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When organizational learning reaches out

The method used for the in-service training of health care staff by Kravmärkt yrkesroll is the result of ten years of development work. What started as a local project in the county of Stockholm is now a trademark protected service that is sold to municipalities and health care providers throughout the country.

Helene Larsson och Asta Josefsson på Johanneslunds äldreboende i Västerhaninge

Helene Larsson and Asta Josefsson at Johanneslund’s home for elderly people in Västerhaninge. Photo: Anna-Karin Florén

When organizational learning reaches out

The method used for the in-service training of health care staff by Kravmärkt yrkesroll is the result of ten years of development work. What started as a local project in the county of Stockholm is now a trademark protected service that is sold to municipalities and health care providers throughout the country.

Marie Ardström is the manager of Kravmärkt yrkesroll. She shares the office in Handenterminalen in Haninge centre with her colleague Annette Larson Beckman who is the development coordinator. To date, Haninge municipality has been in charge of the administration for the project, but during 2011, the organization will become part of Föreningen för yrkesroller och lärande, Fyl (the Association of professional roles and learning) from which municipalities and private healthcare providers across the country will be able to buy eco-labelling as a service.

“Today Kravmärkt yrkesroll is a brand and a quality label,” says Marie Ardström.

The desire for in-service training came from below

But it started as early as in the late 1990’s.

“The number of old people diagnosed with dementia increased, and the nursing staff did not feel as if their skills lived up to the increased demands,” says Marie Ardström.

“Moreover, there was a gap between what the students learned on the Healthcare programme at their upper-secondary school and the skills actually needed for geriatric care. The Healthcare programme was too general. It covered everything from childcare and ambulance services to geriatric care.

To address the shortcomings in the education and at the same time develop the skills of the nursing assistants and auxiliary nurses, a three-year project, Växahuset Vård & Omsorg, was started in Stockholm County in 2001, with financial support from the European Social Fund. The goal was to develop a new model for adult education in healthcare.

“In conjunction with Växahuset, the need for a broader upgrading of the skills among the old-age care staff became obvious,” says Marie Ardström.

“Previously the nursing occupation was regarded as the only career path for nursing assistants and auxiliary nurses, but we also need skilled personal care workers.

Model workplaces

With Stockholm County’s Association of Local Authorities as the project owner, three municipalities and three city districts applied for social funds for a second sub-project, Modellarbetsplatser (Model Workplaces).  

“Before a broader skills upgrade could be carried out, it was important to understand what it is that is required of personal care workers. It is easy to forget how much responsibility this occupational group has. A mistake made when medication is given can have dire consequences,” says Marie Ardström.

A few homes for elderly people and home help service units were selected as model workplaces. The nursing assistants and auxiliary nurses there were given an assignment to describe everything they did in their workplaces and the skills needed to cope with the work.

Helene Larsson på Johanneslunds äldreboende i VästerhaningeHelene Larsson who works at Tallhöjden’s home for elderly people in Handen was one of the first to be involved. She has worked in healthcare since 1991, both as a nursing assistant and as an auxiliary nurse.

Today she works at Johanneslund’s home for elderly people in Västerhaninge, a little more than 30 kilometres south of Stockholm. The home for elderly people is situated in a three-storey building with a magnificent glass entrance. The area has many homes for elderly people scattered throughout a maze of small wooden buildings surrounded by shrubby cinquefoils and lilacs.

Ten nursing assistants and auxiliary nurses work on Ward 1, which is a home for ten women and four men. In a common room, a few residents sit and watch the replay of Allsång på Skansen (a sing-along programme on the TV).  

600 pages become six professional requirements

“We wrote down everything you have to know to be able to work as a nursing assistant, from fixing someone's hair to stroking someone on the cheek, from cooking to legal affairs, crisis management, dressing wounds, giving hugs, heavy lifting, cleaning, contact with families, dealing with moral and ethical issues along with religious festivals for all the world's religions.... Six hundred pages were written!

“The politicians involved in the work group were shocked when they realized how much we do. They did not believe us at first. The best thing about the document was that it made the health care worker’s situation clear to the decision makers. We work in the background, but we have to know so very much,” says Helene Larsson.

The six hundred pages were summarized to six professional requirements. With the professional requirements as a basis, a model was created to validate the staff’s knowledge.

Kravmärkt yrkesroll provides a broad upgrading of staff skills

The project Model workplaces was completed in 2005 at the same time as the possibility of seeking funds from Kompetensstegen came. Kompetensstegen was an initiative developed by the state to promote skills enhancement within municipal old-age care. SEK 1 billion was distributed from 2005 to 2008 on projects around the country.

“Kompetensstegen enabled us to develop a structure as to how validation and skills development could be implemented more widely. The Social Fund provided additional resources and was of extreme importance to enable us to test the idea on a large scale,” says Marie Ardström.

In 2008, 5,000 nursing assistants and auxiliary nurses were validated. Everybody received an individual competence report and three-party talks. This means that the unit manager, the person that was validated and a person from the project get together to talk about the employee’s competence and his/her opportunities for professional development. It appeared that those in need of additional training worked with dementia, geriatrics, psychiatry and law.

