THE CUSTOMER'S FOCUS CONFIDENCE REPORT 2016
“My wish is that my sister’s daily activity will reach another level” LILIA GELI, RELATIVE AND CUSTOMER
CONTENTS
CUSTOMER PERSPECTIVE: Always comes first. At the base are decisions that affect the customer, then the aim and purpose of the paying customer in commissioning the service. At the top are the customer’s own wishes for the best possible quality of life. Pages 4–19
DELIVERY: At the bottom are our attitude
“Flexibility is invaluable in times of change” MARLENE BERGQVIST, HEALTH CONSULTANT, FRÖSUNDA CUSTOMER AND NEW MOTHER, PICTURED ON THE FRONT COVER WITH HER SON LOVIK IN UMEÅ’S ÅRSTIDERNAS PARK. MEET MARLENE ON PAGES 12–13
THE QUALITY PYRAMID
and manner, plus legislation, ordinances and regulations. Above these are policies, processes and procedures, leadership, skills
In one sense, working on
and employeeship. At the top are the best
quality is automatic and part
available knowledge and developments. Pages 20–24
“IT ALL BEGINS AND ENDS WITH THE CUSTOMER” FRÖSUNDA’S QUALITY MANAGER CHRISTINE ROSENCRANTZ EXPLAINS THE CONCEPTS. READ MORE ON PAGE 26
of Frösunda’s core process, but it is also about using the customer experience as the basis for continuous improvements to quality. The quality pyramid shows
CONTROL & MONITORING:
how this works – with com-
At the base are internal controls, together
plementary perspectives and
with supervision and inspections carried out by public agencies. Then come groupwide controls, peer controls, the satisfied e mployee index and key performance indicators. At the top is the satisfied customer index. Pages 25–43
“THE RIGHT MANAGER IN THE RIGHT PLACE”
a solid base. The sides of the
FRÖSUNDA’S CUSTOMER-ORIENTED MANAGEMENT PROGRAMME IS BASED ON THE CUSTOMER’S FOCUS. READ MORE ON PAGE 10
Read more on pages
pyramids describe the Customer Perspective, Delivery and Control & Monitoring.
41 and 43
THE DIFFERENCE WITH THE CUSTOMER’S FOCUS Frösunda’s customers want to be just like everyone else. They want to make decisions, and to be noticed, validated, loved and respected. It might sound obvious, but unfortunately it is far from the reality for many people with a disability, or a difficult family situation. What we need is a change in social attitudes that makes our customers a natural part of society. Frösunda wants to lead the way on this front by offering a new kind of care that stands resolutely on the side of the customer.
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THE PAST YEAR HAS SEEN US TAKE perhaps the most
2015: MANAGER AND RELATIVES
important step in the journey of change that we first embarked on four years ago. We have gone from a cus tomer focus to the Customer’s focus – from looking at and understanding the customer, to developing our abi lity to adopt the customer’s perspective. Only then can we get a grip on what good quality care really means. A key dimension that is often overlooked is the fact that the customers are in a position of dependency. If they had the choice, they would much prefer not to have society and us getting involved. They don’t need benevolence. They need respect, commitment and curiosity.
The focus of 2015 has been on manager development. Since managers are the key figures in our work on the Customer’s focus, we have implemented a compre hensive customer-oriented development programme. This has proven a challenging task. Not everyone has been prepared to surrender their traditional desk job and become a leader who is driven byinteraction and dialogue with customers. Manager recruitment is also our biggest challenge moving forward. The law precisely dictates back ground and experience and in order to operate at the quality level we want, we need managers who are willing and able to embrace the Customer’s focus.
In order to deliver care that properly prepares a place in society, we need courageous people, leaders and companies who are willing to stand on the side of the customer in every situation. Our journey of change is about how we at Frösunda are going to fully commit to this role, and grow within it. The change has been set in motion, and we are al ready seeing positive signals, with recurring customers and renewed trust in the procurement process. But we are not there yet, and resilience, flexibility and contin ued innovation will be needed over the years to come.
As part of our customer work, we have also paid particular attention to the relatives. Although we use the word ‘relative’, it is actually up to the customer to decide who is important to them, whatever their relationship may be. Relatives are often an invisible customer group who have a major influence on our operations – on our ability to deliver care with the Customer’s focus. Working with relatives is one of our areas of devel opment, and one that we have been exploring in our
everyday operations and in pilot projects run jointly with Carers Sweden.
2016: LOBBYING UNDER TOUGH PRESSURE We are seeing a continuation of the general pressure on prices in the care sector. The standard allowance for personal assistance is not rising in line with general costs, particularly pay. The political decision to scrap the youth discount on the employer’s contributions is also having an impact. All of this combined places further pressure on all care providers, both public and private. Frösunda continues to find solutions for the customer, based on the current conditions set by society, while also advocating long-term change for our customers. Our challenge to ourselves is to lobby even more clearly for our customers and their right to live their lives on the same terms as everyone else.
COURAGE AND RESILIENCE The customer decides – that is our promise. And that is what will make us the customer’s preferred choice. And, when conducted with courage and resilience, it will also affect our customers’ place in society, as well as their conditions for living their life exactly how they want to. In 2016, we will continue with leadership develop ment at all levels, with extensive concept development in Individual & Family, and with continued develop ment of the other business areas, so that the customer gets to make the decisions. It is going to take another two or three years before we complete the changes we have set in motion. To keep us on track, we seek our customers’ input in the form of follow-ups and evaluations. You will meet many of them here in the Confidence Report, and I will leave it to them to describe how well we are doing. SUSANNE SIDÉN CEO
CUSTOMER PERSPECTIVE
VISION FrĂśsunda is a driving force in the Âdevelopment of new ground rules for the care sector, so that everyone enjoys a better life and a natural place in society. SUCCESS FORMULA We earn trust by taking responsibility. VALUES Respect, Commitment, Curiosity
People with disabilities, older people and young people enjoy a natural place in society.
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Four years ago, we made a decision: we will be the best by learning from our customers. This has taken us on a journey of change that is not just about us at Frösunda, but also about our customers’ place in society. We are not there yet, and it will still take courage and resilience for us to achieve the change we are aiming for. But with the customers’ help, we can see the milestones we have passed so far and check that we are on the right track.
2013
“The contract has been awarded to another tenderer”
Our entire business depends on receiving contracts from the paying customers. This is about prescribed cost parameters, but there is more to it than that. At some point in the past, we as an industry seem to have fallen into the trap of believing that good quality simply boils down to higher staffing levels. We have gone astray. The solution is to go back to basics. Why are we here? For the customer, of course. All resources should be beneficial to the customer – that is how we can offer a quality service within the set economic framework. A new strategy and mission, and a new set of values, are the first steps.
STRATEGY: We will win business by being the best for the customer
VALUES: Respect, Commitment, Curiosity
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Work begins on a customer focus – and the insight that our customers are an unusually disparate group that we need to understand in as much depth as possible. Four customer groups in four different business areas make no fewer than 16 groups a constant presence. All these are vital as we drive change at both societal and individual levels because in the end, it all boils down to how we see the person and draw on their resources.
“It was cool. The CEO asked a lot of questions and responded to what we said. She listens and I think it’s going to lead to change.”
MISSION: We earn trust by taking responsibility
HOLD OURSELVES RESPONSIBLE In deciding to speak openly about our journey, this Confidence Report becomes our key tool. We are also beginningto investigate and initiate systematic measurements of our customers’ well-being.
2014
“You are monumen tally inflexible”
Selver, 18, customer living at a residential home
“All I want is communication! That someone would contact us carers and say that we take your views 100% seriously.” Anonymous mother of a 15-year-old with severe autism and epilepsy
THE MANAGEMENT SPEAKS DIRECTLY TO THE CUSTOMERS We have begun the change management work, but progress is slow. We are discovering how deeply rooted traditions and institutionalisation are in the care sector, and in our own approach. To truly ensure a customer focus, the whole senior management team spends at least two days on the front line each year as a way of meeting the customers in their everyday life. Every quarter, CEO Susanne Sidén also holds her own meetings with customer groups from all the business areas, so as to gain a unique insight into their situations..
Frösunda’s customer profile Assistance “Frösunda’s values are fantastic. I particularly like the word curiosity. I want people to be curious about mum.”
Customer
Marianne, daughter of Alice, 93, Elderly Care customer
Paying customer
Relative
Internal customer
Disability
Individual & Family
Elderly Care
2015
“Without the right manager, it’s all futile”
“I want to feel competent in my life and in my home.” Marlene, customer in Assistance
We realise that a customer focus is not enough – it is not sufficient to look at the customer. We need a deeper understanding, and and an ability to adopt the customer’s perspective. We are therefore taking the vital step from customer focus to the Customer’s focus.
CUSTOMER-ORIENTED MANAGEMENT PROGRAMME As there are currently no existing external m anagement programmes with an in-depth emphasis on the Customer’s focus, Frösunda is developing its own customer-oriented management programme. All 300 managers spend four weekends on training over the year. One outcome is that those who do not want to adopt the Customer’s focus are replaced.
THE CUSTOMER’S FOCUS = knowledge about the individual + knowledge of cognition
RESPONSIBILITY FOR MISSTEPS ALONG THE WAY Public contracts won and customers who come back are positive indicators that the change management work is yielding results. But not everything runs smoothly at all times, and the real test is about taking responsibility when s omething goes wrong.
“Our goal is for all our residents to feel even better than they do now.” Åsa Zacharoff, Alingsås Municipality, paying customer, Elderly Care
“The social welfare board takes the failures that we saw very seriously, and we are pleased to see what improvements have been made.” Eva Folke, head of social welfare Upplands-Bro, on the improvement work at Hagtorp elderly care unit
2016
CUSTOMER PERSPECTIVE
FRÖSUNDA’S JOURNEY OF CHANGE “You listen”
We have begun changing the culture, and in 2016, we want our customers to tell us that we listen. This applies to the customers themselves, and to relatives and paying customers, all of whom are important, but with very different needs. The cultural change is also about us being courageous enough to always stand on the side of the customer. Always. This means we need to take on board the vulnerable position that many of our customers have in society, and understand it. We will break the customer’s powerlessness, and all that it entails.
At the same time, we also have to focus on the paying c ustomer – the economic circumstances and priorities of the individual municipality. Our services are of good quality only when all our customer groups say so. PROMISE FOR THE FUTURE Our promise to listen to the customer - to always work from the Customer’s focus – is a promise for the future. It is a promise to r espect and support human rights in line with the UN Guiding Principles on Business and Human Rights. But above all, it is a promise to our customers and to the society in which we operate:
The customer decides
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A FUTURE IN WHICH I DECIDE The aim of the work is a future where customers decide for themselves. A future where care providers compete to offer services designed and carried out in the way the customer wants. To get to this point, limited resources must be used for the right things and in the right way. In short: we are leading the way towards a care system in which the overarching principle is customer satisfaction.
THE LIFE STORY HELPS TO SET THE FOCUS – AINA, ELDERLY CARE “I had a great time in the shop where I worked as a youngster. Particularly when it was full of customers. And I soon learned that the customer is always right. You shouldn’t contradict what the customer thinks, but you can give good advice if they ask and so on.”
Working with the Customer’s focus involves operating on the basis of the customer’s own reality. And that means that if we are to deliver quality, we need to understand the customer’s values and opinions. The way in which we learn more about what the customer values is often through listening to stories about their life. By listening to what the customer focuses on, we can also draw lessons for our own work.
