Welcome!!

Ref:

Sandro

Boticceli

The courage to see what is important!

• The need to feel appreciated , to be part of , and

to be needed throughout life

• The need to allow my selves to feel good and be

happy with what you do, on my own terms

• The joy of being active participant and co-

creator

• The importance of being able to control my self

and my life

• Courage to do new things Leva hela livet

Bjursell, Hultman

The Future is

now

Every System

2016-02-01

Finland 2015-09-23

• Dominant element

Disease

Care

Doctor and Nurse

Specialization

Hospitals and Budgets

Episodic treatment

Standardization

Patients comes to CG

The patient must

have patience

Produce and P4P

• Safety and quality

• Co-learning

• Networking

• A new ecosystem

• Prevention Team

Integrated treatment

Follow-up care

Individual

Interaction at a distance

Proactive patients

Quality

Drivers The development

of knowledge

Demographics

Epidemiology

Technology

Robotization

Costs

Patients awareness

Social Networks

Complex systems

The big opportunity

Before and Now The New Health

Key questions: • The social implications of and for

health? • How do fragmentarisation effect

our service?

• Are the different incentives we have in pace with each other?

Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

• Easy to have a healthy lifestyle

• Healthcare at the top of the

league

• Clean air

• Green areas

• Healthy food

• Excellent public transport

According to this report:

Welcome to one

of ten healthiest

areas in the world

Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

One of ten coolest

innovative counties

around the world

Welcome also to…

http://plus.rjl.se/esther

Good for Esther = good for all seniors

What is best for Esther ?

Esther… no matter where

We will be there!

Success factors

• Patient/person centeredness

• One story, one vision, the common

values

• Meeting places, co-learning

• Everybody involved and Participation of the whole

staff

• Improvement together with patients and citizens

• Simple rules – make it easy

• Open minded – innovative minds

• Trust is a must .

We combine professional knowledge with

improvement knowledge in creative ways to

develop effective changes for improvement.

Source: Batalden, Deming

Science of Improvement:

A way to transform the culture?

Change the

whole culture

of the

company

Change the

attitude of

individuals

Change

behaviour

Nya arbetssätt

metoder& verktyg

New way to work and to use

methods and tools

”We act into a new

way of thinking”

Deming, Norman

The Big idea

Although traditional hierarchies and

processes – which together form a

company’s ”operating system” – are

optimized for day to day business, they can’t

handle the challenges of mounting

complexity and rapid change.

John P. Kotter, Harvard Business Review, November 2012

Kotter cont…

The solution is a second operating system,

devoted to the design and implementation

of strategy, that uses an agile, network-like

structure and a very different set of processes.

The new operating system continually

assesses the business, the industry and the organization,

and reacts with greater agility, speed, and creativity than

the existing one.

It complements rather than underbundens the hierarchy,

thus freeing the latter to do what it’s optimized to do.

It actually makes enterprises easier to run and accelerate

strategic change. John P. Kotter, Harvard Business Review, November 2012

Two structures – One organization

Traditional hierarchies and processes, which together

form an organization’s ”operating system”, do a great job of

handling the operational needs of most companies, but

they are too rigid to adjust to the quick shifts in today’s

marketplace.

The most agile innovative companies add a second

operating system, built on fluid, network-like structure, to

continually formulate and implement strategy.

The second operating system runs to its own processes

(the eight accelerators) and is staffed by volunteers from

throughout the company. John P. Kotter, Harvard Business Review, November 2012

Kotter cont…

Quality as

business

strategy looks

very different

but having the

same baseline

2016-02-01

Finland 2015-09-23

Better life for elderly

I can get older in a safe and reliable context

where I can keep my authority

• Optimal medication

• Care prevention

• Best possible dementia

care

• Care services without

fragmentarisation

• Honorable palliative care

Better life for elderly

• New design

• New ways of working

• Improved leadership

• Support to improvement

• Seniors involved

I en genomsnittlig kommun har ca 20 procent av individerna över 65 år någon kommunal insats

12

Kommunala insatser för invånare över 65 år

100% = totalt antal individer 65 år och över

(80%)10-20%

4-7%Eget boende utan hemtjänst eller hemsjukvård

Eget boende med hemtjänst eller hemsjukvård

Särskilt boende

Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

……

Treat me like a fellow human being

Give me knowledge

Look into my eyes

and imagine you are me

Listen to me

Talk with me, not to me

Let my family

be part of my health care

Meet me with respect

……

Let me be a part of my own care

Don’t let me be reduced

Reference: Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

Patient in the center Patient – a part of the team

The patient’s

needs

A shift in perspective…..

