ThroughtheNationalProgramserviceproviderswillbeabletocomparetheirresultswithanationaldatasetgainedfromtheconsistentapproachtomeasuringqualityoutcomes.PartD–ConsumerengagementContextTheHub’sfocusonconsumerengagementwascloselyconnectedwiththeworkinrelationtogovernanceandproviderparticipationintheHubTrialincludedacommitmenttobothgovernanceandconsumerengagement.IntheinitialstagesoftheimplementationoftheHubTrial,aconsumerengagementstrategywaspreparedbytheQualityAgencyandcirculatedtoHubTrialparticipants.Insummary,thestrategyincluded:• anapproachforHubproviderstodevelopaconsumerengagementstrategy:

- toinvolveconsumersinassessingwhatalreadyworksandwhy,andplanningwhatcould

workbetter;and- todevelopwithconsumers,astrategywithanevaluationplanprovidingperformance

indicatorsforsuccess;

• consumerengagementdrivers(e.g.communityandconsumerexpectations,demandfor‘individualchoice’withinmodelsofcareandqualitypracticesthatbestpromoteQoL,independence,socialandeconomicparticipation);

• abroadframeworkforinitiatingandsustainingconstructiveconsumerrelationships;

• questionstosupportevaluationandmonitoringofthestrategy;and

• informationaboutmechanismsforincreasingconsumerengagement.COTAalsoledaconsumerengagementCoPthatfocusedon:

• providingworkshopsforHubproviders.WorkshopsincludedpresentationsfromCOTAandavisitingexpertfromtheUnitedKingdomspecialisinginpersonalbudgetsandsystemsofself-directedsupport.SomeHubparticipantsalsoworkedwithCOTASAinrelationtoconsumerengagementandcomplaints.COTASAnotedthisworkisongoing,withconsumerworkshops(focusedonimprovingco-design)planned;and

• discussingexamplesoftoolsthatcouldbeusedtoobjectivelymeasurethequalityofconsumerengagement.ThisincludedtheOwlRatingmodel,aninitiativeoftheNRMAinpartnershipwithCOTAandGallup(aglobalresearchcompany)14.

MembersoftheconsumerengagementCoPnotedthattheemphasiswaslargelyonsharinginsightsandinformationaroundmodels,principlesandopportunitiesforimprovedconsumerengagement.ThisCoPalsoconsideredhowaconsumerengagementstrategycouldgiveanorganisation’sBoardvisibilityofthedepth,breadthandmeasureofconsumersatisfactiontobetterinformco-productionmodelsofengagement15.Hubprovidersnotedthatsomeoftheworkthathadbeenplannedinrelationtoconsumerengagementandco-productiondidnotprogressasoriginallyintended,asitwasovertakenbyothereventsandinitiativessuchastheStepForwardTogetherpilot.ThisisajointinitiativeofCommunityWestInc.andCOTA(fundedbythethenDepartmentofSocialServices)tohelpagedcareservicesmovebeyondconsultingtoco-producing16.ThedepartmentalsoreportedthatconsumerengagementwouldalsobeafocusoftheworkdevelopingtheSingleQualityFramework.ExperienceofHubTrialparticipantsandoutcomesachievedWhilesomechangesweremadewithinindividualorganisationstoenhanceconsumerengagementandCDC,thetimingandscopeofthisevaluationdidnotenablemeasurementofoutcomesforconsumers.FeedbackfromHubTrialparticipantswasvariedinrelationtotheconsumerengagementinitiatives:• somefeltthattheconsumerengagementworkoftheHubwasessentiallyanopportunityto

alignandvalidateworkthatproviderswerealreadyundertakinginthisspace;

14OwlRatingsaredisplayedontheLivingWellNavigatorwebsiteandindependentlyrateretirementlivingoptionstohelpconsumerstonavigateretirementlivingandagedcare,includingknowinghowtochoosethebestserviceproviderfromapersonalperspective.

15Thisisanewwayofworkingwithconsumersofagedcareservicestoco-designservicedelivery.Theserviceproviderworkswithconsumersasequalpartnersinthedesignprocesstoensurethattheserviceofferedisrelevanttotheconsumerandmeetstheirneeds.16https://www.communitywest.com.au/explore/exploring-co-design-with-catalyst/step-forward-together-projectviewed30May2016

• someprovidershadusedtheopportunitypresentedbytheHubtore-visitandimprovetheirconsumerengagementmechanisms;

- Forexample,onelargeprovidernotedthattheyhad,forsometime,hadaconsumerand

carerengagementcommitteebutthecommitteehadnotbeendirectlyfeedingintotheBoard.TheHubhadpromptedthemtoconsiderhowbetterconnectionscouldbemadebetweenconsumers,carersandtheBoard.ChangesweremadesothatrepresentativesfromtheconsumersandcarersengagementcommitteewouldattendtheBoardsub-committeemeetingstoprovidedirectfeedbackinrelationtoconsumeroutcomes.

• anumberofprovidersnotedthecloselinkagesbetweentheworkongovernance,QoL,

complaintsandconsumerengagement.Inparticular,providersnotedthatconsumerengagement(andmeasurementofquality)needstobeattheheartofallagedcareserviceplanninganddelivery,andthisnecessarilyinfluencesthegovernanceofproviderorganisations;and

• anumberofHubTrialparticipantsfeltthattheTrialhighlightedthepotentialformuchdeeper

consumerengagement,co-designandco-productionbetweenprovidersandconsumers.SomenotedthattheyhadhopedthattheHubproviderswouldmakefurtherprogress(beyondtheHubTrial),particularlyaroundco-productionandCDCintheresidentialcarecontext;

- Forexample,someHubprovidersfeltstronglythatCDCinresidentialcarewasanatural

extensionofCDCinhomecare,butitrequiredconsiderationofsomecomplexissuesincludinganyfundingramifications.Tothisend,theCDCinResidentialCareWorkingGroup(whichlatermorphedintoacombinedCDCandconsumerengagementCoP)undertookaSWOTanalysisofasinglecarefundingregime.TheCoPsubsequentlyadvocatedforasingleassessment,approvalandfundingregime(acrossallcaretypes).ThiswasalsorecommendedbytheAgedCareRoadmap,preparedbytheAgedCareSectorCommittee.

PartE–ComplaintshandlingContextAspartofthelightertouchregulationinitiativestrialledthroughtheHub,providersweregiventheopportunitytodemonstratetheeffectivenessoftheircomplaintshandlingmechanisms.ItwasalsointendedthatdecreasedinterventionbytheComplaintsSchemeinprovideroperationswouldreduceregulatoryburden.ThekeyoutcomessoughtbytheComplaintsManagementinitiativewere:

• improvedservicedeliveryoutcomesforconsumersachievedthroughHubprovidershaving

effectiveinternalcomplaintshandling;

• appropriateandresponsivegovernancetorespondtoemergingissuespriortocomplaintsbeingraised;and

• complaintsmechanismsthatareintegratedintotheprovider’soverallqualitysystems.

InrelationtocomplaintsraisedaboutHubparticipantservicesduringtheHubTrial:

• theSchemecontinuedtoresolvecomplaintsviaearlyresolution,whereverpossibleand

appropriate;

• complaintsthatwouldtypicallybehandledthroughafullSchemeresolutionprocesswerereferredtotheproviderforresolutionwithinanagreedtimeframe(exceptwhereamajororsignificantrisktocarerecipientswasidentified);

• ifthecomplaintposedamajororsignificantrisktoacarerecipient,theproviderneededtosatisfytheSchemethatithadappropriatestrategiesinplacetomitigatetheriskpriortotheSchemereferringthemattertotheproviderforresolution;

• theSchemecoulddecidenottoreferacomplainttotheproviderwherethecomplainanthadraisedconcernsaboutthemattersbeingresolvedbytheprovider;and

• oncetheproviderhadresolvedthecomplaint,orhadexhausteditsefforts,itadvisedtheScheme(nowrittenreportrequired).TheSchemetestedthecomplainant’ssatisfactionthatthecomplaintwasresolvedand,ifsatisfied,closedthecase.Ifthecomplainantwasnotsatisfied,theSchemewouldconsiderwhetherfurtherinvolvementwaswarranted.

WithintheHub,acomplaintsCoPwasformedtodevelopacomplaintsfeedbackframeworkbasedonbestpractice(withprocessesmappedanddocumented)whichcouldbeusedtoguideindustrypractice.Toprogressthiswork,theCoP:

• circulatedaquestionnairetoHubprovidersseekinginformationabouteachproviders’

mechanismsforcollectingandreportingoncomplaintsandcomplaintsdata;and

• undertookareviewofrelevantresourcesrelatingtogoodcomplaintshandlingincludingdocumentspublishedbytheAustralianNationalAuditOffice,theCommonwealthOmbudsman,theSouthAustralianDepartmentofEducationandChildDevelopment,theVictorianHealthServicesReviewCouncil,andthe(then)AgedCareCommissioner.

Followingthecollectionofthisinformation(andrelativelyearlyintheprocess),theComplaintsCoPidentifiedthattherewaslittlevalueincomparingprocessesanddevelopingadetailedproceduralframeworkfordealingwithcomplaints(notingthatprovidershavearangeofdifferentprocesses,butitwastheoutcomesthatmattered).Instead,itwasagreedthattheworkoftheCoPshouldfocusontheprinciplesunderpinningeffectivecomplaintshandlingmechanisms.Drawingonbestpracticemodelsandadvicefromthe(then)AgedCareCommissioner,theComplaintsCoPdevelopedatwo-pagedocumententitledComplaintsManagement–GuidingPrinciples.Thedocumentdetailedfourguidingprinciplesforcomplaintshandlingfocusedon:

• Culture–anopenandlearningorganisationalcultureisfundamentaltoapositiveconsumer

experience.Thisincludesopenness,honestyandacknowledgementwiththewholeprocesscommencingwith,andcentredon,theconsumer’spointofview.

