Evaluation „HPC-MOBIL – Integration of hospice culture and palliative care in home care“
Hospice Austria has initiated an intervention project for the integration of hospice culture and palliative care within the framework of home care, which is supported by the Fonds Gesundes Österreich and was carried out over three years (duration: June 2015 to May 2018). Due to demographic change, this topic is important and will become increasingly important in the future. Within the framework of the project "HPC Mobil - Integration of Hospice Culture and Palliative Care in Home Nursing" (short: HPC Mobil), comprehensive measures were taken to sustainably anchor hospice culture and palliative care in the participating carrier organisations of home nursing with the aim of supporting the employees (home helpers and home nursing staff) in their work with seriously ill and dying people. The project was accompanied by the Competence Center for Nonprofit Organizations and Social Entrepreneurship in the context of an evaluation study.
The evaluation design included quantitative (written questionnaires) and qualitative (guideline-based interviews and focus groups) survey tools. The care of terminally ill and dying people is always a burden for home care workers, especially the worry of getting into the homes of clients for whom death is foreseeable. In the course of the project it became clear how strongly tabooed the subject of dying is. Clients, relatives and friends do not like to deal with it. The topic has also not been discussed much in the organisations providing mobile care and support. An important measure taken by HPC Mobil was to provide further training for its staff and to strengthen and support them in dealing with terminally ill and dying clients. The participating institutions have therefore committed themselves to train at least 80 percent of their staff at all organizational levels in a three-day workshop, half of them (40 percent of the staff) within the three-year project period. For this purpose, a curriculum was first developed within the framework of HPC Mobil and then trainers were trained by each organization. During the project period, these trainers conducted 95 training sessions with more than 1,500 participants, thus far exceeding the specified 40 percent mark. The training rate at the end of the project was between 60 and 80 percent.
The workshops were also rated extremely successful in terms of content. Using the story line method, the workshop participants created a case study which was used to work on important topics and processes in the care and support of terminally ill and dying people. The training of the trainers worked very well, as the feedback forms of the trainers themselves and the feedback of the workshop participants show, who gave the trainers top marks. In each case, 99 percent of the participants rated the trainers as well educated, well prepared and motivated. In the focus group discussions and project meetings the enthusiasm for the applied method and the results of the workshops was also noticeable.
There was also an atmospheric sense of relief at finding a common language for the topics of dying and death. This was confirmed by the results of the survey of employees, which was carried out at two points in time in order to identify changes. For example, the death and dying of clients is increasingly a topic of discussion, employees are better able to assess when clients are likely to die, and documentation has improved in terms of knowing the wishes and needs of clients. In addition, employees are more likely to be able to say goodbye to the deceased and their relatives (e.g. by visiting a funeral). For some objectives, no significant improvement has yet been achieved, for example in the organisation of round tables with all those involved in the care and support process. Here, however, there is also a lack of remuneration, which is therefore beyond the direct sphere of influence of the project. The assessment of the cooperation with family doctors has deteriorated in the second survey, which can be interpreted as an increasing awareness of how important the cooperation with family doctors is and how much it is desired by the staff. It would make sense to re-evaluate the survey at a later date, as some measures were initiated by HPC Mobil but had not yet been fully implemented at the end of the project.
In spite of the difficult framework conditions that exist in mobile care and support, HPC Mobil was able to achieve an immense amount during the three-year project period, as the results of all survey instruments used in the evaluation reflect. The project started at many different points in order to bring about changes. The support of the top management level, which was regularly involved in the steering group, was important. The contract and the writing of objectives, outputs and indicators were effective tools to create a common understanding and commitment. The development group, consisting of the project management duos of the supporting organisations as well as the HPC Mobil project management, project coordination and the organisational development consultant played a key role in the development of the various measures and in bringing them into the organisations.
They were supported by the palliative care officers and groups, which was newly introduced in the course of the project. Together, they worked out how hospice and palliative care could be brought closer to the more than 2,000 employees of the four supporting organisations and integrated into their everyday work so that the employees are supported in their work with seriously ill clients and the wishes of the clients for their last phase of life can be better fulfilled. The participants considered the exchange between the four organisations to be particularly helpful, which was a novelty in Vienna in the field of mobile care and support. HPC Mobil also opened up spaces for an exchange between professional groups, which is not often the case in mobile care, which was also mentioned positively. One point which, in retrospect, could or should have been pushed even more was the involvement of the operational managers. This is the group that has to support the performance, goals and indicators to a very large extent and ensure that they are implemented. At the same time, it did not directly participate in the development.
The project revealed areas of action that are difficult to influence. This applies especially to the cooperation with family doctors. HPC Mobil focused on information in order to reach those doctors who are particularly interested in the topic. The measures taken have met with a positive response. In order to achieve sustainable success, however, appropriate financial framework conditions are required both for the doctors and for the supporting organisations of mobile care and support. Improvements are to be sought in particular in the payment for services of foresighted planning and the support of relatives and relatives, as was elaborated in a policy paper. Sustainability was a particular concern for many of the respondents to the evaluation. In addition to financial resources and structural changes (continuity of care, flexible times, faster approvals...) by the funding agency, the continuation of the (trainee) workshops, the continuation of the palliative care officers and the palliative care group as well as the exchange between agencies at different levels were mentioned as important measures.