Top risks identified by Aged Care boards in 2018. Risk 4: Governance of Clinical Care – Part 2

Top risks identified by Aged Care boards in 2018. Risk 4: Governance of Clinical Care – Part 2

The Governance Evaluator 2018 Governance Capability Benchmark Report analysed board evaluation responses from over 70 boards comprising almost 700 members across multiple industries.

Join us as we complete our two-part investigation into Governance of Clinical Care; the risks identified by our research, as well as tips and resources for ensuring your board is leading a culture that supports the delivery of safe & quality aged care.

What is Governance of Clinical Care?

The National Clinical Governance Framework, based on the NSQHS Standards (2nd edition) and the Aged Care Quality Standards (2018) are incorporated in the Governance of Clinical Care module themes of the Governance Evaluator Board Evaluation.

The Governance of Clinical Care Benchmark Report Part 2 explores:

  • Leading a safe and quality culture
  • Safety and quality systems
  • Evaluating safety and quality

Click to read the Governance of Clinical Care Benchmark Report Part 1, which takes a closer look at:

  • Genuinely partnering with consumers
  • Governing safety and quality
  • Staff who deliver safe care

Within the Governance Evaluator board evaluation, each theme is explored via a series of targeted questions, each with four possible responses:

  • No: Represents an early capability assessment of the board in that area. Any responses in this category highlight the need for board capability improvement and education.
  • Yes, but qualified: Indicates that board capability is developing and not yet at a mature governance level. Again, these point to opportunities for focus and education.
  • Yes: Represents a mature governance capability within the board and the criteria wholly satisfied, as judged by the participants.
  • Unsure: Measures a construct other than overall board capability as it reflects individual members of the board or leadership team that are unsure of the board’s level of functioning

Leading a safe and quality culture

Leading a culture that prioritises safety and quality is profoundly important.

The board sets the tone for the organisation, by being accountable for the quality of care delivered by the organisation and its staff. The board makes an important leadership contribution to establishing the culture of the organisation, which in turn can influence the process and outcome of care delivery. Boards should role-model thoughtful, purposeful leadership for safety and quality by being visible to staff and consumers. This, in turn, creates an environment where staff, consumers, their families and carers feel supported to speak up about safety and quality issues. Ultimately this leads to an organisation where strategic plans, and safety and quality plans, are a lived experience.

The board alone cannot create a culture that prioritises safety and quality. It shares this role with the executive and staff who by their beliefs, words and actions both create and influence the organisational culture and climate.

2018 Benchmark Data key finding:

Q: Does the Board lead a safe and quality culture? 

Aged Care Benchmark Report for Leading safety and quality in the governance of clinical care

Fig 1:  2018 evaluation findings for safety & quality culture

51% of boards believe there is room for improvement in relation to regularly receiving and evaluating safety and quality evidence from all stakeholders; reflecting on their own leadership in this area; evaluating the level of staff engagement in the delivery of quality services, and ensuring that outstanding achievement in consumer care is recognised, championed and celebrated.

Top Tips for leading a safe and quality culture

Boards should:

  • Reach a shared agreement regarding its leadership role in supporting a culture that prioritises safety and quality of all consumers, eg the specific needs of Aboriginal & Torres Strait Islander people, and continually striving to improve consumers’ quality of life and upholding the principles of Consumer Directed Care
  • Ensure that management is accountable for ensuring that all staff engage effectively in pursuing the board’s vision for safe, high-quality care, continually striving to improve consumers’ quality of life and uphold the principles of Consumer Directed Care
  • Lead a culture that values high-quality care performance, by, for example, celebrating outstanding achievement
  • Assure itself that the organisation has a culture that prioritises safety and quality via:
    • Qualitative activities such as:
      • Organised safety and quality walkarounds to experience the culture and discussions with staff, consumers, families and carers
      • Structures that enable consumers, families, carers and community representatives to share their experiences of care
    • Quantitative reports that include:
      • Care staff engagement in quality and other organisational climate surveys
      • Evidence that there is an organisational learning culture from errors and issues, which encourages an open culture of continuous review and development for quality and safety, innovation and improvement in care delivery
    • Frequently seek feedback on its own performance and effectiveness for leading a quality and safe culture

Links to Resources

Governance Evaluator has sourced some resources which we think you might find useful to build any board’s capabilities in this area:

Safety and quality systems

The board, through its Safety and Quality Committee, needs to satisfy itself that the organisation has a Framework that outlines the structures, responsibilities, accountabilities, measurements and reporting requirements at all levels of the organisation that support safe, quality care provisions to consumers.

