Dr Cathy Balding
Qualityworks PL; Australasian Institute of Clinical Governance; Adjunct Professor James Cook University
‘How can we engage staff in quality? (Or anything?)’ is a familiar refrain from quality managers, executives, and CEOs across human services, including aged care.
It’s impossible to create consistently good care unless staff – those providing the care and those supporting its delivery - are active and positive participants. And that this participation happens in partnership with consumers. But this is challenging to achieve when clinical governance compliance processes are presented to staff as ‘more work’, often without a meaningful ‘why’ or effective ‘how’. Despite the underpinning intent of clinical governance as a support system for staff to provide quality care, staff often experience it the other way around: that they exist to support clinical governance systems that are not useful, poorly implemented - or both.  This breeds disengagement and reduces clinical governance participation and point of care impact – which in turn reduces care quality and consumer satisfaction. In these days of rising expectations of care quality and the challenges of recruiting and retaining staff, it’s time to build a clinical governance bridge between staff and consumer satisfaction.
All staff have a direct or indirect role in point of care quality, from the executive through to line management. This spotlight falls most brightly on managers, from executive to local, who create the conditions, make the decisions, and take the actions that determine how care happens every day. In fact, the quality of organisational and clinical leadership and management is a significant predictor of care quality.  However, this relationship is often overlooked in discussions on poor quality care and services, and few aged care middle managers appear to be purposefully equipped and supported to derive the satisfaction from their role required for them to have a positive impact on consumer care and satisfaction.
We know that staff satisfaction is a predictor of consumer satisfaction, and yet the two are often addressed separately; sometimes one is even addressed at the expense of the other. But core components of staff satisfaction with their role, such as meaning, mastery, appreciation, autonomy and community [3, 4] can be built into the pursuit of quality care, building staff satisfaction through the act of pursuing quality care and higher satisfaction with consumers. This requires that executives:
- define quality care with staff in a way that has meaning for everyone
- implement compliance requirements as supports for staff to achieve quality care, rather than as ‘extra’ work with little meaning
- equip middle managers to deliver quality care in their services, with commensurate recognition, so they, in turn, can support and recognise the efforts of their staff. 
These actions require no extra expenditure apart from focus and energy – and leadership. Compliance requirements supply most of the tools required to create quality care - it’s how we focus and use them to support staff that makes the difference. In these days of searching for solutions to staff retention and consumer satisfaction, addressing them together has the potential to reap significant rewards for consumers, staff and the aged care sector.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.