Region Jnkpings ln Qulturum

IHI Health Improvement Alliance Europe

The participants at the fall meeting 2016 at Qulturum, Jönköping, Sweden.

Participants at the fall meeting 2016.

Fall Meeting November 3-4, 2016
At Qulturum, Jönköping, Sweden

Memory notes & Documentation  -   Photoshow from the meeting

Day One · Thursday, November 3, 2016

1. Introduction & Welcome
Göran Henriks, Derek Feeley, Amelia Brooks, Pedro Delgado and Maureen Bisognano

Göran Henriks with a powerpoint startslide

Göran Henriks, Chief of Learning & Innovation, Region Jönköping County, welcomed the network to Jönköping and Qulturum.
- We are happy and proud to co-host this event together with IHI, Göran said and shortly presented the history of the Qulturum residence. This is the first physical meeting for the European Alliance.

Derek Feeley med mikrofon i handen.- We hope to build a sustainable influence network, said Derek Feeley, President and CEO of IHI and asked everyone to consider how this network can grow over time. This is a time to share and a meeting where we must accept messiness in the beginning and when we come to the end will leave with a wealth of perspectives and stronger relationships.

Pedro talar, tummen upp.Pedro Delgado, IHI, talked about the diversity in the room “Together we are representing 100 million people!” We have brought together innovative leaders to surface common challenges, to shape the future.

The introductions gave the participants a sense of what the alliance is and how we are going to work together - where we are starting and where we hope to go.

The principles of this meeting:

  1. Accept and encourage messiness
  2. Share assets and ideas – be solution focused!
  3. Be energizing and fun
  4. Leave with stronger relationships then when you came
  5. “All teach, all learn”! We have a wealth of perspectives. There is a way for everyone to get engaged regardless of your perspective (policy level, delivery level etc.).

Amelia Brooks porträttAs a start of the meeting Amelia Brooks asked the participants to share fun facts about themselves – around the tables. (A way to get to learn each other morte, and to be used later.




Radical Redesign Principles for Europe?

Is it time for radical redesign? Dereek Feely and Maureen Bisognano asked and answered: Yes, a paradigm shift is needed! (See diagrams etc in their presentation, pdf). They then presented a list of ten radical redesign principles that have been agreed upon in the American IHI Health Improvement Alliance.

Change the Balance of Power
– Co-produce health and wellbeing in partnership with patients, families, and communities. (Example: The co-design of Self dialyses)

Standardize What Makes Sense
– Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care. (Example: The “Swedish list” in a hospital in California)

Customize to the Individual
– Contextualize care to an individual's needs, values, and preferences, guided by an understanding of “what matters” to the person in addition to “what's the matter.” (Example: The Breathe Magic Foundation uses intensive occupational therapy to help children with hemiplegia –Teach magic tricks, juggling, origami, and other creative arts to develop coordination and self-esteem. See also the Dimensions of Humanization.)

Promote Wellbeing
– Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care. (Example: “The Daily Mile” running for school children at S:t Ninian's Primary School in Scotland.)

Create Joy in Work
– Cultivate and mobilize the pride and joy of the health care workforce. (Example: The Five Steps to Create a Joyful, Engaged Workforce)

Make it Easy
– Continually reduce waste and all non-value-added requirements and activities for patients, families, and clinicians. (What rules are holding you back?)

Move Knowledge, Not People
– Exploit all helpful capacities of modern digital care and continually substitute
better alternatives for visits and institutional stays. Meet people where they are, literally. (Example: Children in Africa had their eyes checked by their teachers.)

– Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness. (Example: Project ECHO.)

Assume Abundance
– Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities. (Example: Using the postal workers for healthcare. Promoting independence.)

Return the Money
– Return the money from health care savings to other public and private purposes. 

At the end of the session, the group was asked to evaluate the principles and think if they can be valid even for the European alliance – or if something should be removed or added.

Fem personer kring ett bord diskuterar.Discussion
Are these principles right for Europe? What really resonates for you? What would you change? What's missing?

Comments from the tables: Yes these are right principles, but the whole of Europe is not represented here today. We must engage front line staff, vanguards (= a group of people leading the way in new developments or ideas), pioneers and trendsetters. If not we, who should do it?!


Derek Feeley ended this section by saying: How to address the challenges we have in front of us? We should be proactive and start today to steer our own future. The six Dimensions and 10 Simple Rules from “Crossing the Quality Chasm” are a bit outdated today. Now we need principles for 2020.


