The Microsystem Festival 2019
- Program

A1 Coaching the Art and Science of Health Care Improvement with Team Coaching

Improving health care processes and systems to result in improved outcomes, better systems and happier staff requires more than technical improvement. Discover the "art" of team coaching to improve team dynamics and find joy in providing care and improving care.

Presenters: Marjorie Godfrey (The Dartmouth Institute, USA) et al.

A2 Working through the 5 leadership behaviours

Leading change is an essential skill in today’s complex health and social care delivery. It is also a different skill from those normally taught to clinicians and managers. It starts with how we act as leaders. How we behave. This mini-course will draw on evidence from global high performing health systems and outline five behaviour YOU can practice to lead change.

Presenter: Jason Leitch (Scottish Government, UK)

A3 Gerontechnology for Sustainability

The technological transformation in society is expansive. For example, we spend more time on technical devices than the number of sleeping hours each day. A transformation like this is challenging. Warmly welcome to an interactive class where we will discuss technological challenges and learn how to use a Hackathon approach to promote early involvement of future users on micro and meso level, for sustainable development of  technology and health!

Presenters: Martina Boström (Region Jönköping County, Sweden) and Sofi Fristedt (Jönköping University, Sweden)

A4 Doing change sustainably

Things change and so do we. But how can the organization and we develop resilience in a successful way?
If you join us at this mini course you will learn about how to transform health and care by making the professionals to understand the power of variation as the platform for innovation. This makes change sustainable over time and makes Continuous Improvement to a habit.
In the seminar you will understand how Patient Compact accelerate how we can do change sustainably. You will learn about what questions are important to ask in order to encourage relationship between the patient and provider.

Presenters: Helen Bevan (National Health Service, UK), Göran Henriks and Anette Nilsson (Region Jönköping County, Sweden)

A5 Esther Boot Camp

Coaches and Citizens from the world famous Esther network Sweden including UK and Singapore will organize BOOTCAMP for you to understand and feel the power and joy of ESTHER Network with the purpose: To do What is best for ESTHER.

Presenters: Anna Carlbom Nicoline Vackerberg (Region Jönköping County, Sweden), Marie Winald Karlström (Modiga Mia, Sweden), Johan Thureson (patient representative, Sweden) and Caroline Ärleskog (TUC, Sweden)

A6 Sustainable collaboration for health

In Jönköping County there are fine examples of innovative cross-border collaboration with a health-promoting focus. In this mini course we will exchange examples of concrete interventions for different age groups by using interactive exercises in the whole group. Together we find the building blocks for sustainable cooperation that create more value as a unity for the inhabitant than the parts separately.

Presenters: Jesper Ekberg (Region Jönköping County, Sweden) et al.

B1 Delivering Sustainable Mental Health Services in Singapore - The Institute of Mental Health (IMH) Perspective - through Patient and Staff Focused Approaches

Some key challenges facing Singapore include rapid population growth, ageing and increasing burden of chronic diseases. Mental health and substance abuse account for approximately 11% of the burden of disease. Main challenges facing mental health care in Singapore are;
i. treatment gap
ii. low mental health literacy
iii. narrow concept of recovery and
iv. stigma.
With Institute of Mental Health (IMH) being the only tertiary psychiatric care institution in Singapore providing acute and long-term care to patients, there is an impetus to build a sustainable approach of delivering mental health in the most effective and efficient manner. IMH has rolled out patient and staff centric initiatives, by reorganising its clinical services and empowering its staff, to meet the challenges facing the mental health landscape in Singapore. IMH envisions that persons in recovery can be viewed beyond their mental health diagnosis – where people are viewed not for what they have, but for who they are. 

Presenters: Hong Choon Chua, Raphael Lim and Tina Fang (Institute of Mental Health, Singapore)

B2 Sustain balance and find abilities in your capacity 

Capacity and production management, simply put, means to plan for the maximum output that a unit can produce in a given period with the available resources. However, in order to achieve best capacity planning, one must achieve a consensus about what the available resources are, if they are available and how to place them. Like many other organisations, the health and social care sector consists of very complex organisational structures and the perception of what is what usually differs from care unit to care unit, from hospital to hospital and as well as from person to person.
This seminar will explore how different inputs and views can affect capacity and production management and what happens in a group of staff when you get facts presented that don't always coincide with the view that existed earlier.

Presenters: Lina Johannesson, Maria Ingebritsen, Maria Malmström and Pernilla Söderberg (Region Jönköping County, Sweden) 

B3 (Incudes two seminars)

Going home from hospital – better integrated care! How to plan, act and make the best transition from hospital care to home care

It is important to understand how to involve the patient in a process of transition from hospital care to home care.
We have been working hard to make different professions and organizations adopt a patient’s perspective and aim at the same goal. Engaged coworkers as well as systematic analyzing and identification of development areas are the main factors of success in bringing patients home in time. Together we have put more focus on cooperation in the whole chain from hospital care to home care. From now on the focus will be held on the persons who will be kept at hospital more than three days. We also need to analyze the re-admissions within 30 days for system learning.

Presenters: Ann-Marie Thordeman and Robert Kristiansson (Uppsala County Council, Sweden)

Patient pathway from home to home - a holistic commitment to Health services in Finnmark - North of Norway

Patient pathway from home to home - a holistic commitment to Health services in Finnmark - North of Norway. A joint venture between Finnmark Hospital trust and municipal Health services in the east county. The main aim is to improve the outcome for the patient. The main drivers are "Safe discharge program", "What matters to you?", and interdiciplinary teamwork. We have had a commitment to anchoring the Project and, developing wellfunctioning teams including user representatives. Developing team together with the municipality. Creating understanding of eachothers system. We have four areas of common interest: Capacity building, prevent readmittance, patient centered healthteam, communication.

Developed structured pathway from home to home.
Checklists for Critical transitions With the municipal care.
New procedures for safe discharge
Use of Skype in planning and discharge process.
We are already getting positive results, that will be ready for sharing in january 2019.

Presenter: Kristin Pedersen (The Finnmark Hospital, Norway)

B4 Esther SimLab

What happens when we get new conditions, new working routines, new roles and at the same time are expected to collaborate more? Can we practice/simulate together with the patient i.e Esther? 
Esther SimLab is a model for training non-technical skills together with a patient representative i.e Esther. We hope to give inspiration about practical training of the non-visible "things" in health care, the important values in a personcentered care. We like to share our idea about having a model for practical training in a learning organisation, a way of working with continuous improvements and building competence and sustainability.
As a participant in this seminar you will have the opportunity to share experiences and explore new thinking together with professionals and patient representatives.

Presenters: Maria Johansson, Marcus Lidin, Patrik Blomqvist and Henrik Ånfors (Region Jönköping County, Sweden)

B5 (includes two seminars)

SustainAbility = LeadershipAbility

Leaders do not necessarily know how to lead quality improvement at the front line of care. A leadership development program demonstrates increased capability to lead improvement including awareness of self and others. To develop and to sustain improvement in the microsystem, effective, accessible and consistent leadership is necessary. Further, leadership is about relationships and the work of Schein contributes to this program. Leaders are able to learn the skills those at the front line of care find most supportive of making and sustaining improvements. Lessons learned form this interactive session.

Presenters: Marjorie Godfrey (The Dartmouth Institute, USA) et al.

Sustainable value creation with the microsystem as the driving force - lessons from a 10 years journey

Ten years ago, Bracke Diakonia, one of the largest not-for-profit health care and social service providers in Sweden, decided to build their quality strategies on microsystem thinking. Local microsystem improvement teams started to build competence and capacity for continuous improvement while management and support functions shifted focus to supporting front line units with process support, information on outcome, and patient experience. In the seminar, we will show how six success factors emerged throughput our improvement journey:
(1) Continuity and endurance,
(2) Everybody is on,
(3) Dialogue instead of control,
(4) A culture of curiosity,
(5) Feedback with data,
(6) Support at the front line.

