Dedicated Staff Assignment Anglicare Australia National Conference - - PowerPoint PPT Presentation

Anglicare Australia National Conference Wednesday 19th September 2018

Dedicated Staff Assignment

Presented by: Oonagh Zimmermann, Project Officer

• Amana Living – one of Western Australia’s largest

not-for-profit providers of care and services for

• lder people.
• Established in 1962 our services include; residential

care centres, housing, home care services, respite care, transition care and dementia services, spread across 21 sites in Perth metro, Australind, Kalgoorlie and Albany.

• Amana Living has 13 residential care centres, 12 in the

Perth metro area and one in Kalgoorlie.

About Us

• Pre-2017 we found that our James Brown Care Centre was underperforming. It had experienced

significant management turnover in the previous 5 years and we did not have standard or agreed approach to customer engagement and a person centred care approach was missing at the site.

• Of particular note was our approach to rostering and the rotational assignment that was occurring

at James Brown Care Centre. An approach that was also widely adopted at our other centres.

• A literature review was undertaken, this included the 2010 report Innovative workforce

responses to a changing aged care environment; published by the State Government of Victoria Department of Health and a conference presentation on the Arcare Dedicated Staffing model.

• Our Dedicated Staff Assignment commenced following an identified need for improvement to the

consistency in care delivery for residents at Amana Living’s Care Centres.

Background

Anticipated Benefits

• Residents: Improved resident satisfaction; reduced complaints; reduced clinical

incidents, improved resident care with residents reporting being less pressured and less frustrated as regular staff attend their needs.

• Care Staff: Improved staff engagement and understanding of residents’ care and needs.

Improved staff satisfaction and reduced sick leave. Improved team work; reduced staff injuries; increased staff accountability and reduced errors and reduced preventable clinical incidents.

• Organisation: Improved operations; reduced labour costs; reduced clinical risk; reduced

churn; improved reputation and increased provider of choice.

Anticipated benefits

• Staff hold permanent shifts in our rosters.
• Carers would shift from one area of the site to

another throughout the fortnight.

• Legacy approach from days where staff worked in a

multi-role capacity.

Rotational Assignment

• Frequent changes to rosters (staff instigated)
• An analysis at James Brown uncovered an alarming number of different care staff

providing support to one resident in just a fortnight (October 2016 – January 2017).

• 23 different cares at the lowest point and 28 at the highest point.

What this looked like on paper

• Care staff where task focused
• Increased resident behaviours
• Residents voiced frustration about the carers knowledge

regarding their routine and preferences. Family echoed similar comments.

• Carers where reactive when responding to residents needs.
• High frequency and duration of call bells
• Poor communication & Lack of team work
• Slow to identify change
• Residents where not familiar with the care staff

The observed impacts on floor

Planning:

• Full audit of the roster, identifying frequency and roster patters of the care staff.
• Analysis of current residents, their needs and compatibility to specific staff.

Employee participation and stakeholder engagement:

• Compulsory staff meeting and subsequent meeting’s sought input on how best to modify the

roster.

• These meetings continued throughout the trial to identify and resolve issues of concern.
• An FAQ sheet was developed and updated regularly for staff to read.

Innovative practices:

• Whiteboard to gather feedback and highlight improvements.
• Get to know me posters where introduced to residents rooms.
• Staffing board was placed up with a photograph of every staff member.

Implementation

What it looks like now

Roster based on the principals of Dedicated Staff Assignment How the roster looked previously

• A small number of staff where unsupportive of the model.
• Concerns raised by staff included an increase risk to those assigned to residents requiring

more support with mobility or ADL’s

• Concerns addressed though staff meetings, resident allocations and workload reviews.
• Identified staff who where underperforming and who had largely negative attitudes.
• The trial delivered marked improvements across a number of areas at

James Brown Care Centre.

Trail experiences

• Outcomes where evaluated using clinical and staffing KPI’s, supported by observations of staff

and residents behaviour and attitudes general feedback.

