Hospital Plan 2007 Capital Region

Summary of Hospital for the Capital Region Hospital Plan 2007 Capital Region Summary of the Hospital Plan for the Capital Region Summary of the Hospital Plan for the Capital Region

Summary of the Hospital Plan for the Capital Region

MThe structure of local government in to cope with the challenges of the future. That is why changed in 2007. The reform carried out that year consultations with the professional health-care staff reduced the number of municipalities, but eliminated have played an essential role in the planning process. the counties and instead divided the country into five In the summer of 2006, the region appointed a total within a given district will cooperate to handle the so that any doubts concerning patients dialling the new regions. One is the Capital Region of Denmark, of 40 advisory health care committees. Each advisory hospital-related tasks that arise, thereby ensuring that Danish emergency number (112) can be resolved which formally came into being on January 1st 2007 committee was tasked with assessing the minimum patients receive appropriate treatment and care. jointly by the ambulance team and the triage nurse. when Denmark’s “structural reform” took effect. As of size, and the optimum size, of the population base that date, the Capital Region assumed responsibility each department would serve, and was asked to map holds an exceptional position in Den- The local hospitals do not carry out emergency surgery. for providing the region’s 1.6 million citizens in parti- out and clarify how its own specialty interacted with mark, because as a national hospital it hosts many However, they do have elective-surgery clinics for cer- cular, and in some respects the Danes in general, with other specialties. highly specialiazed functions receiving patients from tain courses of treatment, which offer clinical pathways a hospital system that would be distinguished by its the entire country. However, it also handles a number for a scheduled procedure and follow-up programme, professionalism, cohesion, and good quality of service. During the autumn of 2006 the region’s subcommittee of main functions for the City district. Similarly, and which focus on professional quality and patient on hospital structure reviewed the advice of the com- service. The document summarized here, the Hospital Plan mittees, assessing each specialty individually. Hospital holds a special position because of for the Capital Region, is the first step on the road to The subcommittee’s findings were then compiled into the unique geographical conditions that characterize In order to cope with the anticipated pressure on the creating a truly unified regional health service. a study that analyses the population base for, and the the island of , and while it handles all com- available surgical capacity, which is partly a result of interactions among, the various specialties. mon hospital-related tasks, it is organizationally linked the Danish government’s national one-month treat- The Hospital Plan gathers a wide range of health to Rigshospitalet. ment guarantee, each planning district will make a services in fewer units. The aim of this is to reinforce coordinated effort to plan and distribute the elective- the professional quality of care, and to provide a better The four planning districts surgery tasks among its district hospital and local basis for research and development. All hospitals in the The Hospital Plan geographically divides the Capital Local hospitals hospital(s). region will continue to give research a high priority, Region’s hospital service into four planning districts: Proximity to home is typically a major concern for and those hospitals that host specialized functions will North, Middle, City, and South. medical patients. Each planning district therefore has have special research obligations. One focus area in the one or two facilities designated as local hospitals. District hospitals years to come will be research in the major endemic These planning districts, which are applied in this Each of the four planning districts has one district diseases affecting the Danish population. Hospital Plan and in the corresponding Psychiatry These local hospitals cooperate with the relevant hospital, which handles emergency surgical and medi- Plan, will define the geographical layout of hospital district hospital – which also serves as a local hospital cal treatment. Besides ensuring better patient treatment and care, treatment and care in the future. Citizens living within – to give patients proximity to their own homes and the Hospital Plan will help create an attractive and each of the four planning districts must be ensured a neighbourhoods during treatment and care. The local The location of each district hospital is well suited dynamic working environment for the Capital Region’s uniformly high level of quality and services. hospitals also work closely and constructively with the to its district-wide function in terms of geography and 36,000 employees. We want our facilities to be the local municipal authorities. traffic. The physical framework and capacity of each hospitals of choice for patients and staff alike. Each planning district has a population base of district hospital has a potential for expansion that will 310,000 to 460,000. This volume allows the most com- This means that in the major specialties of internal enable it to handle treatment for the whole district at In November 2006 the Preparatory Committee for the monly occurring illnesses and diseases to be treated medicine, the four planning districts are subdivi- main-function level, and to host certain selected special Capital Region of Denmark reached a consensus on close to the region’s citizens, while maintaining focus ded into smaller catchment areas. Like the planning functions. the fundamental principles upon which the Hospital on providing a continuum of care for the individual districts, the medical catchment areas follow the areas Plan should rest. This consensus crystallized into the and avoiding unnecessary transfers. Each planning of the municipalities and city precincts, enabling the All district hospitals will establish a joint admission regional statements of intent on health policy. These district is equipped to handle emergency services citizens in each municipality and precinct to be linked, for emergency medicine (EM) for the entire planning documents constitute the political framework for the involving surgical procedures, orthopaedic surgery, at least in the first instance, to a single hospital. district. This makes the district hospitals the primary Hospital Plan, and they identify and explain various childbirth and pediatric care, anaesthesia and intensive entry point for patients with illnesses and diseases that considerations that the plan must address. Although care, and medical care in general, including neurology. The local hospitals can receive some emergency require treatment, both for citizens presenting themsel- first and foremost intended to ensure the high quality medical patients from their catchment area, but their ves personally and for citizens whose first contact is of treatment and care, the plan also aims to meet the The planning districts in the Capital Region follow the primary task is to carry out scheduled examinations, through the emergency number 112. The joint AEM demands of various stakeholders for geographical lines of the new municipalities and city precincts as tests, treatments and procedures, sometimes in outpa- functions cover the previously existing emergency- proximity, continuity of care, optimized performance, defined by the structural reform of 2007. The resulting tient settings. room and reception functions, and in accordance with research, development, education, a safe and pleasant changes were necessary in order to create unambi the recommendations from the National Board of working environment, and successful recruitment and guous lines of contact with the region’s citizens, and To continue to offer citizens treatment for emergency Health, each emergency departement is organized as retention of staff. with the municipal partners of the various hospitals. but minor injuries in reasonable proximity to their the only entrance to the hospital for emergency cases . homes, the local hospitals will maintain their emergen- The overarching goal of the Hospital Plan is to create All hospitals in the region – except Rigshospitalet (the cy rooms. These emergency rooms will be open round A district hospital handles all of the district’s emer- the foundation for a hospital service that is equip- national hospital) and Bornholms Hospital – are associ- the clock for patients presenting themselves for care. gency admissions for surgery and medical cases, and ped to deliver high-quality treatment and care, and ated with a planning district. The aim is that hospitals The district hospitals will have a triage function, for births, with one exception: The maternity depart-

