Leadership and Development - Future Elderly Homes, Development Work for Better Care

This article is written from a Swedish perspective. Hopefully, it can inspire interested parties from other countries.

If I want to succeed in leading a person towards a certain goal, I must first find her where she is and start right there (Søren Kierkegaard)

Development work in nursing homes is crucial for improving the quality of care and increasing the quality of life for the residents. By continuously seeking new methods and implementing innovations, nursing homes can offer a safer and more stimulating environment for the elderly.

Foto: Mostphotos

The Future of Elderly Care: Development Work for Better Care

Development work in elderly care homes is crucial for improving the quality of care and enhancing the quality of life for the residents. By constantly seeking new methods and implementing innovations, elderly care homes can provide a safer and more stimulating environment for the elderly.

There is occasional talk about sick organisations. Someone says that "it's in the walls", as if the problems are insoluble and nothing can be done about it. There are operations where management problems higher up make it difficult to be a manager at the operational level.

A culture where the values don't matter in practice and where employees are seen as replaceable cogs in a machinery is difficult to change. Above all, it is difficult to create long-term changes when as a manager you risk being affected by ill-considered decisions about reorganisations.

The opposite can prevail. According to the book "Advanced Level Nursing" by Edberg and others, Swedish healthcare has an organisation with roots in the Middle Ages. It happens that employees defend the status quo tooth and nail, despite the fact that small changes in the way of working can mean better care for the individual. Working in interprofessional teams utilises competencies and shows new ways forward.


It's easy to blame managers. We all have a responsibility for our personal leadership. Each one of us is our own personal brand. Everyone has a responsibility to do their best. If it doesn't work, it's time to look for another job.

Managers can express that the employees are uneducated and uninterested and therefore it is not possible to implement changes. But it is managers who recruit employees and it is part of the leadership to get the employees on board. Employees complain that the manager does not understand and is not open to constructive criticism. In addition, there is insufficient staffing to provide good care. There is not much difference in staffing between different residences. However, there are some where staffing is anorexic and where it is difficult to provide good care. Licensed staff have a particular leadership that is limited to medical issues, which must gear up in other tasks.

There are elderly care homes that easily find trained nursing assistants and nurses, where employees stay and develop. Comparing oneself with others is usually called benchmarking. By learning from the best, the development of the operation can move faster forward.

We all have a responsibility for the work environment and are each other's work environments. In order to do something about our work environment, we must be interested in each other as people and employees. As a manager, nurse, occupational therapist and physiotherapist, be present! You can't lock yourself in your room and think that the operation is developing. Employees need to know that their work means something. Another important part of the development is a common vision. A clear picture of who the operation is for and why.
Often there are things that work well in an operation that can be built on. Likewise, there are often simple improvements to start with in order to begin a positive development. When it comes to changes, it is good to take one step at a time and to ensure that they are really adhered to. Follow-up and evaluation of a new way of working is a big part of leadership.

Salutogenic Leadership

Another article describes a salutogenic approach. It is possible to take advantage of the healthy even in leadership. By making the work meaningful, understandable and manageable, we create a sense of coherence. This is the basis for a health-promoting leadership. The leadership invites good dialogue in the workplace where everyone contributes with personal insights. This is done through coaching, team development and a salutogenic mindset in change work.

With knowledge of change, the chances of success increase. Small tricks can make a big difference and if every step in the change work is successful, the end result will be fantastic while the operation flourishes. With tools to achieve change, it is possible to make care better - every day. In most operations, some form of improvement work is ongoing. Unfortunately, it happens that the work runs out in the sand and that the goals are never achieved. At the same time, it is important to dare to try new ways of working to see what a change can bring.

Gustaf was a former military man with a terrible temper. He was cared for in long-term care after suffering a stroke and losing the ability to walk. His wife came to visit every day. She wanted Gustaf to get training so he could regain his ability to walk. Our physiotherapist did not think it would work, as Gustaf was not so inclined to cooperate. I was 17 years old and got in touch with Gustaf and his wife. Gustav was spastic in his legs, which meant that his legs tensed up when he stood up. Together with his wife, we got him going so that he could walk with support. He was then able to occasionally offer a smile. I think our physiotherapist got a food for thought about what was possible and worth trying.

Prerequisites for Successful Change Work

• Visible and active leadership
• Everyone must understand the goals of the change
• The communication must work
• Resistance should be replaced with security and commitment
• The change work must be evaluated
• The goals of the change must be followed up so that the work does not fall back into old tracks.

To succeed in a change work is about psychology, communication, perseverance and accuracy. A clear goal image is a success factor. Without it, the change work becomes easily a threat and the risk of resistance to the change is evident. It becomes easier in a culture that works with constant improvements. Working in a team that constantly makes the operation better gives satisfied residents and relatives and proud employees.

Change occurs gradually. Therefore, it may be smart to think about in which order the change should be implemented. You as a change leader are probably far ahead of the others in thought when you start talking. By having a listening attitude, you can bring out a lot of smart thoughts that your colleagues have and that make the change work both better and easier. Further education or other complements can enhance the effect of the improvement work.

It's about being SMART in several ways. It is necessary to make those affected by the change involved as well as to set clear measurable goals.
In order to achieve a lasting change, the employee needs to make a commitment to change their way of working. This means that you have to talk about the change several times for the new way of working to take root and become a natural part of the work method.

The residents and relatives are affected by the change work and a success factor is that they are made involved in the development work. This is especially true if the change directly affects the resident. If, for example, we want to work more function-preserving with a resident, success depends on the resident seeing the value of a new way of working.

