Throughout 2020, we will be highlighting the Queen Silvia Nursing Award partners that bring the scholarship to life in their respective regions.
Currently in its 6th year, The Queen Silvia Nursing Award motivates nursing students in Germany, Finland, Poland, and Sweden to contribute to the quality of life and care of the elderly and people living with a dementia diagnosis. We are very proud to announce that a fifth country, Lithuania, will join the program as of this fall 2020.
The Queen Silvia Nursing Award is made possible with the dedication and commitment of partners with a firm focus on the growth of nursing talent and nursing opportunities.
We spoke with Martin Tivéus, CEO of Attendo Group – the Nordic’s leading private provider of care services – about the challenges and opportunities of bringing elderly and dementia care to the region, and the heightened responsibilities demanded during the Covid-19 pandemic.
You have extensive experience in a variety of Swedish industries and now find yourself heading the Nordic’s largest elderly care provider. Could you bring us to up to speed about how you joined Attendo?
I started at Attendo in September 2018 and yes, I do have a number of years in different industries as you said. I have held a variety of CEO roles from telecom, IT, veterinary care and online banking. What has been the common focus throughout these companies is an emphasis on a people-centric experience. I am really passionate about delivering value back to customers, and engaging team members in the service we provide. By getting everyone collaborating and communicating with each other, we can together bring something unique to the market.
This role at Attendo was actually something that I was actively seeking. I have four sisters, two of whom which work within elderly care, and at this stage in life, I’m watching the older members of my family such as aunts or uncles enter the elderly care systems. When you hear the stories and experiences from people so close to you, you realize that it is an amazing profession to care and deliver a high quality of life for our elderly population. It is deeply meaningful work, but it is also work that needs modernization in operating models. I believed that I could make a difference and it has been a really exciting journey throughout these almost 2 years with Attendo.
The group has over 700 nursing homes across the Nordics. The service offering ranges from individual and family care to people with disabilities – two services which are available in Sweden and Finland; and of course, elderly care via nursing homes and home care in Sweden, Finland, Norway and Denmark. We have a decentralized business operating model which is dependent on unit to unit.
That said, as we are all in the people business, with relationships at the core of everything we do, we need to ensure that our team is given as stable prerequisites as possible so they can succeed and do their absolute best for the clients. This means a wide range of factors need to be secured for all of our team members – from knowledge and competence, to equipment and facilities, and even nutrition and physical activity levels. Attendo has a strong business culture that is driven to provide high levels of care for our clients, and that means our professionals need the support to make that delivery happen.
As the Nordic’s largest privately-operated care provider, can you tell us more about the innovations within caregiving at Attendo?
Within the care sector, there are many factors that are predetermined. This means that the space in which we can grow and improve our care standards is extremely important to analyze so we deliver it back to the customers. As a basic premise, we want team members and with our customers to be seen as individuals, and we encourage each to be seen and heard. Each person has a voice and perspective, and we need to listen to them and understand how they can contribute to caregiving or how they want to be cared for. We place a lot of emphasis on the relationships we build and with that the meaningful interactions between people. The people that we serve are our friends, rather than patients, and if we have the ability to improve their quality of life, then we should aim to do so. This means that there is a frequent looping of information, action and improvements at Attendo touching upon anything from activities, food to processes. Anything that can possibly be improved upon should be considered by the team.
One initiative that we’re particularly proud to have completed recently is to digitalize care planning within the facilities. In the past 18 months, we’ve rolled out mobile scheduling and planning systems across all of our units. This was previously limited to our home care service, but we’ve now expanded it so that even residents and team members within the facilities can benefit from a flexibly structured day.
Every morning, a team member is given a phone in which s/he logs in to get the schedule for the day. Installed within the phone is a chip that allows access to the customer’s apartment in which a task is allotted for a specific timeframe. This might include anything from providing medications or having a chat and coffee, or preparing for lunch service. With every completed task, a digital receipt is created so that master planners in every facility can make small, real-time adjustments. Some tasks take longer than others, or there might be more demands depending on the interaction that day. Every planner at the facility can make changes to extend the time for future tasks of a certain nature connected to the customer.
As you can imagine this is particularly helpful with time-critical planning such as medicine distribution, so we know who provided medication at what time and for whom. We also have a running receipt of what was done so that there is a lower rate of inaccuracies whether something has been completed or not. We use information systems to allocate tasks and appropriate team members every day, but there is still a lot of room for meaningful interactions that have paid off for team members and clients alike. It avoids peaks and valleys in the workday and distributes work across the board for everyone so that busier floors can get the support they need. Most importantly, it actually clarifies what needs to be done so that team members can spend valuable time socializing with the residents. It has calmed the tempo of work and freed up time for meaningful interactions to take place, which is absolutely worth the investment.
