Ylä-Savo’s Social and Health Care Federation of Municipalities, the City of Kalajoki, Kallio Health and Social Services Federation of Municipalities, and Mediverkko Hoivapalvelut Oy: Kotihoito 2020 – a 10-step programme for home care
The Kotihoito 2020 project created a 10-step programme for comprehensive development of the entire home care field. With the programme, any municipality can raise its home care to a level that meets the challenges of the new decade. The 10-step continuous development programme consists of clear steps, which the municipality must follow to improve the productivity and effectiveness of its home care. The programme provides the elderly an opportunity to live at home longer, but requires fewer overall resources at the same time. In addition, it helps municipalities to focus on the exact points of development which has the largest impact on their comprehensive home care performance.
The project analysed the productivity, quality and effectiveness of three home care units, and defined the key development areas in order to meet the growing demand. As a result, several functional and organisational solutions emerged to improve the productivity (Kallio) and efficiency (Ylä-Savo and Kalajoki) of home care. The solutions implemented during the Kotihoito 2020 project were founded on concepts and best practices which NHG had developed and tested in other home care units. NHG was involved not only in the planning stage, but also took an active part in the implementation and assessment of the results.
In the Ylä-Savo’s Social and Health Care Federation of Municipalities, a centralised counselling and customer steering unit (OHJURI) was founded, and home rehabilitation and home doctor services developed. OHJURI operates under the one-stop-shop principle. It determines service needs, organises customer-specific services, and coordinates and incorporates services that support the well-being, health, functional capacity and independence of its customers. Mapping of private and third-sector services enabled the utilisation of self-paid services as part of the customer’s service package.
The transfer of the care and service need assessments from home care to OHJURI resulted in a 7% drop in new home care clients, and promoted equality between customers. Supervisors and nurses felt that both the home care practices, and the roles of the staff, had become clearer. Managers were now able to focus more on management, and nurses on service production. Also the number of home care patients’ emergency unit and clinic visits started to decline. In the Iisalmi pilot area, the drop in emergency unit visits was particularly evident in its own special health care (-48.7%) and in the North Savo Health Care District (-39.9%), but visits to health centres also showed a declining trend. In the home care doctor service pilot area, the emergency department visits decreased by 17%.
In Kalajoki, a special low-threshold information point, VERKKO, was created. VERKKO gives advice and provides guidance, determines service needs, draws up service plans, and in case of some particular support services, grants and organises services for new customers. The granting of support services was reported to have become faster and more equal in quality. The new information point was also appreciated by customers who felt that the responders ”had time for my concerns”, and ”one visit or call resolved many issues”. Kalajoki also adopted a ”goal-oriented approach” to promote goal- and customer-orientation in home care. This model helps to ensure that the customers are listened to and that their own potential is fully utilised. All services are coupled with concrete objectives set by the customer and his/her next of kin. The clarified discharge process, also launched within the project, reduced home care customers’ visits to other services. Emergency department visits dropped by 11%, and the number of customers moving to ”heavier” forms of care, dropped.
In the Kallio Health and Social Services Federation of Municipalities, home care management and resource planning were developed, for example, by creating a model for comparing home care customer needs with the available nurse resources. This helped to ensure that the right amount of nurses was always in the right place at the right time, which added to staff adequacy. In the past, home care teams had geared up for busy days with a local labour force buffer. When customer needs vary significantly from day to day, customer needs and the available resources do not meet. This traditional model ties nurses to the wrong places at the wrong time. In Kallio, this problem was tackled by need-based resourcing and visit list planning. The labour force buffer was centralised into one resource pool, from which nurses were allocated to different teams based on the actual customer needs. The aim was not only to better exploit the present resources and to avoid the use of substitutes, but also to even out shift-specific loads, and consequently avoid rushing and to safeguard the quality of the services. The fluctuations between busy and non-busy days are now history.
The workload of individual nurses remains constant regardless of the fluctuation in customer needs, because the number of nurses is regulated accordingly with the help of the resource pool. Preliminary results show that Kallio home care’s short-term productivity has increased by 4%, while the need for short-term substitutes reduced by a third. This is considered important, as the use of substitutes not only undermines the quality of the service, but also increases nurse turnover and home care costs. The management does not expect to see the full improvement until around Christmas 2014, when the changes have taken proper root and become part of the culture. In Kallio, an incentive plan for home care staff was also developed. The aim is to introduce this in 2014.
The project piloted a new innovation motor concept, in which a private service provider (Mediverkko Hoivapalvelut Oy) takes on responsibility for a particular service production area, and supports the public provider in piloting and implementing new concepts. The private provider can pilot new solutions much faster and more flexibly than its public counterpart (in this case Kallio home care), and thus support the planning and deployment of new models.
The project end results were published in the report KH2020: 10-step programme for home care