HOPE EXCHANGE PROGRAMME FOR HOSPITAL AND HEALTHCARE PROFESSIONALS 2013 – FORM P3 - p. 1 / 10

FORM P3 - QUESTIONNAIRE FOR THE PARTICIPANT’S REPORT

Each professional is to write a five-page report (in English, French or German) at the end of his/her attachment by completing this form legibly or by using the scheme of this Form P3. The professional is kindly requested to send, preferably by e-mail, - one copy to his/her host, - one to the co-ordinator in the sending country, - one to the co-ordinator in the host country, - one to HOPE ([email protected]) and this not later than 31 July 2013. If you send this report by post, please do it by NORMAL and NOT by REGISTERED post.

Name of the professional

Märta Karlsson

E-mail

[email protected]

Sending country

Sweden

Host country

Finland

Grade and designation of the professional

Paediatric nurse, department manager, assistant operation manager

Professional's employing organisation

County Council Kronoberg

Hosting organisation

Tampere University Hospital

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Please describe what you did during the period of your attachment I was in Tampere, at TAYS, Tampere university hospital. TAYS is a part at Pirkanmaa Hospital district. Together with me was a woman from Denmark and we have almost the same program. The program was very well arranged and we have met many key persons how know a lot about the organisation and patient safety. The first day we turned around in the hospital area, they told us about the different buildings and things, which was good to know for us. After lunch whitch was already at 11 !!, we meet Erkki Kujansuu, Administrative Medical Director for Tays. He told us about the organisation at TAYS from a leading perspective. In the training center of the hospital we meet Mira and she told as about her job with e-learning, senario trainig, video conferans and much more. It was a very good concept I think and it involve all the staff in some way. One afternoon we have the possibility to take part in a scenario training with stuff from the ambulance. They trained what to do with a simulator doll. They get a story and had to take care of it in the ABCDE strategy. They were observed by an anesthesia doctor and video film. After the scenario they have a debriefing about what they do well and what they could do better.It was very interesting and instructive. Petri Pommelin, development manager at TAYS became a very important person for us and we have very good talks with him about many thinks but ofcourse most about patient safety. He said that a big challenge is to get the board and the administrators and CEO to take PS and communicate it to them who is responsible. We have to improve patient safety in everything. It is important to involve the patient more; you can ask them if they have seen something strange, which information they need and you can listen to their story. At TAYS they have started this job with some patient groups. They have also worked patientcentered design of care with the kidney patient. In this job it is also important to work with care chain, care process and support process. Then the patient can get service on time and it could be cost efficiency. During the first week we also met the manager for the information unit, Marika Järvinen, she was a ingenjör and have worked a lot with marketing. She meant that her main job is to figure out what the patient needs and their experience. They have had a lot of projects which have involved the patient. Inviting’s, website for patient. Customer is the one that’s gets value added! They are interviewing patients to find out the view of the patient and to get their view of Pre service-service-after service- and E-service. In our program we have the possibility to visit a private orthopedic clinic COXA in the TAYS area. Minna Riikka Rantala, head of physiotherapist, told us about their work. It was established in 2002 and they do 2713 surgeries as of 2012. Loss profit is 35 million € They have a Lean philosophy and the leading words are quality, high employee’s quality and efficient, low costs. Other person we met the first week was Rainer Zeitlin, medical expert. He was a consult and a diplomat between doctors, nurses and other staff members. His biggest project just now is: Health ward-cooperates between special and basic ward. We learned about the financial system, in voices, how to track them and statistics from Maria Rantala, financial secretary. She also showed us what’s in the economic rapports monthly. After that we were showed the DRG system and the invoices for a single patient. Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

