The right level of ambition is key to success

This article is written based on Swedish conditions. Hopefully, it can inspire those interested from other countries.

Finding a balance between measuring relevant quality aspects and avoiding excessive measurement is crucial to ensure that nursing homes can deliver high-quality care and service in an efficient and sustainable manner. By choosing the most relevant and meaningful measurement indicators, nursing homes can focus on improving what really matters most to the residents and their well-being.

Foto: Mostphotos

Excessive Measurement

A famous quality guru named Deming is said to have stated – "Only measure what needs to be measured".

For several decades, publicly funded activities have been measured in every possible way with various key indicators. The measurement became almost like a religion for a period. There is a risk with excessive measurement in an operation where everything cannot be measured. Helping an elderly person with showering is such a sensitive situation where the quality of the activity is difficult to measure.

There are those who say that what is not measured does not get done. The opposite can also apply that what is measured gets done but it may also mean that other important things do not get done. One difficulty in a nursing home is to measure the right things. Many things may not need to be measured. Instead, it can be followed up with self-control once or a few times a year.

Eager measurement can also inhibit the employees' engagement and steer focus in the wrong direction. It becomes more important to report pins in the statistics than to deliver a service of good quality. It is also about measuring in a smart way so that we do not take time that could be better used for the residents. There are cases where employees submit statistics that with a little thought could be gathered from the operating system.

There are also values that cannot be measured such as judgment, empathy, and relationship. Key figures used should support talented employees to develop in their professional role. Now there is a new trend - "Trust-based governance and leadership". Exciting to see what it means for our development.

Certification a way to strengthen quality

Certification is a way to assure the quality of operations. For the operation that succeeds in distinguishing itself in quality work, there is also the "Swedish Quality Award – USK". It also provides a drive to work with continuous improvements. Working with certification can be a way to create a culture where continuous improvements are part of the operation. I mainly think of ISO certification but there are also other examples like Silvia certification which provides a structure for continuous improvements. Many nursing homes are also ISO certified. Working with certification is a structured way to develop the quality of the residence. By building systems for self-control, internal audits, and continuous improvements, the operation builds both a culture and control mechanisms that contribute to quality development.  

ISO standard for elderly care

There is also an "elderly standard" since 2015. It clarifies the requirements for care and service for the elderly. It is provided free of charge by the Swedish Institute for Standards (SiS) for the operations that wish to introduce it. It provides good support in the quality development work.  

One value with the certification of operations is that it contributes to creating a systematic work where continuous improvements become part of the operation's culture. If everyone in the operation strives to make the residence better, it will soon give results.

By working with self-control and encouraging employees to write deviations when something goes wrong, the management can get impulses for the improvement work. It is also important to make it easy for residents and relatives to contribute with opinions and improvement suggestions.  

With simple, safe, and well-known routines that everyone follows, it becomes easy even for a relatively newly hired substitute to do the right thing. An important part of this is to have good simple ways for information transfer and a working method that makes it easy for employees to communicate with the management. Present leadership based on trust and a clear set of values also contributes to creating a culture where everyone is important.  

The importance of measuring and following up the right quality aspects in the nursing home

Measuring and following up on different quality aspects in nursing homes is crucial to ensure high standards and quality in caring for the elderly. By using the right measurement methods and analyzing relevant data, one can identify areas for improvement and ensure that the residents' needs are met in the best possible way. Here are some important aspects to consider when measuring quality and following up in nursing homes:
Patient satisfaction: Measuring patient satisfaction provides important feedback on how the residents perceive the care and service they receive. It may include questions about satisfaction with the food, treatment from the staff, access to activities, and the quality of the living environment.
Care quality and safety: It is important to measure and follow up on the care quality and safety in the nursing home, including compliance with medical routines and safety protocols, occurrence of pressure ulcers or fall injuries, and management of medications and healthcare-related infections.
Staffing and competence: Evaluating the competence and availability of the staff is crucial to ensure that the residents receive sufficient support and care. It may involve measuring the staff's level of education, staffing levels in relation to the number of residents, and how well the staff can meet the residents' individual needs.

Excessive measurement and risks:

Even though measurements are important to ensure quality, excessive measurement can lead to inefficiency and waste of resources. Focusing on too many measurement indicators can distract the staff from prioritizing what is really important and reduce focus on the actual care of the residents. In addition, excessive measurement can create a culture of stress and performance anxiety among the staff, which in turn can affect their well-being and work performance negatively.

Reflection questions on ambition in quality work
Care personnel:
• In what ways can you contribute to improving the operation?
• Do you have a good way to report deviations?
• Do deviations lead to the operation improving?
• Do you have any quality council within the operation?
• Is any employee an internal auditor?
• Do you spend time submitting statistics?
• Are the right things measured in the operation?

Manager, nurse, occupational therapist, and physiotherapist:
• Have you considered what is really important to you at your nursing home?
• What are the areas where you have your shortcomings and risks?
• Are you measuring in the smartest way?
• Are all deviations investigated seriously?
• Does the person writing deviations get feedback on the investigation and what measures have been taken?
• Do you give feedback on deviations at APT or in forums?  

Residents and relatives:
• Are there simple ways for you as a resident or relative to submit opinions, complaints, or improvement suggestions?
• Does the operation report any key figures or numbers in the information you receive or on the website?
• Is what is reported what you as a resident and relative consider to be important?
• Is there anything you believe the operation should follow up better?

Erland Olsson
Specialist nurse
Better care every day

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