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The Business of Care is a podcast for people working at the intersection of technology, quality and leadership in health and social care.
Hosted by Marie Page, Head of Marketing at CareLineLive (an all-in-one home care management software platform trusted by over 700 homecare providers across the UK and Australia) each episode brings together experts, innovators and practitioners to explore what it really takes to deliver outstanding care. We get into the data, the tools, the thinking and the decisions that shape how care is delivered on the ground.
This isn't a podcast about software. It's a podcast about the people and ideas that make care work - and the technology that, when it's done right, quietly supports them.
Episodes explore quality benchmarking, AI in care, leadership under pressure, commissioning, workforce, and what the best care organisations are doing differently.
Whether you're running a homecare service, working in an integrated care system, or building the tools that power care delivery - this is your show.
About CareLineLive
CareLineLive is an all-in-one home care management software platform trusted by over 700 homecare agencies and domiciliary care providers across the UK and Australia.
CareLineLive brings together three fully integrated platforms - a management platform for rostering, scheduling, invoicing, payroll and real-time call monitoring; a carer companion app that gives care workers the information they need to deliver person-centred care; and a Care Circle portal that provides families and friends with real-time visibility of visits, notes and medication.
The software also includes MOA Benchmarking, supporting providers in the UK to improve, maintain and evidence their CQC and Care Inspectorate Wales ratings. MOA originates from Australia where it serves more than half of care homes there.
CareLineLive is an NHS England Assured Supplier for Digital Social Care Records, building software that gives carers more time to care. The Business of Care podcast is where that same commitment plays out in conversation, bringing together the experts and innovators shaping what outstanding care looks like in practice.
[01:00:01:00 - 01:00:14:22]
Speaker 1
Hi, welcome to the Business of Care podcast. I'm Marie Page, I'm the Head of Marketing at CareLineLive.
[01:00:16:09 - 01:00:30:03]
Speaker 1
Today I'm joined by Lahn Straney, he's the Chief Scientific Officer at Avaran. Now Avaran is a new brand which covers MOA Benchmarking, Health Metrics and CareLineLive. Lahn, welcome, thank you for joining us.
[01:00:30:03 - 01:00:30:19]
Speaker 2
Thanks for having me.
[01:00:30:19 - 01:00:38:22]
Speaker 1
No worries at all. So as well as being the Chief Scientific Officer for Avaran, you are also an associate professor at Monash University.
[01:00:39:22 - 01:00:41:11]
Speaker 1
Talk about what that involves.
[01:00:42:09 - 01:01:22:23]
Speaker 2
So my background is as a researcher and so I am an adjunct associate professor there, I have a PhD student, most of my research work has really been around how we can use data to make a calculated evaluation of care quality and a lot of that work sort of involves risk adjustment models and the like and so I started working at Monash full-time back in 2012 and once I left to come out into industry I kept my adjunct associate professorship. So I'm still involved in some research from time to time and some supervision but yeah, very much on the side of my focus now.
[01:01:22:23 - 01:01:24:00]
Speaker 1
So
[01:01:24:00 - 01:01:26:15]
Speaker 1
your speciality is epidemiology.
[01:01:28:01 - 01:01:30:16]
Speaker 1
I guess we understand that a little bit more because of COVID.
[01:01:30:16 - 01:01:31:07]
Speaker 2
Yes.
[01:01:31:07 - 01:01:34:23]
Speaker 1
What on earth does epidemiology have to do with social care?
[01:01:34:23 - 01:02:18:15]
Speaker 2
Well epidemiology is a pretty broad field, it literally translates to study of what's upon the people and the epidemiologist most people will be familiar with through COVID and movies like Outbreak, what we term the cool epidemiologists and so they're the more infectious disease but there are many chronic disease epidemiologists such as myself and we look more at both chronic conditions but also population level you know health conditions including aging and my focus really been health services and probably more quantitative epidemiology so things like biostatistics and so I'm sort of on that quantitative side as opposed to the public health side.
[01:02:19:20 - 01:02:34:17]
Speaker 1
So explain in kind of human terms, I know you speak very humanly rather than like an academic but explain what that really means for providers in health and social care, what benefits can they derive from the work that you've put in over the years?
[01:02:36:07 - 01:03:27:12]
Speaker 2
I might need to go back a little bit, one of the first epidemiological studies happened in Soho here in London and that was a physician by the name of John Snow who basically traced the origins of a cholera outbreak in Central London to a particular water pump and so that involved mapping where people where the cholera was occurring in patients and then sort of mapping that they used the same pump for water and so effectively it's making sense of different signals and data and information that we get and being able to bring that together to get an insight you may not have been able to get if you were looking at individual cases so it's about looking at information and data in an aggregate form so that we can understand what's going on.
[01:03:27:12 - 01:03:37:19]
Speaker 1
Great so can you give me a couple of examples of how your work as an epidemiologist has informed it in a parallel with that cholera piece?
[01:03:37:19 - 01:03:38:16]
Speaker 2
Yeah so
[01:03:38:16 - 01:04:26:14]
Speaker 2
one of the so as I say it's pretty broad but in terms of using data to make evaluations my focus on care quality one of the really common things you come up against when you're trying to make assessments or judgments around the quality of the service is that it can be really difficult to make comparisons because the people receiving care are quite different and so one of the challenges in care quality both in you know hospital systems and in social care is how do we enable fairer comparisons and so building out algorithms we call them risk adjustment models which allows us to make fairer comparisons of outcomes across different services and so that's work that we do through the MOA Benchmarking group in terms of quality indicators and tracking and monitoring those.
[01:04:26:14 - 01:04:30:18]
Speaker 1
How did you get involved with MOA in the first place?