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In the afternoon on Friday we visited Pirkanmaa Hospice. Tiina Surakka showed us around and told us everything worth to know about the hospice. It was the first Nordic Hospice and the first patient arrived January 1988. At the Hospice there are 24 beds. They also have about 30 home care patients. The staff are 38 and voluntary workers about 100! The second week started with a talk to Tiina Tanni in charge for communication and PR unit. This year they have been doing more marketing because they have to think more about what they can do and how to do it. From next year the patients can choice where they want´s their healthcare. It will be a lot of changes and they are trying to let the people and the staffs talk. Their work is a lot of more than to inform people. 2-3 years ago they have a project where they have to teach the staff to do their own administration. For example book up a journey for a conference. The unit was back up with communications tools. They made two magazines. One for the staff which comes three times a year, and one for the people in the area which comes out two times a year. The unit is in charge for the intra and the extern website. At this moment there is about 150 persons how are involved in the job with updating the Webb. They also have a site at Facebook and a few videos on You Tub. A new thing is that once in mouth the public can call the C.O and ask their questions. Medical Doctor Juha Öhman told us about the work with GTT (Global Trigger Tools). At TAYS it started 6 years ago. He showed us two examples; a project for the neonatology unit and one for the neurosurgery. The basic idea is finding the solution from your own perspective and solving the problem together without judging. In the future maybe the triggers pop up in the report when there is something wrong happening!? We have a meeting at the unit for services of information. (IT) There is 1, 2 million people living in the expert responsibility area and they have 25 information systems. They have two units inside one for development and one for service. The person we met was in charge for the one with service. She showed us some of the reports they do. One example was how many beds they are using. This report will be up date every ten minutes. After that we were told about the Electrical Medical report. The report was introduced in 2006. We have to see it in the training version. They also worked with education and they have a telephone support with three persons. One day we went by car to the small village Ylöjärvi and the care for people how are mentally disabled. There are 198 patients how are from 1 ½ to 93 years old. Nearly 100 of them are doing something every day like school or job. One unit worked with mental criminals. Two units for people with autism. All units have their own head nurse and it´s nearly 350 employers working there. They told us about their new buildings witch will be ready in 2014 in Nokia. After that we met Päivi Salonen, she worked with recruiting in the area. She showed as the e-paper for searching job, and the HR system for the employed. We also talked about different program for management and staff. In the afternoon we went to see the Eye center at TAYS. It´s quite new and lays in same building as the patient hotel. Their patients use the reception of the hotel for registration and information. The center is own and build by a private company and the vision for the clinic is to promote wellbeing of patients/citizens. When they build the center one of the architects was blind and that results in a lot of visual things that helps the patients a lot. We participate to the TAMK international week one day. TAMK are the nursing school. The program this day was about “Family nursing and cultural diversity of nursing”. In the morning we listen to David Ravnik from Slovenia. It was about the consequences of not do good values in life for a good health. “Just aheadit´s not too late to start!” Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

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Dr Agata Christine Onayango from Kenya told as about the country and the university system. Professor Rosabella Ogutu from Kenya told as about public care in Kenya Janice McKnight and Debbie Morgan from North Umbria university, New Castel, UK talked about “Caring in socially and culturally diverse community- examples from North East England. They gave us a view of the part of UK called North east England and told us about the big changes how have been there for the last 20 years and how it hade influents the people, the mental health and their lifestyle. They try to learn the students how to compeer with this from the start of their education. In the afternoon we were invited to be with the teachers in a dialog about the security in training for the students. Ombudsman Marja Nieminen works for TAYS and the Mental hospital in Nokia. She has worked as a social worker for many years. They started to use the ombudsman when the new Act says they had to. It was 1993.There are a lot of patients and relatives how needs a person to talk to, if they haven’t understand what went wrong. Her work is to listen to the patient and relatives, help them to take contact with people in the hospitals and help them to fill in the complaint. She answers in the phone 4 days in week and she also can be contacted by mail. She has nearly 2000 contacts in one year. Antti Vadén, managing outsourced service. He is a manager at the purchasing department. He worked with service, equipment and materials for the whole district and the work is a lot about doing contracts. They have more than 500 contracts in the area. The workers in outsourced service have now started to take the offers from the department. They also order and pack things up in the storages, laundry etc. they called it” Just in time” concept! The focus will be on quality and cost. Isto Nordback, project leader for the new buildings at TAYS gave as a very interesting view of the project. Revamped hospital promises good service! The project started 2009 and the new buildings will be ready 2020. In the project they had start to look at how the work is done then they go on with the building plans. E.g. Functional: How to get the plans implemented. Medicine, one person from the ward, one from the pharmacies, dictates-wright itself, and registration is done by the patient itself. Outpatient ward: All wards had to think about how they shall work together. A logistic person is involved of what wards it most important to have near each other and a lot of analysis about the traffic for patient and personal. The costs of the project is about 218 milj € In the end of this day Birgit Aikio, Head manager at the patient hotel, Norlandia care gave us a presentation of the vision and background for the hotel concept. Friday again! We were showed around and told about security and safety system at TAYS. They work with: Risk management at all levels of the organization, action of safety organization, security systems, guarding, special rooms, reporting, talking action at once. We walked around TAYS area and looked at the fire alarm system and security system. They have a system with buttons to push in their culvert in case of someone in the staff will be attached. He also showed us the system with video cameras at the TAYS area. One person is looking at data monitors all the time and can call the guards direct if he need. A guard from Securitas told us about his work. Then lunch with de C.O Rauno Ihalainen. Very interesting speaks about Pirkanmaa Hospital District and Tampere University Hospital in general. In the afternoon we visit Kela. Kela is a sort of insurance for all citizens if you are sick och have had a baby. 25/5-28/5, Mid –evaluation in Rovaniemi. It was a very great experience to come to Lapland. The weather was so good and the sun was up nearly the whole days! Saturday we met some of the other participants in Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

