The aged care sector

Caring for the aged is demanding, both physically and emotionally. Services are needed on a 24-hour basis. Duties include heavy lifting and meeting personal needs, and death and grief must be coped with on a regular basis. Historically under-funded, many positions in this sector are "low skilled", and consequently, pay has been low compared with the other health care sectors.

Changing societal and demographic trends have also meant that the work has become even more demanding. Overall, the population has a longer life expectancy, and people typically access aged care services in a more dependent state compared with previous generations. Labour shortages are a problem; there's a particular need for individuals with a mix of operational skill and management experience.

Legislative changes, such as enhanced Holidays Act provisions and the introduction of health care standards for aged care services, has meant increased costs and compliance requirements. An accreditation programme was introduced by the Ministry of Health in 2004 to help providers show compliance with the new standards. While the process of preparing for accreditation is described as stressful and time-consuming (it takes two years), it does offer providers a way of attracting residents and supporting more stable occupancy rates.

Internal factors: the Aubert Home of Compassion

When the project began, it was evident that a number of negative factors specific to Aubert had exacerbated the pressures of the sector and contributed to the development of negative workplace relationships.

For instance, Aubert had a unique governance and management arrangement, which was hierarchical in structure and style. Prior to the partnership project, information sharing in Aubert tended to be upward from staff to the manager and to the Board. The governing Board was relatively invisible to most staff. The problems with information flow were highlighted when Aubert sought to be re-accredited. Recognising this, the Board hired a consultant to work with the manager on the re-accreditation process. However, while the Board received additional information via the consultant, the level and regularity of information shared with staff did not change.

The continued hierarchical upward style of communication created a sense of distrust and anxiety among all staff. While the Board itself was aware and concerned about increasing pressures on staff, staff viewed the Board as invisible, obstructive and unsupportive.

The nature of the care and duties required to support residents also contributed to a level of workforce duality and multiple workforce cultures. Two dualities were evident: rest home versus hospital staff, and caregiving versus other services.

The two types of care - rest home and hospital - are separated by the physical layout of the home. Rest home care is upstairs, while hospital care is downstairs. Hospital care tends to be more demanding, with the more fragile residents in care. Hospital staff tend to work more cooperatively, and it is seen as more rewarding work. The rest home residents are more independent. Rest home staff tend to work more autonomously and felt isolated compared with their team-spirited hospital counterparts.

Another duality existed between the different occupations and level of contact with residents. Caregiving staff are qualified professionals, usually employed in permanent full-time positions, and have regular direct and ongoing interaction with residents. A number of other staff, such as kitchen, cleaning and maintenance staff, provide other critical, but less direct, services for residents. They tend to be lower skilled and more likely to be employed casually or part-time. Their work is also more time pressured and repetitive, and the staff generally felt less valued. These differences led to an "us and them" culture.

Like the rest of the aged care sector, Aubert has been affected by the ongoing challenge to find enough suitably skilled staff. It was also becoming apparent that certain employees were engaging in inappropriate and divisive behaviour that fuelled conflict in the workplace.

Supporting factors

Despite the challenges noted above, there are some other factors that actually work in Aubert's favour when it comes to partnership.

For instance, Aubert's founding principles continue to guide and influence the organisation. The home was established 77 years ago by Sister Suzanne Aubert to provide support for the "vulnerable and the overlooked". The eventual inclusion of two Sisters on the current Board has ensured that these altruistic principles would continue to be relevant. The Board members' willingness to address the divisive workplace culture was guided by their awareness that the situation was philosophically inappropriate given Aubert's founding principles and the nature of caregiving work.

Aubert also has a number of long-serving employees. These committed and experienced staff hold an institutional memory of a happier workplace and provide a source of stability. Partnership resonated with their recollections of the past, and these staff were able to informally and positively promote the project's values across the workplace.

Some key staffing changes also contributed to the project's success. These included the appointment of an independent consultant and a new manager (both prior to the project) and a new Board chairperson (during the project). As newcomers, the consultant and the manager were not captured by the workplace conflict to the same extent as current staff. Both were able to create an environment open to change and were committed to building a more positive workplace.

The new chairperson happened to be a long-serving Board member and a local GP who consulted at Aubert. As he was already known and visible to the operational staff, they were more confident that he would be able to communicate their commitment and concerns to the Board.

Motivations for the project

The factors and influences outlined above gave Aubert a number of reasons to want to be part of the partnership project and confront some major issues for the organisation, including the following:

• Limited closed workplace communication: Increasing workload stress prompted staff to report a range of concerns about their working conditions and inappropriate behaviour of other staff. However, the culture of the workplace and the governance and management structures were not conducive to clear and shared discussion about such issues. Staff were frustrated by the lack of full, regular and consistent information sharing.
• Distrust and conflict between staff and management: Wider sector pressures and poor communication saw a significant level of distrust emerge between staff, management and the Board. Staff also tended to bypass managers in favour of talking directly with union organisers.
• Ongoing adversarial relationships: In the 18 months prior to the project, protracted conflicts, formal written complaints and negatively focused union involvement were commonplace. Distrust between union and management also contributed to difficult wage negotiations.
• Negative public profile: Local knowledge of the workplace difficulties at Aubert spread when a staff member approached the local media. A newspaper article resulted in damage to Aubert's reputation, making it difficult to recruit suitable staff and reducing occupancy rates as families became concerned about Aubert's quality of care.
• Demoralised fatigued workforce: The collective impact of all these symptoms contributed to extremely low workplace morale and general fatigue among staff.

Collectively, these factors helped identify a clear focus for the partnership project: to realign the workplace culture and practice with the philosophy and intent of Aubert's founding principles. In August 2006, the "Creating a Culture We are Proud of Project" began.