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Great aged care: Applying the lessons from great companies

We all say we do good dementia care. Some even go so far as to say they do excellent dementia care. But what makes great dementia care? What makes some aged care organisations stand out?

Using the insights of Jim Collins in Good to Great: Why some companies make the leap and others don’t, we can gain a clear understanding and identify the way forward for aged care organizations in their efforts to create great care for our elders.

The first stage in becoming a great aged care organization is to have disciplined people. The first component of this is leaders. Leaders must be more ambitious for the success of the company and the cause, the mission, than themselves and have a habit of attributing success to others and taking responsibility for failures themselves. This is what Collins calls Level Five leadership.

In an aged care organization whether you are a for-profit or not-for-profit organisation your leadership must be able to put their own ego aside for the sake of the company/mission and its success. Level Five leaders are those who are able to remain focused on the goal and not be wavered by the latest fad or direction. They know and understand the core values of the company and are prepared to do what it takes to see those values brought into reality.

Second, great companies make sure they have the right people on the bus, the right people in the right seats and the wrong people off the bus. Once they have identified the right people, then they set about the work. This is crucial for aged care as the people who work in our care homes are caring for frail and vulnerable elders who need gentleness, empathy and skillful care. Our staff are paid low wages and so we find minimally educated people are attracted to aged care work. Some are not suitable.

Organisations that on the road to greatness are selective about who gets on the bus. They then set standards for staff performance and the wrong people are encouraged to select out from the organizations and find employment in fields that they are more likely to be successful at. We must have the right people caring for our elders. Staffing problems cause so much distraction and diversion of effort for managers and CEOs.

Promoting people into management roles without appropriate training is a common cause of problems in aged care. Some are good nurses but poor managers but may with training and education become better managers. Do you hold off promoting people until you find the right people or do you fill holes out of urgency and a need to have someone in the position? It is costly to make hiring errors – costs about as much as the salary for the position when you consider lost time and effort.

Does your organization think ahead about leadership and cultivate a culture of preparation of people so they can assume leadership in time? Leadership succession is of vital importance in aged care. So many times we see new people brought in from outside the organization who do not share the values of the organization nor do they have the history and knowledge of the culture that those within do. This is costly and distracting.

Do you get the wrong people off the bus? Failure to act when the person is wrong for the organisation is one of the most draining problems facing aged care. Managers are reluctant to make the move and are often fearful of appearing hard and ruthless. It is better however, to be rigorous, to be focused on the goal of getting the right people on the bus and the wrong people to find a new position, and if that is not working, to help them get off the bus.

The Second stage in building a company that achieves greatness is to have disciplined thought.

Confront the brutal facts – This involves being prepared to see what you have in your organization for what it is. Stop calling it ‘good care’ if it is ‘not good care’. Address the documentation issues. Address the skill issues. Call it a staffing issue if it is. AND at the same time retain an unwavering faith that by doing so you will prevail in the end. Many do not and believe that by hoping it will get better things will change themselves. This is hope based on a faulty view of reality. Only when the hope you hold is based on a rigorous appraisal of reality do you have a chance of achieving your goal in the face of obstacles.

The Hedgehog concept – Australians might call this their Echidna Concept. The fox was good at many things but the hedgehog was good at one thing and made this his expertise. The Hedgehog Concept is a simple coherent concept that drives your decision making consistently so that over time you build a series of consistent decisions focused on achieving a simple goal. There are three intersecting circles that form your Hedgehog Concept: What can you be the best in the world at? What are you deeply passionate about? What best drives your economic or resource engine?

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