2008 annual report

1Breaking boundaries

careum Foundation

Breaking boundaries2008 Annual Report

2 Careum Foundation, 2008 Annual Report

Images of boundariesThe series of images contained in this report illus

trates the idea of ‘boundaries’ in many different and

sometimes unusual ways. In viewing the images,

people cannot help but ask themselves what the

point in having boundaries is. Where does one stop

and the other begin? Can the act of breaking or

even doing away with boundaries actually strengthen

the whole? When is it appropriate to draw clear

boundaries? And when is it appropriate to tear them

down? Can the desire to abolish restrictive boun d

aries really be fulfilled?


Table of contents

Breaking boundaries: Helping to shape the healthcare world of tomorrow

Hypothesis 1

Supporting new professions with new textbooks: Careum Publishing

The end of an era: Careum School for Healthcare Professions DN II closes its

doors after 126 years

Targeted advanced training delivered in modules at the Careum Institute

Healthcare professions of the future: The need for qualified personnel is

on the rise

Hypothesis 2

Practicable knowledge and skills with problembased learning

Hypothesis 3

Overcoming professional boundaries: Learning and working in an

interprofessional context

Hypothesis 4

Information literacy in the healthcare sector: Careum Explorer and CareOL

Hypothesis 5

Looking ahead to the healthcare world of the future: Drivers of change

Board of Trustees and Committees

Organisational chart

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Breaking boundaries: Helping to shape the healthcare world of tomorrow

If we are to take a comprehensive approach to healthcare in the future and create a healthcare sector that operates across boundaries, then these attributes will also need to be applied to training strategies and the healthcare professions. If we do not base the education we provide today on the needs of tomorrow, we will find ourselves unable to make a valuable contribution to the future of healthcare. This is why the Careum Foundation takes account of current trends, provides inspirational ideas and makes its contribution to shaping the healthcare world of tomorrow.

In 2008, the Careum Foundation reached another im

portant milestone: at its meeting of 8 May 2008, the

Board of Trustees officially approved all the buildings

on the Careum Campus, noting with great satisfac

tion that the construction work had not only come in

on budget and on schedule, but also that all the build

ings had been fully leased following their completion.

The new buildings are now full of people eager to

learn more about their chosen profession. The vision

of a lively campus that is home to all the different

professions within the healthcare sector and all age

groups is becoming more of a reality day by day.

On an average day, over 1,000 students are on the

campus, where they have the opportunity to come

into contact with employees of the healthcare

institutions which are also housed on the site,

whe ther they come across each other in Careum’s

medical library, the skills labs of the Careum Training

Centre or the beautiful campus courtyards. The

Careum Campus is increasingly being used as a

venue for forwardthinking events, helping it to de

ve lop into an institution with a national profile.

Since 2002, the Board of Trustees and the managing

committees have had to focus a great deal of their at

tention on managing the campus construction pro ject.

With building work now complete, the resources that

have been freed up are being channelled towards the

Careum Foundation’s core activities: Accordingly, dur

ing 2008, both the Management Committee and

Board of Trustees worked intensively on the strategic

focus of the Foundation.

The healthcare sector is currently experiencing

radical change, leaving it facing some great chal

lenges. Healthcare has become comprehensive, with

services operating across boundaries. Therefore, if

the approaches and models applied in the health

care sector are to be fit for the future, they must

meet these same demands too, while also taking a

raft of additional factors into account, such as

training strategies and modules, markets and expect

ations, socioeconomic trends, new technologies

and research. This opens up new opportunities and

creates new strengths, with the result that the

tra ditional boundaries between disciplines, profes

sions, institutions and countries are shifting or

disappearing altogether. The boundaries between

the range of services on offer and citizens, as well as

between market and regulation, doctor and patient,

and service provider and consumer are also being

redefined.

This year’s annual report has been created against

this backdrop of continuing change in the healthcare

sector and has taken its lead from the associated

idea of ‘breaking boundaries’. The various ways in

which the Careum Foundation works and the ap

proaches it takes are illustrated by means of four cur

rent and future developments that were discussed

in the book published to commemo rate its 125th

anniversary, “Pushing the boundaries – essays on the

future of healthcare education”. There then follows

a new, fifth hypothesis, which outlines the healthcare

world of tomorrow and analyses the relevant drivers

of change. This fifth hypothesis will form a basis for

Careum’s future activities.

Hans Gut, ChairmanIlona KickbuschRené KühneBeat SottasManagement Committee


In the near future, the demands made in terms of the efficiency and effectiveness

of healthcare education will rise sharply. On the one hand, the need to attract more

people to work in the healthcare sector will increase, due to higher demand and the

shorter working life of many female employees in the sector. On the other hand,

time spent on training will have to be optimised for reasons of cost; this can be

achieved by creating the right mix of depth, breadth and length in terms of educa

tion provision.

This will lead to the shared ground between all healthcare professions being kept

to a practical minimum, but without impairing the quality of training. The essential

aspects of the curriculum, such as the basic functions of the human organism and

an understanding of cultural, ethical and economic issues, will be taught to the

various professional groups together, as preparation for their subsequent working

lives where colleagues from different healthcare professions have to cooperate with

one another.

Specialist training modules will then build on these foundations. They will be much

more focused on the specific area and therefore considerably shorter than the op

tions available at present. Additional training courses will enable practitioners to

change their field of expertise by following clearly defined paths.

A shared foundation, enhanced by specialist modulesHypothesis 1

Education is given a clearer structure and made more efficient


Supporting new professions with new textbooks: Careum Publishing

The huge changes taking place in the health and social care sector also affect professional education at upper secondary school level, i.e. vocational training. New professions are coming into being, while existing ones are being restructured and reclassified. Careum Publishing is making a vital contribution to this process by developing new textbooks.