Presenters: Thomas Schneider and Charlotte Forsberg (Bracke Diakonia, Sweden)

B6 (includes two seminars)

Improve early identification and management of adult patients with sepsis in the emergency department in the University Hospital of Northern Norway

The aim of this improvement project was that within 6 months >80% of all adult patients referred to the Emergency Department identified as sepsis, would receive antibiotics within one hour. We started an improvement project where we studied our system, our data in the Emergency Department and tested different improvement suggestions using PDSA-method. Sepsis may be hard to recognise. The most challenging part of the project was to improve the nurses and doctors’ skills to identify sepsis and to empower them to execute critical care for the patients within one hour. The most important change was implementing an emergency team in the Emergency Department and starting simulation training of the team. Within 6 months our sepsis treatment improved and we reached our goal. Our new systems in the Emergency Department are now well established and we still find new things to improve.

Presenters: Trine Olsen (University Hospital of Northern Norway)

Improving the Care of Patients with Acute Kidney Injury

The aim of a reduction of Acute Kidney Injury of 20% by June 2017 was not met, partly due to lower overall rates than expected and delay in algorithm availability to start the project. We have learnt about the barriers to team engagement and how to overcome them. How to lead a team in an area you do not work in – persistence, understanding of the local challenges to improvement work, encouragement. We now have a greater understanding of the human factors and behaviour around engagement, and we have been working with a broad team with diverse and exciting ideas. The project is now spreading through the hospital and we are learning what tools work better in each department, how practices differ and how best to adapt in each area to improve patient care.

Presenter: Fiona Duthie (National Health Service, UK)

B7 (includes two seminars)

The St. Triduana’s Story Implementing care and support planning within a House of Care framework for people with long term conditions

HoC CSP BENEFITS: PATIENTS:People like getting information beforehand, they can see results, helps make mental link & they see connection between lifestyle stuff & results (PN). It’s improved our use of more than medicine. We used to give people medicine when in fact problem was with social issues. Having this approached & then refer to Links Workers is real benefit to patient care (GP). STAFF: Reception found this process lot less work than previous appointment systems for chronic diseases (Administrator). Helps people operate at top of licence and frees time (GP). We’ve seen links between  staff groups improving (PM). PRACTICE: CSP helped with safety-combining appointments meant chance of something getting missed was less (PM). We’ve one of lowest DNA rates & number of GP appointments is going down (PM). I believe we can run successful business and be patientcentred by focusing on what matters to the person…so proud that we have a system which is both positive & sustainable (PM).

Presenter: Alison Fox (St Triduana's Medical Practice, Scotland)

Together for a better health and equal care

Swedish health care system is under transformation. This transformation means moving care from specialist to primary care and from primary care to home care.  In the end, it means focusing on health promotion efforts and delivering care closer to the residents. To make this transition possible, Region Jönköping County established the programme called “Together for best possible health and equal care”. Britt-Marie and her family are fictive representatives of the inhabitants that are the core of the mindset of this transformation programme in the Region.  The programme aims to transform the care in a way that it is what the residents really need, when they need it and it is delivered  close to where they are.

Presenter: Anette Nilsson (Region Jönköping County, Sweden)

B8 

We believe in the power of continuous learning in healthcare. Do you?

We believe in lifelong learning together with the patient. How do you fit in with the needs of the nurse and the patient? How do you ensure that current and important information is immediately available when you need it? So that you can provide the optimal care together with the patient. The Green Heart Hospital has, in collaboration with Noordhoff (publisher), devised various technical solutions for making workplace learning possible. The nurse no longer needs to retrieve information from the computer and is available on the mobile phone with clear introductory videos for both the professional and the patient.

Presenter: Jaco van der Worp (Green Hart Hospital, Netherlands)

C1  (includes two seminars)

Using a novel approach, the researcher in residence model, to evaluate system sustainability

In complex health and care environments Quality Improvement (QI) is a cornerstone in delivering high quality, sustainable systems. As well as using highly effective methodologies, such as the IHI, and approaches such as flow coaching, the rir model provides an additional positive approach to ‘improvement work’. With health and care systems increasingly testing out new models of care, where the evidence base is less developed and there is a critical need to understand context and culture as part of the change, the researcher in residence model should be considered as part of the QI toolkit. 
Research evidence often takes years to filter down to the front line. Efforts to address the implementation gap have proven to be wanting. Implementation without a developmental approach is unlikely to achieve the anticipated outcomes. The rir model is uniquely placed to address all these issues, whilst in turn developing more sustainable health and care systems.

Presenters: Susan Martin (National Health Service, UK), Felix Gradinger and Julian Elston (University of Plymouth, UK)

Patient compact for best possible health and equal care

An introduction on Patient Compact as a co-production intervention in Region Jönköping and a case study in relation to the ongoing work. 

Presenters: Sofia Persson and Magdalena Fritzson (Region Jönköping County, Sweden)

C2 Co-production – essential to achieve and maintain sustainable care

Collaborative co-production in healthcare require a relocation of power. One part of a sustainable transformation of power is patients being experts capable of making decisions and professionals shifting from ”fixers” to ”facilitators”. In order to promote Co-production on a mico level (or in a microsystem), a good response/treatment is crucial.
 We welcome You to join our interactive workshop with Patrik, who has more than 30 years of experience from the transition of power in somatic care. Together, we explore how to make Co-production sustainable.

Interactive seminar

Presenters: Patrik Blomqvist, Martina Boström and Annmargreth Kvarnefors (Region Jönköping County, Sweden)

C3 (Includes two seminars) 

A healthy working place for a healthy working life

Across European countries and workplaces, poor mental health is significant and increasing. 25 percent of European citizens will experience a mental health problem during their life time. Building healthy and sustainable working places and sustaining ability at employees and leaders is crucial in order to tackle future challenges in health- and social care. 
‘’A healthy working place for a healthy working life’’ is a collaborative between Region Jönköping County and seven municipalities in Region Jönköping in Sweden which aims to promote mental health and well-being in the workplace. The project is built on networking, collaboration and co-learning and it aims to create structure for sustainability in the improvement. 

Presenters: Agata Rukat (Region Jönköping County, Sweden) et al.

Boston RESILIENT: Using student engagement, co-design, and community organizing to share narratives of hope from the opioid epidemic

“Boston RESILIENT: Narratives of Hope from Boston’s Opioid Crisis” is a photojournalism project developed by medical students at Harvard Medical School in 2018. The purpose of the project was to provide people in recovery, healthcare professionals, law enforcement officers, advocates, policymakers, and educators affected by the opioid crisis an opportunity to share their perspectives with the public. The project educated students, engaged the community, and aspired to help change the narrative on substance use disorders in our community. The project resulted in a professional exhibit featuring photographs of and insights from dozens of individuals in Boston who are finding ways to tackle the opioid crisis, and was displayed at a local academic hospital. This session will take a deeper dive “behind the scenes” of the project to investigate how student and community engagement, principles of co-design, and the community organizing model led to the success of this initiative. We will share narratives of hope from amidst the epidemic and brainstorm together about how participants might apply these success factors within their own institutional and community settings to fight stigma and address substance use disorders and mental health.