2. Patient Partnership: Stories from HIAE Members
Göran Henriks, Qulturum and Patrik Blomqvist, Patient supporter

Göran Henriks med mikrofon       Patrik Blomqvist

Keeping patient partnership as a common thread is designed to keep the patient at the heart of all our discussions and planning over the two days using stories from one of our leading Strategic Partners to start a conversation about patient partnership.

Göran asked Patrik to tell his story from being a patient with diabetes, to a dialyses patient, later on being one of two patients and two staff developing the Self Dialyses unit at Ryhov County Hospital in Jönköping. And now, an employee with the title Patient Supporter, helping patients at the Region's three hospitals. “We meet them as persons and can tell them what they themselves can do.”

The team has also developed a meeting place called Patient Cafés, where patient meet employees to talk, share experiences and learn from each other.

Two common questions to Patrik from families: The dialysis – what does it feel like? How will dialysis affect my daily life? Patrik has also helped creating something called “Living Library”. Here families and staff can “hire” a patient with a lot of experiences from different diseases who can meet with them to tell about his experiences.

Changing perspective to patient being a part of the team.Göran Henriks also talked about the meaning of “Patient Partnership”: seeing and meeting the whole person. The person's story is the starting point for building a relationship, common planning and mutual respect for each other's knowledge.

Another good example is the Mobile Geriatric Team, offering specialist care in the elderly's homes, and the Care Planning Diary at the Dep of Urology.

Göran ended this session saying that, the changes we are looking for, also need a new way of learning, which we have to look into later.

Reflections for the groups

What are you doing at home concerning person centered care?

Comments from the tables:
- Important to have patients participate in new ways of working.
- Both staff and patients, all people, have to contribute, so that we ask every day “What matters to you?”
- This is interesting; it's about patient's self-esteem.
- Supporting people can be done in different ways.
- We are looking for answers that can inspire us, there is a wide opportunity doing something in a new way now.


3. Breaking the Rules Europe
Derek Feeley

Derek Feeley talar inför grupperna.In January 2015 IHI organized a Breaking the Rules Week with 24 participating organizations where 375 rules were submitted.
- We wanted to do something of a social movement together to see what the power of almost 400 organizations is. Breaking the Rules was the start.

It began with the feedback from a unit for newborn children. A mother had been divided from her child because this was the traditional way to do so. The mum and dad asked for a change, and the unit listened to them, and let them stay with their child. Afterward the mum and dad gave feedback, “Thank you, you broke the rules for us!” This happens probably at many, all, hospitals.

During the campaign week the organization leveraged as many as 375 rules. A wide discussion took place and things started to happen thanks to stickers, bands and banners etcetera. IHI shared the Breaking the Rules concept to begin changing health care more broadly.
“Never underestimate banners and bands”, said Derek.

Question to discuss: If you could surface one (or more) rule(s) that get in the way of optimal patient care, what would it be?

Comments from the tables:
- You must have a brave leadership.
- Dare to ask Why are we always doing it this way?
- Delete the saying “What the doctor says…”

- Skip “the visiting times rule”
- Have people stay
- Delete the rule “You're not allowed to bring food”

- Too much information
- Waiting times for medicine
- Delete “Nursing homes must look like institutions, not like homes” (Norway)

- In Scotland there is a home for elderly that has a farm growing vegetable, but the home is not allowed to serve these vegetable because “We cannot guarantee that they are clean”. We broke that rule.

- In Sweden we are not allowed to share information between the healthcare systems and the municipality units.

- Let the patients owned their own patient registers. In Denmark it's the hospitals that own them.

4. IHI's Simple Rules for Eliminating Measures: A Prototyping Workgroup

At their spring meeting the American QI Alliance members requested specific actions for improvement in the areas of measurement. IHI presented these…

Simple Rules for Eliminating Measures

  1. Eliminate measures that have not been collected in over 2 years
  2. Eliminate measures of practice which have achieved near perfect performance
  3. Eliminate redundant measures
  4. Eliminate measures inconsistent with the evidence (or lacking in validity for quality)

Discussion: Measures
• Do you have measures in your system that meets these criteria? Could you eliminate them?

CDiscussion around a table.omments from the tables:
- Too much process measures, more important with outcome measures.
- Measures of time (Scottish Ambulance service)

Discussion: What's next for HIAE?
• Break some rules?
• Burn some measures?
• Check out for checklists? (A nursed complaint: “We have to fill in 12 checklists…!”)