Just a few short years after its introduction, the

‘healthcare specialist’ profession is currently the sixth

most popular career choice in Switzerland – and it

could even move up to third place in the near future.

Thanks to its clear structure, this new profession

will develop into an important – if not central – pillar

of the Swiss healthcare sector. The gap between

finishing school at 16 and starting training at 18, which

proved particularly problematic for many school

leavers entering the degree courses in healthcare offer

ed previously, could be closed with the healthcare

specialist training course, as it is open to students aged

16 and above. This greatly improves the efficiency of

healthcare training.

In only its third year of existence, a combination of

entrepreneurship, professionalism and a lot of

hard work have enabled Careum Publishing to take

on a central role in the provision of textbooks for

several health and social care professions. Par t

nerships with regulatory bodies and national em

ployer organisations form the basis for a highly

efficient operation, clear structures and the wide

spread recognition which its textbooks have

achieved.

Working in conjunction with the OdASanté

healthcare organisation, a nationally recommended

textbook was produced for the new healthcare

specialist profession, which is already being used for

80 percent of vocational courses to great success.

The year 2008 saw work begin on translating this

textbook into all of Switzerland’s official languages.

The Swiss Confederation only ever supports trans

lations into other official languages if the relevant

areas of the country, in this case Western Switzerland

and Ticino, deem the textbook to be worthwhile.

The textbooks for care workers and pharmaceutical

assistants are two other products created in part

nership with the appropriate national employer or

ganisations – SAVOIRSOCIAL and Pharmasuisse.

Both textbooks have been recommended to voca

tional colleges as official texts and will be available

in three official languages for the start of the 2009

academic year.

At tertiary level, Careum Publishing worked together

with the Careum Competence Centre to further

develop the existing textbooks for nursing in order

to improve the level of standardisation, to give

them a clearer structure and to make them more ef

fective as a result.

However, Careum Publishing and the Careum

Competence Centre also address the lesser known

professions, such as the technical medical and

therapeutic careers, which textbook publishers who

are focused on turning a profit would not deem

very attractive. By developing textbooks for use in

these fields, the two Careum departments are

really reflecting the Foundation’s true objectives and

making a lasting contribution to these smaller, but

no less valuable, professions.

As there is always a vast amount of information to

process, the success of each project rests not only on

the project managers and administrative staff of

Careum Publishing, but also on a team of around 100

authors, specialist editors, proofreaders and digital

media designers. This is the only way to ensure that

the content of the textbooks is kept up to date,

that it is of a consistently high quality and that it is

continuously adapted to new education structures.

Felix DettwilerManager of Careum Publishing


The end of an era: Careum School for Healthcare Professions DN II closes its doors after 126 years

After providing education for 126 years, 2009 saw the Careum School for Healthcare Professions DN II enter its last few weeks. These were years that were marked by quality, efficiency and con ti nual adaptation to the current training climate. In spring 2009, the Foundation’s school will close its doors for the very last time.

The year 2008 marked the start of the last full year of

operation for the DN II school; 126 years after the

Foundation and the school were established in 1882.

Changes to the education system at Confederation

level and the shift in responsibility from the health

de partment to the education department at canton

al level meant that all 26 schools established in

accordance with former laws in the Canton of Zurich

and other parts of Switzerland lost their service

mandate. It is for this very reason that Careum’s DN II

school will close in spring 2009.¹

The Foundation’s current school and its predecessors

have always offered traditional training courses,

producing nursing staff over the years with a variety

of specialisms for employment in the Swiss and,

in particular, the Zurich healthcare sector. For an insti

tution that was active in the healthcare sector for

over a century and that wanted to remain successful,

the challenge was to keep moving with the times

in order to meet the everchanging needs of society in

general and of the healthcare sector in particular.

Were new training courses needed, or did existing

ones need to be supplemented somehow? Were the

options on offer structured in a way that made

them attractive to potential students? How could

mea sures for maintaining and improving quality

be anchored in the school’s basic principles? In

ad dition, training courses in regulated fields have

to meet the requirements of the appropriate regula

tory body in order to achieve national and, if appli

cable, international accreditation.

The training courses offered at the Careum School

for Healthcare Professions DN II always strove to

meet the needs of the time, to set trends and to

make a lasting contribution to shaping the health

care sector of the future. For many years, the school

achieved these goals, not only in terms of edu

cation, but also as regards the structure of training

courses. As well as main training courses, it also

offered supplementary further and advanced educa

tion in the form of conversion and transfer pro

grammes. These programmes gained increasing

num bers of imitators and some are still available on

the training market, albeit in a modified format.

The closure is now almost upon us, yet the DN II

school was still able to award 50 new nurses with

their degree certificates during its last full year

of operation. The stated objective of the Foundation,

the school’s management team and the teaching

staff was and still is to run a wellregulated, superior

quality school right up until the last class has gra du

ated. Those involved have managed it so far and they

are determined to continue to deliver until

the school is finally closed.

All those who have helped to reach this difficult

goal of maintaining a wellrun school during a period

of closure deserve sincere thanks, particularly

the students, teachers and sponsors.

Felix DettwilerSchool Principal

¹ Training courses will now be provided by the Careum Training Centre, of which the Careum Foundation is a majority shareholder.


Targeted advanced training delivered in modules at theCareum Institute

The professionalisation of healthcare education is also reflected in the advanced training offered at university level. The WE’G Hochschule Gesundheit (a college of nursing science) and the Careum Institute have joined together to pioneer the development of such training in Germanspeaking Switzerland.