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“I make decisions about my life. I don’t want anyone telling me I have to do this, I mustn’t be silly, but you have to be kind as well.”
CUSTOMER PERSPECTIVE
NOTHING IS IMPOSSIBLE – FREDRIK, DISABILITY
WHO ACTUALLY MAKES THE DECISIONS? – SABINA, INDIVIDUAL & FAMILY
FOCUS ON DIGNITY AND LISTENING – MÅRTEN, ASSISTANCE
“The idea for those of us attending a daily activity, or a regular job, is that we should be doing the task, not the staff. Otherwise going to work feels a bit pointless.”
“Either it’s social services who make decisions about you. Or there’s the staff who decide how they’re going to do what social services say, and then there are my parents, of course. But I don’t think that’s right, I want to decide things for myself.”
“I have sometimes had one or other assistant steamrollering me and not listening. Once, a while back, I had a guy giving me a baby’s bottle. That was awful.”
Taking on challenges at work, learning and developing are important parts of Fredrik’s life. When the Swedish Riksdag was unable to keep Fredrik on as an e mployee, Frösunda arranged for him to do his daily activity there instead. This was a prime example of Frösunda managing to find an individual solution.
Young people placed in homes under LVU and SoL are not always listened to the way they are entitled to be. This has been reported by the UN’s Committee on the Rights of the Child on numerous occasions. With many everyday relationships subject to rules and restrictions, the question of the customer’s right to self-determination comes into sharp focus.
Dealing with customers in their own homes doesn’t always have to be that difficult. The biggest mistakes can be avoided by listening to what they say. S olutions that seem practical in the moment can actually be humiliating, and linger on in customers’ memories. Customers are individuals with integrity and their own specific views about what counts as dignified treatment.
“I want to decide more about my life. There should be adults around to help me get to where I want to be. But I still want to decide on certain things that no-one else can help me with.”
“For me as a customer, it’s impor tant that my assistants understand my preferences and needs, and what I want and don’t want. And I should add that Frösunda is really good.”
“I think it’s good to be able to make your own decisions as much you can, to get as close to life as possible under your own steam. It’s not the end of the world if you need help with reading and writing.”
Going from traditional care to care with the Customer’s focus is a major change for us on the front line, and we are in the middle of this journey. When Frösunda comes in, there can initially be concerns that we are approaching care in a new way, but things start happening quite quickly. And if things don’t happen, there is always someone to talk to, not least our customer o mbudsman. The goal – and our reward – is the pride we have when the customer feels they get to determine their own life.
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REPLACE THE MANAGER! When a municipal paying customer for Elderly Care and Assistance exclaimed in frustration: “Replace the managers! They’re awful!”, Frösunda took this extremely seriously. Since then, all managers have received training, and many have either been replaced, or chosen to move on. Not only the operational managers, but also the managers in finance, administration and IT, now need to shift from a customer focus to the Customer’s focus.
A CUSTOMER FOCUS MEANS focusing on the customer and being an expert on them. Adopting the C ustomer’s focus, however, means that the customer is asked di rectly, “what do you need?”. The management courses have been based around understanding the difference. The entire corps of managers, almost 300 from across Sweden, have undergone Frösunda’s customer- oriented management programme in four parts. When delivery fails, it is always because the operation has no manager, or has the wrong manager. This is the most significant point that Frösunda needs to improve on if it is to achieve its ambitious aims. In order to take the final step forward, all of Frösunda’s managers must be motivated and keen to adopt the Customer’s focus at every level. If people do not wish to operate in this way, then Frösunda is not the right place for them to work. Thus, as a result of this venture, many managers have chosen to seek employment elsewhere. On the other hand, many people have sought us out as a new employer, because they want their work to embrace the Customer’s focus.
to implementing quality improvements, policies and even legislation. “I’ve been in places where a change in the law changes nothing for us residents. It’s not the managers who decide there, it’s the staff, who just do what ever they want,” says Ahmad Ali, 19, customer in Individual & Family. It takes strong and empathetic leadership at all levels to steer all operations in the direction of the Customer’s focus.
CUSTOMERS SEE THE ROLE OF THE MANAGER
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The importance of the manager is confirmed by the customers. Frösunda’s extensive survey of the key factors for customers’ well-being shows that the managers play a crucial role, not least when it comes
Ahmad Ali, 19, customer in Individual & Family, is one of many who can bear witness to the importance of successful management. In his view, if staff are able to make arbitrary decisions, customers’ lives can’t even be improved through changes to the law.
IN-DEPTH TRAINING The first part of Frösunda’s customer-oriented management programme opened with a full day in which managers got to experience a disability: blind ness, deafness or being in a wheelchair. The managers were confused, unprepared, didn’t know what was going on, and were forced to wait and left standing. It was a sobering experience for many. But for Frösunda’s customers, this is often part and parcel of living with a disability. Leading with the Customer’s focus changes that – giving the customers power over their own lives. Anders Springe, the blind owner of Svartkrogen, where the first day of training took place, was one of those on hand to give their perspective. Then came training days with a focus on quality, finance and leadership. The participants got to work together, create concepts, share their experiences, ask questions, protest, laugh and network. “The management programme has put it more into perspective for me, and made it easier for me to understand the customers. Why they might be in a bad mood, for example. You gain a better understanding, that there may be nothing particular behind it. It can just be a bad day,” says Johan Larsson, operational manager in Karlstad. If the manager doesn’t listen, no one else will either!
CUSTOMER PERSPECTIVE
Without any warning, Frösunda’s managers have to take on a disability. Why? To raise awareness of what situation the customers end up in if they don’t receive support based on their own focus. They become confused, feel unprepared, don’t know what is going on, are forced to wait and are left standing.
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NAME: Marlene Bergqvist AGE: 28 FAMILY: Partner Erik, son Lovik,
tortoise Chip JOB: Health consultant and coach CURRENT ACTIVITIES: Parental leave and
moving home LIKES: Being a mother, chocolate, walks, candles, interior crafts DISLIKES: Lack of humanity, cancelled
training sessions, static hair
“Flexibility is how Frösunda is able to keep things together, so that I can live my life.”
“The best thing is that I can forget about the assistance and concentrate on my life.” Marlene’s words get to the heart of 12
Frösunda’s concept for personal assistance. It is all about the customer’s life. Frösunda’s job is to support her so that she can live the way she wants to. Whatever that might be.
She has been featured on the cover of Frösunda’s Confidence Report for the past three years now. And a great deal has happened in Marlene Bergkvist’s life in that time. Now she is 28, and a new mother. Assistance has always been there, through thick and thin. AS WITH MOST PEOPLE, life looks very different when
you are 20 and when you are approaching 30. Since she first became a Frösunda customer, shortly after upper secondary school, Marlene’s single life in a studio flat has become a whole family in a three- bedroom apartment. Studying has turned into a dream job, which is temporarily on hold during parental leave. Right now, she is at home with her four-month-old son Lovik. “Thankfully, we’ve had a couple of weeks now when we’ve been able to sleep.” She laughs and blames ‘baby-brain’ for not recalling exactly what has happened, and when. In the mornings, her partner Erik usually brings her breakfast in bed, and then they both deal with Lovik. Erik is a student and can be around a lot during the day. After breakfast, Marlene exercises to build up her muscles. “I’m trying to get into ‘jogging’ with a wheelchair, but otherwise it’s a case of cycling or walking with the baby buggy. I usually do that on my own.” Then, around lunchtime, her assistant arrives. MARLENE HAS BEEN a customer of Frösunda Assistance
for seven years. She describes becoming a mother as the opportunity to “watch something fantastic unfold”. She wants to prioritise doing most of the caring for Lovik herself. She has therefore given up doing other fun things for the time being, so she has
the strength for as many lifts as possible. “I think the assistants still feel right at home here, even though I now have a baby. They help more with the peripherals: making sure there’s no blanket in the way when I’m putting him down, keeping the chang ing bag properly stocked, holding the wheelchair when I’m sitting down with Lovik in my arms. He’s my focus right now, that’s for sure,” she laughs.
everything, and everything is in its place. It also makes things better for me too.” BEING A GROWING FAMILY in daily contact with Assis tance tests the capacity for everyone involved to work together. For Frösunda, the relatives are an important customer group. It is important how Erik and Lovik are doing, that they feel the assistance is running smoothly. “I’ve come to realise what characteristics are impor tant in assistants and my partner: patience and the abili ty to listen. These characteristics have been so incredibly valuable. It’s important to be able to judge the mood, like for example: ‘Should I be passive in the background and let them do their thing, or can we laugh and joke together?’ At the meetings with the assistants, I always explain what’s important to me right now. It’s crucial to remember that I am always the employer, so they know who to listen to,” says Marlene.
CUSTOMER PERSPECTIVE
CHANGES IN LIFE AND BACK-UP FROM FRÖSUNDA
MARLENE FEELS THAT many assistants are good at
finding the balance between being relaxed and feeling at home, without taking over and acting as if they own the place. A way for Marlene to retain a little privacy with regard to her assistance is to have a rolling schedule of four different assistants who come on different days, so no one person knows all about her private life. The one who comes today won’t know exactly what she did yesterday. MARLENE EXPECTED maternity leave to be a quiet a ffair, but instead it has been all go: training, friends and a move to a place that needs a lot of fixing up. At the moment, they are painting the new three- bedroom apartment and waiting for a new kitchen of an a dapted height. Marlene loves reading interior magazines for inspiration. Interior design is an interest, and order is a necessity: “The first thing is to bring the chaos under c ontrol. It’s easier for the assistants if there is a place for
IN FOUR MONTHS’ TIME the aim is for Marlene to go
back to work as a health consultant, leaving Lovik to be looked after by his father Erik. Life is changing again, and the assistance changes with it. The goal is always for everything to flow as smoothly as possible for Marlene. “Flexibility is invaluable in times of change. It’s what makes things run smoothly: people who listen and go along with your life as it is. It’s how Frösunda is able to keep things together, so that I can live my life.”
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NEW KNOWLEDGE OF THE CUSTOMER’S FOCUS
READ MORE ON PAGES 31–33
Frösunda needs to understand the customer’s world – their focus. To this end, well-being is measured every year through self-assessment. This teaches us more about our customers’ complex reality. Measuring well-being is not just a means to follow up our own work. It is also a vital way to place what we do in a broader context that is important to the customer.
THE WELL-BEING SURVEYS are designed to measure several aspects relating to quality of life. They thus also provide information on what improvements are needed to make the customers feel happier. Gathering information on how customers feel about their quality of life in a systematic way a llows the results to inform every decision, giving the C ustomer’s focus a natural place in decision-making processes.
going on, because I’ve left that life behind me. I have a new life now, thanks to my girlfriend.” Tom, 17
I still get angry sometimes, but now I know how to handle it.” Micke, 19
2. HUMAN CONTACT Relationships are crucial for the way in which customers rate their well-being. “I trust all the women who work here. And I now trust two of the men. I’ve really pushed them to the limit.” Sabina, 15
Surveys conducted: PERMA well-being survey, plus case study with young adults from two units. Read more on page 32.
