Welcome Jönköping County is a county in southern Sweden. The total county population is about 330 00 Arean: 10,495 km² University: Jönköping University Clubs and Teams: HV71, Jönköpings Södra IF, IFK Värnamo, MORE @EstherNtverk
"For a good life in an attractive region" http://www.rjl.se/om-oss/vision-mal-och-varderingar/
The Swedish welfare system - An introduction to the Swedish model and social security system.
Göran Stiernstedt, SOU 2016:2 Energy to live life Nobody unnecessary helpless Nobody unnecessary in the hospital Daily life Health support Primary care Specialist care
Child-care and education All public schooling in Sweden is free of charge (includes university studies), a cooked lunch is included year 0-9 (12). School is from 6 years of age and compulsory for 9 successive years. Child-care is available from when the child is 1 year old until school starts. Child-care fees are subsidized and income related. The same applies to after school programs.
The Swedish health care system All public health care is subsidized. A patient pays a maximum of 1100 SEK (app. 183 SGD) per year. The equivalent for prescription pharmaceuticals is 2200 SEK (app. 366 SGD) per year. Hospital care is 100 SEK (app. 16 SGD) per day. After 10 days, 80 SEK/day ( app 13SGD)) All maternal care (including child birth and contraceptive care) is free of charge. Children have free health- and dental care until the age of 20.
Social insurance The social insurance system is an important part of the Swedish welfare model. The social insurance covers most individuals who live or work in Sweden. The insurance gives economic security through benefits to families and children, individuals with any kind of impairment, illness, work related injury or old age. Some benefits are based on residency in Sweden, some on work and income.
Example of social insurance benefits Child support: 1050 SEK ( app 175 SGD) per child and month until 16 years of age. After 16 student allowance. Parental leave: Both parents get 240 days each paid leave from work with app. 80 % of normal pay Sick leave: app. 80 % of normal pay during sick leave General pension based on pay and amount of working years Housing support to help cover cost of rent, mortgage (based on actual cost and income)
The social services act The social services act gives the municipality an extensive responsibility for it s citizens and any one individual who is in the area at any given point. The social welfare has a responsibility to look out for children s well-being and safety, to give economical support to individuals with low or no income (for example during unemployment) and to provide help, service and support to those in need.
Help, service and support can be home care for the elderly, personal assistance to a person with impairment or education and support in parenthood. The act basically insures every-one s right to safety/security and to have somewhere to live, food to eat and clothes to keep warm.
Municipal Health and medical care Health and medical care in residential homes have been a municipal responsibility since 1992 Responsibility for Health and medical care in ordinary homes has changed from county councils to municipality mainly in the last 5 years Includes care up to specialist nurse level Doctors are still employed by the county councils and responsible for prescribing treatment, medication and so on
Social vs medical care in municipality Social care Application from Esther Social worker assessment of need according to social services act, SoL, or special support and service act, LSS (framelaws) Home care effects Implementation plan Maximum fee 2013 SEK/month (app 335 SGD) Medical care Esther seeks help Proffessional assessment of treatment by health care act (rights law) Careplan Fees in som municipalitys
Göran Stiernstedt, SOU 2016:2 Energy to live life Nobody unnecessary helpless Nobody unnecessary in the hospital Daily life Health support Primary care Specialist care