Further and advanced healthcare training was some

thing of an anomaly until the reforms made to the

Swiss education system in 2002 changed that. Now,

the healthcare sector comes under the same stand

ard framework of reference applied to education for

other professions in Switzerland. After an initial re

structuring phase, professional healthcare education

has been rounded off with the establishment of

training centres and healthcare universities of applied

sciences. This has created clear structures for basic

healthcare education, which is primarily geared to

wards training ‘generalists’ in the nursing professions.

However, these structures are not fully equipped to

meet the many and varied needs of employers in the

healthcare sector, which is why it is so important

to provide the additional specialist expertise requi r

ed in the form of advanced training options that

focus on nursing professions at higherlevel voca

tional colleges and universities of applied sciences.

Careum has shown its commitment to further deve l

oping the provision of specialist professional nursing

education through its involvement in the WE’G Hoch

schule Gesundheit college of nursing science and

the associated training offered at the Careum Institute.

In January 2009, the Careum Institute in Zurich suc

cessfully launched its first training courses in the fields

of palliative care (which has a strong emphasis on

working with colleagues from different healthcare pro

fessions) and oncological care. Following a period

of intensive preparation, these two courses, combined

with the other training courses provided by the WE’G

Hochschule Gesundheit (see below), represent the first

advanced training courses available at university

level in Germanspeaking Switzerland.

Thanks to the modular nature of these courses,

students and healthcare specialists can structure what

they learn according to prior knowledge and their

specific training needs.

Courses at the WE’G Hochschule Gesundheit

– Bachelor of Science in Nursing (BScN)

– Master of Science in Nursing (MScN) by Applied Research

– Master of Advanced Studies (MAS) in Managing Healthcare Institutions

– Master of Advanced Studies (MAS) in Geriatric Care

– Master of Advanced Studies (MAS) in Care Management

– Master of Advanced Studies (MAS) in Oncological Care

– Certificate of Advanced Studies (CAS) in Palliative Care

– Foundation Course in Palliative Care

– Advanced Course in Palliative Care

The courses are modular in form. The following qualifications are achieved by combining compulsory and optional modules:

– Master of Advanced Studies (MAS): 12 modules– 60 ECTS credits (1,800 hours of study)

– Diploma of Advanced Studies (DAS): 6 modules– 30 ECTS credits (900 hours of study)

– Certificate of Advanced Studies (CAS): 3 modules–15 ECTS credits (450 hours of study)


Healthcare professions of the future: The need for qualified personnel is on the rise

The most recent Careum Forum, held on 5 February 2009, dealt with the concerns currently being experienced by health professionals in Switzerland under the title “Qualified and committed! Can my degree act as a stepping stone or will I be left behind?” This title expressed the selfconfidence felt by health professionals and the satisfaction they find in their work, but also the nagging doubts that are fuelled by debates surrounding pay and standards.

Over the past few years, the training concepts and

qualification designations used in the healthcare

professions have undergone rapid change. Time and

again, seemingly effective measures were jetti soned

and replaced by new methods. To those affected, it

appears as though the only constant is change itself.

But this change was brought about by outside forces,

since it is the result of two paradigm shifts that have

been implemented in European and Swiss legisla

tion: now, the objectives and structures of healthcare

education, as well as the curricula followed, are

determined by industry and by the public health pri

orities of the Swiss Confederation. Particularly in

terms of the healthcare sector, these changes repre

sent a distinct break from what has gone before

and necessitate a shift as regards how health profes

sionals see themselves. They make practitioners

feel unsure and inadequate.

In his welcome speech to the 2009 Careum Forum,

titled “Change we can believe in”, Beat Sottas, Member

of the Management Committee, explained the causes

behind and the dynamics of these changes. According

to the OECD, developments in the healthcare sector

can be put down to three driving forces: demographic

change, progress and the availability of financial

resources. All three drivers have a significant impact

on healthcare training strategies.

Financial resourcesThe healthcare sector is the growth industry of the

Swiss economy. In Switzerland, around one billion

Swiss francs are spent annually on continuing profes

sional development for health professionals, with

the medical sector accounting for threequarters of

this amount. What is more, this expenditure looks

set to rise further still, owing to the fact that the

guidelines on patient safety, improving quality and

increasing benefits and efficiency are becoming

ever stricter.

Since the mid1990s, the healthcare professions have

been gradually integrated into the Swiss education

system. In line with the movement launched to offer

young people better training and job prospects

upon finishing their education (“Kein Abschluss ohne

Anschluss”), all further and advanced training op

tions were repositioned. On the one hand, all school

leavers can embark on a career in the healthcare in

dustry as soon as their compulsory schooling is over;

on the other, all professionals wishing to undertake

further education have practically limitless advanced

training opportunities available to them. In view of

the rapid changes taking place in the healthcare sec

tor, advanced training and lifelong learning are key

resources not only for practitioners, but also for com

panies. Today, the Swiss education system is set out

in such a way that it can offer attractive training

packages to all health professionals.

DemographyAt the end of 2008, the Swiss Health Observatory

predicted that the need for qualified healthcare per

sonnel would increase much more quickly than

the rate of population growth would suggest. The

ageing population is one of the most important

factors behind this prediction: by 2020, the propor

tion of the population over 65 years of age will have

risen by 14 percent, while the proportion of those

over 80 will have increased by 35 percent. Another

reason for this forecast is the individualisation of


society, which is leading to a distinct drop in the

number of people practising self care or being cared

for by relatives. As a consequence, the healthcare

industry must create jobs that are attractive to

young people and which will encourage significantly

more of them to pursue a career in the healthcare

sector than is currently the case. This is something of

an emer gency situation, as the number of nursing

and therapeutic professionals required should rise by

13 percent by 2020, and by as much as 30 percent

by 2030, from 174,000 staff today to 226,000 staff by

2030. In conclusion, it is clear to see that there is

a great need for health professionals.