WELL-BEING FACTORS FOR YOUNG ADULTS The customers in Individual & Family – young adults and adults alike – have completed the PERMA survey for the third year in a row. This year also included an in-depth study of well-being factors by Frösunda’s expert Beata Terzis, who has a PhD and has published her work in highly reputable scientific journals. Four areas proved crucial for the customers’ well-being:
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1. COMPARTMENTALISATION A defence mechanism that enables people to handle complex thoughts and emotions. The customers in Individual & Family talk about previous and current identities and behaviours as separate things. “I choose not to have any contact with some of my cousins. I make sure I don’t know everything that’s
3. AGENCY Having an outlet for energy and ambitions is central. “I like old cars. They’re so great. And I make music, raps that my brother has taught me. We get to go horseriding once a week here too, and that’s also really cool.” Cassandra, 15 4. SELF-REFLECTION Customers in Individual & Family have difficult ex periences to process, and they need support in finding themselves and establishing a healthy self-image. “What we do here is to work on ourselves. I’ve learned to handle my emotions and accept that they exist. Before, I used to get violent when I was angry.
STIMULATION AND FREEDOM FOR OLDER PEOPLE An initial well-being survey was conducted when Frösunda took over the Elderly Care unit Ängabo gården in Alingsås, and then a second one was completed a year later, at the end of 2015. Critical factors for the customers’ well-being are: Activities and stimulation that increase the customers’ sense of meaning. Living at Ängabogården gives the customers a better social life and makes them less lonely. This is crucial for well-being. The customers describe how their health and feeling of fitness determine how their day goes. Body and mind are intertwined. Mobility and freedom: There is major potential to improve the support for customers in this area. Many customers dream of being able to move about more
CUSTOMER PERSPECTIVE
“I’ve learned to handle my emotions and accept that they exist,” says Micke, 19, on self-reflection.
freely – despite their failing physical health. “Today is Tuesday, so today it’s keep-fit for the brain. It’s great fun! On Fridays we have a church service and play bingo. We can win things in bingo and when I do, I’m happy for the whole day! I’m happiest though after the church service. I really like the sermon. It’s so lovely.” This is how a customer at Ängabo gården describes the topic of a meaningful existence.
TOOLS FOR MEASURING W ELL-BEING • PERMA is a tool developed at Pennsylvania State University • PERMA has been used in Individual & Family for the third year, as well as in Elderly Care • The Cantril Ladder is one of the most widely used tools for measuring well-being globally • The Cantril Ladder was successfully piloted in Elderly Care and Disability
Surveys conducted: PERMA and interview survey. Read more on page 33.
RECOGNITION AND COMMUNITY IN DAILY ACTIVITIES To meet the needs of customers in the Disability business area, we use the internationally established Cantril Ladder – a self-assessment tool with visual support – combined with qualitative interviews. The areas that prove important for the customers’ well-being are the following: The customers strongly stress the importance of creating something of their own, and making their own decisions as a route to well-being. The company, support and sense of community gained from taking part in Frösunda’s daily activities
are critical for the customers’ well-being. The financial compensation and general recogni tion that the customers receive for their work during Frösunda’s daily activities are a key to the customers’ well-being. The daily activities contribute to well-being by giving the customers a reason to leave their home every day and making sure that they have the freedom to express themselves creatively.
“I wish I could feel a bit better, be happier. I’m constantly worried about my finances. So what I’d like is more money and more friends.” So says a Disability customer on the topic of compensation and recognition. Surveys conducted: The Cantril Ladder and qualitative interviews, pilot at three units. Read more on page 31.
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NEW INNOVATIONS FOR THE CUSTOMER’S BENEFIT “My wish is that my sister’s daily activity will continue to maintain the same quality. And be even better, reach another level.” So says Lilia Geli, relative and Frösunda customer. And that sums up Frösunda’s constant drive. Success depends on developing in consultation with the customer, based on his or her own focus. ADAPTED ENVIRONMENT AT GUTASUND At Gutasund, the fixtures, fittings and local environ ment have all been carefully designed. Every detail has been planned by Frösunda’s quality developer and dementia expert Beata Terzis, PhD. Colours, designs and table settings have been tailored to the needs of dementia sufferers. The garden is a tranquil spot for the customers. And on the top floor there is a spa. This is so that residents can make their day extra special, perhaps with a haircut, nail treatment, a facial or a jacuzzi.
We could go for two or three weeks, couldn’t we?” laughs Eva. Unfortunately, it is often difficult for older people to access outdoor experiences, whether on the beach or in the forest. But because so many people still love the idea, Frösunda has built a heated sun room – a kind of artificial indoor beach – at its new Hanveden unit.
CUSTOMER TO CUSTOMER – ABOUT CUSTOMER MENTORS In the Stockholm region, Frösunda has begun work on a concept called customer mentors. The aim is to create a network between customers, old and new. This gives the customers their own forum for discussing or raising issues that are important to them. It offers a platform for them to make their wishes clear to Frösunda, which can then organise the operation so that it is always based around the Customer’s focus.
INDOOR BEACH AT HANVEDEN
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Frösunda is constantly making investments and adaptations based on the dreams of customers in all the business areas. Eva is 86 and Kicki is one of her closest friends. 20 years ago, Kicki was Eva’s daughterin-law, but after the divorce the two women remained friends. Kicki works in the care sector, but only for another year. She is due to retire in the spring. “And then we’re going to go off travelling, Eva and I,” says Kicki. “Yes, we can go to Gran Canaria,” says Eva. “I’ve been there many times, so I know my way around.
THE NURSE’S PATH TO EXPERT STATUS
Eva-Margareta Larsson and Hillevi Westerholm both moved into Gutasund last summer. They struck up a friendship straight away and now they usually spend their days “talking rubbish”, as Hillevi puts it.
One example of thinking outside the box in our development work is the newly launched trainee programme for nurses. Research has shown that good supervision on the journey – from newly qualified nurse to expert – reduces stress levels and the risk of the person quitting. As trainees, the nurses are introduced to Frösunda’s operations and given practical knowledge about working with the Customer’s focus in elderly care.
rs re en Ca ed Sw
WITHOUT CARERS, SWEDEN WOULD GRIND TO A HALT! There are 1.3 million of us carers in Sweden looking after our loved ones. And we are saving society a considerable amount of money – an incredible SEK 177 billion a year! Just imagine all of us 1.3 million carers buckling under the stress, so that society now has to look after us and our loved ones too. This scenario clearly shows how Sweden would grind to a halt without carers. And now we demand a voice in the debate about care services!
CARERS SWEDEN declared 2015 the Year of the Carer,
and Frösunda came in as our main sponsor. It has proven a fruitful collaboration, as we feel Frösunda has understood the situation that carers are in. Our long-standing relationship is possible because of the mutual desire to really get to grips with the reality for carers – even when it is difficult. BEING A CARER means looking after someone close to you who requires care. Who you are a carer of can vary greatly: it might be a child with a disability, or a spouse who, for age reasons, needs to stay in a care home or be cared for in their own home. There are many commonalities in being a carer, but every situation and person is unique. A carer is also someone you can become at any time: today, tomorrow. The only thing that is certain is that life never stays the same. As a carer, you don’t always know where to turn for help. Life becomes unpredictable and it is easy to feel confused.
THAT’S WHY WE have come together to form Carers Sweden, or Anhörigas Riksförbund as it is known locally. There are 1.3 million of us who regularly look after a relative who can’t manage for him or herself. This involves taking care of contact with authorities, municipalities and healthcare providers, sitting in telephone queues, stressing to get our own jobs done, finding ourselves in dire dire financial straits due to reduced working hours, anxiety and worry about our relatives’ daily life and future… Many don’t even think about their status as a carer, because it is so natural to look after your loved ones. But the truth is that this selfless work needs to be brought out into the light. As stated above, society saves SEK 177 billion every year thanks to our efforts. Society simply couldn’t manage without us carers! WE ARE PROUD OF our personal work as carers, and we want to continue in that role. Frösunda has under stood that carers are as important a customer group as the people being for, as well as and the public bodies commissioning care services. They have begun to shape their services to take account of us carers too.
This is a step in the right direction and an important stance to be taken by one of the care providers for our nearest and dearest. But we need more support and respect from the rest of society: Employers. Munici palities. The Social Insurance Agency. The health service. The care sector. We have to be valued and compensated for the knowledge we possess, and for the work and care we put in. We have saved you SEK 177 billion. What are you going to give us in return?
Ann-Marie Högberg, ordförande Anhörigas Riksförbund
Alf Andersson, samordnare Anhörigåret 2015
17
“I took drugs to punish myself. I had feelings of guilt because I couldn’t do anything to stop dad from beating my siblings.”
18
Feeling trust and building up lasting relationships are central to Sabina’s life. She is in Year 9, and is determined to leave school with good grades.
SPOTLIGHT ON PARENTS IN NEW LEGISLATION The government has conducted an inquiry aimed at strengthening the rights of children in social care. The inquiry also highlights the parents’ need for support to improve their parenting skills. Another key event is that the Social Services Act (SoL) now states that the child has the right to be heard, as a result of the inquiry. This is welcomed by the UN’s Committee on the Rights of the Child, which has singled out children in institutional care for attention in all its observations on Sweden.
In the business area Individual & Family, customers have often had to deal with problems, betrayal and early loss, which affects their family relationships. Working with the Customer’s focus thus involves letting the customers themselves define key relationships and giving them the time to heal, build important new connections and learn to trust again. For Sabina, 15, school has become a point of safety, along with the staff at Juno, her friends and her siblings. She also dreams of a functional relationship with her father.
WHEN SABINA WAS 12, she came into contact with an
older boy who wanted her help. “No one will suspect you,” he explained, as he got Sabina to fill her pockets with packages that would be sold over the course of the day. In the beginning, he was right. No one suspected Sabina, who looked even younger than 12, of selling drugs. She also tried them herself. “I took drugs to punish myself. I had feelings of guilt because I couldn’t do anything to stop dad from beating my siblings. He hit me as well, and there was nothing I could do about it.” IT WAS TOUGH dealing with the events at home. S abina’s mother is mentally ill and was frequently hospitalised. Every other weekend, Sabina and her siblings went to stay with their father. “My sister and I always said it was time to head back to hell. Dad beat us and then forced us to call mum. ‘Say sorry to your mother,’ he told us. He wanted her to know so she was also hurt. And mum wasn’t doing so well.” The turning point for Sabina came when her father appeared while she was out with her friends. He pushed her up against the car and hit her in front of everyone. Her friends called the police and Sabina was moved to
a foster home. But the placement did not go well. “The guy in the family was pig-headed,” explains Sabina in her musical Västerbotten accent. “We fought all the time. He screamed and shouted. He told me to behave myself if I ever wanted to go home to mum again. The other girl who also lived there helped me report him to social services, so I got out of there.”
own dad, when he’s clean. I don’t trust him yet. But I called him on Father’s Day and I’m going to visit him soon.” At school things are going well for Sabina, and when she finishes Year 9, she wants to be a mechanic. “I’m top of the class now! And when I leave, I’m going to move in with my best friend and go to motor mechanics college.”
SABINA WAS MOVED to Frösunda’s residential home Juno. Despite a shaky start to her placement under the Social Services Act, Sabina is working hard to regain her ability to trust. Her focus is on relationships and interpersonal contact, and so Frösunda’s task is naturally to support her in her desire for trust and closeness. “I trust all the women who work here. And I now trust two of the men. I’ve really pushed them to the limit. I’ve fought, shouted and been nasty. I was just waiting for them to shout back or report me. But they never did. So now I trust them.” She thinks a lot about her family and about her relationship with her father. He has an addiction problem and has been diagnosed with ADHD. “Everyone needs a father figure. It’s not easy to live without one. The problem for me is that I want my
WHEN THE ADULT WORLD LETS THEM DOWN and their parents are not the safe haven they should be, it is more important than ever to listen to the child. Children who are mistreated prompt strong reactions, but it is never our job to sit in judgement over the type of relationship customers want with their family members. Children are entitled to their parents – on their own terms. At the same time, society has a duty to protect children from any kind of violence and abuse. It is always a difficult situation, which drives home the point that it is only with the Customer’s focus in mind that we can provide care with respect, commitment and curiosity.
