Often, when I mention the word ‘governance’ to people, I see their faces glaze over and a thought bubble appears above them that almost shouts “oh no, not that boring, hard stuff!”
However, Standard 8 – Organisational Governance – supports all of the other New Aged Care Quality Standards.
‘Governance‘ is how the organisation manages effectively and strategically, ensuring the organisation is well-run.
The word governance is derived from a Greek word meaning to ‘steer’. Steering (or stewarding) infers principles of direction and leadership, risk management, accountability, control and compliance.
Oh, this is the greatest show…
…watching it come true, it’s taking over you
Oh, this is the greatest show
The organisation’s governing body is accountable for the delivery of safe and quality care and services.
If you’ve watched the movie The Greatest Showman – the re-telling of P.T. Barnum who established what became known as ‘the greatest travelling show on earth’ – you’ll know that a lot of work goes into developing and running a successful business of any sort.
In a circus, as in any other business, there is obviously the need to find the right people – those with the right skills and abilities. You also have to develop something that people want to purchase; you’ll want to have safety processes in place; you’ll need to have a well-choreographed program with rules that everyone involved knows and can follow. Is it much different in our world of service provision and ‘aged care business’?
You can’t have a great service without a strong governance foundation including the right systems and processes that effectively support the delivery of safe, quality care.
The governing body of your organisation is responsible for the overall strategic direction and policies for delivering care and services that meet the Aged Care Standards.
A good Board is informed. It is not the role of management to take responsibility for matters that are the scope of the Board. Good decision making and organisation leadership requires transparency, effective communication and clarity in purpose. Otherwise, your service is like a ship sailing with a broken rudder.
Where there is good ‘culture’ and leadership, consumers, staff and other stakeholders have greater confidence that the business is ‘well-run’.
‘I am confident the organisation is well run. I can partner in improving the delivery of care and services.’
If you’ve seen the movie The Greatest Showman, or ever been to a live performance of any kind, you’ll know how much the audience contributes to a successful show. When they are invested in the players, the audience become partners in the outcome of the show.
So if our clients and their carers feel they are a part of the ‘show’, if they are confident in the operation of the service and can contribute to suggestions for improvements, they become players in the success of the organisation.
We want to be able to say to our clients:
It’s everything you ever want
It’s everything you ever need
And it’s here right in front of you
This is where you wanna be
And if your clients are invested in the success of the organisation, if they feel that sense of ownership over the outcomes and services they receive – why would they want to go anywhere else?
Promoting a culture of safe, inclusive and quality care.
Change can make us more effective. P. T. Barnum didn’t start his circus until he was 60 years old, after his museum burnt down. Sometimes, change is good and part of good governance is being open to the possibility of change; reform can make us think differently, and do things differently, becoming more efficient in our processes – for the ultimate benefit of those we seek to serve and support with quality care and services.
In The Greatest Showman, the circus was seen as a safe haven for people who were rejected by society at the time, and it supported cultural safety. It often identified people who were neglected or abused and assisted them to find a place where they belonged. We want to ensure that our services are also culturally and emotionally safe, for both clients and our staff. This may be an opportunity for your organisation to review operations, services and supports against the Aged Care Diversity Frameworks and your own cultural safety plans.
Standard 8 also expects that consumers will be listened to, and engaged in service development relevant to them and their care. They need to be confident that when something goes wrong, action is taken to prevent it happening again.
Effective organisation-wide governance systems.
Systems help us manage effectively – In your organisation, like any business, you need systems to help you effectively manage the day-to-day operations. Systems are what help us know what to do, when to do it, and how to do it. We need to know what information to keep, how to keep it and what to do with it once we no longer need that information.
While P. T. Barnum may have been able to get away with a few flyers and some tickets, we need a little more structure here. Our systems need to manage and maintain client records in accordance with legislation and in a way that makes it easy to access for those who need the information. We need to define strategies for communicating information effectively to stakeholders, for example, client handbooks written in plain English or the target client group’s language.
Information management (systems) – This can be the bane of many managers’ existence. The complexity and scope varies widely and we’ve seen a proliferation of electronic systems in home care and remote service contexts as a result of consumer directed care, home care packages and individual budgets and statements. However, just remember that an Information System is not necessarily an electronic platform, if you are a smaller organisation your Information System may be a simple Excel spreadsheet or some sort of paper-based system; the important thing to consider is that it is a ‘system’ and therefore organised and replicable. Residential services will require more complex systems, but the same principles apply across all service contexts.
