While new standards are on the horizon, current regulations remain in effect, and compliance is still required. One key aspect of this is the Self-Assessment process. To help you stay on track, here are some practical tips for navigating your Self-Assessment effectively.
The Commission defines self-assessment as an "active process", closely linked to planning and ongoing improvement efforts. Issues or opportunities identified during self-assessment should be included in the organisation's plan for continuous improvement (PCI).
Advantages of the self-assessment
Self-assessment can often be viewed as a tedious task, but when integrated into the organisation's strategic operations, it becomes a valuable tool for driving continuous improvement. It helps to evaluate and report on the care and services provided while ensuring that improvement is ongoing.
When done thoroughly, a self-assessment offers a transparent and honest evaluation of how well an organisation meets the Standards. It's also a mandatory requirement, as the Commission may request it during site visits, accreditation, or other assessments.
Self-assessment can be a powerful management tool for:
- understanding the quality of care and services delivered
- reporting and evaluating outcomes for older people, staff, and the organisation
- identifying opportunities for innovation and improvement at both a systemic and individual level
- fostering a culture focused on quality and safety
- communicating the organisation’s performance and risks to the governing board
- initiating changes based on areas needing improvement.
Self-assessment should involve input from a variety of staff members across care and service areas. This collaborative approach ensures that everyone understands the Standards and commits to continuous improvement.
Tips for writing the self-assessment
- Review and understand the Standard, the linked Requirements and what is expected.
- Use the reflective questions detailed in the guidance documents and linked to each Requirement to assess as well as challenge this understanding further.
- Remember the Standards are expressed in three ways and this needs to be included in the self-assessment. These are:
- a statement of outcome for the older people
- a statement of expectation for the organisation and
- organisation requirements to demonstrate that the Standard has been met.
- Use the examples of actions and evidence detailed in the guidance documents and linked to each Requirement in writing the self-assessment document, as well as to identify opportunities for improvement.
- Document the actions and evidence areas of the self-assessment systematically so you don’t miss any of the organisation’s achievements or opportunities for ongoing improvement. This can be accomplished through:
- considering current policies and procedures linked to the Standard and the Requirement. Reflect on linked practices that demonstrate how care and services are provided. This may also include partnerships with other professional and community organisations
- detailing of workforce learning as well as competency and capability systems and achieved outcomes. Consider formal and informal learning, orientation processes and management support and review across these systems
- summarising evaluation and review processes and outcomes. Reflect on how this occurs e.g. audit, performance indicators and other quality review tools, as well as the outcomes and results achieved for older people and supporting evidence. This information is a strategic part in the identifying of areas for ongoing improvement and required actions
- explaining reporting and communicating outcomes and review results, including who receives this information, and related responsibilities. The review of results and outcomes needs to be regarded as a measure of past performance and an opportunity for improvement.
Making self-assessment an active process
Revisit your organisation’s self-assessment and explore the advantages it offers. Make it a collaborative and dynamic process that truly benefits your operations and drives continuous improvement.
Click here to access the Self-Assessment Tool - Aged Care Quality Standards.
Authors
Nicole Chen
Nicole is a Principal Consultant at Ideagen CompliSpace with a background in the healthcare industry across acute, aged, and community services. Throughout her career, she has held various management and clinical positions, contributing significantly to both research and higher education within the sector.
Nicole provides valuable knowledge and insights from both a clinical perspective and a nuanced understanding of the operational and strategic aspects of healthcare. She holds a Doctor of Philosophy (PhD), a Postgraduate Certificate and a Bachelor in Nursing.
Nick Edwards
Nick is a Legal Content Senior Associate at Ideagen CompliSpace. Nick has several years' experience designing and administering eLearning for the Aged Care Sector and holds a Bachelor of Laws from the University of Technology Sydney with First Class Honours.