Jönköping County Sweden Jönköping Eksjö Europe Värnamo A good life in an attractive region © Göran Henriks Jönköping County Council www.lj.se/qulturum From my bedroom?…No, no but close! © Göran Henriks Jönköping County Council www.lj.se/qulturum International Integrated Care Summit Lessons from Sweden: The Esther Project “Look up” not up But out – start a movement of new integration! © Göran Henriks Jönköping County Council www.lj.se/qulturum • How can we, all together, develop something called Horisontal Best Practice? © Göran Henriks Jönköping County Council www.lj.se/qulturum It is the result of the whole systems that counts.. How can I do the best for the patient and facilitate for my care neighbour? Traditional Exampel 1: Traditionell PatientPatientfokuserad focused "funktionell"”functional” Esther ”activities"aktiviteter and part och of delprocesser processes organizedorganiserade after prioritated efter patient prioriteradevalues” patientvärden" Pharmacyapotek 6 municipalitieskommuner (6) Investigate Diagnosis & desitionRehabilitation Prim. care about care/P.c. Prim. care and hospital Esther 6 primaryPV-områden care units (6) Patient pat with treatm disease finished HöglandsjukhusetHospital in Eksjö Medicin E R Rehab Lab Pat asks for treatment Treatment Rehabilitation © Göran Henriks prim. care hospital hospital Municipality Jönköping County Council www.lj.se/qulturum ” Esther and a Better life for elderly’’ a lot of opportunities for improvement and redesign © Göran Henriks Jönköping County Council www.lj.se/qulturum Does it matter for Lilly? ”More days with energy, happiness and vitality”. ”You listen to my needs and together we find out what is important for me”. ”We put focus on preventive actions”. Ref Susanne Lundblad, Senior Alert Lilly, 95 © Göran Henriks Jönköping County Council www.lj.se/qulturum • To find and ”love” the day – Carpe diem © Göran Henriks Jönköping County Council www.lj.se/qulturum See the individual every time Safe care is for me.. - Knowledgeable - Meetings with professional people and feel that I'm welcome -To have a key relationship - Be seen for who I am - A personal approach - Have a linkage to life Book: ”A Taste of Water” © Göran Henriks A Jönköping County Council www.lj.se/qulturum A poet Tomas Tranströmmer wrote Further In On the main road into the city, When the sun is low The traffic thickens, crawls It is a sluggish dragon glittering. I am one of the dragon’s scales. Suddenly the red sun is right in the middle of the windshield streaming in. I am transparent and a writing becomes visible inside me - words in invisible ink That appear when the paper is held to the fire! © Göran Henriks Jönköping County Council www.lj.se/qulturum Further in I know I must get far away straight through the city and then further until it is time to go out and walk far in the forest. Walk in the footprints of the badger. It gets dark, difficult to see. In there on the moss lie stones. One of the stones is precious. It can change everything It can make the darkness shine. It is a switch for the whole country. Everything depends on it. Look at it, touch it… © Göran Henriks Jönköping County Council www.lj.se/qulturum “You can not visit a world you do not have a language for.” Ludwig Wittgenstein © Göran Henriks Jönköping County Council www.lj.se/qulturum Involvement, individualisation, integration, Innovation and information and fight isolation • 5 I:s fight Isolation and fragmentation © Göran Henriks Jönköping County Council www.lj.se/qulturum A redesigned knowledge This Sets our minds free management, financial management but also the patient’s management Creating Shared Value We get the care we need when we need it Costs © Göran Henriks Jönköping County Council www.lj.se/qulturum Managementsystem in the County • 13 basic values • Vision and mission • 6 overall strategic aims • A systemmap • A map of the patients process • Balanced scorecard • Patiens safety annual plan • System to obtain information • 6 strategic improvement areas • Actionplan for improvement work © Göran Henriks Jönköping County Council www.lj.se/qulturum ÖvergripandeTotal index 104index indicators ÖJ © Göran Henriks Jönköping County Council www.lj.se/qulturum The overall Trippel Aim Processer Befolkning/patienter Ekonomi © Göran Henriks Jönköping County Council www.lj.se/qulturum Inhabitants/patients © Göran Henriks Jönköping County Council www.lj.se/qulturum Munici- Average Percentage of Percentage Percen- Children Percen- Percen- pality days on 19 years old of 4 year tage of per 1000 tage of tage of sick without dental olds with pregnant