[01:04:32:05 - 01:05:19:16]
Speaker 2
I was approached by a couple of nurses that were sending out audits around the country back they started in in 1999 I came to know them in 2008 and eventually I'm acquired the business in 2013 but essentially they were starting to get what were very sensible reasonable questions from care providers that said hey you know we need to analyze these data in a more sensible way so that we can actually make proper judgments about how we're doing and where there might be opportunity to improve so I helped them with some methodology that was taken up really nicely by the providers and so came to be increasingly involved and eventually shifted some of the focus I think of the business from what was essentially an auditing type business to more of a data insights type business.
[01:05:20:19 - 01:05:29:02]
Speaker 1
And I guess at this point we should explain the MOA Benchmarking as we are describing it was based in Australia which is where you're based.
[01:05:29:02 - 01:05:30:04]
Speaker 2
Correct yeah so
[01:05:30:04 - 01:05:43:13]
Speaker 2
started actually in Toowoomba which is a town west of Brisbane by a couple of nurses and now serves I think more than half of all aged care homes in Australia.
[01:05:44:15 - 01:05:49:12]
Speaker 1
MOA is serving more than half of aged care homes in Australia? That is really quite impressive.
[01:05:49:12 - 01:07:01:16]
Speaker 2
I think it's about 55% actually yeah. Yeah there's some and the focus is growing and so what started as you know auditing to make sure that policies and practices align with quality standards that's you know that really compliance focus and that's typically the first in terms of a quality posture that's typically the first place we start you know are we compliant with what we are regulated and required to do and so that's where it sort of started and then quality indicators are a bit more abstract because there's a probability there's a distribution to them in terms of well we expect some adverse events to occur when we're dealing with vulnerable populations but is that rate higher or lower than we expected to see and so you know quality indicators have been the next step and then bringing these other pieces together things like feedback and complaints so can feedback act as an early signal for adverse events for example we're bringing in incident management so it's become a much fuller suite where all that data can be connected and provide well the longer term goal is more proactive care so we can prevent adverse things from happening at all.
[01:07:02:17 - 01:07:13:13]
Speaker 1
Great we'll talk a little bit more about how that works on the ground later for now let's just talk about MOA coming into the UK you've been in the UK for how many years now?
[01:07:13:13 - 01:08:03:01]
Speaker 2
Must be coming up three or four years now so pretty soft sort of entry to the market while we tried to understand the different approach and processes here so you know straight off the bat from a home care probably acts quite similarly to Australia but care homes are pretty fundamentally different in terms of size and scope and so you know an average home here might be 30 beds and in Australia it's probably closer to 80 I think 81 is the average now so you know the scale and focus and separation of responsibilities in bigger organizations in bigger care homes is going to be quite different and so their approach to quality and governance is also different.
[01:08:03:01 - 01:08:03:21]
Speaker 1
I
[01:08:03:21 - 01:08:23:13]
Speaker 1
know our experience in the UK when we compare what CareLineLive is doing in home care in relation to the UK and Australia is that there are a lot of smaller providers in the UK I mean we've got something like 14,000 home care providers in the UK whereas in Australia I think it's more like what 700 home care providers?
[01:08:23:13 - 01:08:24:10]
Speaker 2
Yeah there's
[01:08:24:10 - 01:08:57:00]
Speaker 2
probably a bit more I think there's about 1500 there's about 700 providers that are involved in residential care so that might be where that number's from and there is a few more in home care and then of course the line gets a little bit blurred because unlike the UK we have a different care standards or regulatory standards for disability care so it's you know they're separate to aged care and so UK takes a more similar approach to New Zealand with that adult sort of social care approach.
[01:08:57:00 - 01:09:31:05]
Speaker 1
Okay and in terms of the business of care what I've observed for Australia is that we see organisations much more in enterprise level much larger organisations that have people that are responsible for quality management you know rather than what we can see is a little bit of a mom-and-pop kind of business in the UK where they perhaps got maybe half a dozen members of staff and so it's a different buying process isn't it? How have you found that in the UK versus Australia for MOA?
[01:09:31:05 - 01:09:32:02]
Speaker 2
I think
[01:09:32:02 - 01:10:09:15]
Speaker 2
it's tricky because as you identify there doesn't tend to be a dedicated person and so in Australia we would typically work with someone that's dedicated and focused on quality clinical governance those kinds of pieces and more often than not in the smaller operations there tends to be someone wearing multiple hats and so they have split focus and so that can make a little bit trickier for that information to sort of or prioritise to sort of rise to the top of what they want to do but yeah it's a trickier process I think you've really got to prove the value proposition can work at smaller scale as well.
[01:10:09:15 - 01:10:41:18]
Speaker 1
Yeah I was interviewing recently someone whose sole focus in the UK is in quality management for her company – a larger provider and she was like “I love MOA this makes my life so much easier, this saves me loads and loads of time” but when we were trying to take that and communicate that to the smaller providers they're so budget sensitive and you know they're making do doing a lot of kind of in-house quality work you know they have to really really it's a difficult job to convince them.
[01:10:41:18 - 01:10:42:11]
Speaker 2
The
[01:10:42:11 - 01:12:17:09]
Speaker 2
funny thing is I really think the value proposition is quite strong for small because otherwise you need to create a lot of this infrastructure yourself and so a lot of these things tend to be tied together with spreadsheets they tend to be tied to individuals with particular expertise and so that's really difficult if that person moves on or a spreadsheet breaks it can be quite difficult so I think the value proposition is quite strong but it's it's how do you get that to become a priority in those types of organisations. Interestingly from you know a quality perspective we talk about you know smaller larger providers we know empirically that you know small homes and sites tend to have better outcomes in terms of both quantitative and qualitative so qualitative in terms of you know survey results and the like a small location tends to yeah be more positive but we also find large providers tend to have better compliance and regulatory approach and so it kind of paints this picture towards actually small sites so all locations are fine where they're part of a bigger group and we're kind of seeing neither of those approaches come to fruition so in Australia we're seeing a combination of both large organisations and large sites and the UK we're seeing both smaller disaggregated smaller with small locations as well and so I think there's an opportunity to take the benefit from from both of those facts I suppose.