• People–toensurethatconsumersenjoytheirexperience,providerswillensurethattheirpeopleareeducatedandexperiencedtoberesponsiveandinclusive.Consumersshouldfeelheardandunderstoodastheprovidersworktowardsresolvingconcerns.

• Process–providerswillhaveanopenandtransparentprocessforhandlingcomplaints.Thiswillsupportproviderstoberesponsiveandflexibleastheyresolveproblems.

• Analysis–providerswilllearnandgrowfromconsumers’feedbackbyapplyingwhattheylearntoimprovetheirservicesforthebenefitofothersinthefuture.

TheComplaintsManagement–GuidingPrincipleshasbeenpublishedontheHubwebsite.ExperienceofHubTrialparticipantsandoutcomesachievedAsnotedabove,thereweretwomainHubTrialinitiativesrelatingtocomplaints:

• thedevelopmentofcomplaintsprinciples(developedontheinitiativeofthecomplaintsCoP);

• changestothewaythattheComplaintsSchemehandledcomplaintsregardingservicesmanagedbyHubprovidersduringtheperiodofthetrial.

DevelopmentofcomplaintsprinciplesInrelationtothefirst,mostHubprovidersnotedthattheprincipleshadenabledthemtotesttheirownsystemandthat,inmostcases,providersreportedthattheirassessmentoftheircomplaintshandlingprocessesagainsttheprinciplesconfirmedthattheyhadreasonablecomplaintshandlingsystems.SomeHubprovidersnoted:• thevalueofmeetingwiththe(then)AgedCareCommissionerandthefactthatithadshifted

theirfocusfromaprocessorientationtofocusingmoreoncultureandpeopleasbeingcriticalforgoodcomplaintsmanagementandimprovementoftheexperience(andoutcomes)forconsumers;and

• thatthedevelopmentofthecomplaintsprinciplesandthereferralofmorecomplaintstoprovidersforresolutionhad“sharpenedourresponsiveness[inmanagingcomplaints]”.

OneprovideralsonotedthatthecomplaintsprinciplesdevelopedthroughtheCoPhadbeenintegratedintotheirstafftrainingprogram,andgeneratedagreaterfocusonthecreationofacustomerserviceculture.ChangestothehandlingofcomplaintsmadethroughtheComplaintsSchemeThereweremixedresponsesfromHubprovidersinrelationtothechangestotheComplaintsSchemeaspartoftheHubTrial.Mostprovidersconsideredthattherehadbeenalackofclarity

regardingthechangestotheComplaintsScheme’sarrangementsfordealingwithcomplaintsrelatingtoHubservices.Someexpressedconcernthattherehadnotbeenagreaterreductionintheregulatoryburdenassociatedwithcomplaintsrequirements,andthattheComplaintsSchemehadcontinuedtodealwithsomecomplaints(whereastheexpectationofsomeHubprovidershadbeenthatproviderswoulddealwithallcomplaintsinthefirstinstance).Likewise,ComplaintsSchemestaffacknowledgedthatnotallprovidersorallcomplaintsofficershadconsistentlyunderstoodthecircumstancesinwhichmatterswould,andwouldnot,bereferredforresolutionbyHubproviders.Someoftheuncertaintyaroundtheagreedprocesses,mayhavecontributedtotheearlycommunicationsissues.ConsultationwiththecurrentAgedCareComplaintsCommissionerandotherHubmembersindicatedthat:• thenumberofcomplaintsresolvedatearlyresolutiondecreasedduringthecourseofthetrial;

- Consistentwiththechangesmadethroughthecomplaintsinitiative,thisdecreasemaybe

explainedduetoanincreaseincomplaintsbeingreferredforproviderresolution(asopposedtobeingaddressedbytheComplaintsSchemethroughearlyresolution).

• overathirdoftheHubprovidercomplaintshandledthroughearlyresolutiontookmorethan22

daystoresolve(whichwasslightlyhigherthanthestateaverageforthesameperiod);- Theextendedtimeframesforresolutionmayrelatetoaninitiallackofclarityregardingthe

roleoftheComplaintsSchemecomparedtothatoftheHubproviders.• 13ofthe44complaintsreceivedwithrespecttoHubprovidersduringtheperiodoftheHub

TrialwereresolvedbyComplaintsSchemeinvestigationratherthanearlyresolutionorapprovedproviderresolution.Themainreasonsthatmatterswerenotreferredtoprovidersforresolution(orwerereferredbacktotheComplaintsSchemeafteraproviderresolutionprocess)were:

- somecasescommencedbeforetheHubTrialandrequiredfurtherclarificationfollowing

traditionalresolutionprocesses;- insomecases,complainantsweredissatisfiedwiththeprovider’sprocessandsoughtthe

involvementoftheComplaintsScheme.COTAalsonotedthatsomeconsumershadexpressedconcernthat,bybeinginvolvedwithHubproviders,theyfeltthattheyhadlosttheiropportunitytoseekresolutionoftheircomplaintsbyanindependentparty;

- thecomplainant’sdissatisfactionwiththeoutcomesachievedbytheproviderthroughproviderresolution;or

- thecomplainantnotagreeingtobeinvolvedinaHubresolutionprocess.Hubmemberfeedbackonthisinitiativesuggeststhatproviderresolutioncanbeeffectivewhenusedintherightcircumstances.Itdoes,however,dependonthewillingnessofthecomplainanttobeinvolvedandtheprovider’sprocesses,experienceandreadinesstoresolvecomplaints.InsomecircumstancestheindependentinputoftheComplaintsScheme(nowtheAgedCareComplaintsCommissioner)isnecessarytoresolveissues,includingwheretheremayberiskstocarerecipientsorwherethecomplainantortheproviderseekstheinvolvementofanindependentperson.

InparallelwiththeHubTrialcomplaintsinitiative,changeswerealsomadetotheComplaintsScheme,withresponsibilityfortheresolutionofallcomplaintsbeingtransferredtotheAgedCareComplaintsCommissionerfrom1January2016.DiscussionswiththeAgedCareComplaintsCommissionerconfirmedthat:• oneoftheprioritiesoftheAgedCareComplaintsCommissioneristoresolvecomplaintsas

quicklyaspossibleintheinterestsofthecarerecipient.TheAgedCareComplaintsCommissioneralsoacknowledgesandsupportstheimportanceofmaintainingstrongrelationshipsbetweenproviders,consumersandtheirfamiliesandworkingtoempowerbothconsumersandserviceproviderstodealwithmostconcernsdirectlythemselves;and

• theAgedCareComplaintsCommissionerwillcontinuetopromotethebenefitsofresolutionattheproviderlevelforbothcarerecipientsandtheprovider.TheAgedCareComplaintsCommissionerhasadvisedthatshealsointendstocontinuetotakeaproportionateapproachtocomplaintsmanagement,basedonrisk,andlimittheburdenonbothprovidersandcomplainantstoresolveissues.

PartF–FinancialreportingContextAspartoftheHubTrial(andasidentifiedintheSAInnovationHubFramework),theACFAconsultedwithHubTrialparticipantsonreforms(flaggedforpossibleimplementationin2014-2015)toreduceredtapeinproviderfinancialreporting.Aspartoftheconsultation,theACFAbriefedHubparticipantsonrecommendationsithadmadetogovernmentonoptionstoimprovethecollectionoffinancialdatafromagedcareproviders,includingoptionstorationalisefinancialreporting.Inthereportprovidedtogovernment,Improvingthecollectionoffinancialdatafromagedcareproviders(September2014),theACFArecommended:

• theadoptionofasingleComprehensiveFinancialReport(CFR)toreplacetheexistingGPFR,the

AnnualPrudentialComplianceStatement(APCS)andSurveyofAgedCareHomes(SACH)forresidentialagedcare,andtheexistingfinancialreport(FAR)forhomecare;

• thatoncetheCFRwasinplaceandtheminimumdatasetwasagreed,theadoptionofStandardBusinessReporting(SBR)asthemechanismfortransferringdatabetweenprovidersandthedepartment;

• collectionofincomeandexpenditureinformationatthefacilityorservicelevel;and

• wherefinancialdataoutsideoftheminimumdatasetneedstobecollected,thiswillbecollectedusingarepresentativesampleofprovidersratherthanthecurrentCensuscollection(100percentofproviders)approach.

AshortdiscussionpaperwasdevelopedbyHubprovidersinNovember2014providingcommentsontheACFArecommendations.Thedepartmentthenissuedadiscussionpaper,includingadraftformCFR,andsoughtcommentsbyFebruary2015.ItwasproposedthattheCFRwouldreplacethecurrentannualobligationsfor:aGPFR;APCS,FARandSACH.Hubparticipantswereinvitedtomakesubmissionstothedepartment,alongwithallotherproviders.ExperienceofHubTrialparticipantsandoutcomesachievedIndiscussionswithHubproviders,anumberofprovidersexpresseddisappointmentthattheyhadnotbeenmorecloselyinvolvedinthedevelopmentandtriallingoftheCFR.IndiscussionswithACFAandthedepartment,however,bothacknowledgedthatconsultationontheCFRneededtobesignificantlywiderthantheHub(i.e.withadiverserangeofprovidersacrossAustralia)andthatthetrialoftheCFRwasopentoallprovidersincludingHubproviders.HubprovidersalsonotedthatatthecommencementoftheHubtheyhadhopedthattherewouldbemoresharingoffinancialinformation(withintheHub)includingdiscussionsaboutthebestwaytoimprovefinancialaccountabilityandreporting,butoutcomeswerenotachievedinthisparticulararea.Onreflection,Hubprovidersnotedthatthiswasanambitiousagendaandthatitmayhavebeenunrealistictoexpectproviderstosharedetailedfinancialinformation,particularlyearlyintheHubTrial,beforetrusthadbuilt.SomeHubTrialparticipantsconsideredthatthetrustamongstparticipantswassufficientlydevelopedthatthisworkcouldnowproceed,butotherscontinuedtonotethattherewouldbelimitsontheextenttowhichproviderswouldbecomfortablesharinghighlyconfidentialandcommerciallysensitiveinformationwithothers.HubprovidersacknowledgedthatthiswasavaluablelearningintermsofareasthatarechallengingtodiscussopenlythroughaCoPmodel.PartG–ExtendedaccreditationContextOneelementofearnedautonomytrialledthroughtheHubwaslessfrequentauditsandastreamlinedapproachtoassessmentoftheAccreditationStandardsbytheQualityAgency.AsdescribedintheSouthAustraliaInnovationHubFramework,theHubtrialledthreeinitiativesrelatingtoaccreditation:• anextendedaccreditationperiodofuptofiveyears(describedinmoredetailbelow);• astreamlinedaccreditationprocessforcorporate-levelassessmentofStandard1;and• reducedduplicationofassessmentacrosstheAccreditationStandards.ThepurposeoftheinitiativewastofacilitategreaterautonomyofHubprovidersinmanagingtheirservicesandensuringthathighstandardsofcareandservicesaremaintained.Thedesiredoutcomesoftheinitiativeincluded:

• thatqualityofcareismaintained(throughcontinuedcompliancewiththeAccreditationStandardsandcontinuousimprovement);and

• reducedgovernmentinterventioninprovideroperationsandthereforedecreasedregulatoryburden.

