Journal of evaluation in clinical practice
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Nursing homes (also referred to as residential aged care facilities, or long-term care facilities) cater for older people on a respite or long-term basis for those who are no longer able to live independently at home. Globally the sector struggles to meet societal expectations since it is torn between three competing agendas-meeting the needs of residents, meeting the demands of regulators, and meeting the financial imperatives of nursing home proprietors. Competing demands indicate that the system lacks a clear understanding of its purpose-without a clearly understood purpose any system will become dysfunctional overall and across all its levels of organisation. This scoping study aims to summarise and synthesise what is already known about the systemic function and failures in the nursing home system, and the impact this has on the wider health and aged care system. ⋯ The key issues affecting nursing home residents, and the care home sector more generally, are systemic in nature arising from two key issues: first, the lack of shared agreement on the care home system's purpose; and second, the lack of clear governance and accountability frameworks for system regulation and performance at a national level. Addressing these two key issues must be the starting point for any 'real' nursing home system redesign that can achieve a seamlessly integrated system that delivers the outcomes nursing home residents and their families expect. 'Systems thinking' is required to simultaneously improve care quality and outcomes for residents, strengthen regulation and accountability, and enable financial viability.
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Many organisations struggle to achieve their true potential. In part it is a problem of organisational design, which is an outcome of a particularly common-command and control-leadership philosophy. ⋯ Systems and complexity thinking provide different ways of understanding organisations and their complex adaptive behaviours. In this paper, we first describe the key characteristics of complex adaptive organisations-their structure and dynamic behaviours-and then propose a three-dimensional visualisation of a complex adaptive organisation that allows its members to clearly see and appreciate its interdependencies.
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While the Royal Commission into Aged Care Quality and Safety has clearly identified the issues with our Australian residential aged care system, its recommendations-so far-have not been translated into policies that will ensure a framework in which nursing home operators and care staff are empowered to focus on what matters-ensuring vulnerable residents receive care that meets their needs and preserves their dignity. For this to be achievable the system requires measures that in the first instance reflect the system's purpose, and that all stakeholders can use to improve care. Such measures need to be easy to understand and implement, and most importantly reduce bureaucratic burden.