It´s All About People: Goran Henrik`s plenary presentation at the Jönköping Microsystem Festival

The Microsystem Festival March 1–4 2016
plus.rjl.se/microsystemfestival
IT’S ALL
ABOUT
PEOPLE
The Microsystem Festival
1 4 March 2016
Jönköping Sweden

#qmicro @Goran Henriks
Please see me
https://www.youtube.com/watch?v=380MiMDoddI&app=desktop

RJL fantastic
colleagues…
in different
microsystems
They love their work as complexists and futurists

It´s all about people
http://www.iorahealth.com/

It’s a whole new patient experience
Ref: Andrew Allison, Andrew Schutzbank www.iorahealth.com
Iora changes primary care as we
know it.
“Our care team, which includes a
dedicated advocate for each
patient, works together to treat
the whole person.
We see people when they’re sick,
but also when they’re well, so
that we can keep them healthy.
Here, the environment is caring
and patients have a voice. It’s our
job to give them everything they
need to live happier and
healthier lives”

Our technology is designed around patients
Most medical record systems
prioritize billing first, patients
second. Ours is designed around
patients, period. We created our
collaborative care platform to
support caring for the whole
person, and we’re always
improving it based on feedback
from our care teams and their
patients — recent updates
include patient access to their
own records and a place to share
notes. We’ve also built a tool to
manage not only an individual’s
health, but an entire population’s
A new kind of business
intelligence!

2016-03-02 QULTURUM
Patient’s record
Clinical databases
Care taker and care giver
KConnect – search motor
Health on the Net Foundation
University of Sheffield

IT’S ALL ABOUT PEOPLE
realistic medicine and reliable services
Ref: Dr Catherine Calderwood, MA, Cantab FRCOG FRCP Edin, Chief Medical Officer for Scotland

The festival
A tribute to people´s health and reliable care
Signed Sealed Delivered
Health for life
Radical
individualism
and social
trust

Topics and meeting places at the festival - A tribute to people´s care
Health for life
Radical
individualism
and social
trust
The ward round
as a part of
a learning HC
system
Safer healthcare for the real world
People power –
Improving inpatient
care at Sheffield
People make the difference – Esther coaches
Patients as peopleFolkslab
The scale-invariance
of resilience
Empowerment of users/patients and families

Topics and meeting places at the festival - A tribute to people´s care
Health for life
Radical
individualism
and social
trust
The ward round
as a part of
a learning HC
system
Safer healthcare for the real world
People power –
Improving inpatient
care at Sheffield
People make the difference – Esther coaches
Patients as peopleFolkslab
The scale-invariance
of resilience
Empowerment of users/patients and families
Better people – better carePatient as Partner
Integration at the level of the individual – personalized care
Being a
change agent
takes personal
resilience

A tribute to co-learning
From Armenia, Canada, China, Denmark, England,
France, Netherlands, Italy, Singapore, Switzerland,
Sweden Slovenia, USA

The festival as Peters café, the Azores
Curiosity and back-casting
Ideas
Best examples
NetworkingBackcasting

Purpose
Syfte
 Varför finns
vi till?
 Vilket värde
ska vi skapa?
People/
medarbetare
 Hur nyttjar och
tillvaratar vi
medarbetarnas
kompetens på bästa
sätt?
 Hur involverar vi
dem mer i
utvecklingsarbetet?
 Hur ökar vi
medarbetarnas
förståelse för sin
uppgift?
Processer/
flöden
 Hur lär vi oss
mer om våra
processer?
 Hur använder vi
oss av resultatet?
 Hur blir vi bättre
på länkning?
Patterns/
mönster
 Hur
utvärderar vi
variationer i
det kliniska
arbetet?
Att kartlägga, reflektera, samtala och försöka systematiskt förbättra
MMMiiikkkrrrooosssyyysssttteeemmmeeetttsss fffeeemmm PPP
Patienter
 Vilka är de?
 Hur väl känner vi
deras behov?
dem mer?
P
GS
A
Väntetider sjukgymnastik
0
2
4
6
8
10
12
14
16
18
20
v20
v22
v24
v26
v28
v30
v32
v34
vecka
antaldagar
Seven Question show the Way
We
share
and
learn

Co-creation and co-production
• ….meet the real needs
• Personalising the service to improve safety
• Increasing personal responsibility
• Distributing competence so works increases
• Reducing waste and costs
Swedish National Board of Health, 2012,
To give the word and open the space for individuals

• Embrace the
digital
• Include the citizen
• Learn to combine
these two…
Sir John Oldham
National Clinical Lead for Quality &
Productivity, Department of Health,
England

2015: 1539 tweets
2016: We build
a new foundation
of competence
– Personalized
Realistic Medicine
Purpose
Syfte
 Varför finns
vi till?
 Vilket värde
ska vi skapa?
People/
medarbetare
 Hur nyttjar och
tillvaratar vi
medarbetarnas
kompetens på bästa
sätt?
dem mer i
utvecklingsarbetet?
 Hur ökar vi
medarbetarnas
förståelse för sin
uppgift?
Processer/
flöden
 Hur lär vi oss
mer om våra
processer?
 Hur använder vi
oss av resultatet?
 Hur blir vi bättre
på länkning?
Patterns/
mönster
 Hur
utvärderar vi
variationer i
det kliniska
arbetet?
Att kartlägga, reflektera, samtala och försöka systematiskt förbättra
MMMiiikkkrrrooosssyyysssttteeemmmeeetttsss fffeeemmm PPP
Patienter
 Vilka är de?
 Hur väl känner vi
deras behov?
dem mer?