CUSTOMER PERSPECTIVE
SEEKING TRUST AGAIN
19
GUTASUND: RESPONSIBILITY BEGINS When Eva Hedberg’s mother Kerstin first began showing signs of dementia, Eva went into denial. As Kerstin deteriorated, Eva explained it away as mum being tired, or found something to blame that had happened that day. But when Eva started getting 40 missed calls from her mother every day, she realised that it was time to find Kerstin a home where she wouldn’t be alone.
in the implementation plans. Staff must constantly work to ensure that the customers can keep up their identity and their interests. When we enter the room of Aina Björkman, 94, she has just had her daily make-up done by assistant nurse Vicky Hagerimana. She gives a blinding smile for the photographer and jokingly poses with glee. Vicky gently wipes a little lipstick from Ainas’ teeth and then it’s off with the rollator to the common room. “Here they all are,” says Aina. “Hi, girl!” She cheerfully greets her friend on the sofa, patting her head. Her face is beaming with joy and the fresh make-up. “Aina! Look at you!” exclaims nursing assistant Edwin, who shapes his hands into binoculars and focuses on Aina. She laughs and waves him away with her hand. Aina has always loved clothes and make-up. As a young girl, she worked as an assistant in a clothing store and then worked her way up to window dresser. “I don’t mean to boast, but when the boss saw what I’d done, he was over the moon and said: ‘I have to say Aina, that looks like a proper Stockholm shop window!’.”
EVA DECIDED ON Frösunda’s new unit Gutasund. In t aking responsibility for its service delivery, the unit has a special focus on dementia and every detail is considered, based on in-depth knowledge of this cus tomer group’s focus. At the time of the interview, Eva and her mother have only been at Gutasund a month. “This is a transition period for me too. But I think that at least mum isn’t on her own here. If she’s down or anxious, there are people here who will notice and do something about it. At least I hope that’s how it’s going to be for mum.” Ros-Mari Seidlitz was part of Frösunda’s start-up team at Gutasund. For her, contact with the relatives is at least as important as the contact with the customer. She knows that people who have a parent with dementia have very mixed emotions. “The relatives are also our customers, and we need to be here for them. Some relatives are positive: ‘Wow! Lovely, this will be great for mum/dad!’ Others are more anxiety-ridden and worried, and look for faults. As far as we’re concerned, that’s just fine. This is a journey we’re taking together. We get immense satisfaction from gaining the relative’s trust,” says Ros-Mari. 20
CUSTOMER’S FOCUS IN EVERYDAY LIFE
There is a strong connection with Uppsala in the
Linking back to the customer’s earlier life before the home is vital, as is incorporating the Customer’s focus
design of the interiors, while ‘Linneas spa’ adds a touch of luxury to the customers’ lives.
IN LAST YEAR’S CONFIDENCE REPORT, WE TALKED ABOUT THE CHANGE MANAGEMENT WORK THAT TOOK H AGTORP FROM RED TO GREEN. ONE YEAR LATER, THE S ITUATION REMAINS STABLE.
DELIVERY
“I’ve always loved clothes and worked as a window dresser. I still get a lot of pleasure out of it.”
HAGTORP AND ALINGSÅS, WHAT HAS HAPPENED SINCE LAST TIME?
AINA BJÖRKMAN, CUSTOMER GUTASUND
Isabel von Wachenfeldt is head of the Support unit at Upplands-Bro Municipality. She challenges the idea that Hagtorp was in ‘crisis’. “There were a couple of incidents that blew up. It wasn’t about the whole place, just one or two individuals. I think Hagtorp is doing a good job,” she says. She is happy to recommend Hagtorp to the older people in the municipality who need it. “I certainly am. We have an excellent working relationship. We check in with each other once a month to go through the latest cases and give each other information. We also discuss values, feedback and complaints.” Marianne Iggmark of the social welfare office at Upplands-Bro Municipality has been responsible for the quality inspections of Hagtorp since the years of the major quality shortcomings and ‘red points’. “Of course I’m going to look at the points that were red and amber before, and check that they are still good or better. But Haptorp has followed up the issues well. They’ve listened and taken action,” says Marianne. Hagtorp got good grades in the National Board of Health and Welfare’s latest quality survey, Open Comparisons. Open Comparisons is conducted nationwide, independently from the service providers, and includes grades from the customers themselves. One year on in Alingsås, which Frösunda took over in October 2014, challenges still remain. The ambitions that Frösunda clearly set out at the start have not been achieved, and this is reflected in the survey of customers’ well-being. Frösunda has so far not managed to recruit an operational manager who can provide the stable local leadership that is so urgently required.
21
UNIQUE FILM WITH AN INSIDER’S PERSPECTIVE Martin is 25 and lives at Lövstalöt, sheltered housing for people with learning disabilities. He loves making films and, with the help of Frösunda, has made two drama documentaries about Lövstalöt. The second film, which has just had its premiere, tackles tricky situations that can arise in sheltered housing.
“MARTIN’S FILMS ARE UNIQUE – no other filmmaker has the insider’s perspective that he has. His films address various dilemmas that can arise between residents and staff. Some might say: ‘It can’t really have been like that!’ But Martin is a customer, and that’s his experi ence!” says Martin’s father, Lasse. Martin has Down’s syndrome and Lövstalöt is his first experience of sheltered housing. He lives here with five other young people from Labanskolan in Uppsala – or neighbours as he now calls them. But to get here, the relatives of the six young people had to fight for 3½ years to get shared accommodation for the group. It was Lasse who met Frösunda’s expansion manager at the time, Tomas Eriksson, at a support day. “Tomas was competent, not just a ‘salesman’. We understood each other. He liked and supported the idea of shared sheltered housing,” says Lasse. Frösunda immediately began looking for plots and drawing up plans, and by July 2012, the building was completed.
“Martin described how a voice in his head told him he should make a film project about Lövstalöt. Then he started nagging everyone who might possibly be able to help!” relates Lasse.
MARTIN LOVES FILM AND THEATRE 22
Martin was only five when he put on his first theatre production in a barn on his father’s farm. Over time his interest in film grew and grew. He has always had access to video cameras.
Tomas Nordström, whom Martin met on the set of the movie Pistvakt, plays a staff member in the short film.
Martin has gotten in touch with people off his own bat. Among his Facebook friends are several TV and film producers, who have given him some good advice. And it was through his contacts that he was able to tag along on the set of the feature film Pistvakt, which was recorded in Luleå, just to learn more about how it all worked. It was during filming in Luleå that he got to know actor Tomas Nordström, who now plays a role in Martin’s film. “This film isn’t just about what happens at Lövstalöt, it can happen in any sheltered housing. That’s why I want Tomas to play a member of staff,” Martin stated in an interview about his film.
FRÖSUNDA HIDES NOTHING Martin also wrote the script for the film. His father Lasse helped him to whittle down the wealth of mate rial, which was “enough for ten films”. And the film has been helped by financial support from Frösunda. “I’m really proud of Martin and pleased that Frösunda has understood what Martin has to contribute, and had the courage to invest in it. This film flags problems that Frösunda and every other provider of sheltered housing faces. The common view of private care providers is that they try to cover up their failings. But Frösunda doesn’t, they want to get to grips with the problems that arise,” says Lasse. “The most important thing for me as a relative is that Frösunda lives up to the intentions of the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS). It’s about the rights of the individual and should be based on the individual. Most sheltered housing have problems with that. For me, it’s important to remember that every person is unique. I’ve tried to teach my children that they have to grab life by the horns, and that’s just what Martin has done.”
AGE: 58 LIVES IN: Söderbärke, southern Dalarna DOES: Lecturing and training on carer- related issues. Has also written books on the subject. Works at a preschool the rest of his time. INTERESTS: Children and grandchildren, carer-related issues
DELIVERY
NAME: Lasse Nohrstedt, father of Martin
“The common view of private care providers is that they try to cover up their failings. But Frösunda doesn’t” LASSE, FATHER OF MARTIN, WHO HAS MADE A FILM ABOUT HIS DAILY LIFE.
NAME: Martin Fallhagen AGE: 25 LIVES IN: Lövstalöt sheltered housing in
Uppsala with five friends/neighbours FAMILY: father, mother, sister and her children DOES: Makes films. Works part-time (75 %) as part of a daily activity at Labanskolan, an independent school for students with learning disabilities, where he helps out at the fleamarket, in the café and supporting young students with sign language. He is also in L abanskolan’s drama group, which puts on a show at Konserthuset in Uppsala three times a year. INTERESTS: Making films, acting, atching ice hockey, fishing, playing w with his sister’s children
ENTERTAIN AND EDUCATE Martin Fallhagen wrote the script for and directed his short The Film about Lövstalöt 2. The first film about Lövstalöt can be viewed on Frösunda’s website. The Film about Lövstalöt 2 comprises various dramatised scenes based on reality, all of which tackle dilemmas that can arise between customer and staff in sheltered housing. It premiered in Stockholm on 9 December 2015 at a conference on the future of accommodation for people with learning disabilities. The situations featured are by no means unique to Lövstalöt, but could happen at any sheltered housing – which is why the film will be used by Frösunda in its staff training.
23
“Frösunda gives us both quality of life. Wherever I am, my sister is in the back of my mind. That’ll be the case for as long as we live.” LILIA, WHOSE SISTER LJUBA HAS SUFFERED A STROKE
WELL-BEING FOR THE RELATIVES When Lilia’s sister Ljuba suffered a stroke, which left her paralysed down one side and unable to speak, it threw life into chaos. For Lilia as her closest relative, everything revolved around getting life back on track again. An important part of the puzzle turned out to be Frösunda’s daily activity programme at Dalagatan. “Frösunda gives us both quality of life. Wherever I am, my sister is in the back of my mind, and that’ll be the case for as long as we live. But knowing that Ljuba feels secure makes me feel secure too. She can’t speak, but I know she likes it here.” Lilia thinks it is good to have organised and specialised activities that aren’t just there to pass the time. “Knowing that she’s coming here gives Ljuba energy, you can see that it lends meaning to her life. I don’t know what we’d do for her if we didn’t have Dalagatan.” Things are difficult in the holidays. Ljuba hadn’t done any painting before her stroke. But she has taken up the pastime here, using her working left hand. “She paints really well! She lights up when we talk about it, and it feels meaningful to her when she shows off her pictures. That makes me so happy. “I just hope that Dalagatan stays around in the future. That it remains as good, and reaches another level.”
Her sister has been by her side ever since Ljuba suffered a stroke in 2004. Thanks to Frösunda’s daily activity programme at Dalagatan, they both get some respite. Ljuba enjoys her painting and other crafts. 24
CONTROL & MONITORING
C NFIDENCE REPORT IN FIGURES 2016 Frösunda’s vision is to be a driving force in the development of new ground rules for the care sector, so that everyone enjoys a better life and a natural place in society. This vision leads us to our formula for success: we earn trust by taking responsibility. Our responsibility is to adopt the Customer’s focus. The Confidence Report is drawn up within the international framework of the Global R eporting Initiative, GRI G4. This offers a sound way to report how we systematically work on customer dialogues, and how they provide us with answers concerning our quality. The Confidence Report is compiled in line with the following principles: CONTEXT: We want to investigate our influence on society, rather than just our performance.
