How do hospitals transform themselves?

Transkript

1 How do hospitals transform themselves? Aspirering to be the safest local helthcare system in Sweden An example from Värnamo, Jönköping county, Sweden Ann-Christine Johansson, CEO Värnamo health care area, Finitum capax infinitum

2 Varnamo 2006 Friendly, caring Focus on staff incl physicians Average, few measures, excellent spots Bad finances Healthcare is dangerous, so there are complications Acute visits/stays is not possible to plan and most of what we do is acute Focus on money or focus on patient safety? How to create power throughout the organisation? Language of Professionals or Administrators Will, Ideas and Execution (Don Berwick)

3 Being one of the staff doing patient register reviews with GTT in Värnamo health care district I see the big amount of patients that suffer from care injuries. When you see this the work with patient safety is not optional, it is an absolute necessity. Eva K Johansson, KK Everybody cares about patient safety - will Head of departments Head of wards Care staff, also physicians Administrators Staff unions And patients!

4 Mission Värnamo Health Care area is to be one of the safest and most efficient local health care systems in the world before 31 of Dec 2010 Focus Everybody agreed that patient safety is important - Many clinics had been working for several years to give the patient a safe care IHI decided to start two campaigns to save lives and to not do harm SALAR (The Federation of Swedish counties) decided on six areas to do no harm The decision to work with Safe Health Care, every time, all the time was made by the top management in the county Värnamo healthcare district including the hospital, decided to have the mission

5 Ideas IHI:s twelve and SALAR s six recommendations became Safe care all the time in the county Study circles and other help from Qulturum Don't forget the patients ideas and involvement. Among other things we formed a patient safety board with three patients as participants Quality registers and Open comparisons Herman and Brita seminars together with the communities

6 Execution Create structures and support Measure, but only things that are important and you are willing to do something about Give feedback Talk, talk and talk with everyone, everywhere and everyday Hold on Celebrate! All at the same time

7 Meso Experts Representatives patient safety ombudsmen Coordinators Measurements Follow-ups Inspiration seminars Every meeting contains patient safety Leadership groups at all levels Forum for leaders, good examples Collaboration groups with labour unions Working place meetings Top management meet department leadership groups Reviews Staff meetings Lunch, coffee, corridors

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9 Benefits Clear what we have to do Everyone knows Everybody understands their part and are able to directly influence it Everybody wants to be part of a good result Ideas will emerge A certain degree of competitive element The management s own efficiency Access Give time not take Effectiveness in meetings, mails, reports, answers Simple and quick in a complex system. The results of the healthcare area also show what efficiency we as leaders have

10 Best everywhere, every time It is easy to do excellent results at some places and/or sometimes The difficult thing is to do world class results every time and everywhere Rather 98% every time than 100% sometimes Medborgare/kund Population years Days paid by the social insurance Antal dagar dec-10 nov-10 okt-10 sep-10 aug-10 jul-10 jun-10 maj-10 apr-10 mar-10 feb-10 jan-10 dec-09 nov-09 okt-09 sep-09 aug-09 jul-09 jun-09 maj-09 apr-09 mar-09 feb-09 jan-09 Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Totalt

11 Process/produktion: Vårdprevention Risk assessment for fall, nutrition and pressure ulcers 100% Andel (%) 50% 0% jan-09 feb-09 mar-09 apr-09 maj-09 jul-09 jun-09 aug-09 sep-09 Jönköpings sjukvårdsområde okt-09 nov-09 dec-09 jan-10 feb-10 mar-10 apr-10 maj-10 jun-10 Höglandets sjukvårdsområde jul-10 aug-10 sep-10 okt-10 nov-10 dec-10 Värnamo sjukvårdsområde Mål Process/produktion: Vårdprevention Steps taken to minimize risk 100% Andel (%) 50% 0% dec-10 nov-10 okt-10 sep-10 aug-10 jul-10 jun-10 maj-10 apr-10 mar-10 feb-10 jan-10 dec-09 nov-09 okt-09 sep-09 aug-09 jul-09 jun-09 maj-09 apr-09 mar-09 feb-09 jan-09 Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Mål