  Summary of the Hospital Plan for the Capital Region Summary of the Hospital Plan for the Capital Region

ment for the City district is Rigshospitalet and not Bispebjerg Hospital, which serves A number of the changes in the as the district hospital in other respects. There are also special provisions for the new distribution are self-evident. local hospitals in Gentofte and Glostrup. Besides their local-hospital functions, they The district hospitals must have the 4_VO`X\c 7T[bX]V°a 5RY`V[T©_ will handle certain selected main and special functions in the fields of cardiac and specialties necessary to handle the pulmonary medicine (Gentofte Hospital) and neurology, neurosurgery, and neurore- reception, admission, and treatment habilitation (Glostrup Hospital). at main-function level for citizens with acute illnesses and diseases that Generally, the hospital profiles in the new regional structure are as follows: require immediate treatment. This means emergency surgery, emergency 5NY`[¦` • Hillerød Hospital (local and district hospital for North) orthopaedic surgery, emergency • Helsingør Hospital (local hospital for North) internal medicine (cardiology, pul- 3_RQR[`O\_T .ORD • Frederikssund Hospital (local hospital for North) monary medicine, gastroenterology, 5VYYR_©Q endocrinology,geriatrics, infectious 7X[[Ta°S • Herlev Hospital (local and district hospital for Middle) diseases, and rheumatology) as well • Gentofte Hospital (local hospital for Central) as anaesthesiology and intensive care. Ancillary functions include diagno- 5©_`U\YZ • Hvidovre Hospital (local and district hospital for South) stic radiology, clinical biochemistry, • Glostrup Hospital (local hospital for South) pathology, clinical physiology, and • Amager Hospital (local hospital for South) nuclear medicine. In addition, the .YYR_©Q district hospitals with birthing 5aTSTaXZbbd]S ?bQR_`QNY • Bispebjerg Hospital (local and district hospital for City) facilities must have gynaecology and • Frederiksberg Hospital (local hospital for City) obstetrics and a paediatrics depart- • Rigshospitalet (highly specialiazed function hospital) ment with a neonatal function.