RESULTS AND ANALYSIS, GRI INDEX, PAGES 25–42
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 the facts, and the customer judges us on our results.
25
FRÖSUNDA’S QUALITY LOGIC BEGINS AND ENDS WITH THE CUSTOMER OUR CUSTOMERS MAY BE in a wheelchair, approaching
death or have acquired a brain injury. We mustn’t approach this as if it was a problem to solve. Our task is to listen, respond and affirm. We shouldn’t even strive for acceptance from the customers. They are entitled to feel however they like about something – we just need to listen to how the customer describes their situation. This is one of the skills required for a professional manner. Is there any way to measure listening? When we find it, we’ll have discovered a quality indicator for the care provision of the future. And we’re well on the way. We take measurements in order to capture the customers’ experiences and understand their focus. Frösunda’s strategy is that the customer decides. This means that we adopt the Customer’s focus, which begins and ends with the customer: Picture for many customers: Customer compe tence, wider knowledge, legislation, frameworks, all customer groups Concept: The precondition for delivering individualised services Delivery: Manner, method, staffing, environment Picture for individual customer: Follow-up – only the individual customer can say how well we’ve succeeded 26
This is the cornerstone in ensuring that the customer feels that she is making the decisions. We are heading towards a paradigm shift in the care service. This is
QUALITY MEASURES 2015 NPS for paying customers and relatives Implement process control Customer-focused concept, concept description for staff in Assistance Customer-oriented management programme
KEY EVENTS OVER THE YEAR why we conduct quality surveys and plan focus groups in all the business areas. And it is why our experts – Beata Terzis, PhD, cognition expert, and Helén Rönning, PhD, nurse – are out meeting customers and staff every day. Management is both our greatest challenge and most important success factor. Skilled, driven managers are needed if we are to successfully adopt the Customer’s focus and thus meet our quality promise to the customer. Our unique, customer-oriented management programme was the single most important boost to quality in 2015. The results have been quick to appear. By the end of the year, we were clearly a company in motion. Some people have chosen to leave us, because they either didn’t want, or didn’t understand, how to place the power in the hands of the customer. At the same time, we are seeing managers and staff begin to apply to us, precisely because they want to change the care service and take on the challenging task of adopt ing the Customer’s focus. CHRISTINE ROSENCRANTZ, QUALITY MANAGER
2015 was the year when we clearly visualised the future that we want to help realise: We see a future where customers are finally given the opportunity to decide for themselves what an independent life with good living conditions really is. And our vision is to be a driving force in the development of new ground rules for the care sector, so that e veryone enjoys a better life and a natural place in society.
PRIORITIES FOR 2016 Implement the Frösunda programme for managers and staff Well-being surveys Concept follow-up for Assistance Concept roll-out, concept description for staff in Elderly Care, Disability and Individual & Family Continued focus on individual plans Implement process control
CONTROL & MONITORING
“I make the decisions about my life. An important move for me… ...was to change my name from Maja to Glen. I gave my parents two years to stop calling me Maja and they managed it. Now I’ve reclaimed Maja as it felt a little disrespectful to ditch it completely. After all, it was the name my parents gave me. So now I’m called Maja-Glen.” So says Maja-Glen Degerfält, Assistance customer in Skellefteå. We know that our customers want to make their own decisions, just like everyone else, and we see a future where they will finally get to do so – to decide what an independent life with good living conditions really is, in line with the legal rules on influence, co-determination and adaptation to individual needs. 27
THE PRINCIPLE IS CUSTOMER SATISFACTION Frösunda exists to help bring about a future where care providers compete to be the best at offering services shaped and delivered as the customer wishes, so that resources are used for the right things and in the right way. In short: a care system in which the overarching principle is customer satisfaction. Elderly care
OUR MISSION
5%
OUR QUALITY GOALS
We earn trust by taking responsibility The customer decides
100 % customer satisfaction 100 % contractual performance 100 % regulatory compliance
Individual & Family
17 % 47 %
DROPPED NKI FOLLOWING CONSULTATION WITH CUSTOMERS
Assistance
31 %
In 2015, no general survey was conducted using the Satisfied Customer Index tool (NKI). Some units in Disability and Elderly Care conducted their own surveys. The questions were based on our core values – Respect, Commitment and Curiosity – with a binary scale: yes or no.
Disability
Having consulted with our customers, we have established that the NKI survey doesn’t give us the best information on our ability to adopt the Customer’s focus. The measurements of our own capacity to live up to our core values will continue, while we work on further developing customer satisfaction metrics in the form of NPS and well-being surveys. We will also be developing our work on focus groups in all the business areas.
CONTRACTS RENEWED In 2015, three of Frösunda’s operations were put out to a new tender, and in two of these cases Frösunda was chosen to continue by the paying customer. CONTRACTS WON In 2015, Frösunda won 28 public tenders: 13 framework agreements and 15 contracts for operations. 28
2,739
66 %
Assistance
CUSTOMERS
2014 2015
100 %
-*
Disability
55 %
66 %
Individual & Family
60 %
58 %
Elderly Care
29 %
47 %
* No tenders were submitted in Assistance.
-*
Presence from north to south Proportion of Swedish municipalities 2014 2015 Assistance
62 % 59 %
Elderly Care
6 %
Disability
9 % 10 %
Individual & Family
6%
40 % 42 %
NPS – the Net Promoter Score – measures quality as perceived by Frösunda’s customers. Frösunda has a zero vision with regard to critics, and the proportion of critics has become one of our key performance indicators in the operation follow-up presented to the Board. The Net Promoter Score (NPS) is based on the question “Would you recommend Frösunda to a friend?”. The response scale runs from 0–10, with 0 meaning ‘not at all likely’ and 10 meaning ‘highly likely’. The respondents are grouped into three categories: • 0–6 = Critics • 7–8 = Passive NPS is the result of the proportion of ambassadors minus the proportion of critics, which gives a figure on a scale of -100 to 100. 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 critics – and thus a target of NPS 100.
8
Ambassadors: 42 %
In the Individual & Family business area, the experiences of the paying customers have been measured using NPS. Since many customers are placed in residential homes against their will, there is no constructive dialogue to be had from asking the customers whether they would recommend Frösunda. We have therefore focused more on the well-being survey and an in-depth study of factors determining well-being for this customer group. Read more on page 14.
NPS Paying customers
1
Ambassadors paying customers: 33 %
The spread between the units is as wide as it can be, with one unit on NPS 100 and two units on NPS -100. This indicates a continued need to improve work in this business area, in order to ensure that all units with a negative NPS get up to a positive result. The overall results show an improvement compared with 2014 (NPS -5).
”Extraordinary handling of individuals. Has a good plan and back-up. Staff are really on the ball, keeping one step ahead.” “The staff have not been professional, made the work harder.” “Essential to improve staff coordination and presence.”
Customer
Relative
NPS
NPS
23 35 Ambassadors: 46 %
Ambassadors: 54 %
Reasons for being an ambassador • Manner: Good service from operational manager and assistants. • Customer focus: Frösunda listens to the customer and meets the customers’ wishes. • Customer-oriented operational manager: The operational managers listen, are readily available and provide a good service.
What Frösunda needs to improve on • Availability of operational managers: Critics and passive respon dents say that it can be difficult to reach the operational manager and that the manager doesn’t get back to them quickly enough. • Staffing: Critics and passive respondents think it is difficult to find temporary replacement staff, which results in uncertainty for the customer.
Disability
Elderly care NPS
Assistance
“Communication is fantastic. Frösunda offers new suggestions for solutions and a rapid response.”
• 9–10 = Ambassadors
Customer
Individual & Family
CONTROL & MONITORING
WOULD YOU RECOMMEND FRÖSUNDA?
Paying customer Relative
NPS
-21 -5 NPS
Ambassadors: 18 %
Ambassadors: 16 %
The proportion of ambassadors and the NPS have both fallen c ompared with 2014. An analysis of the results shows that relatives find problems getting information on staff changes. This in turn results in criticism of staffing levels. The downturn can be traced to leadership issues in Alingsås. In the same survey, 97 % of relatives state that they feel happy with Frösunda as the care provider and 80% state that Frösunda delivers high quality care.
Relative
Customer
NPS
NPS
-1
Ambassadors: 21%
“Extremely committed, goal-oriented, individually adapted, high quality and target fulfilment.” “Incredibly satisfied. The placement gets to develop, use imagination through baking, etc. Gets to put forward their own suggestions, plus good follow-up.” “Needs a clearer link to the school’s steering document.” “Extremely important to improve staff coordination and presence.”
56
Ambassadors: 72 % The customers in Disability give Frösunda excellent grades in the NPS survey. According to the customers, the success factors are committed staff, meaning ful activities and a sense of community with fellow users of the services.
The task of interpreting the results continues The NPS survey has provided us with important information, but we can report that we still don’t fully understand the results. The surveys and the analysis work continue. So far, we have established that NPS is affected by the respondent’s emotional state on the day, which is problematic when monitoring the figures over time. We will continue the survey across all the business areas in 2016.
29
ASSISTANCE – LARGE-SCALE IMPROVEMENTS Assistance is Frösunda’s largest and oldest business area, but it is also an area under intensive development. By regularly measuring and monitoring customer satisfaction, we are able to identify success factors that can be exported to the other business areas, and we can identify areas where we need to up our game. Since the business area is so large, it is also important for us to analyse the different regions, in order to learn more about our customers’ focus.
1,287 6,006
CUSTOMERS
EMPLOYEES
Operational quality KPIs Every month we check key performance indicators that together give an overall picture of how well we are doing. In 2015, the focus has been on implementing the quality management system.
2
LEX SARAH:
QUALITY MEASURES 2015
Standard indicator for the care sector.
Focus on individual plans
25 %
QUALITY PRIORITIES 2016 Continued focus on individual plans
CRITICS, CUSTOMERS (NPS):
Social records
Customers who have given a score of 0–6 in response to the question “How likely is it, on a scale of 0 to 10, that you would recommend Frösunda to a friend?”. Frösunda has a zero vision for critics.
Regulatory compliance
Focus on individual plans During 2015, the business area has prioritised work on individual plans, as these are an important tool that increases our knowledge of the customer. Every month we have checked the p roportion of individual plans that have been updated within the past six months. The result is a steep rise in the proportion of u pdated individual plans, which creates better conditions for e veryone at Frösunda to work around the Customer’s focus.
20 %
CRITICS, RELATIVES (NPS): Same as above.
65
30
50 % 45 % 40 % Mar -15
Apr -15
Maj -15
Aug -15
Sep -15
Nov -15
Dec -15
The proportion of ambassadors for the various regions is: Relatives 18 % (NPS: -13)
Gothenburg
42 % (NPS: 12)
43 % (NPS: 23)
Central
50 % (NPS: 46)
50 % (NPS: 30)
Mid
50 % (NPS: 14)
45 % (NPS: 22)
North
47 % (NPS: 33)
56 % (NPS: 44)
NO ASSISTANCE:
East
58 % (NPS 42)
64 % (NPS: 57)
No. of sessions for which the assistant did not show up, in the month of December.
Stockholm
31 % (NPS: 4)
33 % (NPS: 6)
South
46 % (NPS: 18)
47 % (NPS: 17)
West
41 % (NPS: 6)
48 % (NPS: 31)
5
55 %
Frösunda’s ambassadors
20 % (NPS: -31)
Average figure for investigations completed in December 2015.
60 %
Frösunda continuously monitors trends and tendencies in the customers’ experiences. Two of the regions have seen their NPS fall. The regions still have high scores, but we are already putting initiatives in place to reverse the downward trend.