[01:12:19:01 - 01:12:41:19]
Speaker 1
in Australia at the moment there's massive changes happening in relation to regulations and certainly in the UK if we look at CQC there's a lot of change I know that hugely impacts the people that are responsible for regulation and quality control in the businesses. Do you want to just talk about what's going on in Australia at the moment and perhaps what the UK can learn from that?
[01:12:41:19 - 01:12:42:12]
Speaker 2
Yeah sure
[01:12:42:12 - 01:13:26:09]
Speaker 2
so November last year we passed the new Aged Care Act as part of that there was a new revised set of aged care standards and so the aged care standards are effectively what you guys have the CQC we have the Aged Care Quality and Safety Commission in Australia and that is the framework by which they're assessing the performance of homes. There's changes to that assessment framework in terms of how they're going to be judged and then on top of that there are other pieces within this Act so things like whistle bolt lower protections for staff so there's multiple changes it's probably one of the largest changes we've seen in you know decades for the aged care sector.
[01:13:26:09 - 01:13:38:17]
Speaker 1
And one of the advantages of working with someone like MOA is that when regulations change you've changed effectively all those spreadsheets we won't have a better word without the providers having to do anything at all.
[01:13:38:17 - 01:13:39:02]
Speaker 2
Correct and
[01:13:39:02 - 01:14:22:03]
Speaker 2
so everything from you know the audits themselves and then any existing or open so if we think of audits you know that can be done in a cycle month to month they're doing any things and so the new standards kick in the new audit tool kick in but there's also elements of work around you know improvement activities or corrective actions that we might be working on those you know that's a living document that demonstrates what we're doing so we will go through a process of mapping any of those that are linked to particular requirements or standards and bring them through into the new standard so none of that good work is being lost and it just automatically keeps people up to date so they can be you know assured that they're checking their systems against where they should be.
[01:14:23:15 - 01:15:14:04]
Speaker 2
I suppose more generally you know when I talk to really good governance quality people both within providers and within sort of consultancy is even when we get these regulatory changes the principles are going to pretty much remain the same that we're delivering the best care we can that we're treating people with respect you know that we're creating systems that allow people to speak up so I think the principle nothing's changing in terms of the principles of what good care looks like and so whilst there is a lot of work I think good providers and will understand that if they're doing if they're following those principles already the rest is kind of window dressing in terms of you know changing links to standards and updating requirements.
[01:15:14:04 - 01:15:19:17]
Speaker 1
Yeah so the box ticking tweaks a little but actually the basic principles that underlie are the same.
[01:15:19:17 - 01:16:06:13]
Speaker 2
Yeah I mean we're starting to hear about you know this shift you know person centred as you know been a mainstay I think in in social care for a while now and you know now we're having conversations about person-led which is certainly language we see in disability support where people are really much more active participants it's obviously a very nice sentiment but we also need to consider people's capacity and also willingness to be involved in the care because part of I think being person-centered is is recognising what someone wants to do and not just insisting that they necessarily want to be involved in in the planning of care but giving them the opportunity to do so where they wish to be.
[01:16:07:09 - 01:16:11:18]
Speaker 1
So what would you see is the differences between person-led and person-centered?
[01:16:11:18 - 01:16:12:13]
Speaker 2
So
[01:16:12:13 - 01:16:37:17]
Speaker 2
I guess person-centered care can involve the person and and and it must sort of consider their best interest and what's right for them whereas a person led would be sort of them suggesting or determining what should happen within some framework of course I mean people don't necessarily understand every aspect of clinical care for example but it puts the person receiving care much more in the driver's seat.
[01:16:51:21 - 01:16:57:10]
Speaker 1
What do you think that the UK can learn from what's been happening in Australia in recent years?
[01:16:59:01 - 01:17:05:12]
Speaker 2
It's a challenging one just because the way the systems are set up are quite different.
[01:17:06:13 - 01:17:39:00]
Speaker 2
I think the work that we've done around putting feedback at the centre of care there's been a really strong emphasis from the Commission for a few years now about how feedback can actually drive better care and this all aligns with this idea of you know person-centered or person-led care it's that this actually gives me the source of truth of what people want for their care to be, how they want their care to work.
[01:17:40:13 - 01:18:40:17]
Speaker 2
You know we've got at the same time we've got these big demographic shifts in terms of population and I think most particularly in the aged care sector most care recipients have been shall we say more easygoing than the next big wave that are likely to be receiving care. I think you know the baby boomers are certainly more financially you know they've got a lot stronger financial position than previous generations and they'll have higher expectations of how care should be delivered so you know there'll be a bit of a reckoning I suppose and I think to be prepared for that we need to be prepared to listen and so I think putting feedback at the centre and having really good mechanisms that allow people to speak up and for that information to translate into improvements is a really great approach.
[01:18:42:12 - 01:18:43:05]
Speaker 1
How
[01:18:43:05 - 01:18:54:02]
Speaker 1
is Australia in terms of the pain points that providers are experiencing? Are they experiencing recruitment and retention challenges in the same way that we are in the
[01:18:54:02 - 01:18:54:10]
Speaker 1
UK?