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our team and we eat and talked together. On Sunday morning we walked to the Arctic museum and have some interesting hours. We were all invited to an evening event with food, sauna and a lot of talking to each other in Team Finland. Monday morning we walked to the hospital. After a short showed around and presentation of the health care in Lapland we have an hour of feedback and work with the presentation. After lunch we went to the university in Rovaniemi and have real scenario training and debriefing. Thursday we all worked with the presentation for the ending conference! After the mid-evaluation I spend three days at the children’s clinic at TAYS. It was very interesting! I was at all units at the clinic and I also have a meeting with the head nurse. The last week we started the morning early with a meeting about Work environment. It is the department of HR Development how works with this area. They have a program and evaluate it every year. We haven’t heard so much about primary health care but we learned about “Role of general practice unit between special health care and primary health” from Doris Holmberg-Marttila. Public healthcare comprise primary healthcare and specialized hospital care. Public health care is provided by municipal health centers. A municipality may run its own health center or do so together with several other municipalities. Some purchase nearly all their services from private providers. Health center may have many branches and wards fore bed care. Public health care covers maternity and child welfare clinics, school healthcare, occupational health, preventive care, medical rehabilitation and dental care. It is taxbased funding. Municipalities are responsible for arranging specialized hospital care for their residents. 2004 they grounded a department of general practice in order to promote and co-operate the cooperation between public health care and specialized health care. Provide seamless service chains. Coordinate education in health centers. Develop and promote research in health centers. They have contracts between every health center, the district- PSHP and University of Tampere. We heard about different systems for data protection. Every employed have to sign a paper that they don’t have to take their own programs into the system of healthcare. They checked everything with log controls. We go by bus to visit Vammala Regional Hospital. The hospital treats somatic and psychiatric patients in need of specialist care. It also operates as maternity hospital and performs about 400 deliveries every year. Psychiatric outpatient care is provided in facilities situated in various localities. Emergency services to Southwestern Pirkanmaa´s health centers 24/7 The Occupational health service is in the organization in Pirkanmaan hospital district. They made reports or contracts and an operating plan every year in April. Then they worked with the plan one year. They also do workplace inquest, physical inspections, have meetings and discussions, medical care, lectures and rehabilitation. The staff are doctor, nurse, psychologist, physiotherapist and if you need other consultants as dietician, optician, hygienist As the last point at our program we went to the gym for a Practice hour with physiotherapist Tarja Myllyniemi. Very interesting and many good things to learn and think about.

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HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

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HOPE EXCHANGE PROGRAMME FOR HOSPITAL AND HEALTHCARE PROFESSIONALS 2013 – FORM P3 - p. 6 / 10