“We did not want to buy traditional courses. We wanted to find new approaches to skills development, not move a school into the workplace.

"Many people who work within these professions did not spend many years at school. In addition, it is not uncommon that these people have low self-esteem when it comes to studying. The key to success is to involve the users in the process. It is time-consuming work. We also saw that there were opportunities for learning. We wanted to learn in order to place better orders with the school,” says Marie Ardström.

New approaches to in-service training

The employees must have a voice in how their training should be conducted.  

“A learning plan is made based on the validation process. If the additional training is about dementia, the learning plan is made with a dementia nurse who then becomes the teacher. The plan is tailored to the person’s learning style. Some people want to work next to somebody else and to gain some practical experience, while others require additional theoretical training.

"When nutritionists, nurses and unit managers get involved as tutors everybody takes part. This has led to improvements in cooperation between the registered staff and the nursing staff in day-to-day working situations.”

New procedures

Ute på arbetsplatserna har arbetet med Kravmärkt yrkesroll lett till flera förändringar.

"Managers feel that members of staff are more observant and that they are more reflective. The validations raise a number of issues regarding the professional approach of the staff in the workplaces. Do I exercise my own volition or is my work based on the needs of the elderly? How do you handle difficult people and how do you understand the reactions of relatives? How do I manage not to take things personally?” says Ardsröm.

Helene Larsson agrees.

Helene Larsson och Asta Josefsson på Johanneslunds äldreboende i Västerhaninge “Kravmärkt has made me more sensitive to the residents. Even if you are old, you still want to take a shower every day, go shopping, go out for a meal, and have a bubble bath. Previously the residents had to adjust to the routines, now the routines are adapted to the residents. Now, they can decide when they want to go to bed and get up in the morning,” she says.

She feels that comfort and collaboration skills have improved, since she knows what sort of skills her colleagues have.

"Nothing is impossible anymore. Sometimes we go out to a restaurant in Nynäshamn. The residents can stay up late and drink wine. In the spring, we had a party with horse riding, a barbecue and a dance. This sort of thing could not happen before.


The experiences are used in regular education

Parallel to her work as a nursing assistant, Helene Larsson lectures about Kravmärkt yrkesroll at educations for health professionals, and on how skills development can be woven into day-to-day work tasks.

The method of in-service training developed by Kravmärkt yrkesroll is now also being used in care programmes, where scholarships with mentoring can offset part of the traditional approach to teaching at school. Johanneslund and other homes for the elderly in Haninge take on pupils studying to become auxiliary nurses for example at the same time as they study Swedish for immigrants, SFI. Through language training, they get to practice Swedish and at the same time learn their trade with the help of tutors in real working situations.

Strong interest from other municipalities and healthcare companies

In addition to raising the quality of care, Kravmärkt has also produced a reduction in staff turnover.

“The staff are more proud of their profession now. Staff that have moved to another municipality and changed jobs have been able to present their validations as evidence of what they actually know. It has also meant that other municipalities have noticed Kravmärkt,” says Ardström.

Now Haninge municipality routinely validates newly recruited staff. And in the municipalities of Haninge and Södertälje, Kravmärkt yrkesroll forms a part of the procurement requirements. Private health care providers who want to sell services to them are therefore required to validate and to ensure that all their staff have basic skills.

New application to the European Social Fund

Because funding from Kompetensstegen and the European Social Fund expired in 2008, the participating municipalities have financed the operations. But now Kravmärkt yrkesroll has applied for and has been granted a further SEK 8 million from the Social Fund.

“We wanted to deepen and consolidate what we had developed in the project and form a more permanent organization. But now, the ambition is that we should proceed with other related professional roles. For example, personal care workers who work with people with disabilities,” says Marie Ardström.

The projects in brief

Växahuset Vård & Omsorg, 2001-2003

  • Aim: To develop a new model for adult education within healthcare on the basis that a high proportion of employees had inadequate training for their work.
  • Project owner: Stockholm County’s Association of Local Authorities
  • Partners: The County Employment Board Stockholm County and the municipalities of Stockholm, Tyresö, Nacka, Järfälla, Salem, Nykvarn and the private company MediHem
  • Participants: 300
  • Budget: SEK 82.7 million of which SEK 33.7 is from ESF

Model workplaces, 2003-2005

  • Aim: To clarify the professional role and to develop methods, structure and plans to increase employees’ competence.
  • Project owner: Stockholm County Association of Local Authorities
  • Partners: The municipalities of Haninge, Sollentuna, Tyresö and the districts Hägersten, Liljeholmen and Vantör in the City of Stockholm.
  • Participants: 165
  • Budget: SEK 26.4 million of which SEK 12.8 is from ESF.

Workplace learning in focus - kravmärkt yrkesroll, 2005-2008

  • Aim: To create a coherent chain from validation to focused interventions to develop skills and improve quality assurance.
  • Project owner: The municipality of Haninge
  • Partners: The municipalities of Haninge, Huddinge, Norrtälje, Stockholm County Association of Local Authorities, OCN Sweden AB, TioHundra AB
  • Participants: 5,000 nursing assistants and auxiliary nurses.
  • Budget: SEK 7.9 million from ESF (fully funded by ESF).

Text and photos: Anna-Karin Florén