Governing for good aged care: opinion

You've just joined an aged care board. You reckon you'll be there for five years and are keen to make a difference – but it's looking harder by the day.

What are you going to do? 

Keep it simple. You want frail, older people to thrive and the business to thrive. 

So, do they? 

You could do worse than start your aged care board career by asking.

Chiefs have the usual suite of indicators for how the business is going.

But I'm yet to meet a chief who knows if their clients are thriving. 

They will tell you that the organisation cares, works hard, and keeps delivering – rain, hail or shine. 

It's at about this point that most directors roll over and fall in line with the chief's narrative. 

You start to believe that what happens to clients is operational and that you are only concerned about the strategy. That you don't hold the hose.

While the services are a long way from the world you live in, you're pleased that your organisation is doing so well with what it's got. 

But what if you don't roll over? 

You'll probably start with some measures for client thrival. 

The problem is that the chief's measure of clients is a bit odd. 

It's good that your organisation is meeting external quality standards, but when you visit the services, you're not at all sure this would be enough for your parents or yourself to thrive. 

So, why would it be enough for your clients? 

Wolf Wolfensberger from Syracuse University says aged care clients aren't that different from the rest of us. 

To thrive, they need roles, people, food, health, settings, joy and a point to their lives. 

For as much of the day as they can sustain, combined with the care that enables this. 

Measuring this can be tricky, but understanding it and whether it's present in your services isn't. 

So, start there and measure later. And starting there is a compelling way of immersing you and your fellow directors in the critical role you can play in client thrival.

To do this, directors will need:

• a clear insight into the client's journey. What are the pain points? Which pain points are unresolved? What's the impact of multiple unresolved pain points?

• a clear statement of organisation purview. Are you doing what you have agreed to do? And are you staying away from what you haven't agreed to do?

• an appreciation of the value of iteratively co-designing and co-testing service solutions with clients (and what happens if you don't).

• an understanding of how clients spend their time. Are they supported to occupy various roles, particularly in how care is provided? 

Boards must turn this into a client-governance framework (client journey; organisation purview; co-design; role-quality). 

They must note how different this is from the more familiar business governance framework that we also need (strategy; finances; risk; protection). 

We searched for organisations using a client governance framework to see how they were growing director skills. 

The trick seems to be combining the well-established learning pathways that inform the elements of the client governance framework.

Things like lived experience, modern elder advisory boards, learning networks, lessons from big data, tech that connects formal and informal care in real-time, and innovations and evaluations that use these pathways. 

All this is good for clients, but is it good for business? 

The Australian Institute of Company Directors (AICD) clearly doesn't think so. 

There's no sign of it in their teachings. 

But client thrival does increase client, family, community and workforce satisfaction. 

It's a role model for ageing well and a testing ground for better use of aged care resources. 

It's impressive. 

But AICD may well be right. 

It seems it doesn't result in clients and workforce deserting the competition and flocking to you. 

Vulnerable clients in regulated markets don't behave like customers, and the client thrival uplift you've managed to create isn't enough to entice them to move.

In fact, your bottom line might get worse, and your star rating even drop.

But you're not done yet – you want to know if any client thrival would deliver you a thriving business. 

The Strathalbyn Co-designing Aged Care Study (SA health department) found that you would need six things in place for client thrival at levels that would be considered typical for the rest of us: 

• home, not an institution; 

• social connectedness; 

• meaning and purpose; 

• choice and control; 

• valuing people; 

• support to make life transitions. 

But this is way more than a bit of improvement – it's a significant change to what you do and how you do it. 

This got us wondering if any aged care businesses were thriving enough to pull this off. 

We borrowed the criteria for a thriving business from Jim Collins (Good to Great) and ran his ruler over some aged care organisations. 

Plenty of good, not much great. 

The problem is, being great is hard work and risky. 

And there is little reason for aged care boards to want to be great and plenty of reasons not to take risks. 

In fact, you can be profitable, grow, get five stars, and be hugely admired without being great. 

AICD clearly thinks that is enough. 

And stuffing boards with AICD graduates will ensure it stays this way— pity about client thrival. 

But along the way, we were amazed to find so many directors with a high personal interest in client thrival who were sad for their clients and frustrated with themselves. 

So, why not start there, AICD? 

Why not beta-test a client governance learning network of interested individual directors? 

Then set them loose on their boards and see what happens.

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