Celebrating the COVID-19 vaccination

The following is contributed by Infection Prevention and Control Consultant (RN) Ruth Barrett –

I am 61 years old, a practicing nurse and recently I had a little celebration. I received my 2nd COVID-19 vaccination from a lovely team in Ashburton Hospital in Canterbury.

I feel like celebrating because I have played a small part towards helping New Zealand (and the world) fight this pandemic and get it under control. By having the vaccine, I am helping to keep my whanau and friends safe from catching the virus from me if I get infected, especially if I don’t have any symptoms. It also means I am happier to continue to look after vulnerable people, knowing I won’t be passing on the virus. It is reassuring to know that the vaccine will stop me getting really sick and ending up in hospital or worse. So, if we do have another large outbreak, my hospital bed can go to someone else.

We are lucky in New Zealand to have access to a vaccine that is very safe and very effective, and recent reports show that it is also works against the new variants that are out there.

I was a little nervous about getting the second dose and how I would feel afterwards. Although I have the influenza vaccine every year without any side effects, this time I needed two jabs. But in the end it was all good – I only needed two paracetamols about 6 hours later, had a good sleep, and then, apart from a sore arm for a day and a half, I felt fine.

Of course, I know that vaccinations are not the only thing that keeps us safe – all our public health measures and infection prevention and control activities are just as important. But if you are a healthcare worker, a parent, a partner, a friend, a child, a sibling, a grandchild or other, you can make a difference in your community by having the COVID-19 vaccine.

 

Ruth Barratt RN, BSc, MAdvPrac (Hons), CICP-E

Infection Prevention and Control Consultant

Christchurch, New Zealand

Avoiding Personal Grievance claims

One thing new and seasoned managers often fear is having a staff member raise a personal grievance against them.  We asked Rainey Collins Law Associate Jaenine Badenhorst for some ideas to support management avoid personal grievances.  The following advice was the response:

We would recommend that you do these key things to help avoid a personal grievance being raised against you/your business. 

 

  1. The first key thing to do is to hire the right candidate in the first instance. (Yes, we know that isn’t always easy)!  You want to make sure you have a robust interview and reference checking system in place.  You could also consider your existing team meeting the candidate to make sure there is a good personality fit.  There is also the possibility of a work trial or probation period, depending on the circumstances.

2.   Have a written employment agreement which clearly sets out the parties expectations (for instance about work hours, flexibility, responsibilities, reporting lines, raising problems, and so on).  It is helpful for these matters to be discussed beforehand, so that everyone is on the same page.  This helps to avoid confusion and misunderstandings.  Employee manuals can also be very helpful to cover more detailed rules and guidelines (for example internet use, health and safety, bullying and harassment, etc.).

3.   Keep accurate employee records and files.  This should cover hours worked, leave taken, superannuation or other agreed deductions, discussion around various work conditions and so on.  The employee file should also cover any issues with performance or misconduct (detailing fair processes followed, and outcomes reached). 

4.   Act in good faith towards each other (by being honest and approachable; as well as open and communicative).  Being a good employer, and having a relationship with employees where they feel free to raise issues early on is the best way to resolve problems before they turn into formal grievances.  Regular catch-ups (like weekly or monthly meetings) is a good way of checking in with employees, and letting them know if there are any issues with their conduct or performance. 

5.   Knowing your obligations around the law and the contract you have with your employee is also very important.  This way you are less likely to cause issues which will turn into grievances.  If you are unsure of your obligations, you should seek professional advice. 

Thanks Jaenine, we hope that helps managers of services who might be struggling with this issue. Following due process and keeping accurate records will also support why you have made decisions and how.  Even with the best processes in place, sometimes you cannot completing avoid a grievance but follow professional advice and you can certainly minimise risk of a claim against you or your organisation.

There will be further articles published here supplied by Rainey Collins Law in relation to supporting your employment processes.

Aged care going digital a raging success!

Receiving emails from our clients who have made the transition from paper-based to digital give us a lot of satisfaction. One provider who had been under DHB monitoring after an audit that didn’t achieve as well as they could have said they saved $100,000 after implementing the HCSL programme.  They had been spending a lot of time researching, writing and submitting corrective actions to audit findings for quite some time.  This doesn’t happen anymore. They have no findings!

