Implementing Changes and Upholding Rights – It Takes Leadership

Written by Lauranne Beernaert, Sector Support Coordinator

It is time for change, and the Sector is part of the solution. The recent release of the Royal Commission into Aged Care Quality and Safety Final Report has highlighted too many failures of the system and too many instances where people were denied their right to access and receive quality Aged Care.

This article will consider the multiple layers in which change needs to happen and provide ideas on how the Sector can also drive change. It will do so by using a human-rights framework, with a particular focus on leadership.

Definition

In order to realise ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (United Nations, 1966, p. 4), both the content and process of all our actions must be “informed by human rights principles such as participation, accountability, equality and empowerment” (Australian Human Rights Commission, 2012, p.3). This represents a significant shift from the current quantitative indicators which govern the Sector, e.g., providers’ subsidies, number of allocated packages, or number of outputs to acquit funding.

1. Leadership from Government

The first level in which change should happen is logically located at the Government level. During this time of crisis, we need the Government to demonstrate that it cares about quality and safety of services and has the will to lead by example. While the easy way to respond is through funding, as evidenced in the Government’s initial response with the allocation of a $452 million package, there is a need for reform that requires vision and courage:

• Establish Human Rights as the base: introduce a New Aged Care Act based on a universal right to high-quality, safe, and timely support and care. This rights-based foundation to Aged Care is necessary for the complete system redesign that Australia needs, and the community expects.
• Show the Aged Care Workforce that it is valued: it is not new, the workforce is overworked and understaffed. It is also predominantly female, and many workers are casually employed. This means that care recipients have limited choice of worker, are unable to form long-lasting relationships with their worker, and that care is discontinued due to high staff turnover. This level of discontinuous care and lack of choice by the care recipient is in direct contravention of human rights-based care. While the Sector can incentivise its staff internally and find ways to be an attractive employer, we cannot do this alone. We need the Government to elevate the value of care work through investment in attracting, developing, and supporting an adequately skilled workforce. This requires revisiting the legislation about minimum wages and pay structure, labour conditions, education and training pathways urgently.
• Establish the different bodies (System Governor, Quality Regulator, Prudential Regulator and Pricing Authority) to provide oversight and fund the new system, monitor performance and quality, address issues and hold every stakeholder accountable. But do not fund these bodies at the expense of properly remunerating the Aged Care workforce.
• Support and enforce cultural safety by building a workforce and research into culturally competent care. This is another opportunity for the Australian Government to show genuine commitment to build an inclusive and respectful society, particularly one that acknowledges the specific needs of Aboriginal and Torres Strait Islander peoples.
• Stamp out ageism – create a society that values and listens to all people, irrespective of age.

2. Leadership from the Sector

The second level in which leadership and change are required is from the Sector itself. Regardless of the particular Aged Care program (CHSP, HCP, Residential and Respite), the Sector, as a collective, needs to take responsibility for the failures within the system as well, and importantly, start a process of introspection.

From a human-rights perspective, this involves the acknowledgement that service providers hold a unique position of power.  Indeed, through their relationships, care workers hold a unique position to support their clients to claim their rights to safe and quality care. For example, a personal care worker who asks the client what their wishes in relation to meals are promotes their right for choice. Further, a personal worker who advocates for a person after noticing that their family is making decisions against their will is actively protecting their right of autonomy. Unfortunately, instances when workers, often unintentionally, violate their client’s rights are common too.  For example, the use of patronising language is an example when the rights to respect and dignity are violated. Similarly, a change of care workers without notice breaches the right for personal security, and comments about the older person’s sexuality is in breach of the right to non-discriminatory treatment. By adopting an explicit human rights approach to care, we can balance the power relation between care consumer and provider, and actively promote and protect the rights of older people.

We have developed a training card to explore the application of human rights to Aged Care. Click here to download it.

In the current context of uncertainty, the Sector can solidify its commitment to delivering quality and safe care and demonstrate the same leadership it demonstrated during the pandemic. Indeed, we have seen the resilience, agility, and dedication of the Sector to providing care in challenging circumstances. For example, when the World Health Organisation declared the COVID-19 pandemic in March 2020, many Aged Care providers had been working on scenario planning for several months. One provider explained they had established their own contact tracing system before the State system was even designed (see the ‘Lessons Learnt From COVID-19’ report here). Other examples of innovation and agility include the quick transition to online activities so that their clients could maintain social connections. This commitment to safe care is a testimony that the Sector has what it takes to address the Aged Care Sector’s crisis, that it can learn from its deficiencies and explore new ways of thinking and doing. And can do so without dependence on Government.

3. Leadership from the Organisation

While everyone within the organisation is responsible for the organisational culture, leaders and managers are uniquely positioned to instil or revive values that are in line with the Sector needs and with the proposed reforms. During this time of anticipated changes, there is space for growth and opportunity.

a. Making Human Rights everyone’s business

We tend to consider human rights as an abstract concept that falls under the United Nations and Governments only.  However, human rights are everyone’s concern because all humans do have rights.

