Confidence Report 2015 by Lumen Behavior

CUSTOMER FOCUS CONFIDENCE REPORT 2015

THE QUALITY PYRAMID In one sense, working on the highest possible quality is automatic, a part of Frösunda’s core process, but it is also about using the customer experience as the basis for continuous improvements of quality. The quality pyramid shows how this works – with complementary perspectives and a solid base. The sides of the pyramid describe the Customer Perspective, Delivery and Control & Monitoring. Read more on pages 33 and 35.

“I want to feel competent in my life and in my home” MARLENE BERGQVIST, HEALTH CONSULTANT, FRÖSUNDA CUSTOMER AND EXPECTANT MOTHER, PICTURED ON THE FRONT COVER WITH EXPECTANT FATHER ERIK APPELBLAD.

CUSTOMER PERSPECTIVE: Always

DELIVERY: At the bottom are our attitudes

CONTROL & MONITORING:

comes first. At the base are decisions that

and manners, plus legislation, ordinances

At the base are internal controls, together

affect the customer – the paying customer,

and regulations. Above these are policies,

with supervision and inspections carried out

aim and purpose with the service. At the top

processes and procedures, leadership, skills

by public agencies. Then come groupwide

are the customer’s own wishes for the best

and employeeship. At the top are the best

controls, peer controls, the satisfied employee

possible quality of life.

available knowledge and developments.

index and key performance indicators. At the

Page 4–17

Page 18–21

top is the satisfied customer index.

Page 22–37

A JOURNEY TOWARDS CHANGE TWO YEARS AGO we set out on Frösunda’s most impor-

tant journey to date, and now we are in the middle of the change management work. A great deal has fallen into place – the organisation, the processes, the direction and not least the objective: to conduct our work with a focus on the customers. No matter what. We are in the process of converting insights into practical action and that is tough. We need to change our way of thinking and working, challenging our everyday assumptions. This is difficult because it is essentially a case of shifting power. We are leading the way towards what we see as the future of social care – where we as the supplier shift from being the one who knows best to the one who listens best to the customer. From well-intentioned expert to care innovator, who finds truth in the interaction with the customer.

In practice, a customer focus means that everything begins with the customer: every document and every process. Each everyday activity should consciously begin with the customer, until this value-driven behaviour is ingrained in each and every one of us, instilling a sense of employeeship where we share the feeling that “I have the tools to make a difference for the customer”. This is important because we work with some of the most vulnerable groups in society. It is our mission to create quality of life for people who are in need of special support, whether they have a disability, suffer from dementia or are in a vulnerable family situation. In this work, we are able to be our customers’ arms and legs. But never their minds. Our professional pride is based on our capacity to treat everyone with the same respect, commitment and curiosity.

quality, ideology or some other parameter. The drive to be the best for the customer advances development and innovation. Frösunda is a social care company that is run for our customers. Our organisation gives us an opportunity to be flexible and innovative. In 2014, researchers from the Karolinska Institute showed that private providers are able to deliver higher quality for customers, at a lower cost for the paying municipality. That is something we want to continue doing.

2015 IS ABOUT LEADERSHIP AND INNOVATION

2014 WAS ABOUT GROWTH AND POLITICS For Frösunda, 2014 was a year of growth in all its business areas in Sweden, while its subsidiary in Norway was sold off. The dialogue with customers has remained a core focus, not least through an NPS survey of the whole company, and a major drive to improve the start-up process has yielded good results where we have started up outsourcing units. In a broader trend, the general election and the politi cal agreement on health and social care dominated the landscape in 2014. This will also have a knock-on effect on the key issues for social care in 2015: 1) We shall make a difference to some of the most vulnerable groups in society. The ultimate goal is that our services shall help to ensure that our customers have a natural place in society. 2) Private care shall be available and it shall drive development. More options give customers g reater opportunities to choose what they think is best, whether they are making their choice on the basis of

The greatest challenges are also those that we have chosen to prioritise in our work over the next year. • Managers: We are placing a clearer responsibility on the managers, whose customer-oriented management style is the key to success in our journey of change. Providing leadership is also a challenge, which requires both improved recruitment and internal sourcing of managers. • Innovation: Our most obvious opportunity for innovation lies in the relationships with the customer. Now we are building a concept to support the informal innovation process in the interaction with the customer. Our strategic direction is formed by the objective of being the customer’s preferred choice. It involves customer-driven management, continued development of elderly care, and not least staffing – the right person, at the right time and in the right way. And above all, it involves a focus on the customer. SUSANNE SIDÉN CEO

CUSTOMER PERSPECTIVE

“The best adults are the ones you can’t scare off” At Frösunda’s Staffansbo centre, Victor has found a way to make life work. As a Frösunda customer, he is well placed to tell us about our quality. This is a fundamental insight into customer focus, which is so crucial to all of us who work in social care for the highest possible quality of life.

VISION We are the obvious choice and a role model for how social care can be provided in a responsible way and with high quality.

MISSION We earn trust by taking responsibility.

VALUES Respect • Commitment • Curiosity

Persons with disabilities, elderly and young people can participate in society.

UNDERSTANDING EVERY CUSTOMER Frösunda works with a customer focus. But the customers are not a uniform group – Frösunda has no fewer than 16 customer groups, whose needs, wishes and circumstances vary. To achieve our mission, we need to have a good dialogue with all groups. We need to know what they want, find patterns and conduct analyses, but we also need to see each individual and understand what he or she thinks is important. Here we present representatives from the complex customer spectrum that we meet on a daily basis: customers, relatives, paying customers and internal customers, in each of our four business areas – Assistance, Disability, Individual & Family, and Elderly Care.

“Frösunda’s values are fantastic. I particularly like the word curiosity.” MARIANNE DELPHIN

“Annie loves long walks, particularly where there are lots of people around. Annie is mostly happy and cheerful. We soon notice when she isn’t!” Sonja Olsson, mother of Annie, 12, relative, Assistance

“With Frösunda, I get to decide what I want to do. I’ve lived in my own home for ten years now and the best thing is that I get to do what I want and make my own mark. I like interior design, so that’s important. I also like going out to concerts, ice hockey matches and the cinema.” Glen Degerfält, customer, Assistance

Försäkringskassan (the Social Insurance Agency) approves or rejects a customer’s request for hours of personal assistance. The agency is paying customer, but the customer gets to choose Frösunda as the provider. Frösunda is able to give the customer or relative legal support, for example when applying for additional assistance. Försäkringskassan, client, Assistance

CUSTOMER PERSPECTIVE

“The most important thing is that our customers receive the best possible care. The customer should experience our core values: respect, commitment and curiosity. And the same applies internally within the company: we embody our values.” Mattias Ragnegård, head of Frösunda Region East, internal customer, Assistance

“When my friends come round, there’s one thing we always talk about: football. My strongest memory from my own football career was when we won the Allsvenskan league in 1954. Back then you couldn’t substitute players and one of our team players was taken off injured, so we won with just ten men on the field.” Rune Jingård, 89, customer, Elderly Care

“Frösunda’s values are fantastic. I particularly like the word curiosity. I want people to be curious about mum.” Marianne Delphin, daughter of Alice Delphin, relative, Elderly Care

“The procurement that Frösunda won was partly about what value the provider can add, but it is also about staffing. Our goal is for all our residents to feel even better than they do now.” Åsa Zacharoff, Alingsås Municipality, paying customer, Elderly Care

“Frösunda appears to have managers who listen, who provide support, security and structure. Without that, staff can feel quite excluded. I’m hoping for a new start when they take over here.” Ester Rebolledo, healthcare assistant at Ängabogård, internal customer, Elderly Care

“I don’t like it when the rules are changed all the time. It makes me angry when adults only see the bad things. I want them to encourage me. It’s much easier for me to look after myself and go to school when I know why I have to do it, and I need to know what’s going to happen to me.” Madeleine Passot, 16, customer, Individual & Family

“It’s good that Victor gets the support he needs. When we see each other, we can now have fun as a family. To all the other parents I’d say just one thing: get help early on. I wish everyone could get this type of support. Collaboration and effective initiatives are incredibly important because what’s the long-term cost if a young person isn’t allowed to reach their potential?” Gabriella Rugås, mother of Victor, relative, Individual & Family

“Frösunda is excellent at making sure the family home gets the right support. They are good at securing agreements and good at finding solutions if something about the assignment changes. They’re flexible and collaborative.” Sandra Gustavsson, social secretary youth section for Skara Municipality, client, Individual & Family

“Children’s rights are an issue close to my heart. Someone high up will often casually declare the importance of focusing on children. But we have to see things from the CHILD’s perspective – there’s a difference. The child’s own perspective is regularly overlooked and that can cause problems. But this is a major political issue.” Asim Abdurahmanovic, operational manager and internal customer, Individual & Family

“At work I help with the washing up and the post. It’s great fun! The best thing is getting to help Peter. He sits in front of his computer and ignores the washing up, so I help him with that. Peter usually teases me, but in a good way. The job is great, really great!” Sara Jansson, customer, Disability

“Pelle wouldn’t have stayed with Frösunda for 20 years if they hadn’t been so good. Frösunda reports on everything they do and I sign it off. Everything is followed up. I’m glad I have them. I can call at any time without feeling I’m a nuisance, and I get to talk to someone who knows what he’s done during the day and knows him like I know him.” Eva Bohlin Strandberg, sister of Pelle Bohlin truster relative, carer, Disability

“A good provider should offer stimulating daily activities based on the users’ needs, it should listen and be open to change, and tailor its operation to the users. I think Frösunda does all that.” Dick Morén, care m anager Skarpnäck District Administration, paying customer, Disability 7

BEING LISTENED TO, SECURITY AND INDEPENDENCE The point of the Confidence Report is to answer customers’ key questions. Above all, they want to know what we do to listen, and to create a sense of security and independence.

