Michael Fine is an Adjunct Professor in the Department of Sociology at Macquarie University. He has researched, published and taught in the fields of social policy, ageing, care and human services for over thirty years.
Much of Michael's research focuses on care and ageing in the contemporary world. In it he seeks to apply social science research to enhance policies and practices related to care and ageing, and to identify the way in which sociological analyses can improve the understanding of each of these issues. With care being such an important issue in today’s society, Michael is interested in how care is being reshaped, re-imagined and sustained.
With a focus on understanding and measuring the outcomes of community care, Professor Fine is currently leading an Australian Research Council (ARC) Linkage research project with Professor Kathy Eagar of the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, on the development of an Australian Community Care Outcomes Measure (ACCOM). At Macquarie he works closely on this study with Dr Beatriz Cardona and Dr Adam Stebbing from the Department of Sociology. The research is undertaken in collaboration with a number of leading community care providers in New South Wales.
To gain more insight into his research, we asked Professor Fine a few questions.
What is your current research project about?
The research is about developing, adapting and testing a measure for the outcomes of community care. What we are after is a simple and easy to use tool that can be used by community care staff and those who receive care to document the impact of receiving support at home over a few months.
Outcomes are the results or consequences of a process. In caring for older people or people with a disability, providing care is unlikely to lead to a full recovery of independence in a short time as often happens with acute health care. Because it is difficult at present to assess the impact of providing care, it is easy for staff, clients or family carers to lose hope, or to become distressed about the problems faced by those who need help. This is where outcome measures come into play. They provide a standard way of measuring - improvement, stability or deterioration - in the most important aspects of an individual’s life.
Why did you decide to conduct this research?
The research project developed as a result of work we were doing with service providers who now are also our research collaborators. They kept pointing to the problems they had with demonstrating the outcomes of their work. Over time, and following on from a larger statewide survey which found that this was a problem that affected nearly all providers across the NSW, I developed this project. If successful, the project will be a significant advance for services, for consumers, for government responsible for funding, planning and regulating care services, and for future research in this field.
Without any common agreed and validated measures, service providers are not able to assess or demonstrate their own effectiveness. In what has become an increasingly commercialised, competitive environment, the focus has often shifted instead to the cost of providing care by the hour. There is a suspicion that some providers seek to exploit the situation by competing for funds on the basis of reducing the costs for each hour of care provided. Unscrupulous providers may attempt to maximise their income by overproviding services – continuing to provide more assistance than is necessary, or targeting those who are easiest to assist.
Effective outcome measures are needed to ensure that consumers obtain the assistance and services that are important to them; and that the approach to service delivery is personalised and respects and values the individual care needs of older people and their carers. The measures will also be powerful research tools for those who study different approaches to care provision.
At what stage is the research at?
The research is now about to enter the field in the final months of 2015 and in early 2016. We aim to test the use of the ACCOM over the next six months with a fairly large sample (400 plus) of consumers and their case managers. We hope to follow up with the first ACCOM users after a period of 3 to 6 months to explore its suitability for measuring change over time. The approach will give us a robust test of the ease of use and operational viability of the tool. It will also enable us to examine its robustness and consistency, as well as permit us to compare variation between consumer self-completion, assisted consumer completion and professional staff completion.
Are you applying any pioneering approaches/innovative methodologies in your research?
To my mind, the key innovation in the study is the collaboration between academic researchers and community service providers. The opportunity for cross-institutional learning that this collaboration presents, as well as the tensions evident in bringing together the academic rigour of university-based researchers with the practical nous of our professional colleagues in services, drives the research.
A second key aspect of innovation builds on the international dimension of the research collaboration. We’re working with the leading international researcher in this field and have been able to draw on an existing approach to outcomes measurement in this field, to move it along and enable us to complete the study within a short time frame with limited resources. This approach will also ensure our results can be compared internationally.
Rather than build an Australian outcomes measure entirely from scratch, we have decided to adopt and where necessary adapt the British measure – the Aged and Social Care Outcomes Tool (ASCOT) developed by Professor Ann Netten and colleagues at the Personal Social Services Research Unit (PSSRU) at the University of Kent. We are extending this approach, using it for the first time as a measure by case managers and service staff, and comparing it by adding to it some key details not used in the UK version to enable us to compare outcomes at the levels of individuals as well as through aggregation at the level of service outlets, service types and different organisations. An important innovation in this regard is the linking in of assessment and functional data with basic demographic and social profiles of each service user – with ethical measures in place to ensure complete client confidentiality.
A third innovative component of the study is the parallel use of computer based data completion alongside the paper version. Initially we expect case managers to be the major users of computer based versions of the ACCOM, but over time we seek to encourage consumers and carers to be able to choose which method of completion they most prefer.
What benefits does your research provide to the community?
This research is intended to make a practical as well as a conceptual contribution to the understanding of how community care services operate. We have developed the research to be able to enhance service quality for consumers and staff, as well as to help identify ways in which providers can make sure their services are cost effective and efficient.