Otherfeaturesofaccreditationinitiativeincluded:• thattheQualityAgencywouldconductanunannouncedvisitatleastonceayearforeach

service;• thatHubproviderswouldimplementconsumerengagementstrategiestomeetconsumer

expectationsoftransparencyandaccountabilityforqualityofcare;• corporate-levelassessment(inrelationtohowtheprovideraddressedexpectedoutcomesin

Standard1)wouldinvolveconsultationwiththeproviderastoanychangesmadesincethelastassessment.Anyassessmentattheservicelevelwouldseektovalidatetheapplicationofthecorporatepoliciesandprocesses;and

• whenundertakingasiteauditorreviewaudit,theQualityAgencywouldconductassessmentagainstanyexpectedoutcomesthatareduplicatedacrosstheAccreditationStandardsasthoughtheywereconsolidated.

Newprocesseswerealsotrialledinrelationtoproviderself-assessmentagainstStandard1(Managementsystems,staffingandorganisationaldevelopment),withoutcomesgiventoQualityAgencyassessorstodemonstrateimpactattheservicelevel.IntheearlystagesoftheHubTrialanaccreditationsub-groupwasformedtoshareandreflectonaccreditationexperiences.However,inMarch2015,theHubprovidersdecideditwasappropriatefortheaccreditationsub-grouptomergewiththeCQICoPgiventherelatednatureoftheworkthatthetwogroupswereundertaking.ThemajorityofHubprovidersreportedanincreasedfocusonqualityoutcomesduringtheHubTrial.DifferentmodelsforensuringCQIwereadoptedbyHubproviders.SomeleveragedofftherelationshipsthattheyhadformedintheHubandestablishedaprocessofpeerreview(includingforreviewofhomecareservices).AnotherproviderdescribedhowitvoluntarilyappliedtheQualityImprovementCouncil(QIC)HealthandCommunityStandardsinitsorganisationasawaytofocuscontinuousimprovementandidentifyqualityimprovementpriorities.Anotherprovidernotedthattheywereintendingtoinviteanexternalevaluatortoreviewtheirservices.Casestudy:BarossaVillageandBoandikLodgeHomeCarePeerReview

InMarch2016,theGeneralManager(HomeCareServices)andQualityCoordinatorofBarossaVillageattendedBoandikLodgeinMountGambiertoworkwithBoandikLodge’sCommunityCareTeamonapeerreviewoftheHomeCareStandards.

ThepeerreviewwasaprocessinwhichcolleaguesintheagedcareindustrycouldprovidefeedbackonBoandikLodge’sperformanceagainsttheHomeCareStandards.ThepeerreviewwasanopportunityforBoandikLodgetogainanindependentopiniononitspreparednessforitsupcomingmid-yearqualityreviewsitevisitbytheQualityAgency.

Thevisitalsoenabledtheorganisationstoshareinformationandsuggestionsastocontinuousimprovementofservicesandprocesses.Forexample,duringthevisitBarossaVillageprovidedsamplesoftheirconsumers’individualisedperson-centredcareplans.TheseplanshavesinceinformedBoandikLodge’sapproachtocareplanpresentation.The

organisationshavealsosharedsampleassessmentformsandapproachestoconsumerassessment,sothatimprovementsinthisareacanbeconsidered.

Thepeerreviewthathasnowbeenestablishedbetweentheorganisationswillcontinue.LaterintheyearrepresentativesfromBoandikLodgecommunitycareteamwillvisitBarossaVillagetoundertakeapeerreviewinadvanceofitsreviewbytheQualityAgency.ExperienceofHubTrialparticipantsandoutcomesachievedBasedondiscussionswithHubproviders,mostreportedthattheincreasedaccreditationperiodwasthemostobviousadvantageresultingfromearnedautonomy.Hubprovidersdescribedthevariousimpactsofextendedaccreditationattheirservicestoinclude:• theheightenedsenseofresponsibilitytoensurethatstandardscontinuedtobemetthrough

theextendedaccreditationcycle;• theimportanceofnot‘restingontheirlaurels’andtomaintainthefocusonqualityoutcomes;• theriskofreputationaldamageifcompliancewiththestandardswasinquestion,particularly

havingbeenaccreditedforfiveyears;and• thebroaderresponsibilitytodemonstratethepositiveeffectsofanextendedaccreditation

periodsothattheinitiativehadthepotentialtobenefitprovidersoutsidetheHub.AnumberofHubprovidersadvisedthat,basedonaccreditationprocessescarriedoutinearly2015,streamlininghadnotbeenevidenced,andthenewcorporate-levelassessmenthadeitherresultedinnosignificantchange,orhadinfactincreasedthetimecommitment.BasedondiscussionswithHubTrialparticipants,theaccreditationinitiativewasbeneficialinthatitopeneduppathwaysforpeerreviewandencouragedorganisationstoinvestinCQIsystemstoensurethatthestandardscontinuedtobemetthroughoutanextendedaccreditationperiod.SomeoftheconceptstestedduringtheHubTrialregardingaccreditationarealsobeingprogressednationally,includingthedepartment’scurrentworkwiththesectortoco-designaSingleQualityFrameworkthatwillbebasedonproportionate,targetedregulation.PartH–ReducedACFIauditsContextThepurposeoftheinitiativewastofacilitategreaterautonomyofproviderswithrespecttoACFIreviewswhilemitigatingCommonwealthbudgetaryrisk.

Aspartoftheinitiative,Hubproviderswouldbeguaranteedasix-monthperiodbeforeanACFIreviewwasundertakenataHubserviceunlessareviewinthepreviousthreeyearshadidentifiedconcernswiththeaccuracyofclaiming.Thereviewswouldalsobelimitedto10%ofconsumers.Itwasagreedthatafterthefirstsixmonths,reviewscouldbeundertakenbythedepartment,butagainlimitedto10%andnomorefrequentlythansixmonthly(unlessconcernswereidentified).Itwasalsoagreedthatthedepartmentcouldundertakemorefrequentreviewsandcomplianceaction,inlinewithnormalpractices,ifconcernswereidentified.

ExperienceofHubTrialparticipantsandoutcomesachievedWhentheinitiativewasfirstimplementeditwasanticipatedthatanyevaluationwouldconsider:

• whethertherehadbeenachangeinCommonwealthbudgetaryrisk(basedonanassessmentof

claimingactivity);and• costsavingstoHubprovidersduetoreducedregulatoryburden.ChangesinCommonwealthbudgetaryriskAspartoftheevaluation,mpconsultingwasprovidedwithdataontheoutcomesofACFIreviewsofHubproviders.Giventheconfidentialnatureofthesereviews(andthereviewoutcomes),thisreportcannotdescribethereviewoutcomesonaprovider-by-providerbasis.However,thedepartmentadvisedthattherateofinaccurateclaimingforHubproviderswasnotmateriallydifferenttoprovidersnationally.ToimprovethenationalaccuracyofACFIclaimingandstrengthencompliance,thegovernmentannouncedanumberofmeasuresaimedatprotectingtheintegrityofACFI.CostsavingstoHubprovidersHubprovidersdidnotcollectinformationaboutthecostsavingsassociatedwithindividualmeasuresthatformedpartoftheHubTrial.SomeprovidersnotedthatduringtheHubTrialtherehadbeenastreamliningofACFIprocessesorreducedACFIreviews;othersdidnotidentifyasignificantdecreaseineffort.ThismaybereflectiveoftheshortperiodoftheHubTrialandthefactthatthenatureoftargeted,risk-basedACFIauditsmeansthatnotallHubservicesweresubjecttoanACFIauditduringtheperiodoftheTrial.ThedepartmentadvisedthattheHubinitiativehasassistedthedepartmenttorefineitsACFIreviewapproachtoensurethatitistailoredandflexibleinanongoingefforttoreducetheadministrativeburdenforapprovedprovidersfoundtohavebeenclaimingaccurately.Thismayinvolvefewerfuturereviewsforaresidentialagedcareservicewhereitisconsideredtobeatlowerriskofsubmittinginaccurateclaims.However,wherethereisevidencethatapprovedprovidershavenotmadetheirclaimsappropriately,thedepartmenthasadvisedthatitwillcontinuetotakeactiontocorrecttheclaimoraddressthenon-compliance.PartI–CentreforLeadershipandExcellenceinAgeingContextThroughtheirengagementintheHub(and,inparticular,theworkundertakeninrelationtogovernanceandQoL),Hubprovidersidentifiedthattherewaspotentialtodevelopandenhanceleadershipintheagedcaresector.ACoPwasthereforeformedlateintheHubTrialperiod,attheinitiativeofHubproviders,todevelopideasaround:• leadershipandworkforce;

• buildingthecapacityofpeoplewhoareabletoleadagedcarebusinessesandtoconfrontstrategicchallengesintheagedcaresector;and