ProgressSince courses in human medicine, dentistry, vet

erinary medicine and pharmacy offered at univer sity

level institutions have undergone a transfor mation

as part of the Bologna process and now result in

Bachelor’s and Master’s degrees being awar ded,

Master’s training is now also the final stage of educa

tion available at healthcare universities of applied

sciences. Around 25 healthcare professions are cur

rently regulated in Switzerland, but this is only the

beginning. The challenges that lie ahead provide

great scope for development:

•Theintroductionofdiagnosis-relatedgroups(DRG;

system of flatrate financing to be introduced in

2011) will lead to new clinical pathways and care

procedures.

•New,customer-focusedmodelsofbasiccareareon

the horizon.

•Thechallengesoflong-termcarecallforsystematic

nursing and care management.

•E-healthandtheprocessingofdatastreams

represent another growth area for the industry.

In line with the therapeutic and technological de

velopments taking place, the professionalisation of

health practitioners is also improving at a rapid

rate: new fields of expertise with new profiles are

coming into being, from which new job descrip

tions will also develop. The 2009 Careum Forum

examined the effects of these changes and the asso

ciated uncertainty felt by health professionals.

Speakers from the Swiss Nursing Association (SBK/

ASI), from the fields of occupational psychology, and

from the world of education and advanced training

shone a light on this topic from many different sides.

The general conclusion reached was that there

is absolutely no need for uncertainty, as the demand

for qualified health professionals continues to grow

unabated and will rise sharply in the future. However,

health professionals must also recognise their own

responsibilities in this regard. The dividing lines which

mark out the different professions must make way for

a greater focus on process thinking and interprofes

sional networking.

2009 Careum Forum

Monika SchäferVice President of WE’G Hochschule Gesundheit

Rolf GilgenDirector of Waid City Hospital, Zurich

Irene CampiOccupational psychologist

Barbara GassmannVice President of Swiss Nursing Association (SBK/ASI)

Beat SottasMember of Management Committee of Careum Foundation


Health trainers as opposed to carers for the sick

The relationship between medical professionals and patients will never be the same

again. Soon, it will be almost impossible to assign clear roles to the two parties, as the

level of knowledge, plus the personal and cultural situations of individual patients will

differ much more strongly than they do today, thus demanding that professionals

become more flexible in their approach. Recognising these sets of circumstances

properly and consciously taking on the ‘correct’ role will be of central importance for

health professionals. The ability to motivate patients to be proactive in preventing an

illness from occurring or in maintaining good health requires quite different social

skills to those needed in today’s health professions, which have a much stronger em

phasis on actual care. A large component of the education and training provided will

deal explicitly with such issues, with teaching staff moving away from imparting

knowledge and heading more towards sharing experience and insights. They will also

take on an increasingly advisory, assisting role.

Hypothesis 2

Education must focus more on the increasingly complex relation-ships between patients and professionals


Practicable knowledge and skills with problembased learning

In modern 21st century society, the role of the individual is being redefined all the time – and it is becoming more and more varied. A person is a citizen in the healthcare community, a consumer in the healthcare market and a patient in the healthcare system.

The term ‘patient’ refers to a person who is suf

fering. It includes the notion of a certain state that

restricts a person’s quality of life. If a patient’s

health is the cause of their suffering, sooner or later

they will make use of healthcare services. Our

ideas about what a patient’s role involves have de

veloped over the last 50 years.

• In1960,thetalkwasofthe‘patronisedpatient’,

who would have information about their diagnosis

withheld from them, particularly if the condition

was serious or life threatening.

• In1970,theideaofthe‘informedpatient’arrived

from the USA. The patient now had the legal right

to give informed consent to medical procedures.

This was a significant move in two ways, as it also

provided the doctor with legal protection.

•Theyear1980sawtheriseofthe‘responsiblepa

tient’, who was allowed to have a certain amount of

input into their treatment, but was also obliged to

take responsibility for it.

• In1990,theresponsiblepatientwassupersededby

the ‘autonomous patient’, who acted as a partner in

determining their own state of health.

The common theme running through these four

stages of development is that the patient’s role is

largely defined by their relationship with others: with

the doctor, health professionals, the judiciary, polit

icians or health insurance providers. At the turn of

the century, however, a completely new aspect be

gan to emerge: the patient’s relationship to oneself.

Now, added to the questions and demands that the

patient has for others, are the questions they must

also ask themselves. It is no longer just about rights,

but about responsibilities as well. Building on the

existing concepts, the talk since the year 2000 has

been of the ‘competent patient’.

The 21st century healthcare community is being

shaped before our very eyes. Life expectancy has in

creased and our societies are becoming home

to more and more old people. Chronic illnesses de

termine the clinical character of our society, but

medical advances have made it possible for increas

ing numbers of seriously ill people to be cured

and for those with chronic diseases to play an active

role in society.

The societal changes of the 21st century outlined

here mean that existing roles and frameworks need

to be brought up to date:

•Competentpatientsexpectallhealthprofes-

sionals to know at least as much about their illness

as they know themselves. They expect to receive

a package of evidencebased diagnosis, treatment,

care and advice and to be given clear informa

tion about both conventional and complementary

treatment options.

•Competentstudentsexpecttobeabletoplayan

active role in managing their own learning process,

focusing on the very latest developments in the

profession and on patients’ needs.

•Competentteachingstaffexpecttobeableto

support students throughout their learning pro

cesses in their role as tutor or trainer, focusing on

the very latest developments in the profession, on

patients’ needs and on developing a professional

manner. This is not just about a concept of teaching

and learning, but also about the context of that

learning process, taking the roles of those affected

and involved into account, plus their expectations,

obligations and structures.

The processes associated with the paradigm shifts

outlined above must be addressed primarily in terms

of further and advanced healthcare provision.