Information management is also about how consumers get information about their care and services. Having culturally appropriate client handbooks in plain English may be one of the ways your organisation can demonstrate this. Verbal and nonverbal communication strategies may also play a role.
Continuous Improvement – No circus could get away with remaining the same year after year. The tricks or the exhibits had to keep changing and getting better in order to continue to draw the crowd.
Fostering an environment where continuous improvement is expected is another key aspect that must be demonstrated with this Standard.
Financial management – This is a huge part of ensuring an effective business. Just as P. T. Barnum needed to find a way of financing his show and then managing it effectively, so do we need to have solid financial practices. If the leader isn’t financially savvy, then ensuring you bring in the right people with relevant skills and knowledge is important.
‘Well-run’ also implies that the organisation does financial planning and makes adequate provision for maintaining a safe and quality service. Good financial management and reporting systems also gives the governing body and management team clarity on organisation or service viability and assurance that programs are compliant.
People, People, People (workforce governance) – Just like you can’t have a circus without the right people, you won’t have a high performing and functional service without the right staff. Staff at the coalface of service delivery have to be informed, engaged, well-supported, and know how to do their job properly. They need to be skilled and savvy (they look, notice and think). You want staff to know how to escalate a concern in a timely manner and be confident in doing so.
Good organisation culture and increasing the level of competency and skill across the workforce to support consistency and quality also needs to be a focus.
Regulatory compliance – In a nutshell, your organisation has to have systems and processes in place to ensure things are done properly and there is compliance with legislation (the Aged Care Act and Principles), regulatory requirements (fire safety, WHS, Industrial relations, etc), professional standards (staff have the proper credentials and meet the requirements for Police or other checks relevant to their role).
Feedback and complaints – We discussed this issue in depth when talking about Standard 6, however responding effectively to feedback and complaints really is a cornerstone of having a well-run organisation – something we should never forget.
Having the systems and processes to identify, capture, address and monitor action and improvement in a transparent and effective way is also key here.
Effective risk management systems and practices.
Of course, like a circus, we need to make sure we have safety at the front of our minds. We need to deliver coordinated support at the time people need it – otherwise they may fall. We need to have people and practices in place to ensure we can ‘catch them if they should fall’.
Managing high-impact or high prevalence risk, identifying and responding appropriately to abuse and neglect are also key requirements under Standard 8 and inextricably linked to other Standards like Supports for Daily Living, Service Environment, Personal and Clinical Care and Human Resources. Identifying, reporting, mitigating, monitoring and implementing better practices are all key ways of helping to meet this requirement.
For circus goers there is always the small risk that something could go wrong for them, but the lure of enjoyment is always worth the risk. This is the same in life. We don’t want people to opt out of what many claim is the ‘Greatest Show’ – life itself.
Where clinical care is provided – a clinical governance framework is in place…
The good thing about the new Standards is that they are applied and assessed according to the services you are funded to provide or the types of services you provide to clients. Therefore, if you are an organisation funded to provide transport services, you won’t be providing clinical care to clients and this section of the Standards won’t apply to you.
However, for those organisations who do provide clinical care, part of your governance responsibilities is to ensure that clinical care is supported by a clinical governance framework.
This means that any clinical care that is provided by staff requires clinical governance oversight. Examples of this would include professional supervision, at a minimum, when providing medication administration, as well as promoting good infection control, minimising inappropriate antibiotic use and limiting restrictive practices.
This is where you wanna be!
If you and your governing body are driving and monitoring improvements to make sure that services and supports provided to your consumers (clients, carers and community) are the best they can be; if the organisation is well-run and able to deliver safe, quality and effective services, then you will be truly providing a ‘Great Show’ and this is where your clients and staff will want to be!
We hope you have enjoyed this series on the New Aged Care Standards. From our perspective, it’s been a lot like ‘working on a show’ and has truly been a team effort, with a lot of discussion and contribution internally generated amongst our team, as well as responding to questions from people, providers and the broader community.
A key objective has been to ‘paint the picture’ and ‘essence’ of the New Aged Care Standards in a way that people can relate to them, and we encourage further reading and resource access to support your transition to the New Standards.
Thank you for the positive feedback we have received from across our readership and new visitors to our site. Please feel welcome to send us feedback by dropping us a line at firstname.lastname@example.org.
Click here to head to the Community Resources area and get this week’s free information sheet on Standard #8.
And keep an eye out for an exciting new development from us that will help you and your organisation get the right knowledge and tools to provide quality care with confidence!
Donna, Carrie & the CDCS Team
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