Dedicated staff assignment

Category: Organisational leadership and staff development

Arcare Greenhill, Epping, Victoria.

Arcare drew on international research, partnerships with stakeholders, and engagement with their community of residents, families and staff to develop a relationship-focused model of care that was implemented through a Dedicated Staff Assignment (DSA) model, changing the organisation’s staff structure, training and approach to service provision.

The new model allowed closer relationships to develop between residents, staff and families, with survey data showing this was highly valued by the residents and their families. There were significant improvements in a wide range of clinical outcomes.

For staff, there was an increase in reported job satisfaction, and a decrease in both sick leave and turnover. This has meant reduced staffing costs through lower turnover, and a reduction in use of agency staff.

In 2012 Arcare asked residents, staff and families to share their stories, highlighting the things they most valued in terms of living in, visiting and working in Arcare residential homes. Further working groups were then made up of 120 residents, staff and family members to distil these highlight stories into values statements and key quality improvement initiatives.

The power and value of consistent and committed relationships was the strongest theme throughout the conversations. Arcare found that the traditional model of rotating staff throughout the facility, and the infrequency of some staff’s shifts, did not support the development and deepening of these relationships.

So Arcare abandoned the traditional rotating staff roster, and developed a consistent staffing model they call Dedicated Staff Assignment (DSA), applied to all staff including care, nursing, environmental, laundry, and catering.

The two key components of Arcare’s DSA model are:
1.       All staff commit to working at least 3 shifts per week
2.       All staff work with the same small group of residents every time they come to work (100% of the time)

Staff, residents and families all played a role in determining who would be the dedicated carer for the resident, based on resident preferences and staff choices on what area they would prefer to work (high care, low care or dementia specific). Staff were trained in the new approach, and there were ongoing opportunities for staff and residents and families to provide feedback and reassess the arrangements.

Monitoring included ongoing oversight of leave management and recruitment; regular informal small meetings of staff for feedback; three-monthly interviews with individual residents (or family) to check quality of care and relationship with dedicated carers; making implementation an agenda item at site level Management Systems Meetings and on managers’ reports.

The findings showed improved outcomes for residents, staff, families and business.
For residents:
•         90% reduction in pressure injuries
•         69% reduction in respiratory tract infections
•         25% reduction in skin tears
•         13% reduction in falls
•         82% reduction in the number of different staff providing personal care
•         52% reduction in use of PRN psychotropic medication
•         Staff sense of hope for residents living with dementia increased 17%
•         15% increase in the quality of staff-family relationships
•         Focus group results showing resident appreciation of the changed staffing system, with emphasis on personal familiarity and trust.

For family:
•         45% increase in compliments
•         100% decrease in complaints
•         Interview results demonstrating family trust in relationships fostered by dedicated staffing.

For staff:
•         Job satisfaction increased 30% for nursing staff and 20% for care staff, with 100% satisfaction with the new Dedicated Staff Assignment model
•         Interview results indicating greater enjoyment of work and the relationships with residents and families.

Sustainability across the organisation:
•         28% reduction in staff sick leave
•         50% reduction in staff turnover
•         33% reduction in agency staff usage overall, including 100% reduction in dementia care unit
•         Nil WorkCover claims

Dedicated Staff Assignment has now been rolled out in 24 of Arcare’s 26 residential homes across Victoria and South East Queensland.

For more information on this program, contact Daniella Greenwood, email: daniella.greenwood@arcare.com.au or phone: 0434 314 866.