Aged Care Reform – A technical or adaptive leadership challenge?
At the end of July 2015 I facilitated two workshops with providers on the implementation of My Aged Care (MAC) and Regional Assessment Services (RAS). In these workshops there were many questions about the implementation of MAC and RAS in NSW.
The introduction of a central gateway through the creation of My Aged Care was a major recommendation of the Productivity Commission Report, Caring for Older Australians as part of simplifying and streamlining entry into the aged care system for older people and their carers. In theory it sounds like a sensible recommendation, however, it is also reliant on effective consultation in the design of MAC and RAS as well as realistic time frames in the implementation of the reform.
One way to frame these challenges and opportunities could be through an Adaptive Leadership Framework. Heifetz and Linksy (2002) in Leadership on the Line argue that adaptive leadership is the activity of mobilising people to tackle tough challenges and thrive. They demonstrate that adaptive leadership challenges are those for which there are no simple, painless solutions – problems that require us to learn new ways. In contrast, technical problems are well defined and the solutions are known and those with adequate expertise and organisational capacity can solve them. Adaptive leadership problems are entirely different, the challenge is complex and not so well defined; and the answers are not known in advance.
The development and roll out of MAC and RAS is both a technical and adaptive leadership challenge reflected in the issues emerging from the roll out of the reforms. Although the concept of My Aged Care (MAC) sounds great the actual implementation of this reform across NSW, Queensland and South Australia has created serious difficulties and challenges for aged care services, service users and carers. The actual process of implementation has been difficult with many older people reporting they have to wait on the phone for up to an hour to get in contact with MAC. Similarly providers across NSW, South Australia and Queensland have reported long wait times to get in contact with MAC.
While these problems may reflect a change management process, the actual implementation could have been improved through more adequate testing of MAC before it went live across three states. MAC was only tested in some regional areas of Victoria which does not reflect the complexity and breadth of the service delivery sector across Queensland, Victoria or NSW. With appropriate testing the technical and adaptive leadership challenges could have been addressed before MAC went live across three states.
There are particular challenges for some groups of older people in accessing MAC, particularly Aboriginal people and people who speak a language other than english. In NSW, Aboriginal service providers are reporting that older Aboriginal people don’t like calling a call centre and prefer to contact someone they have an existing relationship with which is often Aboriginal service providers. Aboriginal services in NSW reported they are navigating Aboriginal people in accessing MAC but are not paid for this as part of their work. For people who speak a language other than English, they need to use the Telephone Interpreting Service to access MAC and many older people who speak a language other than English don’t know how to access interpreting services.
Some Regional Assessment Services have also reported challenges in getting appropriate referrals from MAC and not getting the volume of anticipated referrals which may affect their costing structures and business models. Other challenges include service users being screened by MAC who are referred to both Regional Assessment Services and Aged Care Assessment Teams which means that Regional Assessment Services are following up with older people who have already been assessed by ACATs.
Three steps to address implementation issues
The Department of Health and Health Care Connect are currently working through the issues with the implementation of MAC. If we approach the reform process from an adaptive leadership perspective then a number of immediate strategies could be implemented by government to support the implementation of this major reform.
Firstly, reconsider the current pace and scope of reform underway in aged care. As the implementation of MAC and RAS are major reforms they needed to be embedding in the operations and landscape of all aged care providers and for older people. It takes time to implement these changes so give people enough time to embed these changes in how they work.
Secondly, appropriate resourcing of the sector to implement changes in relation to MAC. This may include the funding of hands on support to sit with providers and walk them through the MAC guides and support them to redesign their systems to meet the MAC requirements. Providing webinars and manual are one strategy but some people need guidance in working through the manual and digesting information in the context of their services.
Thirdly, further consultation with different communities of older people including Aboriginal people and CALD specific groups on whether a different model is needed to guide and navigate people’s entry to the aged care system. This includes whether the current information provided to older people from different groups is culturally appropriate and culturally meaningful for the diversity of older people. It may also mean asking questions about how effective MAC is in promoting entry to older Aboriginal people and older people from culturally and linguistically diverse backgrounds.