Quality indicators in age services - Lessons learnt

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As a component of the Living Longer Living Better initiatives of the previous Government a commitment was made to publish quality indicators for residential aged care on the myagedcare.gov.au website. Leading Aged Services Australia (LASA) has participated in the Quality Indicators Reference Group, a group set up to provide advice on potential indicators for consideration by the Department of Social Services and the issues and opportunities for indicator development.

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LASA supports the development and collection of meaningful data to assist both the provider and consumer. But how do we actually do this and what have we learnt from the acute sector that has developed and refined quality indicators since 1989? There are now more than 330 indicators across 22 different clinical areas in the acute sector, demonstrating that not one type of indicator will provide all the information a consumer or provider may need.
To be of value, indicators need to provide insight into the quality of care and resultant quality of life of older Australians to enable providers to utilise the data within a continuous quality improvement process (rather than focussing on compliance and regulation).
As we travel this path we need not reinvent the wheel. While the particular measures within the acute setting will not mirror the needs within age services, many of the processes and indeed the learnings of both positive and negative outcomes should be regarded.
Interestingly, despite such a long period of implementation and considerable advancement, lead clinicians still demonstrate frustration of recurring ‘road blocks’. A recent comment from an experienced health professional in the acute setting was revealing:
“Results of significant investments in safety and reliability initiatives often yield incremental (and sometimes disturbingly temporary) dividends rather than the hoped for substantial improvement… A quantum leap in the reduction of unwarranted variability in individual, team and organisational performance can sometimes appear a distant dream.”
LASA supports the development of clear, consistent and transparent data, but is wary on how this information may be interpreted, and used. The main aim for the introduction of indicators within the residential aged care sector is to enable consumers to make more informed decisions about which residential care service they choose. But will indicator data provide such support?
How do we establish a reference point for consumers that ensures they are comparing two ‘like’ services? What are acceptable variances within data results? What level of benchmark are we aiming for? How are benchmarks set? What areas are we measuring to provide an overview of a service? What may be important areas for the consumer may not be useful to a provider and vice versa.
The complexities of providing care and services to a diverse cohort must not be underestimated. While some of these challenges have been faced in the acute setting, others are unique to aged care, namely that a facility is the residents’ home and providers offer much more than health care - they are central to the development of an individual’s quality of life. To this end meaningful indicators would need to reflect the diversity of residents’ individual needs and backgrounds, the complexity of acuity including the persistent challenges of complex behaviour and the expectations of both residents and their families.
Political expediency often results in the temptation to develop a measurement tool and publish it for general consumption. We have seen this with education and the ‘My School’ website. LASA is committed to providing consumers with accurate and reliable information and empowering providers to reflect on information that will enable them to assess quality and respond when necessary.
If we do not take the learnings of the last 25 years and acknowledge the complexities of developing indicators that will deliver meaningful data, we run the risk of providing consumers with inaccurate information and prevent providers from using the data as a tool for continuous quality improvement.
While I remain optimistic that accurate data can be developed, careful planning is essential. As the industry peak body, LASA will continue to advocate quality indicators in age services are established only after a full assessment of the experience within the acute sector and with a clear understanding of the diversity of care and services provided and how accurate, relevant and consistent data can be developed

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“If we do not take the learnings of the last 25 years and acknowledge the complexities of developing indicators that will deliver meaningful data, we run the risk of providing consumers with inaccurate information and prevent providers from using the data as a tool for continuous quality improvement.”

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Patrick Reid is the CEO of Leading Age Services Australia.
Leading Age Services Australia
P 02 6230 1676
W lasa.asn.au