Comments which reflect how very easy they found the process of transition reinforce our concept of where possible we opt for one click instead of two in our design processes.  Some client had used other digital packages in the past which they described as cumbersome and clumsy.  Those packages didn’t integrate with other packages so to find all the information needed, staff had to use multiple sources of information.  This made some reluctant to try something new.  Arriving on site at a client one day Gillian was taken to meet two care staff.  Both were very excited to tell her how due to them both having dyslexia, neither had been able to write their own notes before.  Now with the simplicity combined with spell-check in the digital progress notes, they were able to write their own notes.

The co-design of solutions with our clients maintains the philosophy of simplicity being as easy to use as a basic mobile phone or Facebook.

Early on we identified inequity between the resources available to corporate owned multi-site providers and independently or small group owned aged care services. This inequity, in conjunction with shortages of staff led us to work alongside aged care, retirement village and community services to design a one-stop-shop programme and in 2015 HCSL aged care software  went LIVE.  It has continued to be developed since then to a fully cloud based solution.

Clients said they’d like everything in one place. Despite there being other options we were continually pressured to create a NZ specific product that supports not only benchmarking, quality and risk but also all aspects of providing care while incorporating compliance throughout each aspect of the programme.

The integration with Medi-map medication administration systems will further streamline access to resident care information for remote assessment and treatment planning.  More integrations are underway currently to support as seamless flow of resident information regardless of where those needing information to provide care are situated. Clinical records are now accessible and able to be updated from anywhere with an internet / wi-fi connection.

Having been appointed as the step-in temporary manager at Rosewood Resthome and Hospital during the COVID-19 outbreak, Gillian Robinson was able to implement HCSL cloud-based software for telehealth support.  This programme was literally set up overnight and being used by staff with no training as there simply wasn’t time.  The great test for the system was to note the staff were able to successfully use the digital online care-planning and progress notes without any training other than to be supplied their login.  The uploading of a photograph of a wound for the doctor to review remotely was able to done easily after watching the 5 minute instructional video on ‘how to’.

Community, Disability services and mental health residential services along with retirement villages throughout NZ are now enjoying efficient cloud based records.  To find out how you can use this ready to use, NZ specific programme contact us.

Governing Boards and Diversity

Boards of any organisation should be well placed to provide strong and transparent governance. This means the members of the board all need to understand the organisation structure, strategy, finances, client base, market changes and employees for the context in which they are operating.  This includes knowledge of behaviours, culture and ethics. The behaviours of all organisational board members gets reflected in employees to set the culture within the workplace which is experienced by the clients and those advocating for them, their family/whanau and friends.

The skill of judgement is necessary for board members to base decision-making on a set of agreed standards or a clearly defined constitution, organisation vision/mission or philosophy.   To have a progressive Board, there is the need to recruit board members with greater skills than already exist within the board. This ensures progressive diversity of thinking and culture based on more than gender and ethnicity.  A greater diversity is needed to also include creativity, innovation, current commercial practice knowledge, information givers and information seekers to increase depth of conversation and concepts being explored.  The Board member profile could do well to include these attributes, abilities and skills. Collectively they need to advance the organisation purpose, vision/mission or philosophy in a way that meets client current and future needs.

Boards are not the place for the faint-hearted or those at the end of career who simply ‘want to give back’ who may base todays decisions on yesterday outdated models.  Diversity will become a more visible part of boards with the introduction of the new Health and Disability Service Standards later this year.  While they are currently in draft, it seems clear the final version will require more diversity within boards. This will include increased desire for Maori representation and inclusion on Boards.  As American diversity advocate and activist Verna Meyers says, “Diversity is being invited to the party, inclusion is being asked to dance”.