FRÖSUNDAS VISION IS to be the obvious choice and

a role model for how social care can be provided in a responsible way and with high quality. The vision leads to our mission: We earn trust by taking responsibility.

KEYWORDS FOR THE CONFIDENCE REPORT

when we describe our operations. Parameters have been set in dialogue with the manager of the Quality department, business area managers and the CEO. Since Frösunda is producing a GRI report for the first time, we have chosen to focus on effects within the organisation.

CONTEXT: We want to investigate our influence on

society rather than just our performance. MATERIALITY: We conduct a dialogue with the stakeholders, find out what they think is most important and shape our reporting for optimum relevance. COMPLETENESS: This means, for example, that we constantly work to ensure that all deviations are reported and that all important advances and effective solutions are well documented. TRANSPARENCY: We present facts and the customers value our results.

CONTENT IDENTIFIED BY STAKEHOLDERS 8

The report contains information on the effects that internal and external stakeholders have highlighted as most important. We also take account of legislation and international conventions on human rights

CONTEXT FOR TRUST To know that we deserve the incredible trust with which we are honoured, our operations must be sustainable. Frösunda’s context for sustainability is society. Our success in discharging our duties is measured in the customers’ well-being, their satisfaction and how we embrace the vision that ‘everyone has a place in society’. We believe a sustainable society is a society where the groups that our customers represent have a natural place and where their rights are fully respected. Frösunda’s contribution to this development is to do our job as well as possible, but it is also to help increase knowledge in the sector and society as a whole.

GRI: The Confidence Report is drawn up within

the international framework of the Global Reporting Initiative, GRI G4, which is used by all state-owned enterprises, amongst others. Read more on page 30. The customers are our most important stakeholders, and, as we show on the previous page, we have no fewer than 16 unique customer groups – customers, relatives, paying customers and internal customers in each of our four business areas. In addition to the customers, our stakeholder profile includes politicians and officials, local and national, interest groups, employees, owners and the media. Frösunda’s stakeholders thus include individuals from the whole of society – from the most vulnerable groups to the nation’s political leaders. And there is one thing they all agree on: that the customers’ well-being and the quality of the services we deliver to them are paramount. It is a valuable indication that Frösunda’s strategic decision to focus on the customer is supported across the whole spectrum of stakeholders and is relevant in meeting the customers’ requirements.

The main issues that our customers highlight to us are: BEING LISTENED TO. One theme keeps recurring: the need to be treated with curiosity and to have an opportunity to express personal needs and wishes.

EVERYDAY SECURITY. Procedures that work, rules

that are transparent and scope for forward planning, so the day is as predictable as each customer wants it to be. INDEPENDENCE. Making personal choices and shaping life based on personal ambitions. The support must never get in the way of an independent life.

“I WANT PEOPLE TO BE CURIOUS ABOUT MUM.” As a close relative ages and begins to need increasing support, this prompts strong emotions. Anxiety grows

Managers and employees meet customers every day, which allows us to steer the operation in a direction that delivers the highest possible quality of life. At the same time, we want to move the business forward and offer services that enable our customers to participate in society and influence it. We also want to inspire our whole sector to be innovative. This is our contribution to a sustainable world and a society in which everyone participates.

and difficult decisions have to be taken. However there

CUSTOMER PERSPECTIVE

Here in the Confidence Report, we introduce some of the customers to whom we talk on a daily basis. And those conversations are the starting point for everything we do. There are two reasons why we place so much emphasis on the discussions with the customers: a) the customers are our most important stake holders and it is for them that we are here b) our customers belong to society’s most vulnerable groups and it is our responsibility to make sure they are able to have their voices heard.

is still time to be close – to seize the moment and find new sources of joy and togetherness. Marianne is the daughter of Alice, aged 93, who lives at Ängabogården in Alingsås. “Frösunda’s values are fantastic. I particularly like the word curiosity. I want people to be curious about mum,” says Marianne. Frösunda takes its responsibility towards relatives very s eriously. There is particular value in ensuring their satisfaction with and confidence in the service that their nearest and dearest are using. In addition, relatives have unique knowledge that Frösunda needs in order to deliver the best possible quality of life. “Mum has always been a caring person and she is very protective of the family. Now we think a lot about how we can make a nice life for her and the others. One fun thing we did was to hold a film evening. It was so great to see mum being the hostess, and the way the other residents came up to her afterwards to say thank you.” Ängabogården offers a range of different activities, but Alice often declines to take part. As a relative it can be hard to understand this. “I want my mum to get involved in activities, to be part of a social circle. I don’t want her to be lonely. It’s tough to see her so helpless and she sometimes feels terribly anxious. I’m battling to get to grips with the situation and learn how

Marianne is the daughter of Alice, who lives at Frösunda’s elderly care unit in Alingsås. Marianne appreciates Frösunda’s working methods, which include her perspective as a carer.

to handle my new mother.”

CUSTOMER PERSPECTIVE

SHARED HOUSING IN SKELLEFTEÅ In the attached house, there is a tranquil and friendly feel. Marie is taking a nap in her wheelchair. Ove is holding a Skellefteå AIK flag. His favourite team’s colours, yellow and black, recur around the house. OVE AND MARIE are two persons with multiple isabilities who live together. They are supported d by assistants 24 hours a day, but this is not a group accomodation, and they are not partners – they simply share a home. This unique solution has been made possible through collaboration between their relatives and Frösunda, and it has attracted the attention of the municipality and the disability movement. The initiative came from Ove and Marie’s parents, who thought the optimal solution would be a household for their children, when the time came for them to leave the family home. And Frösunda quickly got on board with the whole idea. The result was Ove and Marie’s shared housing, where they each have their own assistance teams that work in parallel, but are also able to support each other. The solution allowed the municipality to invest more resources in adapting one home, while still spending less than on adapting two. The building is located in a quiet area of attached houses. The apartment is all on one level, with a private terrace and garden out the back. Apart from the extra wide doorways and hoists in the ceiling, it looks like an ordinary apartment, tastefully decorated in warm colours with plenty of decorative features. Relatives and assistants helped with the decorating. Ingela is Marie’s younger sister by three years and she is also trustee. She likes the independence of the shared apartment. “It feels like a proper home. We want it to feel like Marie’s own place, so I don’t want to meddle too much. They’re so independent here,” says Ingela.

There are many advantages of having two assistance teams, and many of the assistants have been with Marie and Ove for years. The assistants, who would normally often work alone, now have colleagues. This provides extra security, support and company for everyone involved. The arrangement with two assistance teams means that Marie and Ove can get out more and do more things. For example, they are often accompanied on shopping trips. But this does not mean they want to do everything together. Ove likes ice hockey, bowling and walks, while Marie enjoys being at home and swimming. Ingela is pleased with the housing solution: “I want the very best for my sister, and I can’t imagine anything better than this. It’s stable and secure. It’s also important, of course, that the assistants are people we know and trust. I’d like to see more people being allowed to arrange their assistance this way,” says Ingela. The success factor has been Frösunda’s capacity to meet the customers – in this case Ove, Marie and their relatives. Their needs, wishes and ideas have been the driving force for the collaboration, solution-focused thinking and innovative methods. This has also c reated added value for the paying customer, i.e. the municipality. Marie and Ove’s shared housing has also caused ripples. Numerous visitors have come to see them in their home, including municipal officials and interested parents. This inviting home embodies a joint c ommitment to find the best solution.

THE PATH TO UNIQUE HOUSING

Marie, 41, and Ove, 43, have both had multiple disabilities since birth.

Due to their similar situations, their parents have known each other since the 1970s, when Marie and Ove were young. They had the idea of a flatshare for their children.

Together with Frösunda, they fought for a unique assistance solution.

The municipality was initially not keen on a private solution, but eventually decided to support the shared housing.

Försäkringskassan was hesitant about the ‘flatshare’ concept, but approved the assistance solution.

Local public housing company Skebo rents out the apartment and has made adaptations in the bedrooms, living room and bathroom.

Now their shared housing model is attracting study visits and providing inspiration for new solutions.

The people pictured on the left: Ove Kaller, 43, multiple disabilities; Marie Hillerbring, 41, multiple disabilities; Kicki Johansson, customer ombudsman at Frösunda; Ingela Hillerbring, sister of Marie and trustee.

VALUE FOR SOCIETY BASED AROUND EACH INDIVIDUAL Frösunda has extensive experience in delivering high quality services. We are proud of that. But the most important lesson we have learned over the years is never to become c omplacent. Instead we have to continue being curious about every individual. Frösunda adds value by creating the best possible quality of life for the customer – whatever their situation in life. This means the customer must always be involved, consulted and the main focus.

