Doing more, with less: Reporting on Incidents, Quality, Safety & Risk Outcomes

At the Aged Care Quality, Safety & Risk Forum in September 2022 in Sydney, RLDatix was joined by representatives from across the Australian Aged Care sector to explore how Quality, Safety and Risk have been handled over the COVID-19 pandemic, as well as looking to the future as we reach the ‘new normal’.

The Aged Care sector is complex, and we acknowledge the different approaches to Quality, Safety and Risk that are needed with workers out in the community visiting clients in their home, as well as those in residential care settings.

Over the conference, we heard from our Aged Care leaders with some incredible achievements and initiatives:

• Bolton Clarke, as they built staff capability in infection prevention and control, and Columbia Aged Care Services supporting further training and embracing opportunities within their current workforce.
• Uniting AgeWell’s incredible achievement of no transmission of COVID in the first 20 months of the pandemic, attributed to robust procedures and readiness in the years leading up to the initial outbreak.
• Blue Cross Aged Care, ensuring that they keep the consumer’s voice front and centre in the changes and decisions that need to be made.

Our key mission at RLDatix is to ensure that residents and clients have the safest possible journey, within our Aged Care organisations.  With this lens, we led a round table discussion to explore “Reporting on incidents, quality, safety & risk outcomes to meet Aged Care Quality Standards.”  The findings of which, we would like to share with you below.

There are many contributing factors that can impede workers reporting on incidents, quality, safety & risk outcomes, as the sector is expected to do more, with less – a sentiment that resonated across the round table attendees.

• Consistently, reform happens after something goes wrong.

In a story told at the round table, after several instances of reporting a risk with no action or change, a resident sadly passed away.  This was echoed with many stories of significant change only happening after an adverse event or outbreak.

• End users often do not see the value in reporting and there is an underlying blame culture for those involved.
• There is a focus on timely reporting, but that needs to extend to timely escalations, timely action plans and the timely completion of plans.
• Different providers across home care settings creates a challenge in access for the right people to report incidents, manage cases and attend risk meetings.
• A push to use technology to ease reporting is not without challenges when it comes to digital literacy, connectivity, device access and still taking time away from care.
• Visibility and the sharing of incidents to people who were absent when the event occurred is challenging and can reduce the positive impact of work being done to mitigate risk.

We know that reporting is necessary, to not only to prove compliance to the Aged Care Standards, but also to ensure action plans can be put in place to improve the safety of clients, residents and workers.  Not all reporting is good reporting; if inaccurate data goes into the system, then inaccurate reporting is going to come out.

We asked the round table attendees what initiatives their organisations had implemented to encourage accurate reporting, and how that can help meet some of the challenges outlined, head on.

• Organisations need to consistently work to create a ‘no blame’ culture, and that can be helped with educating everyone on ‘the why’.
• Communicate to the frontline workers why reporting is important through the change and lessons learnt that the reporting is revealing. Lift the curtains on the ‘behind the scenes’ of incident, quality, safety and risk in your organisation.
• Support transparency for incident, quality, safety and risks in a public forum to encourage communication by showing that you are listening but improving education and a positive culture.
• Reward and acknowledge your staff for doing the right thing.  This could be as simple as a thank you message when an incident is submitted.  It is not just about the timeliness of reporting, but the timeliness of a thank you.
• Everyone is responsible and accountable, not just the people involved.  Share access and ownership of incidents, action plans and change to help support a culture shift of blame, to one that can make a difference.

• Having robust Risk Governance established throughout your organisation to ensure that there is oversight of action in response to risks and incidents, and the plans established are completed.  Include a weekly review of risk assessments and update where necessary.

One round table attendee championed their organisation’s formation of an Incident Response Committee, which continued oversight of an incident until the loop was closed.  The committee included C-Suite, Directors and members of the Board.

• Schedule a cyclical review of how you are reporting: is the form capturing the right data? Is it too complicated? How long does it take to complete?  By making reporting easy and efficient, staff will be more inclined to report and not feel that they are being taken away from care for too long.
• Enabling staff and clients to submit ideas for improvement through a portal not only provides organisations with suggestions from people on the front line, but it also feeds into improvement communication within the organisation, and helps your staff feel heard.
• Schedule time to share reporting and actions at a monthly meeting.  Share what has happened across the organisation and the responses to incidents to support education, accountability, responsibility and a no-blame culture with improved communication.

• Staff education is often explored, but there needs to be a focus on client education.  Let your clients and residents know what is happening and why, so that they feel comfortable and safe.

Clients and residents, particularly in home care settings, would become suspicious of not only the mobile technology being used by staff to report with but also of auditors.  Once the clients knew the why, they became more relaxed and accepting.

• Open, honest communication with clients, residents and their families is crucial when it comes to an improved culture within your organisation. This communication should continue through the whole follow-up after an incident.
• The impact an incident has on a family needs to be communicated up to senior levels in the organisation.  The voice of the resident or client should be present for everyone in your organisation.

Preparing for assessors and proving compliance to the Aged Care Quality Standards can be stressful for the staff throughout your organisation. Observing the passion, care and dedication of all attendees of the Forum was heart-warming, and they should be applauded for the work that they do to keep residents and clients safe.

RLDatix hopes that our learnings from the Aged Care Quality, Safety and Risk Forum in our roundtable discussions with leaders from across Australia helps to support your organisation to make positive changes, supporting a safer, better resident journey, a safer, supported workforce and a safer, sustainable organisation.