Please describe the structure of the host organisation and compare and contrast it with that of your employing organisation. What are the advantages and disadvantages of each structure? The organisation of health care in Finish healthcare system is not the same as in Sweden. In Finland, the municipalities are responsible for providing specialised medical care. The funding of specialised medical care comes from the municipalities, who get a state subsidy. There are 21 hospital districts in Finland. Every municipality has an obligation to belong to a hospital district. The hospital districts compose an expert responsibility area that includes a university hospital. In Finland, there are five university hospitals. Next year it will be free choice of care institution for the people. In Finland, there was a new Healthcare Act in May 2011. It says that the health care must degree on quality management and patient safety. It also says that the must be an operational plan for improvement of patient safety. In Sweden, the municipalities take care of social care and social assistance. The county councils/regions are in charge of health and medical care and dental care. The Swedish health care system is tax-financed and decentralised. There are 21 county councils/regions finance almost all health care and provide most of the service. Every county councils/regions must provide its residents with health care of good quality and promote good health in the entire population. The state establishes principles/guidelines, distributes responsibilities, supervises, and allocates government grants. In Sweden, there is free choice of care institution. The Swedish Association of Local Authorities and Regions (SALAR) launched its National Initiative for Improved Patient safety in 2007 along with all the county councils. In Sweden, there was a new Patient Safety Act entered into force on 1 January 2011 and it involves changes for everyone in healthcare. The act states firmly that the responsibility of healthcare must be made clearer. The act is also intended to lay the foundation of a good patient safety culture. Another important innovation in the Act is that the standing of the patients is strengthened considerably. The patients and their family members must have the opportunity to take part in work on patient safety. In the national initiative for improved patient safety SALAR producing care bundles to prevent adverse events. The care bundles is now : Healthcare associated urinary tract infections, central line infections, surgical site infections, falls and fall injuries, pressure ulcers, malnutrition, medication errors in healthcare transitions, drug-related problems. Tampere region is the 2nd biggest region in Finland. The population is 490 000 in an area of 14 470 km2 and 22 municipalities. Tampere city is located 175 km north of Helsinki between two lakes. Tampere is a city of Culture, High technology, services and industries. The vision of Pirkanmaa University Hospital district is to reliable and competitive provider of health service. In the district, good healthcare is based on scientific research, education, innovativeness and high-quality expertise. Operations of Pirkanmaa Hospital district are guided by a strategy extending until 2016. The strategy is based on the ethical principles good healthcare, mutual respect, appreciating competence, social responsibility. The hospital district´s slogan `For life ‘reflects this strategy. It stresses the importance of hospital services at the forefront of people´s everyday lives. In the top of The organisation at the district, there are a council and a board, under them are an administration centre. There are 7 divisions, regional hospitals, different kind of services and some Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

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private centre. The hospital district employed in average 7,239 people. The most important shared development projects applied to patient hotel, development of patient safety and quality management, development of personnel competence, evidence- based patient care and a health care classification system. The hospital district participates in a nation-wide project on development of service for the handicapped. In the work with patient safety in the district there´s a vision and the process has begun and some wards have been successfully, but the attitude must be changed! “Problem is possibilities for learning if we are hiding the problem we ruins the system”. In whole Finland, they use HaiPro. It is a web-based tool for reporting patient safety incidents. HaiPro is used in over 200 social service and health care organizations of various sizes: from small health care centres to entire hospital districts (120 000 users). The HaiPro reporting system supports development of procedures within the organization. Reporting is systematic and easy-to-use which ensures that the users can learn from the information gathered about safety events. The HaiPro tool provides an indication of the sufficiency of current preventive procedures. It can also be used to assess the effect of new measures. This overview is especially useful for supporting decision making within the top-level management. Anonymous and voluntary input ensures confidential reporting and processing of the safety events. The HaiPro method does not seek to blame. Medicine safety has to some extend been successful with good practice. E.g. handling of delegating medicine. Nurses to it before midnight and check the medicine lists so everything is correct in the morning. Good practice has been transferred to all Finland and there is a IT- system, staff can use, when logged in, to see what good practice are in the system an what they are working with in other hospitals. As a part of the Finnish National Programme on Patient Safety, the National Institute for Welfare and Health (THL), a public agency under the Ministry of Social Affairs and Health offers a web-based training programme on patient safety to all 140 000-health workers in Finland in co-operation with the health care institutions. I think that it is a great example for the whole Europe! A new service model will be based on focusing on the patients, the importance of patient´s families, outpatient care and mutual functionality of all the services. In the project where they will renovate the facilities they have used this “Service design”. It is a project they have worked with together with designers from university. One e.g. is the” Cardboard hospital “and she showed us a film on YouTube. It was a three days of workshops with architect’s, doctors, nurses and patients. Very interesting and I think it could be used also in the work with patient safety!! The county council of Kronoberg is a small county council in the southern part of Sweden called “Småland”. There are 183 000 inhabitants in an area of 9 500 km2 In the region there are mostly small business - more than 75% of all business have less than 25 employees. Some very large international companies are IKEA, Electrolux-Wascator, Alstom, SÖDRA, Volvo, and Dynapac. Areas of responsibilities for the County Council are health care, dental care, healthcare education and training, support for handicapped people, subsidies to regional development and to regional culture. Responsibilities for Municipalities are education, social services, urban planning and energy supply, streets, parks, environmental management etc. The vision for the county council is “A good life in vital country”, the mission is “To be a quality controlled Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

