Capturing the sector voice Notes and themes from aged residential care (ARC) sector workshops held in Christchurch, Dunedin, Hamilton, Palmerston North and Auckland October 2017–May 2018 Hosted by the Health Quality & Safety Commission

Improve quality and safety culture Resident and family-centred care Remember the why – we are guests in the resident’s home. Integrating communication Multidisciplinary team recognition and coordinated treatment of acute and subtle deterioration. Improve communication between management and staff and with families. Improve trust establish formal ways of sharing. Toolbox for handovers – specific to conditions, diseases, drugs. Break down professional barriers between care givers, registered nurses and enrolled nurses. Improve links between interRAI assessments and care planning. Listening to residents and staff experience Respect staff experiences and share them. Establish forums so housekeeping, nursing, health care assistants, kitchen staff etc identify their own quality goals to work on. Develop better resources for sharing stories: blogs, videos, social media, Zoom conferences etc. Staff recognition process. Provide for registered nurse study leave. Focus on improvement Minimise restraints: promote resident dignity through education and support resources. Use champions to focus specific issues: eg, palliative care, falls. Enhancing nutrition: enrich food presentation, taste and quality. Wellness initiatives for staff.

Improve shared learning Promoting staff competency Better retention policies to address high staff turnover. Training to meet need through different platforms ie, forums, online, mentors, supervision etc. More leadership development. Structured curriculum for aged residential care clinical staff. Setting education standards at a local and national level. Yearly incentives for personal development plan completion. Education to improve resident care Staff education and training core competencies: dementia care communication resident centred care frailty and recognising and treating deterioration palliative care. Promote a learning culture: toolbox talks & resources policies to promote clinical application of new knowledge assessing education effectiveness in practice. Learning from experience Establish a systematic approach to adverse events review using root cause analysis and appropriate tools; work-up recommendations and improvement with the staff, monitor progress/actions. Involve registered nurses in clinical discussions. Promote staff to make them feel more valued; increase staff profiles with other clinicians. Promote a ‘No blame’ culture. Enhanced orientation for new staff.

Leadership and teamwork ARC leadership development Recognising great work Reward system for staff doing a good job and for emerging leaders. Make it positively framed to improve culture. Supporting attendance to conferences and forums to support quality. Pay parity for registered nurses in ARC, same as in district health boards. There should be cross-pollination of ideas. Open the doors to dispel the myths around ARC- include schools, religious groups, not-for-profits etc. ARC leadership development Develop career pathways. Enhance training at registered nurse and clinical manager levels. More leadership training. Legislate to specify training/education for ARC managers. Development of strong network groups. Clear leadership promotion avenues. Registered nurses mentoring and training for new nursing recruits. Fostering teamwork Restructure staff meetings to be more quality-focused. Identify champions to develop skills and promote shared learnings to improve staff accountability and involvement. Develop a standard orientation pack for incoming facility managers so there is consistency across the sector, allowing for organisational customization.

Measurement for quality improvement Integration of electronic systems and quality measurement Integration of computerised systems. Database for all accidents, incidents, hazards etc. Systematic approach to support standardisation of documentation and availability of best practice and evidence-based resources. Electronic support for prompt response to resident care needs eg, bell system to ensure call bells can be tracked and recorded. Electronic prescribing system for all. Translating data into practice Pictorial and visual tools eg, barometers. Staff surveys. Identify the real needs of each resident. Measure diversity. Enhanced reporting from electronic systems. Enhance the system and use of data from user satisfaction surveys, complaints, adverse events, family feedback to support quality work. Translating InterRAI data into care plans.