births inhabitants inhabitants leave caries overweight women with low with good with high (paid 2008 and obesity smoking birth self- alcohol sick Born 2002- 2006 weight perceived consumpti days) 2004 2005-2007 health on (W/M) July (W/M) 2009 Jönköp- 31,5 30%-53% 14,6% 5,8% 32,7 65/73 7/14 ing Habo 28,4 35% 12,9% 9,2% 21,6 73/74 6/15 Mullsjö 37,7 30% 16,4% 9,6% 28,1 73/67 7/14 Tranås 39,0 42% 12,6% 9,1% 20,3 69/73 7/22 Aneby 34,5 48% 16,3% 10,9% 58,8 68/70 7/13 Eksjö 35,0 48%-59% 13,8% 9,3% 22,8 67/70 5/14 Nässjö 35,4 28%-30% 13,9% 9,8 % 21,7 68/75 6/15 Sävsjö 35,2 41%-54% 12,5% 8,4% 20,4 70/67 8/8 Vetlanda 33,4 35%-42% 15,8% 8,8% 39,2 72/73 9/14 Gislaved 31,3 33%-35% 16,9% 13,6% 33,8 71/73 7/14 Gnosjö 29,2 29% 15,8% 8,9% 32,9 74/72 10/12 Vaggeryd 29,0 28% 14,3% 6,7% 35,6 72/70 9/14 Värnamo 26,7 27-38% 15,3% 8,8% 23,4 76/75 5/11 © Göran Henriks CountyJönköping County Council32,0 38% 14,7% 8,1 30,1 70/73 7/14 www.lj.se/qulturum Sweden 34,1 -** - 7,5 31,1 67/69 10/16 Mothers that smoke while pregnant (in procent) 9,7 9,7 9,1 8,5 6,3 5,2 8,2 10,5 8,6 13,7 8,1 12,9 7,6 5,7 8,1 12,6 8,2 11,5 6 9,8 9,4 9,2 8,9 11,6 8,8 6,3 8,7 11,1 9,5 8,7 12,2 12 11,9 9 Andel (%) rökande bilvande mödrar 7,3 5,2-8,1 (10) 12,6 8,2-11,5 (19) 5,5 11,6-14,1 (9) 14,1 © Göran Henriks Jönköping County Council www.lj.se/qulturum Singapore •Few young •Few elderly Sweden •Few young •A lot of elderly USA •Many young •Elderly © Göran Henriks Jönköping County Council www.lj.se/qulturum We are in Sweden: 2011: 1.75 million people over 65, approx 800 000 over 75 2020; 2,1 million people over 65 och 995 000 over 75 ’’In a European perspective Sweden are in the top in self perceptive health among people over the age 85’’ Resource;Salar © Göran Henriks Jönköping County Council www.lj.se/qulturum Amount of hospital days/year for the most ACG heavy patients © Göran Henriks Jönköping23 County Council www.lj.se/qulturum A new”mindset” From planning and talking to… it is the systems results that counts in a complex content © Göran Henriks Jönköping County Council www.lj.se/qulturum Challenge Vertical or Network Model? Singel Integrator Businessmodel Many Co-Integrators: O Co - dependent A modernized Municipality Model w n e r Independent inter Independent s h i p Dependent Horisontal Integration Network Model Vision,Vertical Principles, Integration Collaborative, Trustable Arrangements © Göran Henriks Jönköping25 County Council Source:www.lj.se/qulturum Stephen Covey and Bill Tolbert, Adapted Gaps challenges but also opportunities • Public health and prevention • Integrated care elderly, children, chronic care • Primary care reform – Inhabitant choice • Advanced access • Individualization • Reliability and “Open comparison” • Patient safety • Practice to research and back © Göran Henriks Jönköping County Council www.lj.se/qulturum Involvement, individualisation, integration, Innovation and information and fight isolation • 5 I:s fight Isolation and fragmentation © Göran Henriks Jönköping County Council www.lj.se/qulturum Order your chlamydia test over the web! - To reach young people - The amount of men that do the test should increase compared with men at the hospitals office - Easy reachable from our web. - Do a good design in marketing that support the new way. © Göran Henriks Jönköping County Council www.lj.se/qulturum Safer Care with eHealth as a method In logged as Dr Test Testman Planned preventive actions on the web site: ”My Healthcare Contacts” © Göran Henriks Jönköping29 County Council www.lj.se/qulturum Safer Care with eHealth as a method In logged as Dr Test Testman Start Your answers Completed actions © Göran Henriks Jönköping30 County Council www.lj.se/qulturum © Göran Henriks Jönköping County Council www.lj.se/qulturum © Göran Henriks Jönköping County Council www.lj.se/qulturum A Care preventive process Using evidence-based instruments for each patient ≥ Patients at risk are 65 years to diagnose investigateed and a plan risk of pressure sores, for preventive measures malnutrition or fall All patients registered in Evaluation of results the registry - Senior Alert - is done in a clinical which is available in all registry - Senior alert hospitals, primary care and in the municipality . © Göran Henriks Jönköping County Council www.lj.se/qulturum John is a patient with the risk of falling. He has a plan with preventive actions Risk assessment, preventive actions and outcomes are registered in the clinical register “Senior alert”. This is done by professionals at the ward, homes for elderly etc; in the healthcare (hospitals, primary care) and in the community.