12 Process/produktion Clothing rules sep-08 okt-08 nov-08 dec-08 jan-09 mar-09 feb-09 apr-09 maj-09 jun-09 jul-09 aug-09 sep-09 okt-09 nov-09 dec-09 jan-10 mar-10 feb-10 apr-10 maj-10 jun-10 jul-10 aug-10 sep-10 okt-10 nov-10 dec-10 jan-11 mar-11 feb-11 Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Folktandvård Medicinsk diagnostik Primärvård Mål apr-11 maj-11 jun-11 jul-11 aug-11 sep-11 okt-11 nov-11 dec-11 Process/produktion Hand hygiene compliance Increase 34% from sept sep-08 okt-08 nov-08 dec-08 jan-09 mar-09 feb-09 apr-09 maj-09 jun-09 jul-09 aug-09 sep-09 okt-09 nov-09 dec-09 jan-10 mar-10 feb-10 apr-10 maj-10 jun-10 jul-10 aug-10 sep-10 okt-10 nov-10 dec-10 jan-11 mar-11 feb-11 Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Folktandvård Medicinsk diagnostik Primärvård Mål apr-11 maj-11 jun-11 jul-11 aug-11 sep-11 okt-11 nov-11 dec-11

13 Färgmarkeringarna betyder: Basala hygienrutiner <80% 80-85% >85% inga resultat Rätt klädd <85% 85-95% >95% inga resultat feb-11 Värnamo sjukvårdsområde basala hygienrutiner antal klädregler antal observationer självskattning ej angivet Akut- och operationsenheten 80% % Barn mott och barnhälsovård 100% % Geriatriska kliniken 95% % Kirurgkliniken 92% % Kvinnokliniken 97% % Medicinkliniken 89% 54 96% Ortopedkliniken 95% % Psykiatriska kliniken 90% 10 86% Samrehab 100% % Ögonmottagningen 100% 5 100% 5 5 Värnamo sjukvårdsområde 91% %

14 Process/produktion Peri-operative safety briefings 100% 90% 80% 70% 60% 50% 40% 30% Bokslut 2011 Tertial Tertial Bokslut 2010 Tertial Tertial Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Mål

15 Access-distribution CDC/AV-fistula, Department of dialyses, Värnamo % 90% Best in Sweden 80% 70% 60% 50% 40% 30% Ranked in the bottom of Swedish hospitals 20% 10% 0% Pat med AV-fistel/graft Pat med CDK Cardiac arrests at Värnamo hospital % reduction in Cardiac arrests

16 Patient harm(ae), GTT Year Vmo Per 1000 days of care , , ,5 500 employees ran to show the importance of health 93 % got at least two hours personal dialog 2,9 % absence due to illness 2010, lowest in Sweden Best result in the Dialog 2010

17 Ekonomi: Hälso- och sjukvård Finances (goal zero) Mnkr Jan Feb Mar Apr Maj Jun Jul Aug Sep Okt Nov Dec Jönköpings sjvo Höglandets sjvo Värnamo sjvo Folktandvården Medicinsk diagnostik Inspiration and execution throughout the organisation The manager must be a living example of what is important. What you do others will do! Be as a kind sheepdog... - make it easy to do the things right, svåra inte te dä - support the right things - be a part of it your self - ask questions - make sure that measures starts, communicates and acts on

18 Other important things Patient safety rounds Japanese sports. Curious professionals with own drive. To do what we decide. Focus on action not planning. Patientvalue and patient s focus Värnamo hospital number one in Sweden 2011! Number two if university hospitals are included. Survey based on Open comparisons and The Swedish webbsite Access in care ( Health Consumer Powerhouse, February 2011

19 Jag känner mig verkligen personligt stolt över att det lilla sjukhuset i min närhet lyckas så bra! Jag är övertygad om att två av framgångsfaktorerna verkligen handlar om öppenhet och delaktighet. Det är chefskapet som avgör om dessa två faktorer uppstår eller inte. Maria Larsson, Minister for Children and the Elderly, Ministry of Health and Social Affairs The Government of Sweden Finitum capax infinitum The limitation contains the infinite

20 Styrdiagram Patientskador 0,08 Patientskador per vårddagar (AE) - Värnamo SVO Genomsnitt/utgångsläge 24;22 patientskador per 1000 vårddagar Antal patientskador per vårddag 0,07 0,06 0,05 0,04 0,03 0,02 0,01 0-0,01-0, januari UCL=0, CEN=0, LCL=0,0 mars maj juli september november 2008 januari mars maj UCL=0, CEN=0, LCL=0,0 juli september november 2009 januari mars maj juli september november 2010 januari mars maj juli september november Månad

21 Care related infections, Värnamo hospital 25 October - 28 November was both admitted and left during the time 31 (4 %) of the patients had a care related infection sometime during their stay. (The Swedish average is 9 %) 20 of the patients already had the infection at arrival (2,6 %) 11 of the patients got a care related infection during the time of care (1,4 %) Execution is the difficult part? How do you get execution in every part every time?