Fit-for-purpose-The bottom-up redesign of the nursing home system: The Australian Aged Care System.

Nursing homes struggle to meet the needs of their residents as they become older and frailer, live with more complex co-morbidity, and are impacted by memory impairment and dementia. Moreover, the nursing home system is overwhelmed with significantly constraining organisational and regulatory demands that stand in the way of achieving resident-focused outcomes. These issues are compounded by the perceptions of poor working environments, poor remuneration, and poor satisfaction amongst staff.

Systemic failures in nursing home care-A scoping study.

Unlabelled: Nursing homes (also referred to as residential aged care facilities, or long-term care facilities) cater for older people on a respite or long-term basis for those who are no longer able to live independently at home. Globally the sector struggles to meet societal expectations since it is torn between three competing agendas-meeting the needs of residents, meeting the demands of regulators, and meeting the financial imperatives of nursing home proprietors. Competing demands indicate that the system lacks a clear understanding of its purpose-without a clearly understood purpose any system will become dysfunctional overall and across all its levels of organisation.

Complex adaptive organisations: How three-dimensional visualisations can help to understand their structures and behaviours.

Many organisations struggle to achieve their true potential. In part it is a problem of organisational design, which is an outcome of a particularly common-command and control-leadership philosophy. The traditional linear hierarchical structure of organisations suggests that all knowledge and power concentrates at the top organisational layer, and that people in the lower layers need to be told what to do and when.

Measures that matter should define accountability and governance frameworks.

While the Royal Commission into Aged Care Quality and Safety has clearly identified the issues with our Australian residential aged care system, its recommendations-so far-have not been translated into policies that will ensure a framework in which nursing home operators and care staff are empowered to focus on what matters-ensuring vulnerable residents receive care that meets their needs and preserves their dignity. For this to be achievable the system requires measures that in the first instance reflect the system's purpose, and that all stakeholders can use to improve care. Such measures need to be easy to understand and implement, and most importantly reduce bureaucratic burden.

'False accountability': The harmful consequences of bureaucratic rigour for aged care residents.

Background: Public outrage about the treatment of aged care residents in some nursing homes has its origins in a failure in each facility's accountability framework. There is an overwhelming focus on documentation of organisational structures and care processes, detracting from what really matters - whether the wellbeing of residents has been achieved.

Objective: This article examines process- or action-oriented versus outcomes- or interaction-oriented accountability principles and their impacts on aged care residents' care.