The Shortcomings of Relying on Staff to Submit Feedback on Behalf of Care Recipients

At the recent ACCPA National Conference, our conversations with numerous aged care providers revealed a prevalent trend: a significant number of providers still rely heavily on their staff to collect feedback and subsequently input it into risk management systems, with some even resorting to basic Excel Spreadsheets. This method, as recent research from Norway suggests, can dramatically affect the quality and impact of the feedback collected. The study shed light on the potential pitfalls of relying exclusively on staff to relay feedback on behalf of care recipients.

In a preceding blog post (and as reported in the Australian Aging Agenda), we referenced Aged Care Quality and Safety Commissioner Janet Anderson's address at the ACCPA National Conference, emphasising the paramount importance of standard six - feedback and complaints. Commissioner Anderson passionately conveyed, "If you're listening to the people you're providing care for, then there is a much better chance of you getting it right … A provider who is leaning in actively towards their consumers, encouraging them to voice their views about their experiences - good, bad and indifferent - is a better provider."

We've consistently championed the idea that feedback is the bedrock of achieving and maintaining excellent care standards, especially in the aged care environment. The insights from the Norwegian research further accentuate the significance of the method in which feedback is procured and its consequent influence on care quality.

A Closer Look at the Research

Introduction:

• The research underscores neglect of nursing home residents' care needs, a critical concern affecting their safety and overall care quality.
• While nursing staff are ideally positioned to identify neglect, they might also be contributors to it.
• A significant issue is the underreporting of neglect.

Methods:

• A qualitative study approach was employed, involving focus groups and interviews with 30 nursing home staff in Norway.
• The constructivist grounded theory method was adopted, emphasizing iterative data collection and analysis.

Results:

The core revelation from the study was the pervasive culture that renders neglect invisible within nursing homes, primarily due to:

1. Omission in Reporting:

• Confusion persists about what's categorized as neglect versus a simple deviation from standard care.
• Existing reporting systems are time-consuming and complex, discouraging timely reporting.
• Informal verbal feedback is preferred over formal written reports.
• Neglect is often seen as "missed care," such as overlooked hygiene practices, which often goes unreported.

2. Protective Behaviour Among Staff:

• Staff exhibit hesitancy in confronting colleagues about neglectful practices, fearing potential conflicts.
• Alternate strategies, like reporting to higher management or issuing general reminders during meetings, are favoured.
• Over time, such non-confrontational strategies inadvertently normalize neglectful actions.

Discussion & Conclusion:

• The research highlights how neglect remains underreported, primarily due to a lack of clear definitions and the existing "blame and shame" culture. This reluctance to confront colleagues further perpetuates neglect.
• Though the study may have its limitations, such as potential data saturation issues, its core message is poignant: while there's a general inclination among staff to report neglect, the culture of underreporting and non-confrontation ensures that neglect remains shrouded.
• This study paints a compelling picture of the urgent need for heightened transparency and accountability in nursing homes.

Implications for Aged Care Feedback Collection

1. Authenticity Matters: Feedback relayed via staff, especially in sensitive areas like neglect, can be influenced by a myriad of factors, potentially diluting its authenticity.
2. Potential for Bias: Staff may unintentionally introduce bias into the feedback, either by omitting specific observations or by interpreting resident feedback based on their perceptions.
3. Empower Direct Channels: Facilitate platforms where residents can provide feedback directly. This can ensure feedback remains untainted by external interpretations or organizational dynamics.
4. Training & Awareness: Staff need to be trained to recognize and appropriately report neglect. Clear definitions and guidelines can be instrumental.

Conclusion

Feedback is pivotal for enhancing care standards in aged care settings. However, as the Norwegian study suggests, indirect methods of feedback collection, especially concerning sensitive issues like neglect, can present challenges. The key lies in fostering an environment of trust, transparency, and direct communication, ensuring that the voices of care recipients are heard, acknowledged, and acted upon.