EACH CUSTOMER IS A UNIQUE PERSON. Every day we

look at the person before us and ask what their specific needs are. We have a wealth of experience, but nothing can replace a genuine conversation. Our experience does, however, help us to ask the right questions. A large part of our task is to tease out what the customer wants and understand their needs, irrespective of their ability to communicate. Frösunda’s operations are sorted into four business areas: Elderly Care, Individual & Family, Disability and Assistance. Customers in the different areas have differing relationships with Frösunda and receive support with different things. In addition, there are as many ideas about what constitutes good quality of life as there are customers. The common thread for the company and the foundation on which it rests is our core values:

RESPECT – Through a dignified and individual approach, we create security and happiness.

COMMITMENT – We care about people and are proud of what we achieve. 12

CURIOSITY– We actively seek new skills that make a difference for our customers.

A complex part of Frösunda’s task is to ensure that the interests of the paying customer, the customer and the relatives are upheld. A client may be social services, the municipality or Försäkringskassan, while a customer could be a young person risking exclusion, an older person in need of everyday security or perhaps a middle-aged person with a disability. To succeed, we need to create value for the whole of society, based around each individual. This is our way of driving change at social and individual level, because in the end it all comes down to how we see the person and draw on their resources. The building blocks that together create what we want to achieve are Attitudes, Staffing, Methods and Environment.

ATTITUDES “The best thing is that I can forget about the company and concentrate on my life. Frösunda is there, I have their number, but I don’t need to call them.” MARLENE BERGQVIST, CUSTOMER, ASSISTANCE

Frösunda’s staff have the task of putting our core values into action. The result is a good attitudes that involves paying attention to the person we are there for. It is a matter of having respect for the life the individual wants to live. This then allows us to create

the conditions for them to feel happy and secure in a life with real meaning. It takes a great deal of commitment and a large dose of curiosity. Whether the customer needs space and integrity, a shoulder to cry on or something else, we should be there. We want to meet each individual in their current situation and guide them towards a life that works for them and their relatives. It is a major undertaking and it demands a lot from us, but in return we get to see individuals grow and develop, find peace and take their natural place in society.

STAFFING “I can talk about my life with perhaps ten percent of people.” EWELINA BROFJORD, CUSTOMER, INDIVIDUAL & FAMILY

Gaining a person’s trust despite their previous traumatic experiences and disappointments is far from easy. But that is our job. We are responsible for ensuring the right person is in the right place and available at the right time. Good leadership is crucial in this respect, with staff being given the support they need to meet the high standards our customers expect. Many of the young people who live at our residential homes talk about how meaningful the

“When my husband died, I was alone, but I don’t want to live alone. Here, I can choose whether I want company or to be by myself in my room.” RUNA LARSSON, CUSTOMER, ELDERLY CARE

METHODS “I want the very best for my sister, and I can’t imagine anything better than this. It’s stable and secure. It’s also important, of course, that the assistants are people we know and trust. I’d like to see more people being allowed to arrange their assistance this way.” INGELA HILLERBRING, RELATIVE, ASSISTANCE

Innovation is integral to our methods. Often we are required to think outside the box. In theory it is easy: we find solutions that work by focusing on what the customers want. However, in practice, it can be

CUSTOMER PERSPECTIVE

ENVIRONMENT

contact with staff is. They describe simple things such as going out for a drive with a member of staff in the evening when anxiety levels start climbing and how the sound of the therapist’s knitting needles helps them to sleep. The presence of adults who want to know how they feel and who are secure enough in their professionalism to take a personal interest works miracles every day. In elderly care, success often comes down to smart timetabling. It should always be based on the customer’s needs and it is important to ensure good staffing levels at times of the day when the c ustomer wants to be active. Clarity and forward planning from the management make it possible to establish procedures that work and that enable customers to feel secure and noticed. Frösunda earns trust by taking responsibility. We are on hand to provide the best possible support so that each individual customer can enjoy the highest possible well-being and quality of life.

more problematic, as old approaches and outdated procedures get in the way. It is important, in such a situation, to take a step back and remember who we are here for. To meet our obligations, we are innovative with the smallest details, when it comes to finding activities and approaches that work, plus we collaborate with researchers and experts to find new answers to the really key questions. We work with outcome-driven innovation, a strategic process where we focus on the customer and what is most important to them.

As the residents of Ängabogård in Alingsås wake up, they are met by the aroma of freshly baked bread. Frösunda won a quality-based tender that involves us adding value for our customers in various ways. Creating a pleasant environment that can be enjoyed with all the senses is a key part of this. Seeing thoroughly cleaned rooms that are thoughtfully furnished, being able to leave the door ajar and hear the neighbours chatting around the coffee table, smelling the aroma of fresh baking and feeling the touch of staff they know and trust gives residents a positive outlook on life. Food is an important component of older people’s well-being, and it is about more than just nutrition. Making all mealtimes into an enjoyable experience is something we take very seriously. We need to work on the taste and smell of the food, and how it is presented on the plate. It is also important that there is a pleasant social aspect to meal times, where older people have the company they want. Some prefer smaller groups, while others like sharing a long table. All the new units that Frösunda builds are designed around the customer’s needs. We also take the planning a step further, including features such as gardens and natural light, and we involve our customers in defining the needs that exist.

HARD FACTS ABOUT SOFT VALUES The highest possible quality of life within the framework of the commissioned service – this is what Frösunda is committed to delivering. To find out whether we are on the right track, we have to take on the challenge of gathering hard facts about soft values – we need to measure well-being. Research, innovative methods and a strong drive to c onstantly improve are the cornerstones of our work. A prime example is our collaboration with P ennsylvania State University, where researchers have developed a method for measuring quality of life, or well-being, in a respectful and transparent way.

FOR THE SECOND YEAR IN A ROW Frösunda has

c onducted a Perma well-being survey, which identifies how successful Frösunda is being in different parts of the business and over time. This is an important tool for building trust and helping management. Frösunda’s customers are affected by a host of different factors. They live in society and have complex and changing relationships that are far beyond Frösunda’s influence. The Perma survey thus provides knowledge on many circumstances other than the care initiative. It is an important tool in understanding the customer as a rounded individual. Frösunda plays a key role in their life, but far from the only one. The objective is to identify positive trends, the extent to which Frösunda’s work has a positive effect on the customers’ quality of life – never on creating ‘perfect’ results.

SURVEYS CONDUCTED IN 2014

Elderly Care: Residents at a unit in Alingsås were invited to complete the survey when Frösunda took over the operations. The point of this was to set a base value that could be followed up later. A small-scale pilot was also carried out with persons with dementia. Individual & Family: All the customers were invited to complete the questionnaire. This is the second stage

of an implementation process aimed at continuously measuring customers’ quality of life.

Five parameters for well-being P Positive emotions: Feeling happy E Engagement: Feeling involved R Relationships: Being happy with your relationships M Meaning: Feeling that life is meaningful A Accomplishment: Achieving your goals

5,8

Perma score Elderly Care

Frösunda’s extensive experience in assistance is also a major asset to us in our work with elderly care. We know how to be flexible enough to meet the differing needs of individuals, but also to follow things up and measure them. 10 9 8 7 6 5 4 3 2 1 0

6,4 Perma score Individual & Family

Customers in the Individual & Family business area often come with previous traumatic experiences. We have a major obligation to understand their past but also to take responsibility for the present and the

Reference group

Customer Elderly Care

10 9 8 7 6 5 4 3 2 1 0

Customer Individual & Family

Reference group

f uture. We have therefore conducted a Perma survey and followed that up with interview-based studies at the units that had the lowest and highest scores.

6 5 4

Perma score Reference group

DIFFERENT INDIVIDUALS, COMMON THEMES The age and circumstances of our customers in Elderly Care and Individual & Family are naturally very different. And certain differences can be seen in the results, with the older people’s scores being significantly lower than both the reference group and the teenagers. However, there are a number of common themes: Both groups are happiest with their relationships Both groups have less positive feelings than the reference group The difference between the reference group and the customer groups is greatest with regard to feeling that life is meaningful.

CUSTOMER WELL-BEING MAP 2 1 The

unit where customers felt they had the best quality 0 life in the Individual & Family business area has of P E R higher scores than the reference group in several areas: they are with2 their relationships, that life Enhethappier 1 Enhet Medelvärde I&F feel Referensgrupp is meaningful to a greater extent and are more likely to think that they are achieving their goals. From an interview-based study of the unit in question, we know that it has a well-developed system for helping the young persons to better themselves, and the young

persons have a strong sense that they know what they want to do in the future and how they can achieve that ambition. M A At the units with the lowest scores, the young people feel they have no idea what the future holds or what they can do about it, despite them all having access to education or work experience. There is, however, another difference between the units: the one with the highest scores is a home for boys and the one with the lowest is a home for girls.

CUSTOMER PERSPECTIVE

7,8

The reference group comprises Frösunda’s administrative staff. The score is higher than the average for the customers, but lower than for the highest scoring unit.

10 9 8 7 6 5 4 3 2 1 0 P

Unit 1

Unit 2

Average score I&F

Reference group

MULTIDIMENSIONAL WELL-BEING Perma is a complex measure of well-being that focuses in on what makes life good. Two individuals can have the same overall score but different parameters take the score up or down. The example below shows two individuals with a Perma score of 5.3, but where one is very satisfied with their relationships and the other with their sense of direction and meaning in life.

