Project to investigate building a culture of safety in Australian residential aged care facilities

  

7 January  2022

ANMJ Journal Article, By ANMJ Staff

A Macquarie University researcher has received a $650,000 National Health and Medical Research Council (NHMRC) Investigator Grant for a project that will examine building a culture of safety in Australian residential aged care facilities.

According to Dr Kate Churruca, a Research Fellow in the Centre for Healthcare Resilience and Implementation Science (CHRIS) at the Australian Institute of Health Innovation, Macquarie University, Australia’s aged care sector is the subject of intense scrutiny due to problems in the safety and quality of care provided to residents.

Many of its failings can be traced back to poor organisational culture, a focus on box ticking instead of quality, and limited respect for residents, she says.

Dr Churruca’s project will look to fill the gap in the lack of research into how aspects of organisational culture influence safety and quality in residential aged care facilities and, importantly, implement an evidence-based culture change intervention targeted at improving outcomes.

The research will involve analysis of safety and organisational culture across residential aged care facilities over a five-year period.

“This topic is at the intersection of two recent and compelling research projects I have taken part in,” Dr Churruca explains.

“Firstly, I have been exploring safety culture in hospitals and how to support the assessment of it, in line with the requirement for it in the National Safety and Quality Health Service (NSQHS) Standards. Crucially, evidence has accumulated to show that the organisational culture of a healthcare organisation has important impacts on patient and staff outcomes.

“In the second project, I worked with a PhD student to investigate how care in residential aged care facilities is prioritised by different stakeholders (staff, residents, family members). Here we found that care prioritisation is influenced by organisational cultural factors.

“Furthermore, the care provided in aged care facilities is far more diverse than hospitals as it must address the medical, psychological, social and spiritual needs of residents. Findings from these two projects suggested an important need to examine culture and its impact on care specifically within aged care facilities and using a rigorous study design.

“The Royal Commission into Aged Care Quality and Safety, which found gaps in care, a number of which were attributable to culture and workforce issues, underscored the urgent need for this research and for findings that would ultimately feed into improving organisational culture in aged care facilities, and thereby care for residents.”

Dr Churruca says her project will look to fill the current lack of large scale, longitudinal research that seeks to understand how different aspects of culture influence safety and quality in aged care and what can be done to improve it.

The findings of the Aged Care Royal Commission have directly informed the research.

“The detailed insights into the context of aged care, including funding, regulation and workforce issues, were important in the design of this research and will further inform the strategy for recruiting facilities,” she says.

“The issues of substandard care found by the Royal Commission highlight the urgency of the problem and have illuminated the kinds of resident outcomes and quality and safety indicators that will be important to study in this research. Finally, the intention of this research is to support and feed into the recommendations of the Royal Commission, including the review of national standards for aged care.”

The project has three overarching aims that will look to generate evidence around safety culture in aged care facilities, and support ongoing improvements for the sector:

1. To determine how organisational culture and context affect safety and quality.
2. To validate a survey instrument to measure safety culture.
3. To implement and evaluate an organisational culture change intervention.

“The first of these aims is a major piece of work spanning the five years of the grant and including as many as 40 residential aged care facilities, with representation from across Australia. Facility staff will be asked to participate annually in a survey of organisational culture; this data will be analysed for its relationship to indicators of quality and safety. A subset of facilities will then be selected to take part in extensive ethnographic fieldwork, where I will be observing and interviewing staff over months to gain a richer picture of the organisational culture within each facility and across the aged care sector, and how this impacts safety and quality.

“Running alongside this work, I will validate the survey of organisational safety culture so it can be utilised beyond the life of the research for monitoring and evaluating culture in Australian aged care facilities, as already occurs routinely in hospitals.

“Finally, drawing on existing research, the results accumulated throughout the project, and in consultation with aged care providers, policymakers and workers, I will develop and test an intervention to improve culture in aged care facilities.”

Dr Churruca says she expects many in the aged care sector to be very supportive of her initiatives to improve the conditions and care of residents, and also to better understand issues around leadership and the impact on culture.

“This research program will have enormous significance in developing our understanding of current practices for safety in aged care facilities and improving the quality of care to residents across Australia,” Dr Churruca says.

“Delivery of a validated survey measure of safety culture for Australian RACFs will support facilities to engage in internal monitoring, identify safety issues, and conduct quality improvement. The culture change intervention and implementation plan developed for this research can be scaled up, or used to develop other interventions to improve culture, safety and quality in RACFs nationally. Ultimately this will improve residents’ health outcomes, wellbeing and experiences of care.”