If Maori representation isn’t part of your board make-up, it may be advantageous to look at forming relationships with local Iwi who fit the attributes needed to fit your board member profile. All Board members will need to be available, ethics driven, commercially aware and able to contribute.  The Board Chair will need to show these same attributes and also provide consistent innovative, clearly communicated strategic leadership.  The Board as a whole will also need to be agile in their response to unplanned events.  2020 and the emergence of COVID-19 reminded us of this.  It appears 2021 and into the foreseeable future will also present the need for agile thinking and innovation. I suggest now is the right time to review how your board is made up and how effectively they perform.  How can this be improved in your organisation?  

Bench-marking – Aged Residential Care

his New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutionhttp://www.hcslqms.co.nz/s Ltd allows you to:

  • Bench-mark in real-time – specific to resident type, event type, date and time of day.
  • Have automated default reports to save you time analysing your data trends and patterns
  • Drill down into your data easily to identify opportunities for continuous improvement
  • Complete your internal audits online and have the corrective actions auto-populate into a corrective action log
  • Log and manage adverse events
  • Bench-marking of adverse events against other aged care providers
  • Support evidencing an active Health & Safety programme is in place
  • Log and manage infections – automatic outbreak registers
  • Bench-marking of infections against other aged care providers
  • Log and manage your complaints with time-frame, investigation and response prompts
  • Dashboard view options for level of care and any chosen 3 monthly time-frame review
  • Dashboard view option of adverse events or infections
  • Logs (event registers) appear with individual events in one colour when open and change to another colour when the event is closed. This allows you to see quickly the status of events. 
  • Use in conjunction with your current policies / procedures or update to the HCSL site specific created policies and procedures. 

Your organisation policies and procedures and related documents (if created by HCSL) are also accessible through the Facility Documents tab on the left of the screen for remote anytime, anywhere access.  The keyword search option on the policies and procedures in addition to precise indexing and coding of documents makes it very quick and easy to locate information for staff to reference.

You can also upload your own documents for confidential safe storage.

This is what Rhonda Sherriff, NZACA Clinical Advisor says about using the HCSL QA system:

“I am very happy to endorse your system as the information is invaluable for CNMs to analyse the data/information and make informed decisions on best practice and innovation to decrease hazards, improve outcomes, and mitigating factors for resident welfare. I’m pleased you are delving into the data to the level you are, as it’s time saving for sites in many respects, and so easy to dice and slice the information to get the trends. CNM’s used to spend hours just writing up the collective information before the analysis, so hugely time saving”

To view a brief video explanation of the system click here. This programme has been operating in NZ Aged Care since mid 2016 so now has many thousands of pieces of data to compare yourself against.  

To find out more contact us here.

Making monitoring your service remotely in LIVE time easy!

Quality Management Systems

The below question and answer were published in the New Zealand Aged Care Association industry ‘In-Touch’ newsletter (19th February 2016).

Question: A member asks “if we purchase a comprehensive quality management system from a provider how assured are we that the system will meet full compliance, come certification and surveillance audit time, as requirements and compliance expectations change frequently?

NZACA Clinical Advisor Answer: “You should be purchasing a complete quality management system that will comply with the Health and Disability Standards specifications, health and safety requirements and meet DHB/ARRC contractual requirements.

The provider of the system would normally initially tailor the full quality management package to reflect accurately the site specifications, H.R. component, and best practice guidelines, after consultation with the owner and management on site. These documents need to be site specific. The provider will normally contract to the site, which sets out obligations between the provider and the site management.

The contract will include the full review and updates of policies and procedures on a bi-annual basis, unless specified more frequently, to keep documents accurate and reflective of best practice. There may be an educational element provided within the contract as well, to benefit staff knowledge and skills. There is normally a good document control system in place and cross referencing of information where required.

Quality management systems are reliant on the skills and knowledge of the site personnel working with them, the way the system is managed and the outcomes/reviews, content and information extricated from the use of the system to improve quality care provision/outputs. The documentation system is reflective of the people using them, and the depth to which documentation and information is created, analysed and utilised for improvements.

Auditors on site rely on the provision of robust up-to-date policies and site adherence to them. Partial attainments can sometimes result from staff deviating from, or not following, their sites actual policies or processes as outlined in their quality management system.”

Where can you get such a system? 

