Empowering patients to need less care and do better in Highland Hospital, South SwedenChange Management Given the waiting lists in 2001, we decided to undertake a fundamental review of the values behind the relations between our patients and the healthcare system. In particular, we analysed our service from a patient perspective. This analysis suggested to us that we needed to redefine the roles of the patients to give them greater personal responsibility for their health. As we redesigned the unit, we also had to find a way to monitor quality, as it was unacceptable to both patients and the hospital that quality should deteriorate and we realised that a shift in attitudes like this (which can be characterised as a paradigm shift) would be criticised. It was essential to us to prove that quality was at least preserved and hopefully improved. The first thing we realised in the analysis was that it was essential to change the patient monitoring system. The underlying principle had previously been that the healthcare system tried to monitor the patient’s health status through regular visits, instead of adapting the system to meet the patient’s actual needs. We realised that we were actually doing too much for some patients, and doing too little for others. At the same time, we were unable to guess when the right time to intervene was – this was when we realised that patients actually knew better than us when their disease was getting worse. This made us realise that we actually harmed some patients, as we could not deliver help at the time the patients actually needed care (partly because of an overcrowded system, the capacity of which was often used up in efforts that did not create real value for the customers). We therefore redesigned the unit to set up a team-based healthcare delivery system in which all participants, including our patients, put their individual competences to use in a proper way. This immediately helped us to cut out some of the inappropriate work which had previously been done, even though it had not produced any real value for the patient. First, we decided to completely change our contact system. Depending on severity of the disease, need of monitoring AND the wishes of the patients, we stratified patients into several groups, each of which would be treated differently, rather than forcing all of them into the same system, as we had done previously.
We were aware that many of the annual visits were of little use – at scheduled visits, we often found patients had no obvious health problems. These visits took up a great deal of our time on the ward, did not create any real value to the patients and, of course, were stressful and disruptive to the patients. Moreover, most of the flare-ups of the disease took place during the rest of the year – patients should, of course, have contacted us when flare-ups occurred, but we didn’t have appropriate routines in place to encourage that (nor the time to deal with such contacts, given that we were constantly dealing with the ‘well patients’ who had come in for their regular check-ups). A further change we made was in the way we worked with in-patients. We realised that we seemed to apply a different set of values in the ways we treated in-patients compared to out-patients. Instead of the medical team ‘doing the rounds’ every morning, and inspecting each patient in their bed, discussing their case ‘over their heads’, we have reversed the procedure. We invite each patient to come to our team room for a planning meeting, where we can put up the relevant charts, X-rays, etc. relevant to their case. Here they can interview us about what has changed since our last discussion, how they feel, what they are worried about and what we are suggesting might be done. What we do is actually to create a scenario which is designed for negotiation instead of top-down prescription. This creates an experience of responsibility, power and control over their health and their disease, factors that are necessary if they are to keep the disease under better control and which give them the confidence to recognise when to contact us in the future, if they have concerns. |
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Dr. Jörgen Tholstrup Dr. Jörgen Tholstrup provided Governance International with this case study on 30 March 2010. The case study was updated in June 2014. |