On 16 September 2018, the Prime Minister announced a Royal Commission into Aged Care Quality and Safety (Royal Commission) focusing on a broad range of matters including clinical standards, mental health and nutrition.
The Royal Commission will explore “governance arrangements and management support systems” relevant to safety and quality in aged care. As part of this, the Royal Commission will inquire into all forms of abuse and any underlying systemic failures.
Recent Royal Commissions into financial services and child sexual abuse have been driven by case studies, with parties often called to provide evidence and testimony within tight timeframes. Organisations from across the aged care sector may be called to appear before the Royal Commission, and boards should take action to help their organisations prepare.
Develop an understanding of service quality and safety
Boards should work with management to establish a ‘warts and all’ picture of the organisation’s performance in service quality and safety. This should include information about non-compliance with law, regulation or policy as well as failures to meet accreditation standards and serious incidents of client harm.
As part of this, the board should ask of management what steps they have taken to ensure that relevant documentation and information is accurate and easily accessible in the event that it must be provided as evidence.
Boards should consider how their reaction to this information contributes to a culture of disclosure. Bad news should travel quickly in the organisation so that it can be identified and acted on and the way the board responds to and encourages reporting of such information is critical.
More broadly, boards should consider what insights they have into the culture of the organisation, particularly about whether there is tolerance of improper standards of care, given the age and vulnerability of clients.
Develop a framework to examine complaints and incidents
Some of the examples of misconduct that will attract the Royal Commission’s attention will already have been raised through the Aged Care Complaints Commissioner, with another government authority or with the aged care provider itself. These can be a valuable source of insight about potential conduct vulnerabilities.
Boards should work with management to undertake a ‘lookback’ on recent complaints and incidents, particularly those that concern serious misconduct, and to consider whether their processes would stand up to the scrutiny of the Royal Commission.
Through doing this, they should establish a framework to evaluate the effectiveness of their response and to improve the means by which they process and remediate existing and future complaints and incidents.
Directors should also look beyond complaints and incidents, enquiring about what proactive steps management has taken to understand the experience of clients and their families to identify potential conduct risks.
Engage and communicate authentically with stakeholders
Reports of misconduct raised through the Royal Commission may encourage stakeholders to come forward with new information or complaints about service quality. Clients and their families may also be interested to know what steps have been taken to ensure that similar misconduct does not exist within their own service environment.
Boards should be satisfied that there is a communications strategy in place to help stakeholders understand the Royal Commission and what it means in the context of their organisation. As part of this, stakeholders should be provided with guidance about how they can raise their concerns with the organisation and the process by which any concerns will be investigated and addressed.
Importantly, engagement with stakeholders should be authentic and oriented to identifying and resolving services issues, if any. Organisations should avoid seeming defensive while also being prepared to defend their actions if justified. Boards play an important role in steering this response and should recognise that just because an action is defensible under the law, it may not necessarily accord with stakeholder and community expectations.
Review compliance with accreditation or benchmarking standards
Boards should seek to understand whether their organisations have identified and are complying with any relevant standards concerning the safety, health and wellbeing of people receiving care. Crucially, boards should not merely accept management’s assurances of compliance – “show, don’t tell.”
It can be difficult for boards to reach an informed opinion on compliance, but there are steps that can be taken to help provide oversight. For example, by seeking independent review of management’s advice, establishing robust systems for reporting and investigating misconduct and seeking professional advice, if necessary.
The new ‘Aged Care Quality Standards’ are expected to come into effect from 1 July 2019, and boards should also be satisfied that there is a plan in place to comply with them. It is a timely opportunity for boards to review their clinical governance frameworks and to seek external advice if required.
Demonstrate a commitment to continuous improvement
The findings of the Royal Commission will provide insight into conduct vulnerabilities and challenges which will be relevant to all organisations in the aged care sector and beyond.
The Royal Commission must provide an interim report before 31 October 2019 and its final report before 30 April 2020. Directors should keep these dates in mind and forward plan their board business to absorb and respond to the insights of these reports.
Boards should seek to set the ‘tone from the top’ about their organisation’s response to the Royal Commission, prioritising learning from the mistakes of others and strengthening their own conduct for the benefit of people in their care.