Against this backdrop, in 2000, Careum decided to

adopt a new course: the educational and didactic

approach of problembased learning. With these ob

jectives in mind, the Careum Competence Centre

developed problembased curricula, along with

lear ning aids and teaching materials for providers of


healthcare education at tertiary levels B and A.

The learning and teaching concept behind problem

based learning takes as its starting point the fact

that, in any given situation, an individual’s actions and

responses will be directed by their subjective know

ledge of the world around them, by their perception

and interpretation of events. So ‘learning’ is viewed

as a constructive, active, selfdirected, problembased

and social process carried out by the individual.

The focus is on the student’s learning pro cess, not on

the act of teaching. The corresponding learning aids

and teaching materials, methods of selfassessment

and the associated infrastructure support independent

learning and can accommodate the learning style

and speed of each individual. The selfstudy learning

landscape promotes independence and individual

responsibility, the use of IT resources, learning via dif

ferent media and the development of a personalised

way of learning. Integrated into this environment are

opportunities for exchanging knowledge with stu

dents from other professions, as well as with experts.

The main aims of problembased learning are to

structure and gain knowledge which is based on a

deep understanding of the issues involved and

which can be called upon quickly at any time and ap

plied to different situations. This knowledge

should be combined with the ability to analyse and

solve problems, to direct one’s own learning, to

work as part of a team and with an ongoing curiosity

and interest in continuous learning.

The products of the Careum Competence Centre –

the problembased curricula and learning aids and

tea ching materials used to train health professionals –

are an appropriate response to current and future edu

ca tional trends that can be seen in the healthcare sys

tem and in society as a whole.

Pia RiedoManager of Careum Competence Centre


Teamwork as opposed to a oneman show

Today, we have successful teamwork to thank for curing diseases and improving

patients’ health; in the future, the focus on working together will become even more

important. On the one hand, increasingly complex care procedures are blurring the

boundaries between the inpatient, outpatient and longterm healthcare sectors.

On the other hand, higher quality requirements can only be met by working to

gether. As a result, it will become standard practice, not to mention a necessity, to

work together with colleagues from different healthcare professions in order to

achieve the best possible effects, to increase efficiency and to improve patient bene

fits and safety. Networks must be made more effective and more emphasis be put

on operating within such networks in an efficient and targetoriented manner. Pro

moting teamwork skills and creating unambiguous, clear and comprehensible docu

mentation will play a major role in healthcare education. Practitioners must learn to

recognise the boundaries of their own particular fields and know when to turn to

colleagues acting in other fields. This means that each individual health profes

sional must be flexible in meeting the demands of wholly different roles and pro

cesses.

Hypothesis 3

Working in a team and across professional boundaries is set to become even more im portant


Overcoming professional boundaries: Learning and working in an interprofessional context

Learning and working in an interprofessional context is the hot topic on everyone’s lips. This just goes to show the importance that the healthcare sector attaches to this issue in terms of both education and practice.

Patients are often treated and looked after by

members of different healthcare professions. If practi

tioners are to be able to work together with col

leagues from other healthcare professions for the

good of the patient, a basic prerequisite is that all the

groups of health professionals involved must ac

knowledge the expertise of all the other groups. They

must be willing and able to speak to one another

about specific patient circumstances. Decisions must

be made as regards how patients and their rela

tives should be dealt with. In addition, personal inter

ests must come second to caring for patients in a

responsible manner.

In the healthcare sector, working with colleagues

from other disciplines brings a number of benefits,

including the following:

• Individualpractitionersareresponsiblefortheir

part in the patient’s treatment and care.

•Thecourseofthepatient’sillnessisfollowedclose

ly, with therapeutic measures being better adapted

to the situation at hand.

• Ifpractitionersworkwithcolleaguesbothfrom

within their own professions and from other health

care professions in a respectful manner, this not

only increases patient satisfaction, but also the sat

isfaction that those practitioners derive from their

work.

To enable budding health professionals to experi

ence learning and working in an interprofessional

context while they are still in training, Careum and

the Medical Faculty of the University of Zurich have

decided to develop compulsory and optional inter

disciplinary learning and training modules. The aim is

to really equip students from the various different

courses with all the tools they will require in their fu

ture working lives. The Careum Training Centre,

working in partnership with the Medical Faculty, has

already created the first module – “Interprofessional

collaboration in emergency situations” – which forms

part of the curriculum. In addition to this, lectures

and briefings that fall outside of the curriculum have

also been developed.

Careum has commissioned the Careum Competence

Centre to further develop the concept of learning

and working in an interprofessional context and to

drive forward the creation of additional training

courses. It is a matter of huge importance to promote

the added value which working in a team and across

professional boundaries brings in a committed and

sustainable way.



Learning how to learn as opposed to learning facts

Knowledge gets out of date faster and faster these days. The prevalence of elec

tronic networks and the way in which knowledge is distributed across them means

that one constantly has to supplement and expand one’s own knowledge. The

gathering and updating of knowledge becomes an endless cycle. Therefore, the

training of tomorrow will have to tackle the issue of how to obtain the latest know

ledge in an efficient and targetoriented manner. Learning strategies, problem

solving strategies and the ability to continually develop will play central roles.

Hypothesis 4

Knowledge needs to be constantly updated


Information literacy in the healthcare sector:Careum Explorer and CareOL

New media not only influence our leisure time, but also how we learn and how we work. Along with the huge opportunities offered by the immense pool of knowledge that is the internet come major challenges. The Careum Explorer and CareOL online platforms enable health professionals to use new media in the way that is most beneficial for them and their professional groups.

In our society, the internet has penetrated every

area of our lives. According to the Swiss Federal Stat

istical Office, in the first three months of 2008, 68

percent of the Swiss population over 16 years of age

used the internet at least twice a week. Around 80

percent of those were using the internet to research

the symptoms of an illness or to find a diagnosis.

