Pohjanmaan palveluohjaus kuntoon : Toimintamalli ja tietojohtamisen tunnusluvut

Maantieteellisesti pitkän ja kapean Pohjanmaan maakunnan väestöpohja on noin 180000. Kaksikielisen Pohjanmaan väestö on terveempää, keski-ikä on korkeampi, koulutustaso on parempi ja työelämässä pysytään pitempään koko maahan verrattuna. Toisaalta palvelujen käyttö on runsaampaa. Pohjanmaan palveluohjaus kuntoon tarkoituksena oli luoda maakunnallinen palveluohjauskeskus toimintamalleineen ja tunnuslukuineen. Hanke kuului kansalliseen kärkihankkeeseen ”Kehitetään ikäihmisten kotihoitoa ja vahvistetaan kaikenikäisten omaishoitoa (I&O). Kehittämistyö toteutettiin I&O muutosagentin koordinoimana asiantuntijatyönä. Kehitetty palveluohjauksen toimintamalli sisältää kolme osiota: (1) yleinen informaatio ja neuvonta/matalan kynnyksen ikäpiste, (2) kertaluontoinen palvelutarpeen arviointi ja palvelusuunnitelma sekä (3) pitempiaikainen/intensiivinen palveluohjaus ja Case managerin antama tuki. Palvelutarpeen arviointia ja -ohjausta toteuttaa ydintiimi, joka tarvittaessa konsultoi erityisasiantuntijoita. Palveluohjauksen työvälineinä toimii tarvepohjaiset, RAI tietoon perustuvat asiakassegmentit. Palveluihin ohjautumista seurataan ja arvioidaan RAI tunnusluvuin. Palveluohjauksen sisäisten tuotteiden ns. kuntahinnat vaihtelevat 30-600 euronvälillä. Palveluohjaus on asiakkaille maksutonta. Tämä julkaisu on tapauskuvaus, jossa esitetään palveluohjauksen toimintamalli ja keskeisiä tietojohtamisen tunnuslukuja maakunnassa toteutetun I&O kehittämistyön näkökulmasta RAI tietoa hyödyntäen. Julkaisussa nostetaan esille myös kehittämistyön kriittiset pisteet ja kehittämishaasteet. Julkaisu on tarkoitettu kaikille, jotka ovat kiinnostuneita palveluohjauksesta ja RAI tiedon hyödyntämisestä siinä. Palveluohjauksen toimintamalli tunnuslukuineen on luotu, jotta se soveltuu Pohjanmaan maakuntaan ja on hyödynnettävissä RAI tietojohtamisen jatkokehittämistyössä maakunnassa. Kehitettyjen mallien valmiusaste vaihtelee

Quality of care plans in long-term care facilities for the older persons : How well is information from RAI assessments utilised in care planning?

AbstractBackground: In Finland, care plans at long-term care facilities (LTCF) for the older persons should be based on information from Resident Assessment Instrument (RAI) assessments and the principles of structured data. Hence, managers are responsible for ensuring that the RAI system is used to a satisfactory extent, the provided information is used in care planning, and that staff members are competent at composing high-quality care plans.Aim: To explore the congruence between first-line managers’ assessments of the extent to which care plans include RAI information and separately observed RAI-related contents of care plans.Methods: The study was based on a descriptive, cross-sectional survey of first-line managers (n = 15) from three LTCF organisations and a randomly selected sample of care plans (n = 45) from two LTCF organisations in Finland. Manager responses and analysis of care plans were reviewed at a general level. The data were gathered in 2019 and analysed using statistical methods and content analysis.Results: First-line managers’ assessments of the extent to which their units’ care plans included RAI information did not match the observed care plan contents. The care plan analysis revealed that managers significantly overestimated the extent to which care plans included RAI-related content.Conclusions: Managers at LTCF organisations need more training to be able to sufficiently support their staff in using RAI information to draft high-quality care plans.Implication for practice: Care plans must include a higher level of information related to RAI assessments. To develop competencies in drafting high-quality care plans, training related to RAI information utilisation on all aspects of the care plan should be emphasised and training should be provided to first-line managers and more broadly across the nursing staff.Abstract Background: In Finland, care plans at long-term care facilities (LTCF) for the older persons should be based on information from Resident Assessment Instrument (RAI) assessments and the principles of structured data. Hence, managers are responsible for ensuring that the RAI system is used to a satisfactory extent, the provided information is used in care planning, and that staff members are competent at composing high-quality care plans. Aim: To explore the congruence between first-line managers’ assessments of the extent to which care plans include RAI information and separately observed RAI-related contents of care plans. Methods: The study was based on a descriptive, cross-sectional survey of first-line managers (n = 15) from three LTCF organisations and a randomly selected sample of care plans (n = 45) from two LTCF organisations in Finland. Manager responses and analysis of care plans were reviewed at a general level. The data were gathered in 2019 and analysed using statistical methods and content analysis. Results: First-line managers’ assessments of the extent to which their units’ care plans included RAI information did not match the observed care plan contents. The care plan analysis revealed that managers significantly overestimated the extent to which care plans included RAI-related content. Conclusions: Managers at LTCF organisations need more training to be able to sufficiently support their staff in using RAI information to draft high-quality care plans. Implication for practice: Care plans must include a higher level of information related to RAI assessments. To develop competencies in drafting high-quality care plans, training related to RAI information utilisation on all aspects of the care plan should be emphasised and training should be provided to first-line managers and more broadly across the nursing staff

