Home | Industry+Policy | The Whiddon Way: Is person-centred care viable in aged care?

The Whiddon Way: Is person-centred care viable in aged care?

Whiddon is a large not-for-profit organisation that operates residential aged care, community care and retirement living, with 19 facilities scattered throughout NSW and parts of Queensland.

Whiddon has been a proponent of the person-centred care model since 2015, its chief executive Chris Mamarelis was recently called to talk to the royal commission as one of the top 100 providers required to appear.

Aged Care Insite spoke with Mamarelis shortly after his appearance and below is an edited extract of the conversation.

ACI: How did you find the whole royal commission experience?

CM: The royal commission itself was a pretty good opportunity. I’ve said to a few people, I think when the dust settles and you look back you realise that it’s actually a privilege. It is a once in a lifetime opportunity to be able to contribute to the royal commission and particularly in a constructive and positive way, the way that Whiddon were asked to, and what we were asked to present on.

That week focused on person-centred care. In 2015, Whiddon changed focus and rebranded three years later to reflect the shift to a person-centred approach. What spurred the change at that time?

Interestingly, the commissioners asked me the same question there. As an organisation, we’d gone through some renewal back at that point in time with a management team and as an organisation. And when that process occurs you start looking at where your focus is and where your focus should be.

So, as any organisation does, we went through a strategic planning process and, working with the board, we really wanted to emphasise that, as an organisation, central to everything we do are the people we care for. And we built a framework, which, at the top of that, had a statement about enriching the people we care for. From that, we had to deliver and build a whole heap of initiatives and really reinvent ourselves as an organisation. From a care perspective and a resident-inclined perspective, that’s where this whole approach to refining our model of care, refining our approach to care to really have this positive impact that we wanted to have was born.

Can you run me through what you see as The Whiddon Way?

Well, I guess there’s three components of what has occurred. The Whiddon Way is really the cultural change that is required to support this shift and this approach to care and the approach to the person, the resident, the client that we are taking. And, obviously, in order to have that positive impact we have to empower the people within the organisation to do that.

Culture is the most significant space that we have to have an impact on. So, we did a lot of work to influence cultural change, and The Whiddon Way is the way that we express ourselves and express our culture. At the heart of The Whiddon Way is nurturing relationships. And those relationships can be predominantly between our team members, employees and those that we care for, but they extend to community, they extend to other stakeholders. And relationships are then central to The Whiddon Way, the way we function and the way we nurture our culture.

The Whiddon Way is also about creating impact and it’s about being progressive and innovative. It’s about, as an organisation, giving licence to our people, our employees to go on this journey with My Life, our model of care and relationship-based care. And culturally, we obviously have to, from the top down, be giving this licence to people if we’re going to facilitate this cultural shift.

So you use that word ‘culture’ and I think that throughout the royal commission we’ve seen that a lot of the instances of poor care are, perhaps, tied to poor culture among the workforce. But I think culture is a very top down thing. How did you personally implement some culture change?

Well I couldn’t agree with you more that the tone is set at the top, 100 per cent. And that’s from the board and as CEO and then it filters through the organisation. I think we see that in good organisations and we see where problems arise.

I said to the commissioners, in my role as CEO, I’m responsible for every resident that we care for in an aged care setting, every client in home care and every resident in a retirement village.

The messaging and how we communicate through the organisation, again, if it’s about giving licence to the people, they have to hear it from the board and from the CEO, that this is the journey we’re taking on. They have to feel supported. But, beyond words, we have to provide resources, we have to provide tools to facilitate that change as well. And I think that we worked within the current funding structures and regimes to modify staffing models to facilitate our approach to relationship-based care. We brought in additional tools and resources to make that happen as well. So, we have to be able to, again, provide the resources for people to go on that journey.

I think these are probably the core components to pushing that change, but this was three years in the making, so a lot of work, effort and energy has gone into this shift.

An a not-for-profit organisation that’s been around for 70-plus years in rural and remote locations, this Whiddon Way and these core values had always been there. As an individual, the reason I’m in this industry is because it’s an industry that really delivers some beautiful outcomes. What we’re doing is very aligned to my own personal values. So, there’s that connection that made this transition quite an easy step to make, but, having said that, with this team and with the board, we could see that there were some gaps and we could see the journey we needed to take. Through my role it was very easy to get motivated to drive resources in that direction and culturally take us on that journey as well. You have to find where that focus area is and push it. So, after settling into the role and that transition was made, you had to find the energy and the motivation to take everyone on that journey with you.

