A trial at four Australian facilities involved residents using technology to connect with family and friends suggests that broadband and other infrastructure is essential. However, there are issues with implementing IT in aged-care.

Linda Belardi and Paul Dagarin look at the report and issues facing New Zealand aged-care providers.

Remote Australian aged-care facilities are utilising the virtual world to help reduce the social isolation of their residents.

Using common video conferencing technology such as Skype, facilities in regional NSW and central and south-west Queensland are overcoming the tyranny of distance and helping residents stay connected with family and friends.

Technology not only enhances communication between residents and the broader community but helps to reconnect them with a familiar past. Applications such as Google Earth are being used by multicultural residents to locate their birthplace.

Improving the quality of resident social interaction is one outcome of a four-site pilot programme intended to expand the use of IT in aged-care.

Church Resources, in partnership with 10 industry and not-for-profit organisations, has developed the ConnectCare programme designed to make IT infrastructure and software available to small and medium-sized providers across Australia.

Initial results of the project have been presented in the white paper, ‘Golden OpportunITy: How information technology can rejuvenate Australia’s aged care sector’, co-authored by Church Resources and project partner, KPMG.

Church Resources argues that access to high-speed broadband and technology can not only improve the quality of life of residents but help manage the sector’s limited resources through time and staff efficiencies.

“We believe making relevant technology more accessible, affordable and easy to use can be a catalyst to reinvigorating this critical sector to help meet the aged-care needs of today’s and tomorrow’s senior Australians,” it says.

The present context also provides a unique opportunity to leverage the Government’s existing eHealth and eBusiness agenda to boost the sector’s resources, the white paper argues.

In particular, by making IT more accessible and affordable, the Government’s national broadband network can facilitate the roll out of technology to the resource-poor areas of rural and remote Australia.

Current usage of IT

Some aged-care facilities have already made positive progress in implementing IT but for the majority of providers this step has proven extremely difficult. IT expertise within the sector is minimal and technology use is often not extended to residents.

The white paper cites an IT survey conducted by the Department of Health and Ageing that found facilities with more than 300 beds were typically using a small number of unconnected computers and running a mix of disparate operating systems and software. These facilities also rarely employ an IT manager who could divert the responsibility of technology issues to an already overburdened care staff.

“Often management and nursing staff are required to spend valuable time managing IT systems, despite their lack of expertise or time to adequately evaluate or implement systems and services,” says Malcolm Alder, digital business partner with KPMG.

Less resourced facilities with fewer than 300 beds face a bleaker situation with many using outdated equipment with little or no IT support staff.

Reddecliffe says that a characteristic of complex IT systems is that maintenance can become more of a burden as systems become more pervasive.

“For smaller sites the onus of maintaining systems will often fall on management and it’s important for people in that situation to realise the risks associated with that strategy and to recognise when it is time to invest in some external expertise to minimise those risks.

“As the aged-care sector has developed in New Zealand different care providers have adopted different processes, so solutions need to provide a high level of flexibility to enable them to be configured to fit the way organisations work rather than dictating practice to fit the system.”

A lack of sector-specific knowledge from technology suppliers and inadequate supplier training are cited as the sector’s most significant grievances. An ageing workforce, the dominance of part-time and volunteer workers and a lack of confidence in using technology all complicate the broad implementation of IT.

Increasingly, says Richard Reddecliffe of VCare, there is a call for simple and flexible solutions to complex problems.

“This, no doubt, is driven in part by the need for the solutions to be understood and operated by an aged-care workforce who are not necessarily as computer savvy as those in some other industries,” says Reddecliffe. “Systems are often sold on the promise of efficiency gains and minimising duplication of effort, so it is important that they can deliver on that promise in the hands of the intended end users.”

Reddecliffe says this creates a dilemma for solution providers who must try to find the right balance of flexibility and configuration time. The more configurable a solution the more involved the user organisation will need to be in that configuration process and in the ongoing maintenance of that configuration as the organisation and the industry evolve.

