Home care suffers from harmful routines – not from a lack of resources
As our population ages, the future load of the public health care system will be lightened with home care. Efficient home care services will be of high demand. The system of home care service is already stretched to its limits though: nurses and patients are stressed due to constant hurry, and staff shortages are replenished by buying extra work from the private sector.
Despite the hurry and the chronic deficiency in nurses, productivity of home care services is low; patients do not get adequate care. Still, what if the problem was not the assumed lack of resources but the ways home care services are designed and carried out?
Johan Groop shows in his dissertation for the Department of Industrial Engineering and Management at Aalto University that low productivity and the constant shortage of work force is caused by routinised procedures in the field falsely considered to be efficient.
Following the management philosophy Theory of Constraints, Groop's research has discovered three interconnected core problems, the resolving of which would radically improve the productivity of home care services.
The morning rush messes up the entire home care service
First of all, the work of home care nurses is currently designed so that the patients of one nurse live as close to each other as possible. This saves travel time and expenses, and thus the ensuing procedure is thought to be efficient. Groop's research shows that this rather leads to an unreasonable demand for labour in the morning and to an excessive capacity later in the day.
– Mornings suffer from a rush peak because nurses are forced to mix tasks that are tied to a specific time of the day and tasks that can be taken care of any time, sums up Groop the root of the problem.
Secondly, the vacancies of nurses are tied to certain districts, and this prevents nurses from moving across districts according to the demand of labour.
– No one wants to waste the nurses' work time in traffic, but the crucial thing would rather be to spread the work evenly throughout the day and to areas with the most demand, suggests Groop.
– Now some districts are compelled to buy extra work force from the private sector, even though there would be available nurses in the neighbouring areas.
The third problem stems from making use of every available nurse in every area regardless of whether everyone is needed or not. Even though in some areas there would be work for only a part of the nurses, the tasks are dealt between everyone. This promotes moving even more tasks and visits that are not tied to a certain time of day to the morning hours.
– Focusing on and making minute details more efficient often ends up only contributing to the actual problem. You wind up efficiently doing things that should not be done in the first place, argues Groop.
The dissertation concentrates on the home care services of the city of Espoo, but Groop believes the problems are similar nation-wide.
Nurses to meet the needs of patients, not districts
– The current mode of operation benefits neither the nurses, the health care system nor the people in need of home care.
Groop presents quite simple solutions. Instead of optimising the nurses' work routes, the focus should be on providing the right kind of services to the right customers regardless of their location. Tasks that are time-critical should all be carried out in the morning; tasks that are not so tied to a certain time of day should be taken care of in the afternoon.
In addition, a 'buffer group' of nurses should be formed. This means that not all the nurses are sent out to the field every morning, but a buffer group is reserved to trump the rush peaks in areas with the most demand.
– By no means does all this entail letting anyone of the nursing staff go, but to strive to make the most of the current resources and alleviate the nurses' workload, emphasises Groop.
– When the nurses are not in a constant hurry, and their schedules are planned to meet the needs of patients and not optimal routes, nurses will have time to really concentrate on improving the quality of life of their patients.
Aalto University School of Science
Department of Industrial Engineering and Management
johan.groop [at] aalto [dot] fi
tel. +358 50 301 6146