In to care is a Dutch programm of the ministry of Healthcare and Vilans the knowledge institute for longterm care. Hundreds of organizations for long term care participate in the program with goals on improving their performance, workers satisfaction and cliënt satisfaction.

1. Up to care!
A nationwide programme to ensure
sustainability of long-term care
-
Henk Nies
Utrecht, 7 april 2011

2. Nation-wide implementation programs
from 2004
• Quality collaboratives in LTC
(falls, medication, pressure ulcers etc.) (>
500 organisations)
• National Dementia Program: Regional
networks of dementia services (57 regions)
• Care for Volunteers (95 organisations)
• Implementation Disease Management (22
pilots)
• Up to care!

3. Quality collaboratives and
participating teams
Emp o wer ment ( 3 ) 69
W ashing car e ( 3 ) 36
Plus imp r o vement p r o g r am ( 2 ) 65
F all p r event io n ( 2 ) 54
So cial Par t icip at io n ( 2 ) 32 961 teams
Pr o cess imp r o vement ( 2 ) 26 650 organisations
Pr o b lem B ehavio ur ( 3 ) 49
Pr event io n sexuel ab use ( 3 ) 62
M ed icat io n saf et y ( 4 ) 72
R ed ucing R est r aint s ( 3 ) 82
R eco ver y F o cused car e ( 2 ) 32
M ind & B o d y ( 2 ) 28
Eat ing & D r inking ( 4 ) 119
Pr essur e ulser s ( 3 ) 61
C o nt inence ( 2 ) 26
M ent al Healt h p r o ject ( 2 ) 49
Int er f er ing car e( 2 ) 41
F ixat io n ( 2 ) 31
0 20 40 60 80 10 0 12 0

5. An overview: Care for Better
results
Topic Quantitative And so much more….
Improvement
Medication safety 50% reduction Huge awareness about medication process
Reducing estraints 30% reduction Client focused approach: end of rituals! No
17% reduction increase of aggression, less medication use,
medication more client friendly approaches (technology)
Falls 30% reduction Prevention of falls and attention for safety
Problem behavior 66% reduction 10 step approach works. Improvement on all
sorts of behavior.
Pressure ulcers 40% reduction Complex to improve! Continues attention on
all levels!
Empowerment No average Awareness: how we work with our clients in
measurable every situation
Incontinence care Get it diagnosed and looked after!
Prevention of sexual abuse Learn how to talk about it. Attitude,
competence, steering
Washing without water 20% gain, 90% uses Movement: it is not just about money, about
this method quality! Clients are satisfied, skin improved

6. National Dementia Care Program
(2005-2008)
• Networks in 57 regions across the country
(>90% coverage)
• Views of clients and relatives as point of
departure by local Alzheimer associations (14
fields)
• 206 projects implemented

7. Trends
• Quality Improvement in professional care
processes in single organisations to:
• Improvement in working with volunteers in
single organisations to:
• Developing regional networks of providers
developing integrated care to:
• Optimizing primary care according to Chronic
care model (wagner) to:
• Systems transformation

8. The context
• Population ageing • Shrinking work force
• Increasing demand • Increased need for
for LTC ánd TLC! cost containment
• Decreasing social • Productivity growth
networks lags behind
• Increasing demand • Quality at risk
for care workers • Organisations
collapsing

9. Objectives ‘Up to care!’
To improve sustainability and
transformation of LTC:
• Raise awareness and urgency in the field
• Support major transformations of LTC
organisations
• Implement proven good practices
• Develop a learning sector

10. What are we talking about?
• 600,000 service users in LTC
• 400,000 people employed
• 2,500,000 informal carers
 3,5 million people directly involved (= 1
out of five in the population)
• 13 billion Euros = 18,5 billion US $

11. How?
• Build up or to build upon strategic choices of an
organisation
• Accelerate existing processes
• Input of existing knowledge (many piliots and
programmes have preceded)  the end of
pilotitis!
• Input of expert expertise
• Knowledge management, learning networks,
community of practice

12. How?
• Generate/ spread knowledge on implementation
• Wide spread dissemination
• Transform hundreds of individual organizations
over a period of four to five years supported by
coaches
• Implement good practices, organize learning
activities, communities
• Monitor results/outcomes
• Support the sector by sharing innovations and
communication

13. Aims
• Better value for money
• Lower staff turnover, higher employees’
satisfaction
• Empowered care workers
• In the end: improve quality of care/life

14. The target group
Vernieuwers Snelle Vroege Late Laatbloeiers
Overnemers Meerderheid Meerderheid
2.5% 13.5% 34% 34% 16%
Levenscyclus Innovatie (tijd)
Focus of transition policy

15. Themes
• Technology supported care
• Integrated care
• Empowerment of care workers, bottom up
• Operational management (Lean etc.)

16. Themes
Total in themes (143 participants )
Technology supported
care
Integrated care
Empowerment of care
workers
Operational
management
Depends on scan

17. Size of organisations in Euros
Revenues # %
<€20.000.000 22 15%
€20.000.000-€40.000.000 26 18%
€40.000.000-€60.000.000 19 13%
€60.000.000-€80.000.000 12 8%
€80.000.000-€100.000.000 8 6%
>€100.000.000 25 17%
Unknown 31 22%
Total 143 100%

18. Process
1.Orientation 6. Contract
2.Collect information 7. Action period 1
3.Organisation analysis 8. Evaluation
(scan) 9. Action period 2
4.Edit a plan 10.Assurance
5.Approve plan (by 11.End evaluation
organisation as well
as Up to care!)

19. How far are we?
Total in phases (143 participants )
Com-
pleted
Realising
aims
Edit a
plan
Organisa-
tion
analysis
Orien-
tation

20. Knowledge development, learning
and dissemination
Daily news
Collect Networks
existing Knowledge
kwowledge databank
Produce Prototypes
knowledge Casestudies
Webcontent:
products
what, how,
experience
Disseminate Websites
Training/education
and Communities of
implement practice
Information center
products

21. Lots of communication

22. Challenges in LTC
Improvement
Up to Care!
programmes
Commitment and Involvement of
System Improving
transformation care delivery process
CEOs
Connection with frontline workers
Information Learning & Community Innovation
Centre training of practice places
22

23. Our main challenges
• How to collect, describe, validate and use good
practices on sustainability with very weak evidence?
• How to streamline the method of system improvement
across organizations and coaches?
• How to monitor/measure effects and causalities, while
there are so many interfering factors?
• How to work with low professionalized staff in the
organisations?
• How to ensure position of the client?