It is critical that the board’s Safety and Quality Committee has appropriately skilled directors and a chair who is highly skilled and knowledgeable about safety and quality in aged care.

Effective management of care delivery risk is a crucial element of an effective system for governing the safety and quality of care. The effective identification and management of care delivery risks, therefore, underpins the delivery of safe quality care.

Care delivery risk is an element of organisational risk, which if poorly managed can have significant consequences for the organisation, through the creation of legal, reputational and financial harms.

2018 Benchmark Data key finding:

Q: Is there an effective safety and quality system? 

Aged Care Benchmark Report for Safety and quality systems in the governance of clinical care

Fig 2:  2018 evaluation findings for safety & quality systems

30% of boards are not sufficiently satisfied that their organisation has an effective quality and safety framework and effective communication systems for liaison with consumers, families and carers, and that they are aware of quality of care risks, and receive timely, appropriate reports that identify issues, trends and early warnings.

Top Tips for ensuring safety & quality systems

Boards should:

  • Reach a shared agreement (in either the risk management and/or quality framework) about how it will govern the organisation’s approach to care delivery risk;
  • Ensure that major care delivery risks are captured in an organisational risk register which is regularly updated and regularly reviewed by the board
  • Receive assurance on the management of the organisation’s significant care delivery risks, such as the extreme or high risk rated according to the organisation’s risk matrix
  • Ensure the Safety & Quality Committee oversee the creation of a report that highlights care delivery risks and management status
  • Ensure multiple sources of qualitative and quantitative data are reviewed to obtain a comprehensive picture of quality and safety
  • Be open and honest about any harm that may occur
  • Ensure that care delivery indicators of harm, generated internally and externally, are regularly reviewed, acted on and evaluated within an agreed timeframe
  • Ensure every director is knowledgeable about quality and safety issues relevant to the organisation, and are able to individually exercise their independent judgement to reduce their reliance on aged care experts on the board or the organisation’s APRHA regulated staff

Links to Resources

Governance Evaluator has sourced some resources which we think you might find useful to build any board’s capabilities in this area:

Evaluating safety and quality

In order to exercise their governance responsibilities, boards must be able to make an effective judgement about the safety and quality of care that is provided by the organisation. These judgments must be based on a range of data that is robust, reliable, cross-checked and firmly focused on the process and outcomes of care. The board must make an honest appraisal of how the care that is delivered, performs against the organisational expectations as outlined in its Quality and Safety Framework.

The board must also be conscious that care and systems of care are never perfect, and that care can always be improved. It is also important that there is a focus on organisational learning based on the evaluation of safety and quality outcomes.

2018 Benchmark Data key finding:

Q: Does the Board evaluate the safety and quality of the care provided?

Aged Care Benchmark Report for Evaluating safety and quality in the governance of clinical care

Fig 3:  2018 evaluation findings for evaluating safety & quality

30% of boards are not satisfied that they are provided with the necessary information, have the appropriate skills and knowledge, and dedicate the necessary time and attention to make sound judgements about the quality of care delivered within their organisation.

Top Tips for evaluating safety and quality

The board should:

  • Utilise appropriate data and evidence from various sources, both internally generated and externally generated, qualitative and quantitative
  • Obtain from comparator organisations that are known to have superior performance, credible data that is transparent about meeting acceptable standards. For example, data that is:
    • Internally or externally benchmarked
    • Linked to best practice
    • Trended over time
    • Clear on achievable targets
  • Obtain independent expert opinion, where indicated, to reach a conclusion about how well care is being provided
  • Ensure that different committees, units and departments, regularly report to the board (or committee), preferably face to face, so this information informs the board’s deliberations and any actions that may be necessary
  • Identify where performance gaps in quality and safety exist and satisfy themselves that appropriate strategies to address these gaps are articulated and enacted
  • Ensure that directors are skilled in data analysis and understanding of quality systems., for example; understanding quality improvement methodology, the quality of evidence, lag and lead indicators and trend data
  • Ensure that judgments about quality and safety are not made in isolation from other board responsibilities (i.e. financial sustainability)

Links to Resources

Governance Evaluator has sourced some resources which we think you might find useful to build any board’s capabilities in this area:

  • The NSQHS Standards User Guide for Governing Bodies

  • Governance Evaluator customers can access the following, and other useful resources via the platform here.

    • Governance Manual – 4.11 Safety and Quality Dashboard
    • Governance Evaluator TV – Dr Marcus Kennedy – Clinical governance board reporting
    • Not a customer? Access these resources here.