Ny samordnad vårdplaneringsprocess vid in- och utskrivning (exkl. tvångsvården) Arbetsmaterial SVPL - Samordnad vårdplanering SIP Samordnad individuell plan Vårdplaneringsprocess för personer i alla åldrar, som efter utskrivning från Vårdcentralsluten vård behöver insatser från socialtjänst, den kommunalt finansierade hälso- och sjukvården eller den landstingsfinansierade öppna vården (giltig from 180115) Esther åker till sjukhus Hemsjukvård Text Text Vårdcentral Vårdsamordnare håller ihop SVPL processen Avbokar ev. besök på VC Skicka ADL/Kom-status samt info om aktuella insatser om Esther är känd på Vc. men inte hos kommunen Tittar x 3/dag i Link 8+12+16 Slutenvård Inskrivningsmedd. Inskrivningsmeddelande skickas till VC och kommun när Esther skrivs in - oavsett tid på dygnet. Samtycke inhämtas (Namn, pers.nr, avd. och inläggningsorsak) Tittar x3/dag i Link 8+12+16 Kommun HSL/SOL/LSS Avbokar kommunens insatser Skickar ADL/kom status samt info om aktuella insatser om Esther.är känd. (HSL/SOL/LSS) Tittar x 3/dag i Link 8+12+16 Vårdcentral Tar del av vårdtidsplaneringen Planerar för Esthers hemgång tillsammans med kommunen Slutenvård Vårdtidsplanering Efter första rondtillfället som sker inom 24 tim. skickas information angående förväntad vårdtid. Kommun HSL/SOL/LSS Tar del av vårdtidsplaneringen Planerar för Esthers hemgång tillsammans med vårdsamordnare vad gäller nytillkomna behov av hjälpmedel och insatser (medicinskt, omvårdnad, rehab) Vårdcentral Bemannar i Link Skickar prel. tid för SVPL som äger rum i bostaden inom 3 dagar efter utskrivning, Dokumenterar ansvar/insatser löpande i Linkvårdplan Slutenvård Initiera SVPL Vid nytt eller utökat behov, inhämta samtycke till SVPL Initierar SVPL = skicka kallelse Dokumenterar ansvar/insatser löpande i Linkvårdplan Kommun HSL/SOL/LSS Kvitterar kallelsen Bemannar i Link Bekräftar prel. tid för SVPL i hemmet Dokumenterar kommunens ansvar/insatser löpande i Linkvårdplan Vårdcentral Slutenvård 2017-11-07 (ange enhet via Infoga sidfot) Vårdsamordnare stämmer av med berörda parter ang. aktuella insatser inför en trygg hemgång - som ska täcka för pat. behov fram till SIP skrivs Sammankallar berörda parter till SVPL i bostaden Utskrivningsmedd. Esther är utskrivningsklar och kan komma åter till bostaden inom 24 tim. Allt ska vara klart innan utskrivningsmeddelandet skickas Epikriser klara Läkemedel klart att skickas med enligt ök, Hjälpmedel förskrivna Linkvårdplanen ges till Esther Transport beställs enl. ök med kommunen Kommun HSL/SOL/LSS Meddelar tid när Esther kan komma hem (inom 24 h). Bekräftar den fastställda tiden för SVPL. Processbild samordnad vårdplanering, SVPL Utarbetad i projekt Vårdsamordning Jönköpings län 2017 R a m b e s l u t Hemma SVPL genomförs med SIP som resultat Vårdcentral Vårdsamordnaren leder SVPLmötet Vårdsamordnare dokumenterar SIP i Cosmic journalmall under mötet Om någon part måste återkomma med beslut signeras inte anteckningen utan vårdsamordnare inväntar beslut Ger/skickar SIP ev. till Esther samt övriga parter som ej har åtkomst Kommun Kallade professioner deltar aktivt i SVPL-mötet SIP Vårdsamordnaren dokumenterar SIP -Cosmic Vad är viktigt för dig? Egenvård/behandling Vad kan du göra själv? Vad behöver du hjälp och stöttning med? Åtkomst till dok. SIP för Esther Journal via nätet Vårdsamordnare följer upp SIP inom 1 mån.
"give people facts and you feed their minds for an hour awaken their curiosity and they feed their own minds for a lifetime" Ian Russel
What Is Best For Esther? Sweden has one of the world s highest percentages of seniors, and in the late 1990s Höglandet s local hospital began overflowing with patients. Officials from the Jönköping region and healthcare employees collaborated on a better system to care for the elderly, who frequently ended up in the hospital. They dreamed up their fictional character Esther, a reasonably self-sufficient 88-year-old pensioner with some chronic health issues. Then they asked, What is best for Esther?
