7305MED_AndreaTrubody_s5048151_assessment3_final

7305MED Assignment 3 Andrea Trubody s5048151
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Student: Andrea Trubody s5048151
Essay/Report Title:
Reforms required in aged healthcare workforce roles to improve productivity and
support more effective and efficient service delivery.
Word count: 2509
(excluding title page, index, reference list/bibliography and appendices)

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Table of Contents
Executive Summary 3
1. Introduction. 4
2 Rationale 4
3.Goals and Objectives 5
4 Evidence BasedStrategies 6
4.1 Background 6
4.2 Productivity Commission Recommendations (2011) 7
4.3 Job Satisfaction 8
4.3.1 Increase staffing levels 8
4.3.2. Create a clear career progression path 9
4.3.3 Strategic conversation 9
4.3.4 ‘Bringing nurses back into the workforce’ 9
4.3.5 Consider what is important to staff 10
4.4 Increase in Productivity 10
4.4.1 Assistive Technology (AT)/Electronic Documentation (ED) 10
5. Change Issues 11
5.1 Types of change 11
5.2 Kotter’s 8 stages of change 12
5.3 Organisational Justice (OJ) 12
6. Recommendations 13
6.1 Government 13
6.2 Organisation 13
7 Conclusion 13

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Executive Summary
The purpose of the report is to examine what types of reforms are required in aged
healthcare workforce roles to improve productivity and support more effective and
efficient service delivery. Effective service delivery from the age care perspective can
be defined as the degree to which the health of patients is improved by health
services. An efficient service delivery is one that delivers the best outcomes with the
resources available. Research was conducted into the current state of the issue
examining areas of
 Job Satisfaction
 Staff perception of causes of problems
 Recruitment of staff
 Working conditions
as well as formulating possible solutions. Recommendations have been made as part
of the concluding section.

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1 Introduction
Both governments and those in aged care facilities and their families have questioned
the standard of care provided. Policies need to consider firstly what actions /skills are
required (in demand) to improve service delivery and productivity in aged care and
then formulate strategies to obtain them (Duckett & Willcox, 2015). This is a
departure from static workforce planning which approaches the problem by simply
increasing the supply of staff of the profession which provides the service in demand
(Crettenden, McCarty, Fenech, Heywood, Taitz &Tudman , 2014).Staffing levels,
patient safety and dignity, and inattention to patient care plans have been examined by
families and found to be wanting (Bernoth, Dietsch & Davies, 2013). In 2012 a report
by the Aged Care Standards and Accreditation Agency (ACSAA) which was the
watchdog for residential aged care (RAC) standards, found that standards were not
being met (Aged Care Standards and Accreditation Agency, 2012)
2. Rationale (why is it a workforce issue?)
In order to maximize performance both production and allocative efficiency is
required (Begley,Lairson & Morgan, 2013, pp.1-5). Health care models and roles of
yesterday may be unsuitable to meet the needs of the future Australian community
(Crittenden et al, 2014). Duckett & Willcox (2015) feel that innovation must occur at
every level of workforce planning to increase productivity which they see as the key
to the development of a workforce able to meet future demands. Areas of concern
include work hours, work relations, work schedules. The solution to these issues
ultimately lies with those who construct rosters, assemble teams and assign roles and
responsibilities.

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3. Goals and Objectives.
 Improve pay parity
 Reduce workloads
 Improve workplace conditions.
 Increase retention rates
 Service appropriate skill mixes
 Creation of succession plan/defined career path.
 Improved communication especially concerning role changes.
 Development of strong professional leadership.

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4.Evidence BasedStrategies
4.1. Background
Figure 1. Projected proportion of the 65+ population to 2054.
Source: Australian Institute of Health and Welfare (AIHW), 2016.
Aged Care is a ‘growth industry’ due to the trend in increasing life expectancy. Figure
1 shows the growing proportion of the 65+ y.o. population till 2054. Both the
numbers and population percent of this age group are expected to continue to steadily
grow (Australian Institute of Health and Welfare (AIHW), 2016). The largest increase
has been seen in those living to 100 years of age. It has been forecast that this age
group will increase at a rate in excess of 20 times that of the general population by
2050. Data shows a similar increase in life expectancy for indigenous persons who
have additional cultural requirements such as staying within their communities
(especially in rural/remote areas) (Moyle, Parker & Bramble, 2014). From 2011 the
baby boomers have begun to turn 65. Within this cohort are those who have large
amounts of disposable income, are well educated, have held influential positions both
in government and industry (AIHW, 2016) and expect quality service delivery.