[01:18:54:10 - 01:19:38:20]
Speaker 2
Yeah I mean that's probably always when I came to my first conference in the UK and listened to kind of those workforce challenges you've got you know diverse working population it mirrors almost precisely the same challenges that Australia faces so those challenges persist I mean in some ways in Australia now that they're kind of just accepted as that they're going to exist and that they're going to be there and yeah certainly that's true I think as with any big regulatory change the real pressure now is on the regulatory burden and how much is required.
[01:19:40:04 - 01:20:10:21]
Speaker 2
Our regulator is shifting much more to an information risk-based approach in terms of how they assess risk and they're using disparate pieces of information and being able to provide all that information easily and readily is challenging and so we're seeing a lot of consolidation you know we're not really seeing small facilities open up anymore much larger, larger providers we're seeing a lot of amalgamation in the industry so the pace of regulatory changes is yeah very difficult.
[01:20:42:09 - 01:21:08:15]
Speaker 1
So let's talk about how software is changing for providers both in the UK and Australia so we're at a situation where CareLineLive and MOA and Health Metrics or eCase are coming under the one umbrella of Evaran. How is that happening in Australia at the moment in terms of other software companies? Are they consolidating? Are they using a lot of new options coming into the market? What's going on there?
[01:21:08:15 - 01:21:09:09]
Speaker 2
Yeah I
[01:21:09:09 - 01:22:03:13]
Speaker 2
think we're certainly seeing a increasing emphasis on integrations. I think for a long time providers have had to use lots of different pieces of software in order to get best of breed so if they want to use the best auditing system they might be using MOA but that doesn't form part of their care management system and so there's kind of this trade-off right in terms of having this all in one but maybe doesn't do everything very well versus best of breed but now I've got all these fragmented systems and so really that's the problem that all the challenge that Avaran is trying to solve. There hasn't been before this I don't think there's been this kind of amalgamation that we're attempting to do but this will save you know a lot of operational pain points but it also unlocks a lot of potential in terms of how information can come together to drive and improve care.
[01:22:04:22 - 01:22:19:01]
Speaker 1
So let's talk a little bit about the vision for Evaran in terms of you know a common data layer across the different software platforms that are operating there. What is the level of interoperability going to be like?
[01:22:19:01 - 01:22:20:00]
Speaker 2
Yeah so
[01:22:20:00 - 01:22:58:08]
Speaker 2
there will be full interoperability but I think even before we get there I don't think we can understate the value in consolidating systems just from an operational perspective. I mean providers need to do you know technology risk assessments they need to you know assess security posture of their vendors setting up and managing logins and users whether that be through SSO or something else. So even just before you get to those downstream benefits of the data coming together there are a lot of operational benefits to having you know one consolidated organization that can serve a lot more of your technology needs.
[01:22:59:16 - 01:24:23:17]
Speaker 2
After that when we start to talk about well what are the you know future benefits well I think that's where I'm really that's something I'm really excited about I think there's tremendous opportunity to start to bring data together around sort of what's happening at the individual resident level bring that together into predictions about the future for that home helping groups to maybe understand where risk exists in their organizations and then within the organization right down to the individual level. So across the using some Australian data at the moment across health metrics and and MOA we've been able to build out prediction models so what is the probability that someone will experience functional decline next quarter and we use current information and status about that individual person and then we can aggregate that up so as a summoning governance I've got a really macro view around how much risk exists across different locations or different homes and then if I'm at the service level that data gets translated to me in terms of what risk profile does this individual person have but also what are the risk factors that are driving increased or decreased risk within that person because some things will be protective of course women tend to fall less than men do in a care home so being female in that instance is protective.
[01:24:25:09 - 01:24:35:01]
Speaker 1
And for the individual service user mapping their journey perhaps from home care to retirement living to care home
[01:24:36:03 - 01:24:42:14]
Speaker 1
where are we at in terms of interoperability for them so a single care record that is shared across different agencies?
[01:24:42:14 - 01:25:07:00]
Speaker 2
Yeah so there's certainly that is an underlying objective of what we're doing here and bringing these systems together to make that information journey more seamless so that is part of I guess the pitch for Aviren to bring those things together so that as people move through their care journey their information flows through as well.
Yeah so at the moment MOA has been fairly agnostic in terms of the other software providers that it works with so I know in the UK you're working with CareLineLive but you're also working with a number of other I'd say CareLineLive competitors that's all good and I know in Australia you're not just working with eCase. What's the plan going forwards?
[01:26:16:09 - 01:26:17:08]
Speaker 2
Yeah that's right
[01:26:17:08 - 01:26:46:03]
Speaker 2
I mean I think at this stage the plans continue being agnostic and working with our partner providers to support them in getting the most from the system and that if that means integrating either with a different care management system or as is increasingly the case their own data warehouses because a lot of the times now these bigger providers are bringing their own sort of data layer themselves and so we're interacting with that so my view is that that will continue.
[01:26:49:12 - 01:26:49:21]
Speaker 1
For
[01:26:49:21 - 01:27:07:21]
Speaker 1
providers that are looking for an all-in-one software solution and I know there were a lot of them on the market that claim to be all-in-one what would you suggest they are what questions should they be asking what should they really be looking for amidst the claims that are made for different platforms?
[01:27:07:21 - 01:27:08:20]
Speaker 2
I think
[01:27:08:20 - 01:28:10:21]
Speaker 2
providers are getting really good at asking very insightful questions about what their expectations are and how they should work. I'd encourage any provider that's looking to do an assessment to get down into the functional detail of the requirements and things you need it to do and there are obviously great consultants that can help with that but also speak with other providers. I know you know something like quality and governance I've always admired that it's not really a competitive sort of field among providers because I think every person providing care is there because they want to ultimately improve the life of someone else and so when you talk about quality of governance I find people across those teams across organizations will be very helpful and share here's our functional requirement list that we had but also speak to the vendors and say well you know tell me why you think it is what you do is so much better and that you can offer and decide whether or not that's a critical factor for you that you want to put in your functional requirements as well.