What matters to Esther? What does Esther need/ want/ prefer? What is important for Esther when she gets sick? Partners Who has to cooperate to fulfil Esther s needs, expectations? Improvements What improvements do we need to do : what is most important for Esther? Esther is involved from the start to the end
3 hospitals 13 municipalities 46 Primarycare units
Sense of urgency 1997
The Challenge Person centered care Delivering a service that is truly patient centered is an enormous challenge which can only be overcome by actively engaging patients as valuable resource. GREENHALGH, T., HUMPHREY, C. & WOODARD, F. 2011. User involvement in health care, Chichester, John Wiley & Sons, Ltd. Complexity Healthcare systems are complex, and repairing them is complex. GLOUBERMAN, S. & ZIMMERMAN, B. 2002. Complicated and complex systems: what would successful reform of Medicare look like? Changing Health Care in Canada: The Romanow Papers, 2, 21-53.
Development Highland district Care 2000 2014 2016 Hospital beds 375 263 207 Care homes 1740 1290 (inc short term stay) Homecare 1000 2000 2200 1273 (Inc short term stay) Homevisits - Increases
Care situations No process No ending Process/ Ending One unit More units Leading Health Care
System levels Microsystem Mesosystem Macrosystem
Simple Rules We protect the patients and ourselves It is the system s result that counts We share the results from our development and improvement work with others Health care emanates from the patient s value, need and whishes Either solve the problem or take responsibility for the handing over to next step Feedback to the step before Work with guidelines
If I want to succeed by bringing a person to a certain goal, I must first find out where he is and start right there. He who can not do that, fools himself when he thinks he can help others. To help someone I must understand more than he does, but first and foremost understand what he understands. If I can not, my greater understanding does not help him at all. Do I still want to show how much I can, it's because I'm vain and proud and really want to be admired by the other instead of helping him. All genuine helpfulness begins with humility for the one I want to help and I have to understand that helping is not to dominate, but to serve. To help is a not to be the most dominating but the most patient. If I can not do this, I can not help anyone either. Danish philosopher Soren Kierkegaard 1813-1855
So: Your learning style? Think about a time when you learned something that was really important to you How did you learn that important thing? What did others do to support your learning?
Learning Understanding Head Doing Hands Feeling Heart
What are your best hopes for this week? Think 2 minutes and write down in your book How are you going to contribute to this?
How to transform 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& methods verktyg and tools We act into a new way of thinking
Vision without action is just a dream. Action without vision is just a pastime. Vision with action can change the world. Mahatma Gandhi
2017-11-07 (ange enhet via Infoga sidfot)
Imagine yourself as a learner! In a time of drastic change, it is the learners who inherit the future. The learned find themselves equipped to live in a world that no longer exists Eric J. Hoffer Social Writer: 1902 1983
Value of reflection Reflection is the process of stepping back from experience to process what the experience means, with a view to planning further action. It is the critical link between concrete experience, the interpretation and taking new action. Coghlan D, Brannick T. Doing action research in your own organization. London: SAGE; 2001, p. 31.
Improving & Experiential Learning Anticipate requisite assessment Concrete experience Notice Testing implications of concepts in new situations Observations and reflections Implications for setting, context Formation of abstract concepts and generalizations Make sense David Kolb Paul Batalden
Multipel levels av importancy Your own experience Team and group experience Other groups and persons (blog, facebook, presentations) Other organizations (blog)
Journal keeping is a significant mechanism for developing reflective skills. Keeping a journal regularly imposes a discipline and captures your experience of key events close to when they happen and before the passage of time changes your perception of them. Coghlan D, Brannick T. Doing action research in your own organization. London: SAGE; 2001, p. 33.
Summing and Reflections