3_RQR_VX``b[Q 9f[TOfANN_O¦X -IDT • Bornholms Hospital (local hospital for the island of Bornholm) 2TRQNY 3b_R`©

4R[a\SaR 4YNQ`NeR Pre-hospital care /NYYR_b] 5R_YRc 6T]c^UcT 7Ta[Te One aim of the Hospital Plan is to ensure coherence and cooperation between the "YEN Capital Region’s daily emergency care and medical preparedness in generel. 8©OR[UNc[ Emergency care include patient access to the emergency call number 112 and the 4Y\`a_b] on-call general practitioners’ services. Emergency care also includes the Emergency ?©Q\c_R .YOR_a`Yb[Q 3_O Medical Dispatch center, Emergency Medical Services (EMS), and the Major Incident 6[^bcad_ Command Center (MICC). The MICC is in charge of command and control in case 0\PVTa of a major incident and liaise with police and rescue services. The chief emergency /_©[QOf 5©WRANN`a_b] 7eXS^eaT physcician is in charge of all medical care at scene. As part of the hospital plan all The specialties within internal CNY YR[` 5cVQ\c_R emergency planning is going to be handle in an integrated medical dispatch center. medicine, in particular, must retain 6`U©W O¦X The Hospital Plan will be supplemented with a special plan for the Capital Region’s the right to organize themselves A¥_[Of contingency services and pre-hospital care. differently depending on local 1_NT©_ conditions and functions, including 3YD the composition and volume of their Allocation of specialties among the hospitals specialties. This means that the inter- in the Capital Region nal-medicine functions can either be 1Xb_TQYTaV organized in independent depart- The Hospital Plan merges a large number of specialties into fewer units. The ments for each relevant specialty, or /V`]R ¢`aR_ "YEN /_©[`U©W OWR_T new allocation of specialties reflects the Capital Region’s new division into more be grouped together in departments 5b`bZ O_\ ;©__R sustainable planning districts, resulting in a new between the district hospitals and as appropriate. O_\ AXVbW^b_XcP[Tc local hospitals. Functions marked off in Table 1 CN[Y©`R 5aTSTaXZbQTaV indicate that the specialty is covered It also reflects the region’s general wish to gather the specialties in fewer locations at the hospital in question, not that 3_O 6[Q_R /f with the aim of ensuring a high and uniform quality. The specialties are distributed it has its own independent depart- /\_[U\YZ .ZNTR_ among the region’s hospitals as set out in the table below. ment. Each planning district will ensure the professional coordination CNYOf CR`aR_ ¢`a 1^a]W^[\ O_\ The specialties fall into two among internal-medicine specialties .ZNTR_ categories: Main functions, which include the most common interventions within by setting up cooperation forums 3YD CR`a 0\PVTa the given specialty, and special functions, which include rare, expensive and/or with participation from the relevant complicated interventions. hospitals.

  Summary of the Hospital Plan for the Capital Region Summary of the Hospital Plan for the Capital Region

Table 1. Allocation of specialties among hospitals in the Capital Region Basically, each special function in the region will be brought together at a single North Central City South location. Rigshospitalet will handle much of the highly specialized treatment, but other hospitals in the region will also offer specialized treatments in certain selected specialties. For some special functions the number of patients will be so large that it may be necessary to allocate these functions to two hospitals in the region. Con- versely, it is true of certain main functions that patient volume indicates it would be suitable to centralize treatment, concentrating it at no more than two (or three)

Hillerød Helsingør Frederikssund Herlev Gentofte Bispebjerg Frederiksberg Hvidovre Amager Glostrup Bornholm Rigshospitalet hospitals in the region.