[01:28:10:21 - 01:28:38:20]
Speaker 1
We find at CareLineLive we often are given a list of functional requirements these are more from enterprise larger organisations and it's kind of sometimes a little bit the moon on the stick and you're like oh my word I don't think there's any software platform out there that delivers all of that and so for providers it's that okay what are we going to have to compromise on here because not you know one provider isn't gonna do everything I guess we're getting there with Evaran.
[01:28:38:20 - 01:28:40:04]
Speaker 2
Well that's the hope
[01:28:40:04 - 01:29:13:00]
Speaker 2
I think and you know there's you know there's still an evolving roadmap for Evaran as well so it's not a case of just bring these together and stop there we know there are other requirements that people have that will be looking to build out more capability over time but I think yeah look there's nothing wrong with starting with a wish list but you know I think people working in care also know how to be pragmatic and and so it's a case of well what's a requirement versus what is a nice to have and yeah.
[01:29:14:00 - 01:29:21:14]
Speaker 1
Yeah and asking for those feature requests as time goes on and seeing if you know the software will develop along those lines.
[01:29:21:14 - 01:29:22:07]
Speaker 2
Yep.
[01:29:33:13 - 01:29:40:15]
Speaker 1
what was the problem that MOA was originally put in place to solve in social care?
[01:29:43:01 - 01:30:26:02]
Speaker 2
It was being able to demonstrate compliance with regulatory standards and I mentioned earlier this idea of quality posture I think quality posture tends to start with compliance we're doing what we are legally required to do and so I think that was the starting point we're auditing that our policies are consistent with the requirements and then we're observing practice are we doing what we say we should be doing in our policy at a very sort of basic level I think you know we've evolved through there as governance and quality systems and that approach has become more sophisticated over time we've evolved with that.
[01:30:27:03 - 01:30:31:23]
Speaker 1
how different is what you've built in MOA now to what the original vision was?
[01:30:33:01 - 01:31:47:20]
Speaker 2
Probably quite different so I think you know audits are very small component of what we offer now we offer a scheduled program of audits that meet the regulatory standards of the particular jurisdiction so whether that be in England or New Zealand or Australia that's certainly broadened in scope so within our standard sort of tools we'll have audits but we'll also have quality indicators and in Australia also the National Quality Indicator Program surveys and then those will bundle directly into a digital plan for continuous improvement and so that as the Commission changed their posture from a more compliance to a more improvement the next piece of information they really wanted to see was that variably called in different jurisdictions continuous improvement plans action plans quality improvement plans plan for continuous improvement so that having that all documented properly became their focus and so we found that where they found any gaps or they found any flags across those reports of the self-assessment tools they could push that instantly into an improvement action and basically start to demonstrate that improvement cycle.
[01:31:47:20 - 01:31:49:12]
Speaker 1
Let's
[01:31:49:12 - 01:31:53:17]
Speaker 1
talk CIW and CQC taking it back to the UK.
[01:31:53:17 - 01:31:54:08]
Speaker 2
Yep.
[01:31:54:08 - 01:32:02:13]
Speaker 1
So I guess you know one of the key aims of any provider is to get that outstanding inspection.
[01:32:03:22 - 01:32:09:04]
Speaker 1
How does MOA help with that? Does working with MOA kind of guarantee that?
[01:32:09:04 - 01:32:10:04]
Speaker 2
Well
[01:32:10:04 - 01:33:25:05]
Speaker 2
I don't think you know a system or can ever guarantee something like that but what it can do is enable a really robust process around continuous improvement and so you know my conversations that I've had with the CQC is there's a real that they're at that stage where there's a real desire to see okay we're doing the work in terms of our assessments and we're auditing but how we actually translating that information into an opportunity for improvement and then how we actioning that and holding ourselves accountable to what success looks like in that action and so you know that whole process can be managed very cleanly end-to-end you can demonstrate where the problem was found what we plan to do about it what the outcome looked like in terms of whether or not it was successful and then evaluate that down the track and that all happens within the workflow I think any good system in a sector that is you know really challenged for time it's really important to get the workflow right and so embedding it in a sensible workflow we'll be able to help them put them in good stead and for demonstrating that.
[01:33:26:04 - 01:33:28:19]
Speaker 1
Let's talk about benchmarking.
[01:33:28:19 - 01:33:29:04]
Speaker 2
Sure.
[01:33:29:04 - 01:33:39:06]
Speaker 1
Because you are using data from other providers to help your customer providers benchmark their performance how does that work?
[01:33:39:06 - 01:33:40:03]
Speaker 2
Yeah that's
[01:33:40:03 - 01:34:27:09]
Speaker 2
right so the premise is that in any area particularly something like you know if we if we talk about falls among older people that's something that's going to occur and so the question doesn't become whether or not you we're not aiming for zero we're not aiming for zero pressure it's just not a realistic goal and so the question becomes well are we seeing more than we expected to see based on like services to ours and so what benchmarking enables and that's obviously done confidentially between providers but it allows you to get a picture of not just whether or not you're higher or lower than your own historical performance but whether or not how you compare across the sector.
[01:34:27:09 - 01:34:37:09]
Speaker 1
So that will give a provider a degree of confidence when they're going into inspection that you know we're we're above the industry kind of benchmark here so we should be
[01:34:37:09 - 01:34:37:17]
Speaker 1
okay.