WHAT NEEDS TO BE IMPROVED? The Perma analysis indicates that there is potential to improve customers’ access to meaningful tasks, hobbies or work/education. Both older people and those within Individual & Family lack a place in the world of work, which impacts on their everyday life. Although the need for an occupation varies, it affects well-being– not least because these people often lack a forum for self-fulfilment.

10 9 8 7 6

10 9 8 7 6 5 4 3 2 1 0

GIRLS ARE LESS HAPPY 4

P Individual 1

R Individual 2

THE CUSTOMER’S VOICE

There is a clear pattern in the data: girls are less happy. This conclusion 3 is also supported by research and other surveys. Relevant literature 2 suggests a number of possible causes, and indicates that risk and 1 protective factors can be different for girls and boys. This means that 0 organisations need to take particular account of girls’ specific needs, P and circumstances. E R M A experiences Enhet 1

Enhet 2

Medelvärde I&F

Referensgrupp

The customer’s right to have their voice heard and to be able to plan their day and their future is important to Frösunda. We want to look after each individual and understand what they mean by quality of life. No matter what.

“ADULTS HAVE TO LISTEN. AND UNDERSTAND.” Linn is 16 years old and has told her story many times over. All the adults ask – how could this happen? But not everyone has really listened. And even fewer have understood.

LINN LIVES AT JUNO, one of Frösunda’s homes for girls

exhibiting trauma and self-harming behaviours. Here she has a life that works and adults she trusts. Adults who ask the right questions and do their best to understand. But it has not always been like this. In school, Linn and her twin sister often ended up in trouble and there was bullying in class. In s econdary school they switched schools for a quieter life and so they could concentrate, but they felt misunderstood from the first moment. “It felt like the headmaster had decided he didn’t like us. Where everyone else got to choose where to sit and work, he told us that if we wanted to go upstairs, we had to sit in with him. There were glass walls everywhere, so we felt we were being singled out when we sat in there.” Linn liked the family home, but was not well. One evening she took as many tablets as she could swallow. She vomited all night and when the family noticed in the morning, she was admitted to hospital. “It wasn’t exactly where I wanted to be. I wanted to kill myself, but in a way I was glad it didn’t work. I wasn’t allowed to have sharp or any medicines. But in the end I asked for my wallet and got it. I had the blade from a pencil sharpener in there, so I was able to cut my arms with it. I didn’t like the doctor there. He didn’t listen to anything I said and he failed to ask any questions. I explained everything really well, but it didn’t get through.”

The Social services decided that the family home where Linn had lived for eight months should no longer look after her and in April 2014 she moved to Juno. “There used to be a lot of aggravation between the persons here. But now it’s all good. We go to the cinema, go out for a coffee or out to eat.”

LOCKED IN THE GARAGE Linn regularly meets a psychologist and talks a great deal to her contact at Juno. She has a lot to process. “I have good childhood memories. We were abroad, my sisters and mum. But mum met a guy who was a real idiot. He was cruel to us, but mainly to mum. He had a cat that was old, blind and deaf, and mum accidentally ran over it. He locked her in the garage for a day for that. I was six and kept asking where mum was. He just said she was out somewhere. “Mum dumped him and changed the phone number so he couldn’t call, but he managed to keep hold of a key. One night he let himself in. We woke up to hear him standing there, shouting. Some years later, mum met another man who also turned out to be violent. “I remember mum putting clean laundry into the laundry basket to carry it to the wardrobe. Maybe something had happened before, I don’t know, but when her boyfriend saw it, he got angry. He started

hitting her in front of me and my twin. The police came and promised to arrest him if he did it again.”

SOMEONE TO TALK TO These are difficult things to recall and talk about. Linn has seen several different therapists and psychologists, and is clear about how critical it is that it feels right. “When I saw one of the BUP psychologists, I knew straight away that it wasn’t going to work. I told the staff here and they arranged for me to see someone else. I got to talk to a therapist called Nina, who was a good listener and understood.” The staff at Juno also play a crucial role for Linn. “The staff here are good. If, for example, I get very anxious in the evening, I can go out for a drive with a member of staff and grab a coffee or something. It’s important that adults listen to what you say and understand. I know I can’t decide everything, but at least I want to be involved in making the decisions. “Adults often find it hard to understand what I’m feeling. Crying, for example, doesn’t always mean I’m upset. I cry for all sorts of reasons. Because I’m so angry it drives me to tears, and sometimes I don’t even know why. Then someone comes and presses me for an explanation, but I don’t always have one. Sometimes something has happened and sometimes there’s nothing.” Several times in her life, Linn has felt like she wanted to die. Like life is so difficult that she no longer wants it to continue. It is still not easy, but now she is in a place where life works, and she can expect the people around her to respect her and listen to what she says. “I’m doing an internship at a dog daycare. I take the dogs out for walks and there are things they can do for training. Running machines and things that make them think. “And best of all, I’ve got to know Tove, who also lives here. We get on really well.”

Children and young persons who are unable to live at home may be placed in a family home or residential home under the Social Services Act or the Care of Young Persons Act (LVU). Children may also be placed in special residential homes run by the Swedish National Board of Institutional Care (SiS), which are secure facilities.

CUSTOMER PERSPECTIVE

FACTS: CHILDREN PLACED IN CARE

In Sweden, the number of children taken out of the home for at least a day is large – some 32,600 children in 2013. This has attracted the attention of the UN Committee on the Rights of the Child, and Sweden has been urged to strengthen its work to ensure that more children are able to have their rights met while still living with their parents.

“It’s important that adults listen to what you say and understand. I know I can’t decide everything, but I at least want to be involved in making the decisions.” WHAT HAPPENED NEXT? In last year’s Confidence Report, we met Bilal. His application for a residence permit has been rejected. With the help of the efforts made at the Frösunda home, he now has a job. Bilal is working with great commitment and focus to realise his dreams for the future.

NOTHING IS IMPOSSIBLE Fredrik Steininger is proof positive that nothing is impossible, but he is quick to acknowledge that he faces plenty of challenges. Fredrik is 25 years old and a driven, sociable person with cerebral palsy, which means he needs support from Frösunda. Since Fredrik has always been determind to enter the labour market, much of the teamwork with Frösunda has focused on that goal. “When I tried looking for a job, it turned out to be harder than I thought,” says Fredrik. “I’m a sociable person and I find it easy to connect with other people. I need to work, I’ve never been one to sit at home and do nothing.” Together with Frösunda, Fredrik has now secured not just one job, but three. “I like being at different places. I work at the Riksdag, in the Internal Services department. One of my tasks there is to hand out post each day on my rounds. I also work at the offices of Djurgårdens IF in Hjorthagen two days a week. I do the cleaning and tidying, and have fun with the others who work there. And on top of that, I work at Frösunda’s head office. “The most enjoyable aspect of working is the social side, meeting people and getting out and about. In my spare time, I write songs. That’s a new thing for me. I’m also looking for love on the internet. It takes time. Part of my disability is that writing takes a long time.” Fredrik also gives talks about his life and passes on knowledge about what it is like to live with a disability. As such, he is increasing understanding of others in the same situation and helping to create a world where everyone has a natural place in society.

FREDRIK’S ADVICE TO THOSE WHO WORK ALONGSIDE PEOPLE WITH A DISABILITY: Your job is not to take care of me, but to help me do my job. • Take your time and have patience. • Talk to and get to know the individual – we are people, not disabilities! • Talk about yourself: likes and dislikes. That can avoid misunderstandings. • Don’t help without asking first. • The worst thing you can do is make me feel like I don’t have anything important to say, because of my disability. • I think everyone is important and everyone has a job to do on this earth, whatever their circumstances!

“When I tried looking for a job, it turned out to be harder than I thought.”

Behind us lies a year of vociferous public debate that, first in the election campaign and then in the political turmoil of last autumn, moved further and further away from the persons who really matter – our customers. Those who have to fight every day for what politicians and commentators take for granted, a natural place in society. THE debate about the organisational form that care takes is of no interest to us. The only thing we are interested in is that the persons we are here for enjoy the best possible opportunities to live their own life, on their own terms.

However, we do have an organisational form – Frösunda is a large, financially strong private care provider. And we believe the form we have chosen is the best – the one that produces the best effect for the customer through innovation. We are here to give our customers the best possible quality of life within the framework of the commissioned service. We are in no doubt that continued development and innovation is what will give us, and all providers, irrespective of their ownership structure, the conditions for improvement. Because we have to improve. Our customers belong to some of the most vulnerable groups in society. Young people suffering social exclusion, old persons who are

anxious and afraid, disabled persons whose s tatutory support and services are failing – there are many persons who need support from society.

“EVERY KRONA OF PUBLIC MONEY THAT IS WASTED IS TAKING AWAY SOMEONE’S OPPORTUNITY TO RECEIVE SUPPORT.” We take responsibility by driving developments that benefit the customer. This is our contribution to social progress that everyone can be proud of. And we believe that our way of organising the work – within a company – puts us in the best position to drive this development forward. But don’t just take our word for it. Only the customers, relatives and paying customers can say whether we are succeeding. So what do they think? Find out on page 6.

