Life In The Slower Lane

Here is the standardised PICO analysis for the twelfth uploaded article:

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Full Title

Measures that matter should define accountability and governance frameworks

Authors: Joachim Sturmberg and Len Gainsford

Journal: Journal of Evaluation in Clinical Practice, 2024; 30:503–510

DOI: 10.1111/jep.13943

Type of Study

Theoretical policy analysis and commentary focused on governance design in aged care, responding to Australia’s Royal Commission into Aged Care Quality and Safety

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PICO Summary

Population (P)

• Australian residential aged care sector
• Implied stakeholders: policymakers, care regulators, nursing home operators, aged care residents and their families
• Context: systemic governance failure, per the 2021 Royal Commission report

Intervention (I)

• Redesign of accountability and governance frameworks to prioritise what matters to residents, using complexity science and systems thinking
• Framework includes:
  • Four domains: Inputs, Outputs, Outcomes, and Values
  • Emphasis on measuring resident-centred outcomes (e.g., preserved dignity, satisfaction, quality of life), rather than compliance checklists
  • A proposed shift from adversarial regulation to context-sensitive, co-adaptive evaluation models
  • Tables and models identifying specific “measures that matter” for each stakeholder group (residents, staff, operators, regulators, leadership) 

Comparison (C)

• Current compliance- and process-focused governance systems that rely on paper-based performance metrics and hierarchical oversight
• Criticised for being disconnected from residents’ lived experiences and not promoting system-wide learning or improvement

Outcomes (O)

Process/structural outcomes:

• Establishment of accountability structures that are:
  • Collaborative, trust-based, and locally responsive
  • Capable of ongoing learning and adaptation
  • Measured by relevance and impact, not just documentation or KPIs 

Resident-centred outcomes:

• Improved care quality, dignity, and satisfaction
• Outcomes that are defined and assessed by residents and families (e.g., being heard, feeling safe, trust in care, preserved dignity) 

System-level outcomes:

• Aged care systems become adaptive, resilient, and better aligned to community values
• Framework allows pre-emptive evaluation of policy or operational changes by visualising impacts across interdependent domains 

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Findings Summary

• The article makes a compelling case for governance frameworks that prioritise “measures that matter”—outcomes that reflect the purpose of care rather than just compliance
• Emphasises that systemic quality arises from interdependencies, and failures at any point affect the whole system
• Argues for a paradigm shift: from measuring activity (e.g. tick-box forms) to understanding whether care improves lives
• Provides a practical framework (see Figure 2 and Table 3, pp. 5–7) to help leaders, providers, and regulators redefine aged care success from the ground up 

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