[01:34:37:17 - 01:35:04:03]
Speaker 2
Yeah for something like auditing obviously you want to be above for adverse events something like falls you want to be below so yes it gives you you a degree of confidence. The other point I'll make with that benchmarking is we'll flag them relative to some underlying rate which is our benchmark but we'll also flag whether or not someone's significantly lower than we expected because under reporting and lack of information can also be quite problematic.
[01:35:04:03 - 01:35:05:09]
Speaker 1
And are you
[01:35:05:09 - 01:35:13:01]
Speaker 1
giving pointers as to what a provider can do if their indicators are suggesting that they're not performing as well as they could?
[01:35:13:22 - 01:35:18:07]
Speaker 2
I think if there's a particular indicator generally
[01:35:19:10 - 01:35:34:04]
Speaker 2
we'll provide broad recommendations about the kinds of strategies that you put in place and that exists within both the audits and the quality indicators within MOA. We also have an AI assistant to help co-design improvement actions as well.
[01:35:37:18 - 01:35:45:13]
Speaker 1
philosophical question here if you could change one thing about how quality is currently measured in the sector what would that be?
[01:35:46:16 - 01:35:49:00]
Speaker 2
I think there's probably too much...
[01:35:50:07 - 01:37:14:13]
Speaker 2
the challenge that I have as an epidemiologist is obviously I want as much data as possible but I think there's probably an over-reliance on information documentation and so whilst I think all that data is necessary I think we need to focus our attention on how we make the capture of that information more seamless and easier. One of the other pieces that I'd really like to see is quality can sometimes be viewed at a governance level or at an organizational level and quality of course is everyone's responsibility but what we're not doing very well is returning value to the care worker and so things like data quality really depend you know it's often viewed as a compliance piece and so you know have they entered the information piece that they were supposed to whereas if you start to say once you've given me this information here's the value I can provide to you as a care worker so that you can do your job more effectively or better understand how risk is this within your client list that becomes a very different proposition and I think if people see the benefit they're gonna straight away realize if I put in the wrong value I put in the wrong information I'm not gonna get the right value back to me and so that's something that I'm really interested in ramping up in terms of how we return value to the person at the front line that's responsible for entering the information.
[01:37:14:13 - 01:37:15:08]
Speaker 1
So
[01:37:15:08 - 01:37:21:22]
Speaker 1
much more joined-up approach between management carers and the people receiving care.
[01:37:21:22 - 01:37:22:13]
Speaker 2
Yeah and
[01:37:22:13 - 01:38:05:11]
Speaker 2
recognising that there are different information requirements across those levels so the board doesn't necessarily you know of a large organization doesn't necessarily need to know that you know Denny Smith refused away but you know what does that look like across my organization is their systemic sort of issues that I need to solve for yes they need that information but if we can return different use the same data and create more value from it by sharing it in different ways to different audiences I think that will open up you know a better conversation around quality because it'll support better data and better information across the whole organization.
[01:39:52:13 - 01:40:09:20]
Speaker 1
Let's talk about quality assurance in a little bit more detail now what should be expected of roles in quality assurance and quality improvement what kind of skills and experience should providers be looking for in fulfilling those roles and how do software tools that MOA help with it?
[01:40:09:20 - 01:40:10:11]
Speaker 2
Well
[01:40:10:11 - 01:41:16:04]
Speaker 2
I think in some ways your questions framed it really nicely because I think we've traditionally taken quality assurance and compliance kind of separately to quality improvement and the challenge is that now the expectation is all that information works together to drive better care it can be challenging because the type of people that are really compliance focused tend to be quite structured in the way things are done and quality improvement sort of necessitate sometimes thinking outside the box a little bit of creativity and so I think you know structuring a team or people resources within those teams to be able to consider both sides of because they are you know two sides at the same coin in terms of we're both here ultimately to ensure that the care we deliver is of high quality and so I think recognizing that the traits that can make someone really good at the compliance piece can sometimes close them off from the improvement piece but I think getting a mix of skills is the right approach.
[01:41:19:00 - 01:41:19:03]
Speaker 1
So
[01:41:19:03 - 01:41:48:15]
Speaker 1
reading through some of your LinkedIn pieces that you've written in the last few months and I would recommend to people to follow you on LinkedIn because it's a little bit of a left field view beyond the normal marketing things that I would be writing I really like that more sort of academic side that you bring to the discussion but you have said in some of your pieces recently that improving care outcomes requires more than meeting regulatory requirements can you explain your thinking on that a little more?
[01:41:48:15 - 01:42:45:06]
Speaker 2
Yeah I mean I think meeting regulatory requirements is the bare minimum right and so that's saying we're doing exactly what we're supposed to do and potentially no more and so I think it's how do we bring all those other bits of information and and so through something like the National Quality Indicator Program in Australia teams that are up until that time being relatively separate so clinical sort of quality teams through to you know survey type questions that might have been in a customer experience kind of team are forced to sort of come together likewise with workforce data and the like and build a picture of how the provider is doing so yeah I think it actually requires a much more multifaceted view than just thinking purely about meeting regulations.
[01:42:48:05 - 01:43:08:09]
Speaker 1
So you've talked before about the quality continuum as a spectrum of compliance and continuous improvement what you see is the role of regulators in this continuum and what should providers be doing beyond just ticking the boxes?
[01:43:09:16 - 01:43:10:07]
Speaker 2
Yeah
[01:43:10:07 - 01:43:29:00]
Speaker 2
I think quality is tricky because it's a pretty broad concept and I think regularly that regulators are increasingly understanding that and so they are looking for quite different bits of information in order to build a full picture of how providers are doing.
