Jönköping Eksjö

Värnamo

Europe

Sweden

France

UK Ger- many

Italy

Spain

Population: 340,000 13 cities/municipalities 3 healthcare districts

3 hospitals

48 primary care units

Region Jönköping County and Healthcare Services

Region Jönköping County Two main areas- many activities

2016-09-19

• Public health, Health and care, Dental care

• Regionla growth and development

• 10 000 employees, over 100 professions

What the region does?

2016-09-19

An ordinary day in health and care in Jönköping County

2016-09-19

• 4 600 persons get care • 1 700 persons have an appointment at Primary Care Centre • 1 400 persons have appointment at the spec. doctor • 200 persons get admitted at the hospital • 800 persons get x-ray • 11 children are born

We are proud of • Best hospitals in Sweden • Hygien prize • Master education at Jönköping Academy • Inhabitants most satisfied • Top results in Patient Safety • Clinical Simulation center

2016-09-19

QULturum • center for development of improvement

knowledge and innovation in healthcare.

• the improvement unit at Region Jönköping County, responsible for the healthcare services in the county

• engaged in several improvement activities both on a regional, national and international level.

• focus on developing improvement knowledge concerning patients, patient involvement, co-operation and flow, inter professional teams, leadership, management and the design of healthcare.

Strategic areas

QULturum - a center for innovation and

renewal - a meeting place for creative

cooperation and development of - methods - competence - ways of working

- a source for employees to find

new inspiration for the joy to improve

Inspiration Skagen…

A home of the light that reflects sharpness, vitality…and creativity

Qulturum Metaphors …

Helen Bevan, CEO of transformation services, NHS England tweeting: ‘’According to @lucienengelen, we need a triple-P to transform healthcare: Patients, Professionals, Pirates’’

The pirates of mindsets

https://www.youtube.com/watch?v=R4UCiSDbfNY

Science of Improvement: Learn to combine subject matter knowledge and profound knowledge in creative ways to develop

effective changes for improvement.

Source:W.Edwards Deming

‘’Every system is perfectly designed to achieve the results it gets’’

Donald Berwick

Tillsammans för god och jämlik hälsa

Britt-Marie Malin

Sigge Arne

Gun

2015-01-16

Acting into new thinking – QUL: Quality, Improvement and Leadership

Learning by doing

Innovation Consulting/Coaching Training Method development Concept development Spread

Innovation

Spread

Analyses

New design

Co-learning

Re-engineering Microsystem

Meeting places

Leadership

Coaching Person-centered care

Local Regional National International Prevention Patient safety

http://plus.rjl.se/qulturum

Quality Regitry

Efficiency Resilience

Our Learning Culture

Everyday life is a constant learning

We want to make the things that work well visible for others- and to make them together

We test first on a small scale before we make a big change

We always follow a systematic approach in the improvement

process

From fix and forget to See, Solve and Share

2016-09-19

PDSA-circle

Improvement Fundamentals

Microsystem

-studycirkle

Why we work with Microsystemthinking and how we work to implement it.

"Every system is perfectly designed to get the results it gets."

Donald Berwick

Why do we have to work with microsystem?

Health care used to be simple, safe and ineffective . . .

.. . . but now it is complex, efficient, and potentially dangerous

( and expensive)

In one unit there can be……

• 150 organizational PM • 100 guidlines in care • 30 department-specific guidelines • 23 357 articles about COPD (Chronic obstructive pulmonary

disease) • 70 089 articles about Lungcancer • 30 different salary criteria • . . .

2012 01 31 Jon Ahlberg

2010 01 20 St Eriks Ögonsjukhus

If you go astray long enough

you start to feel at home

Drive the train in 200 km/h

. . . and lay the rails for the future

Akuten Cor lab IVA/HIA Rehab

Micro

Systemmeasures

Andel kliniker som skattat implementering av "Säker vård - alla gånger" 090402

0%10%20%30%40%50%60%70%80%90%

100%

Höglandet Jönköping Värnamo

2008

Ref; Henriks, Bojestig, Nilsson, Edvinsson

Building bridges……

We know.. We do..

The Study circle in microsystem

How to improve in the daily work

LS 1 30 mars

Why are we here? Identify area for improvement Try 5P

Goals Start measuring

How do we handle changes ? Tests

What new experiences and insights have we gained ? Present a Poster

LS 2 19 april

LS 3 16 maj

LS 4 12 juni

Baseline Customer Focus Improvement-areas

Measurements Tools and methods

Change psychology, and team work

Vernissage This is where it begins!

Purpose Syfte • Varför finns

vi till? • Vilket värde

ska vi skapa?

People/ medarbetare • Hur nyttjar och

tillvaratar vi medarbetarnas kompetens på bästa sätt?

• Hur involverar vi dem mer i utvecklingsarbetet?

• Hur ökar vi medarbetarnas förståelse för sin uppgift?

Processer/ flöden • Hur lär vi oss

mer om våra processer?

• Hur använder vi

oss av resultatet? • Hur blir vi bättre

på länkning?

Patterns/ mönster • Hur

utvärderar vi variationer i det kliniska arbetet?

Att kartlägga, reflektera, samtala och försöka systematiskt förbättra

MMMiiikkkrrrooosssyyysssttteeemmmeeetttsss fffeeemmm PPP

Patienter • Vilka är de? • Hur väl känner vi

deras behov? • Hur involverar vi

dem mer?

P

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2008 Ref: Godfrey, Nelson,Batalden

Patienter • Vilka är de? • Hur väl känner vi

deras behov? • Hur involverar vi

dem mer?

People/ medarbetare • Hur nyttjar och

tillvaratar vi medarbetarnas kompetens på bästa sätt?

