Preventing another Oakden: How proper onboarding leads to better care

The Minister for Aged Care has announced that residential facilities will no longer receive any warning of visits by government watchdog the Australian Aged Care Quality Agency. Re-accreditation reviews of aged care providers will also now involve a more comprehensive assessment against industry standards detailed in the Quality of Care Principles 2014.1

The shake up follows evidence that previous accreditation practices had failed residents of the Oakden Older Persons Medical Health Service. An independent review of Oakden was undertaken by SA Health’s Chief Psychiatrist Dr Aaron Groves after a patient received 10 times the amount of prescribed medication and was left with unexplained bruises that resulted in hospitalisation.2

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A lack of performance management and poor training led to patient abuse

Dr Groves’s review of Oakden found that employees at the facility engaged in practices that breached regulatory requirements and at times were inhumane.  It suggested staff punished residents for misbehaviour and performed their duties according to what was convenient rather than what was best for the patient.  The report indicated that such shocking practices were the result of poor leadership, and highlighted significant gaps in training and performance management practices.  

Dr Groves concluded that:

  • Oakden had a culture that was hostile to learning and that staff were prone to rejecting ideas that contradicted their own approaches;
  • Staff were not provided with adequate mandatory training;
  • Only about 50% of employees had completed a Performance Review and Development – but it was not clear what actually constituted ‘development’.
Aged Care Onboarding

A lesson for all

Thankfully, cases as serious as Oakden are rare. Most would agree that the majority of aged care services provide excellent care and are continually working to improve. However, this does not make the industry immune to the types of issues that plagued the Oakden facility.

The importance of culture in achieving care outcomes

Rising costs, staff shortages, staff turnover, productivity issues and communication problems are all barriers to providing high levels of care. However, a Griffith University study found that focusing on sustainable culture change can improve quality standards in aged care residences.3

Culture encompasses the attitudes, experiences, beliefs and values of an organisation and the people that work in it. Many aspects of culture are diffcult to define but include: unwritten rules and expectations; how workers communicate with each other; language and lingo; staff relationships and social interactions; and how employees react when faced with challenges, problems or when a crisis hits.

How onboarding helps shape culture

Onboarding reduces many of the staffing challenges that can be damaging to culture and reputation. Organisations with effective onboarding experience as much as 54% greater new-hire productivity and a 50% increase in new-hire retention.4

As discussed in Cognology’s Guide to a Great Onboarding Process onboarding equips staff with the skills, knowledge and confidence to not only do their job, but to do it well. Through a series of interactive formal and informal training, coaching, information sharing, goal setting, feedback, networking and social interventions, new staff better understand how the facility operates and what part they have to play in delivering high levels of care. The more tailored and personalised the onboarding program, the faster a new team member can be up and running and performing at a high level.

Good onboarding increases overall staff engagement and morale. And when staff are engaged, absenteeism is reduced – which in turn reduces the burden on already stretched staffing resources.

Current onboarding methods in the aged care industry

Many in the industry are already taking action to improve their onboarding processes. In 2014, the Northern Territory became the first jurisdiction to introduce standardised inductions for all new aged care employees. The NT program includes critical information about the aged care industry, workplace health and safety, safe food handling, infection control and elder abuse.

According to peak industry body Leading Aged Services Australia, in addition to traditional induction material, many providers are also implementing a range of modern onboarding techniques to ensure staff are work-ready such as:

  • Tailored and individualised onboarding plans;
  • Web based, in house and external training programs in industry specific modules;
  • Mentoring programs;
  • Buddy systems;
  • Peer feedback;
  • Observations; and
  • Coaching

Use of Technology

Bringing a new staff member on board comes with a lot of paperwork. Onboarding systems literally save aged care providers thousands of dollars in admin each year by automating the sending and collecting of forms in a digital format.

Great systems link seamlessly with existing platforms to automate and drive other aspects of the onboarding such as e learning, performance management and peer collaboration. This results in a fully integrated onboarding processes, that mobile and remote workers can access on-line where and when they need to.

Finally, good record keeping remains an essential part of aged care accreditation. With easy access to forms and records, an onboarding system takes the stress out of demonstrating compliance.

A workforce for the future

Aged care is an industry in transition. As community expectations change, funding and care models are moving towards giving consumers greater choice. Maintaining a good reputation and the trust of the public will be a high priority for providers into the future, but can only be achieved by developing and retaining high performing staff that care about what they do.

Works Cited

  2. Etherton-Beer, Christopher, et al. “Organisational Culture in Residential Aged Care Facilities: A Cross-Sectional Observational Study.” PLoS ONE, vol. 8, no. 3, July 2013, doi:10.1371/journal.pone.0058002.