Presenter: Galina Gheihman (Harvard Medical School, USA)

C4 (Includes two seminars)

“We make it easy to get it right” when handling medicines. Nine nursing homes going from short term project thinking to systematic and sustainable quality improvement

In 2016, the Municipality of Copenhagen, decided on a new approach towards quality improvement to ensure sustainability and durability in the quality of care of the elderly. Starting out with nine nursing homes, a new improvement organisation was built on several levels to implement the systematic improvement methodology of the IHI. The strategy was to build capacity by learning and using the methods on one specific topic: medication. Within two years all nine nursing homes showed significant improvements in the medication handling process and the risk concerning patient safety on medication process has been reduced. Also, it appears that the improvement has been sustained. At the same time knowledge about the improvement methods has been unfolded both organisationally and concerning other quality issues. Notably the improvement team structure across organisational levels has proven a success by facilitating communication and understanding across contexts.

Presenter: Dorte Münter (Health and Care management, Municipality of Copenhagen, Denmark)

I trust my physician – Older persons' experiences regarding evaluation of their medication treatment

We explored older persons’ experiences regarding evaluation of their medications. They revealed a deep trust in physicians, apparently assuming that physicians evaluate their medications. At the same time, many lacked a comprehensive review of all medications, but indicated being unconcerned about the lack of evaluation due to
their old age. Older persons wanted to be involved in their medication treatment but seemed challenged by insufficient time at appointments, difficulties in understanding or remembering information and lack of written information. From a patient safety perspective, older persons can be one important barrier to Adverse Drug Events (ADE) if physicians support them in evaluating their medication. Older persons thus will benefit from a person-centred and regular approach to the evaluation of medications. These findings can inform the design of future interventions to avoid ADEs in the medication use process.

Presenter: Malin Holmqvist (Region Jönköping County and Jönköping University, Sweden)

C5 (includes two seminars)

From good to great! The building of multi professional teams that with effectiveness, high competence and an approach of concern, curiosity and participation can give a better support to children and adolescents with chronic diseases

It is always difficult to evaluate complex organizations and activities. Health care is complex and children and adolescents are vulnerable persons by their age. But the feeling among managers and employees is that the clinic's ongoing improvement work creates prerequisites for effective care processes as well as increased partipation and security for the children, adolescents and familis who need support from the Children's Clinic in Region Kronoberg. To work in new ways have an impact on both macro-, meso- and micro level.

Presenter: Gabriella Roström (Region Kronoberg, Sweden) 

Torbay Charts in Patient-centred Shared Decision Making

Although the concept of Shared Decision Making (SDM) has been there for many decades, it has not, for many reasons, been extensively adopted in everyday practice. Effective SDM requires an enthusiastic, open-minded medical professional, a willing patient and a good information repository or patient decision aids (PDA). Numerous PDA’s have been developed in the past and lack of user friendliness has been one of the reasons for their failure to be adopted. The components that are not captured in current PDA’s are a lack of overview of the whole disease progress, treatment options appropriate to disease stages, and the lack of inter-activeness when comparing different treatment options. The Torbay Chart addresses these issues and by having a layered approach, it allows excellent patient participation and interaction while considering all relevant options before choosing the correct one. The principles within this PDA are transferable to other conditions as this approach could be easily adapted.

Presenter: Rangaraju Ramesh (National Health Service, UK)

C6 (includes two seminars)

Reducing Harm from Acute Kidney Injury (AKI) in NHS Grampian

Following the introduction of these interventions we saw an increase in the knowledge and awareness of Acute Kidney Injury (AKI) amongst trainee doctors. There appeared to be a trend of reducing the number of AKI episodes. A key component to the success if this project has been the involvement of a multidisciplinary team and close collaboration with senior clinical and management teams. The next step will be to assess the effect of these interventions on hard outcomes of length of stay, mortality & need for acute dialysis and to sustain the improvement that we have seen thus far.

Presenter: Laura Clark (National Health Service, UK)

Adopting 'Daily Dynamic Discharges' in an acute medical ward in NHS Tayside, Scotland

The 'Daily Dynamic Discharge' (DDD) approach has helped our acute medical ward to be more proactive and prepared when planning a discharge, particular in times of increased pressure. We increased the number of weekly discharges (from a baseline median of 9 to a 14 with the DDD approach). We did not make a significant change in the number of discharge before lunchtime; this may have to do with 'external factors' such as social work and transport but there may be some gains to be made in continuing to shift the culture to get every member of staff planning and aiming for a discharge before lunch routinely.

Presenter: Dirk Habicht (National Health Service, UK)

C7 (includes two seminars)

Microsystems in Armenia: pediatric experience of university hospital - How to make a sustainable development?

Presenters: Nune Baghdasaryan, Nane Mnatsakanyan (Yerevan State Medical University, Armenia) and Hrant Kalenteryan, Hasmik Yeghiazaryan (Muracan Medical Complex, Armenia), 

Current collaboration between Armenia and Region Jönköping County

Presenters: Simon Rundquist, Fredrik Ingemansson and Peter Iveroth (Region Jönköping County, Sweden)

Welcome to the co-creative learning at the pre-festival session where we will share with you the good examples in our healthcare system that came up as a result of many years with improvement work. Shared values, competence and skills, trust, innovation, working processes, accuracy, integration and person-centeredness; all those together are quality which has been a driving force for the County's work for many years and they are still the basis for our ambition to create a resilient system for health and care and social welfare for the citizens at Jönköping County.
In the morning, you will meet the Chief Executive of Region Jönköping County Agneta Jansmyr, Chief Medical Officer Mats Bojestig and Chief Executive of learning and Innovation Göran Henriks. They will share with you some facts and their vision on leadership and improvement of health and care services in Jönköping County.
In the afternoon, you will go for site visits and see examples of improvement work where the innovative thinking, teamwork and person-centeredness were key elements to create new working processes and methods.

Program
9.30-10.00 Registration and Morning Refreshments

10.00-12.00 Meeting with Region Jönköping County leaders

12.00-13.00 LUNCH

13.00-16.00 Site visits (one of the options below)

• Option 1 - Esther - Network for Cooperation in Health and Social care
  • 12.00-16.00 Site visit to Ingsbergsgården, Nässjö Municipality
    Presenters: Malin Johansson, Chief of Improvement at Social Services, Nässjö municipality and Annica Lindström, Business Development Officer, Psychiatry Clinic, Eksjö Hospital
     
• Option 2 - Division of Medical care
  • 13.00-14.30 Self-dialyses unit, promoting patients ability for self-care
    Location: County Hospital Ryhov, D4
    Presenter: Patrik Blomqvist, Patient supporter, Qulturum
  • 14.30-16.00 House of Heart, Incl Afternoon Refreshments 
    Location: Herrgården, M7
    Presenter: Maggie Målevik, Project manager, Qulturum
     
• Option 3 - Division of Rehabilitation, Psychiatry and Medical Diagnostics
  • 13.00-14.00 Interdisciplinary teamwork and person-centered care at Rehabilitation Medicine.
    Location: Medical Rehabilitation, Ryhov County Hospital
    Presenter: Malin Heden, Head of Physiotherapy unit
  • 14.00-14.30 Afternoon refreshments
  • 14.30-15.30 Laboratory Medicine: Efficient production flows and short response times, to constantly work on improvement.
    Location: Laboratory Medicine, Ryhov County Hospital
    Presenter: Maysae Quttineh, Biomedical analyst
     
• Option 4 - Division of Surgical Care
  • 13.00-14.00 Using patient compact for innovation of sustainable change in the hip joint replacement process
    Location: Orthopedic clinic 
    Presenter: Sandrah Sollenby, vice Clinic Operations Director, Orthopedic Clinic
  • 14.00-14.30 Afternoon refreshments
  • 14.30-15.30 Cooperation in the Best Interest of the Child 
    Presenters: Eva Geel, radiographer, Radiology department, Klas Gustafsson, specialist anesthesiology nurse, Operation and IC Clinic andGunilla Yngve, specialist anesthesiology nurse, Operation and IC Clinic 

Welcome to an interactive afternoon where the spirit of creativity is our driving force and one of the main sources to achieve sustainable improvement!

