Managing Risk in a Critical Care Environment
Opal Aged Care operates an important business, with 6,000 residential aged care beds across the country. Caring for the elderly requires particular focus on risk management, to ensure patients receive the best possible health outcomes.
General Manager for Corporate Services, Harley Wright explains the business concentrates on managing key risk categories. These include: adverse clinical events affecting residents; workplace health and safety; financial performance; market risk; reputational risk; and industrial relations risk. The first two, clinical outcomes and safety, are priorities for an aged care business.
“We're quite a large business with over 6,000 beds, which makes us one of the largest private providers in the country. However, even with this many beds, we only have about 3% market share; normally in a market in Australia large players typically have somewhere between 10 per cent and 20 per cent market share. So aged care is a relatively fragmented industry. The other feature of aged care is that we're dealing with vulnerable people,” Wright explains.
Looking after residents in the last years of their lives creates risks. When people come to us they're often dehydrated and frail because they've often been living alone at home. They come to us and more often than not improve their hydration and nutrition, and are in a far more social environment,” he explains.
Additionally, Wright says around half the residents have dementia or some sort of cognitive impairment. “Against all that, we are trying to manage clinical outcomes and workplace health and safety. On the clinical side there's a balance between a resident's quality of life and their independence and the risk. A really risk-free way of looking after someone who's very elderly is to discourage them from walking around so they can’t fall. We find that problematic, as do many families.”
Quality of life is utmost and Opal Aged Care has a number of specialist dementia facilities including walking tracks to allow residents to walk around. “There is a balance in risk management. But as an operator, I like everything to be very low-risk,” says Wright.
So rather than use bed rails to stop residents falling out of bed, an alternate is to use a very low bed, only 30 centimetres from the ground, with a mat next to the bed to cushion any falls.
Says Wright: “We’re always building better systems to manage risk and our employee culture is to report all risks. Reporting allows us to track events and identify themes, and then address those themes.”
So when it comes to the second major risk, occupational health and safety, spills are cleaned up quickly and dried thoroughly, and signs alert staff and residents to the spill. “Getting that culture of safety through our business has been a challenge, but I'm pleased to say we've had some success. Our philosophy in relation to OH&S is zero harm. Every employee deserves to go home uninjured, and in exactly the same state as when they arrived.”
Opal Aged Care has dramatically reduced its lost time injury frequency rate (LTIFR), the number of injuries that cause the business to lose a shift per million hours worked. Five years ago the business had an LTIFR of 15, compared to an industry average of about 7.5 in aged care. Now its LTIFR is below three, since the business improved injury reporting and improved feedback to the business. Opal Aged Care now has risk and safety reports, and tracks incidents through a system called Riskman.
“We use Riskman to communicate all of our incidents, even if they're not lost time. Our top three issues in workplace health and safety are slips, trips and falls, followed by resident aggression – residents with dementia can lash out and resist care. The third risk is manual handling, which is getting residents in and out of bed, getting them dressed and helping them walk,” Wright explains.
Opal Aged Care has a strong relationship with Alzheimer's Australia who train all staff on dementia awareness, so they are better able to understand a dementia resident's perspective on life. Now, if a resident is resisting care staff back away. That means the likelihood of an aggressive outcome is much lower. When it comes to manual handling, the business ensures staff are physically able to perform the job. It also runs a healthy lifestyle program called Opal Thrive, to promote fitness and wellness.
Right now the business is investing in IT, recently implementing a clinical management system called AutumnCare, a software system for managing elderly residents in nursing homes. It helps manage clinical outcomes, and document and monitor residents' care.
“This investment helps drive efficiencies and reduce risk. We're investing in online platforms to provide staff education. We also have representatives in each state who move from one home to the next to provide face-to-face training, backed up by a computer-based resource,” Wright adds.
Opal Aged Care is constantly managing strategic risk. Where once the major stakeholder for aged care homes was the government, the business model is now much more consumer-oriented.
“If you’re only offering a basic, government-level service you might find residents who are spending their own money will vote with their feet and choose another provider. Aged care providers now offer a range of services with lots of options around what sort of care and extras you can have,” says Wright. At Opal, residents can pay an extra fee for Opal Premium, which provides premium linen, L'Occitane toiletries, and additional meal options.
From a sovereign risk perspective, Opal Aged Care ensures it stays close to government to keep abreast of any public policy changes that could affect the government subsidies it receives.
“Aged care as an industry is maturing, We can learn a lot from industries like private health care, but aged care is unusual. We are a sub-acute hospital business where residents stay for years and not days. We must manage the care our residents need without being overly controlling. It’s an interesting balance. Plus, our workplace is also our residents’ home, so half the people in an aged care facility are working and the other half are living there,” says Wright.
“You can't make it look like a factory because people won't want to live there. Recent homes we've opened look like hotels; they look a lot less institutional. At the same time, we need to comply with workplace health and safety legislation, so there’s a balance,” he adds.
Managing risk in such a complex environment is challenging and rewarding and, thanks to its clear focus on providing the best care possible, operators such as Opal Aged Care ensure everyone who enters one of its facilities is as safe as they can be.