This can start with embedding the human rights language into all ‘business as usual’ activities, and revise organisation’s key documents. For example, the following fictitious value statement “Respect: we recognise the dignity of every person” could be changed to: “Respect: we recognise that it is the right of each person to be treated with dignity”. Further reflective questions are the following:

• Which rights are we talking about (right for personal autonomy, right for privacy, right to social participation, right to equitable access of services)? Which rights are absolute (cannot be removed/compromised), and which rights may be restricted? Under which circumstances?
• How do these rights translate into practice? For example, how does the right for privacy apply to a context where a personal care worker needs to undress, bathe, and dress a person?
• How to ensure that the content (e.g., the act of undressing and bathing a person) AND the process of our action (e.g. how the personal care worker uses their relationship to perform this task) align with human rights?
• What are the implications for our hiring strategy and induction programs? Do we hire a new staff member for their hard skills and qualifications, or do we prioritise people who demonstrate soft skills, alignment with human rights and “live the values”, and train them subsequently?
• How do we know that we are delivering rights-based care?
• How can our clients/consumers tell us when we are not?
• How do we monitor and respond to human rights breaches?

At the end of this reflective process that takes stock of where the organisation is at, there will be a need to start an ongoing discussion with staff to explore the application of these rights.

Ideas to start with:

• Organise focus groups, set-up a committee, discuss this topic during informal chats with staff.
• Develop an action plan in collaboration with all teams: what do we want to achieve? What do we need to change or review? Who will be the change champions?
• Develop a communication plan to explain the changes and why it is important. How do you monitor the implementation of the changes?

b. Revisiting our managerial skills and values

The Royal Commission’s recommendations refer to a variety of leadership responsibilities and accountabilities, including alignment of organisational culture and practice with the rights-based new Act, support regular feedback from clients and staff on the quality and safety of services, and establish effective systems to process and analyse complaints, to name a few.

A commonality between all these elements is that they all require the establishment of a work environment that is conducive to change, which needs to be facilitated by leaders:

‘Change won’t happen unless people feel free and psychologically safe to raise concerns and do things differently’. – Dympna Cunnane

Learn more by watching this video from The Health Foundation The changing role of leadership in healthcare).

Qualities of a change leader include:

• Communication and Dialogue
• Enthusiasm
• Emotional intelligence
• Integrity
• Humility

Values and behaviours are mirrored within the organisation and beyond. In practice, it means that if staff are treated with respect, trust, and autonomy, it is likely that they will replicate these values with their colleagues and their clients. To read a discussion piece by Change Factory that explores organisational culture and how leaders can create a caring and sharing culture within their organisation, click here.

In periods of change, we tend to add onto our existing processes. Is there anything in your organisation that is not meaningful? If yes, perhaps it is a good time to let it go and make space for your organisation’s renewed vision.

c. Understand what drives a quality oriented workforce

While there are numerous articles about motivation, contemporary works have challenged traditional beliefs that motivation is driven by rewards and fear of punishment (‘carrot and stick’ method). For example, Daniel Pink in his TED Talk argues that intrinsic motivation, derived from autonomy, mastery and purpose, is the true driver for high performance and quality. In practice, this means giving employees empowerment and independence.

Concluding thoughts

• Implementing changes and upholding rights is not easy. While the Government needs to play its part in reforming the system, it is truly a shared responsibility between the Government and the Sector. It is about time that we all acknowledge that the current quality of care is not good enough and that we can do better than this.
• At the organisational level, there is so much potential to lead by example by creating a work culture that is conducive to self-reflection, innovation and improvement. This is everyone’s responsibility, but it needs to start with strong leaders. Will that be you?

References

Australian Human Rights Commission. (2012). Human rights approach to ageing and health: Respect and choice. Retrieved from https://humanrights.gov.au/sites/default/files/document/publication/human_rights_framework_for_ageing_and_health.pdf.

United Nations. (1966). International Covenant on Economic, Social and Cultural Rights. Retrieved from https://humanrights.gov.au/our-work/commission-general/international-covenant-economic-social-and-cultural-rights-human-rights.

Learning Library

Additional reading

Australian Human Rights Commission. (2019). A Human Rights Perspective on Aged Care. Retrieved from https://Agedcare.royalcommission.gov.au/system/files/2020-06/AWF.500.00267.0002.pdf

Equality and Human Rights Commission. (2011). Close to home. An Inquiry into older people and human rights in home care. Retrieved from https://www.equalityhumanrights.com/sites/default/files/close_to_home.pdf.

World Health Organisation. (2021).  Global report on ageism. Retrieved from https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/global-report-on-ageism.

Tools

Scottish Human Rights Commission. (2018). Human Rights Based Approach. A Self-Assessment Tool. Retrieved from  https://www.scottishhumanrights.com/media/1814/shrc_panel_self-assessment_tool_vfinal.pdf

Victorian Equal Opportunity & Human Rights Commission. (2008). From Principle to Practice: Implementing the Human Rights Based Approach in Community Organisations. Retrieved from https://acfid.asn.au/sites/site.acfid/files/resource_document/From-Principle-to-Practice-Implementing-the-Human-Rights-Based-Approach-in-Community.pdf.

Podcast

Salt, B. (Host). (2021, April 28). Post COVID-19: What Happens Next? Aged Care – Building a healthy and happy future (No. 7) [Audio podcast episode]. In Post COVID-19: What Happens Next?. KPMG. https://home.kpmg/au/en/home/insights/2020/05/covid-19-what-happens-next-podcast.html?cid=PostBeyond%01341933