It goes without saying that pupils and students make

use of the internet everyday, and that it has long

established itself as an essential tool within schools,

colleges and universities.

Yet, although the internet offers untold benefits,

it also poses huge challenges. A certain degree of in

formation literacy is required just to carry out

meaningful research via a search engine: one needs

to enter the right combination of the right search

terms, and be able to assess and narrow down the re

sulting hits. For many internet users, this is a tall or

der. The concept of information literacy only arrived

on the scene in schools, colleges and universities

fairly recently, while in the working world, it is still

usually seriously neglected.

Careum carried out a small survey among nursing

staff, asking what they considered to be the major

problems when searching for specialist nursing infor

mation. The responses enabled the following three key

problems to be identified: the large amount of time

consumed, a lack of research expertise and the difficul

ty of assessing the quality and topicality of informa

tion. This means that help needs to be provided at

vari ous levels. On the one hand, more training in

infor mation literacy is needed, and on the other, it

must be made easier for health professionals to

access specialist information in electronic format.

This is where the Careum Explorer project, Careum’s

specialist online portal for the healthcare profes

sions, comes in.

Careum Explorer has been online since September

2007 and its content and services are being constant

ly expanded. The specialist structure on which the

portal is based is fundamental to how this content is

accessed, comprising as it does around 50 specialist

categories relating to health professionals other than

doctors. All content is assigned to these specialist

categories, so users can focus their searches on sub

jects such as oncological care, emergency care,

physiotherapy or nutritional advice. Once they have

selected the appropriate specialist area, users can

run queries in nearly 20 external databases or

brow se available ebooks and the portal itself. Infor

mation in the portal includes the latest news in the

field, conference and congress dates, book reviews,

information on courses, specialist publications, art

icles and a comprehensive range of links to further

information on each topic.

Most journal articles can still only be obtained

on payment of a fee. The titles which are available in

electronic format and that can be accessed free of

charge can be called up directly via Careum Explorer,

whereas those that require a fee to be paid can be

ordered from a library. The next steps involve expand

ing the portal’s content, in particular its multi

media features.

A userfriendly internet portal should offer the

following:

•Standardpointofentry

•Simplicity

•Powerfulsearchtools

•Largeamountsofdata

•Structuredandeditedinformation

• Integrationofadditionalfunctions

•Personalisation

•Communicationandcollaboration

•Validation


Careum Explorer meets all the criteria of a user

friendly internet portal, thereby providing users with

a reliable anchor in a sea of information. The portal

is being continuously updated, and both its content

and services are being constantly expanded.

The fact that knowledge is being superseded faster

and faster all the time these days also has an effect on

developments in education, as this is also a field

that needs to respond to social change. Educational

and didactic concepts such as problembased

learning focus on the act of learning itself, rather than

on teaching. Learning packages based on this un der

standing enable students to organise their learning

for themselves, to do so in an appropriate

fashion and to come up with solutions when faced

with new situations.

Problembased learning packages using multiple

methods allow students to learn and be taught both

face to face and online. With CareOL (Careum On

line Learning), Careum has created an innovative

multi media learning platform that provides author

ised users with a protected space in which to

learn. The varied range of services available on

CareOL offers students support in terms of their own

learning processes, but also in terms of communi

cating and collaborating with fellow students and

teaching staff.

CareOL is defined by the following main features:

•Provisionofknowledge:Thebulkofthelearning

content is offered as PDF documents or HTML

pages. Training films can be viewed online. Links

are available to various topics.

•Checkingofknowledge:Interactivetestscanbe

taken.

•Collaborationandcommunication:Awiderange

of tools are available to facilitate teamwork (chat,

email, forums, Wikipedia, folders for data exchange).

Summaries of learning outcomes, presentations.

•Distributionofinformation:Studentscanuse

CareOL to access information and documents pro

vided by their educational institutions and

teaching staff.

•Acquisitionofmediahandlingskills:Linkstoonline

learning modules help students to acquire learning

strategies to enable them to use various media,

particularly in terms of performing internet re

search.

With the CareOL and Careum Explorer online plat

forms, Careum is encouraging health professionals to

acquire the skills that will enable them to meet the

challenge of change headon.

Susanne MayerCareum Explorer Project Manager


www.careumexplorer.ch

www.careum.ch

“What a great idea! For me,

the really important thing

would be to be able to call up

care standards, prophylactic

measures, links to other portals

and lists (of diagnoses, for

example). Of course, a clear,

inviting and professional over-

all look would be a bonus.”

Response of student who participated in survey


Drivers of change

What is driving the rapid changes taking place in the healthcare sector? Where is that

dynamic force coming from? Four drivers are particularly significant in this regard:

demographic change, medical innovations and technologies, economic factors such

as rising costs and the growth of the market in healthcare services, plus the evolving

role of the patient.

Hypothesis 5

Looking ahead to the healthcare world of the future


Looking ahead to the healthcare world of the future: Drivers of change

What is driving the rapid changes taking place in the healthcare sector? Where is that dynamic force coming from? Four drivers are particularly significant in this regard: demographic change, medical innovations and technologies, economic factors such as rising costs and the growth of the market in healthcare services, plus the evolving role of the patient.

The healthcare sector is experiencing a period of

historic change. New opportunities are opening up

and conventional thinking is being challenged.

Health is all pervasive; it is shifting and overcoming

existing boundaries. In order to be fit for the future,

however, strategies and models created in and for

the healthcare system not only have to take these

de velopments into account, but also numerous other

aspects, such as changes in education, training,

care procedures and markets, socioeconomic trends,

different expectations, new technologies and research.

Below, the four major driving forces are examined

in terms of their relevance for Careum’s strategic focus.