During this workshop we intend to lay the foundation for the next three Festival days with a deeper, explorative focus around this year’s theme: Sustainability. What we come up with will be included during the rest of the Festival days. The intent of the workshop is to challenge ourselves about what is needed to create sustainability as well as how sustainability is perceived and interpreted in different contexts of society. What conditions need to be in place and what aspects do we have to consider to make sure we support, treat and cure our patients and inhabitants both today as well as tomorrow?

By playing with the theme, we can divide it into three different perspectives:

1. Sustainability
2. Sustain 
3. Ability

This allows us to further explore the deeper meaning of what sustainability actually mean and how shifting our focus can help us to create the future we want or need help us through our challenges?

Let’s think together and push the boundaries, because after all creativity is intelligence having fun!

Be prepared for a think tank afternoon filled with creativity, wise thoughts, fellowship and the power of joy in working together.

Facilitators: Pernilla Söderberg, Jesper Ekberg (Region Jönköping County, Sweden) and Boel Andersson Gäre (Region Jönköping and Jönköping University, Sweden)

Barbro Westerholm talks about the importance of working for people's rights
with focus on the rights of older people and the rights of LGBT people.
Barbro Westerholm is a doctor, researcher, official and parliamentary member
(A liberal). She has a number of significant assignments on her track record. Barbro has made important efforts in many areas of public health science and in recent years, her efforts for the health of older people have been particularly important.
During her time at the Swedish National Board of Health and Welfare, Barbro was the one who in 1979 pushed through that gay sexuality would no longer be considered a mental illness. After that, she has been involved in other questions around
gay rights and continue to work for LGBT issues and gay, bi- and transgender's rights. Among other things, she was the chairman of the so-called partner investigation and partnership legislation in the early 1990s. Her work continues and her position is that it is still important to fight for LGBT people's rights as well as combating discrimination, both within Sweden
and the EU.

Lucien is CEO of Transform.health  supporting companies, governments, institutions and industry with the current (digital) transformation.

As an Edge Fellow for the Deloitte Center for the Edge  Lucien leads Global Strategy on Digital Health and pushes the needle on a global scale for the needed change of the operational model and the H-UX as he coined it; the Healthcare User-Experience. 
He helps corporates understand and act on the current and future grand challenges within health(care) and aims to (re)shape the health(care) sector.
Lucien has decades of experience within healthcare innovation: lastly 11 years as an advisor to the executive board at Radboud University Medical Center in Nijmegen, The Netherlands. He was also the founding director of the well-known REshape Center for Health(care) Innovation at Radboudumc.  Lucien also initiated the Health Innovation School and build this in co-creation with the Dutch Ministry of Health into a (inter)national effort. 

Lucien is also faculty at Singularity University’s Exponential Medicine (Silicon Valley) since 2011
His modus operandi is always challenging, creative, sometimes provocative but always techno-realistic. His goal is to prepare for a ‘soft landing into the future’, meanwhile creating a sustainable global health(care) for all. 
As a public speaker, he touches on how the intersection of technology and patient empowerment is creating momentum for the delocalization of healthcare, and the shift of data in the hands of patients. 
Succeeding his former books, in Spring 2018 his new book Augmented health(care): “the end of the beginning” was launched in Barcelona, Spain during the HIMSS conference. 
With over 800.000 followers Lucien is one of the initial 100 official LinkedIn influencers, happily keeping his followers up to date on all (healthcare) innovations.

https://www.linkedin.com/in/lucienengelen

Jason has worked for the Scottish Government since 2007 and in January 2015 was appointed as The National Clinical Director in the Health and Social Care Directorate. He is a Scottish Government Director and a member of the Health and Social Care Management Board. He is one of the senior team responsible for the NHS in Scotland.

Marjorie M. Godfrey, PhD, MS, BSN, FAAN is Founder and Co-Director of The Dartmouth Institute Microsystem Academy and Lecturer for The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA. Dr. Godfrey demonstrates her sustained commitment to improving the quality and value of health care in the United States and other countries around the world through focused attention on care delivery at the front line of care, leadership development and team coaching. She has led interprofessional quality improvement education and practice with collaboration with academics, interprofessional colleagues, front line systems of care, health care organizations, national professional organizations and health care systems globally.

Martina Boström, PhD in Gerontology (2014) and Master (2008), work as an improvement leader at Qulturum. Since her Bachelor of Science in Public Health and Health promotion (2000) she has worked with various assignments within Jönköping University, healthcare and municipality sector such as senior professor, older strategist and Head of Unit. Her focus is how to promote sense of security together with older persons in various context, not at least their relation between learning and use of smart homes and innovative technology.

Sofi Fristedt has a Ph D in occupational therapy and is a council certified specialist in occupational therapy. She is employed as an assistant professor at Jönköping University, School of Health and Welfare, and also partly working as researcher at Futurum – the academy of health and care. She is currently also working as a researcher at Lund University in a project focusing on technology from a generational perspective including gerontechnology, and is affiliated to Curtin University in Perth.

Helen Bevan is Chief of Service Transformation at the NHS Institute for Innovation and Improvement. This is an organisation that supports the 1.3 million staff of the English NHS to accelerate the delivery of world-class health and healthcare by encouraging innovation and developing capability at the frontline of patient care. Over the past 15 years Helen has led change initiatives at local and national level which have created improvements for millions of patients. Her current role is to keep NHS improvement knowledge fresh, relevant and impactful at the leading edge. In 2008, the 60th Anniversary of the NHS, Helen was named as one of the 60 most influential people in the history of the NHS. Helen is currently leading efforts across the NHS to mobilise and organise NHS staff and service users to deliver cost and quality improvement goals at scale.

Galina Gheihman is in her final year at Harvard Medical School (HMS) in Boston, MA, USA. She is originally from Toronto, Canada where she attended the University of Toronto and studied Neurosciences and Psychology. She has wide research interests including international health systems and health services research, quality improvement (QI) and patient safety, primary care innovation, leadership, resilience, and longitudinal medical education design. In 2015, Galina travelled to Jonkoping for a summer research fellowship, conducting a qualitative study investigating how patients and their families can be involved in healthcare quality improvement and redesign. At HMS, Galina is co-lead of the Student Leadership Committee at the Centre for Primary Care, and former leader of the Narrative Medicine subcommittee. Galina is interested in a career in Neurology, combining clinical medicine, medical education reform, and health systems transformation and redesign.

Anna Carlbom, ESTHER Lead Coach Design and Learning Centrefor Clinical and Social Innovation. Kent County Council. A trained nurse with over 30 years experience of care, hospital as well and community. A great interest in Quality Improvement for the users of various care services lead to personal development at work in the quality area. This lead on to the role as one of two co-ordinators for the Swedish ESTHER network. Since 2016 Anna has been working in Kent UK as ESTHER Lead Coach, leading the local implementation of the philosophy.

Nicoline Vackerberg, Senior Development Leader Qulturum, Sweden, Coordinator Esther Network International, Faculty Jönköping Academy, Sweden. 1999 she combined her work as a physiotherapist with a leading position in The Esther Network. This was the start of leading several collaborative national and international projects to strengthen integrated and person driven care. She even studied management, pedagogic, mediating, leadership, coaching and organizational communication at university level and has a master degree in Quality improvement in Health and Welfare, and combines her work at Qulturum with university faculty. She teaches Quality improvement, project leading and coaching for improvement at The Jönköping Academy. She is a frequent speaker at national and international conferences.