Customers
70 % 65 %
Inga is Frösunda’s first customer. Over the years since Frösunda was founded in 1994, she has learned a lot about what is important to her. “For me, it’s important that I’m the one making the decisions about my own life. That I don’t have to completely change in order to adapt to having someone here at home.” Frösunda’s task is to ensure that life runs smoothly – in the way that the customer wants. By constantly gathering relevant data on the customer’s experience, we hope to be able to offer customers assistance that they stick with and don’t want to keep replacing.
Operational contracts
LEAD TIMES, DEVIATION REPORTS:
75 %
With Frösunda over time
The Cantril Ladder measures well-being
The Disability business area has grown rapidly over the past two years. The number of customers and staff has risen, and quality work has been stepped up. As part of this, the customer dialogue in the area has seen improvements, and the Cantril Ladder has been tested for the first time as a method of measuring customer well-being.
An initial pilot of the Cantril Ladder was successfully performed. The tool proved to work exceedingly well for the target group and a larger-scale survey is planned for 2016. The survey provides information on the current situation, the future outlook and areas for improvement in relation to well-being.
CUSTOMER WELL-BEING: DAILY OPERATIONS.
863 1,274 CUSTOMERS
EMPLOYEES
10 %
QUALITY MEASURES 2015 Focus on individual plans Nursing and care deviations
QUALITY PRIORITIES 2016
Operational quality KPIs
Comments and complaints
Every month we check key performance indicators that together give an overall picture of how well we are doing in Disability. In 2015, the focus has been on implementing the quality management system.
Individual plan
25
LEAD TIMES, DEVIATION REPORTS How many days from the report to a concluded investigation, average in December 2015.
82 %
CONTRACTUAL PERFORMANCE Aggregated January–December 2015.
Three of the KPIs show the number of critics. Customers, relatives and paying customers who have given a score of 0–6 in responding to the question “How likely is it, on a scale of 0 to 10, that you would recommend Frösunda to a friend?”. This is part of the NPS survey. Frösunda has a zero vision for critics.
3%
CRITICS, CUSTOMERS
21 %
CRITICS, RELATIVES
18 %
CRITICS, PAYING CUSTOMERS
Quality committees
36 %
NKI – SATISFIED CUSTOMER INDEX Within parts of the Disability business area, customer satisfaction was measured using the Satisfied Customer Index (NKI) tool. The questions are based on Frösunda’s core values, with a binary scale: yes or no. Respect
Commitment
INDIVIDUAL PLAN
Proportion of individual plans u pdated between July and D ecember 2015.
Curiosity
Happy
Struggling
54 %
Suffering
In the analysis of the results, we combined the points for perceived well-being today with the customers’ forecast for the future, in order to improve reliability. Based on this, the customers split into three categories: 54 % of the respondents are happy: well-being is high, stable and on the up (present and future scored over 6)
77 %
97 %
CONTROL & MONITORING
DISABILITY – AN AREA OF RAPID DEVELOPMENT
82 %
77 %
74 % NKI CUSTOMERS The survey throws up three areas where customers want to see improvements: 1. Manager turnover: “Frösunda has a high turnover of managers, which is not good for my behaviour.” 2. The survey: “You can’t give a correct answer if you only get to choose between Yes, No or Don’t know. Because it’s not always a Yes or No question. That’s why I wrote in SOMETIMES myself.” 3. Self-determination: “I have wishes that are not taken seriously”, “Would like more of a say on when staff come.”
36 % of the respondents are struggling: well-being is moderate or not sustained (present and future scored between 2 and 5) 10 % of the respondents are suffering: Well-being is dangerously low (present and future scored between 0 and 2) The results were combined with qualitative interviews in order to gain a deeper understanding. The business area’s management team has reviewed the analysis and clearly recognises the picture painted regarding the customers’ key issues: • Individuality and personal expression • Human contact • Compensation and recognition • Freedom and mobility The next step is to implement the surveys on a larger scale. The results will also be used in the task of training managers and staff on how to adopt the Customer’s focus.
31
INDIVIDUAL & FAMILY – DEMANDS A COMPLEX UNDERSTANDING OF QUALITY Within Individual & Family, Frösunda has worked on strategic concept development over the year and drawn up action plans for quality improvements across the business area. Comprehensive surveys of customers’ well-being have also been conducted at the same time.
453 441 CUSTOMERS
EMPLOYEES
QUALITY MEASURES 2015 Permits
QUALITY PRIORITIES 2016 Regulatory compliance Social records
Contractual performance Average grade in municipalities’ contract monitoring
North
100 %
For the third year in a row, a PERMA survey was conducted in Individual & Family, this time in combination with an in-depth study of factors determining well-being. The chart shows the results for 2015 compared with 2014. The average value has risen from 6.4 to 6.5. The difference is too small for any major conclusions to be drawn, but it is conceivable that the extensive initiatives that have been implemented to improve management skills are reflected in the results. 10
Operational quality KPIs Every month we check key performance indicators that together give an overall picture of how well we are doing. As well as the five below, there is also the KPI contractual performance. In 2015, the focus has been on getting all the permits in place.
1
LEX SARAH:
9 8 7 6 5 4 3 2 1 0
Standard indicator for the care sector.
31 %
CRITICS, PAYING CUSTOMERS (NPS): Paying customers who have given a score of 0–6 in responding to the question “How likely is it, on a scale of 0 to 10, that you would recommend Frösunda to a friend?”. Frösunda has a zero vision for critics.
Individual plans
Rise in reported well-being
76 %
CONTRACTUAL PERFORMANCE
Mid
75 %
Average for January–December 2015.
South
55 %
Total
76 %
174
2014
P
E
R
M
A
2015
Complex picture of NPS & PERMA When the results from the PERMA survey are compared with NPS, it is clear that there is no correlation. It could thus be the case that the paying customer is very satisfied but the customers still feel terribly unhappy. It may be that Frösunda is delivering high quality, but that this is not enough to make the customer content with the situation. The comparison also makes it clear that the paying customer is not in a position to speak for the end customer, and so both metrics are needed.
Girls are less happy The PERMA survey shows that the girls are less happy than the boys, a pattern that has carried over from surveys in previous years. Access to leisure activities appears to be a contributory factor. Through good leisure activities girls who, due to a chaotic life, have trouble with school could still gain a sense of meaning and community.
LEAD TIMES, DEVIATION REPORTS:
Having someone to call
32
A priority measure in 2016 is to improve management of complaints in the business area. One of those who knows how important it is to have an adult to turn to when something goes wrong is Maritha Fransson of social services in Flen. She stresses that young people need a reliable adult to turn to when they have something to say or a complaint to make: “I work exclusively with children and young people and I’m often the only reliable adult they have. I always say that when a child stops ringing me, that’s when I know they’re doing better, and they’ve settled down.”
How many days from the report to a concluded investigation, average in December 2015.
88 %
INDIVIDUAL PLANS: Proportion of individual plans updated between July and December 2015.
“Yesterday we did our nails together, the staff and I. But my favourite thing to do is mess around with old cars. And I like making music, raps that my brother has taught me. Living here at Juno, I get to go horseriding once a week too, and that’s so cool!” Cassandra, 15
Lack of leadership reflected in customers’ well-being
Elderly Care is Frösunda’s newest business area. Over the year, the opening of Gutasund has been a major event. The unit is especially adapted to provide stimulating and safe accommodation for older people who are entitled to sheltered housing due to physical problems or dementia. Intensive implementation of the principles surrounding person-centred care have also begun, with all the staff receiving training.
CUSTOMERS
2 1
Individual plans
0
QUALITY PRIORITIES 2016
96 %
90 % NKI CUSTOMERS The success factors behind the high values are that the right person is present at the right time, and that Frösunda is seen as a company that keeps its promises.
Operational quality KPIs Every month we check key performance indicators that together give an overall picture of how well we are doing. In 2015, the focus has been on ensuring that deviation reports are written correctly and that individual plans are updated.
P
2014
Comments and complaints
E
Concept follow-up
In order to measure well-being among people who live with dementia, and to implement measures to improve quality of life, symptoms are recorded in the BPSD register. Behavioural and psychological symptoms of dementia (BPSD) affect around 90% of all those who suffer dementia at some point. These symptoms may include aggression, anxiety, apathy, hallucinations or disrupted sleep, and they cause major suffering for the person with dementia in particular, but also for relatives. Frösunda’s dementia expert Beata Terzis will be training all staff in the business area over the course of the year, giving everyone access to useful tools. This will also create opportunities for reflection on how staff can best work on adopting the Customer’s focus.
LEX SARAH:
Standard indicator for the care sector.
M
2014
5.9
Issue: No operational manager in post
19
Issue: Communication on staffing levels
PERMA
68 % 21 % 41 % 28 CONTRACTUAL PERFORMANCE:
Aggregated January–December 2015.
A
The downward trend regarding both customers’ well-being and relatives’ satisfaction can be explained in part by the lack of an operational manager in Alingsås. The post was filled in early 2016 and the results are expected to improve in the next reporting period. Another contributory factor is that work on staffing the unit so that customers can decide how their day is structured has led to timetabling changes that we have not managed to communicate well enough to relatives.
NPS
1
R
2015
Relatives are key in helping us to improve our operations. In the latest NPS survey of relatives, the figures are down. In 2014, 42 % were ambassadors and an NPS of 19 was achieved. In the 2015 survey, only 16 % were ambassadors, giving a low NPS of -21.
Quality committees
BPSD register
Curiosity
96 %
7
3
Nursing and care deviations
A Satisfied Customer Index survey has been conducted at Safiren. The index measures how well Frösunda delivers in line with its values of Respect, Commitment and Curiosity.
86 %
8
4
QUALITY MEASURES 2015
EMPLOYEES
Commitment
9
5
NKI – SATISFIED CUSTOMER INDEX AT SAFIREN
Respect
10
6
136 242
A PERMA survey was first conducted at the Ängabogården unit in Alingsås in October 2014, followed by a second survey a year later. The chart shows that customers’ well-being has fallen from 5.9 to 5.4.
CONTROL & MONITORING
ELDERLY CARE – GROWTH WITH QUALITY
CRITICS, CUSTOMERS: Responded 0–6 in NPS survey
CRITICS, RELATIVES:
Responded 0–6 in NPS survey
LEAD TIMES:
How many days from deviation report to concluded investigation, average in December 2015.
2015
5.4 PERMA
-21 NPS
91 % INDIVIDUAL PLAN:
Updated between July and December 2015.
33
SYSTEMATIC FOLLOW-UP OF SHORTCOMINGS No care provider can guarantee that nothing will ever go wrong. The important thing is how we act when something does happen. Having mistakes and deviations identified, documented and rectified is how we improve quality for our customers. Our systematic work on nursing and care deviations is in place for customer safety. The procedures are based on the regulation: Management system for systematic quality work (SOFSF 2011:9).
SOMETHING HAPPENS Medication forgotten A door lock jams A customer doesn’t want to take a walk A customer doesn’t come home at night Incontinence pads run out Assistant fails to turn up
Frösunda has worked systematically since 2014 to have more deviations reported. It is only when all mishaps and problems come to light that we can improve our operations. Some of the issues that are reported as deviations lead to constructive discussions with staff – the operational manager can use the opportunity to underline the importance of customers getting to decide whether or not they want to go for a walk, for example. Other cases need to be escalated, and action must be taken.
