Rethinking Middle Management in Residential Aged Care: Evaluation of a Dyad House Leadership Model Intervention

New leadership models in Australian aged care facilities are required to respond to increasing demands, decreasing supply of talent and more complex care clients.

In this study, we cocreated and evaluated a dyad house leadership model across three residential aged care sites in South Australia using a pre-post intervention methodology.

Data were collected over three time periods. We first interviewed employees (n = 28), families (n = 8) and residents (n = 8), then conducted 90 h of observations across 9 leaders. Three codesign sessions were then held to cocreate the solution. The intervention (a dyad house leadership model) was trialled for 6 months. We then evaluated by conducting interviews with employees (n = 21 mid and n = 28 post), families (n = 6 mid, and n = 8 post) and residents (n = 8 mid and n = 13 post) and observations with leaders (n = 32 h mid, n = 96 h post).

Participants reported improved role clarity, career progression, wellbeing and perceptions of quality of care alongside greater satisfaction with communication and care; however, some clinicians perceived some risks to their career progression. At the 6-month point, no significant changes were found in the counts of hospitalisation, client incidents and average call-bell response time.

Dyad house leadership represents promising middle-management model for residential aged care, with potential to improve role clarity, redistribute operational workload and expand leadership capacity. Successful implementation requires clearly defined clinical and nonclinical accountabilities, and careful attention to clinical governance and succession planning.

Effective dyad leadership requires both deliberate career infrastructure and structures that enable clinical and nonclinical leaders to work together effectively. Clear progression pathways, reporting relationships, role transitions and shared ways of working can help broaden the leadership pipeline while preserving clinical career trajectories and reducing traditional silos.