Marie Winald Karlström, Modiga Mia. As a mother to Jesper, a coach to all Esthercoaches and with a considerble pedagogic background Marie has very valuable experience and knowledge how to coach others in clientfocus and presentationsskills. In a humble way she coaches the question: Is this best for Esther? and how to involve patients/ clients in improvements projects. She also supports Esther coaches in Singapore online. Besides presentations skills Marie is very talented in music and she made the ESTHER song as a collaboration between England, Singapore and Sweden. You can find it on Youtube.

Johan Thuresson, Region Jönköping County. A father, husband and friend, a person with a lot of experience from Health and Socialcare due to his severe car accident a couple of years ago. Today he is a part of Esther faculty and trains Esther coaches in Sweden to keep reminding "What is best for Esther"? He teaches at graduate level assistent nurses in Esther philosophy and is very active to spread and develop the Network further. He is a frequent speaker at national conferences.

Caroline Ärleskog, TUC. Education leader TUC Yrkeshögskola Esther coach and masterstudent at Jonköping Academy with a social background. Caroline wrote her Philosophy Bachelor Degree thesis essay about involving patients/ clients in improvement work and is eager to develop this to the next level. She is teaching and supporting Esthercoaches in Co-production and personcentredness. Exploring powershifts, possibilities and challenges when ESTHERS are more like partners in the room.

Jesper has been working in collaborations focusing on Public Health and improvement work since 2001. He was the national project leader at Qulturum, coordinating the national spread of Senior alert, a quality registry supporting preventive work for seniors health. As a Public Health Manager at the Region of Jönköping, he is involved in the launch of the regional program "United action for health equity and a good life" and development work connecting the community with primary care and other recourses in the local society.

Dr Chua Hong Choon is Chief Executive Officer of the Institute of Mental Health (IMH) and Deputy Group Chief Executive Officer (Clinical) of the National Healthcare Group (NHG) in Singapore. A psychiatrist by training, Dr Chua is also the Chairman of the national Residency Advisory Committee (RAC) for Psychiatry, and Adjunct Associate Professor at Duke-NUS Graduate Medical School, Yong Loo Lin Medical School and Lee Kong Chian School of Medicine. Dr Chua has keen interests in the fields of public health, psychiatric epidemiology, depression and quality & safety in health care; and he was the first Patient Safety Officer at the Institute of Mental Health, where he developed programmes and initiatives to improve clinical quality and safeguard patient safety in mental healthcare. 

Raphael's 28-year career has spanned different industries in the public, private, and not-for-profit sectors. The industries encompass policy work, public education, social work, media - TV, and healthcare. He has been with the Institute of Mental Health since 2009.

Dr Tina Fang heads Clinical Governance and Quality (CGQ) at Institute of Mental Health in Singapore. CGQ coordinates hospital-wide patient safety program, clinical practice improvement program, clinical policies, clinical data analysis, service program evaluation, hospital accreditation and licensing, provides medico-legal advice, etc.

Lina has worked as a unit manager at the women's health service in Jönköping since 2016. Before she became a manager, she has worked as a midwife for many years. Lina has as a priority to lead and distribute resources in a way that leads to good working environment for all the employees. 

Maria Ingebrigtsen works as an administrative coordinator at the Women's health care center in Jönköping. She has worked with KPS over the past year and has worked with goals and methods to balance the needs and capacity of the unit. Maria previously worked as an assistant nurse at the Women's Health Care.

Maria Malmström, Development leader at Qulturum, Region Jönköping County, has a Master of Science in Industrial Engineering and Management and works mainly with capacity and production planning and control, and process improvements often with focus on logistics.

Pernilla Söderberg is a development and project leader at Qulturum, Region Jönköping County, Sweden. Her interests and focus are in microsystem thinking, access, and Triple Aim. Pernilla is a nurse and has worked as a first line leader in primary care.

Ann Marie Thordeman is a senior project manager with the eyes of a patient due to her recent experiences. She has worked as nurse leader, which is the most senior position in the municipality, and as a project manager. She has also worked as care teacher and training leader. Since her retirement she has been full time employed by the Region and managed the very successful elderly project in Uppsala.

Dr Robert Sarkadi Kristiansson, works as a CMO and is focused on quality improvement especially in care processes for the elderly. He is a specialist GP, has an MBA and is a fellow at Intermountain health care. He teaches Quality Improvement in the national advanced training program as well as running his own Regions primary health care quality educations Dr Robert Sarkadi Kristiansson has been presenting for large audiences in IHI conferences, he has a vast experience of leading large and small workshops, improvement teaching/learning sessions as well as leading programmes for quality improvement.

Maria Johansson, Region Jönköping County, Sweden.
Maria Johansson has been working as an improvement leader at Qulturum since 2013. Her main areas have been coaching different improvement programmes, working with care prevention in the national quality register Senior alert, buiding e-learning modules and coordinating co-design project. Today her focus is the learning context and co-production.

Marcus Lidin, Region Jönköping County, Sweden.
Marcus Lidin has been working as an improvement leader at Qulturum since 2014. 
Experiences from working with patient education at the self-dialysis unit in Jönköping and after that working with medtech education as clinical consultant. 
Today working at a clinical training center with training and simulation for instructors in health care organization.

Patrik Blomqvist is employed by Qulturum, Region Jönköping County as a patient supporter resource for the whole county. Patrik has been living for many years with diabetes and renal failure and he has an experience of peritoneal dialyses and hemodialysis. He was transplanted in September 2011. These experiences are valuable when he provides support to other patients. Patrik is engaged in most patient close and co-production projects such as Health cafe's and the Living Library.

Henrik Ånfors, Region Jönköping County. 
Henrik Ånfors is a patient reprecentant included in the so called Living Library at Qulturum, Region Jönköping County, since 2016. His main task is to see the care from a patient's point of view. The areas he is involved in include the Health café, Co-production, Esther coach training and Esther SimLab.

Thomas Schneider is the Chief Quality Officer at Bracke Diakonia, one of the largest not-for-profit providers in Sweden, and adjuncted lecturer at The Jönköping Academy for Improvement of Health and Welfare. He was involved in the development of improvement programs for social sector organizations based on the microsystem approach. He has a broad experience in quality improvement and leadership in healthcare and social services and he has been an expert in several national committees regarding quality, health policy and eHealth. His interests concern mainly quality improvement with strong focus on co-production, professional's drive and value creating for patients and users.

Charlotte Forsberg works as a medical nurse at Bracke Diakonia, a non-profit-provider with more than 40 different health care and social service units thorughout Sweden. Her work is based on a microsystem approach that mainly concerns patient safety, quality development and education in improvement skills. She has previously worked in palliative care and has been the head nurse of an oncology education unit and a care department at Karolinska University Hospital, where she has run projects as a person-centered bedside report, started a specialized emergency reception for patients with cancer. Today she is a master student at Jönköping Academy for quality improvement and leadership in health and welfare.

Trine Olsen has been working as a Chief Senior Consultant for the last 4 years. She is a Nephrologist and has a Ph.D. in inflammatory bowel disease. The last year Trine has been attending the program of Scottish Fellowship (cohort X) and has been learning a lot about how to improve and lead improvement project in health care.

Fiona Duthie, NHS Lothian. Fiona Duthie is a final Registrar in Renal Medicine in South East Scotland, with a clinical and research interest in Acute Kidney Injury (AKI). Fiona was part of Cohort 9 of the Scottish Quality and Safety Fellowship, and thoroughly enjoyed learning more about leadership, patient safety and improvement science with the aim of improving care for my patients. Fiona is passionate about improving awareness of AKI, and understanding its importance in recognising deteriorating patients.

Graham Kramer, GP and National Clinical Lead for Care and Support Planning using Scotland's House of Care approach, former Self Management and Health Literacy, Scottish Government. "If GPs are to meet the changing demands and expectations of society and medicine they will need more training, support, parity of resources and helping hands from across health and social care, third and voluntary sector and their communities. Importantly people and communities will need be seen as resourceful and contributing to the solution rather than being blamed for being part of the problem".

