A ground-breaking survey of aged care leaders reveals a surprising deficit.

Evidence of a growing number of assaults on patrons in Australian aged care homes and subsequent complaints from family members, led to the instigation of a Royal Commission into the aged care industry in 2018.

Recently the issues highlighted by the Royal Commission have been exacerbated by the outbreak of COVID-19, particularly in Victoria.

It’s not surprising then, that there has been significant criticism of leadership within the sector, linked to the Royal Commission’s findings in their final report.

Complex issues require strong leadership

With the sector beset with complex issues including a significant increase in demand, shifting demographics, budgetary and financial challenges and workforce shortages, finding people with the best credentials is not easy.

Dr Jacqueline O’Toole from Monash Business School’s Department of Management has been extensively researching this area since 2012 and believes that her recent research could assist with the recruitment of leaders in residential aged care.

“Research on leadership in aged care is still a relatively new concept,” Dr O’Toole says.

“The unique complexities of the sector and its continued separation from the greater health sector have meant they have had limited success in adopting general health care leadership models.”

There has also been limited work undertaken in preparing aged care workers for leadership roles, and a lack of well-defined standards or strategies developed to evaluate leadership capability in the aged care sector.

What the current crop of leaders think

To better understand the current issues, Dr O’Toole conducted interviews with 18 senior leaders in Victorian residential aged care in roles such as manager, CEO, director, aged care leadership consultant, nurse manager and general practitioner.

The research questions were specifically focused on discovering what senior managers in residential aged care understood as the significant challenges to the industry leaders, the possible solutions and skills and attributes they required as leaders to steer their organisations into the future.

“Participants who were selected for the study were required to be considered an aged care ‘expert’ through current employment within the aged care sector and having relevant knowledge and experience in clinical practice, management, service delivery, policy, research or education,” Dr O’Toole says.

They were also currently in charge of residential aged care services that managed facilities or several facilities ranging from less than 100 beds to over 1,000 beds.

“We found that the background and experience of participants fell into three different categories: those who came from a medical background with nursing qualifications; those who came from a health background without nursing qualifications; and those who came from a completely unrelated vocational or industry background,” Dr O’Toole says.

We need a diversity of skills

Dr O’Toole says there was a clear recognition by all participants that effective leadership skills are required within their organisation if they are to be successful in the delivery of quality care and client satisfaction, as well as attracting and retaining a skilled workforce.

However, when the participants were asked what skills and attributes that they believed were essential for senior employees in the residential aged care to be influential leaders, there was significant diversity in their responses.

“Very few of the participants identified leadership skills that were agreed upon unanimously and many different skills and requirements for an effective leader in the residential aged care industry were acknowledged,” Dr O’Toole says.

The results did, however, convey the complex mix of skills required for leaders in residential aged care. This included being able to:

• Effectively communicate and collaborate with staff, residents and their families
• Demonstrate compassion and empathy in their dealings with aged residents and their families
• Develop, communicate and implement an organisational strategic vision
• Manage finance and budgets successfully
• Drive change within the industry and individual organisations.

Other skills, such as the management of residents with dementia and providing quality end-of-life care, were also highlighted by various participants.

The two ‘C’s

But two key attributes stood out – compassion and communication.

“Communication is really significant because as a leader you have to communicate with so many different stakeholders on different levels and be able to effectively communicate with residents and their families,” says Dr O’Toole.

Yet the study identified that communication and compassion were lacking among leaders in the sector.

“Participants identified that residential aged care leaders currently lack key skills including the ability to be compassionate, strategic and innovative and the capacity to communicate a vision for their organisation,” she says.

“While acknowledging the critical role of medical qualifications in effectively making care decisions and managing an aged care facility, almost half of the participants were opposed to recruiting organisation or aged care facility leaders based solely on their clinical skills.”

A better approach

There was a clear finding in the Australian Royal Commission into Aged Care Final Report that compassion as a duty of aged care providers in maintaining the dignity and well-being of older persons, is sadly lacking in the current system.

Dr O’Toole explains that there needs to be a better approach to recruiting and training leaders in aged care.

“A lot of leaders in aged care from my research just kind of end up there,” she says.

“They might be a nurse manager and some of them brought in because they’ve got good business skills. But there doesn’t seem to be any real kind of research or effort put into ensuring that people understand, or people have the right attributes to be a leader in this industry.

“Our study has important implications for aged care leadership development. If compassion is a significant requirement for residential aged care leaders, then it needs to be determined whether and how it can best be taught to potential aged care leaders.”