• theestablishmentofaleadershipcentrewhichcouldoperateindependentlyoftheHub.Toprogressthiswork,Hubproviderssummarisedtheirorganisations’currentapproachtoleadershiptraining,undertookaneedsanalysisandidentifiedprioritiesforagedcareeducation.HubprovidersalsocompletedabriefsurveytoidentifyforeachoftheHuborganisations:• thetopthreetofiveareasofinterestinthecontextofpositioningtheorganisationsforgrowth

inacomplexandrapidlychangingenvironment(forexample,consumerengagement,leadership,changemanagementandworkforcedevelopment);

• thetypesofprogramsthattheorganisationwouldbenefitfrom(forexample,peermentoring,leadershipdevelopmentprograms,mentoringandcoaching);and

• thegroupsofpeopleinanorganisationwhowouldbenefitfromanagedcareacademyconcept.Followingtheresultsofthesurvey,andcommencinginMay2015,theCentreforLeadershipandExcellenceinAgeing(CLEA)CoPhas:• determinedthescopeofworkandtheadvantagesandopportunitiesforaCoPsuchastheHub;

• discussedlocalandinternationalmodels,examplesandprogramgoals,andpotentialpartners

(suchasTAFE,universities);• workedwithalocallybasedleadershipconsultant;and

• engagedwithProfessorJulienneMeyer,ExecutiveDirectorofMyHomeLife(aUK-wide

initiativetopromoteQoLforthoseliving,dying,visitingandworkingincarehomesforolderpeople)andProfessorofNursingCareforOlderAdultatCityUniversity,Londontodrawoninternationalmodelsandlearnings,andtodiscusshowtheHubcouldcollaboratewithMyHomeLife.

ExperienceofHubTrialparticipantsandoutcomesachievedTheCLEAconcepthascontinuedtoevolvebeyondtheperiodoftheHubTrialtothepointthataDraftBusinessPlanwasproducedinMarch2016.TheCLEADraftBusinessPlanincludesthegoals,values,strategicdirectionofCLEA,andkeyprioritiesforthefirstthreeyears.Atthetimeofthisevaluation,HubprovidersacknowledgedthatCLEAwasstilldevelopingasaconceptandthatfinaldecisionshadnotyetbeenmaderegardingthefocus,structureandmembershipofCLEA.MostprovidersagreedthatthepotentialvalueofCLEAwasthatitprovidedleadershipsupportbutwithafocusonagedcare,ratherthanbeingagenericleadershipcourse.ProvidersalsoreferencedtheappliednatureoftheCLEAapproachasapointofdifferencecomparedtomanyotherleadershipdevelopmentsolutions.

Chapter4–SummaryofoutcomesandlearningsPartA–CommunitiesofPracticeasamodelforcollaborationAsdescribedinChapter1,theHubTrialwasbasedontheCoPmodelofcollaborationandsharedlearning.Adoptingthismodelprovedparticularlyvaluableinenablingproviderstoleverageoffexistingcapability,experienceandthediversityofHubmembership.CriticalsuccessfactorsforaCoPAspartoftheevaluation,mpconsultinghasbeenaskedtoidentifysomeofthecriticalsuccessfactorsforaCoPthatmayberelevanttoothersseekingtoestablishCoPs.Basedonmpconsulting’sanalysisandthefeedbackfromHubTrialparticipants,criticalsuccessfactorsforaCoPmodelofengagementincludethefollowing.• AnappropriatelysizedCoP.

- Membershiphastobeconducivetogenuineengagementandthereforehasanaturallimit.- AsnotedbyoneHubTrialparticipant,“Thislooselyequatestohowmanypeoplecansit

aroundatableandcontribute”.

• Strikingabalancebetweendiversityofmembershipandcommonpurposeandvision.- AcriticalsuccessfactorfortheHubwashavingrepresentationfromsmallerandlarger

organisations,regionalprovidersandurbanprovidersandprovidersfocusingontheneedsofdifferentconsumers(culturallyandlinguisticallydiverseconsumers,consumerswithdementiaetc.).

- DiversitymeantthatthediscussionswithintheHubwerebroad(informedbydifferentperspectives)andthematerialsproducedbytheHubwererelevanttoawiderangeofproviders.

- WorkingwithawiderangeofprovidershelpedHubTrialparticipantstothinkaboutthingsdifferentlyandavoidassumingthatthewaytheycurrentlyoperatedwastheonlyway(oreventheoptimalway).

- HubprovidersconsistentlynotedthattheHubcouldnothaveworkedunlessallprovidershadacommonsetofvalues.Someofthesharedvaluesincludedthedesirefor:astrongnot-for-profitsector;equityofaccess;andanimprovedfocusonQoLforconsumers.

- Thesecommonvaluesmeantthatprovidersweremorewillingtohelpeachotherandshareresources(whichwascriticaltotheoperationoftheHub).AnumberofHubprovidersqueriedwhethertheHubcouldhaveoperatedinthesamewayifprivateproviderscontinuedtobeinvolvedintheHub(asdiscussedinmoredetailbelow).

• ExecutiveandBoardcommitmenttotheCoP.

- EachoftheHubprovidersnotedtheimportanceoftheirExecutiveteamsandBoardhavingacommitmenttotheHubandtheirCEO’sbeingrepresentedontheHubWorkingGroup.

- ThismeantthatadequateresourceswerededicatedtotheHubandthattherewassupportfortriallingnewinitiativesastheywereidentifiedthroughtheHub.

- SomeHubprovidersalsoemphasisedtheimportanceofagoodinsidechampiontocommunicateandnegotiatechangeswithintheorganisation.

TheSAInnovationHub:ACommunityofPracticeinaction

• Willingnesstodedicatesignificanttimeand

resources.- AllHubTrialparticipantsreportedthesignificant

timeandeffortdedicatedtoHubinitiatives.WhileallHubprovidersconsideredthattheinvestmentwasworthit,theyallacknowledgedthatunlesstheBoardandExecutiveoftheorganisationhadcommittedtotheHubandsawbenefitandvalueintheCoP,itwouldnothavecontinued.

- Thecapacityforseniorstafftoinvestasignificantamountoftimeawayfromtheday-to-dayneedsoftheorganisationisalsoseenasacriticalsuccessfactor.

• Trustbetweenmembers.

- Trustiscriticalforinformationsharing,butittakestimeandefforttobuild.- AllHubprovidersexpressedadegreeofsurpriseandsatisfactionaboutthelevelofsharing

thatwasactuallypossible,oncetrusthadbeenestablished.- Hubprovidersalsonotedthattherearealwayslikelytobeboundariesintermsofthe

informationthatcompetitorsarewillingtoshare.ThiswasevidencedwiththeearlyworkoftheHubrelatingtofinancialreporting.AsnotedinChapter3,thisinitiativedidnotprogressasintendedpartlyduetoareluctancebyproviderstosharehighlysensitivecommercialinformationearlyintheHubTrialandbeforetrusthadbeenfullyestablished.

- ACoPneedstobeanenvironmentinwhichitissafetoexploreideas,talkaboutmistakesanddifferentwaysofdoingthingsandcontinuetolearn.

• Authenticengagementandwillingnesstoshare.- MembersofaCoPhavetobewillingtoengageandtheremustbeclearrulesof

engagement.HubprovidersidentifiedthatinrelationtotheHub,“successwasduetoeveryonehavingavoiceandtheircontributionbeingconsideredanddiscussed…Everypersonhadtheopportunitytocontributeandwasencouragedtocontribute”17.

• Capacitytodrawontheexpertise,experience

andpassionofawiderangeofstaffwithintheorganisationsrepresentedintheHub.- Bycombiningexperienceandevidenceof

bestpractice,theHubprovidedsignificantopportunitiesforproviderstobuildexpertise

• Establishmentofsubject-specificCoPsto

pursueparticularinitiatives.- TheHubitselfoperatedasaCoP,butitalso

createdanumberofworkinggroupsor

17BoandikLodge,responsetoquestionnaire

“Thecommunityofpracticeapproachtakenallowedsharingofexistingknowledgeandalsoamuchmoreeffectivecollaborativeapproachtoresearchingandidentifyingnew

solutions.Thisapproachhasallowedverysignificantadvancesinashort

periodoftime,anoutcomeunachievableforanyindividualparticipantprovider.”

JamesBrownMemorialTrust

“TheexperienceoftheHubmembersworkingtogetherhasreinforcedtheideathatagroupoflike-mindedproviderswithsimilargoalsand

aspirationsaroundachievingbetteroutcomesforconsumerscan

overcomeperceivedboundariessuchascompetition,intellectualproperty

anddatasharing.”ACHGroup

smallerCoPstoprogressparticularinitiatives.- Ingeneral,thefocusofthesubject-specificCoPswasagreedbytheHubWorkingGroupand

membershipwasself-directedbasedontheinterestofstaffoftheHubproviders.Thekeytothesuccessofthesesubject-specificCoPsincluded:o Theinvolvementofabroadrangeofindividualswithintheorganisation.Thisminimised

theriskof‘burnout’orlackofcapacitybyasmallnumberofindividuals(includingthoserepresentedontheHubWorkingGroup).

o Thecapacitytodrawonexternalresearchandexpertise.Eachofthesubject-specificCoPsinformedtheirworkthroughreviewofresearchandevidenceandbyinvolvingexpertswherenecessary.Thisprovidedanevidencebasefortheinitiativesandhelpedbuildsupportfortheiradoption.

• Anadaptable,flexibleandresponsiveapproach.

- ThroughouttheHubTrial,CoPmembersrevisitedtheroleofthesubject-specificCoPstodeterminewhatwasachievable,andmostvaluabletoallparticipants.ThismeantthattheinitiativesandprioritiesoftheCoPschanged.

