The Royal Commission into Aged Care Quality and Safety is shining a light on far more than the Aged Care industry. It is painting a picture of how workplace cultures, when they’re broken, have significant impact.
In the care industries, broken workplace cultures break people.
It’s easy to blame staff ineffectiveness for the symptoms of broken workplace cultures. Like that time when you walk into your elderly mother’s room in her expensive aged care facility, to see her unwashed underwear littering the floor, falling out of a washing basket that was full four days ago. Or when your elderly aunt’s diet, provided because she can’t swallow chunks of food any more, is completely ignored, making her both uncomfortable and poorly nourished. Or that time when your grandfather was left alone, in a cold, dirty room, apparently forgotten by a team who appeared devoid of empathy.
It’s easy to get angry. To point to her underwear, to her condition, to his loneliness; to the pile of equipment left in the corner, and the filth on the floor. To become upset is human.
What you miss when you get upset is that even staff ineffectiveness is a symptom.
In the human services, toxic cultures affect much more than a product, or a customer buying a widget. They impact much more than safety figures, or the profitability of an organisation. In the human services, toxic cultures, ‘normalised’ by an industry, injure and impact everybody. You see it in the woman whose mother is neglected in an aged care facility: She experiences anger, grief, and regret. Her circle of relationships is affected, in different ways depending on where in that circle a person sits. In her society, her friends no longer know who they can trust to help them look after their family members. And the workers may find themselves stressed, disliked, discouraged, and ultimately unwell.
The Aged Care industry in Australia is facing a lot of change. The change is often outside of organisations’ control: New regulation, audit requirements, new software systems, how assessments are completed, how parts of the industry interact – or stop interacting. Some of its most well-known components – like the National Disability Insurance Scheme (NDIS) – are merely the tip of the iceberg.
But I want to suggest to you that the greatest challenge facing Australia’s Aged Care industry is something so ‘normal’ that it appears insurmountable.
The challenge is to break the back of the toxic culture that characterises the industry.
As someone who specialises in helping organisations to create positive workplace cultures – and who witnesses the joy, satisfaction, and profitability of organisations who do so – it breaks my heart to see just how broken the industry is.
I’ll show you what I mean.
On Day 9 of the last round of the Royal Commission hearings in Adelaide, which was on 22 February 2019, Counsel Assisting the Commissioners, Dr Timothy McEvoy QC, spoke extensively about the workforce issues that had already surfaced.
Dr McEvoy pointed out that:
- issues with funding appear to have a direct impact on staff morale
- staff morale impacts the levels of quality and safety of care received by older Australians
- remuneration for care staff – from personal care attendants to general practitioners – is far below where it ought to be
- the system (and its people) is stressed, from start to finish.
‘The evidence suggests that the typical personal care attendant is a woman in her 40s and 50s. Her work is hard and poorly remunerated. She is typically qualified, employed on a casual or part-time basis, and needs to work in other jobs to make ends meet. She will not make a living wage, meaning that on an hourly rate of about $21 on a part-time or casual basis, personal care workers struggle to earn enough money to live adequately. Whilst personal care workers describe the work as very rewarding and they value the time they’re able to spend with residents, they report that it is labour intensive work and often delivered hurriedly with service providers requiring them to be task-oriented.‘
If you think that being ‘task-oriented’ is not a big deal, allow me to contrast it with the idea of a ‘performance-oriented’ culture.
In a performance-oriented culture, an organisation maximises the performance of its people, by ensuring that they are physically and mentally well. We’re not talking about the tick-box performance of meeting KPIs. We’re talking about the ability for a human to show up as a whole person, completely present, able to be the best person that he or she needs to be in order to care for someone in a demanding environment.
Simply ‘doing the job’ isn’t enough.
In the hearing, Dr McEvoy went on to point out how many care attendants don’t have time to do their jobs properly. Even though they are given a finite amount of time in which to do their work, they are being asked to take on even more of it. This is happening because registered nurses are comparatively expensive. It shows you that money, not people, is more important in this situation.
Unsurprisingly, Dr McEvoy pointed to significant workforce issues, such as understaffing and low levels of retention, which the Commission refers to as ‘churn’.