Microsystem

2016-02-01

Finland 2015-09-23

Esther

http://www.bbc.com/news/health-28654739

2016-02-01

Finland 2015-09-23 Ref Nickoline Vackerberg,

Qulturum

Learning and innovation

2016-02-01

Finland 2015-09-23

Self Dialysis: https://www.youtube.com/watch?v=neSv7TdsLgk

Ref. Britt-Mari Banck,

https://www.youtube.com/user/QulturumTV

For a Good Life in an Attractive Region

Ve

rsio

n 2

5 S

ep

tem

be

r 2

01

5

For 340,000 citizens

2016-02-01

• Jönköping County is the geographical catchment area, with just over 340,000 inhabitants.

Two assignments – many activities

2016-02-01

• Public health, healthcare and dental care

• Regional development and growth

• We have approximately 10,000 employees in 100 or so professional fields.

It all fits together

2016-02-01

Region Jönköping County works with issues that are crucial to people’s lives and health, and to the county’s growth and development. The links are strong.

Organisation, vision and values

The municipalities’ participation and collaboration

2016-02-01

• The Municipal Forum is the political arena for discussion and co-operation with the municipalities.

• The Primary Municipal Co-operation Body (PMCB) is the decision-making body for the primary municipal activities organised within Region Jönköping County.

Vision and values

2016-02-01

• The vision “For a Good Life in an Attractive Region” links our ambitions within the areas of activities.

• Thirteen fundamental values characterise the work approach, decisions and choice of path.

Public health, healthcare and dental care

Tax funded and democratically governed

2/1/2016

• Healthcare is managed by Region Jönköping County and by private care providers working under agreements with the Region.

• The county has 3 hospitals and 48 health centres.

• Patients are free to choose their care provider, both for primary care and specialised eye care.

From very good to best possible

2016-02-01

Among the best in Sweden

Greatest confidence on the ‘healthcare barometer’

2016-02-01

• The citizens of Jönköping County have the greatest confidence in the healthcare system and are more satisfied with access to healthcare than anywhere else in Sweden.

First prize in EU competition for social innovations

2016-02-01

• Passion för livet/Passion for Life, the Region’s working method for senior health, won first prize in the EU’s Social innovation in ageing – The European Award in 2014.

2016-02-01

Entrepreneur of the Year and Trailblazer of the Year • Region Jönköping County won two of three

prizes when medical magazine Dagens Medicin awarded its ‘Golden Scalpel’ 2015, Sweden’s leading award for renewal in healthcare.

Högland Hospital in Eksjö the best hospital for interns

2016-02-01

• Högland Hospital is one of the top 10 for interns according to the SYLF rankings for 2015. It is also in the top 3 for interns in medicine and psychiatrics.

Ryhov County Hospital best in Sweden

2/1/2016

• Medical magazinel Dagens Medicin has voted Ryhov County Hospital Sweden’s best mid-size hospital three years in a row: 2012, 2013 and 2014.

Successful EU work

2/1/2016

• The Region’s information about the EU for young people has been nominated by Sweden as a ‘best example’ to the European Commission, and is to be spread throughout Europe.

Sweden’s healthiest teeth

2/1/2016

Children and young people in Jönköping County have the healthiest teeth in Sweden, according to the National Board of Health and Welfare.

Top-class healthcare hygiene

2/1/2016

The medical clinic at Värnamo Hospital received the Swedish Hygiene Award 2015 for its work on reducing healthcare-related infections.

High rating for public transport

2/1/2016

National comparisons show that Jönköping County offers a good range of public transport, with very satisfied passengers and high quality.