- Fromthedepartment’sperspective,akeybenefitoftheHubwasitsabilitytoevolveandshiftfocusinresponsetochangesingovernmentpolicyandinitiatives.Forexample,thefocuswithintheHubTrialshiftedinresponsetothedepartmentwishingtopursueissuesandinitiativesraisedthroughtheHubonanationalbasis(e.g.todevelopaSingleQualityFrameworkforagedcare).Whilethesereformswerepursuednationally,theHubTrialplayedasignificantroleindrawingthedepartment’sattentiontotheimplicationsoftheissues.

• Effectivegovernanceandprojectsupport.

- TheHubbenefitedfrom:strongleadership;regular,focusedmeetings;thecloseinvolvementofgovernment,particularlyintheinitialstagesofimplementationwhendeterminingdirection,focusandoutcomes;andastrongprojectofficertosupporttheworkoftheHub.Theprojectofficerwasresponsibleforawiderangeofactivitythatincludedresearch,developmentofpapersandsuggestionsforstrategicdirection.ManyoftheHubmembersnotedthattheassistanceoftheprojectofficerwasacriticalsuccessfactorfortheHub,enablingactionstobeprogressedinatimelyandeffectivewayandmitigatingtheriskofalossofmomentumparticularlybetweenmeetings.

• Geographicalproximityofmembers.

- WhileprovidersacknowledgedthataCoPcouldoperateeffectivelydespitemembersnotbeingphysicallyproximate,itwasalsofeltthatbeingabletomeetregularlyface-to-facewasintegraltobuildingrelationshipsandtrust(particularlyearlyinthelifeoftheCoP)andtofacilitatingsharedideasandlearnings.

- Oneprovideralsonotedthatasharedgeographycreatedcommonalityoflanguageandpurposetohaveprovidersinvestedinthesuccessofthesameregion.

Overall,theCoPmodelofengagementwashighlysuccessfulinsupportingHubTrialparticipantstoprogressinitiatives,share

“TheCoPwasanintegralpartoftheprojectmethodologyandinvolvedafocusonsharedlearningandcapacitybuildingaswellasproductionoftheprojectdeliverables.”

AustralianAgedCareQualityAgency

learnings,testideas,buildtrustedrelationshipsandachieveoutcomes.Importantly,themodelwasnotdependentontheearnedautonomyinitiatives,andisamodelofcollaborationthatcouldbeappliedbyotherprovidersseekingtobuildcapabilityandinnovatecollectively.RiskfactorsforaCoPHubprovidersalsoidentifiedsomeoftherisksinherentinaCoPmodelincluding:• theriskofchangestokeypersonnel;• thechallengeofcommunicationbetweenmeetings;• schedulingmeetingsduringpeakperiodsofactivityacrossthesectorandforindividual

organisations;• thefactthatprovidersarenotalwaysstartingfromthesamepointandmaynotalways‘beas

one’intermsofprioritiesoroutcomessought;and• thedifferingfinancialandresourcecapacityofproviders.

PartB–AchievementofHubTrialobjectivesandaimsAsnotedinChapter1,theobjectiveoftheHubwasto:

…improveandsustainbetteroutcomesforolderAustraliansengagedwithagedcareservices.ThiswillbeachievedthroughdevelopinganearnedautonomyapproachforagedcareinsupportoftheGovernment’sderegulationandsocialpolicies…thataimsto:• Encourageproviderstopursuebetterpracticeinconsumerengagementandgovernance

andimproveservicedeliveryoutcomesforconsumers.• Supportanexpansionininnovativemodelsofcareandservicesinlinewiththeincreasing

demandsofanageingpopulation.• FacilitateamoretargetedapproachtoGovernmentregulatoryactivitiestofocusthemon

wheretheyareneededwhilstmaintainingsafeguardsforconsumers.• Provideopportunityformutualsharing,learningandinnovationamongHubmembersand

partners.While12monthsisnotasufficientperiodtoeffectivelyevaluatewhethertherehavebeensustainedbetteroutcomesforolderAustraliansasaresultoftheHubTrial,therehavebeenachievementsagainsteachofthemainaimsoftheHubTrial.Someoftheseachievementshavebeenabletobeindependentlyverifiedbympconsultingandothershavenot.Forexample,HubprovidersreportedthatoneofthebenefitsoftheHubTrialwasthedevelopmentofstaffcapabilityinareascriticaltoimprovingqualityoflifeforconsumers.Thiscannotbeindependentlyverifiedwithinthescopeofthisevaluation.ThisPartthereforesummarisesthekeyoutcomesoftheHubTrialbasedonmpconsulting’sanalysisofthedocuments,anddiscussionswithHubTrialparticipants,includingself-reportingofbenefitsandoutcomes.

Aim1:BetterpracticeconsumerengagementandgovernanceTheHubTrialaimedtoimprovegovernanceandconsumerengagementandtopositivelyinfluenceservicedeliveryoutcomesforconsumers.Basedonouranalysis,thethreemainwaysthattheHubTrialachievedoutcomesinrelationtoconsumerengagementandgovernancewere:• improvedproviderunderstandingandappreciationofqualityoflife;• strengtheningofgovernance(includingBoardcapacity);and• developmentofBoardandstaffcapability.Qualityoflife• Forthefirsttime,anumberofprovidersparticipatingintheHubTrialhaveadoptedtoolsfor

measuringqualityoflife,amechanismforexploringareasofconcerninmoredetail(revealedthroughthetoplinetools)andapathwayformakingimprovements.

• Thiswaspossible,inpart,throughahighlyeffectiveCoP.FivefeaturesofahighlyeffectiveCoPprocessinclude:usinganevidencebase;sharedlearnings;consideringthebroadercontext;actionlearning;flexibility;andanoutcomesfocus.ThedevelopmentoftheQoLframeworkreflectseachofthesefeature.

- Evidence–Theframeworkwasinformedby

researchandevidence(includingexternaladvicewhereneeded).- Sharedlearnings–ProviderssharedexperiencesandresourceswithothersabouttheQoL

frameworkstheyhadimplemented.- Considerationofbroadercontext–Considerationwasgiventorelatedgovernment

initiativesincludingthequalitytoolsbeingtrialledbythedepartment(throughKPMG)andaconsciousdecisionwasmadetopursuealternativeindicatorsthatfocusmoredirectlyonwellbeing,QoLandsatisfaction.

- Actionlearning–Theframeworkwastrialledbyanumberofprovidersbeforebeingimplemented.Resultofthetrialswereanalysedandadaptationsmade,beforetheframeworkwasappliedmorebroadly.

- Flexibilityenablingwideapplication–Eachproviderwasabletoselectwhichtoolstousebasedontheircircumstance.TheCoPworkedtoensurethattheframeworkhadvalueforallprovidersfromsmallsinglelocationprovidersthroughtolargeproviderswiththeresourcestoimplementsignificantqualityimprovementinitiatives.

- Outcomesfocus–Eachprovideridentifiedareaswhereimprovementscouldbemadeandimplementedchangesincluding:stafftraining;careplanning;lifegoalsettingforresidents;andintroductionofnewactivitiesthatweremeaningfultoindividualconsumers.Toenablebenchmarking,someHubprovidershavealsocommencedsharingindicatoroutcomeswitheachother.

“Ourclientshavebenefitedthroughmoreeffectivegovernance,focusonqualityoflife,reviewofcomplaintsprocesses,researchintoconsumerdirectedresidentialcare,sharingof

resourcesandinformation.” BoandikLodge

“TheinvolvementintheHubassistedResthaven’sstafftoembraceandbechallengedbyanimprovedconsumerfocus

nowandinthefuture.” ResthavenInc.

• EventhoseprovidersthatalreadyhadsystemsinplacetomeasureQoL,reportedthatthey

benefitedfromparticipationintheHubandtheworkoftheCoP.Forexample,oneprovidernotedthatpriortotheirinvolvementintheCoP,theirfeedbackandengagementprocesshadbeenlimitedtoa‘satisfaction’styleaudit.DrawingontheworkoftheCoP,theproviderhadremodelledtheirapproachtoincorporateanappreciativeinquirybasedformatfocusingonQoL.

StrengthenedgovernanceAllprovidersreportedthatasignificantachievementoftheHubwas:• thebetterengagementofBoardmembersonissuesofgovernanceandstrategicagedcare

priorities(includingCDCandQoL);

• theincreasedfocusofBoardsongoodgovernancewithflow-througheffectstotherestoftheorganisation;and

• thestrengtheningofBoardcapacity.EachproviderhasadifferentBoardstructureanddifferentgovernancearrangements.However,eachproviderinterviewednotedthatchangeshadbeenmadeattheBoardlevelasaresultoftheHub(referChapter3).DevelopmentofBoardandstaffcapabilityHubprovidersconsistentlynotedthatoneofthebenefitsoftheHubwasthedevelopmentofitsBoardandworkforce.InadditiontostrengthenedgovernanceandBoardcapacity,providersnotedthat:• staffgreatlybenefitedfrombeinginvolved

inCoPs,leadingworkareasofinterestandexperienceandbeingexposedtonewideasthroughregulardiscussionswithstaffofotherproviders;

• membershipoftheHub(andthevariousinitiatives)promptedanumberofstafftoundertakefurtherprofessionaldevelopmentandtraining.Forexample,completionoftheAICDDirectorsCourseandcompletionoftraininginrelationtoQoLandcontinuousimprovementtools;

• theHubbroughtCEO-levelattentiontothetopicsbeingexploredthroughtheHubinitiativesandencouragedadeparturefromthe‘that'sjustthewaywedothings’mentalitywithinorganisations.Asonestaffmembernoted“TheHubhasreallymademethinkatamuchmorestrategiclevelratherthanintheday-to-daydetail.”

“Ihaveobservedgrowthintheteammembersdevelopmentally…

Irecognisethatthispilothasclearlyshiftedthelevelofthinkingabouttheindustry,consumerandhowtheproviderswork

together.Fromthefirstmeetingtowherewearenowthereisaverymarkeddifferenceintheinterpersonalinteractionsandincreased

empathyforthevariouspositionsandplayers.Ithasbuiltnetworks,developedindividualsandcontributedadiversityof

perspectivethatcreatesagreaterthansumeffect.”

