Independent review by Nous Group


16 March 2018: The Board of Opal Aged Care has today announced the conclusion of an independent review undertaken by Nous Group.

The review was commissioned to identify opportunities for ongoing improvement with a focus on clinical leadership, customer service excellence, and effective complaint management. The Board welcomes the findings of the review, noting it was a valuable exercise for the business.

Nous Group’s report provided seven recommendations, relating to both operational and strategic areas of the business. These included specific suggestions relating to investing in the human resources requirements of the business and its quality and safety functions, implementing a comprehensive IT strategy, and developing both an integrated suite of mobile enabled tools for staff and a dedicated mobile app for customers.

In addition to acknowledging Nous Group’s recommendations, the Board is pleased to note its commitment to excellence was also recognised in the report, which stated that: “Opal has a well-deserved reputation within the residential aged care sector for providing a high level of care to its residents. In a highly challenging environment, the organisation and all who work there are doing many things well. The recommendations…are intended to provide the basis for Opal to use this solid foundation to build an even stronger organisation delivering even better care and service to its residents.”

Nous Group’s recommendations and Opal’s response are attached and available here.

Opal Aged Care Chairman, Prof Peter Shergold, AC, said the report will guide business decisions over the coming year, as well as provide an important source of direction to inform the aged care sector’s response to consumer expectations in the future.

“The aged care sector needs to respond to the changing needs and expectations of consumers – as one of the largest providers in this sector, we are committed to our role in this transformation.

“We take our responsibility of caring for our residents very seriously. While we are proud of our standards and our exemplary accreditation and compliance record, we are committed to continuously improving our clinical care, support, and service for over 6,000 residents across more than 70 homes nationally.”

Opal Aged Care’s management is already implementing several initiatives to address the Nous Group’s recommendations, including:

  • Investing in our IT systems to improve clinical reporting and escalation of incidents;
  • Introducing more rapid, and easily accessible systems to collect customer feedback and manage complaints;
  • The appointment of several new positions including a Chief Marketing Officer who is responsible for improving Opal’s understanding of the needs of residents and families, and the quality of the interactions Opal has with them. The appointment of a Chief Operating Officer who will oversee business projects that will continue to improve the delivery of services and advance the development of its staff. Opal has also appointed additional resources to the Quality team to strengthen clinical leadership.

Prof Shergold added, “Our business, and our valued employees who make up who we are, do many things well and make a significant impact each and every day. As with any business there is always opportunity for improvement and as such we have welcomed Nous’ independent views on areas of potential enhancement and will work towards addressing these at an organisational and sector level.”

Prof Shergold concluded by acknowledging Nous Group for its considered and intensive review and thanked all who participated in the interviews.

“Feedback is a very important input to ensure sustained business improvement. I would like to personally thank all our residents, families and staff who participated in this review. We will continue to seek feedback and to respond in an open and transparent manner.”


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For media information please contact:
Michelle Ryan on 0404 381 886 or Rebecca Wilson 0417 382 391


About Opal Aged Care  

Opal Aged Care delivers specialist aged care through its highly trained staff. Opal is a sector-leading organisation that cares for over 6,000 residents in over 70 homes in four states, employing more than 7,500 staff across Australia.

Opal Aged Care focuses on the provision of specialist residential care, particularly for those living with dementia and has formed a national education partnership with Dementia Australia to ensure its residents living with dementia receive high quality care and support from expertly trained staff, to help them maintain their independence and dignity.

APPENDIX – Nous Group’s recommendations and Opal responses

Introduction to Opal response:

We thank Nous for the considerable amount of time that they have invested in conducting their Independent Review of Opal. We would also like to thank our residents, families and staff for providing their valuable feedback to Nous and contributing to the report’s findings.

The goal of this review was to have an impartial observer conduct an evaluation of Opal’s operations, culture, policies and procedures to identify opportunities to further improve the delivery of care to our residents and their families.  Opal engaged Nous to conduct this review.  We made it clear from the outset that we would approach this exercise in a spirit of transparency, accountability and a readiness to learn and improve.  We committed to making the findings public.  We want our residents and their families to know the outcomes of our review and we wanted our people to read and discuss the findings.

Of course, we are pleased that Nous has found that Opal generally meets the needs of our residents and has an exemplary accreditation and compliance record.  But we asked Nous to focus on the challenges we faced and how we might best address them. We believe that this review and its recommendations provide a guide to further strengthen Opal and drive additional improvements and consistency across our care and services. The importance of such focus is particularly relevant in an environment of significant change within the sector led by a move to more consumer focussed and directed outcomes.


1.    Invest more deeply in the Human Resources requirements of the business. The investment should focus on resource planning, recruitment, training, accountabilities, professional development, staff engagement, remuneration and performance management. The intent of this investment is to best position Opal to attract and retain the best people in the industry.

