Fronditha Care

Three personal care workers and five nurses trialed three CQI Assistant functionalities for managing continuous improvement (1) Issues; (2) Actions and (3) Outcomes. The initial trial comprised two co-design sessions, one training session and a two-week trial, all led by the Project Lead. The trial offered insights into customising both the digital platform and associated workflow.  

A second training session and a smaller one-week trial were also completed later in the project, led by the Lead Nurses (Clinical Care Coordinators), together with a smaller team of two staff members. The second trial informed the CQI team rotation process and the training material for internal rotation of CQI teams. Facility nurses also trialled a Digital Auditing functionality, allowing issues identified during audits become actions inside the CQI Assistant. 

Co-design revealed necessary changes to the software, intended use and workflow. Following refinements, the CQI Assistant met key user requirements. The Assistant now provides a digital and time-efficient workflow available on Smart Phone or Tablet, incorporated educational material on wound management and functionality for outcome documentation. The CQI Assistant also supports assignment of corrective actions based on scope of practice and sharing of continuous improvement priorities, targets and results to motivate staff performance. The Assistant can be applied to pressure injury prevention or any other improvement priority. 

The trial revealed a 67% drop in the incidence of pressure injuries, representing potential savings of $240,000 per facility per annum if sustained. Findings also showed improved relevance and allocation of corrective actions (based on contemporary best practice, allocated according to scope of practice), significant increase in number and variety of corrective actions and outcomes completed and documented, active care staff adoption, and improved care staff awareness, skills and education on wound management and pressure injury prevention. Importantly, use of the CQI Assistant enabled culture change – from quality improvement being primarily owned by managers to a model where frontline staff actively contribute.  

a digital and time-efficient workflow, educational material on wound management and supports assignment of corrective actions based on scope of practice together with outcome documentation. The workflow also supports sharing continuous improvement issues, targets, results and progress to motivate staff performance. 

Beyond user requirements, the co-design sessions and two CQI trials achieved several outcomes. The outcomes inform future use and implementation of the CQI Assistant across other Fronditha Care facilities and national quality indicators. Evidence collected suggests improved relevance and allocation of corrective actions, greater staff awareness of continuous improvement goals, increased participation in improvement activities, stronger documentation of outcomes, enhanced evidence of the effectiveness of Fronditha Care's continuous improvement processes, and a 67% reduction in pressure injuries. 

Evidence also suggests that the CQI Assistant can enable broader participation in continuous improvement goals. Staff are supported through role based assignment of actions according to scope of practice. By supporting pressure injury prevention, the has the potential to deliver cost savings and may also be applied to other improvement priorities in the future. 

Fronditha Care will continue developing and refining the CQI Assistant together with QPS Benchmarking into 2027 and beyond. In the more immediate future (August – December) the team, alongside QPS Benchmarking, will continue working with staff at the St. Albans facility. We will embed, refine and operationalise the CQI Assistant and digital Auditing functions. Over this time, similar work will commence in our Clayton facility. Beyond wound management, we will explore the development of CQI Assistant functionality for other national quality indicators, including falls management, unplanned weight loss and incident management as immediate priorities. Grant funding opportunities to better resource this work, and its evaluation will be investigated. In 2027 and beyond, the CQI Assistant should be implemented in all five facilities and across key mandatory quality indicators. Lastly, our Support at Home team will explore the potential of the CQI Assistant in this context.  

Continuous improvement is a known challenge in aged care. Quality improvement priorities are constantly changing. One quarter a facility may be focused on pressure injuries, the next on falls, and the next on unexplained weight loss. In this time-sensitive environment, immediate compliance and operational requirements (completing sighting charts, bowel charts, weight charts) often overrule longer term quality improvement activities.  

Fronditha Care's research and co-design highlighted three key requirements for effective continuous improvement: dedicated CQI capability, clear processes for assigning and monitoring actions, and access to practical educational resources. 

The research shows that continuous improvement issues are more systemic, persistent and complex, demanding nuanced, experienced and educated responses. Addressing these issues requires a dedicated CQI team of diverse roles in both leadership and non-leadership positions. It also requires that staff are adequately supported through evidence-based corrective actions and associated educational information.  

The CQI Assistant supports this approach by enabling actions to be assigned according to scope of practice, providing access to educational resources, and improving visibility of issues, targets, progress and outcomes across the organisation. 

In short, the CQI Assistant supports the workforce to meet CQI goals, including complex goals like pressure injury prevention. The Assistant can help organisations respond more effectively to complex and persistent quality improvement challenges and offers promise as a digital intervention for improving data and practices associated with continuous improvement. The aged care industry and Government should consider closely the potential of the CQI Assistant and similar software interventions for continuous improvement. 

The project highlighted several important lessons for implementing digital quality improvement tools in aged care. 

• Staff initially found it difficult to distinguish between day-to-day operational tasks and continuous improvement activities. Clear training and communication were essential to help staff understand the purpose of the CQI Assistant and how it complemented existing clinical management systems. 
• Continuous improvement activities were more effective when responsibilities were aligned with staff roles. Managers, clinical leaders and frontline staff each played different but important roles in identifying issues, implementing actions and reviewing outcomes. 
• Frontline staff needed quality improvement activities to fit within existing workloads. Feedback from participants led to refinements that made the system more practical and accessible, including mobile functionality and role-specific workflows. 
• The CQI Assistant also supported staff learning. Most participating staff reported increased knowledge of pressure injury prevention, wound management and person-centred care, demonstrating the value of combining education with quality improvement activities.