Aiming for Sustainable Home Care

During 2019 an innovative project concerning the organisation of home care took off at Arcada. Since the autumn of 2018 Åsa Rosengren and Jukka Piippo, Head Teachers at the Department of Health and Welfare, have been researching how self-managing home care teams have worked out and what the effects of this model have been on the wellbeing of both clients and personnel.

– This model has a holistic view of the client. It’s based on seeing the needs of the client and the client’s life situation as one whole, says Rosengren.

This project came from the Dutch self-managing organisational model Buurtsorg (in English neighbourhood care). The idea behind Buurtsorg is a self-managing and self-organizing team; all decisions, everything from administration to healthcare needs to vacation timetables and office facilities, are taken collectively and without a leader/foreman. The team is not, however, left in free fall – there are external coaches to consult if needed. The role of the coaches is to support and to guide, not to make decisions. In the Netherlands this model has shown positive results with increased staff and client satisfaction – as well as having proven to be cost-effective.

– It’s essential to trust the competence of each team member and to carry on a continuous dialogue, says Piippo.

Rosengren and Piippo are carrying out two case studies where the Buurtsorg model is being tested: one in a small Finnish municipality and the other in a larger one. In this research project Arcada is responsible for conducting the interviews while THL (The Finnish Institute for Health and Welfare) is in charge of measuring work satisfaction, wellbeing, stress and quality of care. Hanken, School of Economics contributes by calculating cost-effectiveness. Through interviewing clients and staff Arcada is looking to find answers to the following questions: how could the Dutch self-managing model be adapted in Finland? Is the model conducive to increased work and client satisfaction? Is the model cost-effective?

It’s too early to say anything about the final results, but the fact is that there have already been positive results in Finland. In the smaller municipality where the model is being tested, the year 2019 showed a drop in staff sick leaves.

– In this municipality the home care staff decides collectively on the work schedule and fits it to individual needs. The foreman doesn’t chair the meetings, they are self-managed by the team members – the foreman is only called in when necessary. The team members have made another big change: clients are divided into smaller areas geographically. This has led to fewer clients per area and team member, says Rosengren.

These changes have been significant for client satisfaction. High on the clients’ list of priorities is continuity, having the same carer.

The flatter the organisation, the more flexible the changeovers

The future will tell whether we are looking at a shift to self-managing home care teams. This model suits some better than others.

– The more hierarchical an organisation is the more difficult the shift would be. In a flatter organisation the process is easier, Piippo points out.

– In all related research it’s important to be able to test innovative projects and models together with the organisations and communes as well as those the projects affect. The project has to allow for a sufficient time span. And follow-up studies are required to be able to say something about the long-term effects on the well-being of the home care staff, says Piippo.

The results of the project will be published in 2020.