Jönköping County Council and Health care services

Transcription

1 "Designing and managing care integration in the County of Jönköping Welcome to Jönköping County Council and Health care services 24 October Pernilla Söderberg Qulturum Jönköping Sweden Jönköping Jönköping district Eksjö Highland Eksjö district Spain UK France Norway Germany Italy Sweden Jönköping County To meet the future or to create the future Welcome to Qulturum Jönköping County Council Värnamo Värnamo district Europe Jönköping County: Population: cities/municipalities Mission Best possible care all the time How to create a culture where everyone is inspired to give the best possible care all the time. And also to create an evironment of curiosity for how to make today s work even better tomorrow. The true journey of discovery is not to search for new sites, but to see the old, familiar one with new eyes. Marcel Proust French Novelist 1

2 Drive the train at 200 km/h Put on different lenses... and lay the rails for the future And look closely at the microsystem... Very close Every one looking at the same thing at the same time Some examples of lenses Economic, political, anthropological, information, psychological, mechanical/physical, sociological and biological To think about. Equal care is NOT that all employees CAN do the same thing Equal care means that all employees both SEE and DO the same thing! If something works do not break it Do more of what works If something does not work do it differently If it is too slow go slower Pernilla Söderberg 2

3 WILL -Attitudes -Driving force IDEAS -Conrete ideas about how something could be better. Inspiration from good examples -Methods and tools EXECUTION -Go from word into action -Measure results and make it visible Improvement in Our Heart with the patient s perspective Science + context = result Our GPS Ref; IHI Tom Nolan Better patient, population outcome From theory to praxis and back again Better professional development To develop a culture of improvement : You have two jobs: to do your job and to improve it! Professional knowledge - Professional knowledge - Personal skills - Values, ethics Improvement knowledge - System - Variation - Psychology - Knowledge Everyone Better system performance Our GPS Ref; Paul Batalden Our GPS Improving diagnosis, treatment, care, rehabilitation and follow-up + Improvement in processes and systems in health care Increased Value for the Patients Paul Batalden Batalden et al. Simple Rules Health care always emanates from the patient s value, need and whishes 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 Either solve the problem or take responsibility for the handing over to next step Feedback to the step before Our GPS Work with guidelines 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:

4 The Mikrosystemets 5 P s of the microsystem fem P LEAN Purpose /syfte Patienter Patients People/colleagues medarbetare Processes Processer/ flöden How do we Patterns/ mönster How do we learn more about What value Who Vilka are är they? de? How do w e use and Hur nyttjar och Hur lär vi oss evaluate Hur the shall we take care of the our processes? variations in the Vilket värde How well do we tillvaratar vi mer om våra utvärderar vi competence of our accomplish? clinical work? ska vi know Hur their väl känner needs? vi medarbetarnas How processer? do we use variationer i colleagues in the best åstadkomma? deras behov? wkompetens ay? på bästa the result? det kliniska How do we sätt? How do w e involve How Hur do använder we arbetet? involve them more? Hur involverar vi them Hur more involverar the vi improve vi oss av our cooperation? dem mer? improvement dem mer i w ork? resultatet? utvecklingsarbetet? How do w e increase our colleague s Hur ökar vi Hur blir vi understanding medarbetarnas of our bättre på mission? förståelse för sin länkning/samv uppgift? erkan? To map Att out, kartlägga, reflect, reflektera, discuss samtala and try to och systematically försöka systematiskt improve förbättra Ref; Henriks, Nilsson, Bojestig, Edvinsson, Berger Ref: Godfrey, Nelson,Batalden Tools and Methods Every system is perfectly designed to achieve the results it gets Donald Berwick Ref:Caroline Fruberg 4

5 antal dagar v 20 v 22 v 24 v 26 v 28 v 30 v 32 v 34 antal dagar v 20 v 35 06/11/2012 Breast cancer process Time in the old days 42 days. Surgeon 2-3 hours Surgeon Punction och cytology Mammography and ultrasound Activity is not always change This is NOT Change Planning Having a meeting Educate staff Do a protocol Point out a responsible person Write on the intranet This IS change Increase phonetimes Change schedule based on needs 5 S pharmacy stock Feedback (measures) an compliance to standards Reduce no of steps in a care process Find the gap, analyze the problem, do tests To measure and analyze over time Plan small tests (goal, measure and time) 5 P to understand your setting. do test Describe the process from the study results patient s perspective. decide new test? where are the largest gaps? Fishbone How do we measure? Define the problem Ask why, why, why Brainstorm Sort and group Multi-vote Act Plan vecka antal dagar v v Väntetider sjukgymnastik Study Do TEST fr o m v 26 Havregrynsgrötsfrukost HYPOTES vecka Ökad effektivitet på dagtid ger kortare väntetid Most problems are found in processes not in people vecka v 20 v 21 v 22 v 23 v 24 v 25 v 26 v 27 v 28 v 29 v 30 v 31 v 32 v 33 v 34 v 35 antal dagar Väntetider sjukgymnastik vecka TEST fr o m v 26 Havregrynsgrötsfrukost HYPOTES Ökad effektivitet på dagtid ger kortare väntetid 5