Psychosocial factors at work after the implementation of kinaesthetics in elderly care

AbstractBackground:Research on employee satisfaction and rehabilitation care practice models in elderly care is scarce, and no previous studies exist regarding the effects of implementation of Kinaesthetics on psychosocial factors at work.Aim:This study aimed to describe job satisfaction among employees in elderly care after implementation of Kinaesthetics as a patient mobility support model in rehabilitation care. The target organisation was a joint collaboration area of four municipalities in Finland.Methodology:A descriptive cross-sectional design was used. The data were part of a larger occupational wellbeing survey, the Hospital Personnel Study. Psychosocial factors at work, including job characteristics, team climate and organisational justice, among elderly care staff were examined in 2012 (N=336), 2014 (N=326) and 2017 (N=370). At the end of 2012, a development project was implemented and during 2013 all employees of geriatric wards underwent basic training in Kinaesthetics. The geriatric ward employees were compared with employees in home care and nursing home in the same organisation.Results:In general, job satisfaction was rather good in all units, and the differences between the units were minor regardless of statistical significance. The change was different between the units only regarding relational justice. Between the baseline and the first follow-up measurement, relational justice improved in all work units, and improvement was more pronounced in geriatric wards where Kinaesthetics was implemented than in other elderly care units. Innovation increased among geriatric ward staff, but not statistically significantly.Conclusion:The study indicated that the implementation of Kinaesthetics seems to effect relational justice positively in elderly care. The implementation of Kinaesthetics possibly gave managers an opportunity to maintain a presence in everyday work. During the study, a nation-wide health and social services reform was being prepared and a larger scale effect of the intervention may have been overridden by other changes in the organisation.Abstract Background:Research on employee satisfaction and rehabilitation care practice models in elderly care is scarce, and no previous studies exist regarding the effects of implementation of Kinaesthetics on psychosocial factors at work. Aim:This study aimed to describe job satisfaction among employees in elderly care after implementation of Kinaesthetics as a patient mobility support model in rehabilitation care. The target organisation was a joint collaboration area of four municipalities in Finland. Methodology:A descriptive cross-sectional design was used. The data were part of a larger occupational wellbeing survey, the Hospital Personnel Study. Psychosocial factors at work, including job characteristics, team climate and organisational justice, among elderly care staff were examined in 2012 (N=336), 2014 (N=326) and 2017 (N=370). At the end of 2012, a development project was implemented and during 2013 all employees of geriatric wards underwent basic training in Kinaesthetics. The geriatric ward employees were compared with employees in home care and nursing home in the same organisation. Results:In general, job satisfaction was rather good in all units, and the differences between the units were minor regardless of statistical significance. The change was different between the units only regarding relational justice. Between the baseline and the first follow-up measurement, relational justice improved in all work units, and improvement was more pronounced in geriatric wards where Kinaesthetics was implemented than in other elderly care units. Innovation increased among geriatric ward staff, but not statistically significantly. Conclusion:The study indicated that the implementation of Kinaesthetics seems to effect relational justice positively in elderly care. The implementation of Kinaesthetics possibly gave managers an opportunity to maintain a presence in everyday work. During the study, a nation-wide health and social services reform was being prepared and a larger scale effect of the intervention may have been overridden by other changes in the organisation

Österbottens servicehandledning i skick –Verksamhetsmodeller och nyckeltal för informationsledning

