Successfully reported this slideshow.
Your SlideShare is downloading. ×

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

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad

Check these out next

1 of 78 Ad
Advertisement

More Related Content

Similar to It´s All About People: Goran Henrik`s plenary presentation at the Jönköping Microsystem Festival (20)

Advertisement

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

  1. 1. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  2. 2. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Please see me https://www.youtube.com/watch?v=380MiMDoddI&app=desktop
  3. 3. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  4. 4. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
  5. 5. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival RJL fantastic colleagues… in different microsystems They love their work as complexists and futurists
  6. 6. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks It´s all about people http://www.iorahealth.com/
  7. 7. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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”
  8. 8. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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!
  9. 9. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  10. 10. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks IT’S ALL ABOUT PEOPLE realistic medicine and reliable services Ref: Dr Catherine Calderwood, MA, Cantab FRCOG FRCP Edin, Chief Medical Officer for Scotland
  11. 11. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
  12. 12. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival The festival A tribute to people´s health and reliable care Signed Sealed Delivered Health for life Radical individualism and social trust
  13. 13. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival Topics and meeting places at the festival - A tribute to people´s care Signed Sealed Delivered 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
  14. 14. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival Topics and meeting places at the festival - A tribute to people´s care Signed Sealed Delivered 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
  15. 15. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks A tribute to co-learning From Armenia, Canada, China, Denmark, England, France, Netherlands, Italy, Singapore, Switzerland, Sweden Slovenia, USA
  16. 16. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks The festival as Peters café, the Azores Curiosity and back-casting Ideas Best examples NetworkingBackcasting
  17. 17. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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?  Hur involverar vi 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
  18. 18. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  19. 19. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival • Embrace the digital • Include the citizen • Learn to combine these two… Sir John Oldham National Clinical Lead for Quality & Productivity, Department of Health, England
  20. 20. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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?  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?  Hur involverar vi dem mer?
  21. 21. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  22. 22. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks The Imagination Age Imagination Age Adapted from: How economic value emerge?!
  23. 23. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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”
  24. 24. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks One second from Swedish talk show Skavlan, http://www.svtplay.se/skavlan
  25. 25. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  26. 26. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  27. 27. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 20 – 40 – 160, 14-15 million + 4-5 million
  28. 28. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks A sea of shoes in Place de la Republique, Paris Protests are banned here so you have to imagine them Source: David Shukman
  29. 29. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks The Matrix – the system and training program
  30. 30. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  31. 31. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Autonomy and authority When learning becomes health - any time require its translation into the reality I'm in
  32. 32. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  33. 33. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks
  34. 34. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 I have access to the care I need
  35. 35. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 There are reasonable waiting times at the care centers
  36. 36. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 My trust for the health and care centers in my region
  37. 37. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 Overall trust for health and care services in your region
  38. 38. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-03-02 Your impression as a whole – largest amount of positive answers in the whole of Sweden: Rydaholm
  39. 39. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 2016-02-09 Regionlednigskontoret Net cost development accumulated adjusted Region Jönköping lower than average average
  40. 40. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  41. 41. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival For a Good Life in an Attractive Region Version25September2015
  42. 42. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival Microsystem Patients and professionals Meso Primary care Medicine Surgical Psychiatric Makro Governance Before Tomorrow
  43. 43. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival Primary care is the entrance – specialty care on demand
  44. 44. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  45. 45. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  46. 46. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival • Person centeredness • Patient support • Microsystems working with the work • Microsystems network orientation • Requires redefinition of professional roles and skills transfer
  47. 47. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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!
  48. 48. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Bra Liv near – always close Reference: Österstad Ulf ulf.osterstad@rjl.se Carlsson Johan johan.carlsson@rjl.se Larsdotter Charlotta <charlotta.larsdotter@rjl.se>
  49. 49. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
  50. 50. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 2009 2010 2012 Patrik From patient to employed From patient to patient support
  51. 51. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival 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
  52. 52. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  53. 53. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  54. 54. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  55. 55. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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?
  56. 56. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks “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
  57. 57. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks “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
  58. 58. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks “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
  59. 59. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival Ejje https://vimeo.com/55094566
  60. 60. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks “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…
  61. 61. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Images courtesy Britt-Mari Banck, Self-Dialysis Unit
  62. 62. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  63. 63. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  64. 64. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks - 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
  65. 65. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks Mobile Geriatric Team • Film: YouTube…. https://www.youtube.com/watch?v=lTfzq5FqATs
  66. 66. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Amountofcaredays Before and after connection Reference: Daniel Gustavsson and Marina Sumanusova
  67. 67. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Number of visits to doctors in primary care offices
  68. 68. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
  69. 69. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  70. 70. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Sweden ERAS Implementation
  71. 71. The Microsystem Festival March 1–4 2016 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
  72. 72. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks The Matrix – System failure
  73. 73. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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
  74. 74. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks 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).
  75. 75. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks
  76. 76. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Avedis Donabedian “Ultimately, the secret of quality is love. …… If you have love, you can then work backward to monitor and improve the system”.
  77. 77. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks Key tactics : Out-love everyone else Source of image: Bradley Burgess
  78. 78. The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival #qmicro @Goran Henriks

Editor's Notes

  • KConnect sökmotor söker upp information i både patientjournaler och medicinska litteraturdatabaser.
  • http://www.expressen.se/nyheter/madeleines-hemliga-tecken--om-chris-har/
    http://www.expressen.se/nyheter/hyllningen-till-karleksbeviset/
  • The region’s general strategy – a shift from in-patient to out-patient forms of care, primary care as a basis and co-ordinator, in co-operation with civil society and supported by digital solutions.

  • Welcome to a presentation of Region Jönköping County.

    The Region’s vision “For a Good Life in an Attractive Region” sums up our operations and our ambitions.
  • Vårt angreppssätt är att utgå från mikro, meso och makro nivån och se på olika behov och samspel.

    Mikrosystemnivån:
    Hur behöver ett vårdprogram vara designat för att vara lätt att använda?
    Vilka data behövs för att prioritera? Hur behöver de vara förpackade?
    Vilket stöd behövs för att omsätta kunskap i praktiken?
    Hur kan vi sprida våra goda erfarenheter vidare?
    Vad händer när andra nivåer bestämmer ”huret”? (t ex. Specialister – allmänläk)

    Mesonivå
    Vad behövs för att stödja strukturer för kunskapsstyrning?
    Vilka data behövs för att prioritera? Hur behöver de vara förpackade?
    Hur behöver överenskommelser och samarbeten se ut?

    Makronivå
  • Varför tror jag på PCV ? Det finns många anledningar Patrik, är en. Patrik fick dialbetes vid 18 års ålder och började med dialys när han var 29 år. Efter ett år i hemodialys fanns möjligheten att bli mer delaktig i sin behandling genom att själv lära sig att sköta dialysen.

×