Patient involvement results in… • More engaged, activated patients and better health outcomes

• Better understanding of one’s illness and capacity for self-

management

• Reduced healthcare costs

• Health systems adopting processes and achieving outcomes

that matter to patients

The health of the population

Citizens experience Cost per inhabitant

47

Fysisk aktivitet och

goda matvanor

Patientupplevt funktionellt status vid första besök efter operation i samband med koloncancerresultat av enkätsvar

Sydöstra sjukvårdsregionen

2011 - 2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

jan-jun 2011 (n=15) jul-dec 2011 (n=21) jan-jun 2012 jul-dec 2012

Jag klarar av mina huvudsakliga aktiviteter (andel svar Ja, helt och hållet)

Aptit (andel svar 0-3, 0=bästa möjliga aptit, 10=ingen aptit)

Oro/ångest (andel svar 0-3, 0=ingen oro/ångest, 10=värsta tänkbara oro/ångest)

Livskvalitet (andel svar 0-3, 0=bästa möjliga livskvalitet, 10=sämsta tänkbara livskvalitet)

Clinical Status

Functional status / health status

Patient/Customer’s

needs

Resources / Costs

Good care

Colon cancer

Quality of life

Agitation/Anxiety

Appetite

Main activities

Complications

Stadium after

diagnosed

Lead time

Competence

Hospitalization

Investigation costs

Survival

Coverage ratio

Welcoming attitude

Involvement

Information

Integration depends also on how we measure

Value Compass for Colon Cancer

0

5

10

15

20

25

30

35

40

2008 Tertial 1 Tertial 2 Tertial 3 2009 Tertial 1 Tertial 2 Tertial 3 2010 Tertial 1 Tertial 2

Pa

tien

tska

do

r p

er

tus

en

vård

da

ga

r

Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde Landstinget

0

5

10

15

20

Maj 2008 November 2008 April 2009 November 2009 April 2010 November 2010

Pro

cen

t

Höglandets Sjukvårdsområde Jönköpings SjukvårdsområdeVärnamo Sjukvårdsområde Mål

Resultatmått Processmått

Påverkansanalys Säker vård – alla gånger Mars 2011 (uppdaterad 110426)

Följsamhet till riktlinjer basala hygienrutiner Punktprevalensmätning Vårdrelaterade infektioner (PPM VRI) Följsamhet Område 3 Förebygg läkemedelsfel vid

vårdens övergångar. Mål:100 procent

Förebyggande bedömningar före operation Vårdprevention – Riskbedömning av fall, nutrition och trycksår

Patientskador per 1000 vårddagar (AE)

0

10

20

30

40

50

60

70

80

90

100

Oktober 2008 April 2009 Oktober 2009 April 2010 Oktober 2010

Pro

ce

nt

Jönköpings Sjukvårdsområde Höglandets Sjukvårdsområde Värnamo Sjukvårdsområde Mål

Mål: Säker Vård

alla gånger

Övergripande

resultatmått:Antal patientskador

per 1000 patientdygn

Primära drivkrafter

Följsamhet område 3 och 7

Sekundära drivkrafter

Undvik

Vårdrelaterade

infektioner

Följsamhet Basala

Hygienrutiner och Rätt Klädd

Följsamhet område 9 och 14

Följsamhet område 4, 5, 6, 8,

10 och 13

Undvik

Läkemedelsrel

patientskador

Undvik Fall och

trycksår

Tillförlitlig

Hjärtsjukvård Följsamhet område 2 och 11

Följsamhet omr 12

Följsamhet omr 1

Stödjande

ledarskap

Följsamhet riktlinjer ”KAD bara när det behövs”

0

10

20

30

40

50

60

70

80

90

100

jan

ua

ri

febru

ari

mars

ap

ril

maj

jun

i

juli

au

gu

sti

sep

tem

be

r

okto

be

r

no

vem

be

r

de

cem

be

r

jan

ua

ri

febru

ari

mars

ap

ril

maj

jun

i

juli

au

gu

sti

sep

tem

be

r

okto

be

r

no

vem

be

r

de

cem

be

r

jan

ua

ri

febru

ari

mars

n=6 n=4 n=8 n=7 n=10 n=8 n=6 n=8 n=14 n=13 n=11 n=16 n=19 n=18 n=20 n=26 n=26 n=21 n=18 n=20 n=26 n=29 n=31 n=30 n=31 n=26 n=24

Månad 2009-2011 (n=antal mätande enheter i Landstinget)

Pro

cen

tuell a

nd

el

Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde

Månad

AD

E p

er

do

s

decokt

aug

jun

apr

feb

decokt

aug

jun

apr

feb

deco kt

aug

jun

apr

feb

deco kt

aug

jun

apr

feb

decokt

aug

jun

apr

feb

decokt

aug

jun

apr

feb

decokt

aug

jun

apr

feb

decokt

aug

jun

0,006

0,005

0,004

0,003

0,002

0,001

0,000

_U=0,003058

UCL=0,005282

LCL=0,000835

20032004 2005 2006 2007 2008 2009 20101

11

11

Tests performed with unequal sample sizes

Läkemedelsrelaterade patientskador (ADE), genomsnitt 3,1 ADE per 1000 doser

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

jan-1

0

feb

-10

ma

r-1

0

apr-

10

ma

j-1

0

jun-1

0

jul-1

0

aug

-10

se

p-1

0

okt-

10

nov-1

0

dec-1

0

jan-1

1

feb

-11

ma

r-1

1

%

Höglandets sjukvårdsområde på op enhet Jönköpings sjukvårdsområde på op enhet Värnamo sjukvårdsområde på op enhet Mål

