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ORGANISATIONAL DEVELOPMENT - To increase the quality of the care

Employees in the care sector suffer from lack of time and are frustrated by not being able to keep up. Politicians are pushing to make savings to cope with the economic situation. At the same time, the number of elderly people is increasing. The situation feels hopeless and something must be done, the only question is what. It is a challenge to meet future demands for increased resources while we not only maintain but also increase the quality of care. Will it be enough to hire more staff and work faster? How will staff be able to do more when they already feel pressured and inadequate in many cases?

We are confident that the solution lies in developing and follow up actions over time in a structured way. The follow-up would be facilitated by establishing relevant key performance indicators. The basis for these key performance indicators can most likely be found partly within the organisation in the form of data in various systems but this data often needs to be supplemented. The key performance indicators should reflect the organisation’s vision as well as the intentions of the Social Services Act. Other important organisations have demands and requirements of the organisation.

To successfully develop the operations, it is important to get everyone in the organisation to understand how and more importantly why we implement certain measures. If managed properly, you achieve an acceptance of changes in the organisation and thereby help to enforce them in practice.

In order to develop and enhance an organisation, measures need to be based on fact and experience. We therefore use a proven method that is based on four different stages or phases. What elements should be included in the different stages is determined together with you based on your requirements.

Pilot study

The pilot study is used to make a realistic assessment of what we need to do to succeed. How much time is spent on the pilot study is entirely dependent on which issues there are and what we want to achieve with the work.

First the goal and purpose of the work needs to be described. What do we want to achieve and why?

The purpose of the pilot study is to identify the specific problems involved and find out what conditions and tools your particular operation has access to.

What we look at, amongst other things is:

• the order (permitted time, planned time, completed time)

• resources (number of employees, number of long term employees, scheduled time, service levels)

• how resources are used (efficiency, continuity, absence)

• procedures, how do they help the organisation (which procedures support activities and which take time without adding value)

• support in the form of systems and functions

We also go through the various terms used within the organisation, such as permitted time and customer time, to ensure that we are talking about the same thing and that the results we get can be compared with other local authorities and information from for instance SKL.

The pilot study is summarised in a status report.

Analysis and planning

With the help of the pilot study, we can confirm if we have enough information to be able to go directly to our problem case study or if we first need to gather more information. Do we know what the reality looks like? Are there different scenarios of what the realities are within the organisation?

Analysis of data

We analyse the data that is available in different systems as it gives us important information about what steps need to be taken. We also carry out a large number of calculations of the organisation to see how different scenarios unfold, which goals are realistic to achieve and the cost of various measures. Do we have full-time projects in our local authority for instance? If so, how does it affect our ability to carry out our order and what is the cost for such a reform? Can we implement it without taking it in turns?

Time measurement

If the purpose of the work is to measure the efficiency of operations, we need information on how big a part of the resources go to customer time and other time respectively. If we lack sufficient information if we need to carry out a time measurement where we for a limited time period measure how the organisation uses its resources. It is also common that the local authority has systems that account for customer time but we find this time too low. Then a time measurement helps us understand what other time is used for, which is important for the correct action to be taken.

Key performance indicators

Development of relevant key performance indicators is very important. The key performance indicators should reflect the organisation’s vision as well as the intentions of the Social Services Act. Furthermore, procedures for monitoring and promoting key performance indicators should be established and made known in the organisation. Everyone should understand the meaning of the key performance indicators to achieve the goals. This work must be done both vertically and horizontally, i.e. from the board down to employees and within the various levels of the organisation.

Action plan

The analysis and planning phase ends with the establishment of an action plan which includes a detailed action plan. The action plan identifies the need for any training for managers and staff, identifying relevant key performance indicators, how they should be followed up, etc. Modification of existing procedures and introduction of new ones is also an important part of the work.


It is now time to implement the planned actions. These can be changes of procedures, creating monitoring procedures, creating reports for monitoring and training of employees, managers and politicians.

It is important that the implementation is integrated in the regular operations. This should not be perceived by the organisation as taxing or a temporary strain that will soon disappear. Depending on the scope, the duration of the implementation will differ. However, it is realistic to expect that the changes we will carry out will take between 1–3 years to become established and have the full effect.

All actions should be carried out at the right level in the organisation and everyone must accept and understand why they should be implemented. This is very educational work that we obviously are a big part of. This is where our training constitutes a central part. The training can be conducted with the same basic content but with three different perspectives for employees, managers and politicians.

We are involved throughout the implementation process and are continuously monitored.

To ensure that we are on the right track, additional time measurement can be implemented.


During the follow-up phase, all actions from the action plan and key performance indicators are followed up. It is important during this phase is to see if the measures to achieve improvements in the measurement of the key performance indicators has the desired effect. Perhaps procedures or measurements need to be adjusted or supplemented. An evaluation of the training effort is carried out. Support for first-line managers for instance, do they have the ability to take the process in the right direction? It is key to the success of the work so in some cases additional guidance is needed for these managers.

On completion of the evaluation the action plan is adjusted and a new time for the follow-up is set.

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For improved quality of care

Increased efficiency, better use of resources

Better working environment for staff

Greater involvement

The right key performance indicators for monitoring

Structured approach

Proven tools

Development based on facts and data

Experience from local authorities with similar requirements