Three cities learn together about immigration over a weekend
24 hours exploring design and new ideas
Learn from many at the same time
1,200
20,000

The Imagination Age
Imagination Age
Adapted from:
How economic value emerge?!

Emotional nudging and adaptive moves
Princess Madeleine – ambassador for vulnerable children, World Childhood Foundation,
https://sv.wikipedia.org/wiki/World_Childhood_Foundation
“ I want to be a
prince/princess”

One second from Swedish talk show Skavlan,
http://www.svtplay.se/skavlan

We cannot wait – it´s time
Reaching extraordinary results
how to provide real help faster
• Improving capability
• Value readiness
• Adaptive moves
• Preface importance
Ref: Edgar Schein and Marjorie Godfrey
• Embrace the digital
• Include the citizen

Often a VUCA world for many
Changes in the world challenge us and
hinder positive imaginations
Source of diagramme Tony Loyd https://www.linkedin.com/pulse/masters-vuca-universe-tony-loyd

2016-03-02
20 – 40 – 160, 14-15 million + 4-5 million

A sea of shoes in Place de la Republique, Paris
Protests are
banned
here so you
have to
imagine
them
Source:
David Shukman

The Matrix – the system and training program

Matrix is a computer system that provides
people's minds with a false world
so that they will not be aware that their bodies
actually lie motionless in incubators and
generate energy to the machines
A “negative” intelligence explosion

Autonomy and authority
When learning becomes health - any time require its translation into the reality I'm in

High Social reliability develops when
you yourself can:
1. maintain your health
2. keep your influence
3. develop my skills and our skills
4. receive impartial treatment
5. create meaning in life
Integrity, influence, competence, impartiality and
meaningfulness
Merlina Missimer, institution for strategic reliable development, Blekinge
Tekniska högskola

2016-03-02
I have access to the care I need

2016-03-02
There are reasonable waiting times at the care centers

2016-03-02
My trust for the health and care centers in my region

2016-03-02
Overall trust for health and care services in your region

2016-03-02
Your impression as a whole – largest amount of positive
answers in the whole of Sweden: Rydaholm

2016-02-09 Regionlednigskontoret
Net cost development accumulated adjusted
Region Jönköping lower than average
average

The best possible care and
health on equal terms
Safe, people-centred care
The health centre – the gateway to care and
better health
Health for life
Everyday life Support for body and soul Primary care Specialised care

For a Good Life in an Attractive
Region
Version25September2015

Microsystem
Patients and professionals
Meso
Primary care
Medicine
Surgical
Psychiatric
Makro
Governance
Before Tomorrow

Primary care is the entrance – specialty care on demand

Very good Best possible
Patient satisfaction
Take care of the problems
Person centered care
Prevention and plan for the next step
Reduce over, under and misuse
Standardize work and specialization
Run faster/more resources
Everything everywhere
Good examples Faster diffusion – equal care
Strategic principles

We need to find new concepts!
• The key is not only the product but the functional
consequences for citizens and patients
• The competence base is no longer just what I
do…
• ..so how can we best develop collaboration, both
internally in the patient journey but also in every
meeting?
• This is something profoundly different to pure
production logic

• Person centeredness
• Patient support
• Microsystems working with the work
• Microsystems network orientation
• Requires redefinition of professional roles
and skills transfer

A structure for target group orientation
developed competence about complexity and
future1990s
• Esther Project
Early 2000s
• Family centers
• Elderly center in Tranås
2010 and beyond:
• Youth centers for age 6 - 20
• Children as relatives
• Centers for abused children
Establishing
new
microsystems
for target
groups!