They show that the Foundation can only achie ve its

objectives if Careum also looks at wider issues relating

to the healthcare system as a whole.

1. The major driver of change in the healthcare sector is demographic change.

All over the world people are not only living longer, they are also staying

healthy for longer or achieving a greater degree of independence while living

with a chronic illness. This means that the aims and main areas of activity of

the healthcare system also have to undergo a fundamental development. The

healthcare system must adapt to:

•Anolderpopulationwithmorechronicdiseasesand,accordingly,

different needs.

•Theincreasedincidenceofmentalillness–particularlyintheelderly.

•Agrowingpopulationofveryoldpeoplewhorequirecomplexcare

packages.

•Anewwayofdealingwithdyinganddeath.

This presents the healthcare professions with new challenges and focal

points, not all of which are medical in nature, and is resulting in new profes

sional fields that require appropriate advanced training. All those involved

in the healthcare sector are being called on to radically change their attitudes

to the treatment of chronic illness and older patients. The healthcare profes

sions are being given a new focus and are growing in importance. Those who

work in this sector must also play their part in helping the healthcare system

to adapt to these huge changes; they must be careful not cling to outofdate

attitudes to age which – at the start of the 21st century – no longer do older

people justice.

At the same time, demographic change also has another dimension: the pro

fessionals themselves are becoming older and the training places available for

the next generation can no longer be filled. This throws up a new problem in


2. Medical innovation and technological change will change the face of the healthcare sector and the procedures associated with it.

The close relationship between medical innovation and technological change

will shape the healthcare world of tomorrow. On the one hand, the rapid

development of information technology will enable new organisational proce

dures and processes to be introduced to the healthcare sector, which in turn

can lead to improved quality, safety and efficiency. Global access to expertise

and the latest scientific findings are also bringing about a radical shift in

terms of the information available to practitioners for the purpose of making

diagnoses and other medical decisions. On the other hand, developments

in medical technology and pharmacology are making it possible for those with

chronic illnesses to lead independent lives, resulting in a new form of inter

action between the medical system and the patient. Patients and professionals

will increasingly communicate with one another remotely, with the support

of IT facilities and networked monitors that constantly check the patient’s state

of health and trigger an alarm if anything out of the ordinary occurs.

For health professionals, this means acquiring a number of new skills that

extend far beyond specialist medical and nursing expertise. They will become

increasingly reliant on their IT skills, for example – which in turn represents

a challenge in terms of education and advanced training. Furthermore, these

developments will lead to a considerable shift in existing responsibilities

and relationships among healthcare professions, as well as between practi

tioners and patients.

3. The increasing economic importance of public health, rising costs in the healthcare sector and the rapid growth of the healthcare market are significant economic and political drivers.

The high economic importance of health is being taken increasingly seriously,

as a crucial aspect of a country’s human capital, as a significant factor in terms

of demographic change and as a market for goods and services. In the ma

jority of OECD countries, over 10 percent of all workers are active in the health

sector – and that percentage is growing. Around 70 percent of the entire

health budget is allocated to staffing costs. Innovation is an important factor

here too; one which is bringing a number of different industries and compan

ies together in new and exciting ways.

terms of managing not only healthcare, but also education policy, and is close

ly linked to other political spheres such as the promotion of economic devel

opment and immigration legislation.


Almost every decision we

make in our everyday lives

has an impact on our

health, resulting in conse-

quences not only for us

as individuals, but also for

society as a whole.

Both the health expectations of the population and the relationship between

the costs and results associated with different healthcare systems are pro viding

the basis for more and more international comparisons and rankings. Regions

define themselves as ‘health regions’ and cooperate on both re search and care,

sometimes even across national borders. This means that healthcare is becom

ing part of some very diverse political spheres, such as in the fields of economic

policy, tax, immigration and tourism.

This development is leading to competition on an international stage, not

only between different systems and models of care, but also between indus

tries; it is also resulting in competition to attract health professionals and

patients. A market which requires new forms of management and regulation,

and has new needs in terms of information, is coming into being. Health

care and education systems can no longer do their planning and thinking on a

purely national level. In addition, the growing market in healthcare services

is creating new areas of activity, such as health tourism, and with them, new

opportunities.

These opportunities manifest themselves in the form of increased choice for

health professionals and the chance for them to improve their income.

However, this also means increased pressure to perform and to relocate or

commute long distances. New professions are being developed, with

more and more im portance being placed on qualifications that are recognised

by different countries. As employees are becoming more mobile, the issue of

making the healthcare system an attractive place for people to work is being

taken more seriously too. Finally, the population’s growing interest in inno

vative approa ches to health, such as preventive healthcare and wellness, plus

the need to have services that are easily accessible, are becoming increasingly

significant factors when it comes to developing healthcare systems.

4. The most important social driving force is the changing role of the patient within the healthcare system.

All the aforementioned drivers really come down to just one thing: the citizen/

consumer/patient. The healthcare community of tomorrow will require the

individual to play an active and informed role in maintaining their own health,

in dealing with chronic illnesses and in the growing healthcare market. Al

most every decision we make in our everyday lives has an impact on our

health, resulting in consequences not only for us as individuals, but also for

society as a whole. More and more, the medical system is demanding that not

only professionals, but also patients have the skills to interact with one an

other in order to make the right decisions and to achieve successful treatment.


The opportunities for citizens and patients to gain these skills from an

edu cational institution remain practically nonexistent; but the professionals

working within the healthcare sector are underprepared in this regard too.

Healthcare systems are only just beginning to adapt gradually to this signifi

cant new challenge. Patients and citizens, however, have reacted faster,

not only by forming patients’ organisations and selfhelp groups, but also by

making active use of the health information available to them, particularly

on the internet. The market has responded to this need and now offers an over

whelming volume of information, materials and services.

