Table 2 An overview of the identified issues and chosen intervention in each of the four cases
Case 1 | A “backup” resource for unforeseen events The most pressing need was related to the high occurrence of temporary staff needed to cover up for absence of permanent members of the staff and for unforeseen events. Temporary staff had low knowledge about the care recipients and could only tend to more simple tasks, always leaving the heavier and complex tasks to the permanent staff. To meet this need, the group decided upon an intervention that involved recruiting one extra person who would not be on a fixed schedule but serve as a backup in the organization to cover for someone being away, to respond to alarms during the day and to assist with recipients who have a heavy care burden. It was considered important that this be an educated and experienced person who could support the home care units in all types of tasks. As a first test, this person was set to serve two home care units and use a third unit as a control group The intervention was implemented as planned |
Case 2 | Reflective work unit meetings with a facilitator The intervention work group prioritized the issue of a deteriorating social climate in the organization and decided upon an intervention to improve this situation. The group suggested that regular meetings be scheduled in each home care unit, where various aspects related to the work situation could be discussed and reflected upon. The aim was to get everyone within one unit to be more engaged in one’s own work situation as well as the work situation of one’s closest colleagues, and build a sense of community. The meetings would provide time to reflect together around the work content, the work environment and similar aspects. Two persons in each unit would be educated and serve as facilitators for the meeting, scheduled once a month The intervention was not implemented as planned, due to a reorganization of both management and groups that started just after the intervention planning phase ended |
Case 3 | A new way to estimate travel time The work group focused on issues related to time slots dedicated to planning or travelling that often disappear due to other tasks. The travel time was currently based on an estimate from Google Maps that did not always match reality and did not take the type of building, or area, into account. If one needed to spend time on parking or climb three floors of stairs, this was not considered in the estimated travel time. The group suggested a dedicated time slot that each person could manage as best suited during the day, instead of letting the system automatically calculate and assign travel time. This time slot should cover travel time but could also be used for managing other tasks, including a phone call to a relative or to the medical nurse. The final intervention included an addition of two time slots of 15 min each that could be distributed as needed by the staff The intervention was implemented as planned |
Case 4 | Raise work environment–related issues on the regular meeting agenda The main problem that was identified concerned time management, with a shortage of time between visits to different care recipients, in particular when they should visit a doctor, come home after a hospital stay or other activities that required more time than usual. Further, several employees perceived that there was an uneven distribution between the employees regarding care recipients who were physically and mentally demanding. Better time margins were requested. There was also a request that the entire staff group should agree on routines to help each other with physically and mentally demanding care recipients and support from the manager was requested to get this working. The intervention work group also discussed aids related to their physical work environment. The group did know that there were aids for care recipients. However, they appeared to be unaware of their own rights to have access to, for instance, lifting aids. As a consequence, they had not asked for them, despite the physical issues being brought up in the group. These discussions resulted in an identified need of a regular forum dedicated to discussing these very fundamental but important questions relating to work environment. The determined intervention was set to focus on introducing regular meetings where such issues could be handled The intervention was partly implemented, but impossible to follow up due to a reorganization that dissolved the home care unit before the intervention could be evaluated |