Bra Liv near – always close
Reference:
Österstad Ulf ulf.osterstad@rjl.se
Carlsson Johan johan.carlsson@rjl.se
Larsdotter Charlotta <charlotta.larsdotter@rjl.se>

2009 2010 2012
Patrik
From patient to employed
From patient to patient support

Projekt Unga vuxna
Ideas
• A health promotion approach to
vaccinate against future mental health
challenges
• Contact via natural meeting places in the
local environment
• Without a connection to the health
center or psychiatric services
• No therapy or nursing care
• Personal calls but not private
• Provide tools to cope with life
therese.rostedt@rjl.se, agata.rukat@rjl.se

Café House of Health
• For patients with chronic
diseases and relatives
• Focus on health and well-being
• Supports the living of life with
chronic conditions , maintaining
autonomy
• The possibility of support and
hope through conversations
with other people experience

When and how patient involvement?
Health
Literacy
Shared
Decision-Making
Feedback for
Improvement
Patient Partnership
In Health
Patient Partnership
In Redesign
Ref: Galina Gheihman, Kvarnefors, Henriks 2015

Defining Patient Involvement
Image courtesy of Region Jönköping County
The pa ent in the center The pa ent as a part of the team and
their needs and preferences at the center
Pa ent needs
and preferences

History and evolution of patient involvement
1990s
• Clinical Microsystems
• Quality as a Strategy
(Malcolm Baldrige)
• Esther Project
Early 2000s
• National Quality Register
projects
• Practicing co-production
• Committed leadership
2010 and beyond:
• Data, technology, and
communication systems
• Focus on equity
• The “Ketchup Effect”
From
Why
to
How?

“The patient says:
‘Thank you, you are a hero, I was sick and you
came and fixed everything. And because of this
the nurses and the doctors became heroes.
I think that’s a problem in our health care
[system] today. We are considered ‘heroes’ and it
should be the other way around: the patients
should be considered heroes.”
Open-minded Professionals

“It’s important that you give concrete examples
and address the staff as fellow human beings.
That is when it is very powerful.
When the staff can go across the bridge and
not stay on the professional side but really see
the ‘persons with patient experience’ as fellow
human beings.
That’s when it is really powerful.”
Effective Patient Partners

“It’s maybe the way I am, as a leader.
Because I don’t see the problems, at
first. A lot of people do.
This could happen, or this, or that.
Yeah, but what if not [I ask]? Then we
have missed the train…”
Supportive Leadership

Ejje https://vimeo.com/55094566

“A team without a patient would focus
on what to do, practical things to test.
When you have person with lived
experience, you concentrate more on
why. Why do we do this?
What is the value of this?”
For QI work…

Images courtesy Britt-Mari Banck, Self-Dialysis Unit

Making a difference
1. Adapting a value-based system in which patient’s needs
come first
2. Strong leadership that permits innovation, celebrates
successes (and tolerates mistakes)
3. Paying attention to language, communication, and
therefore culture
From… To…
Patient Person with experience
Recruitment Invitation
Engaging the patient (1-way) Building relationships (2-way)
Mistakes or problems Opportunities

Stronger Patient involvement can results in…
• More engaged, activated patients and better health
outcomes
• Better understanding of one’s illness and capacity for self-
management
• Reduced healthcare costs
• Health systems adopting processes and achieving outcomes
that matter to patients

- people involvement provide real help
faster
• Improves capability
• Understand the readiness
• Helps us to Adaptive moves
• See the Preface importance
Ref: Edgar Schein
and Marjorie Godfrey
• Reaching extraordinary results

Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks
Mobile Geriatric Team • Film: YouTube….
https://www.youtube.com/watch?v=lTfzq5FqATs

Amountofcaredays
Before and after connection
Reference: Daniel Gustavsson and Marina Sumanusova

Number of visits to doctors in primary care offices

Enhanced Recovery After Surgery (ERAS)
team approach
• Surgeon
• Anesthetist
• HDU specialist
• Ward nurses
• Anesthesia nurses
• Physiotherapist
• Dietitian
• Management
Team work:
• Training
• Implementing
• Planning
• Auditing
• Updating
• Reporting
• Research

Sweden ERAS Implementation

plus.rjl.se/microsystemfestival 71
ERAS®Society 2015
100+ units in 17+ countries
More than one Implementation program
Implementation program running/announced
ERAS Center in place
ERAS center in training
ERAS center discussions
Manilla
Dubai
Singapore
Guadalajara
Bogota
Lisbon
Tokyo
Nanjing
Melbourne
Krakau
Cape town
Buenos Aires
Auckland
Mayo Clinic
AHS, McGill Hamburg
CT, Charlotte
Soeul

The Matrix – System failure

Vitality and self empowerment grows
when you have this in place
• A sense and understanding of context
• A sense and understanding of what true
skill is
• A sense and understanding of self- control
Gretchen Spreitzner, USC, 1995

Adaptation in turbulent environments
Organizations will have to "learn how to learn“
• More than minor adjustments to the present way
of doing things
• Requires genuinely innovative thrusts--new
missions, new goals, new products and services,
new ways of getting things done, and even new
values and assumptions.
• Most importantly adaptation involves the
development of the capacity to manage
"perpetual change.“
Reference: (Schein, 1980; Argyris & Schon, 1978) and to become "self-
designing" (Weick, 1977).

Avedis Donabedian
“Ultimately, the secret of
quality is love.
…… If you have love, you
can then work backward
to monitor and improve
the system”.

Key tactics :
Out-love everyone else
Source of image: Bradley Burgess

It´s All About People: Goran Henrik`s plenary presentation at the Jönköping Microsystem Festival

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