C1 -The Art of improvement at the Urology Unit Jönköpings County Council Bruno Larsson Md, Head of Urology Department Promises to cancer patients in southeastern health care region to commence appropriate treatment within four weeks offered diagnosis and treatment of best practice to be well informed and participant in the entire continuum of care end of life care is given equally, good palliative care offered the best possible health promotion and effective screening Regional Cancer Center to prioritize patient-oriented research in the cancer field 1
Background One county 340 000 inhabitants Three hospitals urology part of each local surgery department» different cultures» differences in access» local quality problems» no common guidelines» results not available for comparison» three small units sensitive to number of staff» no formalized/planned teaching of staff members Lake Vättern Norway Sweden Jönköping Jönköping district Eksjö Highland Eksjö district Spain UK France Germany Italy Jönköping County Värnamo Värnamo district Europe 2
The Urology Journey Assignment National leading system for Quality and Patients Safety in Swedish Health care We pursue a Health care that is safe knowledge based and appropriate patient focused effective equal in good time The Swedish National Board of Health care and Social welfare 3
Form a project group Including method support from Qulturum Representatives from all three hospitals Representing a wide range of professions New organization Stop thinking geography! Start thinking processes! 4
Processes system map Stödprocesser Kärnverksamhet Ledningsprocesser Testing Testing strategies in one clinical process First macroscopic haematuri Multidisciplinary team with members from different parts of the county urologist, nurse, assistant nurse, administrator Cooperating with other departments is absolutely necessary to be able to make any changes Process mapping from the patient journey trough the system Learning: it takes time to change from geography to clinical processes 5
Implementation based on what we learned from testing one clinical process in other clinical processes Nephrolithiasis LUTS Lower Urinary Tract Symptoms Prostate cancer Diseases in Upper Urinary Tract 6
We always start from the patient's path through the health care The way through the health care for patient with prostate cancer = examination/investigation = action/treatment = information = competens Patients preferences We involved the patient in our work 7
We designed the process out of the patient point of view An example - idée 2011-12-01 A. Hematuriutredning B. Konsultationsremiss (annan klinik/kirurgkliniken) med misstänkt njurtumör Besök urologmottagning Internremiss till läkare i njurteamet Operationsanmälan Narkosbedömning Informationsblad till patient Operationskoordinator i Eksjö kallar och meddelar patient när operationsbeslut är klart Telefonuppföljning inom 14 dagar efter PAD-besked Kontaktuppgifter till Eksjö Kontaktsjuksköterska Internremiss Kontaktsjuksköterska Operation Kontaktsjuksköterska kontaktar patient under vårdtiden C. Njurtumör identifierad i samband med röntgen (utan någon kontakt med urolog) Läkarbesök Eksjö Operationsanmälan Narkosbedömning Postoperativt besök med PAD-svar med ställningstagande till fortsatt uppföljning Informationsblad till patient kontaktuppgifter till Eksjö Clinical Value Compass Prostate Cancer Jönköping County Council Functional status Clinical status Patient Satisfaction Resources 8
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500 450 400 350 Ledtider prostatacancer - prostatektomi urologienheten, Landstinget i Jönköpings län 2010-2011 Remiss in - ultraljud/ prostatatbiopsi Prostata-biopsi - besked till patient Besked till patient - prostatektomi Terapibeslut - prostatektomi Remiss in - prostatektomi 300 dagar 250 200 150 100 50 0 april juni juni juni juli juli juli juli 2010 2011 500 Ledtider prostatacancer - strålbehandling urologienheten, Landstinget i Jönköpings län 2010-2011 450 400 350 Remiss in - ultraljud/ prostata-biopsi Prostata-biopsi - besked till patient Terapibeslut - strålbehandling Remiss in - strålbehandling 300 250 200 150 100 50 0 april juni juni juli april antal dagar 2009 2010 2011 10
Ledtider från terapibeslut till SEEDS-behandling i samband med prostatacancer urologienheten, Landstinget i Jönköpings län 2010-2011 160 2010 140 120 100 2011 80 medel=69 dagar 60 40 20 april 0 jun jun jul april medel=40 dagar april april april juni juni juni juli juli 800 000 Läkemedelskostnader - prostatacancer urologienheten, Landstinget i Jönköpings län 2010-2012 Leuprorelin L02AE02 Bikalutamid L02BB03 Resurs/ekonomi 700 000 600 000 500 000 kr 400 000 300 000 200 000 100 000 0 mar apr jun jul mar apr jun jul mar apr jun jul 2010 2011 2012 11
Project Leader Working Committee Management team Project Group Balanced Score Card Urology Unit Jönköping County Council Patient/customer Learning/ination Process Resources 12
Estimation of process development 1 = The process is not defined. It is a new process that needs to be designed, and documented. 2 = The process is known by those working in it. No documentation or standards exist. No improvement was made. 3 = The process is defined and understood by employees and customers. Documentation is available as flow charts, standards, policies, job descriptions, manuals and more. 4 = The process is well defined. Measurement is the process performance and quality are being made to follow the process. Graphical charts are used for evaluation. 5 = The process has been improved. Measurements in progress include customer feedback. Standards and other documents are updated regularly. 6 = Measurements of process and process results are stable. The services will constantly meet up with the expectations of customers. Highly developed process. Njursten LUTS Processutveckling - kliniska processer urologienheten, Landstinget i Jönköpings län 2011-2012 -12 jul-12-12 -11 jul-11-11 Prostata Tumör övre urinvägar Hematuri/blåscancer 1 2 3 4 5 6 skattning 1-6 (6=välutvecklad process) 13
Väntande till NB urologienheten, Landstinget i Jönköpings län 2010-2012 700 600 500 Höglandet Nässjö Jönköping Värnamo Totalt 400 300 200 100 0 mar apr jun jul mar apr jun jul mar apr jun jul antal 2010 2011 2012 100% 90% Andel besök till annan profession än läkare urologienheten, Landstinget i Jönköpings län 2011-2012 Höglandet Jönköping Värnamo 80% 70% 60% 50% 40% 30% 20% 10% 0% Höglandet Jönköping Värnamo 14
Background One county 340 000 inhabitants Three hospitals urology part of each local surgery department» different cultures» differences in access» local quality problems» no common guidelines» results not available for comparison» three small units sensitive to number of staff» no formalized/planned teaching of staff members Processes system map 15
The journey continues Thank you! 16