ORCID Profile
0000-0003-4958-0811
Current Organisation
UNSW Sydney
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Publisher: Wiley
Date: 23-08-2023
DOI: 10.1111/AJAG.13132
Abstract: In Australia, temporary agency workers are a relatively small but enduring component of the residential aged care workforce. However, evidence from other countries suggests reliance on agency workers has a detrimental effect on the quality of care (QoC). We examined whether QoC outcomes differ for Australian residential aged care facilities (RACFs) based on their reliance on agency care staff. A retrospective observational study was conducted using de-identified datasets obtained under the legal authority of the Royal Commission into Aged Care Quality and Safety. Regression analysis was conducted using data comprising 6221 RACF-year observations, across 5 years (2015-2019), from 1709 unique RACFs in Australia. After controlling for other determinants of QoC, RACFs with a greater reliance on agency care staff have poorer QoC outcomes, with significantly higher rates of complaints, missing persons, reportable assaults, hospitalisations, and accreditation flags. Consistent with international evidence, we found that the QoC of Australian RACFs is sensitive to the reliance on agency staff in delivering direct care to residents. These findings illustrate the importance of workers' employment conditions, alongside other workforce characteristics, in driving the quality of residential aged care.
Publisher: SAGE Publications
Date: 21-07-2022
DOI: 10.1177/03128962221109279
Abstract: This article examines the influence of business model workforce configurations on value creation and capture in a skills-based service setting, extending previous research on business model performance. We investigate workforce configurations (higher versus lower stability and skills) and value creation and appropriation in aged care organisations. More skilled and stable workforces are associated with greater value creation but not appropriation, while less skilled and less stable workforces are associated with lower value creation and higher appropriation. This informs a substantive challenge in delivering value creation while ensuring financially viable business models in a sector with significant consequences for quality failure. JEL Classification: J24 - Human Capital • Skills • Occupational Choice • Labor Productivity L2 - Firm Objectives, Organization, and Behavior M12 - Personnel Management I11 - Analysis of Health Care Markets
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4349248
Publisher: Informa UK Limited
Date: 03-03-2023
Publisher: Emerald
Date: 18-02-2019
DOI: 10.1108/AAAJ-11-2017-3223
Abstract: The purpose of this paper is to reframe the debate about the tension between management control and employee empowerment by drawing on a theory of paradox. Reframing the problem in this way draws attention to the variety of ways in which organisations can attend to both control and empowerment simultaneously. The authors undertake a conceptual examination of the relationship between empowerment and control using a paradox theory lens. First, the authors bring together two dimensions of empowerment – structural empowerment and psychological empowerment – and combine them to produce three new empowerment “scenarios”: illusory empowerment, obstructed empowerment and authentic empowerment. For each of these three scenarios, the central tenets of paradox theory are applied in order to explain the nature of the paradoxical tension, anticipated behavioural responses and the resulting challenges for ongoing management control. The authors find that neither structural nor psychological empowerment alone can account for variation in behavioural responses to management control. The conceptual analysis highlights the interplay of socio-ideological control and systems of accountability in generating psychological empowerment and demonstrates that this does not come at a cost to management control but instead results in a reduction in the scale and scope of ongoing challenges. This paper contributes a new theoretical perspective on the classic problem of tension between management control and employee empowerment. Rather than positioning control and empowerment either as a managerial choice or dialectic, the authors identify three different ways in which organisations can engage with both paradoxical elements simultaneously.
Publisher: CSIRO Publishing
Date: 05-10-2021
DOI: 10.1071/AH21160
Abstract: Objective To compare the historical staffing patterns and organisational characteristics of Australian residential aged care facilities (RACFs) against the new minimum staffing standards recommended by the Royal Commission into Aged Care Quality and Safety (RCACQS). Method Retrospective data analysis was used to compare the staffing levels and characteristics of 1705 RACFs (for 4 years, 2016–19) with the three new mandatory staffing requirements. De-identified datasets were provided by the RCACQS, obtained under its legal authority. Results Only 3.8% of RACFs have staffing levels at or above all three requirements. Although many (79.7%) already meet the requirement to have a registered nurse (RN) on-site for morning and afternoon shifts, few have staffing levels above requirements for total direct care per resident per day (10.4%) or care provided by an RN per resident per day (11.1%). Historical levels of on-site RNs, total direct care, and RN care vary significantly across facilities of different size, location and provider scale. Conclusion The new staffing standards, to be mandatory by 2023, prescribe minimum requirements significantly higher than existing levels, particularly in care per resident per day. Each of the three requirements will likely have a differential effect for different types of RACFs. What is known about the topic? International evidence suggests that introducing mandatory minimum staffing standards tends to increase the amount of care provided by staff in residential aged care facilities (RACFs). However, the impact of staffing standards is influenced by the stringency of the minimum threshold relative to existing staffing levels, the capacity of organisations to increase their staffing levels, and the specific way the regulation is formulated. What does this paper add? This paper explores the potential implications of the three national minimum staffing standards, to be in force by October 2023, specifying total direct care, care received by a registered nurse (RN), and an RN on-site. By examining the existing staffing levels of Australian RACFs, it identifies the extent to which facilities already meet the new standards and the characteristics of facilities with staffing levels above and below the three requirements (in idually and in combination). What are the implications for practitioners? The study informs both policy and practice in relation to the likely effects of implementing the national minimum staffing standards for residential aged care in Australia. It demonstrates that the new minimum thresholds are likely to require substantial increases in staffing across the sector, both in terms of all direct care workers and RNs. It also shows that the three requirements are likely to have a differential effect for RACFs of different size, location and chain affiliation, thereby guiding policy about the future needs for Australia’s aged care workforce.
No related grants have been discovered for Rachael Lewis.