industry & reform
Keep it simple
Governing for good aged care .
By Mike Rungie
You ’ ve just joined an aged care board . You reckon you ’ ll be there for five years and are keen to make a difference – but it ’ s looking harder by the day . What are you going to do ? Keep it simple . You want frail , older people to thrive and the business to thrive . So , do they ? You could do worse than start your aged care board career by asking . Chiefs have the usual suite of indicators for how the business is going . But I ’ m yet to meet a chief who knows if their clients are thriving .
They will tell you that the organisation cares , works hard , and keeps delivering – rain , hail or shine .
It ’ s at about this point that most directors roll over and fall in line with the chief ’ s narrative .
You start to believe that what happens to clients is operational and that you are only concerned about the strategy . That you don ’ t hold the hose .
While the services are a long way from the world you live in , you ’ re pleased that your organisation is doing so well with what it ’ s got . But what if you don ’ t roll over ? You ’ ll probably start with some measures for client thrival . The problem is that the chief ’ s measure of clients is a bit odd . It ’ s good that your organisation is meeting external quality standards , but when you visit the services , you ’ re not at all sure this would be enough for your parents or yourself to thrive .
So , why would it be enough for your clients ?
Wolf Wolfensberger from Syracuse University says aged care clients aren ’ t that different from the rest of us .
To thrive , they need roles , people , food , health , settings , joy and a point to their lives .
For as much of the day as they can sustain , combined with the care that enables this .
Measuring this can be tricky , but understanding it and whether it ’ s present in your services isn ’ t .
So , start there and measure later . And starting there is a compelling way of immersing you and your fellow directors in the critical role you can play in client thrival . To do this , directors will need :
• a clear insight into the client ’ s journey . What are the pain points ? Which pain points are unresolved ? What ’ s the impact of multiple unresolved pain points ?
• a clear statement of organisation purview . Are you doing what you have agreed to do ? And are you staying away from what you haven ’ t agreed to do ?
• an appreciation of the value of iteratively co-designing and co-testing service solutions with clients ( and what happens if you don ’ t ).
• an understanding of how clients spend their time . Are they supported to occupy various roles , particularly in how care is provided ? Boards must turn this into a clientgovernance framework ( client journey ; organisation purview ; co-design ; role-quality ).
They must note how different this is from the more familiar business governance framework that we also need ( strategy ; finances ; risk ; protection ).
We searched for organisations using a client governance framework to see how they were growing director skills .
The trick seems to be combining the well-established learning pathways that inform the elements of the client governance framework .
Things like lived experience , modern elder advisory boards , learning networks , lessons from big data , tech that connects formal and informal care in real-time , and innovations and evaluations that use these pathways .
All this is good for clients , but is it good for business ?
The Australian Institute of Company
Directors ( AICD ) clearly doesn ’ t think so . There ’ s no sign of it in their teachings . But client thrival does increase client , family , community and workforce satisfaction .
It ’ s a role model for ageing well and a testing ground for better use of aged care resources .
It ’ s impressive .
But AICD may well be right .
It seems it doesn ’ t result in clients and workforce deserting the competition and flocking to you .
Vulnerable clients in regulated markets don ’ t behave like customers , and the client thrival uplift you ’ ve managed to create isn ’ t enough to entice them to move .
In fact , your bottom line might get worse , and your star rating even drop .
But you ’ re not done yet – you want to know if any client thrival would deliver you a thriving business .
The Strathalbyn Co-designing Aged Care Study ( SA health department ) found that you would need six things in place for client thrival at levels that would be considered typical for the rest of us :
• home , not an institution ;
• social connectedness ;
• meaning and purpose ;
• choice and control ;
• valuing people ;
• support to make life transitions . But this is way more than a bit of improvement – it ’ s a significant change to what you do and how you do it .
This got us wondering if any aged care businesses were thriving enough to pull this off .
We borrowed the criteria for a thriving business from Jim Collins ( Good to Great ) and ran his ruler over some aged care organisations . Plenty of good , not much great . The problem is , being great is hard work and risky .
And there is little reason for aged care boards to want to be great and plenty of reasons not to take risks .
In fact , you can be profitable , grow , get five stars , and be hugely admired without being great . AICD clearly thinks that is enough . And stuffing boards with AICD graduates will ensure it stays this way — pity about client thrival .
But along the way , we were amazed to find so many directors with a high personal interest in client thrival who were sad for their clients and frustrated with themselves . So , why not start there , AICD ? Why not beta-test a client governance learning network of interested individual directors ?
Then set them loose on their boards and see what happens . ■
8 agedcareinsite . com . au