Classification The incident is reported to the operational manager and analysed. First it has to be classified. The table shows how nursing and care deviations from September to December 2015 have been classified: Individual & Family
Assistance
Disability
Elderly care
Fall
0
37
47
86
Information transfer
1
0
0
0
Intervention
0
4
30
0
Information/communication
2
0
8
1
Medication/aids
0
6
147
27
1
0
41
0
Violence and abuse
34
Nursing
0
7
15
25
Work routines
5
13
103
37
Criminal acts
5
2
4
6
Manner
2
4
15
4
0
26
11
0
Assistant absent from session
A customer slips
Follow-up to cut lead times
Lex Sarah and Lex Maria
An assessment is made of how serious the consequences of the incident were for the customer. At the same time, the investigator decides whether or not the incident is so serious that it needs to be reported to the Health and Social Care Inspectorate (IVO).
As we predicted, the number of deviation reports has also risen in 2015. By putting our nursing and care deviations under the microscope and always being transparent when we have not succeeded, we can improve the quality of our operations. We feel that five Lex Sarah reports is a low figure – so we believe there is still a certain amount of underreporting. We predict a continued rise in deviation reports and probably some increase in Lex Sarah reports over the coming year.
The incidents that are most serious, and that affect the customer most, are naturally most important for us to handle quickly. But we need to be better along the whole line, and to this end we therefore follow up on average lead times each month. If a deviation is not dealt with by the operational manager, a message is sent automatically to the CEO and the Quality Manager.
46 %
Proportion of deviation cases concluded within 14 days
10 %
Proportion of deviation cases open for longer than 40 days
Operation
Investigations 2014
2015
IVO reports 2014
2015
Lex Sarah Assistance
30
15
3
2
Disability
28
26
1
1
Individual & Family
6
7
3
1
Elderly care
5
26
0
1
Lex Maria
6
0
0
0
75
74
7
5
Total
3 %
2,887
10 %
66 %
21%
SEK MILLION TURNOVER
2,887
2012
2013
2014
2015
8,071
Assistance Disability Individual & Family Elderly Care
MSEK 1,905 MSEK 615 MSEK 279 MSEK 88
Disability 11,274 274
NPS 5 among employees: We use the Net Promoter Score to measure the company’s attractiveness and staff loyalty.
33%
Women 69% 69 %
Gender breakdown
senior management
Men 33 % 33%
69%
67% Women 67 %
6,006 6 006 Assistance
67%
Form of employment
Women Men Total
Permanent
1,117 423 1,540
Temporary contract
2,564
1,262
3,826
Zero hours contract
1,887
816
2,703
Sum total
5,568
2,503
8,071
Concerns about a child If aware or suspect that a child is being abused or neglected.
Lex Sarah and Lex Maria In the event of irregularities, or significant risk of irregularities.
Customer ombudsman Acts as a bridge between Frösunda and the customers.
Whistleblower line The whistleblower line is available to Frösunda’s staff.
53.87 % 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.
The employees play a key role in both customer satisfaction and business success. When staff work according to the Customer’s focus and to Frösunda’s core values, we take a joint step towards a future where our customers decide over their own lives – fully in line with current legislation.
Elderly care Overheads 242 108 108 441 Individual & Family 441
Gender breakdown all employees
6.15 % 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.
Reporting voluntary
Committed employees
EMPLOYEES
Men 31% 31%
Reporting compulsory
Frösunda total
2,702 employees responded
Commitment
2,863
SEK 178 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.
From satisfied to committed: The employee surveys show that we have many satisfied employees, but that we need to work harder to gain more employees who are committed and proud. Our challenge: To increase commitment. To be the best private care provider, we need to lead the way on commitment. Collective agreements: 100 percent of employees are covered by collective agreements.
26% (25%) 12% (10%)
28% (43%) 17% (9%)
16% (11%)
Commitment model’s five categories: Frösunda’s commitment model comprises two energy questions and two clarity questions. Normal values in brackets.
Clarity
Commitment
2,497
If we are to be certain that we can identify and correct faults, staff need to feel confident about reporting concerns internally and be familiar with their obligations. In the first instance, all concerns are to be reported to the line manager. Frösunda has a whistleblower line that staff can call anonymously.
0.84 % 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.
Turnover per business area 2,369
When alarm bells ring
CONTROL & MONITORING
KEY FINANCIAL FIGURES
SEK 2,887 million Turnover: The company’s total earnings: invoiced, cash and other.
Quality Market HR BA Individual & Family BA Assistance Frösunda total BA Disability Finances BA Elderly Care
Clarity
Employees’ commitment by business area: A shift towards greater commitment is needed in all the business areas and among administrative staff.
35
GRI REPORT 2015 Shifting from a customer focus to the Customer’s focus was one of the key changes that Frösunda implemented in 2015. But when it comes to reporting, this has not involved any major changes. Reporting on what the customers have as their focus is already well established in the framework. THE GLOBAL REPORTING INITIATIVE, GRI, is one of
36
the most widely used frameworks for sustainability reporting. Frösunda has chosen to report in line with GRI-G4 Core Option. This means that the customers, as the most important stakeholders, have considerable influence over what is described. The report is about what is most important to them – entirely in line with our goal of working according to the Customer’s focus. This – Frösunda’s second GRI report – is an important tool for the planning and follow-up of sustainability work. In reviewing last year’s report and assessing the relevance of the aspects that were defined in it, it is clear that – through more dialogues and systematised processes for data gathering and analysis – we could have been more specific in expressing what was most important to customers. In other words, we have more still to consider. Nevertheless, we believe the same indicators as were used last year remain relevant today. The health and safety of customers and the results of the customer surveys are once again reported this year. It may be that we expand the number of indicators at a later date, but above all, we see a future challenge in shifting the aspect boundaries and analysing the effect that Frösunda has outside the organisation in even greater depth. This is because the priority stake holders, customers and management express a desire to help create a changed society, where there is more space for all our customers to be themselves.
GENERAL STANDARD DISCLOSURES ‘IN ACCORDANCE’ – CORE
Strategy and Analysis
Heading
Page
G4-1
The difference with the customer’s focus
4
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 a number of limited companies. In spring 2010, HG Capital acquired Frösunda from the previous owner Polaris Equity. It operates in the European market and invests in well-established compa nies. As the owner, HG Capital brings expertise plus active and committed support.
G4-8
Markets served
Frösunda’s market is Sweden. Frösunda offers assistance, daily activities, accommodation, schooling, elderly care, coaching, and accom modation and support for young people in line with the Social Services Act (SoL) or the Care of Young Persons Act (LVU).
G4-9
Scale
Key financial figures.
35
G4-10
Employees
Key financial figures.
35
G4-11
Collective bargaining agreements
Key financial figures.
35
G4-12
Supply chain
Frösunda’s services are delivered in the interac tion 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 and food are also important suppliers.
G4-13
Significant changes
2015 saw growth in all Frösunda’s business areas.We won 28 new public contracts.
G4-14
The precautio nary principle
The precautionary principle is about applying relevant environmental considerations when we build new units and plan for low energy consumption.
Heading
G4-15
WHO International Classification of Function ing 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. In 2015, the company also began to work with Children’s Rights and Business Principles.
G4-16
Frameworks and principles
Memberships
Page
Susanne Sidén is a member of the Swedish Asso ciation of Private Care Providers’ main board. Eva Ingemarsdotri stepped down as a member of the industry board for Individual & Family.
Identified Material Aspects and Boundaries G4-17
Consolidated financial statements
Frösunda’s Annual Report 2015.
G4-18
Aspect bounda ries and defining report content
Process for identifying aspects and aspect boundaries.
40
G4-19
Material aspects
New knowledge of the Customer’s focus, Key issues for stakeholders.
14, 38
G4-20
Internal aspect boundaries
Process for identifying aspects and aspect boundaries.
40
G4-21
External aspect boundaries
Process for identifying aspects and aspect boundaries.
40
G4-22
Changes to measurement methods
Frösunda is reporting under GRI for the second time. Measurements of customers’ self-assessed well-being expanded. Otherwise no significant differences in measurement methods.
G4-23
Changes in the scope and aspect boundaries
No changes compared with the previous year.
G4-26
Engagement
Stakeholder engagement.
39
G4-27
Key topics and concerns
Key issues for stakeholders.
38
Report Profile
Heading
Page
G4-28
Reporting period
Calendar year.
G4-29
Previous report
2015.
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.
CONTROL & MONITORING
Organisational Profile
43 32
Governance G4-34
Ethics and Integrity G4-56
Values
Success formula: 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 happiness. 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.
5
DMA & indicators ‘In Accordance’ – Core
Stakeholder Engagement G4-24
Stakeholder groups engaged
New knowledge of the Customer’s focus, Stakeholder engagement.
14, 39
G4-25
Identification and selection
Stakeholder engagement.
39
G4-DMA G4-PR2
Customers’ health and safety in relation to the services
Quality goals & assessment. Lex Sarah & Lex Maria reports.
34
G4-DMA G4-PR5
Results of surveys measu ring customer satisfaction
New knowledge of the Customer’s focus, Principle of customer satisfaction, Assistance, Disability, Individual & Family, Elderly Care.
14, 28, 29, 30, 31, 32, 33
37
KEY ISSUES FOR STAKEHOLDERS Redirecting the business so that every intervention is based on the Customer’s focus has taken a great deal of effort over the year. The end customer has an obvious role in this, but the r elatives and paying customers are also customers and priority stakeholders. DISABILITY
ASSISTANCE
The management of the business area and the end customers on the front line give the same answer to the question of what makes going to work fun: it’s the challenge! The focus of the various customer groups is more clearly shared in this business area than in the others: a challenging and social existence where good performance is given due recognition. The ability for customers to realise their own p otential and have safe and stable relationships, as well as casual a cquaintances and networks, is a priority for customers, relatives, paying customers and managers alike.
Freedom, dignity and a sense of independence are what customers in the Assistance business area value most. And the needs are often the same for the rela tives – they state that an assistant who fits in well with the family and the customer’s other social situations is the most important issue. For the assistants, it is the ability to be sensitive to the customer’s needs. The key point for the paying customer is the matching, with customers receiving exactly the right help for them.
KEY ISSUES FOR STAKEHOLDERS
WEIGHTING
ELDERLY CARE For end customers in Elderly Care, social relationships are crucial, as is the differentiation between communi
ty and individuality. The connection to life beforehand is important, so that all solutions are individual rather than collective. For the relatives too, the connection to life beforehand is important, the customer being seen for who he or she has always been. The paying customer values transparency: clarity in reporting, a company that is easy to reach and keeps its promises. The managers in the business area strongly emphasise that it is often very difficult to create value for a stakeholder in a way that generates value for the others. They feel there is a risk of a trade-off, where value is instead added at the expense of one or more stakeholder groups.
BEING LISTENED TO. The need to be treated with c uriosity, and to have an opportunity to express personal needs and wishes. EVERYDAY SECURITY. An everyday life that is as predictable as each customer wants it to be. 38
INDEPENDENCE. Making personal choices and shaping life based on personal ambitions. DISABILITY
ASSISTANCE
ELDERLY CARE
INDIVIDUAL & FAMILY
End customers have a focus on relationships and put a lot of effort into making these work. Obstacles to this include a lack of relevant information and a sense of not being heard. In the business area, three different types of relatives have been identified: 1) those who are focused on collaboration; 2) those who lack the capacity for active collaboration and have their own vulnerabilities and/or pose a risk to the child; and 3) those who are absent or far removed, as is the case for unaccompanied minors, for example. Individual solutions are therefore required for a functioning collaboration with relatives. The paying customer generally engages strongly with the individual young person. One indicator that a service provider has succeeded in its relationship with a paying customer at social services might be that the young person stops contacting their social worker. Operational managers see major challenges in not having sufficient power over the decisions that are taken with regard to individual children and when a placement is ended.
