Birgir Jakobsson Director of Health Iceland The role of supervision in improving quality and safety: Perspective of a hospital manager 24th EPSO-conference 25-27 September Reykjavik Birgir Jakobsson Director of Health Iceland

Supervisory organisations and producers of social- and healthcare have a common goal To improve the quality and safety of care

Good Care Evidence based Safe Patient focused Effective Equal Provided at the right time EPSO, Reykjavik 2017

The challenge of healthcare Bilaga E, 2007-2010 The challenge of healthcare Increased cost without increase in quality of care Patient safety – patients get hurt in healthcare Difficulties in recruiting staff All this is connected Detta hänger ihop. Finansieren blir inte glad, patienter klagar på vården, personalen känner sig otillräcklig trots att de jobbar mycket.

Why does it go wrong in healthcare? Bilaga E, 2007-2010 Why does it go wrong in healthcare? Lack of competence and shortage of staff Lack of continuity Lack of co-operation (teamwork) and communication EPSO meeting, IVO 2016 Jag är inte så säker på att det finns brist på kompetens i vården. Men det finns brist på rätt kompetens på rätt plats. Det har att göra med kultur!

Personal experience Lack of introduction Lack of support to younger coworkers Too much responsibility on young and inexperienced staff Single work Culture of hierarchy Healthcare has become more complex, patients and their families are better informed and more demanding

Our VISION for healthcare Unnecessary harm to patients does not exist – Zero vision Unnecessary care and vaste has been eliminated Healthcare is based on available evidence EPSO, Reykjavik 2017

How do we achieve this?

Improving results Way of working Results EPSO, Reykjavik 2017 Peter Alvarsson och Anna Rasmuson

Change of culture Future Present Values Principles Way of working For whom are we here Fokus on patient value and staff Flow principles: Right from beginning Reduce variation Link activities ”Pull not push” Standardisation Silos Hierarchies Principles Single work Sequensial Team work Short meetings Visualisation Way of working Safety Quality Accessability Working environment Efficiency Variation Results Unpredictable Predictable Peter Alvarsson och Anna Rasmuson

How do we bring about CHANGE ? Communicating the strategi through a simple business plan As a process As a tool Introduce a system for continuous improvement Focus on patient value Create a culture of continuous improvement Staff driven improvement Improving leadership Coaching management teams Coaching of leaders in groups Individual leadership EPSO, Reykjavik 2017

Systems for learning, continuous improvement and long-term sustainability Q Patient value Problemsolving at the right level Team of staff Visualisation 1:st line officer Escalation of problems if needed Tillämpa alla delar att börja fungera i ett system Head of dpt White board Head of division CEO EPSO, Reykjavik 2017

The developing leadership is important in order to implement a culture of continuous improvement Role model Vision and Values Personal concern Support and challenge Inspiration and motivation Stimulate teamwork and creativity Individual development Krav och belöning Eftersträva överenskommelser Conventional leadarship Kontroll Vidta nödvändiga åtgärder Krav och belöning Piska och morot Det gör att man lika ofta ser Utvecklande ledarskap längs axlarna Individuell utveckling och Organisatoriska resultat. Det är lite om modellen och vad världen utanför visat vad den kan hjälpa till med. Tillbaka till Karolinska, hur hänger den ihop med vad vi gör? Kontroll Överkontroll Låt-gå Organisational performance Non-leadarship Nordisk tillsynskonference 2017

Values = tool to change culture ! Performance Använd “Visa” menyn och “sidhuvud och sidfot” för att ändra eller ta bort texten under strecket. Attitudes and behaviour 14 14

Can this be achieved through Economic incentives Bilaga E, 2007-2010 Can this be achieved through Economic incentives Tailored systems for reimbursment Privatisation Organisational change Ad hoc improvement projects Probably not But there is no quick fix EPSO, Reykjavik 2017

.......but supervision may be helpful Bilaga E, 2007-2010 .......but supervision may be helpful In order to be helpful supervisory authorities have to be supportive In order to be supportive supervisory authorities have to understand change management So, does supervision improve patient or user safety? I don´t know but in order to be useful

What should we look for during supervision Is the assignment clear – owners directive (OD) Is there a business plan in accordance with OD and does it communicate the strategy for improvement Is the leadership clear – ”accountability and power”, clear delegations, support and continuous improvement Are quality indicators present and visible and what do these show Is there an incident report system and is it used in the improvement work Is the strategy for improvement known and practiced on the floor Do all categories of staff participate in the improvement work Facilities, staffing and working environment

Characteristics of a sustainable organisation Health Results What do we achieve, production of care at the wright quality within balanced economy Our ability as an organisation to continously question and challenge ourselves in order to reach sustainable results ”Coninuous improvement” EPSO, Reykjavik 2017 STH-LLQ066-20120831-MPE-budgetbalans

Supervisory authorities should be looking for organisational health

Concluding evaluation Clear strategy Leadership A culture of continuous improvement Outcome and visible results Facilities, staffing and working environment

Birgir Jakobsson, MD, PhD Directorate of Health Iceland Contact information Birgir Jakobsson, MD, PhD Directorate of Health Iceland E-mail: birgir@landlaeknir.is EPSO, Reykjavik 2017