Staff want better training, and they want both education and leadership. What they need is to be supported and cared for, so that they can, in turn, care for others. What they are getting is an insurmountable workload, increasing demands, and fewer hours in which to get anything done. Fewer hours often results in higher stress because they know they can’t provide the care they’d life to. It results in worry for their clients. But it also results in lower remuneration, and thus the carers’ own quality of life is impacted. You can see that being able to point to staff who tick all the right boxes doesn’t lead to completeness of care.
While it’s early days for the Royal Commission, it has already received submissions pointing to instances of dangerous clinical practice, and to important aspects of care that are being missed altogether.
What we are already seeing is a light shone on organisations that, although they provide care for people, are not focusing on the people who make that care possible.
The risk with the Royal Commission is that those who lead Aged Care organisations will entrench even more tick-boxes, frameworks, and standards, without focusing on the cultures within which people work. When this happens, care staff get squashed by the weight of having to those tick boxes. It creates situations in which highly capable people begin to feel their confidence eroding.
The remarkable Australians who provide care for our ageing families are already poorly treated.
It’s no longer enough to rest on our laurels, comfortable knowing that care workers describe their work as ‘rewarding’. Just because they are satisfied that their work is important and impactful, does it mean that they are not entitled to be treated as the valuable and important employees they are?
No, of course not. But this treatment isn’t something that can be imposed by a regulation. It requires cultural change; the type of change that shifts the fabric of organisations.
Cultural shift requires leadership from the front.
For every leadership team in an Aged Care organisation that isn’t working to create a robust culture, there is a community that erodes.
How long does it take to change a culture?
It’s impossible to say, because culture is about individuals. It’s not enough to have a set of values on the wall, and assume that everyone applies them. How long it takes to reorient your culture will depend on your business, and how deeply your organisation values its people.
Few organisations know the depth of cultural change as well as ADSSI Home Living Australia. The organisation recognised that caring for people takes a lot out of its staff: The work is physically and mentally draining, and every client needs you to be at your very best. That’s challenging for personal care attendants on whom demands and workloads are high.
ADSSI Home Living Australia went deep, building a positive workplace culture into the fabric of the organisation. In their case, they opted to bring in the ORANGES Toolkit, a wellbeing and resilience program developed by Camp Quality.
Since first allowing people to voluntarily participate, ADSSI Home Living Australia has embedded the principles in every facet of the business. It’s part of every meeting, every interaction. It’s in the language used in the organisation. It’s even embedded in staff members’ KPIs.
When ADSSI Home Living Australia acquired another business in their region, one which was pessimistic, even negative, their new staff members started asking about the Toolkit. Nobody had spoken about it to them on a formal basis.
CEO of ADSSI Home Living Australia, Jenni Allen, explained how their cultural shift started to spread:
‘When you finish the training course, we give you a badge in the shape of an orange. So it’s sort of like, “oh wow, I can wear that on my lapel with pride”,’ she enthused. ‘Other people will ask you, external people and new staff, “What’s your orange badge? Tell me about it.“ So that launches you off in another conversation.’
The numbers at ADSSI Home Living prove the change that the team can see. Now, 99% of their people believe in their values. The ratings they’ve achieved, measured by Your Voice, are rare even in values-oriented industries like Aged Care. Read that case study here.
The old saying, ‘change begins at home’ isn’t a cliche in Aged Care.
The change in one workplace, for one individual, doesn’t simply shift one person’s life. It has the potential to shift their family’s lives, the lives and families of people being cared for, and, by virtue of a network effect, the communities in which carers work.
The Royal Commission into Aged Care Quality and Safety is an important stepping stone in improving Australia’s Aged Care industry. But we would be remiss in thinking that it’s going to solve the problem.
Any resolution to a systemic problem isn’t a quick fix. The ‘fix’ can only be achieved at an individual level, in individual organisations.
It’s only when enough robust-culture, forward-thinking organisations emerge, to create a tipping point, that the industry will change.
Until then, the industry will continue to tick boxes, and positive cultures will remain a rarity.