HOPE EXCHANGE PROGRAMME FOR HOSPITAL AND HEALTHCARE PROFESSIONALS EXCHANGE DOCUMENT 4 - p. 1 / 6

DOCUMENT 4 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 Document 4. 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 2012. If you send this report by post, please do it by NORMAL and NOT by REGISTERED post.

Name of the professional

Allan Karlsson

E-mail

[email protected]

Sending country

Sweden

Host country

Hungary

Grade and designation of the professional

Divisional ward manager

Professional's employing organisation

Landstinget Kronoberg, SE-35185 Växjö, Sweden

Hosting organisation

Hungarian hospital association, Budapest

Head nurse

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

www.hope.be

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Please describe what you did during the period of your attachment The first week started in Budapest, on Monday we met our national coordinator, Dr Harmat at Madarasz Children’s hospital for a first presentation of the Hungarian health care system, hospital organisation, insurance system, etc. We discussed problems and attempts to solutions. Hungary has many hospital beds compared to other countries in the EU. Hungary has a high consumption of pharmaceuticals. Big problems with how to finance health care in the country. We got information about health care workers situation, why there are so many leaving the country. How they attempt to make changes in the systems to keep younger doctors staying, lot of doctors were very old and still working. We also met representatives from the National health Insurance fund that informed us about the insurance system and how the hospitals get reimbursed by the DRG-system. We were at The Ministry of health, discussed the low life expectancy, differences between the socialist period and the rest of Western Europe. high drug costs, investments that are made in different screenings methods and Salary and employment conditions for health care professionals. How Hungary will meet their manpower in the future if nothing is done now. Physicians can earn as much money on a weekend in England that they earn in a month in Hungary! We visited the Hungarian Medical Association, where we talked about the generation gap, international recruitment and the number of staff available. "Policy makers do not see the problem" was one comment we received. Hopeless situation! We made several visits to different hospitals, Cardiology Institute, Heim Pal Children's Hospital, Rehabilitation Hospital, informed about their activities, challenges and successes. It is striking how important it is with a leading hospital manager to achieve success. What I miss though, is how hospitals can work together more. After the first week we moved to the south west of Hungary to Veszprem County. Where we were the next two weeks. We were presented with an extensive program of daily visits to different hospitals and departments. It began with a presentation of the county's health care organization. We were shown around the ICU, radiology, cardiac services and more. It was striking how many hospitals there were at very short distances between them. We were in a local hospital in Zirc, government cardiac hospital in Balatonfüred, City Hospital in Papa, psychiatric hospital in Sümeg, psychiatric rehabilitation center in Doba and finally Balatonmadi Medical Centre. Problems with staff recruitment was common to almost all hospitals, psychiatric hospitals was acutely problematic. Hard to get a handle on how they are actively working on future manpower supply, missing nursing students, etc. The cooperation with universities was unclear particularly concerning nursing students.

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 EXCHANGE DOCUMENT 4 - p. 3 / 6

