A county-wide approach – the key to improving healthcare access - Norrbotten County Council

Engelsk översättning av tidigare artikel publicerad 28 oktober 2008 Se länet som en helhet - viktig del i tillgänglighetsarbetet >>.

At the core of this process are the role and responsibilities of management, which must gear planning and control to needs and resources. Planning must draw on continuous monitoring and evaluation based on agreed measures that provide decision data and in-depth information about activities.

Coordinated action to improve access

Before the extended healthcare guarantee was introduced in 2005 there were long wait times for outpatient services and operations at the County Ear, Nose, Throat and Oral Surgery Clinic. Its services were evaluated and several decisive measures were taken to improve access, including a temporary financial injection in some cases

- If you feel comfortable with your performance, you both dare to, and can, take several measures at the same time, which in turn may be crucial to achieving sustainable healthcare access, says Per Berglund, Head of the County Ear, Nose, Throat and Oral Surgery Clinic.

The Clinic took proactive measures such as cutting wait times; rapidly increased capacity by contracting care providers for specific services; implemented a new holistic approach called Good Clinic; and hired more resident physicians. These measures enabled the County Council, by implementing a long-term perspective, to increase healthcare capacity county-wide and reorganize use of the county's physician resources in such a way as to increase the number of operations.

- Another improvement project in the field of oral surgery, which is also a specialty of this clinic, helped to free up one operating theatre day per week, says Per. The need for dental treatment under anesthetic was cut by changing dental procedures in such a way as to increase capacity for treating patients with dental phobia without anesthetic.

County-wide routines and technical solutions are crucial

The management's goal is to move tasks rather than staff, thus increasing physician mobility in the county.

- To make it possible for physicians to work effectively and flexibly wherever they are, it is vital to have uniform routines and identical equipment in the county's clinics and operating theatres, says Per Berglund. We also make sure to rotate different types of operations and patient groups between the different operating theatres and clinics.

Technical solutions must be implemented county-wide if they are to be successful.

- The following components are absolutely essential: county-wide patient records, a county-wide operation waiting list, a dedicated server for the digital dictation system, and a telephony system that makes it possible to direct calls to the clinic that is currently responsible for the county as a whole, says Per Berglund.

With such a telephony system the County Clinic can deal with patients regardless of the phone number they call and adjust the number of nurses who answer calls at any one time, for example by having just one nurse in one place for the whole county or having several nurses at all the three ear, nose, throat and oral surgery clinics at the same time.

Efficiency gains and support for coordination

The process of transcribing patient data is coordinated county-wide by means of digital dictation and a dedicated server.

- The objective is to avoid wasting non-value creating time on transcribing patient records, says Eva Barrelöv, Nurse Manager at the County Ear, Nose, Throat and Oral Surgery Clinic. Medium and low-prioritized dictations are coordinated and transcribed by secretaries, the aim being to limit transcription times to seven days. This in turn ensures better patient safety. We can share out the task of dictation at peak times or when production time is lost due to staff absence, says Eva.

Deeper understanding promotes optimal use of all resources

In the context of its continuous efforts to improve its performance the County Ear, Nose, Throat and Oral Surgery Clinic emphasizes the importance of using agreed measures for the purpose of evaluating results.

- One essential condition for good healthcare access is optimal use of all resources. This calls for deeper understanding of the Clinic's work, says Per Berglund.

For some time the Clinic has been developing various measures relating to visits to the Clinic, referral inflows and wait lists. Together with the County Council, the Clinic has examined whether equal care is offered throughout the county, "consumer behavior" when it comes to inflows from community health centres, and the Clinic's ability to terminate episodes of care.

Agreed measures for evaluation and planning purposes

Together with her colleagues, Eva Barrelöv has implemented the Good Clinic approach, which aims to offer all new visitors to the clinic an appointment in accordance with the healthcare guarantee and to schedule all revisits within the stipulated time, at the County Ear, Nose, Throat and Oral Surgery Clinic.

Fig: Third Available Time (TAT), control card average Days.

- The measures that we use are Third Available Time (TAT), which is a measure of the capacity of our clinic services. We also take into account the work environment, Tele Q flows (Tele Q is a telephone answering system), economic factors, and physician supply, says Eva Barrelöv. One person has overall responsibility for the measurement system and the Nurse Manager is responsible for monitoring, evaluation and feedback to the Clinic.

Every week, the TAT at the three clinics, the county average and the standard deviation for the period in question are measured.

- There are several advantages with a county-wide clinic where we can direct the flows to match spare capacity and control the balance between operations and clinic reception, says Eva Barrelöv. This means that we are less vulnerable when staff are sick or absent for other reasons, and we can therefore maintain a high level of healthcare access for our patients. We can also coordinate patient flows, for example in connection with staff vacations, in plenty of time. That is why our county-wide routines, county-wide telephone health advisory service and Tele Q appointment booking service are so important.

Contact details

Per Berglund, per.berglund@nll.se
Eva Barrelöv, eva.barrelov@nll.se

Text: Ulf Gripkow, Sveriges Kommuner och Landsting, e-post: vardgaranti@skl.se