Edinburgh October 3th 2014

Integrated care – bridging the gap

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What we would like to focus on • • • • •

A glance on Norwegian healthcare in general and specified on integrated care The gap and background for reforms and need for changes The coordination reform The bridges Initatives taken to bridge the gap, examples

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Norwegian Healthcare system

= Approx 5 mill people = Public financed system. = Primary care owned by the municipalities = Hospitals owned by the state Hospitals are organized into: 4 Regional Health Trusts and 31 Hospital trust Responsible for • Specialized hospital services • Psychiatry • Pharmacy services • Pre-hospital services • Research • Training/ education Different hospital units within one Hospital trust: • Regional Hospitals • University Hospitals • Local Hospitals, different size and functionality (from 700 to 50 beds) • Nearly all hospitals have acute and • emergency functions • Some specialized, elective hospitals

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Healthcare development, Norway

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Activity in specialized health care, trends 2002-2012

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The Gap Chronical ill patients experience lack of communication and continuity between primary health care and specialized health care A culture in both primary health care and specialized health care to talk about us and them High status in working in specialized health care, low status working in primary health care Finances do not support cooperation

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Home

Primary health care

Specialized health care Centralization

Home

Specialized health care

Primary health care Decentralization

Home

Primary health care

Specialized health care

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Home

Primary health care

Specialized health care Centralization

Home

Specialized health care

Primary health care Decentralization

Home

Primary health care

Specialized health care

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The Coordination Reform • • • • • • •

Reduce or control growth in hospital expenditure Move responsibilities, tasks and money to the municipalities Financial incentives in place to reduce flow of patient to the hospitals Introducing Acute Care units on primary care level Introducing intermediary treatment and care units in primary care Reduction in number of small local acute hospitals New and exiting institutional structures are emerging

• The reform is a reform of direction • Focus on health promotion

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Bridging the gap with technology Communication between staff in specialized and primary healthcare Communication between staff and patient Virtual treatment room

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Interdisciplinary, across service providers

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Photo: Henning Tunsli

Trygge spor/safe way. Project on GPS and dementia

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• Skiing alone, • Free to take a walk, take bus etc • Holiday

Photo: Safecall

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Olav

Anita Photo: Safecall

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Photo: Ingrid Svagård

Effects found • • • • •

Photo: Henning Tunsli

Increased safety and security Freedom and absence of constraints Increased quality of life Possible to live home longer But major product development potential

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Bridging the gap by empowering patients Extended knowledge Easy access to information Patients take control over their own pathway Reduced barriers and enhanced expectations Well informed patients User participation in planning, quality assurance of health care services

Have patients taking control over their own health situation Wellness centers for treatment and prevention Reduction in smoking, obesity, alcohol and increased physical activity

Challenge for patients to differentiate between good and not that good information

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Bridging the gap with collaboration, good leadership and management …and it is challenging to manage and be a good leader across organisations and professions … most of all culture workers …but it is an important successfactor

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Bridging the gap with built environment and infrastructure

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Experiences from the Coordination reform so far? Acute 24 hour services in primary health care • By 2014 approximately 280 municipalities will have acute 24 hour services • 69 % of referrals are in evenings, night and weekends • 75 % of patients are above 67 years • 91 % of patients are referred from their homes • 80 % of patients have less than 3 days stay ACUTE BEDS

0

20

40

60

1-2 senger

48

3-5 senger

30

6-9 senger 10-14 senger

15 6

25 eller flere… 2 SINTEF Technology and Society 21

Overall planning for hospitals and health care • Integrated front end planning system for hospitals and primary care • Mapping and calculation brought together to do overall planning for hospitals trusts or single units – Refurbishing, rehabilitation, reconstruction and extension of existing hospitals – Planning new hospital buildings

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Specialized Healthcare

Hospital

Hospital

RHS

RHS RHS

RHS

RHS

RHS

Primary Healthcare

Family doctors, home care, nursing homes

Privat virksomhet

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Rauma municipality

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Vesterålen District Hospital – integrated services

Vesterålen hospital Population: 30 000 Beds: 56+5 HDU+ patient hotel Observation beds : 3+1

Narvik hospital Population: 26 000 Beds: 44+5 HDU+ patient hotel Observation beds : 3 SINTEF Technology and Society

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New Narvik Hospital – Integrated Local Hospital A&E; hospital and municipality

- Somatic and Psyciatric Acute Hospital - Addiction Treatment - Primary Care Functions - Common service functions

Hospital

Home care, Health center

Nursing home

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Øya Helsehus

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Future challenges • Sustainable, high quality solutions in a decentralised system • Recruiting professionals to the small, district hospitals • Collaboration and integration between hospital and primary care – the need for innovation and new solutions • Public expectations and demand • Strategic planning and market solutions • Research programs and transfer of knowledge

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Thank you for listening!

Contact information: • •

Marte Lauvsnes [email protected] Hilde Tradin [email protected]

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www.sykehusplan.no

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