This type of scheduling has allowed a greater form of flexibility and agility in adapting to the realities of our operations. We start every day with a reflection session with team members, reviewing any activities from the evening prior, or what might have worked well or requires improvement for the future. Team members get their phone and know their day well in advance. They also know if something takes longer, we can plan around the change. Something like this is important for our team to see what they have done at the end of the day and that they can return home proud in knowing that they have contributed to the wellbeing of the residents. This has had a really positive impact on the work-life balance for team members and the lifting of quality and safety for our residents.
It is an empowering and an agile way of working and we want to keep pushing this envelop forward. We are also in the midst of launching our new employee app to continue building an organization that is centered on the competence and knowledge of our team members. Because we have such a mobile work force that is locally based, we don’t have the capacity to have traditional face-to-face training in all situations. We rely on the connections via our mobile so that talent, experience and opportunities can tie us together. The app has educational opportunities installed onto the platform, as well as discussion groups topics such as nutrition and dementia. There are videos, training and knowledge refreshing sessions that people can do on the bus, during a break, etc. We need to find new ways to engage our teams in real-time with information that helps them with their work and private lives so this application will be helpful in this regard.
In the future, we’re creating a family or relatives app as well. This will allow family members with loved one at Attendo locations to check in and see how things are going. They can check for updates and see what activities have been done that day, or what is coming up in the weeks ahead. Family members can also order services for their relatives, like cake, “fika” or flowers. We always encourage a dialogue with family members and we hope that this function will allow a flow of dialogue between family and our team members so we can continue focusing our efforts on providing a high quality of care for the customers.
With technology in place we can make meaningful interactions happen for all of our stakeholders.
Tell us about the current challenges today. How is the ongoing pandemic impacting these very stakeholders you are referring to?
I think it is important to remember that while none of us can possibly predict what the outcome of Covid-19 will be, we should all be able to look ourselves in the mirror and ask if we did everything in our power to protect our society.
In Sweden, Attendo relied on our own network of specialists and experts in the field. When we started to receive guidelines from the public authorities, it was with quick realization that the advice was to service the entire population, with no specific target groups in mind. For us who work with very high-risk groups such as the elderly, we had an entirely different mindset in terms of protection and safeguarding. We took the Swedish guidelines as the baseline of advice only, and began to map a more comprehensive strategy for our vulnerable clients.
I took a call on 9th of March with a good friend who is a doctor based in the Stockholm region responsible for coronavirus care. They were in the midst of building contagion models of the virus, working from the worst-case scenario perspectives which were significantly different from the public health authority expressions. I asked him straight out what he would do if he was responsible for elderly age facilities, and what measures he would take to protect these residents. His response was that he would lock the facilities down and create a stringent gatekeeper function to reduce the risk of infection.
On March 10, Attendo did exactly that in all of our markets. We introduced health controls for all of our team members that day and cancelled non-essential traffic into the facilities. This included any public works, renovations, outsourcing tasks, etc. We needed to really control what was going on within the facilities and who was coming and going. The absolute majority of family members reacted positively, with an understanding that we were doing all we could in our power to protect their elderly loved ones.
Where we received critique and criticism was from local authorities and municipalities. Some were noisier than others. There was one municipality that was very critical of our steps to protect the elderly. I attended an online meeting in which 28 representatives were in the same room together to speak with me about Attendo’s strategy. Rather than give in, we outlined our thinking, strategy and process. In efforts to encourage others to do the same, we shared this information with our competitors. It isn’t even a question of competition when you are responsible for human lives. We had no choice but to work closely with each other. Quite quickly, on the 12 March, Ambea – another actor within elderly care – closed their facilities, and others followed suit. It wasn’t until a week later that the municipalities adopted our guidelines and shut the doors to their facilities as well.
I continue to be in close contact with the other actors within our field, like Fredrik Gren of Ambea. We discuss the latest challenges in personal protection equipment (PPE), sharing resources and other key issues in our shared fight against covid-19. We are not competing with each other at this time. This virus needs all of us to work together to find the best practices and solutions so we can move faster and plan ahead as much as possible.
With Attendo as the Nordic’s largest care provider, what have you noticed in terms of how countries have been addressing the coronavirus?
There have been very obvious differences in national response and results of the pandemic.
At Attendo we noticed that after 2.5 weeks of lockdown and daily health checks for our team members, there were still residents getting infected. We had taken many steps to refurbish the homes such as placing chairs 2 meters from each other, removing sofas altogether, etc. We knew that this could not be related to the traffic of relatives or contractors coming into the building either as they were no longer allowed into our homes. We were also doing daily health checks for team members who were not displaying any symptoms. It became quickly apparent to us that the virus could be spread by having no symptoms during the critical incubation time, and our staff was unknowingly coming into work and spreading infection.