Befolkningsunderlaget i det geografiskt smala och långsträckta landskapet Österbotten är cirka 180 000. Befolkningen i det tvåspråkiga Österbotten är friskare, har högre medelålder, har bättre utbildningsnivå och stannar kvar längre i arbetslivet än befolkningen i resten av landet. Användningen av tjänster är dock även större. Syftet med projektet Österbottens servicehandledning i skick var att skapa ett servicehandledningscenter i landskapet samt verksamhetsmodeller och nyckeltal. Projektet ingick i det nationella spetsprojektet Hemvård för äldre utvecklas och närståendevården för alla ålderskategorier förbättras (I&O). Utvecklingsarbetet genomfördes i form av sakkunnigarbete som samordnades av en I&O-förändringsagent. Den verksamhetsmodell för servicehandledning som utvecklades består av tre delar: (1) allmän information och rådgivning/seniorpunkt med låg tröskel, (2) en bedömning av servicebehovet och en serviceplan samt (3) långvarigare/intensiv servicehandledning och stöd av en case manager. Bedömningen av servicebehovet och servicehandledningen genomförs av ett kärnteam, som vid behov konsulterar specialsakkunniga. Som verktyg för servicehandledningen fungerar behovsbaserade kundsegment baserade på RAI-uppgifter. Hänvisningen till tjänsterna följs upp och utvärderas med hjälp av RAI-nyckeltal. De s.k. kommunala priserna på produkterna inom servicehandledningen varierar mellan 30 och 600 euro. Servicehandledningen är avgiftsfri för klienterna. Denna publikation är en fallbeskrivning, där det presenteras en verksamhetsmodell för servicehandledningen och viktiga nyckeltal för informationsledningen betraktat ur perspektivet av det I&O-utvecklingsarbete som genomförts i landskapet och med användning av RAI-uppgifter. I publikationen lyfts även fram kritiska punkter vid utvecklingsarbetet samt utvecklingsutmaningar. Publikationen är avsedd för alla som är intresserade av servicehandledning och av att utnyttja RAI- uppgifter inom den. Verksamhetsmodellen för servicehandledningen och tillhörande nyckeltal har skapats för att passa för landskapet Österbotten, och den kan användas vid det fortsatta utvecklandet av RAI-informationsledningen i landskapet. Hur pass färdigutvecklade modellerna är varierar

Johtajien näkemyksiä RAI-tiedon hyödyntämisestä ikääntyneiden kotihoidossa vuosina 2013 ja 2022

RAI-järjestelmää (Resident Assessment Instrument) ja sen tuottamaa tietoa voidaan hyödyntää ikääntyneiden kotihoidon johtamisessa ja päätöksenteon tukena. Poikkileikkausasetelmassa toteutetussa kyselytutkimuksessa kuvattiin johtajien näkemyksiä yksikkönsä hoitajien RAI-osaamisesta, RAI-arvioinnin tekemiseen liittyvistä käytänteistä sekä toiminnan seurannasta ja arvioinnista ikääntyneiden kotihoidossa vuosina 2013 ja 2022. Tutkimusaineisto kerättiin syksyllä 2022 ikääntyneiden kotihoidon johtajilta eri puolilta Suomea hyödyntäen RAIHYJ-mittaria (RAI-järjestelmän hyödyntäminen johtamisessa). Tuloksia vertailtiin vuonna 2013 toteutetun kyselyn tuloksiin, jossa käytettiin samaa mittaria. Aineisto analysoitiin tilastollisin menetelmin. Johtajien näkemyksien mukaan yksiköiden hoitajien RAI-osaamisessa, RAI-arvioinnin tekemiseen liittyvissä käytänteissä sekä toiminnan seurannassa ja arvioinnissa oli kehitettävää. Parhaiten toteutui hoitajien RAI-osaaminen, eniten kehitettävää taas oli toiminnan seurannassa ja arvioinnissa. Johtajien itsearvioidussa RAI-järjestelmään liittyvässä johtamisosaamisessa havaittiin merkittäviä puutteita. Johtajien näkemykset vuosina 2013 ja 2022 olivat samansuuntaisia, mutta myönteistä kehitystä oli havaittavissa kaikilla sisältöalueilla. Tulokset osoittavat, että henkilöstöä ja johtajia tulee ikääntyneiden kotihoidon organisaatioissa kouluttaa systemaattisesti ja koulutus tulee kohdentaa oikein. Lisäksi on tärkeää varmistaa RAI-arviointiprosessin toteutuminen. Managers’ perceptions on the utilization of Resident Assessment Instrument system in home-care services for the older persons in 2013 and 2022  The RAI system (Resident Assessment Instrument) and the information it produces can be used in the management and decision-making of home care services for older people. The aim of this cross-sectional survey was to describe managers’ perceptions of the RAI competence of nurses in their unit, practices related to RAI assessments, and monitoring and evaluation in home care services for older persons. In addition, the study aimed to compare the differences in managers’ perceptions between 2013 and 2022. The data were collected in autumn 2022 from managers of home care services in different parts of Finland using the RAIHYJ (Utilization of the Resident Assessment Instrument in Management) scale. The results of the study were compared to the results of a survey conducted in 2013 in a project concerning the development of elderly care resources and quality of care, in which the data were collected using the same RAIHYJ scale. The data were analyzed using statistical methods. According to the managers’ perceptions, there is a need for improvement in their unit’s nurses’ RAI competence, practices related to RAI assessment, and monitoring and evaluation. RAI competence was rated at the highest level, while monitoring and evaluation were perceived as needing the most improvement. Significant deficiencies were found in the managers’ self-assessed RAI-related management competency. The managers’ perceptions appeared to be approximately similar in 2013 and 2022, but positive developments were noted in every content area. The results of the study emphasize the need for systematic properly targeted training of the entire staff and for ensuring the implementation of the RAI assessment process in home care organizations for older people