Careprevention, reliable organisations, and co-production are concepts needed for tomorrows work with the work for the many

1. 115-11-24
Qulturum

2. 215-11-24
Qulturum

4. Why this?
2017-08-25
• Healthcare is a sociotechnical, largely complex
system
• Safety in complex systems is largely about
managing risks
• Healthcare is not a homogeneous system - one
size does not fit all
• You need several different theoretical approaches
to understand and manage risks in sociotechnical
systems

5. 2017-08-25
(ange enhet via Infoga sidfot)
https://www.accenture.com/au-
en/insight-interactive-
orchestra?sr_source=lift_twitter&c=dig
_anzorchfy17_100000010&n=smc_07
17
the Accenture Liquid Studio team
programmed Baxter, an industrial
collaborative robot, to play the marimba as
a featured soloist in our orchestra.

7. Flourishing – a key concept for
innovation

9. 2017-08-25
Folkhälsa och sjukvård
Our success are measured in lives and health

10. Safe care – every time
Success facors
Health and health care
• Person centered
• Knowledge based
• Organizing for a work that can be done safe
Preventive approaches – to be a step ahead, thinking lateral
and work horizontal integration
All levels all employees work for safe care – every time

11. What matter´s to you?
”All services are in one or the other way co-
produced, co-designed”
- We need new models of care!
2017-08-25
Utvecklingskraft 2016
Maureen

12. The Patient Act
new Swedish legislation since 2015
Emphasis on:
• Patient empowerment
• Cooperation between patient and health
care provider
• Information and communication
• Freedom to choose

13. The Swedish Patient Safety Act
System
Individual
Individual
responsability
To work according
to best evidence
and best practice
To take part in
patient safety work
System (health
care provider)
responsability
Systematic
patient safety
work
Investigate and
report patient
harm

14. Possible Vision: Free from incidents
• This requires investment in competence
development and developing new skills
• Identification of the most serious risks
• See the wholeness of the patient´s process
• A preventive thinking

15. Number of days in between the occurrence of
catheter-related infections in CVK / CDK
6th of Dec, 2010 - 30th of May, 2011
180 days
30th of May, 2011- 1st of November,2011
180 days
1st of November, 2011 - ……
so far more than 600 days!
Värnamo

16. https://www.youtube.com/watch?v=ZTbZGAeJ374
78 133 has seen the Hand washing video
Develop the robust microsystem
Togetherness, passion, inspiration, patient centeredness
About hand disinfectant, gloves and robustness

17. 2017-08-25
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18. 2017-08-25
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20. The Four Leadership Questions
1. Do you know how good you are?
2. Do you know where you stand relative to the best?
3. Do you know where the variation exists?
4. Do you know the rate of improvement over time?
Ref: Maureen Bisognano

21. https://www.weforum.org/agenda/2016/11/8-predictions-for-the-world-in-
2030?utm_content=buffer2a7fd&utm_medium=social&utm_source=twitter.com&
utm_campaign=buffer
• All products have become services
• There is a global price on carbon
• US domination is over. We have a handful of global
powers
• Farewell hospitals, hello home-spital
• We are eating much less meat
• Today´s Syrian refugees, 2030, CEOs
• The values that built the West have been tested to
breaking point
• By the 2030s we´ll be ready to move humans to the
red planet
Predictions for the world in

22. The need for welfare services will increase BUT
the labour force will not
1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
1,8
1,6
1,4
1,2
1,0
0,8
0,6
0,4
0,2
0,0
-0,2
Inhabitants age 20–64 Inhabitants in need of welfare servicesPercent
År
Source: SKL.
The latest
20 years
have been
manageable
Next
20 years will be
tougher
Roger Molin

23. People's actions are not governed by rules
and instructions
No, instead, action takes place based on people's
understanding of the situation they are in
Sandberg, J. & Targama, A. (2013). Ledning och förståelse Lund:
Studentlitteratur

24. Theory of Normal Accidents (Perrow)
2017-08-25
Closely coupled, highly complex systems are difficult to control
• Systems with a high degree of complexity can only be
effectively controlled with a decentralized organization
• Systems with dense connections can only be controlled
effectively with a highly centralized organization
An organizational dilemma
The risk of normal accidents!