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Within Queensland the increase in demand can also be attributed to the influx of
retirees from other states (Eley,Hegney,Buikstra, Fallon,Plank & Parker, 2007).These
statistics alone suggest the need for aged care staff to modify practices and create
guidelines to meet these increased demands.
4.2 Productivity Commission Recommendations (2011)
In 2011 the Productivity Commission (PC) (Productivity Commission, 2011)
recommended attention be paid to numerous issues (including the following) to boost
productivity
 Competitive wages
 Improving access to education and training for workers (especially in
rural/remote areas.
 Developing well defined career paths.
 Appropriate Funding.
Henderson, Willis, Xiao, Toffoli & Verrall (2016) have examined the impact of these
recommendations. This has focused on facilities in the rural/remote areas through
discussion with nursing staff. The magnitude of the impact was dependent upon the
classification as either a residential aged care facility (RACF) which was largely
funded by not-for –profit organisations or part of a multi-purpose service (MPS)
which is government funded. Participants from the RACF speak of funding cuts
impacting on the quality of care (e.g. using the correct dressings or having access to
adequate equipment). Sources of funding cuts were identified to be (Henderson et al.,
2016).
 means testing of accommodation leading to inability to fill beds. This resulted
in a reduction in aged care funding.

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 Confusion regarding which Government funds what in facilities when
transitioning from RACP to MPS.
4.3 Job Satisfaction
4.3.1 Increase Staffing Levels
Prior to the 1997 reform aged care policy was designed based upon the focus that
aged care was simply a form of accommodation for seniors. Since that time the focus
has changed to meeting the needs of the residents especially those needing intensive
24 hour care (De Bellis, 2010). [I acknowledge that this reference is 6 years old,
however it isn’t data. It is simply an observation not made in any other literature.]
However some facilities still compose workforce teams without consideration of the
special skills and staffing levels required. This needs to change. Staffing levels are
also associated with funding cuts. This has been noted over time with staffing
shortfalls being experienced as funding is reduced. This impacts job satisfaction as
staff is forced to work long hours to make up the shortfall. Access to allied health
services such as opticians and dentists is also lessened. One facility manager
suggested one solution was charge accommodation fees to increase available funds
and employee additional staff (Henderson et al., 2016). One avenue of raising funds is
to create a day care service that allows access to healthcare services tailored to the
65+ population. This service would be open to not only the residents of the facility
but also to the community. A fee structure could be calculated which could be added
as (1) an ‘extra’ for residents or (2) a payment from an individual still living at home
(UnitingCare NSW/ACT Aging & Disability Service, 2001). [Even though this is a
suggestion from a document published in 2001 I feel that the strategy has merit and
does not feature in other documents.]

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4.3.2 Create a clear career progression path.
For a facility to both grow and deliver an efficient service delivery it requires many
managers (who possess desired skills). This can be assured by the development of a
succession plan. The plan affords an opportunity to develop talent as well as retain
experienced employees (Collins & Collins, 2007). Lack of a clear career path is a
concern especially for nurses. In one survey 85% of nurses stated their organization
didn’t have a career pathway (Parker, Keleher & Forrest, 2011). Cost of education
and lack of management support were also issues of concern. (Eley,Francis &
Hegney, 2013). Clear career advancement will also attract employees as well as grow
the reputation of the employer.
4.3.3 Strategic Conversations
This is a continuing discussion that allows the workforce to collaborate with
management concerning methods to improve productivity and support more effective
and efficient service delivery. Besides harvesting knowledge of shortcomings gleaned
‘at the coalface’ this may also be an opportunity for making workers feel as though
their opinions matter leading to increased job satisfaction (Deloitte, 2015).
4.3.4 ‘Bringing Nurses Back into the Workforce.’
This initiative was aimed at increasing the size of the available workforce by
providing a financial incentive to eligible workers to return to age care after an
absence of a minimum of 12 months. It was hoped to attract to attract some 6,200 of
the then 30 000 nurses who were no longer in the healthcare workforce for various
reasons including the number of hours spent at work, wage rates and family
commitments (Commonwealth Department of Health And Aging, 2008) [I
acknowledge this is published before 2011 however it outlines the aims of the
programme]. The scheme was aimed at nurses in all types of healthcare facilities

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(including aged care), but in this case a similar scheme aimed specifically at aged care
workforce should be applied.
4.3.5 Consider what is important to current staff.
What is important differs between generations. Retention of older workers involves
an increased supervisor feedback (Radford, Shacklock & Bradley, 2015). These
workers also value flexibility in hours and work locations (not always confined to an
office), promotion and rank. Flexibility is also prized by gen 2020. Distrust of
authority is a shared attribute between older workers (baby boomer) and millenials.
Gen Yers differ from older workers as they dislike supervision and challenge the
authority of supervisors (especially if they are older) (Shacklock & Brunetto,
2011).For a definition of generation categorization see Appendix 1.
4.4 Increase in Productivity
Productivity levels can be affected by a number of factors such as the number of
hours worked, remuneration for those hours and type of work such as paperwork. The
gap between wages in the public and private sectors should be closed. There also
needs to be a mandated skill set for each team as well as a maximum staff/patient
ratio determined to meet the care requirements of all aged care residents (Australian
Nursing and Midwifery Foundation (ANMF), 2016).
4.4.1 Assistive Technologies (AT)/ Electronic Documentation (ED)
Studies have shown that AT has been used to improve the quality of life (QOL)
among older age groups (Khosravi & Ghapanchi, 2016). This improvement in QOL
can been interpreted as a sign of improved efficiency of service delivery. The Nursing
Care Plan (NCP) records the nursing process for each patient and is essential for safe
and efficient healthcare delivery. It is constantly updated as it provides information
which allows for continuity of care (Wang, Yu & Hailey, 2015). Electronic