[01:43:30:18 - 01:44:18:10]
Speaker 2
Something like you know quality indicators they're sort of serving let me think how to phrase this a regulator is sometimes serving multiple purposes so they're serving the needs of what is a significant payer typically your government and your taxpayers and they're serving the needs of the people receiving care and then to some extent they're supporting the providers to get better and and and provide better care. Those goals can sometimes work together really well but other times there's a differing view on what constitutes good quality so almost anyone that interacts with health care or social care they will view good care as good outcomes.
[01:44:19:13 - 01:44:51:00]
Speaker 2
Most people delivering care will view good care as good practices and process and then the payer will generally look to optimise both recognising that sometimes those things don't necessarily go hand in hand. So it's difficult but I think by tracking multiple bits of information across things like feedback, improvement activities, audits you can build a full picture and I think regulators are doing that.
[01:44:52:13 - 01:44:52:15]
Speaker 1
It's
[01:44:52:15 - 01:45:07:12]
Speaker 1
interesting that you bring up the subjects of who's paying because in the UK we have huge pressure on social services budgets at the moment and you know the hourly rate that some of them are prepared to pay providers is quite shockingly low.
[01:45:08:15 - 01:45:14:02]
Speaker 1
Where does quality sit in in that spectrum really?
[01:45:14:02 - 01:46:05:00]
Speaker 2
Look it's an uncomfortable conversation but you know we have to have a conversation about how much we're willing to pay and what sacrifices we're potentially willing to make to other spending in order to get care delivered to the standard that we want it to be. There's no getting around the fact that you know good care costs money and so like with any kind of expenditure it needs to be rationalised in terms of how much we're spending and how much value we're creating within that system. You know I think there's a very strong sort of moral imperative in social care but we also need to recognise you know financial constraints and so how do we deliver optimally in those systems at low cost.
[01:46:05:20 - 01:46:24:06]
Speaker 1
And to put my marketing hat on having chatted to different providers that have used systems like CareLineLive and MOA they are saying well we are saving time in terms of staff time whether that's office based staff or carer staff because of the efficiencies that the software can bring.
[01:46:24:06 - 01:47:33:20]
Speaker 2
Yeah that's right I mean manual processes I mean manual writing of audits, manual documentation you know those last-minute scrambles can cost an enormous amount of money in terms of preparing for an inspection. We also see the UK tends to have a little bit of a reactive approach to waiting until they'll get some feedback and then remediating a problem right and so the cost of remediation of any sort of problem in care tends to be quite high and so it can be difficult to rationalize well we're paying to prevent that problem that you'll remediate later from occurring at all and so that can be difficult because it's viewed as expansion now but operationally you know there certainly can be savings if you know people are required to maintain these systems and maintain audits and tracking and Excel documents and then bring all this information together there is a cost to that and I don't think people necessarily fully appreciate that there is a cost to maintaining all those things.
[01:47:35:10 - 01:47:41:01]
Speaker 1
For the three kind of areas of care, home care,
[01:47:42:13 - 01:47:55:07]
Speaker 1
retirement living, residential care where are they in terms of quality and compliance and their use of technology are they all at a similar level or do you see differences between those three areas?
[01:47:55:07 - 01:47:56:00]
Speaker 2
I'm
[01:47:56:00 - 01:50:35:01]
Speaker 2
all very different so retirement obviously is effectively independent living and so there's a the focus to the extent that there is a focus on quality it's focused less on care and more about experience and so you know if we talk about the old sort of framework of quality from Donobedian you know the structure process outcomes outcomes often includes experience sometimes it's at its own domain so it sits in that experience domain you know these are typically able-bodied independent people what we are seeing though is increasingly retirement living providers are also acting as home care providers within their retirement villages and so this now opens them up to potentially the quality approach in home care and so are we delivering the care and supports that people need to a high standard. Home care is obviously really tricky because you've got a decentralized workforce providing care in other people's homes or retirement villages and so it can be really difficult for those process things because there isn't the capacity or power to observe how care is delivered and so yeah it will focus a little bit more on documentation and that the process of care in terms of documentation is correct. Residential is the most sophisticated obviously we've seen an increase in acuity typically of people entering so people are entering later in life at higher acuity and so they are becoming you know quite clinically focused in terms of you know medication you know you can have dialysis so yeah they're much more sophisticated in terms of that captured environment in terms of and there's more so in a residential environment there is an accountability to outcomes when you're dealing with a home care client that potentially is only seen a few hours a week to what extent is the provider accountable for adverse outcomes to what extent is their local GP responsible to what extent is there other supports that they might use responsible so that attribution problem when you're asking about what the quality of services is really challenging and really difficult to unpack it it's something the Australian government is struggling with at the moment because they're looking at how they might be able to introduce something similar to the National Quality Indicator Program we have for residential into home care and it's going to be very very challenging to do that because of that attribution challenge.
[01:50:36:19 - 01:50:39:23]
Speaker 1
Do
[01:50:39:23 - 01:50:50:15]
Speaker 1
you feel that there's a tension between what care providers are focused on and what care recipients would like to have be emphasised?
[01:50:54:01 - 01:51:50:10]
Speaker 2
Probably yes I mean I think I alluded to a little bit before in the sense that people receiving care tend to be very focused on outcomes and experience right so am I having a good experience of care and did I get my desired outcome and so that you know in a residential care you know if I look at feedback the most common feedback for people using MOA feedback and complaints is around food so food is a big part of their experience right in in terms of living in an environment if I went through and looked at where the quality improvement activities were in our care home I can guarantee that will not be the highest category of where they're drawing their attention and so they're much more clinically focused they'll tend to be much more processed focused on on how they deliver care less focused on probably the things that are coming up for residents.
