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.  

HCSL Aged Care Software user feedback

We asked a random group of clients for their responses in relation to using HCSL Aged Care Cloud based software.

What do you like best about the HCSL software and your current use of it? Below is their responses:

  • I like the layout of the LTCP and being able to load and access documents in the one programme.
  • At the end of the month the stats are all there done without me having to calculate; the system does that itself, love it, I print off the bar graphs for the staff to see each months results with the related information written up to show the story behind the data
  • The advantage of having HCSL software in our facility means enabling quick access to residents records for more coordinated, efficient care and securely share information with residents and other clinicians. Holly Lea is in the process of having most of the documentations online. Moving to electronic significantly improved our archiving processes and the need for physical storage space for paper records is also significantly reduced. Being able to search for a file or document from the computer rather than manually dig through a filing cabinet saves time for all of us.
  • Know it is kiwi made and covers aged care in NZ requirements
  • Analysis of data and logs for complaints and incidents
  • Ease of access and user friendly
  • Log in pages are bright and cheerful.
  • Everything is in one spot and easy to access.
  • Audit system, ease of use, easy access to forms.
  • Its clear and easy to use.
  • The Long Term Care Plan (LTCP) is much more concise, great feedback from the care staff, easy to read and understand.
  • Able to compare to the average when reviewing falls or infection rates.
  • Ability to analyse present the information e.g falls.
  • I like the ease of use – the easy to generate reports – everything being in a logical order that ties in very well with the paper files
  • Used correctly the system does pass audit, meets all the requirements of the MOH Standards.
  • Receiving the continual updates we know we always have the most updated material available to meet our MOH requirements
  • This is a central point for data gathering. We have the potential to have most information on line.
  • The system is new to our team, it is still getting established here. We are finding it quite easy to use.
  • Its web based which means I can look at it anytime and am fully up-to date always with whats happening
  • The audits are detailed, and clear
  • The bench-marking is great and easy – saving time – great reporting
  • All of it, Everything on the website is easy to find and I like the bench-marking.
  • I don’t think we utilize enough of the paperwork some things I am discovering now after 5 years of using it!
  • I like the simplicity of the software.
  • I like that it is integrated with quality documentation.
  • I like that it is cloud based.
  • I like the flat fee for use, rather than a fee the number of devices (tablets).
  • The ease of uploading resident photo and easy layout
  • Ability to easily track trends in adverse events.
  • The straight forward user friendly interface, the data analysis, the way corrective actions populate straight to the corrective actions log,

Bethsaida Resthome, Hospital and Retirement Village Testimonial

We are very pleased to have recently been granted 4 year MOH Certification! No corrective actions and three Continuous Improvements.

This follows on from a fully attained Partial Provisional Audit that was required prior to opening our two new wings earlier this year with no corrective actions.

Make no mistake!  HCSL policies, software and support have played a major part in these accomplishments.  The HCSL software we use means we have easy access to information in real time.

I started working with Gillian of HCSL shortly after I took on the role of Facility Nurse Manager at Bethsaida Retirement Village six years ago. The facility was not using Healthcare Compliance Solutions policies at the time and perhaps this was reflected in the previous audit results.

Gillian is always responsive to emails and phone calls which is critical when timely advice is required.

The HCSL regular newsletters are interesting with relevant and up to date information on issues affecting aged care.

Gillian is a lovely person to deal with. She is thoughtful, professional, pragmatic and I have always found her to be keen to help, with practical advice on any issues that might arise in the management of a retirement facility.

I thoroughly recommend HCSL to all aged care facilities.

 

Tracy Holdaway RN BN

Facility Nurse Manager

Bethsaida Retirement Village

August 2019

Mandated minimum nursing hours – will it work to ensure safety and productivity?

The question of whether mandated minimum nursing hours would work has been asked previously. The workload of care and nursing staff is frequently discussed with staff reporting they are pressured for time to complete all the necessary duties assigned.  The Nursing staff have different but over-lapping functions to care staff.  When reviewing your staffing, it’s important to include a number of factors into any review when looking at the productivity and efficiency of your team.

We suggest you look at not only leadership and skill-mix, which are vital for safe services but also consider other factors. These can include the location of high acuity needs residents within your service.  With an increase in the use of dual beds, the mix between rest home and higher acuity hospital level of care are now intermingled and not specifically allocated to one area of the building.  This means the Registered Nurses providing clinical monitoring and oversight may have to spread their attention to a much more fragmented and broader geographical area in your service than was previously the case.

The location of resources and time spent looking for items of use and equipment could be minimised if more thought was put into the design of new facilities and the locating and management of replenishing stores for ready access by staff as and where they need them.  Who does the running and fetching could also be considered in work roles so staff with high end clinical skills are spending the bulk of their time on performing functions specific to their role and skill.  Not doing tasks that could be better delegated to others.

After the recent sudden closure of a care facility in Australia without apparent planning or communication with families, there has been outrage that such a thing could happen.  The “Queensland Premier Annastacia Palaszczuk announced her Government would order fixed nurse-to-resident ratios in state-owned aged-care facilities.”  The ABC news report (19th July 2019) goes on to say “at least 50 per cent of staff having contact with residents in 16 publicly run aged-care centres to be nurses.”  I don’t know if by nurses they mean Registered Nurses only and not Enrolled nurses but I can’t help wonder if this alone will ensure safety.

