Healthcare System in Sweden –

Integrated Care Model and Patient

Centered Approach

Göran Henriks, Chief Executive of Learning and

Innovation, Region Jönköping County

Why activation

Autonomy and authority

Gadamer´s definition –

health is ”that you in joy can be occupied

with your own life tasks”.

Ejje https://vimeo.com/55094566

For 350,000 citizens

• Jönköping County is the geographical catchment area, with just over 350,000 inhabitants.

• 3 Centers for specialty care (hospitals)

• 46 care center

• 16 familycenters

• 30 dental care centers

Rehabiliteringscentrum

“Re-framing is the most important

skill for a leader”

Brenda Zimmerman

Schulich School of Business

Toronto

equal heath and a active life that enables

meaningfulness

We need to increase our efforts to support in the river of life

Our success is measured

in lives and health

Ve

rsio

n 2

01

7-0

2-1

6

Value = A x TQ + SQ waste

Make co – creation and co- learning to the way we think and work

Levels of government

The Parliament

• legislation

• economic steering measures

The County Councils (n=21)

• health and medical care

The Municipalities (n=290)

• social service and medical care

• in ordinary and special housing,

Medical doctors omitted

Access to social service: political

Access to health care: profession

Demographic factors in Sweden 2018

Population size (thousands) 10 128

Share of population over age 65 (%) 20

Population projections for people 65 years and older Per 100 000 inhabitants

65 -74 years

≥75 years

https://www.weforum.org/agenda/2016/11/8-

predictions-for-the-world-in-

2030?utm_content=buffer2a7fd&utm_medium=social&

utm_source=twitter.com&utm_campaign=buffer

• All products have become services

• There is a global price on carbon

• US dominate is over. We have a handful of global powers

• Farewell hospitals, hello home-spital

• We are eating much less meat

• Today´s Syrian refugees, 2030 CEO:s

• The values that built the West have been tested to

breaking point

• By the 2030s we´ll be ready to move humans to the red

planet

Predictions for the world in 2030

2013 2014 2015 2016

Women 89 88 87 88

Men 86 86 84 79

Total 88 87 86 83

% of students that are directly relevant to “High school program

*Excluded from society: someone who is NOT an integrated,

economically active citizen

The school - a major reason for early exclusion

from society* Failure at school means a 4-6 times higher risk to exclusion

from society

50 -100 children/year in Jönköping

Everything is connected

Prevention

work Prioritize

school

Agenda

2030 Sustainable

development

Commis-

sions Social

sustainability

Sustainable

development

addiction,

dependence

Mission

mental

health

LfR

Social services

Better life

for ill elderly

Patient-

safety

Reference:SALAR, www.skl.se

Everything is connected

Prevention

work

Prioritize

school

Agenda

2030

Sustainable

development

Commis-

sions

Social

sustainability

Sustainable

development

addiction,

dependence

Mission

mental

health

LfR

Social services

Better life

for ill elderly

Patient-

safety

Students in

Grade 5:

Teachers in my

school takes

consideration

to students'

opinions, share

(%)

Source: SALAR

Residents 17-

24 years who

neither study

nor work,

share (%)

Good and

Equitable

Health

Best

possible

Quality

Reliable

Sustainable

Remaining life

expectancy at birth (men

and women) region-

municipality/year

Strategy for health – being best in becoming better 22 aims and indicators

Chronic diseases

80% preventable

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

Outpatient visits 2011–2014

Fredrik Högberg 13 maj 2018 19

Inpatient care in hospitals

Hospital Home Care

Primary care

Municipal health and

medical care

Social care

Michaela Prochazka_National Board of Health and Welfare

Unplanned readmissions within 30

days among the elderly

Easy to come in easy to get out

• Dörr här

Taking ”self-management” to the edge

Patrik Blomqvist, patient supporter Eje Grennborg, rehab instructor

New ways of making the consultations

Koloncancerprojekt

The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival

Referens Patrik Sundström

Care

Care as a distance- and imaging business

Dependent

Independent

Co-dependent

Single Integrator

Independent Co-

Source: Stephen Covey and Bill Tolbert, Adapted by Dave Ford

Multiple Co-Integrators:

A modernized Municipality Model

Vertical Integration

Horizontal Integration

O

w

n

e

r

s

h

i

p

Vision, Principles, Collaborative, Trustable

meeting places

Challenges Vertical or Network Model?

Network Model

Business model

Today

Redesigning our welfare system

From patient in the center to co-creation

From reactive to proactive management

Beyond todays patient records

Earlier

To work with the work in new ways

Not everything that is faced

Will change

But nothing will change

That is not Faced

How to work with the work?

Change the

whole culture

of the

company

Change the

attitude of

individuals

Change

behaviour

Nya arbetssätt

metoder& verktyg New way to work and to use methods and tools

”We act into a new way of

thinking”

Reference: Norman, API

Value models

Mean-HbA1c mmol/mol, 2013.

Röda har varit

med i IQ-

programmen.

Bergeling, Eriksson, Bergelin, 2017

Average time for hip replacement surgery

Goals – High Quality Health Care -IOM

• Knowledgebased. Should be based on best and latest knowledge, it should be based on research result and best practise.

• Safe. Should be safe. Risk management procedures shall prohibit events and injuries. The health care shall be according to rule of law.

• Patient centered. Shall be given with respect for the specific needs of the individual, his/hers expectations and integrity. The Individual shall be given the possibility to participate in the planning of his/her own health care.

• Fairly distributed (Equal). Shall be provided and distributed under the same conditions for everyone.

• Available. Shall shall be available and given within reasonable time.

• Resource Efficient. Resources shall be used in the best possbile way and be available for the whole population

God vård: enligt Socialstyrelsen

Different areas of diseases With specialist representing different regions

National Joint Action Groups

Future

Medical record Decision support , follow up and research

Other type of data

Patient reported data

Biobank

National

Health

Data

Registries

Selective implementation

with systematic follow-up

Clinical studies,

including RCT.s

Systematic

reviews /

guidelines

Pre-clinical

research

Implementation in

clinical routine,

nationally and locally

Knowledge based health care

Role for Quality Registries

Outcome research

Clopidogrel

Utbildnings-

period

Resultat

Mätning innan

projektstart

Clopidogrel

Utbildnings-

period

Resultat

Mätning innan

projektstart

ClopidogrelClopidogrel

Utbildnings-

period

Utbildnings-

period

ResultatResultat

Mätning innan

projektstart

Mätning innan

projektstart

Follow up of outcome and side-

effects in clinical routine,

nationally and locally

Types of technologies in the social services, in

the older persons’ own home

0

10

20

30

40

50

60

70

80

90

100

Social carealarms/sensors

Planningconference with

video

Gps-alarms forsocial care

Electronic locksto the elderly

home

Camerasurveillande,

night time

Medicinereminder, and..

Camerasurveillande,aynight time

Other

Pro

po

rtio

n o

f m

un

icip

alit

ies %

2016 2017Source: Socialstyrelsen.

Change the Balance of Power

• Ryhov Hospital in Jönköping had traditional hemodialysis

and peritoneal dialysis center.

• But in 2005, a patient, Christian, asked about doing it

himself.

Update

• Now calculated costs at 50% of costs in other

hemo-dialysis units

• Complications dramatically reduced and

subsequent expensive care avoided

• Measuring success by “number of patients

working”

2009 2010 2012

Patrik

From patient to employed

From patient to patient support

https://vimeo.com/163250855

Malin Wengholm, Regionråd