Seneca congres - Presentatie Melvin Samsom
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1. Healthcare in Sweden is tax-funded and managed by county councils, of which Stockholm County Council is one of the largest. Stockholm County Council owns and operates most healthcare providers in the region, including Karolinska University Hospital. 2. Stockholm County Council has initiated a "Future Plan" to expand and build new hospitals to address the growing population and provide more accessible and innovative healthcare. This includes the construction of the new Karolinska Solna hospital. 3. Karolinska University Hospital is undergoing a transformation with the goal of implementing value-based healthcare principles to improve outcomes and lower costs. This includes reorganizing care around over 280 defined patient groups and appointing patient flow captains to
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Seneca congres - Presentatie Melvin Samsom
- 1. 1 Patient first together we create the best healthcare
- 2. âą Healthcare is tax funded and the responsibility of county councils âą Sweden has 20 county councils âą Karolinska University hospital is located in and governed by the Stockholm County Council âą A âone owner â one provider systemâ (~90% of HC providers are owned by county councils, including Karolinska) âą Stockholm County Council is growing and approaching 2,2 million inhabitants âą Budget 2015: ~9 billion euro of which ~60% is health care Karolinska in Stockholm, in Sweden
- 3. SödertÀlje SödertÀlje sjukhus Karolinska Solna Karolinska Institutet Healthcare in Stockholm County Council Danderyds sjukhus NorrtÀlje sjukhus NorrtÀlje SödertÀlje sjukhus Karolinska Solna Karolinska Institutet Danderyds sjukhus NorrtÀlje sjukhus Karolinska Huddinge Karolinska Institutet Söder-sjukhuset S:t Göran S:t Erik SLSO Psychiatry Primary care
- 4. The âFuture Planâ is one of the largest ventures of healthcare in Sweden ever Andra steget ï§ Konkretisering och förslag till de förĂ€ndringar som behöver göras för att nĂ„ mĂ„lbilden för framtidens hĂ€lso- och sjukvĂ„rd Tredje steget ï§ Första genomförande- planerna ï§ Ă tgĂ€rder för ökad effektivitet ï§ Summering av genomfört arbete ï§ Fokus för fortsatt arbete Andra steget 2013 Tredje steget 2014Juni 2011 Första steget ï§ Planering och inriktning ï§ Investeringsplan Första steget 2012 Framtidsplan ï§ MĂ„lbild och vision
- 5. âą Stockholm is expanding and building new hospitals âą The goal is to create a better and more accessible health and medical care âą The world-class New Karolinska Solna will be a hospital with the most innovative medical care Building new and expanding hospitals
- 7. Developing the network Rehabilitation Emergency hospital Psychiatric care Geriatric care Specialised health care outside emergency hospitals Specialised healthcare outside emergency hospitals University hospital Family doctor e-hÀlsa The individual's health is the focal point at each appointment within the healthcare system, regardless of provider 1 2 Regardless of where the individual approaches the healthcare system, support is offered to make sure appropriate care is provided 3 Sufficient and adequate information together with expertise is provided throughout the entire healthcare system 4 The individual's overall needs are the starting point for the care offered 7
- 8. Government and County Council envision and invest in a life scince hub Image of K KI Image of SciLIfe
- 10. âą Each individual living in Sweden has a unique 12 digit number âą After approval from the ethical committee one can ask for âcouplingâ between different registries, frequently performed by the Swedish board for Health and Welfare Sweden has a long history of keeping national healthcare registries 10
- 11. Example: The national Cancer registry was founded in 1958 Examples of registries relevant for the cancer area âą National Cancer Registry (1958) identifying secondary cancers âą Out-patient prescription registry (2005) âą Multi generation/twin registry (MEB, KI) âą In patient registry (hospitalization- side effects) âą Regional tumour specific registries (breast cancer started in Stockholm around 1976- date primary diagnosis, primary tumour characteristics, primary therapy, date & site for relapse) âą National registry INCA (2008) for several cancer types âą Pathology data bases âą Socioeconomic registries (socioeconomic situation e.g. early retirement) âą Death cause registry 11
- 12. Open national comparisons are published every year 12 The Stockholm region places number 3 in Sweden Relative 5-year survival of cancer 2008-2012, patients aged 30-89 years at diagnosis. Age standardized SOURCE: Open national comparisons 2014
- 13. Karolinska â one of the largest university hospitals in Europe 1,5 million out-patient visits / year 108 000 in-patient episodes / year 34 000 in-patient surgeries / year 16 000 employees 1,6 billion euro turnover ~ 2 500 researchers ~ 2 500 scientific articles / year in cooperation with KI ~ 120 million euro external R&D contributions
- 14. Karolinska â a university hospital on two sites undergoing major new development Completely new hospital ready 2016/2018 NKS â North site NKH â South site New OR/intervention/ICU ready 2019
- 15. Karolinska transformation LEADING COLLABORATION Network Innovation R&D Migration to New Karolinska Current financial issues Redesigning sustainable healthcare VALUE Patient Society