Comments from the tables: Okay to do something.
- We want you to challenge the dominant “thinking” said Derek Feeley.

5. Three Workshops x 2

Each participant took part in two of the workshops


6. Patient Partnership: Stories from HIAE Members
Jason Leitch, Scotland


Jason talked about a boy taking part in a Numeracy program (learning to count).

During first six weeks the score went up and the amount of support went down. Nine month after start the boy had a speaking part in a Christmas play


7. Wrap-up and Preparation for Day 2 (+ a surprise!)

All together learning to sing in a choir! What a team!

Day one ended with a surprise: Karin Seiborg, singer and piano artist, had a singing lesson with all participants teaching them to sing in a choir. What a team!


Day Two · Thursday, November 3, 2016


  • Site visit at the Self dialysis unit, Ryhov County hospital in Jönköping
  • Patients in the room
  • Action planning
  • Short break
  • Collective voice
  • Next steps


8. Patient Partnership: Stories from HIAE Members
Amar Shah



9. Planning for Action
Maureen Bisognano and Pedro Delgado

Example: From a program aimed to diminish number of C-section deliveries. Outcome: Double vaginal deliveries over 18 months (26 hospitals).

The facilitators of the design sessions on Day One summarized the outcomes of all three sessions. (See ”IHI HIAE Fall Meeting 2016 Slides”, page 55 -  65!)

Participants then spent time selecting, planning and committing to tests of change within their preferred work stream(s).

What Next for Work Streams?

  • Synthesize the discussions, post-its, thoughts (1 week)
  • Draft connection of vision with drivers (driver diagram?) for each work stream (2 weeks)
  • Share the draft –HIAE members choose which aspects of which work stream they want to work on (4 weeks)
  • Virtual meetings/actions planned for next 6 months (5 weeks)
  • HIAE members identify operational teams to join virtual work streams (6 weeks)
  • Report back to HIAE meeting in April 2017

IHI High Impact Leadership Framework

Slide: High Impact Leadership Framework.

The Four Leadership Questions

  • Do you know how good you are?
  • Do you know where you stand relative to the best?
  • Do you know where the variation exists?

Do you know the rate of improvement over time?


Pedro Delgado


10. Creating a Collective Voice for HIAE
Pedro Delgado

Collective Voice

  1. Audience
  2. Media
    – Many assets
  3. Content prioritization for year 1
    – Radical redesign principles Europe
    – Work stream connections
    – Storytelling


Closing reflections & Next steps

What's next? Reflections

1) What is (or do you hope will be) the specific value added to your work in being a part of this network?

• What do you hope you could tell your colleagues/boss/team when you go home about what this network is doing to help make your work better/more effective/more joyful?

2) Imagine it's 2 weeks (or 2 months) from now. What would you have members of this network on “speed dial” to help you with?

• What types of information would you want to share or receive over an email list?

3) What do you hope you can get from this network that you're not getting anywhere else?


Next Steps for the HIAE

  • Schedule work stream calls and work towards implementing action plans
  • Launching of HIAE User group–keep the energy up
  • IHI Leadership Alliance & Health Improvement Alliance Europe Welcome Reception will take place at the National Forum in Orlando, FL on Monday, December 5th from 5:30 –7:00 PM
  • Next virtual meeting: February 22, 2017 at 13.00 GMT

Next face-to-face: during IHI's International Forum in London from April 26-28, 2017 – exact date coming soon

Thank you all for this first meeting!



Listen to some of the participants

Content this webbpage

1. Introduction & Welcome

2. Patient Partnership 1: Stories from HIAE Members

3. Breaking the Rules Europe

4. IHI's Simple Rules for Eliminating Measures: A Prototyping Workgroup

5. Three Workshops x 2

6. Patient Partnership 2: Stories from HIAE Members

7. Wrap-up and Preparation for Day 2 (+ a surprise!)

Day 2

8. Patient Partnership 3: Stories from HIAE Members

9. Planning for Action

10. Creating a Collective Voice for HIAE

11. Closing Reflections & Next Steps


More information on IHI:s website for HIAE

To join the HIAE

Please contact Amber Watson
at .

Contact in Jönköping:

Göran Henriks


Uppdaterad: 2016-11-22
Anna Lindman, Kommunikationsavdelningen, RLK o Verksamhetsnära funktion