STAKEHOLDER ENGAGEMENT Frösunda’s stakeholder profile is complex, but there is no doubt where our priorities lie: the customers are and always will be the most important. Frösunda has 16 unique customer groups – customers, relatives, clients and internal customers in each of our four business areas. For this year’s Confidence Report, we have particularly highlighted the dialogues with relatives. There are two challenges in making the dialogues with stakeholders an effective way of working on development. Firstly, we need the courage to listen even when customers and relatives express dissatisfaction. It is in these situations that the capacity to resolve problems and think innovatively really comes to the fore. The s econd challenge relates to the fact that the stakeholders have differing interests and perspectives. We must never take shortcuts and add value for one customer group at the expense of another. We need to always focus on the bigger picture while also listening to the individuals at the same time. Stakeholders
G4-25 Basis for identification
G4-26 Frequency of engagement
Customers
The Customer’s focus – that is our job. This means basing our work on what is important to the cus tomer, and this requires an ongoing and respectful dialogue. Our customers are not objects on which we can be experts – they are people with whom we can share perspectives.
Dialogue with customers lies at the heart of all our working processes, and all activities are to be based on the Customer’s focus. The CEO meets customers in organised dialogues six times a year. The senior management team and administrative staff do work experience on the front line. Each year, customers answer questions on their self-assessed well-being. A number of interviews have been conducted as part of the work on this Confidence 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 prepara tions for this report. The ‘grandfather principle’ is applied to key decisions. Open regional panels, open telephone meetings for dialogue.
Politicians and public officials
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.
Owners
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.
Opinion-formers, interest groups and the media
Over the year, Frösunda has intensified its collaboration with carers’ interest groups.
Continuous.
Management
The senior management team has the ultimate responsibility for decisions and for the implemen tation of the quality work. They have been instru mental in the dialogue that sets the parameters for the reporting.
Continuous.
FRÖSUNDA MEETS THE CUSTOMER • Staffing • Manner • Availability
THE FOUNDATION OF FRÖSUNDA’S CONCEPT: WITH THE CUSTOMER’S FOCUS
MANNER
METHOD
STAFFING
ENVIRONMENT
CONTROL & MONITORING
INDIVIDUAL & FAMILY
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PROCESS FOR IDENTIFYING ASPECTS AND ASPECT BOUNDARIES Frösunda plays a central role in many people’s lives. And we make our mark in society. A systematic way to monitor, measure and plan our impact is therefore essential. It is also important to document the process that has led to identifying the key aspects of our influence, and to openly report how we monitor where this influence occurs.
THE STAKEHOLDERS ARE INVOLVED in defining the
content of the report. They highlight what they see as most significant and their voices form the f oundation of the Confidence Report. At the same time, we also make reference to the frameworks that affect the business on an ongoing basis, with legislation and international conventions on human rights playing a major role. The parameters that determine the core focus of the report are set in dialogue with the senior management team. An intensive process of dialogue with prioritised stakeholders and of gathering information arising out of the daily interactions between different stakeholder groups has provided a sound basis for the materiality analysis that GRI requires. This analysis has prompted the decision to report on two GRI indicators: • The number of cases of regulatory non-compliance under the aspect Health and safety in relation to the services • The results of customer surveys under the aspect Product and service labelling. 40
We have chosen to report on the effects that arise within the organisation, since we believe our primary
impact occurs through our services. However, the dialogues that form the basis for this year’s report indicate a new trend: the stakeholders are increasingly making references to the society surrounding the customer and talking about a need to develop Frösunda’s influence on society. This means that in future reports it may become relevant to report on effects that lie outside the organisation.
THE QUALITY PYRAMID We use the quality pyramid to describe our value chain. It gives us a picture of our situation in terms of customers and consumers. The industry has both statutory and voluntary inspections at several points along the value chain and it is by gathering the information from all these inspections that we obtain guidance on how to move forwards. • The first side of the quality pyramid represents the customer. At the base of the pyramid are decisions that affect the customer,
At the same time, it is important that what happens within the organisation is always understood in con text. For Frösunda, it is always relevant to link both strategy and operations to wider society. Our success in discharging our duties is measured in the customers’ well-being, their satisfaction and how well we live up to our vision.
then comes the purpose of the paying customer in commissioning the service. At the top is the customer’s own focus, what has to be in place for them to make their own decisions. • The second side describes the delivery. Here, our attitudes sit at the base. This section takes in manner, plus laws and regulations. Next come leadership, policies, processes and procedures. At the top is best available knowledge, which helps us to stay at the leading edge.
We believe a sustainable society to be 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 well, while at the same time helping to increase knowledge in the sector and society as a whole.
• The third side describes controls and monitoring. At the base lie internal and external inspections. Key performance indicators such as the Satisfied Customer Index and groupwide controls sit in the middle. At the top are the customer surveys.
CONTROL & MONITORING
THE QUALITY PYRAMID
CUSTOMER
DELIVERY Customer’s own wishes
CHECK Best available knowledge
The CEO’s customer groups Customer ombudsman NKI
CUSTOMER
Attitudes Documentation Law
Appropriate decision for customer
CUSTOMER
DELIVERY Customer’s own wishes
Policy & procedures Skills Leadership
Appropriate decision for customer
Attitudes Documentation Law
NKI
Peer controls
Leadership
customer. We start with the customer’s wishes, as well as the paying customer’s purpose and aim. The
Mystery Shoppers
Customer ombudsman
Mystery KPIs Shoppers Peer controls
CHECK
Our customer relationship is dependent on more complex factors than a simple consumer choice. The figure shows how the aspect Customer surveys is designed based on that knowledge. We Quality KPIs
delivery of our services is governed by policies, procedures Attitudes and laws on how we should report deviations.
therefore employ traditional customer satisfaction surveys, where we ask about delivery (NKI and
This dictates the information we obtain on risks
NPS), but we also apply a specific measure of well-being (PERMA). The results of these surveys are
Appropriate decision for customer
Documentation Law the regarding
customer’s health and safety. Certain cases
are submitted to IVO under the Lex Sarah and Lex Maria provisions on compulsory reporting incidents. Deviations in of health and social care Self-assessment Internal and external inspections
CUSTOMER CUSTOMER
reported transparently in the voluntary checks that Frösunda undergoes every year. Perma
DELIVERY
DELIVERY
CHECK
Quality KPIs
Perma
Mystery Shoppers
Deviations in health and social care Self-assessment Internal and external inspections
FIG 2. GRI CUSTOMER INDICATOR: RESULTS OFDELIVERY CUSTOMER SURVEYS
KPIs
The CEO’s customer groups
KPIs
Deviations in health and social care Self-assessment Internal and external inspections
Customer ombudsman
Policy procedures The figure shows how the aspect Health and safety is&Skills incorporated when we design our services for the Paying customers’ purpose & aim
Peer controls
Paying customers’ purpose & aim
The CEO’s customer groups
FIG 1. GRI INDICATOR: HEALTH AND SAFETY COMPLIANCE
Best available knowledge
NKI
CHECK Best available knowledge
CHECK
Customer’s own wishes
Policy & procedures Skills Leadership
Paying customers’ purpose & aim
DELIVERY
CHECK CUSTOMER
DELIVERY
CHECK
Quality KPIs NKI/NPS
Confidence Report (voluntary report)
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PATIENT SAFETY REPORT SUMMARY 2015 THE PATIENT SAFETY REPORT is prepared every year
OVERALL STRATEGIES 2016
and covers special housing for the elderly and persons with physical and mental disabilities. The full patient safety report can be found at www.frosunda.se. What follows is a summary:
For elderly care units, work is ongoing to turn national guidelines for dementia patients into structured individ ual working methods for quality assurance. The saluto genic approach and manner of the staff will continue to be developed and quality-assured. Work to implement Frösunda’s MY method – for the promotion of health and function in elderly care units – continues. This includes physical and social activities. Cooperation with relevant medical practitioners in elderly people’s accommodation will continue to 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 are continuing to work on implementing a quality-assured way of working, with the support of evidence-based national care programmes and care plans. Development of the collaboration with care providers and commissioning bodies who are responsible for home care and primary care, areas for which Frösunda itself is not responsible. 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.
MAJOR ACTIONS 2015 During the year, MAS carried out inspections and a quality review of special housing and was also involved in self-assessments. 2015 saw Frösunda’s dietician continue to imple ment the action plan for food, mealtimes and the care programme to prevent undernourishment. Over the year, the dietician followed up on the agreed q uality indicators in all the elderly care units. Internal and external training activities on pa tient safety issues are held all the time. Frösunda is continuing to put together digital interactive courses to ensure access to knowledge and skills develop ment in areas that include patient safety. The Quality Department’s expert in dementia care is continuing to ensure implementation of the MY method (which contributes to patient safety by means of a saluto genic 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
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have a major bearing on the patient safety work. Among other things, this is ensured by all the opera tions having clear procedures on how customers, relatives and staff should report risks, nursing and care deviations, irregularities, comments and complaints. In 2015, Frösunda continued its work on introducing quality committees, as an aid to local quality work.
SERIOUS IRREGULARITIES AND BREACHES OF CARE Lex Sarah is part of the Social Services Act (SOSFS 2011:5), and the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS). It states that employees must report irregu larities and risks, that the operation must investi gate, remedy and eradicate the irregularity without delay, and that if the irregularity is serious it must
immediately be reported to the Health and Social Care Inspectorate (IVO). IVO ensures that the care provider has taken the necessary measures for good patient safety. 2015 saw the reporting of 74 cases of suspected irregularities in Frösunda’s case management system. Of these, five were judged to be an irregularity or a sig nificant risk of an irregularity. These five were reported to IVO. A total of 2,559 nursing and care deviations were reported in the case management system. Lex Maria is part of the provisions in the Patient Safety Act (2010:659) and states that the care provider must report to IVO any incidents that have led to or could have led to a serious breach of care. Healthcare professionals are obliged to support good patient safety by reporting risks and incidents. The care provider must conduct an investigation to establish the course of events and take action to prevent similar incidents or remove risks. IVO ensures that the care provider has taken the necessary measures for good patient safety. No Lex Maria reports were made in 2015.
THE QUALITY PYRAMID In a sense, working to deliver high quality is automatic and part of Frösunda’s core process, yet at the same time it is about people working with people. Constantly improving quality is therefore a question of our manner, and of working from the c ustomer’s experience. This task is a constant element in our everyday operations. The quality pyramid shows how it works – with complementary perspectives and a solid base. The sides of the pyramids describe the Customer Perspective, Delivery and Controls & Monitoring.
Frösunda Omsorg AB
If you have any questions about our quality
Reporting partner: Lumen Behavior
Box 708
work or the Confidence Report, please contact
Design: Pondus Kommunikation
169 27 Solna
our Quality Manager Christine Rosencrantz.
Photos: Johan Spinell, Andreas Nilsson, Conny Westman,
Street address: Råsundavägen 18
e-mail: christine.rosencrantz@frosunda.se
Linus Magnusson, Jonny Rönnblom
+46 (0)10-130 30 00
tel: +46 (0)10-130 31 53
3D graphics: Pondus Kommunikation
www.frosunda.se
Printing: Joma Grafisk Produktion, 2016
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