25. Theory about High Reliable Organisations
2017-08-25
Key principles and strategies for HROs
1. To be concerned/aware with risks and accidents
2. To avoid simplifying interpretations of causes and relationships
3. "Sensitivity to operations" - check the mode
4. Devotion to resilience - redundancy -
5. Relying on expertise - let the most important decisions be taken by the
experts in the "sharp end“
 Competence
 Communication Collective mindfullness
 Culture
 Restructure if necessary

26. Peoples actions are not directed by external factors as rules
and instructions
Instead the actions seems to be based on peoples own
understanding of the situation
Sandberg, J. & Targama, A. (2013). Ledning och
förståelse Lund: Studentlitteratur
For both professionals and patients - Essence of co-learning

27. Stefan holm

28. Jidoka – to prevent – work upstreams and a
way we develop this by co-creating co-
production?
• To prevent and do the right thing from the
beginning
• To make every day work to daily school at
work
• Simple to do the right things

29. 29
Passion for Life
Take it on a hip
http://www.youtube.com/watch?v=neSv7TdsLgk

30. Café House of Health – about life,
autonomi and authority
• 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

32. challenges
2017-08-25
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• About 85% of all healthcare costs are related to
chronic diseases
• 80% of all chronic diseases can be prevented.
With healthier living habits,
• 80 percent of the incidence of cardiovascular
disease and 30 percent of cancerous diseases
are considered to be preventable.
• Diabetes mellitus 2 may correspondingly be
either prevented or delayed
Ref: Swedish National board of health

33. 2017-08-25
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• Approx. 1 000 people die each year as a
result of a falls accident.
• 70 000 are injured, usually older people.
By comparison, 263 people died in traffic
in 2016.
• The total cost of accidents in the
community is approximately SEK 14
billion.
• By 2050, they are estimated to be SEK 22
billion if nothing is done.

34. Indicators on the macro - level
2017-08-25
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• Remaining life expectancy at birth
(women/men) municipality, year
• Injuries caused by falling among people
80+ county councils, number / 100 000
inhabitant

35. Sweden understand more about
risks among the elderly (age 65+)
• Risk of fall 66%
• Risk of malnutrition 59%
• Risk of bad oral health 48%
• Risk of pressure ulcers 23%
• No risk 17%

36. 2017-08-25
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• Senior alert is a national quality register that aims
to ensure a preventative approach within the
areas of
– cases of falls
– ulcers/pressure sores
– malnutrition
– poor oral health
– bladder dysfunction/incontinence

37. Register in
Senior alert
Systematic
work process
Improvement
work
Analyze and
reflect
results

38. 1) Registration in the quality register
2017-08-25
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• The register supports a systematic approach in which all the
steps of the preventative care policy are recorded by hand.
The steps are
• Risk assessment
• The underlying causes of risk
• Planning of preventative measures
• Events such as falls, ulcers, weight, poor oral health
• Follow-up and closure.
• Registration in Senior Alert is the organisation's own
platformfor continuous improvement efforts. All registration
can be followed online over time and extracted as reports.
• To use the quality register, it is required that the
organisation is connected to the Senior Alert IT system.

39. 2017-08-25
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• Preventative approaches
• Risk assessment
• Team-based investigation of the underlying
causes
• Preventative actions/interventions
• Events
• Foloow-ups
• Closures

40. 2017-08-25
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3) Reflecting about the results
The reports from Senior alert enable users,
units and management to follow their own
preventative approach.
• Actionsplans

41. 2017-08-25
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4) Improvements
• Working with Senior alert encourages
employees and managers to work with
continuous improvements, where the
individual s needs and values are the most
important