DELIVERY

STRONG PRIVATE PROVIDER THAT WORKS HARD FOR THE CUSTOMER STOP TALKING ABOUT STAFFING In the Confidence Report 2014 we said “Stop talking about staffing” because we strongly reject the notion that micromanaged staffing guarantees quality of care for the customer.

Over the past year, we have f ocused on action rather than words. A s ignificant innovation for us has been to link the customer’s needs to staffing, which provides stability for the customer and efficient use of the paying customer's resources. We have clarified the managers’ responsibility for this, developed customer-focused systems and made this a key component of our management programme for 2015.

THE POWER TO ACT IF SOMETHING GOES WRONG Delivering on our promises and complying with agreements are essential in establishing trust. If customers are to receive the support to which they are entitled, we have to carry out our work within the parameters that we have agreed with the paying customer. Frösunda’s quality goal of 100 p ercent contractual compliance is therefore a high priority. However, sometimes we fail, and then the key is to swiftly take the right action.

ON I5 MAY 2013 Frösunda took over the operation of Hagtorp elderly care unit in Upplands-Bro. However, things got off to a shaky start. When the social welfare board in Upplands-Bro conducted its first contract follow-up in February 2014, result was not good, as we did not deliver the added value promised in the agreement. Frösunda’s management reacted immediately to the highlighted concerns and put every available resource into turning the situation around. Just a month later there was a second follow-up. “Contractual compliance was lacking on too many points the first time round, which is what prompted us to carry out a second follow-up so quickly. We went through the amber and red points to see how they had been improved,” explains Marianne Iggmark of the social welfare office at Upplands-Bro Municipality, who is responsible for the quality inspections at Hagtorp. And as it turned out, the trend had been broken! Only two red and 18 amber points remained, along with an action plan to tackle them. In a press release from April, Upplands-Bro states

that the customers at Hagtorp: “say they feel secure and have a large degree of influence over which activities they take part in.” The next inspection came in September, and at the time of writing only four amber points remain. A change in local leadership, clarity from Frösunda’s management, all the necessary resources and the authority to act directly were the factors that turned failure into success.

14 FEBRUARY 2014: WARNING LIGHTS AT HAGTORP The social welfare board in Upplands-Bro conducted its first contract follow-up in February 2014. Of 124 points reviewed, the results of the first inspection were: 55 green, 34 amber and 35 red points. Goals, agreements and the quality of the business are measured in a c olour-coded template where green means the results comply fully with the requirement, amber means the results comply partially with the requirement, and red means that the results do not comply with the requirement at all. The 35 red points concerned shortcomings in added value and

WHEN THE INFORMATION COMES TOO LATE

requirements for services relating to food, activities, quality, staffing

However, things did not go so well for Almen elderly care unit in Järfälla. Frösunda was contracted to run Almen in 2012 under an agreement that was set to expire in 2016, but Järfälla Municipality decided to take back the operations before the end of the contract period. “The municipality choosing to terminate the contract is a failure for us. We have a quality goal of 100% contractual compliance and we will therefore be focusing even more in the future on ensuring that we keep our promises,” said Quality Manager Christine Rosencrantz in Frösunda’s press release of November 2014.

and controls. CEO Susanne Sidén was informed immediately. “We take on board the criticism and are trying to ensure that everyone is satisfied. We were aware of some of the issues, but by no means all of them. We have a clear duty to run the unit properly, and we therefore take the situation extremely seriously,” said Susanne Sidén in a press release, when the results were first announced.

red points and 34 amber from a total of 124. A serious signal that drastic action is required, and fast.

DELIVERY

RESPONSIBLE FOR DIFFICULT DECISIONS Frösunda is involved in our customers lives, making the delivery of our services a major responsibility. Because we can be our customers’ arms and legs, but never their minds. It has to be admitted that the care sector has a long tradition of deciding what is best for the customers, often over their heads. Although well-intentioned, this approach is unacceptable,

24 MARCH 2014: THE MOMENT OF TRUTH

3 SEPTEMBER 2014: ON TRACK WITH RIGHT LEADERSHIP

Then came the moment of truth. Just a month later, in March 2014,

On the third follow-up inspection, in September 2014, it was clear that

there was another follow-up inspection. It was clear that c onsiderable

all the hard work had yielded results. There were no more red points

improvements had been made. Improvements to the documentation

and only four amber points left. They relate to the promised outdoor

had begun and more home-made food had started being served.

activity for customers who Frösunda not yet documented at the

The green points had increased from 55 to 104.

individual level. But everything else, like food, meetings, evaluation,

brother, who is trustee, to move from the group accomodation

reporting is fixed.To Frösunda to succeed in its ambitious targets

where she was living, to her own home with a personal

to deliver the highest possible quality of life for clients regardless

assistant. It was a much-anticipated move that nevertheless

Leadership is a key.

caused anxiety, discomfort and poorer health.

Frösunda focused on rectifying the problems point by point, and on improving internal communication. After the second follow-up inspection, the head of social welfare

and as we work to make the switch from well-intentioned to respectful, we face a number of difficult ethical decisions on a daily basis. In this situation, customer focus is the light that guides us in the right direction And our customers help us to understand its importance. Take the example of the customer who decided, with her

Mona Zakeri was recruited as the new Managing Director of

The assistance team was self-critical, why had they failed

2014: “The social welfare board takes the failures that we saw very

Hagtorp, where she is now focusing on getting everyone to pull in

in making the customer happy? The case manager considered

seriously, and we are pleased to see what improvements have been

the same direction. It was tough getting to grips with the work at

making a Lex Sarah notification. It was then that talking to the

made. We will be monitoring progress via regular inspections, both

the start, but Hagtorp is now back on track.

in Upplands-Bro, Eva Folke, stated in a press release on 29 April

before and after the summer.”

The collaboration between the municipality and Frösunda continues, with ongoing checks and follow-ups to ensure the best possible quality for the customers.

brother revealed the crucial information. He and the customer were well aware that the actual move would be hard going and they accepted that. Instead of being reported and enduring further change, the customer wanted stability and support in getting through the unpleasantness that a new situation causes, so that in the longer term she could achieve her long-held goal – the security of her own home.

red points and 18 amber from a total of 124. In a month, Frösunda worked systematically to rectify the problems.

In meeting with the customer and her relative, we learned red points, 4 amber and 120 green from a total of 124.

what was needed to resolve the situation with some minor

Intensive measures have turned the stop sign into

adjustments, a focus on the customer’s goal and an

a green light!

ongoing dialogue.

“I NEEDED TO FEEL NOTICED” Simon is 18 years old, engaged and in the process of signing a lease on an apartment. Six months after Frösunda’s intervention, he remains resolutely drug-free and is on the brink of properly coming of age. DRUGS BECAME A PART OF Simon’s life in his early

with drug and alcohol-related problems. He went there

teens. Vandalism and attempted burglary got him the

regularly to take blood tests and to meet a counsellor.

attention he craved, and he was often out with his friends.

One day she was late.

At the age of just 14, he decided to leave home.

“Eventually, three police officers came and took me to the Frösunda Hasselakollektivet treatment centre in

Simon’s mother, father and best friend reported him to the

Hälsingland. I felt tricked and offended.”

social services. As an emergency solution, he was placed in a family home in Knutby. But instead of coming to a safe

But gradually Simon changed. By having to relate to others

place, he was dropped off by social services outside the

who wanted to give up drugs, he gained new insights into

house in the middle of the night. Simon was left to go up to

how his behaviour not only damaged his own body, but

the door himself and ask to come in. When Simon took out

also hurt the people around him. He decided to become

his mobile phone, he was beaten by the man of the family.

drug-free – and that is what he did. After a year and a half,

The man also took the phone off him, which meant Simon

he was ready to leave Hassela.

lost his only connection with the outside world. “The man and woman both had alcohol problems,

“I learned that life is good without drugs. My general mood is much better now and I have a broader emotional

so I quickly realised things weren’t going to go well,

range. I accept that going from happy to angry is part of life,

if I stayed there.”

so it doesn’t scare me any more.”

After just a week, he moved to his aunt’s, and that became his second foster home for six months. Then he ended up staying with his friends. His trust in social services was destroyed and Simon’s drug abuse worsened.

He also met Linnea, and on 3 July 2014 they got engaged. Now they live together at her parents’ home in Norrtälje. “I like it here, but getting our own place is an important next step for me.”

“By the end I had to take something just to get me out of bed. It was like that for four years, and it took its toll. I now

January 2015 marked Simon’s second anniversary of being

have damaged joints, with pain in my knees and elbows,

drug-free. Now he is studying to improve his school grades

as well as in my Achilles’ tendons, neck and groin.”

and he is also taking a post-upper secondary vocational course in teaching and leadership at Fryshuset in S tockholm.

When Simon was 16, he was admitted as an emergency 22

case to Mini-Maria in Norrtälje, a centre for young persons

That was his childhood. Now comes life as an adult.

CONTROL & MONITORING

C NFIDENCE REPORT I N FIGURES 2015

We earn trust by taking responsibility – that is what guides us in our work. And it is in the interaction with the customer that trust is created, providing a true touchstone for our quality. A customer focus is therefore the obvious starting point when we set about measuring our quality. It is also why, in this Confidence Report, we illustrate customer focus with a diamond: it is our most valuable contribution and it exists only in the interaction with the customer.

