Welcome!! Ref: Sandro Boticceli

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 cocreator 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 Finland 2015-09-23 2016-02-01

The big opportunity Before and Now The New Health 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 Drivers The development of knowledge Demographics Epidemiology Technology Robotization Costs Patients awareness Social Networks Complex systems Co-learning Networking A new ecosystem Prevention Team Integrated treatment Follow-up care Individual Interaction at a distance Proactive patients Quality

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?

Welcome to one of ten healthiest areas in the world 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: Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

Welcome also to One of ten coolest innovative counties around the world Good for Esther = good for all seniors http://plus.rjl.se/esther Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

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.

Science of Improvement: We combine professional knowledge with improvement knowledge in creative ways to develop effective changes for improvement. Source: Batalden, Deming

A way to transform the culture? Change the whole culture of the company Change the attitude of individuals Change behaviour New way Nya to arbetssätt work and to use metoder& verktyg 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

Kotter cont 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

Quality as business strategy looks very different but having the same baseline Finland 2015-09-23 2016-02-01

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 Kommunala insatser för invånare över 65 år 100% = totalt antal individer 65 år och över (80%) 4-7% 10-20% Särskilt boende Eget boende med hemtjänst eller hemsjukvård Eget boende utan hemtjänst eller hemsjukvård 12

Talk with me, not to me Meet me with respect Give me knowledge Treat me like a fellow human being Don t let me be reduced Look into my eyes and imagine you are me Let me be a part of my own care Let my family be part of my health care Listen to me Anette Abrahamsson,

A shift in perspective.. The patient s needs Patient in the center Patient a part of the team Reference: Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

Microsystem Finland 2015-09-23 2016-02-01

Esther http://www.bbc.com/news/health-28654739 Finland 2015-09-23 2016-02-01 Ref Nickoline Vackerberg, Qulturum

Learning and innovation Self Dialysis: https://www.youtube.com/watch?v=nesv7tdslgk Finland 2015-09-23 2016-02-01 Ref. Britt-Mari Banck, https://www.youtube.com/user/qulturumtv

Version 25 September 2015 For a Good Life in an Attractive Region

For 340,000 citizens Jönköping County is the geographical catchment area, with just over 340,000 inhabitants. 2016-02-01

Two assignments many activities Public health, healthcare and dental care Regional development and growth We have approximately 10,000 employees in 100 or so professional fields. 2016-02-01

It all fits together 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. 2016-02-01

Organisation, vision and values

The municipalities participation and collaboration 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. 2016-02-01

Vision and values 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. 2016-02-01

Public health, healthcare and dental care

Tax funded and democratically governed 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. 2/1/2016

2016-02-01 From very good to best possible

Among the best in Sweden

Greatest confidence on the healthcare barometer 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. 2016-02-01

First prize in EU competition for social innovations 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. 2016-02-01

Högland Hospital in Eksjö the best hospital for interns 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. 2016-02-01

Ryhov County Hospital best in Sweden Medical magazinel Dagens Medicin has voted Ryhov County Hospital Sweden s best mid-size hospital three years in a row: 2012, 2013 and 2014. 2/1/2016

Successful EU work 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. 2/1/2016

Sweden s healthiest teeth Children and young people in Jönköping County have the healthiest teeth in Sweden, according to the National Board of Health and Welfare. 2/1/2016

Top-class healthcare hygiene The medical clinic at Värnamo Hospital received the Swedish Hygiene Award 2015 for its work on reducing healthcare-related infections. 2/1/2016

High rating for public transport National comparisons show that Jönköping County offers a good range of public transport, with very satisfied passengers and high quality. 2/1/2016

Patient involvement results in More engaged, activated patients and better health outcomes Better understanding of one s illness and capacity for selfmanagement Reduced healthcare costs Health systems adopting processes and achieving outcomes that matter to patients

The health of the population Fysisk aktivitet och goda matvanor Citizens experience Cost per inhabitant 47

Patientupplevt funktionellt status vid första besök efter operation i samband med koloncancer 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) Integration depends also on how we measure Value Compass for Colon Cancer Functional status / health status Survival Coverage ratio Clinical Status Complications 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% resultat av enkätsvar Sydöstra sjukvårdsregionen 2011-2012 jan-jun 2011 (n=15) jul-dec 2011 (n=21) jan-jun 2012 jul-dec 2012 Good care Colon cancer Quality of life Agitation/Anxiety Appetite Main activities Patient/Customer s needs Welcoming attitude Involvement Information Stadium after diagnosed Resources / Costs Competence Lead time Hospitalization Investigation costs