Residential aged care is a highly people-intensive business and Opal’s continued success depends on attracting and recruiting the right number of the right people, providing them with the appropriate training and development opportunities, paying them fairly and creating an environment in which they are motivated and fully engaged in their work. A well-functioning HR function with a strategic focus is therefore critical.

Opal response:


Opal is committed to investing further in its Human Resources function to support our people. This investment will be designed to facilitate a strategic approach to the management of our people. Opal has made significant investment in understanding and improving staff engagement and culture over the past five years (culminating in a further reduction in staff turnover to 18.8% during 2017). Yet more can be done in a number of key areas including staff education and training.

Opal has recently appointed (January 2018) a new Head of Learning and Development who will report to Opal’s Head of Human Resources. The role is focussed on education, training and professional development.  The role will work to further develop Opal’s existing programs with the Australian College of Nursing and Western Sydney University.  These programs provide opportunities to Opal’s registered nurses and managers to develop their clinical skills, leadership and managerial expertise. Importantly, they also provide a career pathway to our staff.

Opal is also trialling an on-line education platform to deliver education to Opal’s homes across Australia.  The platform is planned to deliver consistent education programs to all of Opal’s homes and will streamline attendance records making it easier to ensure that staff have completed the training they require.

In 2018 Opal will review its approach to staff recognition and performance management to ensure we continuously improve our staff engagement and reduce staff turnover.


2.    Invest further in Opal’s Quality and Safety functions to provide the necessary level of expertise and oversight for ensuring the health and safety of residents and employees and to improve reporting to the Board of the attendant risks and management thereof.

Having the appropriate level of quality and safety expertise is essential to meeting the most fundamental expectation of regulators and the community that residential aged care providers keep residents and employees healthy and safe.

Opal response:


Opal’s key priorities are to provide high quality residential care and to ensure the safety of our residents and staff.

We are pleased with Opal’s progress on quality and safety, most notably demonstrated by our compliance record and our very low staff Lost Time Injury Frequency Rate (LTIFR) of 3.3 (Dec 2017) which is significantly lower than the industry average. But we can certainly do more and will continue to invest to drive further improvement.

Opal has appointed additional resources to the Quality team and following this review will add further resources in 2018.  This will boost clinical leadership and enable Opal’s Clinical Governance Committee to more effectively address the strategic challenges identified by Nous, challenges that reflect increasing resident acuity, changing consumer expectations and staffing pressures in the sector.

Opal has reviewed the presentation and content of its Quality and Safety Board reporting and will take the necessary steps to improve the level of analysis.  Further work will now be done to improve the presentation of clinical and safety data – see also response to recommendation number 6.


3.    Develop and implement a comprehensive IT strategy to build on the significant recent progress made in clinical and core operational systems and reporting, and realise the vision for the future IT environment articulated in the 2017-18 IT strategy.

The strategy should outline a clear implementation plan to achieve the target state and articulate the business case for required investments. It should consider strategic improvements across customer facing channels, better customer management and feedback systems (including complaints management), innovative use of online platforms to engage and hire casual staff and suppliers, integration of core operational systems to improve consistency of administrative processes (e.g. HR and Leave management) and improvements in the digital infrastructure in facilities.

To accomplish such an outcome, Opal’s IT function will have to shift from its current operational ‘business as usual’ systems maintenance focus to one that is more strategic.

Opal response:


Opal has undertaken some large IT projects in recent years such as the installation of an electronic care management system.  We concur that alone this is not sufficient. Opal will work on developing a comprehensive IT strategy as a matter of priority.  It will focus on our residents and our staff.  Several significant IT projects are being considered including software and process improvements in resident care, customer feedback, complaint management and admission processes. Employee on-boarding will be improved.  Opal is committed to investing further in information technology to reduce the administrative workload to allow staff more time to focus on resident care.


4.    Develop an integrated suite of mobile enabled tools to increase the mobility and productivity of staff members.

Staff members spend a significant amount of their time in core systems such as AutumnCare and use print-outs and paper for daily care related processes. There is an opportunity to significantly improve staff productivity through a series of targeted mobile applications. These can simplify work, improve productivity, increase the visibility of staff on the floor and reduce manual errors. They can integrate with, and provide a simple and intuitive interface to current core systems.

Opal response:

Agreed. Opal recognises that there is an opportunity to develop mobile enabled tools to leverage our care management system in order to enhance the productivity of our staff, simplify work and reduce manual errors.  The development of these tools will form part of the comprehensive IT strategy (see response to recommendation 3).


5.    Develop a dedicated mobile app to enable better interaction and connection with customers.

Residents and their families interact with the facilities principally through phone and in-person channels. There is an opportunity to offer a better way for residents and families to stay connected and share in what is taking place in the facility each day. The app will also enable more timely feedback from residents and families, as well as simplify the way families lodge and track requests and complaints, thus creating more real-time transparency on what is happening in each facility.