PAGES 23–34

The following pages present a summary of our results and our analysis. 23

CARE MUST HAVE ITS OWN QUALITY LOGIC QUALITY MEASURES 2014

REAL QUALITY – that is the challenge that occupies

us on a daily basis in the Quality department. The development of technical innovations, new products and aids is of course important. But it is in the customer interaction that it truly comes to the fore. Quality is determined in the moment that we meet the customer. It is one of what Swedish business legend Jan Carlzon referred to as the moments of truth. It is the moment for respect, commitment and curiosity. This becomes particularly apparent when we encounter a customer who expresses dissatisfaction. This situation, more than ever, requires good, valuedriven service. I would suggest that service short comings when the customer is at his or her most vulnerable are the true quality issue for Swedish care. It happens with us, it happens with others and it is only human – but it is never okay. This is also the crux of the challenge: the care must build up its own quality logic that clearly values the customer. Our services intrude in people’s lives; that is the nature of care. Quality is a measure of how well we handle this. Every failure in our services is a failure that must be remedied. Our entire success, not to mention our reason for being, depends on it. This is also why transparency at every level is so vital. Poor service must be flagged up. All our data, all our key performance indicators must be understood accordingly. The results must be read within the context that we always strive for 100 percent customer satisfaction. 24

On occasion, I have encountered raised eyebrows – questions about why Frösunda’s CEO Susanne Sidén

and I, as Quality Manager, spend so much time to personally meet our most dissatisfied customers. But to us, it seems the natural thing to do. By prioritising these trips and conversations, we gain invaluable knowledge about what has gone wrong with our service, with our procedures and systems. These customers give us what we need to continue driving Frösunda’s work towards the only acceptable goal – quality results of 100 percent.

Develop process control Continue development work on customer surveys Run two ‘mystery shopper’ projects Produce local management systems: Ongoing. Proved more complicated – involved redesigning our IT structure, for example. Introduce quality committees: Introduction of quality committees is ongoing, but has been put on hold in Assistance due to a reorganisation. Leadership development: Frösunda decided to put the brakes on the leadership programme in 2014, in order to focus on clarification of fundamentals and values. Instead, Frösunda’s customer-oriented management programme will be implemented in 2015, starting in February.

PRIORITIES FOR 2015 • NPS for paying customers and relatives • Implement process control • Customer-focused concepts • Customer-oriented management programme

CHRISTINE ROSENCRANTZ QUALITY MANAGER

QUALITY GOAL

RESULTS FOR 2014

Customer satisfaction

NKI – Satisfied customer index

>90%

94%

NPS

100

Care’s own quality logic provides the quality goals of the future

CONTROL & MONITORING

“I want Annie to have an assistant who makes her feel safe… … but also dares to challenge and push her to develop. It’s important that Annie has an independent life.” So says Sonja Olsson, mother of Annie, aged 12. They are Frösunda customers – and thus two of the persons best placed to judge our quality. Customer focus is our diamond. It encourages us to see things from the customer’s perspective at every turn. It is the guiding principle that enables us to meet the customer’s needs in an innovative and effective way. It is the most valuable thing we can do and it can only exist in the interaction with the customer.

QUALITY GOALS WITH A CUSTOMER FOCUS Since Frösunda is a quality-driven organisation with a customer focus, it is important that we report the results of our customer surveys. The way we work on them is evaluated as part of an ongoing dialogue within the management team. This year we have had more respondents and we have expanded the work on obtaining responses from our customers. Our key performance indicators show that we are on the right path. This section provides details and analysis of our successes and challenges, as we continue with our change management work.

OUR MISSION

OUR QUALITY GOALS > 90 % customer satisfaction

We earn trust by taking responsibility Customer focus

100 % contractual compliance 100 % regulatory compliance

SATISFIED INTERNAL CUSTOMER INDEX The Satisfied internal customer survey for 2014 indicates that availability is the biggest area for improvement within the administrative functions, IT receives the highest marks from internal customers. There appears to be a gap between what is expected from the administrative staff and what they deliver, which should be seen in light of the needs that arise from Frösunda’s rapid rate of development.

67%

Availability and attitudes

Skills

63 %

67 %

CONTRACTS RENEWED In 2014, four of Frösunda’s operations were put out to a new tender, and in each case Frösunda was chosen to continue by the paying customer. This provides a clear indication that the paying customer is satisfied with the service delivered by Frösunda.

CONTRACTS WON The proportion of public contracts won gives an indication of how the paying customer views Frösunda’s offering. Of the 29 public contracts put out for tender in 2014, Frösunda won 52%.

Reliability and delivery

94% Customer satisfaction was measured in the Disability business area in 2014, with a value-focused survey. The questions are based on our core values – respect, commitment and curiosity – with a binary scale: yes or no. The North region saw a significant rise from 92 to 96. Factors behind the rise include the fact that “the staff listen to me”.

63 %

100%

Assistance

NKI – SATISFIED CUSTOMER INDEX

100%

Disability

55%

Individual & Family

60%

Elderly Care

29%

Respect

Commitment

95 %

Curiosity

96 %

95 %

91%

94%

Frösunda 2013

Frösunda 2014

75%

72%

Average for Frösunda businesses in 2011 the care sector

SATISFIED RELATIVE INDEX The survey of relatives was conducted in the business areas Disability, Assistance and Elderly Care in 2014.

84%

Respekt

Commitment

85%

83%

Curiosity

81%

NPS – the Net Promoter Score – measures quality as perceived by the customers, and satisfaction among Frösunda’s customers. The survey identifies ‘promoters’, who would recommend Frösunda to others, ‘passives’, who are satisfied customers, and ‘detractors’, who are dissatisfied customers. The NPS is expressed as the percentage of promoters minus the percentage of detractors. 2014 saw NPS surveys conducted in all the business areas. Considerable differences were discovered at unit level, flagging up major opportunities to identify and spread success factors. Based on the survey, success factors and development areas have been identified for each business area. A positive NPS, i.e. a result above 0, is generally considered a good result. The average for service companies is below 10. However, Frösunda has much higher ambitions. We have a zero vision for detractors – and thus a target of NPS 100.

NPS Disability NPS Customers, daily operations

74 15 NPS Relatives

NPS Assistance NPS Customers

• Inclusive way of approaching activities • Customers feel safe and secure in their accommodation

NPS Relatives

27 28

NPS Paying customers

-5

• Good relations between staff and customers, good attitudes

• Good relationship with Frösunda, good brand

• Attitude, responsiveness and good attitudes for customers

• Concern about high staff turnover, concern about staffing of certain shifts

• Knowledge of customer’s diagnosis, skills development

• Good contact between social secretaries and case manager

• Staffing, concern about staffing of certain shifts

• Good monthly reporting

• Availability of operational managers

All social secretaries contacted responded to the NPS survey. The respondents expressed appreciation that their input as a paying customer was being sought.

• Good treatment

• Incorrect staffing • Lack of competence and training in the team

NPS Elderly Care

• Poor monthly reporting

NPS Customers

15 -1

• Good relations between staff and customers • Customers appreciate the activities

• Insufficient variation in the food • Relatives feel a need for better staffing according to the customer’s needs

COMPLEX PICTURE OF HAGTORP • Unclear how customers can submit comments and complaints

The results of the survey among paying customers in the business area Individual & Family do not match up to Frösunda’s aim of being the quality leader in the industry. Work is focusing on ensuring that all units with a negative NPS achieve positive results. Lessons are being drawn from Alunda, with its NPS of 100.

• Good relations between staff and customers, good attitudes

NPS Relatives

• Good attitudes, curious listening

NPS Individual & Family

CONTROL & MONITORING

WOULD YOU RECOMMEND FRÖSUNDA?

Hagtorp elderly care unit received high marks from the customers, NPS 50, but low ones from relatives, NPS -25. Good relations with the staff and fun activities were what the customers liked most, while concern about staffing was uppermost in the minds of the relatives.

NPS Paying customers, Alunda unit

100

For Individual & Family, the orders are placed by the municipal social secretaries. The highest marks in the whole survey were given to Alunda, a residential home for girls aged 13–20. Seven social secretaries responded to the survey, and the result was NPS 100. The social secretaries put the fantastic result down to:

Skilled staff who care about the customers Professional and trustworthy case managers The unit being open to the wishes of the social secretaries and the customers

QUALITY GOALS & ASSESSMENT The purpose of the Quality department, whose head is a member of the management team, is to maintain the drive for quality. The health and safety of the customer is of paramount importance to this task. In order to guarantee this at every level, we have developed the tools to measure Contractual compliance and Regulatory compliance, and this work is set to continue in 2015. Over the course of 2014, each business area was subject to an assessment relating to the quality goals and risks. An analysis conducted within Individual & Family showed that the national average for inspections from IVO with deviations is 50 percent, while Frösunda’s results are considerably lower, at 15 percent. There has also been an analysis of the Lex Sarah reports from 2013, aimed at assessing implementa tion of the measures set out in the investigations.

MYSTERY SHOPPERS ”Frösunda provides a good service – as long as you can get in touch with us.” This is how Frösunda’s Mystery Shoppers sum up the results of 263 calls to all the business areas and to head office in February–March 2014. The project checks availability, service and information. 2014. 67 percent of the calls resulted in a direct answer or quick feedback, which is an improvement on the year before. However, 29 percent of the calls received no answer and no

REPORTS

feedback, which indicates that availability remains the biggest area for improvement. The survey showed that feedback is the most important point, and revealed certain shortcomings in the technical system concerning the telephone system and call forwarding – a matter that was rectified in 2014. A new Mystery Shoppers project will be conducted in 2015.

