ASMENS NAMUOSE TEIKIAMŲ STANDARTIZUOTŲ SOCIALINIŲ PASLAUGŲ KOKYBĖS VERTINIMAS: INDIVIDUALIOS PRIEŽIŪROS DARBUOTOJŲ PATIRTYS

Abstract

Demographic ageing is becoming one of the most pressing social problems in Lithuania. It is being addressed by increasing the scope and accessibility of social services, resulting in a pressing need for quality assurance (Micevičienė, 2023). The changing needs and expectations of society for social services increase the quality requirements, which subsequently become an integral part of the development and improvement of organisations. In Lithuania, the main quality standard for social services was considered to be the Inventory of Social Care Norms (2007), but accession to the European Union has provided the opportunity to adopt the experience of foreign countries and apply a wider range of quality standards for social services. In order to improve the provision of social services in Lithuania, the EQUASS standard has been introduced. One of the objectives of EQUASS is to involve staff in the process of continuous quality improvement, ensuring that service recipients are involved in the process of implementing the quality system and receive highquality services. This article aims to shed light on how the quality assessment of social services provided by personal care workers has changed since the introduction of the EQUASS standard. What changes have individual care workers experienced in the provision of social services? A further aim is to highlight the experiences of personal care workers in assessing the quality of social services in individuals’ homes within the context of the EQUASS standard. The following research methods were used: analysis of scientific literature and legislation, and semi-structured interviews. The research was conducted between November and December 2023, and is funded by the Research Council of Lithuania. The research instrument is student research conducted during semesters. The content analysis method was used to analyse the research data. The method of non-probability sampling used for the research involved a criterion sample as follows: working in a social care institution with at least 3 years of implementation of the EQUASS standard; providing social services in the homes of service recipients; and having at least 5 years of social work experience. Eight personal care workers who fulfilled all of the above criteria participated in the research. In terms of research ethics, participants were given the opportunity to take part in the research voluntarily; they were informed in advance of the purpose of the research, and those who agreed to participate were invited for an interview. The questionnaire did not contain any offensive or derogatory statements. The interviews took place in a setting in which the participants did not feel fear or stress. The confidentiality and privacy of the participants was ensured by providing a unique code to each respondent. This empirical study enabled deeper insights into the application of the EQUASS standard in a care facility. The experiences of personal care workers in relation to the assessment of the quality of social services prior to and during the implementation of the EQUASS standard were revealed. The research revealed that prior to the introduction of the EQUASS standard, personal care workers assessed the quality of social services provided in their institutions intuitively and objectively. The participants of the research assessed the quality of social services based on the feedback of the service recipients and their satisfaction or dissatisfaction with the services provided. The perception of the quality of social services was highly individual and depended on the expectations, experiences or attitudes of the workers. Improved quality of life or positive attitudes of service recipients was also a factor for personal care workers in determining the quality of services. The quality of social services prior to the EQUASS standard was also assessed by personal care workers through annual surveys. On the other hand, receiving feedback from service recipients and not receiving any complaints was a reason for staff to believe that they were delivering quality services. The statements given by the personal care workers who took part in the study revealed that the quality of social services provided in the institution following the implementation of the EQUASS standard is assessed subjectively, intersubjectively and objectively. The implementation of the EQUASS standard has made it necessary for the participants to submit a self-assessment, which is seen as both a time-consuming exercise and a quality assurance factor. The intersubjective evaluation is linked to the self-assessment of the personal care workers combined with the assessment of the social workers, analysing and discussing the quality of the services provided. The subjective evaluation of the services provided by the personal care workers is provided by the service recipients, who write their observations, preferences and suggestions on evaluation sheets. This research reveals that with the EQUASS standard, the quality of social services provided by personal care workers is linked to compliance with the intended criteria for assessing the quality of services and a measurable outcome. After the implementation of the EQUASS standard, personal care workers experience changes at the individual and institutional levels. Changes at the individual level are reflected in efforts to empower the service recipient, working towards achieving a specific result, and in the evaluation of the services provided. The empowerment of service recipients represents a significant change experienced by personal care workers. The empowerment of service recipients is guided by specific and clear requirements for service provision and a person-centred approach. Clear criteria for assessing the quality of the service enable the focus to be on a specific outcome that can be measured. According to the participants, self-assessment influences the improvement of service delivery and encourages self-improvement. The participants associate the changes they have experienced as a result of implementing the EQUASS standard at the level of the institution with teamwork, a wider range of services, and the systematic evaluation of the services provided. The EQUASS standard has particularly strengthened teamwork in the institution, which is reflected in the context of client empowerment and in the process of assessing results. The increase in the range of services provided is partly the result of the active involvement of social partners and the increased opportunity to share good practice, which is seen as a change at the institutional level. The survey also revealed that the application of the EQUASS standard has led to a move towards the systematic evaluation of the quality of services provided and a perceived need to measure the results achieved. Personal care workers perceived the quality of social services provided in people’s homes before the EQUASS standard was introduced in a very individual way. This perception depended on their experience and preconceived notions about meeting the expectations of service recipients. This also led to a predominantly intuitive assessment of social services. The application of the EQUASS standard has inspired a change in the perception of the quality of social services from an intuitive perception to one that can be measured. The evaluation of personal care workers’ performance is carried out through a combination of self-assessment, assessment by service recipients and social workers, and the collection of data from different sources for the evaluation. The application of the EQUASS standard has changed the perception of the meaning of the services provided by personal care workers from “providing services that meet an identified need” to “providing services that meet the specific needs of the service recipients through empowerment”. The provision of quality criteria enables personal care workers to achieve a specific and measurable result, which at the same time enhances motivation. Performance evaluation is linked to the improvement of service delivery and incentives for professional development. The provision of standardised services increases the focus of the staff and the importance of teamwork in the context of service recipient empowerment and service improvement. The changes experienced by personal care workers are manifested in an increase in the supply of services, the involvement of social partners in offering services and the emergence of a culture of monitoring the quality of services within the facility.