Long-term care must and can be done better

Sooner or later, every professional in long-term care will run up against the gut feeling that "this has to be done better". This was not what you had in mind, when you started your education or first job full of ideals, says Mirella Minkman, distinguished professor at TIAS.

1996. As a trainee nurse and as green as grass, I worked for the first time ever in a nursing home. It was lunchtime and the staff were having a break. The two of us, a nutrition assistant and myself, were tasked to help the residents to eat. I didn't know any names, hadn't read the dossier, but I did what I was told. And when a lady wanted to go to the toilet, I accompanied her to give her support. Seemed logical.

When we returned, I got a dressing down from the staff who had by now returned from their lunch. However could I even think of leaving the group alone while eating? The lady should have waited. The only thing I could think of was: why did you go and have lunch somewhere else? Why not just here, together with the residents, just like at home? "This has to be done better", went through my head. One of the residents saw how shaken I was and gave me a reassuring wink.

More control

Now, more than  twenty years later, a lot has been changed and improved. The white coats are gone, they eat with the residents and cook together. And it is much more homely. But every so often that gut feeling comes back. Things could be so much better in long-term care.

And I am not the only one who thinks along these lines. We want to give clients more control, while at the same time we have taken away a lot of their responsibilities. We want to offer customization, while we allow ourselves to be guided by policy-level systems thinking. I can see the same intrinsic motivation on all levels: it must be and can be done better. Why then doesn't it succeed?

Accountability

It is impossible to point to a scapegoat. It is the methodology which we have together created, a complex system of roles, relationships, governing bodies and care providers. Here the accountability system weighs more than customer demand. "What are we allowed to offer" instead of "what does someone really need." This system is difficult to break through. How can you build a bridge between professional quality and giving the client a say? Just try as a manager with limited resources to find the balance.

If we want to achieve change, then change is needed at all levels. Let us accept that. And let us concentrate on the question: how can we make a core business out of the needs and wishes of the client?

Real effect

Let us start with finding out what does work. For instance, what does the deployment of district nurses deliver and at what scale do we have to implement interventions? In the neighborhood, district or in the region? How can we organize effective collaboration? An investigation is also needed into how we can better arrange governance of long-term care.

At the new Chair of the TIAS School for Business and Society I am looking for pragmatic answers. It is my mission to initiate actions using research. Can we substantiate that an intervention or process really does have an effect, that it will make care better and not more expensive? Then surely we cannot just do nothing with it. Something will have to happen too.

Mirella Minkman is distinguished professor of Innovation in Organization and Management of Long-Term Integral Care inside TIAS GovernanceLAB.

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