The E-Qalin quality management system

Warum wurde diese Initiative implementiert?

E-Qalin was developed by training and consultancy agencies together with interest organisations of directors of care homes and around 50 care homes (AT, DE, IT, LU, SI) to create a QM system focusing on the characteristics of long term care. General QM systems (ISO, EFQM) have often been criticised by LTC professionals as being too complicated and not appropriate for their requirements. Furthermore, LTC facilities have been confronted over the past 20 years with increasing demands for (public) reporting, transparency and other regulatory frameworks. Yet, no formal training has been offered to underpin the generally welcomed attempts by regulators to provide incentives for quality improvement.

Quality management in LTC calls for a collaborative approach involving all stakeholders to gain consensus, to analyse problems and to plan improvement. Again, mechanisms to enable stakeholders to plan, organise and implement such processes (organisational development) are scarcely promoted and facilitated. Furthermore, quality management is often delegated to a specific 'expert' in the organisation, rather than involving all staff and relevant stakeholders in continuous improvement.

E-Qalin addressed and tested, in the first place, multi-stakeholder collaboration in quality management in residential care facilities. In the meantime also versions for community care and for services for people with disabilities are available. As QM systems addressing the links and interfaces of LTC are lacking it is planned to make the system also applicable to organisations providing both home care and residential care to expand opportunities for team-buidling and the involvement of all relevant stakeholders in LTC.

Beschreibung

The E-Qalin quality management (QM) system is the result of a successful Leonardo da Vinci project (2004-2007) with partners from Austria, Germany, Italy, Luxembourg and Slovenia. It is based on training of staff for becoming so-called Process Managers (management staff) and Group Facilitators (selected staff members). They are thus enabled to implement QM in their organisation with an organisational development approach and an orientation towards involvement and participation of all relevant stakeholders.

Following an internal self-assessment process, improvement is achieved by projects based on suggestions that have emerged from this process. Only after having terminated at least one assessment cycle and having initiated a continuous improvement process (6-12 months), the organisation may apply for an external audit to achieve an E-Qalin certification.

During the self-assessment 66 criteria in the area “Structures & Processes” and 25 foci in the area “Results” are considered from five different perspectives: residents, staff, leadership, social context (social accountability) and ‘learning organisation’ (future orientation). The self-assessment process is implemented by two Process Managers, a steering group (with representatives of all major stakeholders, including the residents’ council and/or other advocates of residents and families/friends) and specific assessment groups (facilitated by E-Qalin Group Facilitators). These groups serve to have defined criteria evaluated by representatives from different stakeholders’ views, in particular from different professions and hierarchical levels. Individual criteria, e.g. those affecting residents and their families directly, may also be assessed in special groups with these stakeholders.

Today, more than 150 care homes in Austria, Germany, Luxembourg and Slovenia apply E-Qalin. Experience has shown that the training of Process Managers and Group Facilitators is of utmost importance as knowledge and skills concerning quality management, organisational development, group facilitation and project management are relatively underdeveloped in care homes. An important precondition for the implementation of E-Qalin is a participative leadership approach that allows for involvement and participation.

Costs for training are relatively contained: the 5-day training course per participant costs less than a daily rate that would be charged by a consultant. An assessment cycle, for which usually no additional external consultancy is needed, requires about 700 to 1,000 person-hours per care home with 80-100 places over a period of 6-12 months (every 3 years), depending on its size and the extent of staff involvement. As a result of the assessment, numerous improvement projects will have to be organised and implemented following each assessment cycle to live up to a continuous improvement process. Resources for making this process sustainable will have to be dedicated by the management according to priorities, feasibility and urgency.

Welche Effekte wurden erzielt?

An evaluation during the pilot-phase has shown a remarkable acceptance and most positive results concerning the implementation of quality-thinking in care homes (Rosenbaum/Schlüter, 2007). The implementation of E-Qalin (version for residential care facilities) is mainly addressing the inter-professional cooperation of staff within the organisation and, in a second step, the care home’s relationship with families, friends, volunteers and other stakeholdes. In particular inter-professional relationships have proven to improve in terms of team-working and information-sharing. On the organisational level, staff and other stakeholders involved in the assessment-process have increased their perception of residents’ and their families’ needs.

Reality shows, however, that the involvement of residents and families in the assessment of quality is still often restricted to satisfaction surveys. This is partly due to the fact that, in most care homes, a high percentage of residents is suffering from cognitive and other diseases, and that their length of stay is gradually reduced to a maximum of 2 years. As hitherto different types of satisfaction surveys have been applied by care homes, comparisons and evidence for improved quality of life are scarce.

For the future, a more systematic use of satisfaction surveys, together with a greater focus on result indicators and quality of life, is therefore being envisaged to facilitate comparisons or even benchmarking within and between organisations. The spreading of E-Qalin, in particular in Austria and Slovenia, has produced several positive consequences on regional, national and trans-national levels:

• New versions for community care services and for services for people with disabilities have been developed, thus offering the opportunity for trans-organisational quality assessment and improvement.
• In some regions (Lower Austria), within some large provider groups (Vienna) and in Slovenia E-Qalin has become the general QM standard in care homes so that the basis for comparisons and benchmarking has been prepared.
• In Austria, a self-assessment with E-Qalin, ISO 9000 or QAP (EFQM) has become the basic requirement for care homes to apply for the National Quality Certificate (NQZ) which might thus become the external audit for also for E-Qalin care homes (Trukeschitz, 2010).
• E-Qalin is currently being transferred to other countries, but it will depend on national regulatory frameworks, leadership issues and traditions of further education in the care sector to create acceptance and a systemic impact.

Worin bestehen die Stärken und Schwächen der Initiative?

Strengths

• E-Qalin is a QM system has been developed by involving training agencies in the health and care sectors as well as by providers: it is thus respecting the characteristics and values of long term care.
• E-Qalin supports providers in assessing the quality of structures, processes and results of long term care provision.
• The system has been developed trans-nationally and is open to national adaptations and regional requirements as it does not define standards, but provides a methodology to evaluate reality in LTC organisations.
• The system is based on self-assessment without external support and is able to implement quality thinking and user-orientation at all staff levels. 

Weaknesses

• E-Qalin requires a multitude of sophisticated skills by management and staff, reaching from group facilitation to project management and organisational development – all these skills can be acquired by additional training, but not all care homes are ready or willing to invest in further training of staff.
• E-Qalin is not easy to understand at first sight as it can only be ‘experienced’ during the Process Manager training and the implementation process.
• E-Qalin is not for ‘everybody’ as it requires leadership and other preconditions to be implemented. 

Opportunities

• The system might spread in selected countries, depending on national framework conditions and the ability of training agencies to convince providers (or public authorities, such as in Slovenia and in the region of Lower Austria) to invest in further training and organisational development. 
• The system might further develop into a ‘long term care’ QM system across providers and across individual services. 

Threats

• Current crisis management and the reduction of public spending will certainly have an impact as, unfortunately and short-sightedly, investments in further training and quality development might be subject to cut costs.

Impressum

Autor: Kai Leichsenring
Reviewer 1: Judy Triantafillou
Reviewer 2: Stephanie Carretero
Verified by: Heidemarie Staflinger, E-Qalin Ltd.

Externe Links und Literatur

• The E-Qalin Quality Management System 
• Rosenbaum, U./Schlüter, W. (2007). Endbericht Evaluierung E-Qalin. Zwickau: Westsächsische Hochschule. 
• Trukeschitz, B. (2010) ‘Safeguarding good quality in long-term care: the Austrian approach’ in: Eurohealth, Vol. 16, 2: 17-20.

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