Emergency care Functions that are handled at two of the region’s hospitals will preferably be located Trauma centre at one hospital in the North or Middle planning district and one hospital in the Emergency Room South or City district. Birthing location Internal-medicine functions The allocation table also shows that some hospitals will handle certain specialties Endocrinology as “external” or “satellite” functions. An external function is one that is handled Gastroenterology at special-function level or main-function level by staff (often medical specialists) Cardiology from another physical location. Such an external function can be based either on a Pulmonary medicine fixed schedule or on an ad-hoc arrangement with supervision or consultation called Infectious diseases upon as needed. A satellite function is one that is handled at special-function level Geriatrics by the hospital’s own staff, but is under the responsibility and supervision of a Rheumatology corresponding specialist department at another physical location. One example of a Nephrology satellite function is dialysis. Haematology Surgical departments Surgery (gastroenterological procedures) Vascular surgery Consequences of the new structure Plastic surgery The Hospital Plan will mean that the neurorehabilitation functions existing today at Thoracic surgery the locations in Esbønderup and Hornbæk will be transferred to other hospitals in Urology the region. This may enable the region to sell these two locations. Mammary surgery Paediatric surgery All of the functions existing at the location in Hørsholm in 2007 will gradually be Orthopaedic surgery transferred and integrated into the other hospitals in the region, freeing up the Other clinical specialties/functions physical location for use by the Capital Region’s psychiatric services. Gynaecology and obstetrics Paediatrics Clinical oncology Neurology Financial issues Neurosurgery The aim of the Hospital Plan is to enable the region to optimize performance and Dental, oral and maxillofacial surgery effectively utilize the financial resources employed. Overall, bringing the functions Otorhinolaryngology together at fewer locations will result in operational savings, and simplifying the Audiology administrative and managerial organization will liberate resources that can be used Ophthalmology for clinical work. Dermatology – venerology Allergology In financial terms, projections say that when fully implemented the rationalization Occupational and environmental medicine efforts embodied in the Hospital Plan may lead to savings in the range of DKK Palliative unit 250–300 million per year. Dementia unit Interdisciplinary specialties A precondition for implementing the Hospital Plan is that significant investments Anaesthesiology are made in reconstructing and adapting the existing buildings and installations to – intensive-care unit suit their future use. This is particularly true of Rigshospitalet and the four district Pathological anatomy and cytology hospitals, where major investments will be needed to achieve an appropriate func- Diagnostic radiology tionality and size. Clinical biochemistry Clinical microbiology The capital investments expected to arise from the changes outlined in the Hospital Clinical pharmacology Plan total roughly DKK 13 billion, distributed over a period of several years. About Clinical physiology and nuclear medicine two-thirds of this amount arises directly from the restructuring stipulated in the Clinical genetics plan, while about one-third is associated with necessary and, in some cases, planned Clinical immunology renovations that would, and will, have to be completed in all events. *) For internal medicine at the local hospitals, the presence of specialist doctors in the internal-medicine function is marked. **) Tasks at special-function level must subsequently be allocated between or among departments.   Implementing the Hospital Plan

The Hospital Plan cannot be implemented all at once. Some of the changes sketched out in the plan call for reconstruction and adaptation of existing physical facilities at the locations in question. Furthermore, relocation will sometimes involve several departments in an interlinked process – since one department must be moved out in order for another to move in.

The Capital Region aims to implement the Hospital Plan as quickly as possible, both out of consideration for the region’s citizens and, no less importantly, out of consideration for the many hospital employees who will be affected as the new structure takes shape.

The region expects to implement most of the Hospital Plan between 2007 and 2012.

Management and employees

The Capital Region appreciates that implementing the Hospital Plan is a complex process. Reallocating specialties and reorganizing the cooperation between hospitals, the plan will bring wide-ranging changes for many of the region’s employees with respect to their job content as well as their physical working location, colleagues, and management. This will place great demands on the employees, while significantly increasing managerial and administrative challenges in the years to come.

The Hospital Plan includes a series of general, staff-related initiatives aimed at ensuring flexible transitional arran- gements during the reorganization process. These initiatives also aim to ensure professional, high-quality handling of hospital-related tasks throughout the planning period. They are likewise intended to promote the growth of a common culture and a shared identity across all four planning districts, thereby ultimately strengthening regional coherence.

Cappital Region Kongens Vænge 2 - 4 3400 Hillerød

Telefon: 48 20 50 00 E-mail: [email protected] www.regionhovedstaden.dk