Anette Nilsson works as an development strategist in Region Jönköping County. Her focus is improvement, big scale change, coaching, integration and innovation. She has long experiences from Qulturum where she has worked within the areas leadership, coaching, improvement and innovation both nationally and internationally. She has experiences from being a fellow at IHI. She has also experiences as a project manager at SALAR, Swedish Association of Local Authorities and Regions, with a national leadership program connected to a big scale change – Better life for elderly people – an agreement between the Swedish Government and SALAR. Anette Nilsson is also the founder of Passion for life which won the first price in Social Innovation in Ageing 2014- The European Award Ashoka Changemakers in cooperation with King Baudouin Foundation. Today, her major focus is driving strategies for the transformation to closer care within the strategy in Region Jönköping named "Together for best possible health and equal care". She also works part of her time with co – production with a national big scale program “ Patient Compact”  for SALAR intiated from the Swedish Government.

Susan Martin works as a quality improvement manager and coach at Torbay and South Devon NHS Foundation Trust. Torbay and South Devon was one of the first integrated health and care systems in the NHS, developing the ‘Mrs Smith’ model and then becoming an integrated care organisation. The quality improvement team forms part of the Strategy and Improvement Directorate within the Trust. Susan as Associate Director (QI) heads up this service. Recent improvement work by the team includes working on emergency and urgent care, primary care streaming, patient flow across the ICO, maternity services, outpatients and developing the innovative NHS quicker app. https://www.nhsquicker.co.uk/. Projects that Susan has led on with teams vary in size and complexity. Susan is a member of the Q Community and one of the founding members of the Health & Care Impact Network, a collaboration of people between health and care organisations and Universities, primarily in the South West of England. From this collaborative work with the Universities Susan has led on the development of the researcher in residence model within an NHS setting. Susan has a background in information science with a MBA from Exeter University. Susan has worked in both academia as well as the private and public sector, starting her career in the energy industry. Susan is passionate about working with people to deliver high quality services that both the staff and the people using them can be proud of.

(PhD, MA, MSc); Researcher-in-Residence (Integrated Care): An efficient and versatile international health and wellbeing researcher and educator: with a multidisciplinary background in Health Services Research, Humanities, Medical Sociology, Clinical Psychology and experience in clinical (sleep disorders, mental health) and non-clinical research (public health, systematic reviews, implementation science, public involvement) whose research is inspired by a bio-psycho-social model of health, and who has applied mainly qualitative but also mixed-/quantitative methods with a passion to creating pathways to impact trough engaged, applied, translational and embedded research.

Dr Julian Elston (PhD, MSc, BSc (Hons), FFPH); Researcher-in-Residence (Integrated Care): A lecturer and Consultant in Public Health who has worked in the NHS and academia has an interest in quality improvement, quality assurance, integrated care and inter-organisational working with experience of a range of primary and secondary research methodologies and methods (qualitative and quantitative), undertaking multidisciplinary research in health services, public health, sociology, economics and organisation theory, as well as systematic reviews whose research is inspired by a bio-psycho-social model of health, and is committed to improve health services and reduce health inequalities through applied, embedded research.

Sofia Persson, MSc in 1999 (in Lund), has worked as a physiotherapist since 2000 in combination with various managerial assignments; Head of Unit, Operations Manager and Development Manager. Further educated with for instance Philosophy Master's Degree focused on Quality Improvement and Leadership in Health and Welfare.
Since 2015, improvement leader at Qulturum, and from 2018, the improvement work will be combined with a doctoral thesis at half-time.

Magdalena’s formal education is Intensive Care Nurse, Tropical Medicine and Principal. She has been active within Emergency Care, Intensive Care, Heart Intensive, Dialysis and Pain Management Nursing. Magdalena started a section of a Palliative Team in Jönköping region ((Eksjö) with focus on providing consulting teams for home care and special housing. She is also the product developer of a pain pump at the company Noricinfu care where Magdalena also worked with Parkinson's patients as well as children and adults with PID-Primary Immune Defincy (primary immune deficiency). She started and ran a section of adult education and vocational education for undergraduate students for 8 years – as Principal. Magdalena was also the Head of Department for Home Care and Home Services in Municipal Activities. Current employment as Improvement leader at Qulturum with focus on cross-border responsibility for development for palliative care, project manager for patient compact and a member of a support group for healthcare coordination.

Annmargreth Kvarnefors, Improvement Leader at Qulturum in the areas of person centered care and patient safety. Her focus is to work together with people who have care experience from the perspective of a patient or a relative. Annmargreth is an anesthesiology nurse by profession.

Agata Rukat; an improvement leader at Qulturum, Region Jönköping County with special interest in learning networks and innovation. Agata is a deputy project leader of "A healthy working place for a healthy working life", a collaborative between Region Jönköping County and seven municipalities in Region Jönköping in Sweden.

Dorte Münter, Chief consultant in Department of Quality and Patient safety in Health and Care management, Municipality of Copenhagen. More than 15 years of experience in quality improvement in hospitals and primary care. Special interest in the cultural changes and leadership behaviors in order to achieve improvement in health care quality. Winner of the Capital Region’s quality improvement award 2014 for a project on introducing formal dialogues between psychiatrists and clinical pharmacologists with the purpose of improving medical decisions.

Malin Holmqvist works as a clinical pharmacist in Region Jönköping county and is a PhD student at Jönköping university. She graduated as a pharmacist in 1995 and took a Master in Clinical pharmacy 2007. Her focus is patient safety and is involved in Region Jönköping County's work with safe medication management. Her supervisors are:
- Johan Thor (JT), MD, MPH, PhD, Associate Professor, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Axel Ros (AR), MD, PhD, Region Jönköping County and Jönköping University, Jönköping, Sweden
- Linda Johansson (LJ), RN, PhD, Senior Lecturer, Research Fellow, Institute of Gerontology, Aging Research Network-J Jönköping, Jönköping University,  Jönköping, Sweden

Jaco van der Worp has been working at the GHZ since 2003. As a HBO nurse he has worked on cardiology and CCU. He was a practical trainer for several years at the CCU and he was involved in elearning. In the course of time, his enthusiasm for training grew and since the beginning of 2016 he has been working full-time at the Landsteiner GHZ His passion lies in innovation and workplace learning. For new training questions, Jaco look for the best learning solution; more on testing in practice and supporting learning on the work floor during work. By deploying new technology, there are more possibilities than ever. The GHZ cooperates intensively with other hospitals in the Netherlands in the cooperative Profportaal Zorg, Jaco is part of the editorial board of this cooperative.

Gabriella Roström, Region Kronoberg County. Gabriella is a Registered Nurse, specialized in children and adolescent medicine. Gabriella has been working as Head of Department for two years and is a member of the management team of the Children's Clinic in Region Kronoberg. Gabriella has studied a Master's Program in Leadership and Improvement in Care at Jönköping Academy and plan to complete her Master's thesis. Gabriella has a big interest in how to make system changes out of experiences of changes on a mikro-level.

Mr Ramesh is an orthopaedic consultant surgeon working at Torbay Hospital for the last 14 years. He has developed number of tools that help to forge strong partnership with patients to have a better experience and to have a safe treatment journey. His Material Risk Assessment tool allows a patient to clearly understand about the risks that matter to them. By using COMPASS risk assessment tools, he was able to improve the preoperative preparation of patients for surgery. He has pioneered in developing a concise interactive patient information system for patients to explore different treatment options for hip and knee arthritis.