PEER CONTROLS

Operation

Reports 2013 2014

IVO notifications 2013 2014

Lex Sarah Assistance Disability Individual & Family Elderly Care

4 14 1 2

30 2 28 1 6 0 5 1

3 1 3 0

Lex Maria

Total

22 75 5 7

Peer controls are one of Frösunda’s quality instruments, aimed at creating a platform for learning and development between colleagues. Case managers meet in pairs for a learning discussion, backed up by checklists. The peer controls are a tool for risk analysis and development work. The results are reported to the Quality

CUSTOMER FOCUS 2015

department, where they are analysed and used for operational and

Apply a customer-oriented approach in all improvement work, through initiatives such as: • Housing concepts • Talent management • Customer-oriented staffing

commercial planning. 184 peer controls were conducted in 2014.

2014: INTERNAL INSPECTIONS Mystery Shoppers Reviews of social documentation in all operations

LEX SARAH & LEX MARIA

QUALID

Quality audits for the patient safety report

Persons in the late stages of dementia often have difficulty expressing how they feel. The US tool Qualid allows for staff who know the person to measure quality of life based on observable behaviours and moods. The scale goes from 11, the highest quality of life, to 55 as the lowest quality of life. Measurements have been taken at five departments in Alingsås, with an average Qualid score of 22.2.

Contract follow-ups Reviews of individual units Focus groups

2014: EXTERNAL INSPECTIONS External inspections are conducted by the Health and Social Care Inspectorate (IVO) and the Swedish Schools Inspectorate. In 2014, Frösunda had 65 external inspections.

As we predicted in last year’s Confidence Report, an increased focus on deviations in health and social care has led to a rise in the number of reported deviations. We believe this increase will continue in 2015, since there is still a certain amount of underreporting. Each year, we disclose the number of reports and notifications here in the Confidence Report. By putting our deviations under the microscope and always being transparent when we have not succeeded, we can improve the quality of our opera tions. In order to take the next step, from 2015 we will be monitoring lead times in the process, as a way of focusing on how we handle each individual case. The frameworks and rules that exist for reporting irregularities are very important to us. Lex Sarah and Lex Maria provide peace of mind for our customers and for us, but they are only one of the elements in a broad quality process, which we monitor through our quality KPIs.

5% Individual & Family

11%

31%

Disability

53%

Assistance

KEY FINANCIAL FIGURES

SEK 2,863 million Turnover: The company’s total earnings: invoiced, cash and other.

2,863

SEK 150 million Operating profit (EBITDA): This represents the first part of the income statement and is the difference between earnings and expenses, before interest, tax, depreciation and amortisation. Calculation: Operating profit plus depreciation.

SEK MILLION TURNOVER

15% Organic growth: Calculated as: the most recent year’s net turnover divided by the previous year’s net turnover. Organic growth means that we grow through expansion, not acquisitions. 5.2% Profit margin: The profit margin is used primarily to monitor the company’s progress or to compare companies in an industry. Calculated as: Operating profit/Turnover.

2014

2,613 CUSTOMERS Presence from north to south

2,369

2,497

2,863

2012

2013

2014

8,806 EMPLOYEES

Assistance Elderly Care Disability Individual & Family

Gender breakdown all employees

62%

Elderly Care

Disability Individual & Family

9% 40%

50.9% Equity ratio: Equity as a proportion of total assets. Calculated as: Reported shareholders’ equity and loans from the owners as a percentage of total assets.

LSI – Leadership index

Men

31%

33%

69%

Women

Individual & Family 287

71%

74%

75%

Frösunda 2011

Frösunda 2013

67% NMI – Satisfied employee index

Gender breakdown senior management Men

31%

33%

85%

Proportion of Swedish municipalities Assistance

MSEK 1,986 MSEK 65 MSEK 580 MSEK 229

Average for businesses in the service sector

Disability 813 Elderly care 107

CONTROL & MONITORING

Elderly care

Average for businesses in the service sector

769% 064 Assistance

67% Women

91%

92%

Frösunda 2011

Frösunda 2013

A new employee survey will be conducted in 2015, based around a customer focus. An initial downturn is expected when we change the survey to focus on adding value in relation to the customer.

GRI REPORT 2014 The Global Reporting Initiative, GRI, is one of the most widely used frameworks for sustainability reporting. Frösunda has chosen to report in line with GRI-G4 Core Option, which means that the focus of the Confidence Report lies on what is most important for our stakeholders. This is fully in line with our customer focus. A year ago, the international initiative launched an update – G4 – which created a new framework that proved of interest to Frösunda. The focus now is on the stakeholders and reporting on what they see as most important. The framework is used by all state enterprises in Sweden, and by listed companies around the world. This Confidence Report is therefore also Frösunda’s first GRI report. This report is a key starting point for monitoring sustainability work going forward. For us, the important issue is not reporting in line with the framework. For us, it is more about answering our customers’ questions. It lends an incredible power to the reporting work, since it encourages us in our drive for transparency. Our aim is not just to report on what we have done well – we also want our areas for improvement to be set out in black and white. Our customers are those who really know whether our core values have been implemented out in the operations and it is their testimony that gives us the information we need for our continuous development. The benefit of reporting within a framework is that it gives structure and makes it easier to report systematically over time.

GENERAL STANDARD DISCLOSURES ‘IN ACCORDANCE’ – CORE

Strategy and Analysis

Heading

Page

G4-1

A journey towards change

Statement from CEO

Organisational Profile G4-3

Name

Frösunda Omsorg AB

G4-4

Brand

Frösunda

G4-5

Headquarters

Solna, Sweden

G4-6

Countries

Sweden

G4-7

Ownership and legal form

Frösunda is a Swedish group comprising of a number of limited liability companies. In spring 2010, HG Capital acquired Frösunda from the previous owner Polaris Equity. HG Capital is a British investment company that counts the health and social care sector as one of its specia lity areas. It operates in the European market and invests in well-established companies. As owner, HG Capital brings industry-specific expertise plus active and committed support.

G4-8

Markets served

Frösunda’s market is Sweden. Frösunda offers personal assistance, daily activities, accommodation, schooling, elderly care, coaching, respite care and support for children and young people with social problems.

G4-9

Scale

Employees & Turnover

G4-10

Employees

Employees & Turnover

G4-11

Collective bargaining agreements

Employees & Turnover

G4-12

Supply chain

Frösunda’s services are delivered in the interaction between our staff and our customer. Staff represent our biggest cost. Other key parts of our supply chain are suppliers of knowledge in the form of consultants and researchers. Those from whom we rent premises and those who supply us with aids are also important suppliers.

G4-13

Significant changes

For Frösunda, 2014 was a year of growth in all its business areas in Sweden, while our Norwegian subsidiary was sold off. We won 15 new public contracts.

Heading

G4-14

The precautionary principle

The precautionary principle is about applying relevant environmental considerations when we build new units and plan for low energy consumption.

G4-15

Frameworks and principles

WHO International Classification of Functioning Disability and Health, UN Convention on the Rights of the Child, UN Convention on the Rights of Persons with Disabilities, Universal Declaration of Human Rights

G4-16

Memberships

Page

Susanne Sidén is a member of the Swedish Association of Private Care Providers’ main board. Eva Ingemarsdotri is a member of the industry board for Individual & Family.

G4-26

Engagement

Stakeholder engagement

G4-27

Key topics and concerns

Being listened to, security and independence, Value for the whole of society, based around each individual

8, 12, 13

Report Profile

Heading

Page

G4-28

Reporting period

Calendar year

G4-29

Previous report

No previous GRI report

G4-30

Reporting cycle

Annual

G4-31

Contact

Quality Manager Christine Rosencrantz

G4-

‘In Accordance’ – Core

G4-33

External assurance

The policy is for the annual report to be audited. No external assurance for GRI in this first year of reporting.

Governance structure

The Frösunda Group has operations in assistance, disability, elderly care, and individual & family, as well as administrative staff. Find more information at frosunda.se under Organisation.

Identified Material Aspects and Boundaries G4-17

Consolidated financial statements

Frösunda’s Annual Report 2014

G4-18

Aspect boundaries and defining report content

Being listened to, security and independence

G4-19

Material aspects

Being listened to, security and independence

G4-20

Internal aspect boundaries

Quality in the value chain

G4-21

External aspect boundaries

Quality in the value chain

G4-22

Changes to measure ment methods

Frösunda is reporting under GRI for the first time. Perma measurement expanded, NPS conducted in all business areas. Otherwise no significant differences in measurement methods.

G4-23

Changes in the scope and aspect boundaries

GRI report for the first time

G4-25

35 32

Governance G4-34

Ethics and Integrity G4-56

Values

Mission: We earn trust by taking responsibility. Frösunda’s values are summed up in three words: Respect – Through a dignified and individual approach, we create security and joy. Commitment – We care about people and are proud of what we achieve. Curiosity– We actively seek new skills that make a difference for our customers.

