On a plane on my way back from Sydney to Queensland, I was going through the normal processes of fitting in to the seat and getting comfortable. As the plane settled for take off, it was impossible not to overhear the conversation one row behind between a woman and a man who were talking about working in aged care.
As usual, when you hear the term “aged care” being discussed, your ears prick up.
A woman was discussing the attributes of the home she works in, the attributes of the “poor” management (as they have gone through a number in the past 12 months) and the people inside the home, staff, residents and families.
The woman disclosed the daily grind of aged care work and the attributes of residents, their diagnoses, their behaviours, their family’s attitudes and that of the management not supporting the staff or the residents.
She also discussed the new aged care standards and the impact (according to her) on the role and the outcomes she needed to reach. This was being done in detail and as the other party asked questions, she disclosed more and more.
Aged care worker showed “disdain” for aged care
What struck me more than the open breaches of confidentiality and trust was her use of negative language and the obvious disdain she had for the role, residents and the home.
She stated she loved her residents, but…
This woman sounded like she was from the hard end of life and had a colourful yet uneducated level of communication. Without prejudice (as I come from a broken socioeconomic home background) I understand that many people who work in aged care come from the school of hard knocks.
I understand that this type of work attracts strong-willed and courageous people who speak their minds and actually see the work they do as beneficial for the community.
I also understand that being overworked and underpaid brings a discourse to workers who will take any opportunity to be the voice they believe should be heard.
So, I listened as much as I tried not to. The volume was very loud and strangely the rest of the plane was more than usual quiet and attentive. I guess the subject matter and details were like hot gossip or a session of MAFS.
What did it for me was her comments on the use of restraints and the change in laws “so now we can’t medicate them down at night and knock’ em out, so we can get on with our work. We have to just put up with their behaviours.”
What kind of a culture allows this disrespect?
In the baggage collection area, I just had to approach her and said, “Hi. Excuse me. My name is Dr Drew Dwyer and I couldn’t help but overhear your conversation about where you work in aged care.”
The woman looked at me. I continued. “I work in aged care too and I think you need to check yourself and the way you speak about our industry and your service. In my opinion it was appalling to say the least.”
The women just stared through me and said nothing. I then walked away.
This conversation made me uncomfortable and agitated, as the level of disrespect, in my opinion, was over the top, and uncalled for in a tight open public space like a plane. The language use was bad enough and then when she was discussing the characteristics of clients and their vulnerability, I felt ashamed that this was happening.
There were four things that forced me to reflect while she was talking:
- Why is this woman talking like this on a plane about the care of our elderly?
- What kind of a culture in an organisation has allowed this level of disrespect to the values in care?
- Am I at fault too for not saying something now in the public and making a spectacle of myself and her?
- Man, we have so long to go before we make the right changes.
The culture of aged care is tired and beaten
The incident tells me several things, things that I know are the truth about our industry.
- The culture of the aged care workforce is tired and beaten.
- We have got a long way to go to make the real and necessary industry changes for better care and outcomes in care sectors.
- The value of leadership is not espoused by those leading the industry.
- There is a tendency not to want to ‘rock the boat’.
Induction and probation are needed to create an education and transformation process to get the right staff in the right job. We are still recruiting the wrong people into the aged care workforce. The workforce is so undervalued it attracts the wrong demographic of workers. Pay peanuts, you get monkeys, as they say.
A poor culture leads to poor care outcomes
A poor culture in aged care sector creates the ‘iceberg’ phenomenon: you only see the 20% of the culture on the surface, but underneath is the other 80% of the subculture – and this is what can ‘sink the ship’.
Poor culture will lead to a lack of empathy for the person we serve and the people in our teams.
It creates a division from the mission and separates the leaders from the pack.
Poor culture can lead to poor outcomes in care for the following reasons:
- Ignoring the needs and wants of individuals and groups
- Seeing consumers as a burden rather than having a mission to serve
- Takes our fingers off the pulse – we miss the important observations and data that needs to be collected and reported
- Creates a task-orientated mentality rather than respecting the time to give care
- It disrespects the most valuable resource – staff – and sets a tone for disruption
- It changes the focus of the shared mission to that of the management mission
- It places a barrier to open disclosure and conflict management
- It silences the real leadership in care settings
- It devalues the roles and responsibilities that are needed for discipline and accountability.
Poor culture is a reflection of poor leadership
There are numerous ways that a poor culture can arise in a service but, in general, it rises because of poor leadership.
Aged care today is still filled with bullying and harassment, although in different forms than it used to be. It’s embedded in the subculture of the iceberg.
There is a lack of highly experienced and respected clinical leaders. The best clinical leaders are registered health practitioners, those who are legally bound by the law to meet the standards, those who are registered, and have a responsibility to the greater good. Those for whom there are consequences for their actions if things go wrong.
The reality is, the culture is only as good as those who lead the people with an understanding and empathy of what it takes to work in aged care.
Should we accept some negative attitudes from aged care staff?
I cannot agree that we simply accept anyone who wants to have a job or that our industry has no choice and that a person’s pay or background reflects their attitude to work.
People – if they are led well, have a genuine passion to succeed, and the right values – can be transformed. It’s what all people should want out of their work.
Aged care has now, more than before, the opportunity to look for new workforce leaders – and this includes frontline staff. They could be older workers looking for change or part-time retirement, older women and men who want to make a difference in people’s lives or give back, the semi-retiree or baby boomer looking for a career change or an organisation that shares their values. We could coach our millennials.
But I’m often told we don’t have the time nor the budget.
Transforming an organisation
So how do we transform a whole organisation to be proactive and demonstrate leadership at all levels of the business?
The first level of leadership is ‘values leadership’, the process of the organisation and its senior management opening the dialog between its key stakeholders and its system of management, policy and procedures.
A healthy objective is to seek feedback from the teams in order to establish the values and principles across the board for all key stakeholders and design that value system that can reflect the whole organisation and its people, consumers included. By doing this the whole organisation understands that their values are acknowledged and known.
The next area is building ‘transactional leadership’. This process is the development of the leaders who have a KPIs aligned with the development and maintenance of healthy workplaces.
Finally, ‘transformational leadership’ is the vehicle that moves to a new paradigm of care. Organisation would do well to develop a transformational leadership learning and development program within their service.
To help bring staff along for the change, make them accountable: I use the Toyota mentality. Turn the organisation upside down and allow their input to workplace systems and processes to build the space they want to see and operate in (within reason and regulation).
Communication and having the right values enables leaders to transform at all levels. The workforce that has helped aged care staff design the system they now have must be valued and supported, which requires mentoring, education and leadership.
I look for change champions at all levels in the workforce. They are there, but often not identified.
Dr Drew Dwyer has over 25 years of experience as a professional nurse, nurse leader and educator. He is currently the Principal Consultant in Gerontology, Disabilities and Community Services for the Frontline Care Solutions group and the Australasian College of Care Leadership & Management. He also holds an Adjunct Associate Professor position at the University of Queensland School of Nursing, Midwifery and Social Work (UQSoNMSW).