Laura Cark, NHS Grampian, UK. Laura is a Consultant Nephrologist working in Aberdeen Royal Infirrmary a major teaching hospital in the North-East corner of Scotland. Laura has a special interest in Quality Improvement and has recently completed the highly regarded Scottish Quality and Safety Fellowship. Laura is committed to improving the care of patients with AKI and would like to develop the home dialysis therapies program locally. Laura is the Clinical Lead for the Hospital at Night Team which involves continually reviewing the service to improve patient safety and trainee wellbeing.

Dirk Habicht, NHS Tayside, Scotland. Dirk has been a consultant in Medicine for the Elderly and Internal Medicine for 7 years and works in a district general hospital (Perth Royal Infirmary) in the heart of Scotland. Dirk originate from Germany and has qualified there but ever since been training and working in Scotland. Dirk does enjoy working in Scotland and recently had the opportunity to complete a year's course in quality improvement, the Scottish Quality and Safety Fellowship. This has given Dirk new enthusiasm to look at the processes of working and work with teams to make improvements. Dirk has been fortunate to be working for the new Quality Directorate that has come into life earlier this year in NHS Tayside.

Göran Henriks is Chief Executive of Learning and Innovation at Qulturum http://plus.rjl.se/qulturum in Region Jönköping County, Sweden www.rjl.se  
Mr. Henriks academic background is in Psychology from the University of Lund, and worked as a child psychologist. He holds a Master's degree in Business Administration from University of Gothenburg. He worked as a child- and school psychologist during 1976-1983. Between 1978 and 2000 he was also engaged in top sport as he was coaching national teams in basketball. Mr. Henriks has more than thirty years' experience of management in the Swedish healthcare system. He is a member of the Region Jönköping County's Top Management and Strategic Group. Göran is a board member of the Swedish Institute for Quality, SIQ. http://www.siq.se/Home.htm and the chairman of the South East Health Care regions Quality registers centre. http://rcso.se/

He is also the chairman of the Strategic Committee of the International Quality Forum organised by the British Medical Journal (BMJ) and the Institute for Healthcare Improvement, http://internationalforum.bmj.com/. Göran is also appointed as a Senior Fellow at the Institute of Health Care Improvement, www.ihi.org. He is also appointed as professor in Quality Management at University of Yerevan, Armenia. Göran Henriks is appointed as key note speaker and teacher at many national and international conferences, such as the International Forum of Quality and Safety, APAC and the international ISQUA conference. He has written articles about balanced scorecard, learning, access and spread, and improvement of quality in cancer care.

Kristin was born and raised in Finnmark in northern Norway, on the border to Finland and Russia. Kristin works as a coordination coordinator at the clinic Kirkenes, and cooperates with the municipalities connected to the clinic. She started out as a Physiotherapist and has worked at the clinic since 2003. Kristin has an education within management and project management. Since 2016 Kristin has worked as a quality consultant and coordinator. She was then local programmer for patient safety in Finnmark Hopsital. In that role Kristin joined the Scottish fellowship program and has also participated in Improvement coach program through IHI and the Norwegian Patient Security Program - In safe hands 24/7. These experiences have led her to a big commitment to quality improvement in health services.

Julie Reed has established herself as a leading figure in the science of improvement and the drive to accelerate the uptake and use of research evidence in healthcare practice. Julie leads a programme of research which seeks to understand how change and improvements can be brought about in health services. The research recognises that change is hard to achieve and that it can involve behaviour change of many different people who need to work together collectively to deliver high quality care. Julie’s interests lie in the development and utilization of structured approaches to deliver improvements in healthcare. 
Julie provides academic and thought leadership to the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London. The CLAHRC programme has established the programme as an ambitious, forward thinking initiative that has rapidly delivered demonstrable benefits to staff and patients in Northwest London with national and international impact.  Julie’s credibility in this field has been recognised by the award of a prestigious Health Foundation Improvement Science Fellowship.

Background
Residents predominantly learn in clinical practice. Creating a strong learning environment for all learners is essential to optimize and stimulate this learning. In the Radboudumc we have developed a system where departments are in the lead concerning the quality of learning environment. Based on the plan-do-check-act cycle departments continuously improve their educational programs. They can choose the moment for evaluation, and also how to use the different quality tools that are available. Beside this internal system, ewe have an external quality assessment every five years.

Goals
During this workshop we will focus on the following questions:

1. What makes a stimulating (evidence-based) learning climate and (how) can it be measured?
2. What behavior of individuals contribute to a stimulating learning climate?
3. What are practical tips for creating a stimulating learning climate within your department?

Organization and method of presentation
After a short interactive introduction, participants will work in small groups on several tasks. Perceptions of the ‘ideal’ learning climate will be shared in small groups. We discuss different ways to look at the learning climate, and evidence based tools for measuring the quality of the learning climate. Participants are challenged to formulate items for measuring the quality of their learning climate. Finally, we present the quality system that is used in Nijmegen and share our experiences. Learning objectives Participants will learn:

• What factors contribute to a stimulating (evidence-based) learning climate and (how) can it be measured
• Behaviors of individuals that contribute to a stimulating learning climate
• Practical tips for creating a stimulating learning climate within their department

Presenters: C.R.M.G. Cornelia Fluit, MD, PhD and T.P.F.M. Tim Klaassen MSc, Radboud University Medical Center Health Academy, Nijmegen, the Netherlands.

Background
Changes and improvements to health care systems are usually guided by methods that
focus disproportionally on the implementation of change and pay less attention to the
sustainability of change.
Socio-technical systems, such as health care, do not respond passively to what happens.
Changes inevitably destabilise existing equilibria and the system dynamically tries to
compensate for that. This may easily lead to subsidiary effects that can challenge the
assumptions on which the planned changes were based. In addition to that, health care
systems are continuously subjected to multiple external and internal forces that can be
difficult to anticipate.

Goals
During this workshop we will focus on the following questions:
How appropriate are sequential approaches, such as the PDSA, for complex adaptive
systems?
What is needed to anticipate how performance conditions are likely to change during the
implementation period and what may happen as a consequence of the change?
What is the experience of how long it takes for an intended change to become firmly
established, and how realistic were the expectations when the change was planned?

Organization and method of presentation
The three invited speakers will each make a 15-20 minute presentation of the central issues
and identify critical problems. Following that the participants will discuss their own
experiences and concerns in groups. The purpose is to identify the most relevant practical
problems to be addressed in the near term, how they can be observed and how they should
be analysed.

Presenters: Erik Hollnagel, PhD, professor at Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
Axel Ros, MD, PhD, Chief Medical Officer, Region Jönköping County, and lecturer at Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
Boel Andersson Gäre, MD, PhD, professor at Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden

How might patient involvement in healthcare quality improvement efforts work – A realist literature review

This realist review identifies three overarching, interconnected and dependent IPTs to guide ealthcare organisations when involving patients in improving healthcare quality: tailoring, interaction and partnership, and behavioural change. They can be considered resource and reasoning mechanisms, as well as outcomes essential for QI efforts. Together they form recommendations for healthcare organisations managing QI efforts involving patients. In healthcare QI efforts, resources, reasoning and the local context are all important. To further refine the IPTs and develop a more nuanced and powerful programme theory, research on how they work at different rganisational levels, and from different stakeholder’s perspectives, is required.

Presenter: Carolina Bergerum, The University of Borås

Quality improvement in daily work in primary care

Primary health centres (PHCs) nowadays have access to data feed-back through different sources. However, while some HCSs are constantly running improvement projects others don’t use feed-back data. A national system for the audit and feed-back, Primary Care Quality, is now introduced in Sweden. Increased knowledge aboutthe reasons behind the different use of audit and feed-back data at different PHCs would be helpful help to improve conditions for use of data for quality improvement. Focus group interviews were conducted with staff and management teams at primary care centres in Sweden during. Data was analysed using qualitative content analysis. Preliminary results are three main themes that describes different approaches to quality improvement in daily practice. Each theme represents a quality improvement strategy with specifik characteristics. The three themes can be described on an axis from simple to complicated to complex.

