Codesigned framework for organisational culture reform in South Australian older persons' mental health services after the Oakden Report

Abstract

The Oakden Report documented failures in governance, clinical practice and organisational culture occurring at the Oakden Older Persons’ Mental Health Service and drew national attention to the care of older people with complex clinical needs. Responding to the recommendations of the Report, a working group brought together stakeholders to engage in a codesign process involving literature review, gallery walks and focus groups, under the governance of the Oakden Response Oversight Committee. The working group developed a framework as a blueprint for organisational culture reform built around a central philosophy of compassionate relationship-centred care, supported by four priorities: developing a values-based workforce, cultivating psychological safety, facilitating excellence in care and providing transparent accountability. The purpose of the framework was to provide a way forward for South Australian older persons’ mental health services after The Oakden Report, and it may provide insight into similar processes of codesign and culture change in other service contexts. What is known about the topic? Changes to healthcare systems, requiring improved efficiencies and lower costs, are contributing to increasing challenges with staff satisfaction and wellbeing, and consistent delivery of dignified, meaningful care to people and their families. The need to nurture and lead healthcare organisations characterised by compassionate cultures is an increasingly prominent theme in global healthcare literature. The engagement of people with lived experience at all levels of system design supports effective and ethical service development. What does this paper add? This paper illustrates an approach to positive, compassion-focused organisational culture change, developed through codesign, occurring as a reform process following a crisis in service delivery. The paper applies key concepts in a framework that may be applied in a range of services to achieve positive organisational transformation. What are the implications for practitioners? Committed action to develop positive organisational culture characterised by compassionate relationship-centred care will have benefit for healthcare providers and the people who receive care. Keeping people with lived experience at the centre of design and development will support optimal outcomes for all stakeholders.

Everyone matters; everyone contributes; everyone grows: a pilot project cultivating psychological safety to promote growth-oriented service culture after the Oakden Report

“…A cornerstone objective was cultivating psychological safety, consistent with the culture framework. 3 A metaanalysis of psychological safety research confirms benefits in performance, increased learning, engagement, information sharing, workforce interdependence, teamwork, improved satisfaction and commitment. 18 Manley and Jackson identify five features of effective workplace culture, resulting from microsystems change.…”

“…2 The culture framework described a central philosophy of compassionate relationship-centred care, supported by four priorities: developing a values-based workforce; cultivating psychological safety; facilitating excellence in care; and providing transparent accountability. 3 Further, an objective of the South Australian Health Strategic Plan 2017-20 was to cultivate a learning culture, translating learning and innovation into practice. 4 In response to these strategic objectives, the SA DHW partnered with Uncharted Leadership Institute (Uncharted) to design a pilot program delivered at Northgate House, which was established following the Oakden Report, providing 16 placesof-care for people with extreme behaviours and psychological symptoms of dementia.…”