Understanding how the risk and governance bar is lifting in aged care

How to start your governance and risk reset 

Each chapter is designed to frame a conversation with your board and leadership team, to:

• Review how the aged care royal commission’s final report is lifting the bar on governance and risk 

• Deepen everyone’s understanding of what good governance and risk management look like 

• Uncover the gaps, weaknesses and strengths in your governance and risk management today

• Help you build the plan to lift your governance and risk to meet the higher expectations of consumers as consumers, regulators and the community.

Each chapter provides a ‘background briefing’ and then a set of questions for you, your board and leadership team to work through.

Addressing the governance gap  

One of the uncomfortable truths is the ‘governance gap’ uncovered by the final report. To date, the aged care sector has not met better practice in the way it governs and manages risk, and this has contributed to some serious service failures. In short, the royal commission’s final report calls out the need for a fundamental reset in aged care governance and risk management. 

Behind the recommendations to strengthen governance and risk we see four themes: 

1. Providers should be supervised and held to account by stronger and more effective aged care regulator/s¹ 
2. Providers should be governed and overseen by an independent body 
3. Effective risk management must be established and verified
4. The sector should be opened up to greater public transparency and scrutiny of performance. 

Other important recommendations

Providers will also need to move to become more of an open, listening and transparent organisation, proactive in their management of risks for the benefit of its consumers and supported by capable leaders:

Continuing to meet immediate requirements set out in the standards

As we look ahead to responding to the royal commission and advancing clinical governance and quality standards, it is important that we don’t lose sight of what we need to demonstrate and maintain compliance today. As an executive and a board, it is important to be aware of the trends and areas of repeat and common failures against today’s requirements.

The commission's reports have highlighted common themes of non-compliance across the aged care quality standards, confirmed by the royal commission’s final report. Over the past 18 months, the new quality and safety regime has highlighted deficiencies particularly relating to Std 3 Personal and Clinical Care and Std 8 Organisational Governance. 

Standard 8 - What you need to know?

Standard 8 enables all the other aged care standards. It supports how the organisation strategically focuses on the requirements of each standard to ensure the organisation is well governed.

The failures in clinical and personal care documented in the Aged Care Quality and Safety Commission sector reports and the royal commission’s final report are often matched by a failure in governance with the provider not meeting the current standard 8 on organisational governance, such as:

• Not having an effective clinical governance framework in place.
• Not having effective risk management systems and practices to prevent harm to consumers, managing feedback or complaints or supporting open disclosure.
• Staff lacking knowledge or understanding of key policies and procedures to manage significant risks e.g. on the use of chemical or physical restraints.
• Inadequate escalation, reporting and monitoring to the governing body e.g. indicators, antimicrobial stewardship, reporting of abuse/neglect or improper use of restraint. 

So, whilst we must have an eye to the future and the changes to come, it is also essential to stay focussed on maintaining compliance and meeting today's expected standards.