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Well Planned Is Half Done

Most of us know and admit this proverb to be quite true. However, the Finnish culture and way of working is often characterized by a more “no looking back “approach. We appreciate the fact that action is taken without too much hesitation.

I first came across the RAI assessment system in 2002, when I started working in home-care nursing. Initially, I did not see the benefits or significance of the tool, being that I was a caregiver and the assessments were viewed more “statistically.”

I did the assessments when they had to be done, but I never really understand why the assessments were being done? I felt they took too much time, making it become more of a burden then anything.

This tool had been chosen by my employer, therefore I had to except using it. I'm the type of person that wants to do meaningful work, and I want to understand the purpose behind it. So I took initiative and went out searching for a better understanding of RAI. I learned how RAI broadly includes the things at my work that are usually monitored, observed, interviewed, and recorded (the elderly, mental health, and developmental disability).The entire content of RAI is familiar to care workers.

I realized that the RAI content wasn’t new to me. However, it reassured me that I’m going through the same things with all my clients. In addition, I was able to show the compilation of the client’s overall situation to the client, relatives, and my employer. I was able to make everything I do viewable.

RAI is done regularyly, at least once every six months, and everything we accomplish can then able to be viewed.

This was just the beginning of an exciting phase. I had found a tool that could make nursing  work visible.

RAI is first and foremost a tool for care planning, it is not a separate part but goes hand in hand with customer care planning. RAI is a tool used in both client encounters and discussions, providing a framework for the customer and relative discussions.

This is how I used it: once every six months, I held a consultation with the client and their relatives. From there, an individual care plan was built based on RAI, which gave us all a common direction. 

I have worked a long time around the RAI system, and still to this day, I get the question, “why is RAI done”. I get much feedback, but the comments that challenge me the most are that: it takes time from the nursing staff, it costs too much, the nurses don’t have time to do it, too heavy to maintain, we’ve been thinking about giving up altogether, etc ...

I have spent a lot of time thinking about why this could be.The biggest challenge I see, is that we will still do not give enough value to the planning of care, compared to the value we give the implementation of care. However, individualized care should always start with the design of the care, that we value the care individually according to the needs of each of our clients. Only after this begins a properly targeted so-called. "implementation phase" as described above. When each treatment is planned individually, we get a more sensible and high-quality whole. Usually the so-called revolving door phenomenon is also reduced.

For example, surgeries are well planned and prepared for, because errors must be minimized - otherwise it can be catastrophic. In holistic treatment, errors are usually less acute, so the design is not entirely necessary in the same way.

We have recently been reading sad news about elderly care. As if everyone was surprised by the situation. I think this is why the planning of care and work needs to be raised to their due value. If we don’t have goals, there is also a quality tracking search shoot. Above all else, we need to make sure the voices and experiences of the customer and relatives are heard. Then we will know if we have succeeded.

At this point there is usually an appeal that resources are limited - there is no time. This is also true! But nothing will change if nothing is done. I didn’t get any more resources for my team when we systematically started making RAI-based management plans. As a team leader, I was able to design the entirety of the process so that we can make time for it. Admittedly, I did a little overtime with my supervisor’s permission to get the whole thing in order.

After all, once the whole process was planned, our clients’ care plans were up-to-date and individualized. Which resulted in providing much higher quality care with the same resources.

I am sorry that my reflection is long, but it is impossible to bring out all my thoughts in merely a few sentences.

What should we do to make better use of limited resources without compromising the quality of care?

Investing in individual care planning

- If the foundation and planning isn’t done, it can require a lot of time and resources to create. But once the groundwork is done properly, the benefits are endless.

Utilize the technology, so that the nurses can use their skills and time to plan the care. I think below are great examples of successful technology innovations:

  • drug dosing
  • Medicine robots
  • extensive opportunities of artificial intelligence

We are all aging. Let's work together for the common good, then we will succeed.

Minna Wentus                                                                                                                                       
Chief Customer Service Officer