Procent Patientskador per tusen vårddagar ADE per dos Påverkansanalys Säker vård alla gånger Mars 2011 (uppdaterad 110426) 0 dec-11 nov-11 okt-11 sep-11 aug-11 jul-11 jun-11 maj-11 apr-11 mar-11 feb-11 jan-11 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 dec-08 nov-08 okt-08 sep-08 dec-11 nov-11 okt-11 sep-11 aug-11 jul-11 jun-11 maj-11 apr-11 mar-11 feb-11 jan-11 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 Procentuell andel % Procent januari jan-10 februari mars feb-10 april mar-10 maj juni apr-10 juli augusti maj-10 september oktober jun-10 november december jul-10 januari februari aug-10 mars april sep-10 maj juni okt-10 juli augusti nov-10 september oktober dec-10 november december jan-11 januari februari feb-11 mars mar-11 20 Punktprevalensmätning Vårdrelaterade infektioner (PPM VRI) 100 Följsamhet till riktlinjer basala hygienrutiner Följsamhet Område 3 Förebygg läkemedelsfel vid vårdens övergångar. Mål:100 procent 95 15 90 100 90 85 80 10 80 70 75 60 50 5 70 40 65 30 0 Maj 2008 November 2008 April 2009 November 2009 April 2010 November 2010 60 20 10 Höglandets Sjukvårdsområde Värnamo Sjukvårdsområde Jönköpings Sjukvårdsområde Mål Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Folktandvård Medicinsk diagnostik Primärvård Mål 0 Oktober 2008 April 2009 Oktober 2009 April 2010 Oktober 2010 Jönköpings Sjukvårdsområde Höglandets Sjukvårdsområde Värnamo Sjukvårdsområde Mål 40 35 30 Patientskador per 1000 vårddagar (AE) Primära drivkrafter Undvik Vårdrelaterade infektioner Sekundära drivkrafter Följsamhet Basala Hygienrutiner och Rätt Klädd Följsamhet område 4, 5, 6, 8, 10 och 13 100 90 80 Följsamhet riktlinjer KAD bara när det behövs 25 20 15 10 5 Mål: Säker Vård alla gånger Övergripande resultatmått: Antal patientskador per 1000 patientdygn Tillförlitlig Hjärtsjukvård Följsamhet område 2 och 11 Undvik Läkemedelsrel patientskador Undvik Fall och trycksår Följsamhet omr 1 Följsamhet område 3 och 7 Följsamhet område 9 och 14 70 60 50 40 30 20 10 0 2008 Tertial 1 Tertial 2 Tertial 3 2009 Tertial 1 Tertial 2 Tertial 3 2010 Tertial 1 Tertial 2 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) Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde Landstinget Stödjande ledarskap Följsamhet omr 12 Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde Läkemedelsrelaterade patientskador (ADE), genomsnitt 3,1 ADE per 1000 doser 0,006 0,005 0,004 0,003 2003 2004 2005 2006 2007 2008 2009 2010 1 1 1 1 1 UCL=0,005282 _ U=0,003058 110% 100% 90% 80% Vårdprevention Riskbedömning av fall, nutrition och trycksår 100% 90% 80% 70% 60% 50% Förebyggande bedömningar före operation 0,002 70% 40% 30% 0,001 0,000 jun aug ok t d ec feb apr jun aug ok t dec feb apr jun aug LCL=0,000835 60% 20% ok t dec apr feb Tests performed with unequal sample sizes ok t dec feb apr jun aug okt dec feb apr jun au g okt dec feb apr ju n au g ok t d ec feb apr jun aug ok t d ec jun aug Månad Resultatmått 10% 50% 0% Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde Totalt i länet Mål Höglandets sjukvårdsområde på op enhet Jönköpings sjukvårdsområde på op enhet Värnamo sjukvårdsområde på op enhet Mål Processmått

Quality as a strategy - we make everybody move We focus on Learning and innovation more than the other three perspectives! Patient/ Customer/Citizen Process Learning and innovation Finances This will spread and effect the other perspectives!

Balanced Scorecard: Four perspectives Citizen or consumer OUTWARDS Who are our consumers? What needs do they have? Are the consumers satisfied? 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? Process and production INWARDS What are our resources? In what fields are we going to be good? In what way? Finance BACKWARDS What does our economic presumptions look like? What economic resources are necessary to reach our goals in short terms and long terms? Agneta Jansmyr 01/02/2016

(ange enhet via Infoga sidfot) 2016-02-01

Visualization of results to follow up the results,...to act on results to get hold of ones context

Partnership and patient safety Film about Self-dialyses unit (5:45) Agneta Jansmyr 01/02/2016

ACTIVITIES Diet? Risk assessment? Screening? Pt. education? Colonoscopy? Biopsy? Staging? Surgery? Colostomy? Radiation? Chemotherapy? Pt. education? Shared decision-making? Zone of greatest attention Colostomy care? Cancer activity? Pt. education? Shared decisionmaking? Palliative care? Pt. education? Shared decisionmaking? Pre-diagnosis Diagnosis & treatment Follow-up & monitoring End of life care Screening events? Prevalence? Pt. awareness? MEASURES 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? Ref: Paul Batalden

Strategic Improvement Areas Learning and innovation Access How we receive Prevention Selfcare Cooperation/flow Clinical improvement work Patient safety Medication Good finances Reliability V a l u e f o r p a t i e n t i n c r e a s e s

You can t turn back the clock But you can wind it up again