As far as health professionals are concerned, this means that they must

recognise the knowledge and expertise that the patient of today has. They

must also play their own, increasingly active, part in promoting health

literacy and patient skills. Various models have now been created that need to

be introduced into all healthcare systems. In some countries, foundations have

led from the front and actively taken up this challenge. The ‘mini med schools’

and ‘patient universities’ in particular are extremely popular, although more

and more specially developed programmes for disadvantaged sections of the

population are also coming into being.

Without the full cooperation of patients, plus a significant democratisation

of and increased transparency in healthcare systems, it will not be possible to

achieve the objectives of 21st century healthcare, nor to meet the challenges

it poses.

ConclusionThe healthcare community is becoming more and more global. This devel

opment means that the traditional boundaries between disciplines and profes

sions, institutions and countries are becoming blurred. The relationships be

tween the range of services on offer and citizens, between the market and

regulation, between the doctor and patient, and between the service provider

and consumer are also being redefined. New strategic approaches and models for

the healthcare sector must take all the varying demands of education and

advanced training, market systems, socioeconomic trends, and new technologies

and research into account in order to make a real contribution to the healthcare

of tomorrow.

Careum wants to show how these trends can be picked up and turned into

concrete educational procedures. Its aim is to provide appropriate ideas and to

highlight approaches for dealing with the healthcare world of the future,

particularly in terms of healthcare education, and for playing an active role in

shaping that world.


Board of Trustees and CommitteesAs at April 2009

Gut Hans, Chairman, BoT, MC

Dipl. Ing. ETH, MS

Entrepreneur

Herrliberg ZH

(Trustee since 1999)

Bliggenstorfer Andreas, BoT

Priest, Chairman of Founders’

Association (StifterVerein )

Dietlikon ZH


Burkolter Max, BoT

Dr. theol.

Priest

Wald ZH


De Geest Sabina, BoT

Prof. Dr.

Managing Director of Institute

for Nursing Science,

University of Basel

Basel BS


Birchler Urs, BoT, CC

Dr. oec. publ.

Managing Director of Inselspital,

Bern University Hospital

Bolligen BE


Brühwiler Barbara, BoT

Head of Nursing and HRM of

University Hospital Zurich

Zollikerberg ZH


Buschor Ernst, BoT, AC

Prof. Dr. oec.

Former Government Councillor

Dübendorf ZH


Gutzwiller Felix, BoT, CC

Prof. Dr. med.

Director of Institute for Social

and Preventive Medicine,

University of Zurich

Councillor of State for Canton

of Zurich

Zurich ZH



AC – Audit CommitteeBoT – Board of TrusteesCC – Compensation CommitteeMC – Management Committee

Furler Lukas, BoT

Vice Director and Head of Nursing

of Waid City Hospital, Zurich

Münchenstein BL


Holenstein Hildegard, BoT

Dr. phil.

Berne BE


Kühne René, BoT, MC

Dr. oec. publ.

Business Consultant

Hurden SZ


Kickbusch Ilona, BoT, MC

Prof. Dr. Dr. h. c.

Director of Global Health

Programme,

The Graduate Institute, Geneva

Brienz BE


Sottas Beat, BoT, MC

Dr. phil.

Advisor for education and

healthcare policy

formative works

Bourguillon FR


Lauper Bernhard, BoT, AC

Coowner of construction and

real estate consultancy firm

Immopro AG, Zurich

Feldmeilen ZH


SatrapaSchill Almut, BoT

Dr. phil.

Head of Health and Humanitarian

Aid Department of Robert

Bosch Foundation, Stuttgart

Grafenau, Germany


Weibel Peter, BoT, AC

Dr. oec. publ.

Member of Board of Directors

of Credit Suisse Group, Zurich

Zurich ZH



Careum Publishing

Felix Dettwiler

Careum Competence CentrePia Riedo

School for Healthcare Professions DN IIFelix Dettwiler(until 4/2009)

Administration

Daniel Achermann

Management CommitteeHans Gut, ChairmanIlona KickbuschRené KühneBeat Sottas

Assistant

Paula Büeler

Associates

Projects

Hans Gut, ChairmanUrs BirchlerAndreas BliggenstorferBarbara BrühwilerMax BurkolterErnst BuschorSabina De GeestLukas Furler

Felix GutzwillerHildegard HolensteinIlona KickbuschRené KühneBernhard LauperAlmut SatrapaSchillBeat SottasPeter Weibel

Board of Trustees

Compensation CommitteeUrs BirchlerFelix Gutzwiller

Audit Committee

Peter WeibelErnst BuschorBernhard Lauper

WE’G HochschuleGesundheit AG 1)

Representatives on the Board:René KühneBeat Sottas

Careum AG Training Centre for Health Professions1)Representatives on the Board:Hans Gut, ChairmanBarbara BrühwilerRené Kühne

1) Associate of Careum Foundation

Organisational chartAs at April 2009


Published by: Careum Foundation, Content/project management: Careum Foundation, Design: BieriDesign Zurich, Photos: Giorgio von Arb Zurich, pp. 12–13 Julia Brütsch,

English version: Clíona Coyne, Printed by: Zürichsee Druckereien AG, Stäfa

Careum FoundationPestalozzistrasse 3CH8032 ZurichPhone +41 43 222 50 00Fax +41 43 222 50 [email protected]


Education is given a clearer structure and made more efficient

Education must focus more on the increasingly complex relationships between patients and professionals

Working in a team and across professional boundaries is set to become even more important

Knowledge needs to be constantly updated

Looking ahead to the healthcare world of the future

2008 annual report

Documents

careum campus

future of healthcare

healthcare sector

healthcare institutions

careum school

careum explorer

healthcare professions

healthcare world of