Introducing cancer patient pathways as a health care reform – why and how a Scandinavian comparative study A brief version of presentation held at The annual meeting - Research on «pakkeforløp» Stockholm 11.16.18 Per Magnus Mæhle, Oslo University Hospital and Faculty of Medicine, Univ of Oslo OUS Kreftsenter CCC
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Introducing cancer patient pathways as a health care reform – why and howa Scandinavian comparative study
A brief version of presentation held at
The annual meeting - Research on «pakkeforløp»Stockholm 11.16.18
Per Magnus Mæhle, Oslo University Hospital and Faculty of Medicine, Univ of Oslo
OUS Kreftsenter CCC
The roadmap to this presentation• What is the issue of our inquiry• What kind of cases – similarities and differences• A story of and to which problems do we want to contribute to answers
three phases and an overture• Similarities and differences across the three cases – a preliminary approach
The presentation is preliminary findings of a project accomplished by - Per Magnus Mæhle, Oslo University Hospital og Dept of Health Management
and Economy, Med.fak., UiO, in a cooperation with- Senada Hajdarvic, Department of Nursing, Umeå University- Erna Håland, Dept. of Education and Lifelong Learning, Norwegian University
of Science and Technology- Rikke Aarhus, Research Unit for General Practice, Aarhus University
OUS Kreftsenter CCC
What is the issue of our inquiry and to which problems do we want to contribute to answers
Introducing cancer patient pathways as a health care reform –why and how - A Scandinavian comparative study Ambition: Useful learning of how health care reforms and transformation should be accomplishedContribute to theory development on Institutional change in public sector organizations
OUS Kreftsenter CCC
The phases constituting the cases
First step of lifting up on the agenda
Staging the need for a reform
Constituting a situation of urgency
Enabling dynamics and building capacity for change
Contextual issues interfering with the process
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2005 2007 2009 2011 2013 2015 2017
DK
SE
NO
Differences and similarities in the context and its consequences - 1
Similarity: Type of health care system
A public expectation to the welfare state to deliverHealth care a political issue
OUS Kreftsenter CCC
Differences and similarities in the context and its consequences - 2
Difference: The institutional structuring of health care
The ability to implement all the way down – the role of negotiation and governance
OUS Kreftsenter CCC
OUS Kreftsenter CCC
Helse-departement
Helse-departement
Helse-departement
Sundhets-styrelsen
DanskeRegionere eksMidt Jylland
Helse-direktoratet
Helseregioner eksSør-Øst Region
HospitalHospital Hospital
Social-styrelsen
LänenEks
SkåneRCC
Differences and similarities in the context and its consequences - 3
Difference: The overall motive
The espoused challenge and over all aims- Relative survival- Social and/or geographical inequality- Increased patient satisfaction- Cost efficiency - Delivering the best cancer care
OUS Kreftsenter CCC
Differences and similarities in the context and its consequences - 4
Similarity: Identical interventions
The same ideas, immediate motivation and content of the reformAmbitious and long way downDiffusion or learning?
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1. Staging the need for a reform
• The investment crises hitting cancer diagnostics and treatment• Building national clinical programs and guidelines for cancer
diagnosis• The acknowledgement and focus on the needs to accomplish far
better coordination across the silos Pathway and some crises• The establishment of special positions and institutions cancer
care on national and/or regional level• The establishment of special positions and institutions cancer
care on national and/or regional level• The appearance of examples of delivering practical solutions to
the perceived challenges
OUS Kreftsenter CCC
2. Constituting a situation of urgency • The role of media, interest groups and some specialists• Defining the dominant way of conceptualize the
problem and the solution• National political commitment on a very high level• Short way from political embracement to politically
demand for action
OUS Kreftsenter CCC
3. Enabling dynamics and building capacity for change• Extraordinary organizational structures – some
previously established and some created as part of implementation
• A room for institutional entrepreneurship created and filled by experienced actors - mainly insidersExtraordinary organizational structures – utilized by
institutional entrepreneurs
• Activating specialists – bottom up meets top down• Existing models actively integrated in the change
process
Enabling dynamics and building capacity for changeDifferences and their impact?
• Differences in rules framing the implementation processes– Governance vs facilitating vs consultancy– Mandatory vs voluntary
• The role of funding facilitating implementation?• The role of monitoring pathway data in changing
behavior and outcome
OUS Kreftsenter CCC
How did it work?
• Huge energy, an extraordinary experience and perceived success
• However: Right and only answer to the challenge? How should we measure a success of the SPP reform? When is the mission completed?
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CPP - The right answer to the challenges?
• What about other quality measurements?• What about those cancer patients not being included
into SPPs? • What about integration of primary care?• What about patient pathway after the start of first
treatment?
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How did it work? - 2
• There is several possible scales to measure:– Monitoring waiting time a part of governance– Standardized patient pathway as a part of governance– Improved waiting time– Continuous improvement processes organized along pathway– More satisfied patients– Decreased inequalities– More cost efficient health care– Improved planning system and logistics – Patient perspective penetrating the systems and behavior– And at least: a lesson to learn from
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Invitation to a further dialogue
• Since this project want to be a part of a learning process I will be happy to present and discuss our findings in other fora and organizations that have some connection to these stories
• Contact informationPer Magnus Mæhle Email: [email protected]: +47 91356340