42. Risk-
assess-
ment
Team
based
analysis
Preven-
tive
inter-
vention
s
Evalu-
ation
Dis-
charged
/
informa
-tion
Register in Senior alert
0
20
40
60
80
Oral ealth
0
5
10
15
20
25
Pressure ulcers
0
10
20
30
40
Weightlosses
0
5
10
15
20 Falls
Actions

43. Start page

44. Risk assessment

45. Causes of risk

46. Interventions

47. Evaluation

48. The individual map

49. The teams data

50. Care prevention and results
© Senior
alert,

51. It´s getting better!
Systematic care prevention in Swedish nursing
homes
2011 2015 100%

52. Reduction of falls
An example from a municipality

53. Pressure ulcers are reduced
Municipalitie
s
County councils
%
Region
Jönköping county
Regions and
county councils
Municipalities

54. Weightlosses >5% are reduced 2011-2015
municipalitie
s
County councils
• Municipalities: 14%→ 12%
• County councils: 5%→ 4%

55. Better oral health
Less oral problems
with
- oral mucosa
- teeth
- saliva
- gum
County councils
Municipalities
Percentage with at least one ”2” or ”3” in ROAG

56. How the areas are connected?
2017-08-25
Ref:Trinks,Nordvall

57. Iteractive maps
• http://plus.rjl.se/infopag
e.jsf?nodeId=40605
2017-08-25

58. Webb education
• http://plus.rjl.se/infopage.jsf?childId=21979
&nodeId=43959#
• 4282 indiividuals 2017-07-24.
2017-08-25

59. 2017-08-25
43%
22%
14%
8%
6%
4%
3%
0%
Webbutbildning Att främja den äldres hälsa
Andel kursdeltagare per yrkeskategori
2017-07-24
Undersköterska
Sjuksköterska
Annat
Arbetsterapeut
Sjukgymnast
Administrativ personal
Distriktssköterska
Dietist
Läkare
Biståndshandläggare

60. 2017-08-25
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• Publications
• Johansson I, Jansson H, Lindmark U. (2016) Nursing Research. Oral Health Status of
Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments.
• Lannering C, Ernsth Bravell M, Midlöv P, Östgren C-J, Mölstad S. (2016) Journal of
clinical nursing. Factors related to falls, weight-loss and pressure ulcers – more
insight in risk assessment among nursing home residents
• Lannering C, Ernsth Bravell M, Johansson L. (2016) Health and social care in the
community. Prevention of falls, malnutrition and pressure ulcers among older persons
– nursing staff's experiences of a structured preventive care process.
• Johansson L, Wijk H, Christensson L. (2016) The journal of nutrition, health & aging.
Improving nutritional status of older persons with dementia using a national preventive
care program.
• Edvinsson J, Rahm M, Trinks A, Höglund PJ. (2015) Quality Management in Health
Care. Senior Alert: A Quality Registry to Support a Standardized, Structured, and
Systematic Preventive Care Process for Older Adults.
• Persenius M, Hall-Lord M-L, Wilde-Larsson B. & Carlsson E. (2015) Journal of
Nursing Management. Clinical nursing leaders' perceptions of nutrition quality
indicators in Swedish stroke wards: a national survey.
• Rosengren K, Höglund PJ. & Hedberg B. (2012) Journal of Nursing Management.
Quality registry, a tool for patient advantages – from a preventive caring perspective.

61. 2017-08-25
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62. Referens Patrik Sundström
CareCare as a digital business

63. 2017-08-25
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64. Dependent
Independent
Co-dependent
Single Integrator
IndependentCo-
Source: Stephen Covey and Bill Tolbert, Adapted by Dave Ford
Multiple Co-Integrators:
A modernized Municipality Model
Vertical Integration
Horizontal Integration
O
w
n
e
r
s
h
i
p
Vision, Principles, Collaborative, Trustable
meeting places
Challenges Vertical or Network Model?
Network Model
Business model

65. 2017-
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To create a better everyday life for the many people/IKEA.com

66. 2017-08-25
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Learn - more contact
• Anna.trinks@rjl.se
• Dennis.nordvall@rjl.se