CARP ACTION
FIXING HOME CARE
BACK IN MY finance days, I worked with a clerk who liked to buy office supplies in small batches several times a week. She declared proudly that she was saving company money because no supplies sat around “being wasted.”
We were always running out of supplies. Staff would have to wait for a supply run, and the clerk could have found better uses for her time than repeated trips to the supply store. This is an example of a well-meaning decision producing terrible results.
Sometimes these are small oneoff decisions that are easily fixed. Other times, the problem is more severe, such as the series of decisions taken across this country in the delivery of home care.
Decades ago, across Canada, home care was largely provided by registered nurses who visited patients and performed a variety of tasks, from changing wound dressings, administering medications and checking vital signs to helping patients dress, bathe and use the toilet.
Then came pressure to trim costs. Health administrators started to ask why trained professional nurses were doing work that could be done by less skilled staff for less money. Instead of having a nurse bathe and dress a patient, why not hire somebody else, call them a personal support worker and let them look after the more menial aspects of care?
This would not only save money but also free nurses to do work more worthy of their skills and credentials. And why stop there? Much of the cost of home care is driven by the difficulty of servicing different patients in varying locations – logistics. Why not hire logistical experts to cut costs by plotting out the most efficient way for nursing staff to visit patients? And why not have the most experienced nurses set schedules for patient visits, so every nursing hour could be used ideally and costs kept to a minimum?
Each decision was made with good intentions, but the results are far from satisfactory. Clients are unhappy. Nurses are unhappy. And any savings from efficiencies are redirected to the increasing cost of administering the mess. There is another solution. A decade ago, Jos de Blok, a Dutch home-care nurse, decided to challenge the Netherlands model (which was similar to the Canadian one) with a radically different approach. He started Buurtzorg (literally, neighbourhood care), an organization that would favour humanity over bureaucracy.
At Buurtzorg, nurses provide home care that includes not only the medical services that require nursing training but also the support services that lesser-trained (and less costly) personnel provide at other care facilities in the Netherlands (and Canada).
Self-governing teams of 10 to 12 highly trained nurses are responsible for the home care of 50 to 60 patients in a given neighbourhood. The teams work with the patients and their families, primary-care providers and community resources to meet patients’ needs and help them maintain or regain their independence.
If the nurses run into problems, they turn to coaches, not managers. Buurtzorg had 15 coaches for 700 teams in early 2015. Jan Zwart, a coach interviewed for a case study, noted that his job focused more on helping teams function than on providing advice regarding patient care.The result: highly satisfied patients and very happy nurses.
The 2015 case study had this to say about the organization: Government surveys have repeatedly shown that Buurtzorg’s patients are highly satisfied. Moreover, surveys of employees over several years indicate the organization has the most satisfied workforce of any Dutch company with more than 1,000 employees. What’s more, Buurtzorg’s costs, when measured in terms of care hours provided, are no higher and sometimes lower than the costs incurred by competing agencies.
When polls are conducted about respect by profession, nurses routinely top the charts. Why, then, are we managing them like indolent teenagers?
From New Westminster, B.C., to the Avalon in Newfoundland, our members share their stories of home-care challenges. More administration and even more resources won’t fix a broken system. Our provincial governments must recognize something Canadians already know: it’s time to put humanity before bureaucracy and give nurses, along with all health professionals, a system that lets them do their jobs.