8, 12

DMA & indicators ‘In Accordance’ – Core

Stakeholder Engagement G4-24

CONTROL & MONITORING

Organisational Profile

Stakeholder groups engaged

Understanding every customer, Stakeholder engagement

6–7, 32

Identification and selection

Being listened to, security and independence, Stakeholder engagement

8, 32

G4-DMA G4-PR2

Customers’ health and safety in relation to the services

Quality goals & Assessment Lex Sarah & Lex Maria reports

G4-DMA G4-PR5

Results of surveys measuring customer satisfaction

Hard facts about soft values, Quality goals with a customer focus, Would you recommend Frösunda?

14, 15, 26, 27

EMPLOYEES & TURNOVER

STAKEHOLDER ENGAGEMENT The customers are our most important stakeholders, and, as we show in the report, we have no fewer than 16 unique customer groups – customers, rela tives, paying customers and internal customers in each of our four business areas. It is with these that we maintain the most intensive dialogue. In addition to our customers, however, we also have politicians and public officials, interest groups, employees, owners and the media on our list of stakeholders. Stakeholders

G4-25 Basis for identification

G4-26 Frequency of engagement

Customers

The dialogue with the customer lies at the heart of Frösunda’s work. The customer is the reason we exist.

We maintain a dialogue with our customers in every part of our work. The CEO meets customers in organised dialogues six times a year. The management and administrative staff do work experience on the front line and meet customers. A number of customers have been interviewed to gather information for this report.

Employees

Frösunda informs and involves its employees, who provide relevant information to help the company make decisions that improve their ability to deliver quality to the customer.

Interviews have been conducted as part of preparations for this report. The ‘grandfather principle’ is applied to key decisions. Open regional panels, open telephone meetings for dialogue.

Political decisions and their implementation affect Frösunda’s work.

Ongoing dialogue is maintained at all times. Interviews have been conducted as part of preparations for this report.

Frösunda’s owners create the conditions for innovation across the organisation.

Ongoing dialogue is maintained at all times. Regular board meetings, at which the owners are represented.

Politicians and public officials

Owners

Opinion-formers, interest groups and the media

Frösunda has implemented a shift in policy and now prioritises greater participation in the public arena.

Continuous.

In 2014, customers numbered 2,432, turnover amounted to SEK 2,863 million, the equity ratio was 50.9% and Frösunda employed 8,806 people. Of these, 6,199 were women and 2,606 were men. 100 percent are covered by a collective bargaining agreement. The employees are formally employed and thus cannot be considered self-employed.

AS AT THE END OF 2014, THE GROUP COMPRISES THE FOLLOWING OPERATING COMPANIES: • • • • • • •

Frösunda Omsorg AB Frösunda LSS i Södra Sverige AB Frösunda Omsorg i Östergötland AB IKASUS AB Frösunda LSS i Väst Sverige AB Frösunda Omsorg i Uppland AB Frösunda Omsorg i Stockholm AB

• • • • • •

Frösunda Omsorg i Örebro AB Frösunda Omsorg i Uppland 2 AB Försunda Omsorg i Jämtland AB Frösunda Omsorg i Gävleborg AB Frösunda Omsorg i Gävleborg 2 AB Frösunda Omsorg i Uppland 3

The table shows how many men and women are employed on a temporary and permanent basis. Permanent contract Women

Permanent contract Men

Temporary contract Women

Temporary contract Men

Temporary contract Women*

Temporary contract Men*

1,550

503

220

106

4,343

2,084

* Temporary contract as long as the customer still requires the assistant: Collective Agreement Sector G – Personal Assistance

The table shows how many men and women are employed in the different regions North region

Central region

S-holm region

South region

G-burg region

768

374

1,320

449

434

225

1,377

574

2,214

1,071

Total Women

Total Men

Grand total

6,113

2,693

8,806

The value chain describes the connected activities that an operation focuses on in order to deliver valuable services. The care industry has a complex value chain, which we have chosen to illustrate in our quality pyramid. It helps us to understand the complex customer and consumer picture, and what statutory and voluntary controls the industry has at different points along the value chain. The materiality analysis led us to two GRI aspects – Health and Safety and Customer Satisfaction Surveys. Both reported aspects are important in every part of the organisation and they are included in the value chain. The illustration shows how the aspect of Health and Safety is included when we design our services for the customer, based on the needs that arise out of the customer’s wishes, the paying customer’s purpose and the objective of the decisions taken. In the actual deli very of the service, policies, procedures and legislation determine the way deviations are reported. They also govern our data on risks relating to the customer’s health and safety. Finally, reports are submitted to IVO, where applicable, under the Lex Sarah and Lex Maria provisions on compulsory reporting of incidents. The illustration also shows how the aspect of Customer Satisfaction Surveys takes account of the fact that our customer relations rely on more complex factors than a simple consumer choice. As a consequence, we have the traditional customer satisfaction survey, where we ask about delivery (NKI and NPS), but we also apply a measure of well-being (Perma). The results of these surveys are reported transparently as part of the voluntary checks that Frösunda undergoes.

THE QUALITY PYRAMID CUSTOMER

DELIVERY Customer’s own wishes

CHECK Best available knowledge

Paying customers’ purpose & aim

Policy & procedures Skills Leadership

Appropriate decision for customer

Attitudes Documentation Law

Customer ombudsman NKI KPIs Peer controls

Mystery Shoppers

Deviations in health and social care Self-assessment Internal and external inspections

GRI ASPECT: HEALTH AND SAFETY

CUSTOMER

The CEO’s customer groups

CONTROL & MONITORING

ASPECT BOUNDARIES IN THE VALUE CHAIN

DELIVERY

CHECK

Quality KPIs

GRI ASPECT: CUSTOMER SATISFACTION SURVEYS

CUSTOMER

Perma

DELIVERY

CHECK

NKI/NPS

Confidence Report (voluntary report)

PATIENT SAFTEY REPORT THE PATIENT SAFETY REPORT is prepared every year and covers special housing for the elderly and persons with physical and mental disabilities. The full patient safety report can be found at frosunda.se.

MAJOR ACTIONS 2014 Work on improving patient safety continued in 2014. The chief medical nurse (MAS), who is an expert on health and safety issues, continued working on developing procedures, forms and care programmes with a focus on health and social care and patient safety. During the year, MAS carried out inspections and a quality review of special housing and was also involved in self-assessments. Frösunda’s dietician implemented the action plan for food and mealtimes and the care programme to prevent undernourishment Over the year, the dietician followed up on the agreed quality indicators in all the elderly care units. All authorised staff, including contract staff, log entries in the electronic patient journal Safe-Doc. Internal and external training activities on patient safety issues are held all the time. Frösunda is conti

nuing to put together digital interactive courses for skills development in patient safety. The Quality department has a new member of staff with expertise in dementia care, as part of the drive to ensure implementation of the MY method (which contributes to patient safety by means of a salutogenic way of working), the national care programme for dementia care and the quality register BPSD in the elderly care units. Comments from customers and relatives have a major bearing on the patient safety work. Among other things, this is supported by all the operations having clear procedures on how to report risks, deficiencies, comments and complaints. In 2014, Frösunda continued to introduce quality committees, as an aid to local quality work. Experts and the chief medical nurse from the Quality department play an active role in investigating reported serious incidents and shortages of our care.

OVERALL STRATEGIES 2015 The task of ensuring and raising the profile of patient safety work is a constant part of the wider improvement work, and this will continue in 2015. For elderly care units, work is ongoing to turn national guidelines for

dementia patients into structured person-centric working methods. The salutogenic approach and attitudes of the staff will be developed and quality-assured. Work to implement Frösunda’s MY method for the promotion of health and function retention continues. This includes physical and social activities. Cooperation with relevant medical practitioners in elderly person’s accommodation will be pursued throughout the care chain to promote patient safety. This applies especially to the area of medication and care at the end of a person’s life. For end-of-life care, we will continue to work on implementing a quality-assured way of working. For all special housing, development of patient journals in Safe-Doc will continue. Recording and documentation under the Health and Medical Care Act (HSL) will be developed using the national glossary for health and social care, the International Classification of Functioning, Disability and Health (ICF) and the National Board of Health and Welfare classification system (KVÅ). Our internal procedures are to be quality-assured to highlight and analyse risks associated with health and social care provided by Frösunda staff on behalf of others. n

Frösunda Omsorg AB

If you have any questions about our quality

Reporting partner: Lumen Behavior

Frösundaviks Allé 15

work or the Confidence Report, please contact

Design: Pondus Kommunikation

Box 708

our Quality Manager Christine Rosencrantz.

Cover photo: Andreas Nilsson

SE-162 72 Solna

Other photos: Johan Spinell, Katarina Wikström, Andreas Nilsson

+46 (0)10-130 30 00

e-mail: christine.rosencrantz@frosunda.se

3D graphics: Pondus Kommunikation

www.frosunda.se

tel: +46 (0)10-130 31 53

Printing: Joma GP, Ljungby 2015

THE QUALITY PYRAMID In one sense, working on quality is automatic and part of Frösunda’s core process, but it is also about changing people’s behaviour and using customer perceptions to continuously improve quality. The quality pyramid shows how this works – with supplementary perspectives and a constant base. The sides of the pyramids describe the Customer Perspective, Delivery and Control & Monitoring.

WE EARN TRUST BY TAKING RESPONSIBILITY

Care for the highest quality of life. Whatever it takes.