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? Hungary has a population of about 10 million people, this is something more than the population in Sweden. About 20% of the population lives in the area around Budapest. Sweden's land area is about 4 times larger than Hungary, with very long distances between hospitals. Hungary has short distances between the Hospitals. In Hungary there are approximately 175 hospitals that are responsible for acute hospital beds, chronic and rehabilitation beds. Compared to Sweden, this is a very high percentage, in Sweden there are about 80 hospitals with about half the number of beds for acute care. Hospitals in Hungary have a greater responsibility for the overall health of many older people while in Sweden it is the local municipality that has this responsibility in special housing or home care. The number of visits to doctors are on average about 12 / year in Sweden is about 3! The average length of stay for acute patients, however, differ not significantly. The hospitals are divided into state and locally controlled. In the past 60 hospitals transferred to state ownership and in May will be an additional 30th Hospitals are financed by state insurance system, based on the DRG reimbursement methodology. For chronic patients, reimbursement per hospital day. (Capita Plantation fee) In Sweden, the benefit is tax-funded and the DRG system is mainly used for monitoring. Patients do not pay personal contributions during the visit, but there is "pocket money" to a large extent, which in Sweden is totally impermissible. A real problem that was highlighted several times was the financial crisis prevailing in the country, where health care was left to stand back. The infrastructure in the hospitals were very different, with new plants to very worn out and ineffective. this was noticed visibly in psychiatric care HR issues were also very obvious, many doctors are forced to work long after their retirement. Nurses missing in many departments, buildings were empty because of the prevailing shortage of staff. Recruitment of doctors and nurses was a major problem, psychiatry was a shining example of this. How education for nurses was organized, I have unfortunately no clear picture of. I found that, even in such a large hospital that existed in Veszprem there were no nursing students. Here it must be change. Salary levels were described many times as a very big problem to get people looking to work in health care. Physicians in health care centers were often private, paid through general insurance. They often work alone in their office, we visited a health care center which was newly built at Balatonamed. There doctors interacted and so they could keep the clinic open with more flexible hours. Exchange of experiences between new and old colleagues was made possible. This is very important. Collaboration between hospitals was something I responded to, despite the short distances between the hospitals it seemed often to be very little planning how health care should be organized. EU-funded buildings, we could see in many places. A state owned heart hospital with very old buildings took care of the acute cardiac care in the county, why this is not centralized in Veszprem I do not understand. The distances can not be a problem. Local politicians often influence how care is organized, this depending on their voters

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 EXCHANGE DOCUMENT 4 - p. 4 / 6

I asked in many places, how they are actively involved in patient safety, etc., to this question, I usually see a surprised face. Given the low staffing levels may still not so strange. In Sweden, we work a lot with this issue. The same facial expressions I saw with questions regarding terminal care. The use of delegating tasks was also something that differed markedly. When other professionals performed simple tasks, doctors and nurses then can spend their time more for purely medical tasks. Nurses in Sweden has more advanced functions than what I could see that they in Hungary. Compared to OECD figures that Hungary has not few doctors, but they are older. However, Hungary has very few nurses.

Is there anything that could or should have been added to the programme? If so, what? I think the program that we participated in has been very rewarding. There have been so many impressions to absorb. The weeks I spent in Hungary was absolutely amazing!

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? It has been so rewarding to see how it is in another country. We forget how easy it is in ourselves. We have problems at different levels, we solve them in different ways. Culture and traditions affect us very much, I got really impressed while traveling in Hungary. If it's something that I take with me that's probably how the psychiatric care system is. It scared me. I've only got a brief glimpse, so I do not know how it is on a deeper level. Care of the elderly was also a question that I would like to know more about. We got stories how relatives and patients had expectations of care, which is largely based on culture and history. Another thing that I take with me is how important it is that we recruit young people, get young people interested in health care. We must begin to get them interested in their youth.

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

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What problems (if any) did you meet during your attachment? How could they have been avoided? We had no direct problems during their stay. Everything was orderly, many field trips planned. It was interesting to see different hospitals from metropolitan to small communities.

Outside of the work situation, did the attachment have any value, e.g. social and cultural value? I never thought I'd see so much at this time that we actually experienced. Local hosts, coordinators showed incredible hospitality, attentive. Unbelievable! I Love Hungary after this trip!

Would you recommend that the scheme be continued or extended in any way? Why (not)? Yes I think it can be made similar to next year. Possibly the final conference added in the last week as the replacement program is ongoing.

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 EXCHANGE DOCUMENT 4 - p. 6 / 6

Do you have any general comments that you would like to add? Own room is very important during the entire stay and access to internet connectivity. Final Conference that we had in Berlin was amazing, it was very nice and rewarding to meet the other participants of the interaction and experience

Place and date

Signature

Växjö, Sweden July 12, 2012

Allan 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]

www.hope.be