50%

60%

70%

80%

90%

100%

110%

jan

-09

feb

-09

ma

r-09

ap

r-09

ma

j-09

jun

-09

jul-0

9

au

g-0

9

se

p-0

9

okt-0

9

no

v-0

9

de

c-0

9

jan

-10

feb

-10

ma

r-10

ap

r-10

ma

j-10

jun

-10

jul-1

0

au

g-1

0

se

p-1

0

okt-1

0

no

v-1

0

de

c-1

0

jan

-11

feb

-11

ma

r-11

ap

r-11

ma

j-11

jun

-11

jul-1

1

au

g-1

1

se

p-1

1

okt-1

1

no

v-1

1

de

c-1

1

Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde

Totalt i länet Mål

60

65

70

75

80

85

90

95

100

se

p-0

8

okt-0

8

no

v-0

8

de

c-0

8

jan

-09

feb

-09

ma

r-09

ap

r-09

ma

j-09

jun

-09

jul-0

9

au

g-0

9

se

p-0

9

okt-0

9

no

v-0

9

de

c-0

9

jan

-10

feb

-10

ma

r-10

ap

r-10

ma

j-10

jun

-10

jul-1

0

au

g-1

0

se

p-1

0

okt-1

0

no

v-1

0

de

c-1

0

jan

-11

feb

-11

ma

r-11

ap

r-11

ma

j-11

jun

-11

jul-1

1

au

g-1

1

se

p-1

1

okt-1

1

no

v-1

1

de

c-1

1

Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde FolktandvårdMedicinsk diagnostik Primärvård Mål

Quality as a strategy - we make everybody “move”

Process

Learning and

innovation Finances

Patient/

Customer/Citizen

We focus on Learning and innovation more than the other three perspectives!

This will spread and effect the other perspectives!

01/02/2016

Agneta Jansmyr

Citizen or consumer OUTWARDS

• Who are our consumers?

• What needs do they have?

• Are the consumers satisfied?

Balanced Scorecard:

Four perspectives

Process and production

INWARDS

What are our resources?

In what fields are we going to be good?

In what way?

Learning and innovation

AHEAD

What do we believe about the

future?

What must be developed to be

prepared for the future?

How are we going to become

a learning organisation?

Finance

BACKWARDS

What does our economic

presumptions look like?

What economic resources are

necessary to reach our goals in

short terms and long terms?

2016-02-01

(ange enhet via Infoga sidfot)

Visualization of results

…to follow up the results,

...to act on results

…to get hold of ones context

Film about Self-dialyses unit (5:45)

Partnership and patient safety

Agneta Jansmyr

01/02/2016

Pre-diagnosis Diagnosis &

treatment

Follow-up &

monitoring

End of life

care

Diet?

Risk assessment?

Screening?

Pt. education?

Colonoscopy?

Biopsy?

Staging?

Surgery?

Colostomy?

Radiation?

Chemotherapy?

Pt. education?

Shared decision-making?

Colostomy care?

Cancer activity?

Pt. education?

Shared decision-

making?

Palliative care?

Pt. education?

Shared decision-

making?

ACTIVITIES

Screening events?

Prevalence?

Pt. awareness? Stage at diagnosis?

Treatment algorithm?

Complications?

Pt. understanding,

satisfaction?

Q,S,V measures?

Survival length?

Activities of daily living?

Monitoring algorithm?

Complications?

Pt. understanding,

satisfaction?

Pain control?

Good death?

Family help?

MEASURES

Zone of

greatest

attention

Ref: Paul Batalden

V a l u e f o r p a t i e n t i n c r e a s e s

Access How we receive

Coopera-tion/flow

Clinical improvement

work

Patient safety

Medication

Learning and innovation

Good finances

Reliability

Strategic Improvement Areas

Prevention Selfcare

You can´t turn back the clock

But you can wind it up again