Here at Healthcare Compliance Solutions Ltd we provide the services described above and noted as being optimal for achieving excellence in care and audit outcomes.   To see a brief video about the Aged Care software update and now in use by over 3,800 users in NZ, click here. 

Request a no obligation consultation here.  

Staffing levels – is skill-mix the formula for success?

This month we look at the discussion around whether mandated staffing levels in aged care, as a ratio of care hours to residents, would improve care services?

Rather than numbers of personnel alone, to provide safe and appropriate nursing services, staffing skill-mix (taking into consideration the workforce diversity) is essential to ensuring appropriate effective staffing. These factors are not taken into account or provided for within the industry funding levels which puts additional pressure on those working in aged care services.

While performing statutory (temporary) management roles over past years, adequate numbers of staffing alone hasn’t guaranteed safe and appropriate care. Nursing outcomes for residents have been reliant on a mix of highly skilled staff working in conjunction with newer or less experienced staff to guide and mentor.  There could be 10 staff on duty but if none of them have had previous experience working in aged care services, these staff are set-up to fail in performance of their duties, and the resident care outcomes are likely at risk.

SNZ HB 8163:2005 – ‘Indicators for safe aged-care and dementia-care for consumers‘ is a national document which includes formulas for staffing levels based on acuity of residents. This document set industry guidelines and although not mandated, defines staffing from a best practice perspective. Numbers alone as already mentioned are not sufficient.

Outdated for the acuity of residents needs in 2019 and onward, the 2005 guidelines didn’t take into account a range of factors. For example the size and physical layout of the facility, location of resources, the leadership structure and how work teams are configured, economy of scale and appropriate cover.  The minimum staffing requirements in the ARRC   is well below that sufficient to meet resident needs.  Having been implemented in 2005 (SNZ HB 8163:2005) when resident needs were less complex than they are now, it’s well past time to review how staffing skill-mix is determined and more importantly how the industry will be funded for increased staffing to meet the increased needs of residents.

HCSL developed a 5 step acuity assessment tool in response to providers requests after being frustrated by using the two tier InterRai assessment which give outcomes of resthome or hospital level of care. InterRai doesn’t reflect the range of acuity represented in SNZ HB 8163:2005 from a care level perspective.  As reported by numerous registered nurses working in aged care, the complex clinical presentation of residents being admitted into care is not accurately reflected in InterRai which is why they still need to supplement InterRai at times with more detailed clinical assessments.

Achieving desired outcomes for residents and the timeliness of appropriate care support based on individual assessed needs should be the aim for the allocation funding to ensure adequate staffing levels.

Contractor Health and Safety

Managing Contractors from a Health and Safety Perspective

Managing Contractors from a Health and Safety Perspective is a vital component of having external trades people at your workplace.

The use of contractors  is unavoidable in retirement villages and any aged care facility as we look to engage external expertise for specialised work and maintenance tasks.

Section 34 of The Health and Safety at Work Act 2015 provides that all persons conducting a business or undertaking (PCBU) who have duties imposed by the Act in relation to the same matter must, so far as is reasonably practicable, consult, co-operate and co-ordinate their activities with all the other PCBUs who have duties that overlap with them.

There are four main points to remember about overlapping duties:

  • You have a duty to consult, cooperate with and coordinate activities with all other PCBUs you share overlapping duties with, so far as is reasonably practicable.
  • You can’t contract out of your health and safety duties, or push risk onto others in a contracting chain.
  • You can enter into reasonable agreements with other PCBUs to make sure that everyone’s health and safety duties are met.
  • The more influence and control your business has over a workplace or a health and safety matter, the more responsibility you are likely to have.

WorkSafe have made it clear that they expect PCBUs at the top of a contracting chain to be leaders in encouraging good health and safety practices throughout the chain. They also expect these PCBUs to use sound contract management processes.

