Experiences of co-producing person-centred and cohesive clinical pathways in the national system for knowledge-based management in Swedish healthcare: a qualitative study.

BACKGROUND: When the 21 Swedish county councils decided to collaborate in the creation of a national system for knowledge-based management, patient participation was mandatory. Patient and next-of-kin representatives (PR) co-produced person-centred and cohesive clinical pathways together with healthcare professionals (HPR). Research on co-production in healthcare at the national level is scarce. The aim of this study is to explore experiences of patient participation from the perspectives of both PRs and HPRs when co-producing clinical pathways within the Swedish nationwide healthcare system for knowledge-based management. METHODS: A qualitative study was conducted. A strategic sample of nine PRs and eight HPRs were interviewed individually between August 2022 and January 2023 using a semi-structured interview guide. We analysed data using an inductive content analysis. RESULTS: Three main categories were identified: (1) Finding appropriate patient representativeness; (2) Working methods that facilitate a patient perspective; and (3) Influence of the patient perspective in the clinical pathways. CONCLUSIONS: The study demonstrates the importance of patient and next-of-kin participation in the construction of clinical pathways at the national level. The results provide a platform for further research on patient participation on the national level and add to studies on if and how patient participation on this level has an impact on how the clinical pathways are put into practice at the micro level, and the support provided at the meso level. The study contributes to the growing body of literature studying patient participation and co-production. TRIAL REGISTRATION: Region Örebro County ID 276,940. An advisory opinion was obtained from the Swedish Ethical Review Authority (2021-05899-01).

Method to share learning in real time at scientific meetings: lessons from the IHI-BMJ International Conference on Quality and Safety.

BACKGROUND: Capturing and disseminating key learnings on emerging themes for conference participants is challenging, yet also presents a significant opportunity to distill, share and discuss learning in real time with conference organisers and attendees. The Institute for Healthcare Improvement (IHI) and British Medical Journal (BMJ) collaborate annually to convene a Health Quality and Safety conference attracting 1000 to 3000 attendees each year. AIM: To test a learning system that harvested and synthesised the key lessons shared by conference participants at the 2022 IHI-BMJ Gothenburg Forum, and to disseminate this content. METHODS: Twelve invited Forum attendees collected and shared their 'breakthrough learnings' via electronic survey. Three IHI team members synthesised the participants' responses into themes that were shared and refined in real time at an in-person Forum session including 35 additional participants. RESULTS: Participants shared four learning themes: collaboration and co-production, trust, meaningful communication about data, and broadening the scope of the Science of Improvement field to multi-disciplinary and multi-system approaches. CONCLUSIONS: Collection of key learning on emerging topics of interest to the health system improvement community is feasible and yielded information both for dissemination and real-time learning. While not representing the full scope of the conference learnings, the content resonated with an additional group of reviewers at the conclusion of the conference and has guided planning for the next annual meeting. This approach may be helpful in capturing key themes for discussion and planning by similar improvement communities.

Improvement work in mental healthcare: an example from Region Jönköping County, Sweden.

Region Jönköping County (RJC) in Sweden is a healthcare system that is characterised by sustainable work with quality in healthcare and long-term system-wide improvement. This article describes important factors behind the improvement work in RJC, and how the improvement methods and initiatives have been adopted also in mental healthcare. For example, patients otherwise eligible for admission to a psychiatric department were treated at home after introduction of home treatment teams. Patient satisfaction was high and the number of visits to the emergency department, hospital admissions and hospital stay decreased.

What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study.

PURPOSE: The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. DESIGN/METHODOLOGY/APPROACH: A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. FINDINGS: The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. RESEARCH LIMITATIONS/IMPLICATIONS: Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. PRACTICAL IMPLICATIONS: The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. ORIGINALITY/VALUE: This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

Making systemwide improvements in health care: Lessons from Jönköping County, Sweden.

Over the past 10 years, Jönköping County in Sweden has made impressive progress in improving its health care system. The motor of improvement work is Qulturum, an innovation and learning center within the health system. Qulturum has no responsibilities for clinical or administrative functions; its sole mission is improvement work. Qulturum's improvement strategy is based on 3 principles: (1) Learning is key to improvement, (2) Improvement needs to be broad and deep, and (3) Improvement must be both bottom-up and top-down. Based on these principles, Jönköping County has achieved timely access to primary and specialty care, has improved the care of a number of chronic conditions, and has accomplished these goals without increases in expenditures. The United States could benefit by instituting Qulturum-like centers of learning and innovation within health systems.

How improved access to healthcare was successfully spread across Sweden.

BACKGROUND: Swedish healthcare has an internationally high standard, but is often criticized from a patient perspective owing to access problems to primary and specialist care. The waiting time to get in touch or get an appointment with a doctor, nurse, or physiotherapist is often too long. Access problems also create stress for employees when there are too few appointments to offer. In addition, too much time gets spent on the administration of long waiting lists, which adds no value to patients. Jönköping County Council was not satisfied with this situation and decided to make an attempt to improve access in the whole system. PURPOSE: To describe how access was improved in Jönköping County council and how the concept was spread nationally. METHOD: A conceptual model for improved access and reduced queues in Jönköping County called Bra Mottagning (BM) ("Good Clinic" in Swedish) was developed in 1999. It was built on logistic principles and collaborative learning. The program consisted of 4 learning sessions over a period of 8 to 9 months. The process of learning, team development, leadership, and spread of a change concept for improved access in Sweden has evolved through repeated improvement cycles, from small tests to larger pilots and finally to a standardized concept. RESULTS: Since 1999, 2 new BM collaboratives have been started every year. The first 11 teams from the county council of Jönköping, which participated in BM1 to BM3, reduced their median waiting time from 90 to 7 days in 8 months, an improvement of 93% (83 days). The results have been sustainable over the last 7 years. In the county council as a system, advanced access was achieved in 40% of the 179 units in 2006. Since the national spread started, 2200 employees in 316 professional teams from 16 county councils in Sweden have participated in BM collaboratives. Of these, 80% improved access for their patients and 32% reached advanced access in 8 months. CONCLUSION: The described development and spread of a concept for improved access in Sweden has been successful. A general impression is that the spread was more successful in the counties where the top management was strongly committed to the mission and the concept. Important factors for the national spread have been the establishment of a broader planning group as a network, the education of access coaches, the standardization of methods, and scientific assessments of the concept. Our experience is that both leaders and employees need to share a holistic view and systems thinking and also develop a deep interest in learning about strategies for access improvement.