[01:51:52:04 - 01:51:54:15]
Speaker 1
So you mentioned Donabedian?
[01:51:54:15 - 01:51:55:01]
Speaker 2
Yes.
[01:51:55:01 - 01:52:05:00]
Speaker 1
Okay the framework there do you want to walk us through that in a little bit more detail and explain why it's still so relevant such a long time after it was developed?
[01:52:05:00 - 01:52:05:21]
Speaker 2
Yeah so
[01:52:05:21 - 01:53:33:02]
Speaker 2
it was a Hungarian potentially but physician that emigrated to the United States he proposed a framework by which we could consider measuring quality and so he came up with these three domains which are structure, process and outcomes and so structure includes things like the physical equipment required to do my job but also people do people have the right skills qualifications do I have enough care minute time available to me to deliver the type of care I want so that's sort of the structure piece and the process piece is am I doing what I'm supposed to be doing effectively it is what we are doing aligned with what we know should be best practice aligned with our policies so there's that process piece and then the outcomes pieces you know are the people receiving care happier do they have less adverse events that end of the spectrum and so providers tend to you know if I'm looking at a really macro level if I'm looking at government level they'll focus on things like care minutes and so they're in the structure and then the providers themselves and care workers will tend to focus on process I've done what I'm supposed to do the outcomes I can't control and then people receiving care tend to focus on outcomes outcomes broadly considered to include experience but sometimes referred to as its own domain and so that's you know things like satisfaction surveys and the like
[01:53:33:02 - 01:53:34:21]
Speaker 1
how
[01:53:34:21 - 01:53:40:06]
Speaker 1
would you respond if a provider says well we did everything right but we still had a poor outcome
[01:53:40:06 - 01:54:43:01]
Speaker 2
well that is of course possible and so one of the things that we do at MOA is how do you make outcomes comparable after considering differences in the people receiving care because what drives different outcomes despite following the same process is going to be variability of the individual person receiving care and so we focus on case mix adjustment or risk adjustment to better allow for those comparisons to be made fair so we've built out a few models already that are predicting what is the expected probability because I know this person has a different risk profile to this person and then we can use those data to compare to what actually happened after accounting for all those differences at the individual level and we can come up with a much fairer comparison and say well yes you did have worse outcomes but that's explained by the fact that you have much more complex people that you're caring for.
[01:54:43:01 - 01:54:44:10]
Speaker 1
So
[01:54:44:10 - 01:55:02:20]
Speaker 1
you've got me thinking on a complete tangent now about the people behind MOA I've kind of got this picture of scientists and epidemiologists in a room modelling and looking at data and looking at algorithms as well as the developers. What does it really look like?
[01:55:04:02 - 01:56:50:17]
Speaker 2
So we have a couple of data well a data scientist and a data analyst and myself but we also you know I have a network of researchers and other epidemiologists a couple of the largest providers in Australia also have their own research teams within the organisations and so we're working in collaboration with one of them at the moment on a research project and so essentially it's you know what are reasonable questions to ask having all this data what's a reasonable question that we can ask of the data and sometimes those things can be dead ends you know they don't lead to a particularly interesting insight. I remember one time we looked at satisfaction and and this quality of care experience sort of survey and I wanted to ask I said I wonder if people answered it on you know a day where they had nice weather whether they'd be generally happier right and so we mapped every single home that it responded we linked them to the nearest weather station so we downloaded weather station data we you know had little factors to consider whether it was raining whether what the temperature was those kinds of things and then sort of classify them as good or bad weather and looked and that showed us that it made absolutely zero impact at all so it was a lot of work linking them together but that's okay because it means that I can be more confidently saying to someone that asked well you know it's raining and probably here and that makes everyone happy I can confidently say that isn't the case and the data doesn't support that and so sometimes those null findings can also help us to be more robust in our conclusions in other areas.
[01:56:50:17 - 01:56:51:12]
Speaker 1
What
[01:56:51:12 - 01:56:56:11]
Speaker 1
research pieces have you worked on where you've been surprised by what you've found?
[01:56:57:19 - 01:56:59:21]
Speaker 2
Oh that's a good one um
[01:56:59:21 - 01:57:54:12]
Speaker 2
I don't know that I have seen that surprise by what I've revealed like and I think it's important that you know good research will lots of different research happens in social care and and you know we often know what the association is between say polypharmacy and and falls but what isn't sometimes clear is the magnitude of those associations and so it's important to me when we're doing research that there is good face solidity if we're showing something that's radically different to what clinicians understand of risk factors that would probably be quite concerning and I think it's probably nicer these you know algorithms and predictive models we're building now actually confirm a lot of those associations but they go a step further by quantifying them as well.
[01:57:56:04 - 01:58:02:14]
Speaker 1
[01:58:02:14 - 01:58:19:21]
Speaker 1
one of the things that I picked up from one of the papers that you'd written was that you were concerned that best practices are derived from research that may not reflect the diversity of aged care recipients today. How big a problem do you think that is in practice?
[01:58:23:20 - 01:59:38:08]
Speaker 2
Well yeah I mean I think it is a problem if research studies don't reflect the population they're being applied to and we see that come to fruition in clinical trials where they've potentially tested them in you know fairly monolithic population so drug trials and then we find these risk factors or adverse events that we weren't expecting when applied to other populations so that's obviously a pretty serious manifestation of that type of thing. It's probably less risky in terms of social care but for instance you know the kinds of things we're doing are more health services type research so how does this exercise mobility program impact the risk of falls and so if we're only to do those in very small studies only in quite homogenous populations well do we understand the acceptability of this brace or this activity in different cultural populations for example and so I think it's it's important to be mindful that what have been traditionally pretty small studies may not be applicable or work in all other populations.