Home' Australian Ageing Agenda : AAA Mar-Apl 2012 Contents residential and day hospital service -- without
geriatricians. We just did it. It was enjoyable
to be a bit of a pioneer, and just provide good
services that people needed."
But to make a real difference, Dr Flett
knew she needed access to decision
making. She began studying for a
Fellowship of the Royal Australian College
of Medical Administrators.
Then, in 1984, a job came up for her
husband in Perth and she took the job
of medical superintendent at Homes of
Peace two years later. It was a pivotal time
for healthcare administration.
"In the late 80s the 'Social Role
Valorisation' (SRV) movement swept
across the planet and we embraced it at the
Homes of Peace. Once we got our heads
around it, suddenly we could no longer do
what we were doing," Dr Flett recalls.
The 'SRV approach' focused on people
whose roles were less valued within
society, or at risk of being devalued. The
goal was to empower these groups with a
voice, dignity and respect and help them
exercise the right to work, be educated
and socially accepted.
Elderly people and people with
disabilities fell squarely into these
When she started, Dr Flett says Homes of
Peace was two big hospital-style institutions
where nursing staff wore white, cleaning
staff wore blue "and there was green and
mauve in between". The 70-bed wards were
called 'blocks'; toilets and showers had
curtains instead of doors and there were
strict rules and times for everything.
"We started building small domestic-
scale houses and we had to redeploy 515
institutional beds. It was a massive exercise
but the biggest deinstitutionalisation
exercise was of the people. SRV was a
revolution, not an evolution, and it took a
lot of patience and support."
The other revolution underway was the
'quality' movement in management, which
Dr Flett describes as the management
and business parallel to SRV. "SRV put the
care recipient at the centre of everything.
This put the customer at the centre."
"People came to Homes of Peace to
live, not to die," she says. "They might
have had a stroke or have dementia or
Parkinson's disease but our job is to
provide the best expertise we can to
enable them to live as well as they can."
The energetic Dr Flett also had training
in her sights. Her clinical experience in
paediatrics, geriatrics and rehabilitation had
taught her that, to be effective, healthcare
professionals needed to work together.
"All health care professionals are
trained in the hospital environment and
each profession trains their successors
the same way they were trained -- all very
much in professional silos. Staff said, 'It
can't be done', but I bundled physios, OTs
and speech pathologists together early on.
Now we wouldn't work any other way."
A COLLABORATIVE MODEL
Dr Flett's interdisciplinary thinking has
endured and strengthened in recent years
through Brightwater's formal program of
interdisciplinary education, in partnership
with the University of Western Australia
and Curtin University.
But, she says, the real triumph of
interdisciplinary collaboration was the
establishment of a special domestic-scale
rehabilitation service for people with
serious brain injury 20 years ago.
"At the time, they thought if you didn't
recover brain function within a year or so
then there was no hope," says Dr Flett.
"The idea was to give these people the
time they needed -- a year, two years or
three years -- whatever it took, to regain
life skills and ultimately return to live in
"[The service] has evolved and finessed
but it's still there. It's called Oats Street now.
It enables people to tackle a really tough
journey back to relatively independent living
-- to regain simple life skills that we take for
granted. We follow them and support them
as they graduate from one simple task to
another and sort themselves out.
"This is the thing I feel so proud of.
We trusted each other to do it, made it
happen and achieved results which flew in
the face of conventional medical wisdom.
It was a lot of hard work but so successful.
And it goes largely ignored by the people
who should be noticing. I'm not sure why."
A HUGE YEAR
In 1998, Dr Flett won the national Telstra
Businesswoman of the Year award. Then
she was seriously busy.
"There was a huge amount of public
speaking and travelling with the award and
it was intellectually demanding with all the
questions being asked of me. I was also
chair of the Standards and Accreditation
Agency. Then both my parents died.
My father died of Legionnaire's disease
and my mother, who had dementia,
died later the same year. We were still
deeply involved in the transformation and
deinstitutionalisation of Brightwater. It
was also the year I turned 50."
While Dr Flett admits it was a year of
incredibly hard work, at the same time it
was a gift.
"It was also a time of enormous
reflection and I learned a lot. I learned how
to cope. It made me stop and think, what
are all these barriers in life? Well I realised
most of them are self made so you can
ignore most of them. I don't worry about
nearly as many things now as I used to!"
Looking ahead, the slate is typically full.
Just before Christmas, the National Health
and Medical Research Council announced
Brightwater as one of four research
partner organisations in the 'Partnership
Centre for better dementia outcomes'.
And there's a building project for Oats
Street coming up, for which Dr Flett needs
to find $20 million. She plans to ramp up
the advocacy work on this later in the year.
We are yet to know what may lie in store
as a result of the government's response to
the Productivity Commission's report into
Caring for Older Australians.
But whatever happens, Dr Flett says
Brightwater will probably always be an
organisation that looks after the people
who fall through the cracks in the system.
"And if there isn't a program, we will
invent one," she laughs. "There needs to
be some organisations sticking their necks
out. It can be a lonely job but it's good fun
to keep pushing down the barriers.
"Sometimes it takes a long time
-- years sometimes. Biding time,
scrounging a bit of money where you
can and waiting for the decision-making
time to be right. Sometimes you know
the timing is not right and that's when
I remember my grandmother's advice
-- sometimes you should just button up --
silence is golden." n
Leadership is the biggest job of all in
this field because it is entirely about
people. If you can inspire and look after
people, you will ideally have them doing
all the things you want them to do,
because they want to.
You do need to know what everybody
else can do. Respect each other's
skills and focus on the patient/client/
ON THE FUTURE OF
Residential care will become a transit
place. Increasingly, I think there will be
shorter-term periods of residential care,
with specialty areas focused on getting
people ready and able to go home.
The government needs to take away
some of the constraints preventing us
from innovating at the moment and
give us the capacity to try out different
models. We fiddle around at the edges
now, but it's not real innovation.
NFPs have an enormous opportunity
to establish themselves as the people
who can deal with those clients and
service types that don't fit the standard
moulds. Having the same rules for
NFPs and for-profit providers for years
has meant that the capacity to innovate
has been dumbed down.
We need to keep an open mind about
volunteers. I think there is a role for
volunteers with specific skills doing
specifically skilled jobs in the future.
Unions will be against it but after
10 years, I suspect we will be sitting
around wondering how on earth we
ON GROWING OLD:
I think many old people are beautiful.
There is a serenity and a kind of
loveliness in some old ladies. My
ambition in life is to become serene,
I'm not thinking about retirement.
AAA | MARCH -- APRIL 2012 | 53
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