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For a Good Life in an Attractive
Region
Version13August2015
Development power
2015-10-05
“Doing good things together is the whole idea of
Region Jönköping County. I am proud to be in...
For 340,000 citizens
2015-10-05
Jönköping County is the geographical
catchment area, with just over
340,000 inhabitants.
A typical day
in healthcare
2015-10-05
• 4,600 people receive medical treatment
• 1,700 people see a doctor at a health ce...
05/10/2015
Network for health and care collaboration
2014
Sweden has one of the world’s highest
percentages of seniors, an...
Home care
Primary care
Intensive care
Medical unit
Rehabilitation
Sheltered home
Network for health and care
collaboration...
Challenge
Person centered
care
Complexity
Delivering a service that is truly patient-
centered is an enormous challenge wh...
The Basic idea
What is best for Esther ?
Esther… no matter where,
we will be there!
Network for health and care
collaborat...
Individual values
• What does Esther need/ want?
• What is important for Esther when she gets sick?
Partners
• Who has to ...
Seamless care…. what has been helpful ?
Person centeredness
No hierarchy
Thinking about the next provider
Communicating sy...
To work with change/improvement
Esther coach training
A strong discharge process and follow upp
Results Höglandshospital
Type of care 2000 2014
Hospital beds 375 263
People living in
Care homes
1740 Approx. 1290
Amount...
2015-10-05
Finland 2015-09-23
Your confidence in the health care system in your county / region?
A lot A Little
Ref. Salar...
Welcome Back Home package
• Staff from municipal social care is already there
when Esther returns from the hospital
• Make...
Nice to know that Mum is
not coming home to an
empty house.
Esther’s daughter
2012: 17,4
2013: 15,7
2014: 12,1
Average of ...
Senior alert
- a Swedish national quality registry
for preventive care of the elderly
2015-10-05
Senior alert is about preventive care
Register in
Senior alert
Systematic work
process
Improvement
work
Analyze and
reflect results
The use of transparant data to create overall understanding
and possibility to learn and react.
• http://plus.rjl.se/infop...
plus.rjl.se/qulturum
Q x A = E
Quality x Attitudes = Effect
Jack Welch
Culture eats strategi for lunch
2015-10-05
http://www.bbc.com/news/health-28654739
Follow us at
@EstherNtverk
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Nicoline Vackerberg, CE Learning and Innovation, Qulturum, Jonkoping, Sweden

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The role of integrated care in improving population health

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Nicoline Vackerberg, CE Learning and Innovation, Qulturum, Jonkoping, Sweden

  1. 1. For a Good Life in an Attractive Region Version13August2015
  2. 2. Development power 2015-10-05 “Doing good things together is the whole idea of Region Jönköping County. I am proud to be involved in developing welfare, together with the county’s municipalities and everyone who lives and works here.” CEO Agneta Jansmyr
  3. 3. For 340,000 citizens 2015-10-05 Jönköping County is the geographical catchment area, with just over 340,000 inhabitants.
  4. 4. A typical day in healthcare 2015-10-05 • 4,600 people receive medical treatment • 1,700 people see a doctor at a health centre • 1,400 see a specialist doctor • 200 people are admitted to hospital • 800 people have X-rays • 11 children are born
  5. 5. 05/10/2015 Network for health and care collaboration 2014 Sweden has one of the world’s highest percentages of seniors, and in the late 1990s Höglandet’s local hospital began overflowing with patients. Officials from the Jönköping region and healthcare employees collaborated on a better system to care for the elderly, who frequently ended up in the hospital.
  6. 6. Home care Primary care Intensive care Medical unit Rehabilitation Sheltered home Network for health and care collaboration Hospital Psychiatry
  7. 7. Challenge Person centered care Complexity Delivering a service that is truly patient- centered is an enormous challenge which……can only be overcome by actively engaging patients as valuable resource. GREENHALGH, T., HUMPHREY, C. & WOODARD, F. 2011. User involvement in health care, Chichester, John Wiley & Sons, Ltd. Health care systems are complex, and repairing them is complex. GLOUBERMAN, S. & ZIMMERMAN, B. 2002. Complicated and complex systems: what would successful reform of Medicare look like? Changing Health Care in Canada: The Romanow Papers, 2, 21- 53.
  8. 8. The Basic idea What is best for Esther ? Esther… no matter where, we will be there! Network for health and care collaboration
  9. 9. Individual values • What does Esther need/ want? • What is important for Esther when she gets sick? Partners • Who has to cooperate to fulfil Esther’s needs? Changes in the environment • Changes in the system of health care? • New methods? New technology? • Changes in population? Network for health and care collaboration
  10. 10. Seamless care…. what has been helpful ? Person centeredness No hierarchy Thinking about the next provider Communicating systems Your problem is my problem Mutual responsibility for the person Mutual meetings and education Multi professionalism. Openness and learning Improvement together with partners Measurements Improvement knowledge
  11. 11. To work with change/improvement Esther coach training
  12. 12. A strong discharge process and follow upp
  13. 13. Results Höglandshospital Type of care 2000 2014 Hospital beds 375 263 People living in Care homes 1740 Approx. 1290 Amount of people getting Medical care at home 1000 2000
  14. 14. 2015-10-05 Finland 2015-09-23 Your confidence in the health care system in your county / region? A lot A Little Ref. Salar. NPE 2015
  15. 15. Welcome Back Home package • Staff from municipal social care is already there when Esther returns from the hospital • Make sure that… - the home is in order - Esther has got food and a clean bed - Esther got the right equipment and correct medication • If needed, attach and test a personal alarm around the wrist • Check again the care and social plan together with Esther, make changes when needed • Most important! Make sure Esther feels listened to, safe and confident Network for health and care collaboration Photo: Johnny Törnkvist
  16. 16. Nice to know that Mum is not coming home to an empty house. Esther’s daughter 2012: 17,4 2013: 15,7 2014: 12,1 Average of readmissions within 30 days in Tranås It feels satisfying, to not have to leave before Esther says everything is fine. Staff member
  17. 17. Senior alert - a Swedish national quality registry for preventive care of the elderly
  18. 18. 2015-10-05 Senior alert is about preventive care
  19. 19. Register in Senior alert Systematic work process Improvement work Analyze and reflect results
  20. 20. The use of transparant data to create overall understanding and possibility to learn and react. • http://plus.rjl.se/infopage.jsf?nodeId=40884 2015-10-05
  21. 21. plus.rjl.se/qulturum
  22. 22. Q x A = E Quality x Attitudes = Effect Jack Welch Culture eats strategi for lunch
  23. 23. 2015-10-05 http://www.bbc.com/news/health-28654739 Follow us at @EstherNtverk

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