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county”. Health care shall be given with all people’s equal value and with a good treatment. The county council of Kronoberg works for a sustainable development, financial, organic and socially. The organisation of the county council is a council and a board in the top. Under them, there is a chief executive. Since 2010 the operating agency are arranged in 9 centres, which include all the service in the council. An office supports the centres with for example economy, finance, human resource and communication. There are nearly 5000 employed in the council. The work with patient safety in the county council Kronoberg is constant going on. The National Initiative for Improved patient safety is the basis for the work but there are also local investments for example, CEPS-training(Centre for education in paediatric simulation), diabetes coordinator, hygiene measurements, mobile intensive care team, safe in and discharge of patients. There is a web-based tool in the council for reporting all incidents. It is called Synergi. Only the employee can use it. There are also people in charge for event analysis and journal examination.

Is there anything that could or should have been added to the programme? If so, what? The program was heavy and filled up with information. We have a well-planned program and we talk about it nearly every day. Our host was very open-minded. She listens to all our wishes. We have the possibility to be at the sites we work in at home. Therefore, I am very pleased with the program and I do not miss anything.

Have you benefited from your attachment with the hosting organisation? If so, in what ways? Will your experiences be of value in your own job? I have learned a lot of the Finnish country, culture and the health care system. I know a lot about TAYS and get involved in the paediatric clinic. It was very nice get to know many people in the organisation. The experience I will try to take with me to my county council an my clinic is the good things with E- learning, service design and a lot of good examples of patient involving in the development of the health care.

Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

www.hope.be

HOPE EXCHANGE PROGRAMME FOR HOSPITAL AND HEALTHCARE PROFESSIONALS 2013 – FORM P3 - p. 9 / 10

What problems (if any) did you meet during your attachment? How could they have been avoided? There was no problem during my attachment. Our host was fantastic and she takes care of us in a very good way. The Mid- evaluation was a good way get to know the other participants in Team Finland and to start the work with the presentation.

Outside of the work situation, did the attachment have any value, e.g. social and cultural value? Yes. It has been a very special experience. There was a beautiful forest just outside where we lived. We walked, run, bicycled, and looked at the flowers, birds and trees. The weather was very nice all the four weeks. One evening our host take us to see her horse at the stable. It was a wonderful evening. We worked with the horses, filled water, red and build a fence. We also went to a concert with our host. Her son played trumpet. It was a really nice jazzconsert!! We participated in a run and walk race called Likkojen Leenki. It was just for women. We walked with stuff from the hospital administration. A good way to get knows new people. One of the first weeks, we hired bikes and do a lot of sightseeing around the neighbourhood.

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HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

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HOPE EXCHANGE PROGRAMME FOR HOSPITAL AND HEALTHCARE PROFESSIONALS 2013 – FORM P3 - p. 10 / 10

Would you recommend that the scheme be continued or extended in any way? Why (not)? We lived at the patient hotel, Nordlandia Care. It was very comfortable, big, clean rooms, sauna at the eight floor, nice breakfast and restaurant, laundry, free Wi-Fi and staff during the whole days. Outside it was a big and just wonderful forest where we walked and cycled a lot. I think that four weeks are long enough. It could be difficult to be away from job and family for a longer time. At four weeks, You have time to meet many people, learn about the organisation and the culture in the host country. You also have time to learn about the theme, ask questions and meet the person how know most about the special things you want to know things about.

Do you have any general comments that you would like to add? It has been a great time and I will always remember all good experience and people I meet in Finland! I can recommend everyone to do this exchange program. :-)

Place and date Ljungby 130731

Signature Märta Karlsson

Tel +32 -2-742 13 20 THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE

HOPE – European Hospital and Healthcare Federation – Fax +32-2-742 13 25 – [email protected]

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