 

There are six key health and safety steps when it comes to managing your contractors: 

  • Scoping – understand what the body of works is, the risks involved, the training and competencies required, the working environment and any additional measures required.
  • Selection – select the right contractor for job, utilise a contractor selection process that considers the values and systems of the contractor from a safety perspective.
  • Induction – provide the contractor with basic information regarding site hazards, site rules and emergency evacuation procedures.
  • Safe system of work – the contractor must provide (and you must review) safety management information for the job. You must be confident that the contractor has appropriately controlled the risks associated with their works.
  • Monitoring – while the contractor is on site, check that they are carrying out their works in accordance with the safety management information they provided.
  • Review – Examine what went right as well as what can be improved so that both parties may continually improve on their health and safety performance, this should fed-back into future scoping and selection decisions.

 

WorkSafe (New Zealand) have developed Good Practice Guidelines for ‘PCBUs Working Together: Advice When Contracting (June 2019) in order to provide advice on how you can meet your duties under the Health and Safety at Work Act 2015, illustrate different contractual relationships between parties, and provide examples of ways you can build health and safety into contract management.

Author:

Thanks to Shannon Wright, from Imprint Safety Limited for contributing this article. 

Cosman, M., Tooma, M., Butler, A., Marriott, C., Schmidt-McCleave, R. (2018). Safeguard Health & Safety Handbook 2019. Wellington, New Zealand: Thomson Reuters.

WorkSafe. (2019). PCBUs Working Together: Advice When Contracting. Retrieved from https://worksafe.govt.nz/managing-health-and-safety/getting-started/understanding-the-law/overlapping-duties/pcbus-working-together-advice-when-contracting/

Risk Managing Contractors On-site

It’s easy to forget to check contractors staff changes and ensure your risk managing contractors on site is ongoing. Recently I was on site at a care facility when a sub-contractor was working there.  When spoken to, he appeared to speak very limited English. He left empty boxes, a Stanley knife in the main hallway and wet glue and loose carpet at the entrance to a resident’s room. No signage, no clean-up.  I couldn’t help but ask the provider what the contractor knew about health & safety legislation, his responsibilities and risks to residents as a result of his work practices.

The Health and Safety at Work 2015 increased the responsibility on PCBU’s in relation to risk management in the workplace.  When using the services of contractors, there are likely to be overlapping responsibilities. While residents reside in residential care facilities and therefore it’s their home, the legislation defines residential care as a workplace.  As such, contractors coming into your environment must provide evidence of following a health and safety policy and processes which reflects current legislation.

A copy of their document should be kept on file along with verification of contractors (and sub-contractors) orientation to site and confirmation of their acknowledgement of health & safety responsibilities.  These documents are included in the Safe and Appropriate Environment policy manual for services using HCSL in hardcopy and in-the-cloud online. Documents should be re-signed by contractors annually or when changes to the environment occur or a contractors personnel have changed.

Consumer Directed Services

Consumer directed services are core business for retirement villages. The aged care sector has been talking about ‘person centred’ care’ in health and specifically aged care services for a long time now.  Some services express a practice and philosophy of care based on residents being at the centre of all choices. Unfortunately sometimes when you ask the residents in those services, they may not share this view.

An increased focus on consumer directed care was part of the discussion at the Health and Disability Services Standards review workshop I attended recently.  Residents know what they want.  They are not always involved in service development discussions or asked what they need by service providers. When people set their own goals for clear reasons, they are more likely to engage and achieve. Where the support of others to achieve goals is needed, this is reliant on communication.

Retirement and aged care services are in a position to support not only the maintenance of health and well-being but also rehabilitation of those coming into residential based services. “We found that when you engage and motivate people, they do better,” said one of a study’s authors, Eric J. Lenze, MD, a professor of psychiatry.

In Australia “Aged care reforms continue to shift towards increasing choice, control and tailored services for older people and their families. To deliver more innovative and individual services, providers will need to think about their future workforce models and ask which industrial frameworks are best suited to their market and long term goals.”  To read more on this subject, click here.

As always with research, there are other views which should be considered.  These include individual preference for making choices and residents’ ability to make a specific choice in relation to one or multiple aspects of their health.   Read more here on this topic.  Regardless of what decisions are made, I believe we can be sure the time ahead will include challenges.  How those are resolved will be interesting and lead hopefully to more learning.