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CONTENTS
Summary
This was the first and as far as I am aware the only audit ever conducted of the performance of the agency itself. It had only been in operation for a short period of time. The main thrust of the criticisms was the failure to collect useful data to assess whether accreditation had any impact on care, monitor its own performance, measure quality of life. Concern was expressed about the conflicting roles of educator and supporter on the one hand and regulator on the other. These criticisms are much the same as those being made 7 years later. The agency agreed to implement the recommendations made but it is clear that at least some of the advice has not been embraced.
To download the
audit report go to
http://www.anao.gov.au/uploads/documents/2002-03_Audit_Report_42.pdf
Introduction
This audit was the first and only review of the accreditation agency itself. The ANAO recognised this and was kind in its criticisms. It made a number of recommendations which the agency agreed to.
32. The ANAO concludes that the Agency has adequately identified its legislative responsibilities for accreditation and has implemented an adequate process to meet them. In general, its management of its people and workflow supports the management of the accreditation process.
33. However, the ANAO also concludes that there are some weaknesses in the Agency's management systems, which impact adversely on its management of the accreditation process. These include the Agency's costing systems, information management, and quality assurance mechanisms. The ANAO has made six recommendations addressing observed weaknesses.(Page 18)
To the best of my knowledge there has been no further audit of the department itself and it is clear from the review of the accreditation process performed in 2007 as well as from the performance of the agency that it has not been able to implement all of the recommendations made.
When one considers the close relationship with the industry and the powerful position the providers hold on the board, this is not surprising. I suspect they might have resisted the sort of data collection, the sort of analysis, the sort of reporting, and the degree of transparency required.
Data collection
The audit focused on the failure to collect the sort of data required. This is clearly at the root of the problems many critics have had and still have.
22. The Agency is not using data to systematically identify state and national training needs. In addition, the Agency has minimal human resource data on internal and contract assessors. Consequently, the Agency has conducted only limited analysis. As a result, the Agency has little evidence to identify, or address, differences in skill levels of the two different types of assessors.(Page 15)
The audit found that the Agency's Audit Management Information (AMI) was not being properly used and that staff were negative about it. Given the ongoing problems we can only wonder whether the AMI was ever fixed and used.
23. The Agency's Audit Management Information (AMI) system is a workflow management system developed in 1999 to assist the Agency to manage the accreditation process. AMI reflects the requirements of the Accreditation Grant Principles. Since its inception, AMI's utility and accuracy have not been systematically reviewed or evaluated to ensure that AMI adequately meets user needs. In ANAO interviews regarding AMI, the majority of senior staff involved in the accreditation process questioned the system's utility for management and reporting purposes, although it was recognised as a useful and time-saving administrative tool. Reasons given for lack of widespread use were that AMI was not kept up-to-date and was not perceived to be user-friendly.
Recommendation No. 2 Para. 5.50
The ANAO recommends that the Agency review the Accreditation Management Information system to ensure that it meets user needs and achieves its objective to facilitate effective management of the accreditation process.
Agency's response: Agreed.
Reporting on data
The expectation that the agency collect and report on data in the long term as well as the short term and analyse it has never been met. When the Aged Care Crisis Centre pulled data off the agency's web site (before it was removed) over a 1 year period it was able to break down the geographic variables within the sector and show that, when adjusted for location, the for-profit sector was much more likely to fail an accreditation item than the not-for-profit operators. There was so little additional information available that these results were only tentative and other variables could not be considered. Because the department did not make data available it was not possible to do an analysis over a longer period. Because the accreditation process lacked and as the agency did not collect hard data recording successes and failures the analysis was very limited in scope.
This audit was handed down in 2003. As a consequence of the failure of the agency to collect we still do not have the data needed to properly evaluate the performance of the aged care sector or to analyse the impact of different management and operational considerations on the service provided. The opportunity to collect 7 years of invaluable information has been lost. The ability of the 2010 productivity commission inquiry to make sound decisions will be much impaired as a consequence.
24. Most of the Agency's accreditation-related management reports, examined by the ANAO, present a summary of Agency activities and outputs at a particular point in time. The Agency makes limited use of qualitative and long-term measures, analysis of accreditation trends over time, comparisons between states, or actual performance against targets.
Quality of care and quality of life
The criticism that the agency did not collect information that assessed quality of care and which allowed them to evaluate the effectiveness of their activities and the quality of life of residents was still there in 2007. Because that report relied on soft data for its conclusion and no other review has examined performance the criticism remains in 2010.
25. On the whole, performance indicators and targets are focused on the outputs and efficiency of the Agency's accreditation process. However, one of the Agency's objectives, described in its Corporate Plan, is to 'enhance quality of life for residents'. While a number of factors and entities contribute to the quality of care provided to residents, the Agency does not yet have a way to assess the outcome of its accreditation and monitoring work on the residential aged care industry.
Recommendation No. 5 Para. 5.57
The ANAO recommends that the Agency and Health plan an evaluation of the impact of accreditation on the quality of care in the residential care industry.
Agency's response: Agreed. Health's response: Agreed.30. The Agency has implemented a number of quality assurance mechanisms - - - - -. However, the Agency has not documented its existing mechanisms nor systematically reviewed its quality assurance procedures to ensure that they are, and remain, robust, and that they provide the Agency with assurance that its management of the accreditation process is effective. Robust quality assurance procedures would improve the quality of the accreditation process and provide necessary assurance about the Agency's management of the process. (Page 17)
Recommendation No. 3 Para. 5.53
Recommendation No. 6 Para. 6.40
The ANAO recommends that the Agency implement a suitable system to analyse the accreditation process and use the results to identify improvements to the process.
Agency's response: Agreed.
The ANAO recommends that the Agency review its quality mechanisms to ensure that it has a robust, well-documented quality assurance system that supports high quality and consistent assessment outcomes and related decision-making.
Agency's response:Agreed.
Conflicting roles
As early as 2003 even the industry was expressing concern over the conflict between the roles of being an educator and at the same time a monitor and enforcer of care. In the early period its education role had suffered.
27. - - - With the establishment of a national Education Division, the Agency will be in a position to give a higher priority to its education responsibilities. Some industry representatives have expressed concern over the Agency's dual roles as accreditor and educator. - - - - The potential tension between the Agency's dual roles of accreditor and educator, and the response from some parts of the aged care industry, is a risk that the Agency must continue to manage. - - - - . (Page 16)
To download the
audit report go to
http://www.anao.gov.au/uploads/documents/2002-03_Audit_Report_42.pdf
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