Education as a Tool in Change Work

To implement a change often requires a well-thought-out plan. You who drive a change work often have a pre-understanding and motivation for the change. For others who have never even considered that there is room for improvement, it may require more effort to understand and be motivated to change the way of working.

It's about being creative when it comes to planning and implementation, for example to create conditions for further education. Much can be done digitally today and there is a value in utilising the competence that exists in the operation. Clear measurable goals make you see when you have reached. A change is not implemented until everyone follows the new way of working. Coaching, support and follow-up must be included as natural elements.

Tips for Success with Education
• Have a clear, measurable goal image. How should the change be noticed in the operation.
• Give feedback and praise for the desired change.
• Think about what is easy to start with in the change work and take one step at a time until the whole change is implemented.
• Celebrate success.

Person-Centred Care

A central focus in the development work at elderly care homes is to ensure that care is individualised and person-centred. This means that the residents' needs, wishes and values are at the centre of all care and welfare. By involving the elderly and their relatives in the planning and decision-making, you can create an environment that feels safe and homely.

The Role of Technology in Elderly Care

Digital Solutions: Technology can improve the quality of care and increase security in elderly care homes. For example, electronic journal systems can make it easier to keep track of medication and health status for the residents. Remote monitoring and sensors can detect falls or other emergencies quickly, increasing the safety and security of the residents.
Social Interactions: Digital tools can also be used to facilitate social interactions. Video communication and social platforms can help residents keep in touch with their loved ones, which is especially important to counter loneliness and isolation.

Competence Development for the Staff

Continuous Education: To ensure a high quality of care, it is important that the staff is constantly developing and updating within their profession. Through regular further education and competence development, the staff can become better equipped to meet the elderly's needs and handle new challenges.
Interprofessional Collaboration: Working in interprofessional teams, where different professions work together, can lead to better care results and a more holistic view of the residents' health and well-being. This collaboration can also contribute to the staff feeling more involved and motivated.

Environment and Sustainability

Sustainable Design: The development of elderly care homes should also include sustainability aspects. By using environmentally friendly materials and energy-efficient solutions, you can create a sustainable and healthy environment for the residents.
Green Areas: Integrating gardens and green areas in elderly care homes can have many positive effects. It gives the residents the opportunity to be outdoors and enjoy nature, which can improve their mental and physical health.

Continuous Improvement

Systematic Evaluation: To ensure that the development work is effective, it is important to continuously evaluate and follow up the changes that are implemented. By collecting data and feedback from both residents and staff, you can identify areas that need to be improved and adjust the efforts accordingly.
Innovative Solutions: Being open to new ideas and innovations is central to the development work. By testing and implementing new methods and technologies, elderly care homes can be at the forefront and offer the best possible care.


In almost all workplaces, there are employees who are inspirers and role models for others. These people make a big difference for quality. By giving colleagues appreciation for what we see as valuable in them, we can create an inspiring culture.
I see many fantastic nursing assistants who create activity in everyday life and can be an inspiration to others. Different homes have different conditions, but everyone can do something. Focusing on reality should look different can easily become an excuse not to make the best of the present.

People are different and some spread laughter and security in the group. It is a bonus for the workgroups that have a person with a positive attitude and a great commitment, who thinks it is important to have fun and is not afraid to "pitch in" where an extra hand is needed. That person usually creates a good "chemistry" in the group. Our personality can develop over the years and qualities improve with experience and certainly with a certain measure of wisdom. An introverted person can over the years become more open and outgoing in social contexts.
Highlighting a person who inspires others is primarily a leadership issue, but we all have a responsibility to give each other praise in everyday life. A manager has a mandate and hopefully knowledge to "build teams" It is important as a manager to see the profit with each employee's strength and potential, to have an ability to capture and provide the right support. The result is most likely a positive team spirit and a better work environment that creates ripples in the water where good examples can carry everyday work.

People who are inspirers often spread joy in workplaces while being a role model for how the job can be done better and more fun. The climate can hold back the one who could be a role model. Let your colleagues' creativity bloom so the job becomes much more fun.

It easily becomes a bit high-flown when the word inspirer is used. It should be a speaker at a conference or so. The best inspirers are those who are in our everyday life. Those who make us find the strength and job satisfaction when it feels heavy and difficult. Those who make us see other often more positive perspectives. They are a light that shines in an everyday life that can otherwise be heavy and stressful.

It happens that the one who is an inspirer is appointed coordinator or quality representative. It can be a successful move but it can also stifle the ability to be naturally inspiring. Being weighed down by administrative burdens can also strangle creativity and job satisfaction.

Give your inspirers support. Show that you see them, give praise and learn from them. In this way, we create a culture where good examples carry everyday work.

Through focusing on these areas, elderly care homes can create an environment that is both safe and stimulating for the residents. Development work is a continuous process that requires commitment and innovation, but that ultimately leads to better quality of care and increased quality of life for the elderly.

Läs mer om salutogent förhållningssätt

Reflection - Leadership and Development:
Care Staff:
• Are you the kind of person that a good manager wants to have with them when building the elderly care home of the future?
• Do you experience your work as meaningful, manageable and understandable?
• Do those who do the little extra get praise and appreciation?
• Are you or could you become an inspirer for your colleagues?

Manager, Nurse, Occupational Therapist and Physiotherapist:
• Are there operations you can compare yourself with to learn and get better?
• How do you work with changes to make them feel meaningful, understandable and manageable for the employees?
• How do you take advantage of the residents' perspective in development work?
• How do you work to lift your inspirers?

Residents and Relatives:
• Are improvements being made at the residence?
• Is there one of the nursing assistants in your unit who is an inspirer and role model?
• Have you shown that you appreciate that person?

Erland Olsson
Specialist Nurse
Sofrosyne - better care every day.

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