- 16. = Karolinska implementing value-based health care as core strategy to meet the future of academic medicine =Outcomes that matter to patients Cost of achieving outcomes VALUE
- 17. Value-based health care at Karolinska based on five main elements 17 Welll-defined patient groups and Patient Flow Captains Holistic and consistent operating model being developed Multiprofessional and multidisciplinary teams co-design optimal pathways with patient representatives Transparent measurement of outcomes and cost Multi-toolbox improvement approach to better fit with academic medical center innovative way of working
- 18. Our goal: 80% of all care at Karolinska managed by VBHC principles in 2018 18 20182017201620152014 80% Ready for new Karolinska 40% 11% 30% 60% ïŒ
- 19. In order to transform our care delivery model, we have put a lot of effort into understanding our patient groups âą Prostate cancer â diagnosis or suspicions of diagnos can be confirmed at an early stage and is followed by distinct diagnostic and treatment activities âą Abdominal pain â may be the result of a number of underlying conditions but similar diagnostic activities required regardless âą Elderly with multimorbidity â require a holistic view and special care for their specific needs to be met Diagnosis Multiple factors Symptom Patient group type Example and descriptionPatient
- 20. A mapping across Karolinska shows we have 283 patient groups 20 108 100 75 237 36 283 0 50 100 150 200 250 300 PediatricCommon adult and pediatric Adult 2 Multi-factorialSymptomsDiagnosisTotal Misc. 8 # Patient groups Multi disease groups Patientgrupplistan 3.0 â Slutgiltig version
- 21. A few high-volume patient groups account for a large proportion of total patient volumes at Karolinska 10 largest adult patient groups account for ~25% of all treatment days and 10 largest pediatric patient groups for 35% respectively 9,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 10,000 8,000 25,000 Patient groups Treatment days
- 22. A patient flow captain manages ways of working and resources along patient flow = Outcome Cost Value Eg. Faster emergency care through improved flow on X-ray Eg. Register based research project shows that method A > method B PFA Eg. Innovative medtech/IT cooperation enables 20% more efficient diagnostics Eg. Rehab-chain with external parties require monitoring outcomes across care providers Eg. Research results can be applied directly through training in the patient flow group INTERNAL EXTERNAL Patient flow E.g. Stroke
- 23. 19 groups started. ~20 more groups during 2015 â amount to ~30% of total patient vol. 1. Inkluderar patientgrupperna Mycket och Extremt underburna barn. 2. Inkluderar patientgrupperna Ovarialcancer, Corpuscancer, Cervixcancer och Vulva- och vaginalcancer. 3. Delflöde Akut HjĂ€rtinfarkt. 4. Delflöde Nydebuterad RA. 5. Delflöde MS 23 Pediatrics Cancer Other Cystisk fibros Diabetes Typ 1 HörselnedsĂ€ttning Juvenil idiopatisk artrit Pilots (2014) Wave 1 (Q2 2015) Wave 2 & 3 (Q3-Q4 2015) Neonates1 (B. Hallberg) Anorektala missbildningar Appendicit CNS-tumörer CP och motorikstörning Epilepsi Frakturer i bröstkorg, ryggrad och extremiteter Medfödda metabola sjukdomar Medfött diafragmabrĂ„ck Maligna CNS-tumörer Patientgrupp Hematologi (tbd) Akut myeloisk leukemi Esofaguscancer Hudcancer Lever- och gallvĂ€gscancer Lungcancer Maligna lymfom Myleom UrinblĂ„scancer (Alt. Njurcancer) Ăron- nĂ€s- och halscancer Bröstcancer (I. Fredriksson) Gyncancer2 (Charlotte/Carolin) Prostatacancer (I. EhrĂ©n) Rektalcancer (T. Holm) Artros Diabetes Typ 1 Normal-, risk- och högriskgraviditet FörvĂ€rvad ryggmĂ€rgsskada HIV Kognitiv svikt KĂ€kfelstĂ€llning & missbildning Medfödda Metabola Sjukdomar Myositsjukdomar (Alt. Spondartrit) Neuroinflammatoriska sjukdomar5 Njursvikt â Kronisk Std 5 SmĂ€rtproblematik Thorakoabdominellt aneurysm BröstsmĂ€rta (U. Heilborn) HjĂ€rtischemi3 (T. Jernberg) Reumatoid artrit4 (C. Carlens) Stroke (C. Sjöstrand) Patientgrupp (Ansvarig person)
- 24. Themes and Function Areas etc.Periop. Med & Intensiv- vÄrd HÀlso- professioner Bild & funktion Akut KUL Barn och Reproduktion HjÀrta-KÀrl Cancer Inflammation Reparativ Medicin Neuro etc. etc. Themes and function areas include care, research and education
- 25. Patient groups are core Periop. Med & Intensiv- vÄrd Bild & funktion KULAkut HÀlso- professioner Barn & Reproduktion HjÀrta-KÀrl Cancer Inflammation & Infektion Trauma & Reparativ Medicin Neuro PatientomrÄde Patientgrupp PatientomrÄde Patientgrupp etc. à ldrande Patient groups are core in the new organization A multi-disciplinary team is created based on the needs of each patient group
- 26. Patient groups are clustered into patient areas Periop. Med & Intensiv- vÄrd Bild & funktion KULAkut HÀlso- professioner Barn & Reproduktion HjÀrta-KÀrl Cancer Inflammation & Infektion Trauma & Reparativ Medicin Neuro PatientomrÄde Patientgrupp PatientomrÄde Patientgrupp etc. à ldrande Patient areas is the aggregated level of several patient groups for better synergies and collabortation Patient areas have a clear logic in staff competences
- 27. Themes is the higest organizational level under hospital level Periop. Med & Intensiv- vÄrd Bild & funktion KULAkut HÀlso- professioner Barn & Reproduktion HjÀrta-KÀrl Cancer Inflammation & Infektion Trauma & Reparativ Medicin Neuro PatientomrÄde Patientgrupp PatientomrÄde Patientgrupp etc. Tema Themes are clustered patient areas, following a clear care logic
- 28. The way forward
- 29. 29 Patient first together we create the best healthcare