Much of Michael's research focuses on care and ageing in the contemporary world. In it he seeks to apply social science research to enhance policies and practices related to care and ageing, and to identify the way in which sociological analyses can improve the understanding of each of these issues. With care being such an important issue in today’s society, Michael is interested in how care is being reshaped, re-imagined and sustained.
With a focus on understanding and measuring the outcomes of community care, Professor Fine is currently leading an Australian Research Council (ARC) Linkage research project with Professor Kathy Eagar of the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, on the development of an Australian Community Care Outcomes Measure (ACCOM). At Macquarie he works closely on this study with Dr Beatriz Cardona and Dr Adam Stebbing from the Department of Sociology. The research is undertaken in collaboration with a number of leading community care providers in New South Wales.
To gain more insight into his research, we asked Professor Fine a few questions.
What is your current research project about?
The research is about developing, adapting and testing a measure for the outcomes of community care. What we are after is a simple and easy to use tool that can be used by community care staff and those who receive care to document the impact of receiving support at home over a few months.
Outcomes are the results or consequences of a process. In caring for older people or people with a disability, providing care is unlikely to lead to a full recovery of independence in a short time as often happens with acute health care. Because it is difficult at present to assess the impact of providing care, it is easy for staff, clients or family carers to lose hope, or to become distressed about the problems faced by those who need help. This is where outcome measures come into play. They provide a standard way of measuring - improvement, stability or deterioration - in the most important aspects of an individual’s life.
Why did you decide to conduct this research?
The research project developed as a result of work we were doing with service providers who now are also our research collaborators. They kept pointing to the problems they had with demonstrating the outcomes of their work. Over time, and following on from a larger statewide survey which found that this was a problem that affected nearly all providers across the NSW, I developed this project. If successful, the project will be a significant advance for services, for consumers, for government responsible for funding, planning and regulating care services, and for future research in this field.
Without any common agreed and validated measures, service providers are not able to assess or demonstrate their own effectiveness. In what has become an increasingly commercialised, competitive environment, the focus has often shifted instead to the cost of providing care by the hour. There is a suspicion that some providers seek to exploit the situation by competing for funds on the basis of reducing the costs for each hour of care provided. Unscrupulous providers may attempt to maximise their income by overproviding services – continuing to provide more assistance than is necessary, or targeting those who are easiest to assist.
Effective outcome measures are needed to ensure that consumers obtain the assistance and services that are important to them; and that the approach to service delivery is personalised and respects and values the individual care needs of older people and their carers. The measures will also be powerful research tools for those who study different approaches to care provision.
At what stage is the research at?
The research is now about to enter the field in the final months of 2015 and in early 2016. We aim to test the use of the ACCOM over the next six months with a fairly large sample (400 plus) of consumers and their case managers. We hope to follow up with the first ACCOM users after a period of 3 to 6 months to explore its suitability for measuring change over time. The approach will give us a robust test of the ease of use and operational viability of the tool. It will also enable us to examine its robustness and consistency, as well as permit us to compare variation between consumer self-completion, assisted consumer completion and professional staff completion.
Are you applying any pioneering approaches/innovative methodologies in your research?
To my mind, the key innovation in the study is the collaboration between academic researchers and community service providers. The opportunity for cross-institutional learning that this collaboration presents, as well as the tensions evident in bringing together the academic rigour of university-based researchers with the practical nous of our professional colleagues in services, drives the research.
A second key aspect of innovation builds on the international dimension of the research collaboration. We’re working with the leading international researcher in this field and have been able to draw on an existing approach to outcomes measurement in this field, to move it along and enable us to complete the study within a short time frame with limited resources. This approach will also ensure our results can be compared internationally.
Rather than build an Australian outcomes measure entirely from scratch, we have decided to adopt and where necessary adapt the British measure – the Aged and Social Care Outcomes Tool (ASCOT) developed by Professor Ann Netten and colleagues at the Personal Social Services Research Unit (PSSRU) at the University of Kent. We are extending this approach, using it for the first time as a measure by case managers and service staff, and comparing it by adding to it some key details not used in the UK version to enable us to compare outcomes at the levels of individuals as well as through aggregation at the level of service outlets, service types and different organisations. An important innovation in this regard is the linking in of assessment and functional data with basic demographic and social profiles of each service user – with ethical measures in place to ensure complete client confidentiality.
A third innovative component of the study is the parallel use of computer based data completion alongside the paper version. Initially we expect case managers to be the major users of computer based versions of the ACCOM, but over time we seek to encourage consumers and carers to be able to choose which method of completion they most prefer.
What benefits does your research provide to the community?
This research is intended to make a practical as well as a conceptual contribution to the understanding of how community care services operate. We have developed the research to be able to enhance service quality for consumers and staff, as well as to help identify ways in which providers can make sure their services are cost effective and efficient.
