This article on ABC News calls for minimum staffing levels in aged care facilities based on research and expert opinion.
Staffing in Aged Care Facilities
As providers of General Practice services to numerous aged care facilities we would support a call that aims to improve standards of care in aged care. We are also a consultancy firm with expertise in quality and safety. A well-respected approach to evaluating quality is the equation:
structure + process = outcome
originally written about by Avedis Donabedian. Staffing ratio's fall into the structure category. In the UK in response to patient safety concerns at Mid-Staffordshire Hospital, a number of enquiries and reports were formulated. One of these reports, the Berwick Report - Improving the safety of patients in England, called for the government, Health Education England and NHS England to assure that sufficient staff are available (in hospitals as well as other settings) but did not recommend a mandatory minimum staff-patient ratio. Subsequently, the National Institute for Clinical Excellence was charged with the responsibility of looking at the evidence-base and published a guideline. Whilst a minimum standard would be welcome there are risks of unintended consequences that include the minimum becoming the norm! Notwithstanding this, another challenge is how a minimum level may be calculated. The area is enormously complex although there are safe-staffing tools available. However, as concluded in a review:
it is recommended that results from any safe-staffing tool are only appropriate to use as a guide and should always be combined with the expert clinical knowledge and judgement of the clinician(s) completing the assessment.
We know from Donabedian's equation many other factors contribute to quality. Together with the call for minimum staffing ratios may be we should be calling for a strategic look at improving the quality in the sector that goes beyond accreditation and strives towards the best in industry rather than the minimum.