**WP5&WP10 - Project Integrate...Service stas,cs Promo,ng learning | Developing guidance | Sharing ideas FINDINGS (2mins), Norrtalje Integrated health and social care organisaon Aligning

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Promo,nglearning|Developingguidance|Sharingideas

ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentand

demonstra,onundergrantagreementno.305821www.projec,ntegrate.eu

Coordina,ngcareforpeoplewithmentalhealthchallengesandtheircarers(WP5)

John Øvretveit, Director of Research, Professor of Health Innovation and Evaluation, Karolinska Institutet, Stockholm, Sweden


Context:HealthcareandSocialservicesinSweden

Healthcare Socialservices

•  Taxfundedsocialservices•  Municipali,esalsoboth

purchasersandprovidersofsocialservices.

•  Tax-funded•  Coun,esbothpurchasersandprovidersofhealthcare.

Stockholm

• Governmentreformsforprivateproviders(e.g.primarycare)

Coun,es(21) Municipali,es(290)

Specialiststhrough:• Referralsfromfamilydoctor• Emergencydepartment


METHODS(1min),

  Casestudy  Documents:legalforma,onofTioHundraAB,plans,minutes,consultancyreports  Interviews  Servicesta,s,cs


FINDINGS(2mins),

NorrtaljeIntegratedhealthandsocialcareorganisa;onAligningcultures–  Differentviewsaboutcompetenceandwayofworking.–  Interven,onsforbe`ercommunica,on.–  jointbudget–  Internalrealloca,onoffundingpossibleInformalagreementsReduction of in-hospital care   Clinical outcomes, patient satisfaction = comparable to national averages Increased staff satisfaction Increased costs because of successful recruitment of professionals  Challengeincoordina,onwithexternalservices


DISCUSSIONincllimita,onsect(2mins).

Norrtalje External threat and previous history of collaboration Structural and financial integration enables intended changes to be carried out

–  New joint units bringing together health and social services – co-location of services

Cultural integration –  Shared forum –  Education –  Shared planning and care management


FINDINGS-2(2mins),Sodertaljecoordinatedcarenetworkmodel

Standardisation –  Needs assessment – CAN –  Care planning and follow-up

  Real staff behaviour change towards collaboration Client-inclusive practice à quality of care Outcomes: Higher independence and coping scores (CAN) Costs and quality

–  Quality Higher than national average –  Rapid access to outpatient care –  Low inpatient care utilisation

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CONCLUSIONS

  Norrtälje: top-down – merger removing barriers   Södertälje: bottom-up – network overcoming barriers

  ”Purchaser integration” – contracts push   ”Provider integration” – professional pride pull

  Patient/client integration – choice personalised health systems

Surprises?







Suppor,ngcarecoordina,onwithdigitalhealthtechnologies(WP10)

John Øvretveit, Director of Research, Professor of Health Innovation and Evaluation, Karolinska Institutet, Stockholm, Sweden


CONTEXT

Ourpreviousresearch Mostsafety&qualityproblemsarecommunica,on-related DHTgreatpoten,alforimprovingcommunica,on &fordamagingcommunica,on:

–  replacefacetofaceverbal-lost,unauthorisedaccess,toomuchunstructuredinforma,onmakeitdifficulttofindwhatyouneedquickly


METHODS(1min),

CasestudiesofDHTsuppor,ngICschemes2015  2SwedenmentalhealthICcases  1SpainBarcelona“hospitalathome”caremanagementscheme(outreach)  ReportsfromFP7teamsTilburg(diabetes)andBerlin(geriatrics)onHITsystemsintheirICexamples  Interviews;documentanalysis;surveytoTilburgandBerlin  RapidreviewofDHTsupportforIC


FINDINGS(2mins),

  EMRnotEHR(shared)andlimitedaccess/linking;  Pa,entPortalsbeginningbutnotused  Pa,entsbewildered-whysofarbehindotherservices-  egwhycan’twesendemails?-  Whyaskingmeallthisagain-worriesme. StaffresignedtoITprovider-centeredsystemsunder-designedforusers  Noremotemonitoringortelemedicine–faxandphone  Theseareadvancedexamples,

–  publicservices/systems–Swedeninvestmentininfrastructure–  Butpublicserviceskillsandaltudesandsecuritypreoccupa,on

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DISCUSSIONincllimita,onsect(2mins). Currentfunc,oninglimited; Planstodevelopovernext5yearsLocal,Na,onalandEU MorePa,entandclinicianfocusbo`omupbalance  ITdepartmentsunder-resourced(security);under-skilled;under-designed;lackofagreedstandardsforEHRandcomms;lackofinvestmentusinguserdesign Technicalchallengesbutprivacy/securitybecomingthegreaterchallenge


CONCLUSIONS–10recommenda,ons

1 Ensurepa,entsareatthecenter,withachoiceofrole2 Financing–pursuefasterreform3 Reachagreementabouttechnicalstandards4. Privacy–updatelawsandprocedurestogettherightbalance5  Developpoli,calprocessestopreventinnova,onbeing

blocked(autonomy,workredesign) Surprises?


FINDINGS(2mins),

SwedishHITprac,ces:cardlog-ins;EMRaccessauto-auditedmonthly;na,onal/localflexibilityforPHRdevelopment(plaoorm);strategy;qualityregisters

BarcelonaandCatalonaHIT:HIEnetworkforEMRs;localintegra,onofHITintohospitalsystemandPHClinking


