How do we evolve the culture of Australia’s aged care system: a sociological analysis of a Royal Commission’s Final Report

Australia’s aged care system is complex and has encountered major reform initiatives, performance issues and scandals over the past few decades. Recently, attention has turned to the widespread problem of substandard care provided in residential aged care facilities, with multiple investigations including the national Royal Commission into Aged Care Quality and Safety, established in October 2018 with findings published in 2021. Culture is frequently acknowledged as a central issue when failings in healthcare come to light, and recent empirical evidence also highlights associations between organisational culture and patient outcomes. We aimed to identify how culture was deployed in the volumes of the Royal Commission’s report. We examined documents using qualitative content analysis to evaluate mentions of “culture” as they related to care delivery in aged care. Results are reported as descriptive content summaries with exemplary quotes and frequencies. There were 211 references to care culture, the majority focusing on the organisation (n=155), followed by the sector (n=26), the agencies involved in managing aged care (n=21), the national culture relating to the treatment of older people (n=8), and a single mention of professional medical culture. These care cultures were deployed in five ways: (1) highlighting culture as a problem (n=55), (2) showcasing the style of culture that should be aspired to (n=45), (3) reinforcing the importance of culture (n=39), (4) making attributions about factors contributing to culture (n=37), and (5) discussing the need for culture change (n=30). Our analysis highlights that the Royal Commission’s findings emphasise culture and the need for change but provide limited guidance on how these should be achieved or even conceptualised. Recommendations focused on changing structural aspects of aged care, implying a mechanistic view of culture over an organic one. We consider some of the factors associated with changing culture, particularly the role of leadership.