Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 16
Management’s role
in implementing a
palliative approach
Managing an RACF requires a significant set of business and organisational skills. Regulatory
requirements have led to many facilities using management and business frameworks that
enable the processes of control, feedback and development to be handled systematically.
Frameworks such as business cycle planning and quality management systems enable
organisations to focus on their responsibilities and can lead to improved performance in the
facility [447] (Level QE).
Quality management systems aim to assure customers a consistent and improving level of
service, while business planning ensures that operationally the organisation formally assesses
needs, revenues and resources. Integral to both processes is the role of communication with
customers and with the aged care team.
Introducing a palliative approach is a strategic decision for an RACF in providing continuing
care for their residents through to the end-of-life. This will require the organisation to include
a palliative approach in their formal planning and monitoring cycles, and to commit the
appropriate resources to its implementation. Among the resources required are aged care team
members, management time, training and education costs, appropriate facilities, reporting
requirements and access to external supports.
Although education and training are essential elements of successful implementation of a
palliative approach they may not, by themselves, bring about the desired change [448,449] (Level
QE; Level EO). Other factors have been identified as influencing the success of changing
practices. For example, a commitment of adequate resources is fundamental to implementing
changes in practices [6,450] (Level QE; Level QE). The organisational culture and leadership
in the operational area can also be important in introducing and sustaining change [451–453]
(Level EO; Level EO; Level EO). Therefore, boards of management should be included when
training in a palliative approach is undertaken by RACFs, to ensure that the entire organisation
understands the philosophy of providing a palliative approach.
The context for the change and the process of facilitation can also affect the change
environment [373,454] (Level QE; Level EO). Time restrictions and a lack of appropriate members
for an aged care team have also been identified as impediments to change. Implementing a
palliative approach in an RACF requires attention to these potential barriers, as well as focused
problem-solving.
Management structures and processes
There are many RACFs whose management has embraced a palliative approach to care. Some
examples of these include:
Guidelines for a Palliative Approach in Residential Aged Care 183