HubProgramDirector

Aim2:InnovationTheHubprovidedanopportunityformemberstocollaborativelydevelopandtestinnovativeapproachesinareasidentifiedasaprioritybyindustryandgovernment.Italsoprovidedanopportunityinwhichtotrialthebenefitsofaco-designmodelinwhichtheregulatorandprovidersworktogether.TheopportunitytoleveragecollectiveHubmemberexpertiseandtodevelopacrossmultipleareasinsucharapidwaywasparticularlysignificantforsmalltomediumHubproviderswithlimiteddevelopmentresources.AnumberofprovidersnotedthattheHubTrialpromptedthemto‘thinkoutsidethebox’.Asaresult,anumberofactivitiesweretrialledorimplementedthatwerebeyondthescopeoftheHubTrial.Examplesofactivitiesthatprovidershaveinitiatedinclude:• atrialofoptionsforinnovationinfoodservices,

includinggreaterinvolvementofinterestedconsumersinfoodproductionandpreparation;

• atrialofaresidentimpactsurvey,examininghowtheapproachoftheorganisationimpactsthelifeofeachconsumersurveyed;

• apeerreview,wherebytwoprovidersassessedeachother’sperformanceagainsttheHomeCareStandardsinpreparationforaqualityreviewbytheQualityAgency,resultinginrefinementofsomepracticesandimplementationofimprovementsinrelationtoassessmentandpersonalisedcareplanning;

• considerationofhowtobeststructuretheworkforceinordertofocusmoreonthecontinuumofcareandthetransitionofconsumersfromindependentretirementliving,throughhomecareandresidentialcare;

• implementationofheathyageingtraining(deliveredbyanotherHubprovider).

Aim3:MoretargetedapproachtogovernmentregulatoryactivitiesAsnotedinthepreviousChapter,therewerechangesingovernmentregulationinthreemainareas:extendedaccreditation;reducedACFIreviews;andchangestocomplaintsprocessestoincreasethefocusonproviderresolution.

“Theaccelerated,lowerriskdevelopmentopportunityofferedbyHubparticipationisthemostvaluableaspectfortheTrust,withveryreallimitsondevelopmentalresourcesavailabletousasasmallerprovider.ByleveragingtheHubworkinggroupstheTrusthasbeenabletocovermoreground,fasterandatlowerriskthanifwehadattemptedtodosoourselves.”

JamesBrownMemorialTrust

“TheSingleQualityFrameworkwillfocusonconsumerexperienceto

supportaconsumer-driven,market-basedagedcaresystem,encouragedeliveryofhigherqualitycareandreduceredtapeforagedcare

providers.TheFrameworkisbeingco-designedwithconsumergroups,representativesfromtheindustry,expertsinstandardsdevelopment

andagedcareregulationandapublicconsultationprocess.”DepartmentofHealth

Basedondiscussionswiththedepartment,someoftheinitiativesandconceptsinitiallyprogressedintheHubTrialarenowbeingaddressedatanationallevel.InadditiontotheNationalAgedCareQualityIndicatorProgrammerandACFIreforms(e.g.moreriskbasedACFIauditingwithreducedadministrativeburdenonservicesthatmakeaccurateclaims),thisalsoincludesdevelopmentaSingleQualityFrameworkforagedcare.GovernmentisworkingwiththesectornationallytocreateaSingleQualityFrameworkbasedonproportionate,targetedregulationtodeliverhighqualityoutcomesforconsumersandproportionaterisk-basedregulationforagedcareproviders.Inrelationtoextendedaccreditation,mostprovidersnotedthebenefitof5-yearaccreditation.Theynotedthecostsavings,thebenefitofshiftingawayfromacompliancefocus,andthereducedpressureonstaffthatcanbeassociatedwithasitevisit.ItisworthnotingthatanumberofHubprovidersstatedtheywouldimplementothermeasurestoensurethattheycontinuedtomeettherequiredstandardsincludingexternalreview,peerreviewandmoreregularinternalreview.InrelationtoACFIaudits,therewerefewerauditsundertakenbutthereislimitedvalueinassessingtheoutcomesofeachoftheseaudits.InthecontextofbroaderGovernmentpolicychanges,theconceptofearnedautonomythatunderpinnedtheHubTrialhasinformedthedepartment’scurrentfocusonmoreriskbasedACFIauditingwithreducedadministrativeburdenonservicesthatmakeaccurateclaims.Inrelationtocomplaints,theHubTrialdemonstrated:• thevalueoftheAgedCareComplaintsCommissionerprovidingeducationtoprovidersabout

effectivecomplaintshandlings;and• thatreferringagreaternumberofcomplaintstoprovidersforlocalresolution:

- isnotalwaysappropriate,includingwhenthisisnottheoutcomesoughtbythecomplainant;

- doesnotalwaysreducethetimeframeforresolution;and- isonlyeffectivewhenthereisclarityofrolesandresponsibilitiesandwhentheproviderhas

astronginternalcomplaintsprocessandgoodcommunicationwiththeAgedCareComplaintsCommissioner.

ThedepartmentandtheQualityAgencyalsoadvisedthattheHubTrialpromptedthemtoconsiderarangeofissuesinrelationtomoretargetedapproachestogovernmentregulationandthevalueofproportionateregulationmodels,including:

• considerationofthevariousregulatoryleversavailabletoachievethedesiredaims,andthe

risks,costsandbenefitsforconsumers,providers,thesectorandgovernmentassociatedwitheachlever;

• thedifficultiesassociatedwithaccuratelydetermininglevelsofproviderperformanceandeligibilityforlightertouchregulation;

• theimpactonpublicconfidenceofearnedautonomyapproaches;and• theneedtomonitortheeffectivenessofanyearnedautonomyapproach.

Aim4:OpportunityformutualsharingandlearningCasestudy:DevelopmentofregionalCoPDuringthegovernanceproject,anumberoftheHubprovidersmirroredtheCoPprocessesinrelationtosharedlearningsandgoodpracticegovernancebymentoringandworkingwithotherprovidersintheirregions.Throughthisprocess,afewHubprovidersestablishedaregionalCoPthatincludedsupportforlocalIndigenousagedcareproviders.Drawingonstrategies,examplesandtoolsusedintheGovernanceFramework,thisregionalCoPsupportedcapacitybuildingandgoodpracticeingovernanceforregionalproviders.ClearlyoneofthekeybenefitsoftheHubwastheopportunityforproviderstoopenlyandsafelyshareinformationandlearningswitheachotherandwithgovernment.Hubprovidersappreciatedtheopportunityto:• beinvolvedinadiscussionaboutagedcareandto

contributelocally,andtotheagedcaresectormorebroadly;and

• tobuildrelationshipswithgovernmentoutsideofthenormalinteractions,andtoinformagedcarepolicy.

TheHubTrialdemonstratedcollaborationandpartnershipbetweenthegovernment,industryandregulators.Thecloseconsultationofthesepartieswascriticaltoestablishing,settingthedirectionfor,andmonitoringtheoutcomesoftheHubTrial.Providersalsoacknowledgethat,tovaryingdegreesdependingonthenatureoftheworkbeingundertaken,theHubprovidedanopportunityforthepoolingofresources.Whilenotanexplicitinitiative,thisby-productofthepositiveandtrustingrelationshipsdevelopedintheHubhasthepotentialforcostsavingsandefficiencies.Forexample,smallerorganisationswithintheHubweregivenaccesstoanumberofpoliciesandproceduresthatthelargerorganisationshaddeveloped,testedandsubsequentlyimplemented.Thisenabledsmallerproviderstodrawonwell-developedpracticestoinformtheirownpoliciesandprocedures,whilestillretainingautonomy.PartC–ChallengesandlearningsThepreviousPartsummarisessomeofthestrengthsoftheCoPasamodelforcollaborationandsomeoftheachievementsoftheHub.Aspartoftheevaluation,HubTrialparticipantswerealsoaskedfortheiradviceabouthowtheywoulddothingsdifferently,andwhatlearningstheywouldpassontoothersinterestedintheHubCoPmodel.Someofthemattersraisedincludedthefollowing:• theimportanceofbuildingtrustwithinthemembershipoftheHub;

“Localcommunities,localorganisations,localboards,local

people,localiseddecisionmaking…Thistrialprovidesuswithanopportunitytoworksidebysidewithsomeofthelarge,betterresourced,

providersandtotrialhownewinitiativesinbestpracticeand

improvedservicescanbeappliedwithinsmallerorganisationsandwithinrural/regionalproviders.”

BarossaVillage

- ProvidersobservedthatwhilethequalityofrelationshipsderivedfromtheHubareoneofthesignificantbenefits,itdidtaketimeforindustrycompetitorstoestablishtrust.Providersfeltthefinancialreportinginitiativecouldhavebeenmoresuccessfulifitstartedoncerelationshipshadbeenbuilt,whenpeopleweremoreinclinedtosharesensitiveinformation.

• thedifferentstrengthsandlimitationsofsmallerandlargerorganisations;

- AnumberofthesmallerandregionalprovidersemphasisedthevalueofbeingintheHub

andthesignificantbenefitsfromreceivingresourcesfromlargerproviders.TheyalsoidentifiedsomeofthechallengeswithdedicatingstaffresourcestotheHubandwithtraveltomeetings.

- Ontheotherhand,smallerorganisationsareabletoadoptnewapproachesmorequickly,whereasaslargerorganisationscantakelongertotrialorimplementinnovations.

• thechallengeposedbymultiplechangesinthe

governmentandthedepartmentthroughouttheperiodoftheHubTrial.Providersnotedthatthelackofcontinuityhadanimpactonthestrengthofrelationshipsandnetworks,andreducedtheopportunitytoexplorestrategicandnewpolicyopportunitieswiththedepartment;

• whether,iftheHubTrial,andinparticulartheearnedautonomyinitiatives,weremorebroadly

applied,therewouldbesimilaroutcomes;

• theHubTrialperiodof12monthslimitedthedegreetowhichtheeffectivenessoftheHubinitiatives,particularlyforconsumers,couldbedetermined;

• someaspectsoftheHubTrialwouldhavebenefitedfromgreaterclarity;

- Forexample,providersfeltthatthecomplaintsinitiativewasnotwellcommunicated

throughtheComplaintsSchemeandthatthiscreatedsomeinitialdifficultiesinengagingwiththedepartment.