Opal response:


Opal is committed to improving our connection and interaction with residents and their families. This directly links with one of the key focus areas of the Nous review, namely effective complaint escalation, management and resolution.  Opal agrees that technology will facilitate better engagement and provide us timely feedback from residents and families. Opal has already commenced a trial of real time customer feedback in the homes via tablets.  As part of the IT strategy (recommendation 3), Opal will also explore the development of an app, to allow residents and families to provide feedback directly from mobile phones.

Opal has now appointed for the first time a Chief Marketing Officer whose key responsibilities include improving Opal’s understanding of the needs of our residents and families and improving the quality of the interactions that Opal has with them.  We need to do more to let the public, some of whom will require residential aged care in the future, to see what Opal has to offer. In relation to complaint management, Opal is instituting a number of changes including a more defined escalation process.  We will roll out a comprehensive training program across Opal designed to improve the consistency of reporting, escalation and resolution. Changes will also be made to Opal’s risk reporting systems to simplify and consolidate reporting for staff in the homes.


6.    Redesign the reporting suite to enable the Executive and Board to more easily understand and monitor quality and safety performance across the organisation.

There is an opportunity to deploy more advanced statistical, analytical and visual presentation tools to better understand clinical governance issues and direct deep questioning to the right areas. The use of tools such as ‘statistical process control’ (SPC) will significantly increase the value of the rich repository of existing data. Added to an expanded use of the current rate based indicators to monitor key trends for significant areas (e.g. number of incidents per 1,000 bed days), SPC would enable Opal to identify and compare trends.

Opal response:


Opal strongly supports this recommendation. We will review the reporting suite to improve the monitoring of quality and safety performance.  We will consider the adoption of tools such as SPC and the expansion of rate based indicators to allow trends to be monitored.

Opal has already improved reporting from our care system to allow Opal’s clinicians to more easily monitor residents’ health outcomes (e.g. blood glucose levels and wound management) on a daily basis. Such initiatives will be extended.

7.    Opal should consider moving progressively from its current ‘Institutional’ model to a more ‘Home-based’ model for the delivery of care to its residents.

Both the ‘Institutional’ and ‘Home-based’ models place a high priority on ensuring the health and safety of residents and employees. How they go about that, however, is very different.

Under the ‘Institutional’ approach, residents are accommodated in hospital-like facilities with common living areas (dining and lounge rooms). They have limited privacy, even in their bedrooms, which are located off common thoroughfares. They also have limited choice in when they go to sleep, when they wake up, when they bathe, when they eat, what they eat and how they spend their days. The ‘Home-based’ approach sees groups of residents (10-20) accommodated in ‘homes’ which afford them far more privacy than the typical ‘Institutional’ facility. Each ‘home’ has a front door, kitchen, dining and lounge area in addition to the residents’ bedrooms and bathrooms. This approach seeks to replicate as closely as possible the typical living conditions of residents before their entry into residential aged care and to provide them with as much choice as possible in when they go to sleep, when they wake up, when they bathe, when they eat, what they eat and how they spend their days.

There are stark differences in the way the facilities and ‘homes’ are run. The ‘Institutional’ model is characterised by a ‘command and control’ approach that is highly task and compliance focused and where the roles of staff members are standardised and clearly delineated. The ‘Home-based’ model, on the other hand, sees a team of staff assigned to each ‘home’ where they are entrusted with greater responsibility and autonomy to collaboratively respond to the specific needs of residents.

Any decision to move away from the ‘Institutional’ approach will require fundamental changes to many aspects of Opal’s operations. Depending on the model chosen and the extent of the consequent changes, a transformation could take years to fully implement across all facilities.

Opal response:

Supported in principle.

Many of our residents and staff already look on their facilities as a home which provides friendship and care.  But we acknowledge changing consumer expectations and are committed to improving our residents’ experience.  Opal will consider this strategic recommendation positively.

Whilst the overall physical transformation of Opal’s existing portfolio would represent a long term initiative, Opal has instituted many of the design concepts of the ‘home-based’ model in our new developments including private rooms, shorter more private corridors, small dining spaces with fresh food served at each one, small lounge and activity spaces, separate audio lounges to lessen noise generation and discrete back of house corridors to remove non-residential elements from living spaces.

Changes to the model of care will also be explored to deliver greater flexibility and choice to residents, which is consistent with overall regulatory intent and family expectations.

There are a number of important challenges to overcome if the aged care sector evolves its model of care on a large scale basis. This would include ensuring the care needs of an increasingly acute resident cohort can be met. Further, the cost implications for a model change also need to be understood. In some circumstances increased flexibility and choice is likely to increase costs (e.g. on demand meals).

Opal have pride in our achievements.  We are now developing our ethos as a shared value company.  We recognise that our financial returns reflect our success in providing social benefit to Australians in need of support. As a core element of this strategy we will focus on how we can progressively move away from the traditional institutional model of residential aged care, and allow our residents and families greater control over the way we design and operate our homes.

Click here to view the full report by the Nous Group.