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Does an aged care specific leadership program for middle managers improve work environment, staff retention and care quality and
safety?
Professor JEON, YUN-HEE1
Professor Simpson, Judy M1 Ms Li, Zhicheng1
Dr Cunich, Michelle M1 Ms Thomas, Tamsin H1
Professor Chenoweth, Lynn2 Professor Kendig, Hal L3
1. The University of Sydney; 2. UNSW; 3. Australian National University
Person Centred dementia Care (PCC)
• Much of the ill-being experienced by
people with dementia is due to the attitudes and care practices by which they are surrounded
• Symptoms of dementia are the cumulative result of NI, PH, P, PH, P&SE, SE
• Despite the losses experienced … they
are still left with a great capacity to enjoy life
• Application of the key principles of PCC
Kitwood, T. (1997). Dementia reconsidered: The person comes first. Open University Press, Buckingham.
Bradford Dementia Group (1997). Dementia care manual, 7th edn. University of Bradford, Bradford.
“Rural-urban nursing partnership in
dementia care” “Effective management of challenging
behaviours in aged care residents with a cognitive impairment through a nursing care model” (DCM study)
“Evaluating the efficacy of DCM, compared with PCC, in improving quality of life, well–being and quality of care in persons with dementia: a randomised-controlled study” (CADRE Study)
“Person-centred environment and care for residents with dementia (PerCEN Study)”
“ACFI-instructed DEmentia Learning and Information Trial Initiative (ACFIiDeLITI)”
Since 2003...
Aims:
1. to develop and promote evidence-based tools for improving leadership and management in the aged care sector including a clinical leadership qualities framework (ACLQF) and a clinical leadership program in aged care (CLiAC); and
2. to determine the feasibility and the effectiveness of CLiAC in improving workforce recruitment and retention and care safety and quality.
The Study: 2010-2014
Action research project
conducted in four stages
Developing a Toolkit:
ACLQF & CLiAC
Jeon, Y-H., et al. (2015). Validation of a clinical leadership qualities framework for managers in aged care: A Delphi study. Journal of Clinical Nursing. 24(7): 999-1010.
Using the workplace as a place for learning
Undertaking a work based project linked to
clinical care
Support from a facilitator
Delivery of content related to knowledge about leadership &
management for aged care middle managers
Positive improvement in
indicators of effective clinical
leadership of middle
managers in Aged Care
Clinical Leadership in Aged Care (CLiAC): Approach
• 4 Modules delivered in 8 days of face-to-face group workshops
• 6 month individual site specific practice improvement project
10-12 months
Double blind cluster randomised controlled trial The effectiveness of CLiAC being examined at three different time
points against a no program control group (NP)
Primary Hypotheses: The CLiAC group will have the following significant benefits over the NP group.
• HP1 – enhanced work environment for aged care staff • HP2 – improved care quality and safety for aged care recipients • HP3 – reduced staff turnover rates
The Study
11
Staff characteristics
• At baseline, 511 care staff (569 at time 2 and 589 at time 3). • The largest group - those aged 45 to 54 years (37%); the majority
born in Australia (70%), spoke English (94%), and completed secondary education (57%).
• The distributions of characteristics similar between intervention (CLiAC) and control groups.
• 76% of staff nursing/personal care assistants. A small proportion of these staff (17% intervention, 16% control) with no specific training in aged care.
• At baseline most site characteristics similar between the control and intervention group (size of the service, dementia specific service, span of control, and geographic location).
• Slightly more staff were in the control group, but this was proportionate to the size of the service and span of control.
• A similar pattern in the characteristics of staff was observed at all 3 time points.
The main effect of the CLiAC program was on the different MLQ components at time 3. The mean-based ICERs are AUS$1584 for a 1-point increase in the mean score on the most desirable form of leadership, transformational leadership; and AUS$1343 for a 1-point increase in the mean score on overall leadership.
Conclusion
• CLiAC effective in improving staff’s perception of management support
• CLiAC resulting in managers’ leadership styles as more transformational, transactional, and less passive avoidant; and higher on the overall leadership outcomes
• No evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety
The CLiAC program improved managers’ support for staff and their leadership style, behaviours and outcomes at a reasonable cost. A longer period of observation may be required to show an effect on organisational-level outcomes.