- ThedepartmentidentifiedthattheHubTrialwouldhavebenefitedfromgreaterleadtimetoplaninitiatives,establishprocesses,trainstaffandco-designwiththesector.Including,thattheearlierfinalisationofkeydocuments(suchasthecomplaintsinitiative)couldhaveimprovedclarity.

• theinvestmentoftimeandresourcesintheHubrequiredsignificantenergyandcommitmentbyindustryandgovernment(althoughproviderslargelyacknowledgedthatforthemthereturnwasfargreaterthantheoutlay);

• thechallengesinestablishingtheHubTrial;

- HubmemberswereawarethatmanyotherprovidersmayhavelikedtobepartoftheHubandwouldalsohavemettherequirementsforearnedautonomy.However,thenatureof

“Smallerservicesaremorenimbleandadaptableoncetheyhaveadirection.Largergroupsmayhavemoreestablishedandentrenchedsystems,makingtheirchangeelementsmorecomplex.”

ResthavenInc.

theTrialrequiredamanageablenumberofparticipantsandtherewasvalueidentifiedinlocalisingtheTrialsite.

OtherfactorsthatwerenotexpresslyraisedbyHubmembersbutbecameevidentthroughtheevaluationoftheHubTrialincludethefollowing:• theobjectivesandaimsoftheTrialwerebroadlyexpressedand,inmostcases,notabletobe

effectivelyevaluatedafter12months.Nevertheless,asanumberoftheHubTrialinitiativesinformedbroaderagedcareinitiatives,thedepartmentconsideredthatitwasusefulfortheTrialtobeevaluatedatthistimetoinformtheseinitiatives;

• giventhe12-monthperiodoftheHubTrial,theTrialinitiativeshadlimitedtimetobeembeddedinpracticeandproducemeasurableoutcomesforconsumers;

• therewaslimitedpre-andpost-evaluationdatainrelationtoarangeofinitiativesincludedin

theHubTrial;and• whiletheconceptofearnedautonomyforhigherperformingproviderswasinitiallyastrong

driverfortheHubTrial,therehasbeenlimiteddevelopmentandtestingoftheconceptwithintheHub.OneofthelearningsfromtheHubisthedifficultyinidentifyingdifferentiatorsofperformancewithintheexistingregulatoryandpolicysettings.

- Forexample,whenover95%ofagedcareservicescomplywiththeAccreditationStandards

andtheexpectedoutcomesaremeasuredonamet/notmetbasis,itisdifficult(withinthecurrentqualityassessmentframework)todistinguishstrongerperformingorganisationsfromothers.Similarly,therearechallengesincomparingorganisationsbasedoncomplaintsandACFIinformationbecauseofthecommerciallysensitivenatureoftheinformationandthefactthatitisnotroutinelypublishedbythedepartment.

- Thedepartmentalsonotedthechallengeofmaintainingpublicconfidenceinrobustgovernmentoversightinaderegulationcontext.ThisconcernwasreflectedincommunityreactionandmediareportingintheinitialstagesoftheHubTrial.

Chapter5–ThefutureoftheSouthAustraliaInnovationHubBasedondiscussionswithHubproviders,theyintendtocontinuetomeetregularlyandarecommittedtothecontinuationoftheHub.Hubprovidersexpressedinterestincontinuingwithanumberofexistinginitiativesandalsoexpandingintonewareas.ProvidersalsoacknowledgedthatspecificCoPsformedwithintheHubwillchangeovertimeasexistinginitiativesareaddressedandnewinitiativesaredeveloped.OngoingHubactivitiesinclude:

• QoLtrialsthatarebothunderwaycurrently,andplannedatanumberofHubservices;

• governanceworkshopsandongoingnetworkingopportunitiesfortheboardsofHubproviders;and

• consumerengagementandco-designworkshopswithCOTASA.Inaddition,Hubmembersarealsoconsidering:• theestablishmentofCLEA;and• focusingonareasofinterest,suchasCDCinthe

residentialcarecontext,strategiesforhospitalavoidance,andongoingopportunitiestoinnovate.

InconsideringthefutureroleofgovernmentintheHub,providersexpressedarangeofviews.Ontheonehand,providersacknowledgedtheimportanceofnetworkswithgovernmentthatenabletheformingofapartnership,ratherthanarelationshipoffunderandregulator.Forothers,theroleofgovernmentisnotcriticaltothesuccess,orthebenefits,ofbeinginvolvedintheHub.Rather,thefutureoftheHubispredicatedonthemotivationandintentofHubmemberstoworktogether.AllHubprovidersidentifiedthatthebenefitsoftheHubaresomewhatstaged,inthatrelationshipswillcontinuetodevelopandoutcomesforconsumersachievedintime.Forthatreason,HubmembersbelievethatthevalueoftheHubwillcontinuetoberealisedintothefuture.

“TheSAHubprovidershaveagreedtocontinuetogetherwithrenewedagreedpurposeoverthenexttwo-yearperiod…Thereisrenewedandcontinuedfocusongovernance,

consumerengagement,continuousqualityimprovementandextendingthedevelopmentoftheLeadership

andExcellenceinitiative.”SAHubProviderGroup

“…theconceptofearnedautonomyintheHubTrialincludedconsiderationof

opportunityforredtapereductionintheagedcareregulatoryenvironment.WhileredtapereductionwasnotultimatelyafocusoftheHubTrial,HubprovidersaffirmandacknowledgethebroaderGovernmentintenttoreduceredtape,andthecontinuedimportanceofthisintentioninfutureagedcarereforms.”

SAHubProviderGroup

BibliographyACHGroup,ACHAnnualReport2013/2014andAnnualReport2014/2015,www.ach.org.au

ACHGroup,MikeRungie,CEO,ACHGroup,www.ach.org.au,viewed9March2016

AgedCareFinancingAuthority,ImprovingtheCollectionofFinancialDatafromAgedCareProviders,September2014

AndrewsMP,TheHonKevin,PressRelease:TrialaimsforlessredtapeinAgedCareSector,10October2014

AndrewsMP,TheHonKevin,TranscriptofthespeechmadebyTheHon.KevinAndrewsMP,MinisterforSocialServices,LaunchoftheSouthAustraliaInnovationHubTrial,www.kevinandrews.com.au,10October2014

AustralianAgedCareQualityAgency,QualityAgencyBetterPracticePresentation2015–SAHub,7August2015

AustralianAgedCareQualityAgency,DraftInnovationHubStakeholderEngagementStrategy–ConsumerEngagement,19July2014

AustralianAgedCareQualityAgency,DraftGovernanceStrategyFramework,19July2014

AustralianAgedCareQualityAgency,SupportingtheSouthAustraliaInnovationHub–TheHubGovernanceProject,www.aacqa.gov.au,AnnualReport2014/2015

AustralianAgeingAgenda,Balancingregulationwithsupportforinnovation,www.australianageingagenda.com.au,4November2014

Charlton,Simon,QualityUpdate–KalyraNews,www.jamesbrown.org.au,June/July/August2015

CommunityWest,StepForwardTogether,www.communitywest.com.au,viewed30May2016

CommunityWest,MediaRelease:Co-productionprojectisunderway,http://www.communitywest.com.au,16November2015

DepartmentofHealth,Budget2016-2017,www.health.gov.au,3May2016

DepartmentofHealth,JointMediaReleasefromTheHon.SussanLeyMP,MinisterforHealthandTheHonKenWyattMP,AssistantMinisterforHealth,StrongerCompliancetoProtectIntegrityofAgedCareSector,16December2015

DepartmentofSocialServices,Discussionpaper:proposedchangestofinancialreportingforprovidersofresidentialagedcareandhomecare,3February2015

DepartmentofSocialServices,LaunchoftheSouthAustraliaInnovationHub,www.dss.gov.au,10October2014

DepartmentofSocialServices,SouthAustraliaInnovationHubFramework,June2015

DepartmentofSocialServices,SouthAustraliaInnovationHubImplementationPlan,December2014

DepartmentofSocialServices,TheSouthAustraliaInnovationHubTrial,www.dss.gov.au,8December2015

DPSNews,Alookatagedcareaccreditation,www.agedcareguide.com.au,27January2015

Hearn,Richard,ChiefExecutiveOfficer,ResthavenIncorporated,AdelaideAdvertiser,Makingdecisionsthatsupportqualityoflife,www.resthaven.asn.au,31August2015

HelpingHand,SAInnovationHub,www.helpinghand.org.au,viewed8March2016

iSENTIA,SouthAustraliaInnovationHubMediaEvaluation2014

Lannin,Sue;ABCNews,SouthAustraliannursinghomestrialincreasedautonomyamidreportsofloweringstandards,www.abc.net.au,20February2015

LASAVictoria,TheSouthAustralia’sHubTrial,www.lasavictoria.asn.au,23October2014

MirusAustralia,HowcouldtheHubTrialimpactthewideragedcaresector?http://www.mirusaustralia.com,18November2014

Naso,Frank,SaintHilarionAgedCare,QualityofLifeFrameworkPowerPointpresentation,April2016

O’Grady,Lynda(ChairofACFA),LettertoAgedCareProvidersreImprovingthecollectionoffinancialdatafromagedcareproviders

Polley,SenatorHelen,SenateCommunityAffairsCommittee–AnswerstoestimatesquestionsonnoticeSocialServicesPortfolio,www.aph.gov.au,2014/2015EstimatesHearings

Resthaven,SAInnovationHub,www.resthaven.asn.au,10October2014

Rhead,Sarah,CentreforLeadershipandExcellenceinAgeing(CLEA)[workingtitle],DraftBusinessPlan2017-2020,March2016

