Nursing homes should work with systematic quality development

This article, written from a Swedish perspective, can hopefully inspire those interested from other countries

The work with continuous improvements consists of many different tools that are interconnected. Above all, it is about building a culture. Self-control, internal audits, patient safety reports, quality registers, deviation management, key figures and routines all play their role in the work to constantly make the operations better.

Constitution SOSFS 2011:9

All operations working with care are required to work with systematic quality management in the National Board of Health and Welfare's regulations.

Working with systematic quality development means working with continuous improvements. In order to know that things are improving, certain basic prerequisites are required. Tom Johnstone, former CEO of SKF, describes improvement work as an evolution where all changes must build on the improvement work that has been done before.

The Management System

First, we need to know what we are doing. For this, there need to be written procedures for all processes and activities included in the operation. Then we need to measure the effect of what we do, so we know if the operation is improving. In addition, we need systems that make us constantly think about how we can do things better. National quality registries such as Senior Alert, Palliative Registry and the BPSD Registry are examples of development work. The quality registries should contain individual-based information about problems, actions, and results within operations concerning health and social care. The registries lead to change and improvement work and to learning and development of the operations.


Many operations also have quality representatives who carry out internal audits to see that the routines work as intended and that the employees follow them. One way to evaluate one's operation is to cooperate with another residence. The quality representatives can then carry out self-inspection at another residence and someone from outside will review the operation.

Most operations also have quality review of drug management, hygiene rounds, and supervision by a medically responsible nurse. Sometimes the environmental office comes and performs supervision over food handling. In addition to this, certified residences also have an annual operational audit.


Self-inspection can be done through signing lists. This is always present when the staff assist the individual with drug management but can also occur for other steps. Checking food handling is also an area that often requires signing lists. Similarly, fire protection rounds and security rounds can be part of self-inspection. Many operations also regularly review journals.

In order to be able to compare the operation over time and with other operations, key figures are often used. Activation and outdoor stays are such elements that need to be documented in a simple way and sometimes happen with signing. Other key figures can be complaints, the number of people with underweight, the incidence of pressure sores, the use of antibiotics, etc.

Comments and Complaints

Comments and complaints are an important source of knowledge about deficiencies in the operation. Similarly, deviation reports. Having a good process with these where the operation seriously seeks better ways of working and implementing changes means that the risks are reduced while care and nursing improve. We need to handle comments, complaints, and deviations in the operation. By learning from negative events to improve, we get the work to flow better and safer.

Annual Wheel for Quality Work

It is good to have an annual wheel for quality work. This is to make the operation feel secure that all routines are updated and reviewed. It is also important to check that employees follow the applicable routines. Poor adherence to routines is the greatest risk in an operation. If employees are allowed to ignore routines, they are also left to assess what is important or less important in the operation. If there are routines that the management does not consider important to follow, they should be removed.

Patient Safety Story

Each year, the operation is obliged to prepare a patient safety story. It should be made available to anyone who wishes to see it. It is just to ask the unit manager to share it. This applies regardless of whether the operation is in public or private operation. In larger companies and municipalities, the patient safety story is often prepared at the management level. Many operations have broadened the patient safety story to also be a quality and business story. One of the most important perspectives as we look back on the past year is to plan the quality work for the coming year.

What is quality work in care and nursing?
Quality work in care and nursing is about ensuring that the care and nursing environment meets high standards in terms of safety, efficiency, patient or user centering, and that they deliver positive results for patients, users, and their families.

Why is quality work important in care and nursing?
Quality work is important because it guarantees that care and social services are safe and effective, that the residents receive the care and nursing they deserve, and that there is a continuous effort to improve the services based on results and feedback.

What are some common methods for quality work in care and nursing?
Measuring and evaluating results, using surveys for residents and relatives, creating routines, checklists, and self-inspection for different parts of the operation, following up on knowledge and further educating the staff, and conducting regular audits of care processes and other tasks.

How can I, as a healthcare professional, contribute to quality work?
As a healthcare professional, you can contribute by following evidence-based care and guidelines, reporting deviations and incidents, listening to patients' or users' needs and expectations, and participating in education and being curious about development to improve your skills.

What are some examples of the results of successful quality work?
The results of successful quality work include reduced care-related injuries and complications, more satisfied residents and relatives, more enjoyable premises, good meals and activities, and more efficient use of resources.

Are there rules and guidelines governing quality work in care and nursing?
Yes, there are national and international rules and guidelines governing quality work in care and nursing. These can vary depending on the country and care sector, but usually aim to ensure uniform standards and safety levels. In Sweden, the municipality also sets up its own guidelines for various quality areas.

It is important to understand that quality work in care and nursing is an ongoing process that involves many different areas and stakeholders. It is also a joint effort that requires cooperation between healthcare professionals, management, and patients or users to achieve the best results.

Reflection Questions - Systematic Quality Management
Care staff:
- Do you have good quality work on the unit?
- Is adherence to routines good?
- Are deviations treated well?
- Are there routines that you find unnecessarily complicated or insufficient?

Manager, nurse, occupational therapist, and physiotherapist:
- Are there good routines on the unit?
- Are they known by everyone?
- Do you have a working method that makes it "easy to do right"?
- Do you have an annual wheel for quality work?

Resident and relative:
- Is there a functioning handling of viewpoints in the operation?
- Do you feel that the operation works with constant improvements?

Erland Olsson
Specialist Nurse
Better care every day

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