it´s all about people: goran henrik`s plenary presentation at the jönköping microsystem festival

The Microsystem Festival March 1–4 2016plus.rjl.se/microsystemfestival



IT’S ALL

ABOUT

PEOPLEThe Microsystem Festival

1 4 March 2016Jönköping Sweden


#qmicro @Goran Henriks

Please see me

https://www.youtube.com/watch?v=380MiMDoddI&app=desktop

https://www.youtube.com/watch?v=380MiMDoddI&app=desktop




IT’S ALL

ABOUT

PEOPLEThe Microsystem Festival

1 4 March 2016Jönköping Sweden




http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj0qq6UtJ3LAhWmCpoKHYn8DDwQjRwIBw&url=http://news.utoronto.ca/u-t-student-wins-canada-health-innovation-challenge&psig=AFQjCNGJxjaSbHMvqaAcx6fM-sHbM-ZZbg&ust=1456850226640436



RJL fantastic colleagues…in different

microsystems

They love their work as complexists and futurists



It´s all about peoplehttp://www.iorahealth.com/

http://www.iorahealth.com/



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”

http://www.iorahealth.com/



Our technology is designed around patientsMost 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!


2016-03-02 QULTURUM

Patient’s recordClinical databases

Care taker and care giver

KConnect – search motor

Health on the Net FoundationUniversity of Sheffield



IT’S ALL ABOUT PEOPLE realistic medicine and reliable services

Ref: Dr Catherine Calderwood, MA, Cantab FRCOG FRCP Edin, Chief Medical Officer for Scotland


The festival A tribute to people´s health and reliable care

Signed Sealed Delivered

Health for life

Radical individualism

and social trust


Topics and meeting places at the festival - A tribute to people´s care


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


Topics and meeting places at the festival - A tribute to people´s care


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



A tribute to co-learningFrom Armenia, Canada, China, Denmark, England, France, Netherlands, Italy, Singapore, Switzerland,

Sweden Slovenia, USA



The festival as Peters café, the Azores

Curiosity and back-castingIdeas

Best examples

NetworkingBackcasting


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

v 2

0

v 2

2

v 2

4

v 2

6

v 2

8

v 3

0

v 3

2

v 3

4

vecka

an

tal

dag

ar

Seven Question show the Way

Weshareand

learn



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


• Embrace the digital

• Include the citizen

• Learn to combine these two…

Sir John OldhamNational Clinical Lead for Quality & Productivity, Department of Health,

England


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?


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



The Imagination Age

Imagination Age

Adapted from:

How economic value emerge?!



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”

https://sv.wikipedia.org/wiki/World_Childhood_Foundation



One second from Swedish talk show Skavlan, http://www.svtplay.se/skavlan

http://www.svtplay.se/skavlan


#qmicro @Goran HenriksWe cannot wait – it´s time

Reaching extraordinary resultshow to provide real help faster

• Improving capability

• Value readiness

• Adaptive moves

• Preface importanceRef: Edgar Schein and Marjorie Godfrey

• Embrace the digital

• Include the citizen



Often a VUCA world for manyChanges in the world challenge us and

hinder positive imaginations

Source of diagramme Tony Loyd https://www.linkedin.com/pulse/masters-vuca-universe-tony-loyd

https://www.linkedin.com/pulse/masters-vuca-universe-tony-loyd


2016-03-02

20 – 40 – 160, 14-15 million + 4-5 million



A sea of shoes in Place de la Republique, Paris

Protests are banned

here so you have to imagine

them

Source: David Shukman



The Matrix – the system and training program

The Matrix - training program.m4v




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



Autonomy and authority

When learning becomes health - any time require its translation into the reality I'm in



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


2016-03-02

I have access to the care I need


2016-03-02

There are reasonable waiting times at the care centers


2016-03-02

My trust for the health and care centers in my region


2016-03-02

Overall trust for health and care services in your region


2016-03-02

Your impression as a whole – largest amount of positive answers in the whole of Sweden: Rydaholm


2016-02-09 Regionlednigskontoret

Net cost development accumulated adjustedRegion Jönköping lower than average

average


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


For a Good Life in an Attractive Region

Ver

sio

n 2

5 S

epte

mb

er 2

01

5


MicrosystemPatients and professionals

Meso

Primary care Medicine

Surgical

Psychiatric

MakroGovernance

Before Tomorrow


Primary care is the entrance – specialty care on demand


Very good Best possiblePatient 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



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


• Person centeredness• Patient support• Microsystems working with the work• Microsystems network orientation• Requires redefinition of professional roles

and skills transfer



A structure for target group orientationdeveloped 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!



Bra Liv near – always close

Reference:

Österstad Ulf [email protected]

Carlsson Johan [email protected]

Larsdotter Charlotta <[email protected]>

mailto:[email protected]




2009 2010 2012

Patrik

From patient to employedFrom patient to patient support


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 [email protected], [email protected]





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



When and how patient involvement?

Health

LiteracyShared

Decision-Making

Feedback for

Improvement

Patient Partnership

In Health

Patient Partnership

In Redesign

Ref: Galina Gheihman, Kvarnefors, Henriks 2015





Defining Patient Involvement

Image courtesy of Region Jönköping County

Thepa entinthecenter Thepa entasapartoftheteamandtheirneedsandpreferencesatthecenter

Pa entneedsandpreferences



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?



“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



“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



“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


Ejje https://vimeo.com/55094566

https://vimeo.com/55094566



“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…



Images courtesy Britt-Mari Banck, Self-Dialysis Unit



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



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



- people involvement provide real help faster

• Improves capability

• Understand the readiness

• Helps us to Adaptive moves

• See the Preface importanceRef: Edgar Schein

and Marjorie Godfrey

• Reaching extraordinary results



Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks

Mobile Geriatric Team • Film: YouTube….

https://www.youtube.com/watch?v=lTfzq5FqATs

The Mobile Geriatric Team Ryhov County Hospital.mp4

https://www.youtube.com/watch?v=lTfzq5FqATs



Am

ou

nt

of

cared

ays

Before and after connection

Reference: Daniel Gustavsson and Marina Sumanusova



Number of visits to doctors in primary care offices



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



Sweden ERAS Implementation


71

ERAS®Society 2015100+ 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

DubaiSingapore

Guadalajara

Bogota

LisbonTokyo

Nanjing

Melbourne

Krakau

Cape town

Buenos Aires

Auckland

Mayo Clinic

AHS, McGill Hamburg

CT, Charlotte

Soeul



The Matrix – System failure


Matrix - system_failure.m4v



Vitality and self empowerment growswhen 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


#qmicro @Goran HenriksAdaptation in turbulent environmentsOrganizations 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).



Avedis Donabedian

“Ultimately, the secret of quality is love.

…… If you have love, you can then work backward to monitor and improve the system”.



Key tactics :Out-love everyone else

Source of image: Bradley Burgess

it´s all about people: goran henrik`s plenary presentation at the jönköping microsystem festival

Healthcare