• Hur involverar vi dem mer i utvecklingsarbetet?

• Hur ökar vi medarbetarnas förståelse för sin uppgift?

Processer/ flöden • Hur lär vi oss

mer om våra processer?

• Hur använder

vi oss av resultatet?

• Hur blir vi

bättre på länkning/samverkan?

Patterns/ mönster • Hur

utvärderar vi variationer i det kliniska arbetet?

Att kartlägga, reflektera, samtala och försöka systematiskt förbättra

MMMiiikkkrrrooosssyyysssttteeemmmeeetttsss fffeeemmm PPP

Purpose /syfte Vilket värde ska vi åstadkomma?

Purpose Patients People/colleagues Processes Patterns

• What value shall we accomplish?

• Who are they?

• How well do we know their needs?

• How do we involve them more?

• How do we use and take care of the competence of our colleagues in the best way?

• How do we involve them more in the improvement work?

• How do we increase our colleagues understanding of our mission?

• How do we learn more about our processes?

• How do we use the result?

• How do we improve our co-operation?

•How do we evaluate the variations in the clinical work?

To map out, reflect, discuss and try to systematically improve

The 5 P’s of the microsystem

Find the gaps, sort out the causes and do “ Small tests” to reduce the gaps

Fishbone • Define the problem • Ask the question Why, Why, Why…. • Brainstorm • Sort and Group categories. • Multi-vote

2. 5 P to understand the context We describe the process from a

patient point of wiew with photos Where is the biggest gap between

how it is today and what it should be?

How can we measure ?

1. 3.

Plan

Do Study

Act

Plan small tests ( goal, measures and time) Do Study Act

©2005, Trustees of Dartmouth College, Nelson, January

Akuten Cor lab IVA/HIA Rehab

Micro

Systemmeasures

The distribution of colours in Jönköping County Council. 090223

0%10%20%30%40%50%60%70%80%90%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Område

Andel kliniker som skattat implementering av "Säker vård - alla gånger" 090402

0%10%20%30%40%50%60%70%80%90%

100%

Höglandet Jönköping Värnamo

Månad

AD

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sep

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jun

0,006

0,005

0,004

0,003

0,002

0,001

0,000

_U=0,002309

UCL=0,004042

LCL=0,000575

2003 2004 2005 2006 2007 2008

1

11

Tests performed with unequal sample sizes

Läkemedelsrelaterade patientskador (ADE) Landstinget i Jönköpings län

Månad 2007

Pati

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kado

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februa

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0,03

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UCL=0,03795

LCL=0

Tests performed with unequal sample sizes

Patientskador per vårdtillfälle (AE) - Landstinget i Jönköpings län

www.clinicalmicrosystem.org

Do you want to know more. . . ??

“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”

Marcel Proust 1871- 1922. Fransk romanförfattare

Innovation and Improvement

Contextual (new in the

organisation)

Conceptual (new

everywhere)

Improvement =

Change

Innovation

Constant change

To do new

Same but better

Innovation is a new idea,

more effective device or process.The term innovation can be defined as something original and more effective and, as a consequence, new, that "breaks into" the market or society. While a novel device is often described as an innovation, in economics, management science, and other fields of practice and analysis innovation is generally considered to

be a process that brings together various novel ideas in a way that they have an impact on society.

In Healthcare Improvement: Product, Service and Social Innovations

Sustaining Commercial

Transformational-sustaining Disruptive

Start journey

Livli is an app for proactive aging and aims at helping the pre-frail elderly population taking an active approach to maintain an healthy lifestyle.

Product/Service Transformational-Sustaining

Smart bed plattform Intelligence in the bed

Wave system Integrated wave function in the bed

Lightning ’’Under bed light’’ Lamp

Wireless Hand controll

Alarm function Brake alarm ’’Out of bed’’ fluid alarm

Electrical driving Drive the bed with the use of an electronical wheel

Integrated tablets that steer all the functions

Service Data Time of usage Load Service interval Serie number Etc.

The potential services with the use of the smart bed plattform • Wireless function. Works both at the hospital and at home • Alarm functions till caregivers -”Out of bed”, moisture, alarm button, etc. • ”Tracking” -Where the bed is(patient) • Different means of communication : - Speech, pictures • Information about various measurements

• Predestined steering - Unique features for specific situations • General gateway to the operational system, part of the PDM • Possibility of using so-called Apps is adding functionality

Service Disruptive Innovation

Self-Dialyses Unit

https://www.youtube.com/watch?v=VEk-A3k98QA

Passion for life

2016-09-19

http://plus.rjl.se/infopage.jsf?nodeId=33037

Social Innovation Transformational-Sustaining

HOW do we gather ideas for INNOVATIONS?

2016-09-19

(ange enhet via Infoga sidfot)

• From the ’floor’, care providers • From users • Users and care providers • Facilitating workshops, meeting places • Stealing

Most effective to do it together!

Folkslab- Human-centered design workshop

2016-09-19

Designlabb- Human-centered Design- 3 steps: Empathy/Ideas/Prototyping- Problem-solving- Oppen plattform

https://storify.com/CherylAGuest/folkslab#publicize

Innovation is both ideas and execution

And they have very little in common

2016-09-19

Patients spend 5800 hours a year managing their own condition Patients spend about 5 hours a year having an HC professional manage their condition

Bearing in mind that….

Working with design

…we need to act into new thinking.

Acceleration of the integration of new design is critical.

Design is an approach to problem-solving that is creative, user-centered and viable.

= People Powered Health

Before

SYSTEM

CARE

INDIVIDUAL/ LIFE

Now

SYSTEM/ CARE

Because who is perfect? Appreciating diversity

http://www.youtube.com/watch?v=E8umFV69fNg (4:16)