We had been collecting data on this since early March. Here in Sweden, we contacted the public health authorities and elderly healthcare authorities in the region to share our findings. We had powerful data that pointed to contagion even during incubation – and thus we had to consider every employee in a new light. They need to be protected with PPE and needed frequent testing and monitoring beyond just temperature checks.
In Norway, PPE and tests were supplied by the government and public authorities. As a result, there has not been a significant increase in infections in Norway. In Finland, officials reached out to our colleagues to have regular discussions and check in on the latest status and developments. In Finland only 2 nursing homes out of Attendo’s’ 400 have had residents with infections due to the quick and timely actions made by authorities.
Sweden has been significantly different. After a week of offering our information and data, we heard nothing back from the authorities. After another 4 days, I had no choice but to go public with the lack of movement. There was so much uncertainty within elderly care units about infection rates, but we had a very good idea about what measures worked and didn’t work.
Yet we couldn’t get our hands on the right equipment for our team members to do their job safely, nor could we get healthcare tests into our facilities to avoid the spread of infection. In Stockholm, they only just started testing staff and before then there was only 1 region in Sweden that was doing regular staff testing. Attendo has purchased antibody testing kits ourselves, but they are not as accurate as we would like. Private labs with limited capacities are now testing staff but it takes time. We have known for a long time that there is a small number of individuals with zero symptoms who carry the virus and only now that hypothesis is being confirmed.
Our authorities lost valuable time in Sweden to control the spread among the elderly and this can be seen in our high infection rates.
How is the situation today? How is your staff holding up and are you getting the support you need within the facilities?
I´m glad that PPE is now fully available in our care facilities and we know, despite the lack of PPE worldwide, we are succeeding in protecting our employees and thus safeguarding our elderly clients.
I get a sense of security knowing that this is in place. It feels good to get messages from our team members who are relieved that our PPE is under control.
What have your learned from this process so far, Martin?
I’ve learned so much in the past few weeks. For example, how to maneuver the ins and outs of PPE purchasing and the difficulties with supply chain at this tough time. There are a lot of challenges with producers and logistics that we need to be on top of. Orders need to get paid 100% in advance and volumes secured via WeChat. Sometimes your shipment won’t make the scheduled departure; and other times they can get stuck at customs or other authorities. It is a totally different way of working with purchasing that is challenging in and of itself when our only focus is to fight Covid-19.
As a CEO, you don’t want to scare people and cause panic. You are responsible for maneuvering the right channels and demonstrate a willingness to cooperate, learn from others, and share best practice. That is essential when addressing a healthcare challenge that the world has never experienced before. If I sound the alarm too early and too hard, then it leads to backlash or fear. We cannot cause that, and thus timing is important for these delicate issues.
But more pressingly, I have learned that there are fundamental societal questions that we need to address together. Did we come together as quickly and effectively as we could to protect our vulnerable senior population? Were we able to look past our differences i.e. private versus public players in the sector, or even competition within care providers – so we could collaborate with one another? We are all driven by doing our utmost to protect the elderly but it isn’t a challenge that can be addressed by one provider, or even a handful of stakeholders in the industry. You still need authorities and the government to get involved, listen to the experiences, and set the tone in this battle.
What are you hoping to take from this when we get to the “other side” of the pandemic?
Firstly – as a society, I hope that we will be able to mobilize much more quickly in the future. There are talks of a second or third wave of the virus and hopefully by then, we have a better strategy in place to act decisively. Right now, some countries are in the midst of closing a lot of key services around the world, in essence to protect the risk groups. That is a huge cost for every citizen and every industry to absorb. Instead, I hope future plans would focus on increasing capacity in the right areas so that we are prepared. This might include anything from expanding lab abilities, building warehouses, storing PPE or improving risk group training so we are in a better position to meet new healthcare risks.
Secondly – we need to be able to take the positive momentum we’re experiencing today as care professionals to create attractive opportunities for future talent. Despite the many challenges, we are experiencing an upsurge in pride amongst our peers working in the care sector these days. These professionals are getting the kind of attention they deserve as they safeguard society’s grandmothers, grandfathers, uncles and aunts. There is positive momentum and gratitude in the work that we do, so it will be critical to tap into these good feelings in caregiving and nursing so that society can pay more attention to what we are trying to achieve within the elderly care sector.
I hope that future caregiving and nursing talent sees that there is enormous potential for personal and professional growth in caregiving. The room for innovation, improvement, recommendations and impact is huge and we need fresh perspectives to provide input and enthusiasm. We have an unprecedented opportunity to work together to further discussions on so many care levels, so it is a critical time to be a part of this change.