Cost is also regarded as a major barrier to uptake, even amongst early adopters of technology.

According to a national implementation survey conducted by specialist technology consultant KM Group, this reveals a lack of understanding of the value of technology as a business catalyst.

Many providers have adopted a cautious approach towards technology, where implementation is driven by external and ‘cost’ pressures to change rather than by its own strategic goals. This view regards IT “as a cost centre rather than value generator”, says the report.

“Implementation forced by external pressure rather than planned from within can also result in resistance to the change at a management level, and without management buy-in and support for the implementation it is unlikely that staff buy-in will ever be achieved,“ says Reddecliffe.

“Including the IT solution implementation as part of the business strategic plan may enable a more considered and better structured solution which reaps a wider range of benefits earlier and ensures more staff can be involved.”

Signs of IT maturity, however, are emerging. Qualitative data collected from the KM Group’s survey of 87 Australian aged-care facilities indicated an intention by some to integrate operational expansion and increased productivity with the use and need for IT.

The sector is successfully using Government initiatives, with 81 per cent of aged-care services currently engaged in electronic transmissions with Medicare Australia (the Federal healthcare funding agency), says a spokesman from the Department of Health and Ageing.

Change management

The take-up of technology profoundly alters staff responsibilities and work practices and therefore must be implemented in a slow and staged fashion, says Alder.

Staff readiness is more important than software selection and the implementation of IT must be embedded in a broader vision and mindset change.

“The best advice is not to try anything too Big Bang. The single biggest mistake a provider can make is to get the staff offside. The results could be more timely, costly and even counter-productive,” says Alder.

Wayne Doran, managing director of Time Target, says it is therefore important to understand what will work best for everyone. Change management planning is critical and this often depends on how the new system is ‘sold’ to staff.

“Letting them know the details in advance, providing an FAQ list, and explaining the changes from their perspective will help to alleviate the anxiety staff often have towards change,” says Doran.

“Often with technology it’s the fear of the unknown and computers and tech-speak is very foreign, so keep it in laymen’s terms with real-world practicality. If your IT provider truly knows your industry they should have this change management process ready for you to help with the implementation and staff training to ensure it all goes as smoothly as possible. Like most things, a little planning goes a long way.”

 In the best examples of success, momentum for advancement comes from strong leadership and local champions who diffuse a lack of confidence with effective communication, staff support and comprehensive training.

“A good strategy is to involve and engage staff in the early stages and to clearly and regularly communicate what they should expect from the new system and what the changes will mean for them and the way they work,” says Reddecliffe.

“It’s far better to implement functionality in smaller manageable stages so staff are given the opportunity to get familiar with the ‘easier’ parts of the system first, then to introduce other aspects of the system in stages over time as their comfort levels improve. Some easy wins and some time to appreciate them can go a long way towards breaking down the natural resistance to change.”

Indicative of the degree of resistance within the sector, a nurse at one of the Australian pilot sites tendered her resignation in the initial phase of implementation and refused to take part in the training programme.

Successful implementation is not only about changing workplace practice, it is about changing values and attitudes, says Con Koulouris, IT director, Church Resources.

Having the right technology alone is not sufficient. The transformation has to be supported by an integrated change plan revising job descriptions, building design and performance assessment.

The level of comfort and resident satisfaction towards the new technology-driven workplace is also heavily influenced by staff attitude.

To drive the implementation of affordable and appropriate broadband and technology, greater collaboration between independent aged-care facilities is also needed, Church Resources says.

“By working collectively, facilities can have a stronger position with service providers as well as software, hardware, content and integration specialists to deliver clever solutions and applications at a much lower per cost.”

Outsourcing IT to an expert third party will also reduce the management and infrastructure burden of managing their own technology.

Although the initial ConnectCare pilot sites have targeted facilities with fewer than 200 beds, Alder says the results can apply to the experience of larger, commercial providers as the cost dynamics are more acute in smaller facilities.

As staff and resident computer literacy improves, the confidence and experience level of residents will also drive transformation within the sector, says the white paper.