6 Success is achieved through meeting the needs of those we serve You must be the change you want to see in the world Ghandi Defining Quality Background/Project application The study presented in the report "A national cancer strategy for the future" - SOU 2009:11 Their aim is to go from words into action. Regional Colon Cancer Project. More patient-centered and more cohesive cancer treatment In their improvement work, the region aims to focus on the patient s pathway through health care The approach covers the entire health care chain; from colon cancer prevention to the palliative care, in order to create a whole from the different parts. RCC s promises to the patients All patients with cancer in the region should receive treatment within four weeks Symptoms of the individual All patients with cancer should be offered diagnosis and treatment of Best Practice Diagnosis Measures Treatment decisions Diagnostics=good basis for decision Healthy Symptom Healthy Die of cancer Live with cancer Involvement, making own decisions, Getting feeling safe, being informed, worse symptomatic relief Identifying current patient Relaps/Generalising Prevention within the population All patients with cancer should be informed and involved throughout the entire healthcare chain All patients with cancer in palliative care should receive equally good palliative care services no matter where they live All patients with cancer should be offered the best possible health promotion measures and efficient screening program Regional Cancer Centre South East should prioritize patient-oriented research in oncology 6

7 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Patientupplevt funktionellt status vid första besök efter operation i samband med koloncancer resultat av enkätsvar Sydöstra sjukvårdsregionen 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) jan-jun 2011 (n=15) jul-dec 2011 (n=21) jan-jun 2012 jul-dec /11/2012 Method Research Approach Three multi-disciplinary teams from each county council were formed in order to, together with the patients and relatives representatives, develop and improve the process of colon cancer treatment. The learning part throughout the process begins with listening to the experiences of the patient and relatives and ends with examining the actual needs. The Value Compass will be the measuring instrument throughout the work. The improvement work integrates an interactive learning approach for systematic monitoring i.a. through the existing data records in the open quality registries The researchers contribute with the feedback analysis, the theory and methods for the improvement work. Both quantitative and qualitative data will be used Action plan An action plan has been developed with the following focus areas: Overall/General Development of measurements and performance indicators Patient Involvement Primary, secondary and tertiary prevention Early detection Investigation, treatment and rehabilitation Multidisciplinary collaboration Palliation Each area of the Action Plan has a number of objectives and actions identified. Impact Analysis for a good colon cancer treatment IHI Goal / Objective Our promises to the patients with a colon cancer Good Care Primary Impact What Will be given an adequate treatment within the four weeks time Will be offered the diagnosis and treatment of 'best practice' Will be well-informed and involved in the entire health care chain In the end of their life will be given equally good palliative care regardless of place of residence Will be offered the best possible health promotion measures and effective screening programs Regional cancer center will prioritize patient-oriented research in Oncology Secondary Impact How? Early detection Investigation / Treatment Patient involvement Investigation / Treatment Patient involvement Multidisciplinary collaboration Palliation Prevention Interactive research approach in several aspects of the project Investigation phase Patient and family experiences Palliative phase Prevention Research Promise 1 Will be given an adequate treatment within the four weeks time Functional status / health status Quality of life Agitation / anxiety Survival appetite It is important that we identify the improvement areas locally and that we make sure that they are improvements and not just changes. Coverage ratio Clinical Status main activities Patient/Customer s needs Complications Good care Colon cancer Welcoming attitude Involvement Information Stage after diagnosed Resources / Costs lead time competence hospitalization investigation costs 7

8 Patients with colon cancer Results of the survey related to visits following diagnosis and starting treatment, the proportion of answers: yes, completely South East health district Patients experience Results of the survey related to the visits following diagnosis and surgery of colon cancer South East healthcare region Coverage/Ratio in a Colon Cancer Registry The percentage of planned colon cancer surgery reported in INCA within five months after surgery Percentage of post operative MDK-colon cancer(non-emergency surgery) From INCA-registry South East Health District Ur rapport nr 3 från Kolorektalcancerregistret, perioden jan apr, 2012 Percentage of post-operative MDK-colon cancer (elective and emergency surgery) From INCA-registry South East Health District From diagnosed cancer to the treatment (Diagnosis to the start of treatment) Medianen 80:e perc. Östergötland Jönköping Kalmar Medianen 80:e perc. Östergötland Jönköping Kalmar

9 Antal dagar från diagnos till behandlingsstart Patientcentrerad processkartläggning för Information Patientens fysiska, psykiska, sociala och existentiella behov Undersökning bedömning uppföljning Behandling/ åtgärd Kompetens vilka ytterligare kompetenser behövs i i detta steg? Symtom Första symtom Patient Patientcentrerad processkartläggning för Första kontakt Utredning Patientcentrerad processkartläggning för Beslut om åtgärd Behandling/åtgärd Patient Patient Patient Patient Uppföljning Patient 06/11/2012 From diagnosed cancer to the treatment (Diagnosis to the start of treatment) Reflections of a 59 year-old woman. Colon cancer Koloncancer (n=patients), (n=137 Ostergotland patienter), Östergötlands County Council, län, Diagnosår year of diagnosis :e percentilen=50 dagar Median=25 dagar Jan Feb Mars April Maj Juni Juli Aug Sept Okt Nov Dec It was a very long waiting time for the x-ray results; I had to wait 4-5 weeks I ve met many different physicians This can be very confusing Maybe it would be more efficient if I could have registered a day before the surgery and just stayed at the hospital. Once I should have had my surgery in the morning but I didn t leave the hospital until 5 pm. It s quite tough to be without food for such a long time. Patient s individual preferences Patient s process Patient s context First symptom Patient s context First contact Första symtom Första kontakt How to support these processes Patienters individuella preferenser Undersökning bedömning uppföljning Information Behandling/ åtgärd Kompetens Symtom Patient Patient In our region we have 8 process leaders Palliative care Prostate cancer Head and neck cancer Brain tumor Breast cancer Gynecological cancer Lung cancer Malignant lymphoma Support Coaches Education process leader program Learning by doing Thank you! Pernilla Söderberg Qulturum Jönköping Sweden 9