Clinical governance supports aged care organisations to deliver high-quality care and services to achieve good health and wellbeing outcomes through positive care experiences.  Although there is no ‘one-size fits all’ approach to clinical governance,  the Aged Care Quality and Safety Commission (ACQSC) suggests six core, interrelated elements to clinical governance which together promote optimal health and wellbeing outcomes for people receiving aged care services.  Governing bodies should consider each of these and set up systems to manage, operationalise, and monitor success against them. One of these elements is effective workforce. The other core elements are covered in detail in our clinical governance themes.
Why is an effective workforce important to clinical governance?
Everyone has a role to play in delivering safe and high-quality care. While the governing body is ultimately responsible for clinical quality and safety in aged care, the workforce (including visiting health practitioners) is responsible for working within the clinical governance framework.  It is crucial that health practitioners (including those who are employed by the organisation and those who are contracted) and other staff are appropriately qualified and adequately skilled to deliver safe, respectful, and high-quality care. [2, 4]
Aged care services are expected to have sufficiently qualified and skilled staff to meet the needs of the people in their care.  In addition, individual members of the workforce are expected to perform their duties effectively, communicate well, and build relationships with care recipients.  Organisations need to regularly assess, monitor, and review the performance of the workforce to ensure appropriate care is being delivered to individuals.  However, approaches to ensuring workforce effectiveness are likely to differ across care organisations.
Effective workforce and the regulation of Australian aged care
The importance of an effective workforce in delivering safe, high-quality clinical care is captured in the current (2019) Aged Care Quality Standards, particularly within Standard 7 (Human resources). This requires aged care organisations to have ‘a workforce that is sufficient, and is skilled and qualified to provide safe, respectful, and quality care and services’ (7(2)). [4 p148] The Standards also stipulate that the workforce should be:
- Planned to enable, and the number and mix of members of the workforce deployed enables, the delivery and management of safe and quality care and services (7(3)(a))
- Competent, with appropriate qualifications and the knowledge to effectively perform their roles (7(3)(c))
- Recruited, trained, equipped, and supported to deliver the outcomes required by these Standards (7(3)(d)). 
Furthermore, the organisation’s leadership is charged with the regular assessment, monitoring and review of the performance of each member of the workforce (7(3)(e)). 
Current aged care reforms are intended to strengthen and reinforce the importance of an effective workforce. In the Revised Aged Care Quality Standards (2023), considerations for an effective workforce are predominantly covered in Standard 2 (The organisation). The Revised Standards align well with the current requirements regarding the importance of an effective workforce with some slight refinements. These include an increased emphasis on engaging workers as employees wherever possible and reducing the use of contracted staff. 
The Australian Government has also amended the Aged Care Act 1997 to include new responsibilities for providers when employing or reviewing the suitability of key personnel (section 63-1A). Key personnel include people with authority, influence, or responsibilities for decision-making or service planning across the organisation. These changes stress the importance of provider due diligence by requiring them to:
- Consider all key personnel against certain suitability criteria every 12 months
- Be satisfied that these personnel are still suitable to provide care
- Keep records of suitability matters that were considered and provide an explanation as to why they were satisfied with personnel suitability. 
Under section 63-1D(11) of this Act, providers and their governing bodies are also required to ensure that all staff:
- Have the appropriate qualifications, skills or experience to provide the care or other services delivered by the approved provider
- Are given opportunities to develop their capability to provide this care or deliver these services on behalf of the organisation. 
The new Code of Conduct for Aged Care requires aged care services to demonstrate that their workforce is competent, and that staff have the appropriate qualifications and knowledge to perform their roles effectively.  The Code also sets out the behaviours expected of providers, aged care workers, and governing persons to ensure care aligns with community expectations and consumer rights. 
In recognition that quality of care is impacted by the number, knowledge and skills of residential aged care staff, the Australian Government is mandating a minimum number of care minutes per resident. The government is also requiring residential care facilities to always have at least one registered nurse on site. These initiatives are aimed at improving resident care quality and safety by increasing access to personal care workers and experienced clinical care staff. 
Components of an effective workforce
An effective workforce is needed to support safe and high-quality care.  There are multiple components to establishing and maintaining an effective workforce, including clearly defined roles and responsibilities, appropriately qualified and skilled staff, and clear guidance for visiting health professionals.