And so has the rebrand, this move towards person-centred care, yielded tangible results for you?

Definitely. We started with My Life, which is our model of care and it’s the framework. And My Life calls out putting the individual at the centre of everything we do, and moving away from a task-based, service-based approach to care, to a really holistic approach to care. So that was really the very first step. It’s about looking at social connections, lifestyle, emotional support, wellbeing. The foundation pillar to My Life is relationship-based care. So, it’s just important to understand those first couple of steps.

With relationship-based care itself, it’s really pretty simple, it’s just about developing deeper, richer relationships between the employee and the care recipient. And through those deeper relationships you gain greater insights and you’re able to provide deeper, more multidimensional outcomes for the care recipients. It’s just important to understand that chain of events. Once we got there, we were able to measure some of these sorts of outcomes.

We saw really positive outcomes across three different levels. One was with the residents and the care recipient. And with some of the groups that we were conducting a bit more research and measuring some of the outcomes, we saw lower levels of depression and anxiety. We saw increased function with those residents because they were more motivated. We really started to see this positive impact on the individual as a whole. And that was one of the goals.

At an employee level, we saw positive impact. We saw less stress. And that was due to improved familiarity with the work environment. There was less handover pressure between shifts, as they knew that the next person coming on to the shift, because we have consistency of rostering. They knew that there was a greater reliance on the next person coming on the shift, less work to do. And team members also acknowledged the benefits of the relationship-based care and the deeper relationships that were occurring and the outcomes that they were generating. And of course, that leads to greater job satisfaction, and we know statistically the next generation coming in are looking for that richer and deeper job satisfaction in the workplace.

And the last thing was to do with family. In addition to all the other surveying tools and customer feedback tools that are there, we introduced net promoter scores, which a lot of aged care providers do. And we had that across the group. And what we found was really positive in terms of feedback from families, which is traditionally a very difficult area in aged care. But we had higher levels of feedback from family about some of the results they were seeing with their family members that we were caring for.

Away from Whiddon, why isn’t this sort of care commonplace? Why are we at this point where we’ve had to have a royal commission? Why is this not common sense and commonplace?

Well, it’s an interesting question. There are probably a few challenges as an industry that are probably holding us back. And I think that, something I’ve spoken about before is the ACFI funding model. And when I talk about ACFI, I’m not talking about it in the context of, ‘Is it sufficient? Is there enough money there or not?’ It’s just the message that ACFI says sends out to the industry. From Whiddon’s perspective, ACFI is counterintuitive to our approach to care because ACFI is funding and incentivising greater levels of acuity and it’s funding, ‘the sicker you get, the more money you get,’ and that is not really the way our approach to care is. I think ACFI sends a dangerous unconscious message to the industry as a starting point and that probably weaves in nicely to the cultural challenges that we have as an industry.

I said this to the commissioners as well. With the compliance regime – which is obviously necessary in aged care – and the red tape, there are so many barriers and so much fear. Culturally, we’re just sort of ingrained in this space where there’s just lack of this sort of dynamic approach to care.

And I’m thinking as well, you’re not-for-profit so you’re in a bit of a different position, but looking at the for-profit companies, their shares are plummeting. How are they going to be able to afford this Whiddon-type care? I’m thinking prices are going to have to rise for the consumer.

Yeah, they will. I think the challenge when you look at the comparison between for profits and not-for-profits, and I’ve got a background with a for-profits in aged care as well, is that, as a not-for-profit you have more freedom to invest and to focus on this sort of thing because you don’t have a tax burden to start with, so you’re not paying a host of taxes and you don’t have shareholders that are waiting for returns. So, from a funding perspective, you have more freedom, your financial structures allow you more freedom to invest in the people you’re caring for, and, culturally, you have more freedom as well.

So, there’s a lot of pressure on the for-profits from shareholders and their financial regime. By definition, that relationship-based care requires more people engaging in care so that creates a huge challenge for the for-profits before you start. As I said, as an industry it’s very clear – the viability of aged care is diminishing year on year, and this is part of what they’re looking at with the royal commission.

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