Leadership is the key to better health care

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Leadership is the key to better health care

The editor of Australian Ageing Agenda asked me to suggest a solution to a perplexing problem in residential aged care – how to encourage staff to speak up about incidents of mistreatment or poor care of vulnerable residents. I teamed up with Emma Read and we wrote this article: Leadership is the Key. It appears in the May/June 2015 edition of the magazine.

The reader is invited to imagine a scene where the Chair of the Board of an aged care facility makes this statement to a meeting of directors: ‘From this day forward, each of us will be deemed to take personal responsibility for the quality of the services we provide, as expressed through our guiding ethos and vision’.

The Chair made a bold statement but the intent behind it is inescapable. Leadership from the top is critical to ensuring quality of care is all it should be. So what does this leadership look like in practice?

In practice it means that leaders ‘walk the talk’ and are visible, approachable and authentic. They spend time with staff and residents, listening to their stories and concerns. After a time trust builds and people are willing to share more.

Leaders also communicate very clear expectations about standards of behaviour that are acceptable and those that are not. Policies and procedural guidelines alone do not cut it – they are too remote from the everyday reality of busy work days, frequent upsets and resident behaviours that can be challenging for staff. Staff need expectations to be reinforced frequently in face to face situations with leaders acting as credible role models.

Leaders also provide opportunities for shared learning and skill development in client care and enriching the lives of aged residents. They encourage people to talk openly about their feelings and attitudes, and what they expect of themselves and others. Leaders remove any excuse to hide or cover up problems.

These measures are supplemented with more formal channels (such as suggestion boxes) for staff to contribute ideas on improving the service. People are far more likely to take ownership if they are consulted and feel part of processes that benefit the people they care about.

More broadly, leaders create a positive social climate where every staff member feels included and valued. This is how leaders make staff feel safe and supported. People who do not feel included and valued withdraw psychologically, with many ill effects.

In summary, the differences between a culture of silence around reporting concerns and one that is open and supportive are these:

  • Credible leadership from the top with acceptance of personal accountability for service standards
  • Leaders who are visible and model acceptable behaviours
  • Opportunities for group learning and development, where issues of acceptable and unacceptable behaviours are surfaced and openly discussed
  • Encouragement for staff to take ownership and bring forward their ideas and concerns
  • A safe and supportive social climate that drives out fear.