Ismo Rautiainen, Project director of Social and Health services in the county of Päijät-Häme in South of Finland, says that better services are achieved with versatile monitoring.
- The services already form an entirety in the county. This has allowed for us to develop the usage of RAI on a broader provincial scale. Recently many public discussions have been about the quality of services for elderly people and the surprising aberrations thereof. The discourse has focused on the dimensioning of the care services but very little attention has been paid to the actual quality of the services. The biggest challenge for service providers are multi-producing, where the quality of services must be consistent for services produced by themselves as well as for services purchased from the private sector. The RAI system provides a great framework for a versatile quality monitoring, says Rautiainen.
- Especially when it comes to freedom of choice regarding service models clients need information about the quality of the services. The service provider, on the other hand, needs assurance of the effectiveness, the cost efficiency and the quality of the services. Consequently the service producer must be able to prove the same to the provider. Mutual frame work and indicators are needed. The client management needs a tool to help assessing the need of services and to help coordinating the service processes for the clients. When utilized effectively the RAI system provides a tool to all of the above.
-The RAI-system demonstartes the quality, effectiveness and the efficiency of the service and it can be utilized in measuring how goals are achieved. When utilized properly, RAI provides a tool for benchmarking and helps recognize the quality peaks and the anomalies. The RAI system also enables an electronic monitoring if the provider has access to the service producers´ RAI data. The results from the RAI quality indicators establish what level of quality each unit has. In Päijät-Hämee all RAI assessments, our own and the private ones, are in the same "cloud" and consequently the information is available for both the service provider and the client management. The knowledge of assessing is of equal importance. Service providers and care units are presupposed to commit to using RAI and to develop it together.
- RAI and utilizing it does not solely guarantee good monitoring, but it is a big part of it. In addition, reliable information on personnel resources, competence and well-being plus the content and realization of specific services are still needed.
In Siilinjärvi, a municipality in Central Finland, RAI work has kicked off in good speed. Utilizing RAI in managing is still on a basic level but improving all the time.
- In our organization RAI has helped in determining the human resource needs, defining customer profiles and auditing whether the clients are receiving the appropriate services forms or not. We have planned our servicing structure based on the information retrieved from RAI. Utilizing RAI in managing is still in the early days, as I mentioned before, but a profound knowledge-based managing based is possible with the help of RAI, says Kati Kantanen, Director of social and health services in Siilinjärvi.
Anu Vuolukka, Director of Coronaria care services, looks at RAI from a mental health care perspective. She acknowledges the strengths of RAI as an individual motivator and as a factor for displaying know-how and effectiveness in the care business.
- RAI has brought methodics and organisation into the processes and it supports the ground work in the units. RAI helps structure the work processes, re-directs resources from non-relevant to relevant which, on the other hand, affirms the experience of being in control of the work processes and, ultimately, supports work well-being. On a management level, RAI results help steer the development of client need-based know-how and also make visible the special know-how of the organisation. At the same time, the receiving part can utilize RAI results as part of their service development: "these are the kids we have here and this is the right place for them."
Susanna Rantamaa-Rytkönen, Director of the care work in Kannelkoti nursing home and Piia Palviainen, Director of the care work in Pakilakoti nursing home discuss the same questions.
- Our Foundation, the Helsingin Seniorisäätiö, has chosen RAI quality criteria, which we follow up regularly. These criteria include for instance the use of sedatives and sleeping pills; clients who are bedridden and do not participate in any activities; clients who do not participate in the assessment; clients who engage very little in rehabilitating activities. We also follow up on other criteria, but in 2019 the emphasis is on the above mentioned.
- The RAI results give us information in real time about what type of clients reside in our nursing homes and what their conditions are. The individual care plan is based on RAI results. The results can be electronically integrated in our patient information system, ´Hilkka´. This helps us determine the areas for development in our nursing homes and shows us what we need to focus on. RAI has also been the basis when we have determined development projects in our foundation. Our so called ViVa-model, which specifies the clients´ levels of condition and aptitude for rehabilitation, has been developed from the RAI model. We have also set up a RAI training path where the staff receives RAI training in a defined and structured order.
- By doing so we ensure that our staff has the proper RAI knowledge, that the RAI assessments are done correctly and that the results are reliable. Our Foundation is very favourable to developments and we have offered three of our staff members the possibility to participate in the RAI expert consultant training programme. RAI comparison graphs are made twice a year, based on feed-back reports, and with the help of these we can compare different wards and nursing homes to other nursing homes within or own Foundation and with the results from the city of Helsinki and nationally. This shows us where we can improve and where we have succeeded. We also go through the RAI results on a regular basis with the ward nurses for instance.
Anna Haverinen, Director of Elderly care in the city of Oulu says that the reliable assessment is the basis for utilization of RAI information. The city of Oulu has invested in training its whole staff in RAI to improve the reliability of RAI assessments. The city of Oulu presupposes the use of RAI system from service producers entering the tendering procedures and when authorizing so called service cheques to private service producers. RAI is a great support when providing services for knowledge-based managing, directing services, multi-service producing and governing agreements.
- RAI provides information on the quality of care and service on both an organisational and individual level. It helps to expose the needs for development, to set goals and to recognize what actions need to be taken and supports the follow-up and assessment of these measures. Haverinen says that RAI also exposes the possible differences between the private and public service producers and encourages to reflect on the reasons for these: are the differences due to how services are directed, agreement incentives or based on the care chains?