Presenters: Eva Arvidsson, R&D unit for Primary Care, Futurum, Region Jönköping County and Sofia Dahlin, Region Östergötland

PhD student at The University of Borås and Jönköping University since 2015. Interested in the different aspects of patient involvement in healthcare organisations. Master of Quality Improvement and Leadership within Health and Welfare, Jönköping University, 2012. Registered nurse and registered midwife, currently working as a development leader at the Department of gynaecology and obstetrics, Södra Älvsborgs sjukhus, Borås, Sweden.

Eva Arvidsson, MD, PhD, spec in general medicine, research leader, R&D unit for Primary Care, Futurum, Jönköping, Sweden. Eva has worked in primary care as a clinician, strategic planner and coordinator, and medical advisor of primary health care with main responsibilities patient safety and quality in health care. She did her PhD on “Priority Setting and Rationing in Primary Health Care” at Linköping university.

In her present position she is responsible for supporting quality improvement in primary health care in Jönköping County, teaching and supervising GP trainees. Her research projects cover subjects as continuity in care, quality improvement and e-health. She is  also active in the development of the Swedish National Medical Register for Quality Improvement in Primary Care.

Sofia Dahlin is a medical doctor specialized in social medicine/public health with a masters degree in quality improvement. She works as a medical advisor in social medicine in Region Östergötland, as a teacher in the medical programme in Linköping University and as a national coordinator for the Swedish, WHOinitiated, network of healthpromoting hospitals and health services (HFS). In her work she has a special interest in health promotion, health equity and improvement work.

Lia Fluit, MD, PhD,  is associate professor and head of the department for Research in Learning and Education of the Radboudumc Health Academy in Nijmegen, the Netherlands.

The aim of her research is to get a deeper understanding of how professionals learn in health practice and how they learn from and with each other (inter-professional learning), how they enter into a dialogue and provide and receive feedback, both within and between different professions, and how learning takes place when entering a new practice, for instance during internships (boundary crossing).
She studied Medicine from 1975-1983 at the University of Nijmegen. Driven by a strong interest in teaching she started in 1994 with her study Educational Sciences at the Radboud University Nijmegen, which she completed with honors in 2001. Since 1992 she has been involved in many projects in medical education, both in Nijmegen as well at a national and international level. In Nijmegen, she set up the structural evaluation of internships, and gave the faculty development program a major boost. From 2006 to 2010 she was a member of a national workgroup who supported medical specialties in developing competency based training programs. In 2006 she made a start on her PhD research on EFFECT, that was finished in 2013. From 2010 she combined her job as a researcher with the function of Head of the Department of Evaluation, Quality and Development at the Radboud University Medical Centre. 
At this moment she is head of the department for Research in Learning and Education. She supervises 16 PhD students, with a focus on learning in the workplace, complex skills training, curriculum  development, assessment, and evaluation and feedback. She still continues to give workshops and courses on an international level concerning learning and education within the clinical practice, and on conducting educational research.

Tim is an educationalist in medical education at the Radboudumc Health Academy, Nijmegen, The Netherlands. Within his work he teaches and coaches medical and educational science students. He also trains and coaches residents and staff members/groups with special focus on learning in the workplace, providing and receiving feedback, educational systems and collaboration. He is the coordinator of the EFFECT-system (Evaluation and Feedback For Effective Clinical Teaching) which means he supervises all processes and guides individual feedback sessions, gives introductions as well as feedback workshops and evaluates EFFECT during staff and residency evaluation meetings.

Axel Ros, MD, PhD is a specialist in general surgery. He has been Head of the Department of Surgery at the County Hospital Ryhov in Jönköping, Sweden. He is now Chief Medical Officer in Region Jönköping County. Mr. Ros also has a part-time position at Futurum and is an affiliated researcher at the Jönköping Academy at Jönköping University where he teaches patient safety and supervises research. His main focus of interest is patient safety, Human Factors, and the evolving field of resilience in health care.

Consultant in pediatrics
Assistant head of department of pediatrics
Medical lead-physician of in-patient care on pediatric ward
Department of pediatrics
Ryhov county hospital, Jönköping Sweden
Simon has long previous experience of leadership in local politics and recent years in pediatric clinic. He has been working in pediatric clinic since 2005. 
Involved in collaboration-project for improvement work at department of pediatrics at Muratsan hospital, Yerevan, Armenia since 2017. 
He was 2018 elected chairman of the new national program for knowledge support for pediatric care and childrens health in Sweden, with the mission to work on structural improvement of pediatric care and equality of pediatric care all over Sweden.

Peter has a background in economics and accounting. He is a specialist in infectious diseases and have long working experience in Sweden as well as in Tanzania with tropical diseases, HIV and tuberculosis. He has been working with drug handling and financial issues at district level for the primary health care (PHC) services in Tanzania. He has worked in the Health Department at Sida with health development cooperation. Peter has for three and a half years been working for Sida with the Swedish Norwegian regional HIV and AIDS Team in Zambia. In collaboration with the major intergovernmental organisations in the region like SADC, EAC, COMESA and ECOWAS funding programmes and strengthening the member countries in the combat against HIV and AIDS.

Peter Iveroth has worked 25 years in clinical work at Ryhov hospital mainly as a specialist in infectious diseases. Since 2010 up to 2017 he has been working as Chief medical officer for control of communicable diseases at Region Jönköpings län. He had the responsibility for the control of the spread of infectious diseases internally within the health care organisation with three hospitals and 48 primary health care institutions as well as the control of spread of diseases in the society in the county of about 350 000 people. 

The Region has an ongoing collaboration with the Armenian Ministry of health and over the past 4 years I have been engaged in programs in Armenia on infection control and hygiene and the spread of multi resistant bacteria.

Erik Hollnagel is Senior Professor of Patient Safety at Jönköping University and Visiting Professorial Fellow at the Centre for Healthcare Resilience and Implementation Science, Macquarie University (Australia). He has through his career worked at universities, research centres, and industries in several countries and with problems from many domains. He has published widely and is the author/editor of 25 books, including four books on Resilient Health Care, as well as a large number of papers and book chapters.

Health Strategist for corporate wellness at Gislaved municipality. Special interest in workplace health promotion activities/projects, health economy and organizational policies designed to support healthy behavior in the workplace and to improve health outcomes, foremost with the relationship between health, stress and coping. Ylva is a deputy project leader of "A healthy working place for a healthy working life", a collaborative between Region Jönköping County and seven municipalities in Region Jönköping in Sweden.

Chief of Pediatric Department at Yerevan State Medical University, Armenia

Development Officer – Scotland’s House of Care Health and Social Care Alliance Scotland (the ALLIANCE)

William works on Scotland’s House of Care Programme at the ALLIANCE aiming to develop and improve self management and person centred care across health and social care. William’s work on the House of Care project consists spreading care and support planning across Adopter Sites in Scotland and developing a case for change in health and social care with national and local partners.

He also writes briefings, reports and response pieces to the Scottish Government’s policy. He works within the Co-production and Self Management Hub at the ALLIANCE working to enhance self management approaches and co-production in Scotland. He previously worked on the ALLIANCE’s Dementia Carer Voices project and at a Westminster-based think tank on social care policy.

Alison Fox, Primary Care Practice Manager, St Triduana’s Medical Practice, Edinburgh, Scotland.

Alison is the practice manger in a busy city practice with circa 11k patients.  Through strong leadership and the creation of a clear strategy Alison is helping her practice thrive in the current challenging climate. Alison has a keen interest in the development of patient centred models for primary care and in particular how care and support planning can help shape that future.