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The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
IT’S ALLABOUTPEOPLEThe Microsystem Festival
1 4 March 2016Jönköping Sweden
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Please see me
https://www.youtube.com/watch?v=380MiMDoddI&app=desktop
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
IT’S ALLABOUTPEOPLEThe Microsystem Festival
1 4 March 2016Jönköping Sweden
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
RJL fantastic colleagues…in different
microsystems
They love their work as complexists and futurists
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
It´s all about peoplehttp://www.iorahealth.com/
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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”
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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!
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival05/02/2023 QULTURUM
Patient’s recordClinical databases
Care taker and care giver
KConnect – search motor
Health on the Net FoundationUniversity of Sheffield
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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 Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The festival A tribute to people´s health and reliable care
The Digital Patient and Digital Employee
Person centered care – a need for new roles
Signed Sealed Delivered
Health for life
Radical individualism
and social trust
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Topics and meeting places at the festival - A tribute to people´s care
The Digital Patient and Digital Employee
Person centered care – a need for new roles
Signed Sealed Delivered
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Topics and meeting places at the festival - A tribute to people´s care
The Digital Patient and Digital Employee
Person centered care – a need for new roles
Signed Sealed Delivered
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
Beyond the technical
Being a change agent takes personal resilience
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
A tribute to co-learningFrom Armenia, Canada, China, Denmark, England, France,
Netherlands, Italy, Singapore, Switzerland, Sweden Slovenia, USA
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The festival as Peters café, the AzoresCuriosity and back-casting
IdeasBest examples
Networking
Backcasting
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
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?
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Seven Question show the Way
We share and
learn
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
• Embrace the digital
• Include the citizen• Learn to combine
these two…
Sir John Oldham National Clinical Lead for Quality & Productivity, Department of Health,
England
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
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?
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
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 Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The Imagination Age
Imagination Age
Adapted from:
How economic value emerge?!
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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”
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
One second from Swedish talk show Skavlan, http://www.svtplay.se/skavlan
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran HenriksWe cannot wait – it´s timeReaching 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 citizenAND
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival05/02/2023
20 – 40 – 160, 14-15 million + 4-5 million
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
A sea of shoes in Place de la Republique, Paris
Protests are banned
here so you have to imagine
them
Source: David Shukman
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The Matrix – the system and training program
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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 machinesA “negative” intelligence explosion
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Autonomy and authority
When learning becomes health - any time require its translation into the reality I'm in
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival2023-05-02
I have access to the care I need
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival2023-05-02
There are reasonable waiting times at the care centers
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival2023-05-02
My trust for the health and care centers in my region
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival2023-05-02
Overall trust for health and care services in your region
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival2023-05-02
Your impression as a whole – largest amount of positive answers in the whole of Sweden: Rydaholm
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestivalRegionlednigskontoret2016-02-09
Net cost development accumulated adjustedRegion Jönköping lower than average
average
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The best possible care and health on equal termsSafe, 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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
For a Good Life in an Attractive Region
Vers
ion
25
Sept
embe
r 201
5
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
MicrosystemPatients and professionals
MesoPrimary care
Medicine Surgical
Psychiatric
MakroGovernan
ce
Before Tomorrow
Proc
esse
s
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Primary care is the entrance – specialty care on demand
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
• Person centeredness• Patient support• Microsystems working with the work• Microsystems network orientation• Requires redefinition of professional roles and skills
transfer
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
A structure for target group orientationdeveloped competence about complexity and future
1990s• 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
1990 20002000 2010 2010
Establishing new
microsystems for target groups!
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Bra Liv near – always close
Reference:Österstad Ulf [email protected] Johan [email protected] Charlotta <[email protected]>
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
2009 2010 2012
Patrik
From patient to employedFrom patient to patient support
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
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]
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
When and how patient involvement?
Health Literacy
Shared Decision-Making
Feedback for Improvement
Patient PartnershipIn Health
Patient PartnershipIn Redesign
Ref: Galina Gheihman, Kvarnefors, Henriks 2015
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Defining Patient Involvement
Image courtesy of Region Jönköping County
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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”
1990 20002000 2010
2010
From Why
to How?
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
“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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
“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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
“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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Ejje https://vimeo.com/55094566
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
“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…
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Images courtesy Britt-Mari Banck, Self-Dialysis Unit
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Making a difference1. 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 cultureFrom… To…
Patient Person with experience
Recruitment Invitation
Engaging the patient (1-way) Building relationships (2-way)
Mistakes or problems Opportunities
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
- people involvement provide real help faster
• Improves capability• Understand the readiness• Helps us to Adaptive moves• See the Preface importance
Ref: Edgar Schein and Marjorie Godfrey
• Reaching extraordinary results
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Anette Abrahamsson, Annmargreth Kvarnefors and Göran Henriks
Mobile Geriatric Team • Film: YouTube….
https://www.youtube.com/watch?v=lTfzq5FqATs
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Amount of care days
Before and after connection
Reference: Daniel Gustavsson and Marina Sumanusova
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Number of visits to doctors in primary care offices
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
No escape – all around the table
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Sweden ERAS Implementation
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival71
ERAS®Society 2015100+ units in 17+ countries
More than one Implementation programImplementation program running/announced
ERAS Center in placeERAS center in training
ERAS center discussions
ManillaDubai
Singapore
Guadalajara
Bogota
LisbonTokyo
Nanjing
Melbourne
Krakau
Cape townBuenos Aires
Auckland
Mayo Clinic
AHS, McGill Hamburg
CT, Charlotte
Soeul
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The Matrix – System failure
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
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
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#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).
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Avedis Donabedian
“Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system”.
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks
Key tactics :Out-love everyone else
Source of image: Bradley Burgess
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
#qmicro @Goran Henriks