One year on from Simon Wallace (NZACA CEO) reporting on staffing shortages, we haven’t seen any improvement it would seem!  In New Zealand an increasing proportion of our Registered Nurses have come to New Zealand to practice with no prior working knowledge of aged care services. They frequently have limited aged care related experience to conduct the complex assessment and clinical management of high acuity residents in a residential care setting.  This is not to diminish their value as we can’t provide the services needed otherwise.

What I’m trying to highlight in the current circumstances is, we’re frequently seeing nurses set up to fail or provide less than safe care as they simply don’t have the experience in this specialised field of nursing.  I recall conversations in the early 1990’s predicting a massive nursing shortage.  It appears that in the time-span between then and now, we haven’t addressed this issue.

We welcome comments and suggestions of how this could be addressed here in New Zealand before we end up in the depths of a staffing crisis which halts care.

What does a Physiotherapy programme look like in Aged Care?

Prior to contracting a Physiotherapist, or as part of your Physiotherapy service review process, you should consider what your goal is in having physiotherapy input.  These should include key values such as Meaningful Outcomes for residents.

We asked Jessie Snowden of On The Go Physio what should felt was important for a Physiotherapy programme to which she offered the following:

For us this means we carry out thorough assessments, find out what is important or meaningful to the resident, their whānau and how this impacts their functioning in the aged care environment. Our input with people can range from rehabilitation to a previous level of function.  This may be intensive physio input for a few weeks, to ensuring someone is safe and comfortable with appropriate seating and pressure care at the end of life (which could be one visit only).

This level of assessment means that you need to ‘budget’ for 40-60 minutes (sometimes longer for complicated admissions) of physiotherapy time for a new assessment and possibly longer if they are needing to make referrals, liaise with other services and family. Follow up visits will be shorter. It is recommended that if you have a set number of hours per week that your staff and the physiotherapist are clear on expectations and priorities. If you only contract 2 hours per week it is not fair to have 10 new assessments on your ‘urgent’ list!

Some facilities have a set standard of 6 monthly reviews of all their residents. Although we do undertake these if asked, it is often more meaningful to use physiotherapy skills for those residents who may improve with input, or who your staff need assistance with due to functional decline. We suggest  if a 6 monthly review is wanted, then the RN is able to carry this out by considering if there have been changes in mobility, falls rates or other physical changes affecting function. If not then your physiotherapy dollar could be better spent on residents with clear rehabilitation needs or declining function.  The key goal here being to optimise mobility and maintain as much independence as possible.

Once the Physiotherapy service is up and running you can expect your physiotherapist to provide a clearly written assessment and a clear treatment plan, including either a discharge comment or a review date. Ideally you will maintain data related to Physiotherapy input and be able to see clearly if your allocated time is meeting the needs of your staff and residents.

Finally consider which residents will be eligible for physiotherapy assessments. If you are funding a Physiotherapy service you may choose to extend this to your hospital level and rest home level of care residents but not to independent studio units/apartments as these residents will usually be eligible for DHB funded services. Some DHBs will happily provide physiotherapy to rest home level of care residents and some put guidelines around who they will see. Depending on your DHB and care philosophy you may choose only to fund Physiotherapy services to hospital level of care residents or to extend this to rest home. In our company we work with aged care facilities who operate under both of these models and the key is to have it clear to both your Physiotherapist and staff who are completing referrals.

Spend your dollar wisely!

A final note here. Physiotherapists are highly skilled healthcare professionals who will be an asset to your team. The days of Physiotherapists spending all their time on walking programmes are long gone and you should set your expectations high for a physiotherapist who will add quality of life to your residents and cost benefit to your organisation. To use your physiotherapist wisely I strongly recommend you have the expectation that your care staff will have time to walk with people who are safe to do so.  We also encourage you to employ or allocate a Physiotherapy assistant hours into your roster to implement Physiotherapy plans. For information on using Physiotherapy assistants please look at an earlier article here .

This article was kindly contributed by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

Disaster Management should include security measures

This is a good time to be reminded that disaster management or your security policy may need to be extended to include management of threats, both internal and external to your organisation.  During the past years I’ve been personally involved with facilities where a resident entered the facility with a fire-arm, an intruder break-in during the night with a fire-arm, and another where intruders who entered the facility went into an occupied residents room. This last case related to intruders who had allegedly held-up the local bottle store earlier that same day.

Things happen which we don’t expect and we must be prepared as best we can.  It’s impossible to cover every possible eventuality but when events such as the shootings in Christchurch occur, it’s a reminder to ask are we doing enough?  For example, staff security rounds should be strictly enforced and documented to verify these were carried out. If you have surveillance cameras, where are your blind spots? If it’s the staff car park for staff going off duty late at night, improvements are desirable for staff safety. What about your processes for visitor verification? 

Security isn’t just about the people and environment but also about assets and information.  These should all be detailed in your policy documents.

HCSL are currently updating the security policies we provide ARC services to include reduction of risk from internal and external threats. This includes a procedure for lock-down. Let’s hope we never need to use it! 

For those of you wondering about how to debrief with your staff as a means to support them, there are some great resources available here.  For more resources on supporting others in relation to disaster type events, go here