Monitoring quality of care in Finland. Anja Noro, PhD, Research Professor Unit on ageing, disability and functioning

Monitoring quality of care in Finland Anja Noro, PhD, Research Professor Unit on ageing, disability and functioning

Contents Care and services for older people Why monitoring quality of care is important? How to co-create and co-work with service providers and staff? Can care practices and management be changed?

Why monitoring quality is important?

National policy for older care Information guidance Quality recommendations (2000, 2008, 2013) Act on Supporting the Functional Capacity of the Ageing Population and on Social and Health Care Services for older people (980/2012), came in force July 1 st, 2013.

Responsibility of supervising quality of care Service providers both public and private (self supervision plan) Municipalities responsible for organizing services to their population have responsibility of supervising quality of care among service providers acting in their area Regional State Administrative Agencies National Supervisory Authority for Welfare and Health (Valvira) The Older Care Act: Quality of care and views need to be monitored Clients and their relatives Staff

Quality of care Concepts Structure Processes Outcome Perceived vs. clinical Why? Evidence Equality in services Care patterns Management Supervision Policy How often? Continuous process

How to measure quality? Measuring Systematic Continuity Comparable Feedback Involvement Co-creation Co-management Utilizability Care planning and follow-up Care and nursing staff Management Support for staff Unit leader outcomes and challenges Benchmarking Comparing over time and between units

Gains of continuous needs and quality measuring of clients Client: Needs and potentials are known, involvement Staff: Care processes, are they worthwhile or not? Tools for care planning and follow-up Head nurse: case-mix of clients, allocation of resources, unit level monitoring of quality and outcomes, training needs of staff, supervision tools Decision makers: evidence of evolving services, evidence (needs) based allocation of resources National level: comparability over different municipalities and service providers, trends in performance and quality

Trends in services for older people in Finland

Increase in services for 65+ year old population during 2000 2013 in Finland 140000 120000 Health centre hospitals 100000 Residential home 80000 60000 Service housing (24/7 care) 40000 Service housing (no 24/7 services) 20000 Regular home care 0 2000 2001 2003 2005 2007 2008 2009 2010 2011 2012 2013 June 4th, 2015

Share of services for 65+ year old population during 2000-2013 100 % 90 % Health centre hospitals 80 % 70 % Residential home 60 % 50 % Service housing (24/7 care) 40 % 30 % Service housing (no 24/7 services) 20 % 10 % Regular home care 0 % 2000 2001 2003 2005 2007 2008 2009 2010 2011 2012 2013 June 4th, 2015

Policy is preferring for home care but the staff is mainly working in LTIC 100000 90000 80000 70000 60000 Clients 50000 40000 Staff 30000 20000 10000 0 24/7 hour care (LTIC) Home care

Can care practices and management be changed?

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Co-creation and co-management Project Implementation and benchmarking with RAIsystems Voluntary Co-funded Public and private providers Since 2000-50 45 40 35 30 25 20 15 Coverage % Residential homes Health centre hospitals Service housing (24/7) Service housing Home care 10 5 0

Process of benchmarking Design Training Software Benchmarking Databases Feedback Comparison Learning from best practices Guidance group Executive group Learning and doing Assessment of clients Care planning using new information Follow-up of clients Motivation for change Learning and accepting problems and need for change Support from unit heads and management June 4th, 2015

2003_1 2004_2 2006_1 2007_2 2009_1 2010_2 2012_1 2013_2 2001_2 2003_1 2004_2 2006_1 2007_2 2009_1 2010_2 2012_1 2013_2 2001_1 2002_2 2004_1 2005_2 2007_1 2008_2 2010_1 2011_2 2013_1 2014_2 2000_2 2002_1 2003_2 2005_1 2006_2 2008_1 2009_2 2011_1 2012_2 2014_1 Need for care has increased 100 % 90 % 80 % Higher than moderate problems in cognition and ADLs 70 % 60 % 50 % 40 % 30 % Higher than moderate problems in cognition and moderate or less in ADL Moderate or less problems in cognition, higher than moderate problems in ADL 20 % 10 % 0 % Moderate or less problems in cognition and activites of daily living Home care (n=233880) Sheltered housing (n=132393) Residential homes (n=145073)health centre hospital (n=83789)

Staffing levels have been good in units 100 % 90 % 80 % 0,70 + 70 % 60 % 0,60-0,69 50 % 40 % 30 % 0,50-0,59 20 % 10 % alle 0,50 0 % Public Private Public Private Public Private Public Public Private Service housing (24/7 care) Residential homes Health centre hospital Veterans care All service types

2003_1 2004_2 2006_1 2007_2 2009_1 2010_2 2012_1 2013_2 2001_2 2003_1 2004_2 2006_1 2007_2 2009_1 2010_2 2012_1 2013_2 2001_1 2002_2 2004_1 2005_2 2007_1 2008_2 2010_1 2011_2 2013_1 2014_2 2000_2 2002_1 2003_2 2005_1 2006_2 2008_1 2009_2 2011_1 2012_2 2014_1 Rehabilitation potential evident 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % Both nurses and client believe in clients rehabilitation potential Nurses believe client has rehabilitation potential Only client believes his/her own rehabilitation potential 20 % 10 % No rehabilitation potential 0 % Home care (n=233880) Sheltered housing (n=132393) Residential homes (n=145073) Health centre hospital (n=83789)

Conclusions

Tackling with quality issues Care patterns can be changed Increasing need for data for allocation of staff and timing of services based on clients needs for finding rehabilitation potential new clients clients already among services Usable but adequate information in real time Comparability over services in one country, between countries and over time Quality monitoring is as its best when the approach is based on co-creation and involvement of those it concerns

..and what is quality anyhow?

Information www.thl.fi/finrai www.thl.fi/vanhuspalvelulainseuranta E-mail: anja.noro@thl.fi