• Data compared from the 12 months prior to the commencement of the trial (Jan to Dec 2016)

to the 12 months from commencement (Jan to Dec 2017) Clinical

• Call bell wait times: >5 minutes reduced by 75%
• Falls reduced by 35%
• New skin integrity incidents reduced by 27%
• Unplanned hospital transfers reduced by 26%
• Complaints reduced by 68%

Key outcomes

Staffing

• Staff rotation: 61% reduction in the number of staff assigned over a 14 day period
• Sick leave: 17% reduction in sick leave hours.
• Staff stated feeling more prepared and could identify improvements to their workflows.
• Staff observed spending more time with residents and engaging in more meaningful

activities.

• Residents and relatives stated that it was great to have more familiar faces.
• Residents where more settled and the whole environment at the site appeared calmer.
• Trail concluded in July 2017.

Key outcomes cont.

• Since this time, we have successfully imbedded Dedicated Staff Assignment into our remaining

12 sites. (July 2017-June 2018)

• Each care centre presents different challenges, these being related to layout and environment,

the unique staff rosters, skill, competency and resident needs.

• Meeting 1:1 with staff helped to ensure better engagement in the change process. Templated

communication provided a consistent messages to all staff involved.

• Consistency in the casual staff that are supplied to the site is crucial. Impact to integrity of

the model if not managed correctly.

• Ongoing management of the staffing model relies heavily upon maintaining strong leadership.

Rollout learnings and Sustainability

• “Handovers are more informative, care staff are actually self-reporting the things that they could not get done.

They are having conversations and prioritising work because they are pre-emptive of the what the resident will request, especially if it was not achieved on the last shift…documentation has improved as well.” LMH

• “The staff are making better adjustments to scheduled toileting when they notice changes, the consistency has

really improved this for residents and in turn it has helped to decrease the number of behaviours” LMH

• “Yes staff are much more accountable, I can see this change since the model was introduced. At the 11 am handover

the staff are more responsive and provide more interventions and at earlier stage” PAH

• “The staff get themselves more prepared now, sometimes even before handover, they already know which residents

they will be working with so they are more proactive. They will prepare their trolleys and will pop their head into a residents room just to check where the resident is at” FGH

• Carers are coming to me saying …’do you remember that we discussed X yesterday… well I finally got it done!’ …this

type of communication was lacking before because they were often somewhere else on the next shift. PCC

Feedback from Clinical Teams

• “The consistency is really important to my mum. The carers are really good and all lovely people. At the beginning I

was coming to visit her mum everyday, I got to know the carers faces and names, the staffing board is great, it really helped me…As I got to know the staff they even said it would be good to stop visiting every day and that it was ok to have some time for myself. This was good as I knew who would be with mum when I wasn’t there.” PCC

• “What you are doing with the consistency is hugely valuable for my mum. From mums perspective it’s much easier

to have staff who she is familiar with… The staff photo boards in the house are a great idea, my mum and I can get to know the staff.” LMH

• “It's really important to me, having the same cares work in the house makes it easier for me to make an association

with them, I see their faces and know who they are.” SGCC

• “Having the same person to shower me once or twice a week is important to a person of my age… I don’t want lots
• f different people assisting with this as it very personal. I’m more comfortable with the same person coming to

support me most days.” PCC

Feedback from Relatives and Residents

• “The routine for the residents and for me has really improved. Dedicated Staffing was a good idea for the residents

benefit as they are more open to receiving care form someone they are familiar with. Work is better than before… The continuity of care is far better than before and residents are looking much more settled and well presented. They arrive for breakfast and have hair brushed, teeth in, are dressed appropriately and the whole atmosphere is much calmer…because of this they are eating better as well.” PCC

• “I feel much more relaxed now when I come to work. I used to take sick days before if I knew I was working in a

house that I didn’t really know or if there was a team that would not be supportive… I don’t feel like this any longer” SGCC

• “My relationship with residents has changed, I'm in the house 5 days a week, I feel that residents are more

comfortable and there is greater trust and between us and them.” PAH

• “I have seen great improvement, for example if there is a new resident, you have more opportunity to watch and
• bserve their routine. As you see them regularly it means that we can understand this in a shorter period of time

than before. Sometime it would be a long time before you really got to know the resident.” LMH

Feedback form Care Staff