Problem: Ageing population with rising chronicity; fragmented services delivery resulting from split management of health and social services; provider dissatisfaction over the standard of care for elderly patients.
Solution highlights: A new integrated care organization (Hälsostaden) was established to merge primary and hospital care with elderly and social care. Hälsostaden is jointly managed by its regional and municipal government and employs 600 professionals across health and social sectors; early investments in stakeholder relationships and trust building were essential for securing the future of the initiative and developing a foundation based on teamwork; finding the uniting objective of improving care for elderly people enabled stakeholders to move forward with planning; contextualizing the initiative within emerging political priorities helped generate political support and secure the necessary legal frameworks; identifying individual organizational strengths and pooling resources minimized required investments and supported in-house initiatives.
Description of practice
Responsibility for the provision of health and social services in Sweden is split between regional and municipal governments. However, with increasing pressure from rising chronic needs in an ageing population, this separation of roles has contributed to service delivery fragmentation. As a result, the Municipality of Ängelholm and the Regional Council of Skåne grew dissatisfied with the local standard of care for elderly people, reporting concerns such as patients getting lost in the system, service duplication and high hospital readmission rates.
Senior management officials in the Municipality of Ängelholm began talks for an initiative to improve care for their local elderly population. After building stakeholders’ trust through extensive discussions across municipal, primary and hospital levels, a shared vision for change was pitched to the highest regional authority. Approval for a pilot initiative to explore integrated care models was granted and a new integrated care organization, known as Hälsostaden (translation: “city of health”), was established. Hälsostaden works to bring together primary and hospital care with elderly and social care, pooling regional and municipal resources in a joint budget and employing 600 health professionals across these sectors. Through merging previously fragmented professionals under one organization, Hälsostaden has created a shared organizational culture fostering collaboration, cooperation and teamwork among its newly-formed workforce. Several new projects are being tested within Hälsostaden, such as the introduction of mobile care teams, electronic medical records and e-health. As a pilot project, leaders of the initiative have been granted significant freedom to explore innovative models of care, with the long-term view of permanently adopting successful strategies across Sweden.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Hälsostaden is a complex initiative implemented across several organizations and involving many stakeholders. The idea for the initiative emerged out of informal discussions between local leaders in health and social care within Ängelholm. Motivated by a common desire to improve care for elderly people in their region, these leaders lobbied the regional authorities to grant permission for the initiative. Recognizing the upcoming challenges in delivering health and social care to an ageing population, the regional government was open to change and proved forthcoming in developing the necessary legal framework for the initiative. Hälsostaden unites both health and social care providers under shared leadership from the Municipality of Ängelholm and the Regional Council of Skåne, bridging the divide between health and social care in Ängelholm. Hälsostaden is organized directly under the regional council and has its own steering committee and board with representatives from both regional and municipal governments, as well as managers, administrators and other necessary personnel to oversee its functioning.
While evaluation of the initiative by Lund University is ongoing, it is anticipated that Hälsostaden will generate improvements such as reduced hospital stays, fewer emergency visits and increased financial efficiency. The initiative also has a strong focus on improving quality of life for the elderly population, aiming “to add life to years not years to life”. Cost savings as a result of reducing unnecessary hospitalizations have already been demonstrated, over 90% of patients are currently seen within government-set waiting time targets and feedback from patients has so far been very positive. The pilot is set to continue until September 2016 and permanent adoption of the model is a possibility if successful.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Carl-Johan Robertz