Is your business primarily planned or event-driven?

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

The quality of an operation is affected by how event-driven it is. Planned activities more rarely create stress. With planning, the elderly receive the help they are entitled to. The planning is at many different levels. From ensuring that all residents receive good doctor visits to the implementation plan being reflected in the daily work. Purchases and outings, everything needs to be planned. Transitioning from an event-driven to a planned operation in a nursing home requires a conscious change process and commitment from both management and employees.

Much, but not all, of what happens in a nursing home can be planned.

Sometimes when you visit a nursing home, the activities seem rushed, as if everything or most of the things happening are of an urgent nature. Of course, there are urgent events in a nursing home, but most of what happens is expected and there should be routines for how and when it should be done.

The operation has a duty to plan care. All residents should have an implementation plan that describes the social needs of the resident and how they want them to be met. Those with medical needs should have care plans that meet the medical needs.

It is important to take time to listen and plan

It is important that the resident and their relatives are given time to tell how they want it. The nursing assistant and licensed staff must take time to listen, reflect and then update the planning materials. Everyone must also be given time and space to read and understand what is important to the individual. Otherwise, there is a risk that the staff will develop some form of standardized behavior for how to behave when working in someone else's home.

Having intimate hygiene taken care of by a person who knows nothing about my needs or wishes can be uncomfortable. Receiving incorrect diet can be directly dangerous and being repeatedly offered to participate in activities that one has no interest in can also feel offensive.

Good planning increases the chances of remembering and meeting the elder's needs. It can be about everything from sitting down and talking for a while to remembering name days and birthdays. The thing about food and medication that meets the elder's basic needs usually works well, but with inadequate planning, what is the individual's wishes and dreams can be forgotten. Likewise, planning to put a little gold edge on existence can often be forgotten.

Strategies to increase the proportion of planned tasks

Analyze the situation: Do you feel stressed and that a lot of the work is spent on addressing things that have already happened? Start by analyzing and evaluating the current work situation in the nursing home. Identify the areas that are most event-driven and why.

Develop clear routines: Create clear routines for different tasks and activities in the nursing home, including planning, meals, medication management, and activities.

Implement A Planning Culture: Promote a culture where planning and preparation are prioritized and encouraged. Highlight the importance of having a well-thought-out plan for each day and each activity.

Involve all employees: Engage and involve staff in the planning process. Listen to their views and ideas to create a more efficient and planned operation.

Set clear measurable goals: Set concrete goals for the transition to a planned operation and regularly evaluate progress towards these goals.

Adapt further training and self-controls to the current work: Offer training and support to staff to help them develop planning skills and organizational skills.

Review how your operational support looks: Explore the possibilities of using technological tools and systems to facilitate planning and documentation in the nursing home.

Communicate clearly: Ensure that there is clear communication and dissemination of information about planned activities and changes in routines and protocols.

Evaluate the improvement work continuously: Continue to evaluate and improve the planning process based on feedback and experiences from both staff and residents.

There are a number of measures that should take place regularly. Doctor visits, medical risk analyses, evaluation and updating of the implementation plan etc. By having a structure to prepare and carry out these so that planning is synchronized, the operation can achieve both increased safety and a reduced risk for unplanned events.

Reflection questions - planned or event-driven care
Care staff:
- What do you do to make the resident and their relatives participate in the implementation plan?
- How do you work with the resident and their relatives when it comes to the content of the implementation plan?
- Do you have coordination with licensed staff when it comes to their care plans, so that you get a holistic perspective on the resident's needs?

Manager, nurse, occupational therapist and physiotherapist:
- What do you do for the efforts around the individual to be coordinated?
- Is the work with risk analyses, medication reviews, doctor visits, and updating of care plans coordinated with the evaluation and revision of implementation plans?
- Do you do an evaluation of how the team's joint work with the resident works?
- Are there good structures where the resident and relatives are included in the planning process?

Residents and relatives:
- Do you experience the operation as planned or event-driven?
- Do you receive information about meetings and activities in a good time?

Erland Olsson
Specialist Nurse
Better care every day

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