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technologies have been touted to increase ability to deliver more efficient and
effective care. This is achieved though e.g. the replacement of illegible handwritten
documents with electronic care plans, simplified data collection and fast access to
required information. This also allows for the easy sharing of patient information
between practitioners and facilities if patient transfer is required (Jiang &Yu, 2014).
Although there have been some uncertainties concerning security of patients’ data,
Duckett & Willcox (2015) feel that its use has the potential to improve service
delivery as well as workflow.
5. Change Issues
5.1 Types of Change.
There are four types of change (Duckett & Willcox, 2015)
 Moving tasks up or down the ladder (e.g. a senior medical officer
performing a task previously done by nursing staff)
 Expanding the breadth of a job (taking on additional tasks e.g. a nurse
practitioner in a remote area.
 Increasing the depth of a job
 Creating new roles through modification or combination of several
roles.
Change is an inevitable part of any business (especially in the light of technological
advances and marketplace competition (Appelbaum, Habashy, Malo & Shafiq, 2012).
When planning any changes in roles implementation must be carefully made to avoid
confusion of roles and subsequent negative impacts on quality of care (Bohmer &
Imison, 2013). Organisations need to make changes to provide a more productive,
efficient and effective service. This can be enhanced by providing training to middle

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managers (Meissner & Radford, 2015). Consideration also needs to be given to the
reluctance of some professions to change (Duckett & Willcox, 2015).
5.2 Kotter’s 8 stages of change
For an explanation of each of the stages see appendix 2. Depending upon the facility
the Australian age care system appears to be at stages 2-3. Staff (especially nurses)
have expressed the opinion that things need to change, they feel they aren’t listened to
and have articulated a desire to become more involved in the administrative process.
5.3 Organisational Justice
During a period of transitional change attention must be paid to organisational justice
(OJ). It has been found that during this time if staff perceive fair treatment they will
express high levels of job satisfaction. If low job satisfaction is evident then providing
financial rewards will not provide a solution as if a worker already feels negative
about their job (no matter if highly paid) they will remain unsatisfied . Conversely
offering a low reward is also demotivating (Brandis,Fisher,McPhail, Rice, Eljiz,
Fitzgerald, Gapp & Marshall, 2016). Ultimately even if a worker feels dissatisfied
with their current situation if they feel that it has arisen due to fair OJ they will be
satisfied. In order to minimize staff turnover, loss of productivity and increased stress
during the transition it is important to focus on these workplace perceptions (Souba,
2015). When any type of change (organisational or individual) is planned the
perception of the workers roles and workplace must be considered (Brandis et al,
2016).

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6. Recommendations
Recommendations have been made on two levels
 Government (State or Federal)
 Organisation
6.1 Government
 Expansion of the Bringing Nurses Back into the Workforce’ initiative from
simply government facilities to included staff at private ones.
 Introduce an initiative that allows for an influx of overseas staff with a
required skill set.
6.2 Organisation.
 Increase Wages for staff
 Introduce a programme which offers a bonus for a set amount of service years.
 Establish a clear career path within the organization.
 Introduce a training incentive. This is allow for workforce workers to acquire
skills which are in high demand (and short supply)
 Increase the number of available work hours by the provision of technology.
 Provide flexible working arrangements.
 Creation of focus groups to allow workforce staff to voice their opinions
(Chenoweth, Merlyn, Jeon, Tait, & Duffield, 2014).
7. Conclusion.
Research into the changing patterns of heath and risks associated with geriatric illness
and comorbidities is vital in order to understand and meet future aged care
requirements. Job satisfaction plays a large part in the recruitment and retention of
healthcare workers as does salary. Managers should ensure that due attention is paid
to issues such as OJ, role change strategies and lack of the required skill sets. Staff

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should be involved in all levels of policies, procedures and care. Communication
needs to improve between all levels of staff and stakeholders. Finally there is a
widening gap between generations concerning rates of remuneration. If changes are
not made to attract and retain staff future generations may not find aged care work as
attractive career option.

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APPENDICIES
1. Definition of generational terms
(a) Baby Boomer
Those born between the years of 1946-1964.
(b) Gen X
Those born 1965- 1980
(c) Milennials
Those born 1981- 2000
(d) Gen 2020
Those born 2000+ (the generation set to enter the workforce)
2. Kotter’s 8 stages of change
1 Establish a sense of urgency – the change must be made as soon as possible for the
good of the organization.
2. Assemble a group of influential persons who can lead the change.
3. Develop a vision and a strategy. Tell people why the change needs to be made and
‘paint a picture’ of what the change will do.
4. Tell everyone about what is happening and how he or she will benefit from the
change.
5. Involve people, get them thinking about how they can help to achieve it - avoiding
negative thoughts about the change.
6. Generate short term wins
7. Build on the initial successes (build momentum)
8. make sure the changes are embedded in the corporate culture. Don’t revert to old
behaviours.

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