Continuous improvement

What is continuous improvement?
Continuous improvement is a systematic, ongoing effort to raise a residential aged care home’s performance as measured against the Accreditation Standards.

Continuous improvement:

  • takes into account the needs of residents, and may involve them in improvement activities
  • involves a focus on lifting performance against each of the Accreditation Standards and expected outcomes
  • is part of an overall quality system, focusing on systematic and integrated improvements with clearly defined objectives
  • is a results-focused activity which can be demonstrated through outputs and outcomes
  • ranges in scale from smaller programs to significant strategic initiatives.

Approved providers have a responsibility to actively pursue continuous improvement throughout the accreditation period.

What is the relationship between continuous improvement and quality assurance?
Continuous improvement involves the establishment and support of a culture that aims for better practice in care and services for residents. Quality assurance is concerned with the maintenance of systems and processes to ensure variances are managed; continuous improvement moves beyond this to lift the home’s performance to a higher standard.

What are the principles of continuous improvement?
There are many approaches and terms associated with continuous improvement. Whatever approach is used, the following framework helps to drive and support the process:

  • resident-focused
  • strategic planning and implementation
  • clearly defined objectives and outcomes
  • involvement of key stakeholders
  • encouragement of innovation
  • utilisation of a range of approaches and techniques
  • regular monitoring and evaluation.

A culture of continuous improvement means the home is responsive to change from a variety of inputs and can continually develop a quality service that is of value to its residents.

 A sound continuous improvement program can demonstrate:

  • baseline – the current situation the home is trying to change
  • planned improvements and the expected benefit to residents– this includes assigning priorities among improvement activities
  • monitoring – systems to monitor a new process or activity during its implementation including through key milestones or interim indicators
  • evaluation – systems to monitor a new process or activity once it has been implemented, which should help ensure its sustainability and capture the actual improvements.

How do we assess continuous improvement?
The Accreditation Standards include requirements for continuous improvement specific to each of the four standards. An explanation of the considerations in assessing a home’s performance in relation to the expected outcomes is provided in the Results and processes guide (583kb).

Continuous improvement does not mean a home must have plans for improvement in relation to every expected outcome but homes should monitor performance against the Accreditation Standards in order to quickly rectify issues and therefore ensure good quality of care and services to residents.

How can homes implement improvements in a structured manner?
The following model is used by assessment teams to review a homes’ continuous improvement processes:
Contiuous improvement cycle
Plan the improvement
Actively pursuing continuous improvement requires a systematic evaluation and improvement of service quality at various levels including researching possible solutions for improvement priorities, being receptive to suggestions for improvement from residents, representatives and staff, and assessing the practicality of new methods or technologies in terms of the home’s overall planning process.

One aspect that distinguishes an organisation that ‘actively pursues continuous improvement’ from one that does not is the existence of a planned approach to improving (in contrast to an ad hoc approach). In an ad hoc approach, improvements are often only made in response to problems, that is, when something goes wrong. In an ad hoc approach, maintenance or problem-solving can be confused with, and labelled as, continuous improvement activity, for example, malfunctions being corrected, broken furniture being repaired. This does not represent actively pursuing continuous improvement.

Implement the improvement
As a new activity or process is implemented, homes should monitor the implementation to make sure the change is not causing problems, and to see if modifications to the new activity or process need to be made to ensure positive results for residents.

Homes should also be able to demonstrate residents are involved in the implementation, including through keeping them informed as appropriate.

Staff should be involved in the implementation of a new initiative, including through education and training, and updated information in policies and procedures.

Documenting the various stages and evaluation of the new activity during the implementation phase can assist the home in its monitoring, and ensure adequate resident and staff involvement and communication.

Evaluate success of the improvement activity
This step is to used to evaluate how effective the improvement effort has been in improving care and services for residents. This step can often be overlooked in the enthusiasm to improve and make a difference. This part of the improvement cycle may distinguish a mature continuous improvement approach from a less developed approach.

Documenting the evaluation at this stage can assist the home in ensuring this part of the process is complete, and ensure all components of the activity have been closed-off, for instance, updating of any policies and procedures, and seeking resident and staff input.

Having a structured approach to evaluating the success of an improvement activity can also provide guidance for future improvement activities.

Decide next steps
There are at least two possible situations in this step:

  1. The improvement activity has been successful and management want to close the loop
    or
  2. The improvement activity has been unsuccessful or partially successful and staff need to make amendments and start a new cycle of planning, implementing, evaluating and deciding.

Why shouldhomes keep track of their improvement activities?
Keeping track of improvement activities ensures a strategic approach to continuous improvement, including prioritisation of activities. It also allows homes to reflect back on what worked well, and what didn’t.

Homes are required to submit a plan for continuous improvement where there is a failure to meet the Accreditation Standards. A copy of the plan must be made available when requested by the Accreditation Agency.

A plan for continuous improvement can be in the home’s own format but must include clear information on:

  • issues identified
  • the expected outcome/s to which it relates
  • the planned action/s
  • planned completion date.

An example may therefore be:

Item

Issues identified

Expected outcome/s

Planned action

Planned completion date

1

Article about pain management indicated home’s pain assessment tool may not identify pain for residents with dementia

2.8 Pain management

Review form

Source new form

Trial and evaluate new form

Update policies and procedures

Train all staff

Implement new form for all new residents

Implement new form for all other residents

27 March 2009 (completed)

4 May 2009 (completed)

11 May 2009

18 May 2009

18 May 2009

Ongoing


1 June 2009

 Click here to download a Plan for Continuous Improvement template.

Where can I get more information?
We have produced a self-directed learning package which can be downloaded free of charge.