Workflow at a reference hospital

A summary of the most important lessons learnt from the total of 50 hospitals studied, all of which acted as a reference for the New Karolinska Solna can be found below.

The hospitals’ mission
All the hospitals studied had a clear three-part assignment to execute not only high quality care but also research and education. As a rule there was no formal prioritization of the three parts of the assignment.

Integration of research, education and care
Several of the leading academic hospitals coordinate the organization and leadership of health care with the medical faculty/university. The goal is to create structures that better support and integrate care with clinical research and teaching. The international reference hospitals have chosen different models; from completely integrated organizations with shared principal players to collaborative half-integrated organizations with some shared leading functions.

Collaboration within the health care system network
Several of the leading hospitals studied act as a knowledge centre in the health care system/network. The large patient base required to create competent and resourceful centers for highly specialized care is achieved through the network; while the health care providers within the network provide less specialized care and can thus be available for research and teaching.

Operational contents
The number of specialists differs at the hospitals studied, from a comprehensive range to a more specialized selection, although operations primarily focus on a small number of specializations. The specialization and the size of the hospitals influence the number of specialist care units and general care units provided. The hospital’s focus is often related to how collaboration with other hospitals in the health care network develops and how care is financed.

Multidisciplinary themes
The leading hospitals in the USA and Europe maintain that the relationship between health care and research requires new organizational models, which better promote multidisciplinary collaboration. The formation of clinics gives way to the creation of training centers and therapeutic areas. Within a given theme several specialists with strong health care and research interconnections are brought together to facilitate the multidisciplinary and common use of resources. In certain cases a theme has been relocated to another hospital, which is associated with a University hospital.

Specialization
A summary of the leading (highest rated) hospitals in the USA shows that only Johns Hopkins and the Mayo Clinic have managed to achieve an internationally leading position in most specialties. Massachusetts General ranked highest in six specialties, while the other hospitals studied made strategic investments in one to four areas.

Shared resources
In addition to new organizational structures, the reference hospitals invest in joint specialty investments and shared use of resources. Some departments share medical care facilities at the Mayo Clinic. The doctors come to the patient in his or her hospital room rather than the patient being transported between various departments. The multidisciplinary approach has also been introduced in outpatient settings where diagnostic information, treatment schedules and treatments can be carried out in a few days through close cooperation between the specialties. Similar approaches have also been introduced, in among others, the Cleveland Clinic, Duke and Johns Hopkins.

Patient safety and follow-up of performance
The clear focus on “patient first” as many of the leading hospitals emphasize, leads to an active management of patient safety. With the support of flow-oriented organizational models, health care has been structured more easily according to patient needs. The multidisciplinary teams are responsible for ensuring that clear processes are defined in the care programs where specialists from various specialties are included. The processes are continuously followed up and evaluated; deviations reported and addressed. The new organizational structure has led to lead times being reduced while the patients feel safe and experience continuity as they are treated by the same team throughout the entire care process.

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