SAInnovationHub,AccreditationWorkingGroup,MeetingNotes:19December2014and27March2015

SAInnovationHub,ACFITeleconferenceNotes,includingprocessforImplementingtheSAInnovationHubInitiative:AgedCareFundingInstrument(ACFI),18March2015

SAInnovationHub,CDCinResidentialWorkingGroup,Agenda(includingattachment:SWOTanalysis),23October2015

SAInnovationHub,CDCinResidentialWorkingGroup,Update

SAInnovationHub,CentreforLeadershipandExcellenceinAgeingGroup,MeetingMinutes:14May2015,16June2015,23November2015,15February2016and2May2016

SAInnovationHub,CentreforLeadershipandExcellenceinAgeingGroup,SurveyMonkeyResponses,May-June2015

SAInnovationHub,ComplaintsGroup,ComplaintsManagementGuidingPrinciples,www.sainnovationhub.org,viewed15April2016

SAInnovationHub,ComplaintsGroup,Minutes:11May2015and18June2015andNotes,18November2014

SAInnovationHub,ComplaintsGroup,QuestionnaireandQuestionnaireSummary

SAInnovationHub,ConsumerEngagement–Draft,19July2014

SAInnovationHub,ConsumerEngagementWorkshopNotes:10December2014and29January2015

SAInnovationHub,ContinuousQualityImprovementGroup,Minutes:9April2015(draft),13July2015,3August2015,31August2015,12October2015,16November2015,1February2016,7March2016and11April2016

SAInnovationHub,GovernanceWorkingGroup,MeetingMinutes(draft),9June2015and16December2014

SAInnovationHub,e-news:March2015,May2015,August2015andNovember2015

SAInnovationHub,TheSAInnovationHub,ACommunityofPracticeinaction,www.sainnovationhub.org,receivedApril2016

SAInnovationHub,TheSAInnovationHub,ThreeYearVision,October2015www.sainnovationhub.org

SAInnovationHubandAustralianAgedCareQualityAgency,EffectiveGovernance:acomparativeanalysis–ResearchtosupporttheSouthAustraliaInnovationHub–EffectiveGovernanceProject,June2015

SAInnovationHubandAustralianAgedCareQualityAgency,EffectiveGovernance:aframeworkforagedcare,June2015

SAInnovationHubandAustralianAgedCareQualityAgency,EffectiveGovernanceinAgedCare,SouthAustraliaInnovationHubImplementationProjectReport,June2015

SAInnovationHubandAustralianAgedCareQualityAgency,InnovationHub–GovernanceStrategyFramework,ProjectOverview

SAInnovationHubProviders,DiscussionPoints:ImprovingthecollectionofFinancialDatafromAgedCareproviders,November2014

SAInnovationHubwebsite,SAInnovationHub,DrivingQualityinAgedCare,www.sainnovationhub.org,viewed30May

SAInnovationHubWorkingGroup,AgendaItem–BoardGovernanceandConsumerEngagement-SAInnovationHubWorkingGroup,VideoConference,4September2014

SAInnovationHubWorkingGroup,MeetingNotes:30July2014,3September2014,15October2014,3December2014,17February2015,21May2015,19August2015and23March2016

SAInnovationHubWorkingGroup,TermsofReference,December2014

SaintHilarion,Newsletter-TheSocietyofSaintHilarionInc.,AgedCare,www.sainthilarion.asn.au,June2015

Shonhan,Heath,NationalPracticeLead,Health&Ageing,Bentleys,Thinkingaheadon:CDCinresidentialagedcare,BusinessTransformation/Organisationalcapacitydevelopmentplanv2.1,www.bentleys.com.au,February2016

SouthernCrossCare,SAInnovationHubComplaintsManagementWorkingGroup,ComplaintsManagementGuidingPrinciples

VariousmediaarticlesabouttheSAInnovationHub,2014

Williams,Carol,ElderCareWatch,AgedcareanafterthoughtinPM’s“Ministryforthe21stcentury”ElderCareWatchcallsonthenewMinisterforAgedCaretotakeacloselookattheSAInnovationHubtrial,www.eldercarewatch.com.au,30September2015

AttachmentA–SummaryoftoolsusedinQoLFrameworkPersonalWellbeingIndex(cognitive)(PWI)ThePWIhasbeendevelopedtomeasurethesubjectivedimensionofQoL.ThePWIdistinguishesbetweentheobjectiveandsubjectivedimensionsoflifequality,tomeasuresubjectivewellbeing.ThePersonalWellbeingIndexassessesacrosssevendomains–health,personalrelationships,safety,standardofliving,whatyouareachievinginlife,feelingpartofacommunity,andfuturesecurity.QualityofLife-ADMeasure(QOL-AD)TheQOL-ADisabrief,13-itemmeasuredesignedtoobtainaratingofapatient’sQoLfromboththepatientandthecaregiver.Itwasdevelopedforindividualswithdementia,basedonpatient,caregiver,andexpertinput,tomaximizeconstructvalidity,andtoensurethatthemeasurefocusesonQoLdomainsthoughttobeimportantincognitivelyimpairedolderadults.Itusessimpleandstraightforwardlanguageandresponsesandincludesassessmentsoftheindividual'sphysicalhealth,energy,mood,livingsituation,memory,marriage,family,friends,selfasawhole,abilitytodochoresaroundthehouse,abilitytodothingsforfun,moneyandlifeasawhole.Caregiverscompletethemeasureasaquestionnaireabouttheconsumer’sQoL,whileconsumerscompleteitininterviewformatabouttheirownQoL.Themeasureconsistsof13items,ratedonafour-pointscale-patientandcaregiverreportscanbeevaluatedseparatelyand/orcombinedintoasinglescoreifdesired.Itgenerallytakescaregiversabout5minutestocompletethemeasureabouttheirpatients;forpatients,theinterviewtakesabout10to15minutes.NetPromoterScore(NPS)NPSisacustomerloyaltymetricbasedontheperspectivethateverycompany’scustomerscanbeplacedwithinthreetypes:• “Promoter”customersareenthusiasticandloyal,whocontinuallybuyfromthecompanyand

‘promote’thecompanytotheirfriendsandfamily.

• “Passive”customersarehappybutcaneasilybetemptedtoleavebyanattractivecompetitordeal.Passivecustomersmaybecomepromotersifyouimproveyourproduct,serviceorcustomerexperience.

• “Detractor”customersareunhappy,feelmistreatedandtheirexperienceisgoingtoreducetheamountofwhichtheypurchasefromyou.Detractorcustomersalsohaveanincreasedlikelihoodofswitchingtoacompetitoraswellaswarningpotentialcustomerstostayawayfromyourcompany.

Respondentsareaskedtoanswerbyusinga0to10scale,where5isneutral.Customerswhogivearatingof9or10areconsideredPromoters.Customerswhogivearatingof7or8arepassivecustomersandwhilsttheyarenotdissatisfied,theydonotfactorintotheNPSscore.Lastly,anycustomerswhoprovidearatingof6orlowerareconsidereddetractors.TheNetPromoterScoreiscalculatedbysubtractingthepercentageofdetractorsfrompromoterstogetanoverallNPSresult.

WorldHealthOrganisationQualityofLife(WHOQOL)TheWHOQOLisaQoLassessmentdevelopedtohavecross-culturalapplication.WHO,withtheaidof15collaboratingcentersaroundtheworld,developedtwoinstrumentsformeasuringQoL(theWHOQOL-100andtheWHOQOL-BREF),thatcanbeusedinavarietyofculturalsettingswhilstallowingtheresultsfromdifferentpopulationsandcountriestobecompared.ThecoreWHOQOLinstrumentscanassessQoLinavarietyofsituationsandpopulationgroups.WHOdefinesQoLasindividuals’perceptionoftheirpositioninlifeinthecontextofthecultureandvaluesystemsinwhichtheyliveandinrelationtotheirgoals,expectations,standardsandconcerns.Itisabroadrangingconceptaffectedinacomplexwaybytheperson'sphysicalhealth,psychologicalstate,levelofindependence,socialrelationships,personalbeliefsandtheirrelationshiptosalientfeaturesoftheirenvironment.TheWHOQOL-100assesses100items,stemmingfromthesixbroaddomainsofQoL-physicalhealth,psychological,levelofindependence,socialrelationships,environmentandspirituality/religion/personalbeliefs.Allitemsareratedonafive-pointscale(1-5).CIMPACTTheACHGroupdevelopedtheCustomerImpactStatement(CIMPACT)tomeasuretheimpactofACHGroupservicesonthelivesofolderpeople.Itaimstohelpservicestoprovidehighqualitysupportsthataregearedtowardthepromotionandmaintenanceofmeaningfulandpurposefullives.TheCIMPACTreview:• examinesservicesandwhat‘goodpractice’meansfromtheperspectiveofthosewhouse

them;• supportsthedevelopmentandrefinementofprograms;• providesfeedbacktostaffonhowwelltheservicesaremeetingtheneedsofpeopleand

contributingtotheirgrowthanddevelopment;and• contributestoacultureofcontinuousimprovement.TheCIMPACTprocesshasbeendesignedtoseekinformationabouthowprogramsareworkingtowardsdesiredimpactsthroughreviewingasetofqualitydimensionsthatarethoughttobemostlikely(basedonavailableevidence)toachievethoseimpacts.These25dimensionsaregroupedinto5keyareas:• Rightrelationshipswithpeople;• Respectuniqueness,workwithstrengthsandaddressneeds;• Supportcontributionandcommunityengagementthroughvaluedsocialroles;• Supportindependence,wellness,learningandgrowth;and• Presenceofrelevant,intentionalsafeguards.TheCIMPACTprocessisbasedonaninternalpeerreviewprocess.ItusesAppreciativeInquirytechniquestoincreasetheengagementofstaffintheprocessbyfocusingonwhatworks.Italsodrawsonpeoplefromacrosstheorganisationtoparticipateinthereviews,thusgainingacommonunderstandingacrosstheorganisationofwhatisconsideredtoconstitutequalityservices.

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