Kari Kværner 20141002 Transformation & Innovation

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<ul><li> 1. Transformation &amp; Innovation:Preparing Tomorrows Health CareDirector of Innovation Kari J. KvrnerSeptember 2014</li></ul><p> 2. Curriculum VitaeKari J Kvrner, M.D., Ph.D., MHADirector of Innovation, Oslo University Hospital 2010 - Professor UiO 2003 -Director of Research, Ullevl University Hospital 2009 -10 Solstrandkurset for toppledere AFF/NHH (2010)Director of Innovation, Medinnova (Rikshospitalet) 2007-9 MHA UiO (Medical leadership and gender)CEO Confidence Medesign 1999-2002 Ph.D. UiO (genetic epidemiology l996)ENT-physician 1990-2007 M.D. University of Oslo (l986)Federal contracts and grants research 25 mill NOK, start-up capital 17 mill, 68 publications, 8 PhDs 3. Kari Jorunn KvrnerDirector of innovationOslo University HospitalFrom white coat Physician CONSULTANCYTinnitis, cancer, dizzinessProblem solverSupervision of phDcandidates TeachingChronic disordersCoach and motivator Foto: Oslo Medtech 4. ONE day atOslo University Hospital 3300 Patient consultations 360 911- ambulances 1800 Patients transported 2000 Porter activities 26 Births Expenditures: 7 mill $ (3 billion $ budget) 15000 Employees at work 2160 Dinners served 15 tons of washed linen and uniformsOslo University Hospital is the local hospital for 6districts, area hospital for 12 districts, regionalhospital for Eastern and Southern districts andnational hospital in spesific areas of the country 5. Oslo University HospitalCEOBjrn EriksteinFinance, Legal Affairs andInformation TechnologyIntegration and InternationalCollaborationMedicine, Health and DevelopmentHuman ResourcesResearch, Innovation and EducationCommunicationPatient SafetyDivision ofMedicineWomen andChildrensDivisionDivision ofCancerMedicine,Surgery andTrans-plantationDivision ofMentalHealth andAddictionDivision ofCardio-vascularandPulmonaryDiseasesDivision ofSurgery andClinicalNeuro-scienceDivision ofEmergen-ciesandCritical CareDivision ofDiagnosticsand Inter-ventionOsloHospitalServicesCancerRegistryBoardCancerRegistryThe Clinic ofInnovation 6. Agenda:1. The key drivers to innovate in the health system2. Best practice: objectives &amp; results achieved3. The importance of the collaborative or open innovation:how to succeed in innovation collaborating with otherorganizations 7. The key drivers to innovate in the health systemTomorrows healthcare how do we succeed?The three main health challengesIdpoliklinikken 8. The range of innovations.. 9. Radical innovations in health care over time Gastric ulcer: from knife to tablets Heart infarction: from bedside treatment to surgery Surgery: en-bloc treatment raises survival possibilities Cancer treatment: from standardized to personalized Othropedic surgery: When everything can be offered how do we choose? From open surgery to endoscopy: simulation training becomes compulsory 10. Todays healthcare system has developed incrementally during the past60 years, whilst the challenges facing it now require more radical andrapid change. 11. Tomorrows healthcare how do we succeed?Idpoliklinikken 12. Are we justputting out thefire?Kari J. Kvrner 2014 13. or are we ableto address theneeds oftomorrow?Kari J. Kvrner 2014 14. The three main healthcare challengesIdpoliklinikken 15. Main health care challenges:1. MyHealth20202. The need for integrated ICT-infrastructureand services3. The adoption, diffusion ofintegrated patient-centricinnovations involving the healthcare industryIdpoliklinikkenRising costs, an aging population, risingpublic expectations and lack of healthcare workers 16. Focus on patient-centric needsMyHealth20201. Improved conditions for the chronically ill(using 80% of health care resources?)1. Preventive care = self-care in coming yearsIdpoliklinikken 17. Infrastructure how do we succeedwith integrated communication? (ICT)Requires collaboration betweena. Health care providersb. Health care industryc. Health care user (citizen/patient) who identifies the needsIdpoliklinikken 18. Hospital needed 10 months diagnosing cancerThe need for integrated patient-centricinnovations in healthcareKari J. Kvrner 2014The ICT systems aredysfunctional andcommunication acrosstreatment levelsinadequate 19. Our best practice: objectives and resultsBuilding innovation cultureInnovation portfolio and project managementThe challenge of implementationIdpoliklinikken 20. Building innovation cultureIdpoliklinikken 21. Innovation Director atOslo University Hospital: Kari J. Kvrner 22. Innovation at Oslo universitetssykehus in brief 2007 The Clinic of Innovation established atUllevaal University Hospital 2009 2012 KASK Innovation,EU-collaboration with Sweden and Denmark 2009 Co-development with Induct Software 7. juni 2010 launching our webportalwww.idepoliklinikken.no- available to EVERYONEPhoto: Kari J. Kvrner (Medinnova) andAndreas Moan (Director of Research UllevaalUniversity Hospital) establiched Idpoliklinikken17th of August 2007 23. InnovationCultureAction Plan2013-2014InnovationStrategy 2011Innovation Advisors inall Clinics/DepartmentsHospital Innovation AdvisoryBoardVirtual MeetingPlace (InductPlatform)Physically Meeting Placeat Clinic of InnovationIntervensjons-senteret/NorMitMunicipalityCollaboration CompetetionsE-learning 24. Innovation portfolio and managementIdpoliklinikken 25. Our strategic innovation toolsThe Clinic of Innovation is the coordinative platform for innovation inOslo University Hospital and is the contact hub for innovativecollaborations with industry and other health care instiitutionsCommercialinnovationIdpoliklinikkenNon-commercialinnovationInven2- from researchto businessIdpoliklinikken- Your idea is ofvalue! 26. How do we work? 27. Licence income of 10 mill NOK millioner til forskning.yearly /10 years to innovator.IdpoliklinikkenDiagnostic cardiac disease markerTest for hjertesykdom - envellykket lisens som girbetydelige midler tilbakeforskning.Pro-BNP er et peptid somproduseres i hjertet.Dr. Med. Christian Halldokumentertesammenhengen mellompeptidet og hjertesvikt ogutviklet en metode for mlepro-BNP mens han forsketved Ullevl Sykehus. ProfessorHall kontaktet Inven2(tidligere Medinnova) for fvurdert de kommersiellemulighetene.Etter en positiv evalueringble metoden patentert, ogMedinnova inngikk enlisensavtale med F.Hoffmann-La Roche Ltd pvegne av sykehuset ogprofessor Hall.Pro-BNP-testen er lansertglobalt og metodenanvendes i dag i mer enn120 land.Inntektene fra lisensavtalenhar resultert i mange titallsInven2 turning top science into business 28. IdpoliklinikkenEarly diagnosis of colon cancerTykk- og endetarmskreft(tarmkreft) er den nest mestvanlige og ddeligekreftsykdom i Europa. Ofte frpasienter frst diagnosen nrkreftcellene har spredd seg.Fjerning av forstadier og tidligoppdagelse av kreft vil bidratil at flere blir kurert.Professor Ragnhild A. Lotheog hennes forskningsgruppehar i flere r arbeidet for finne bedre mter for tidligdiagnostisering, og harsammen med Inven2patentert et panel avbiomarkrer velegnet for oppdage kreft i tidlig stadium.I februar 2012 ble detsignert lisensavtale mellomInven2 - OUS og OxfordGene Technology basert pbiomarkrer oppdaget avLothe og kolleger.Dette bioteknologiselskapetskal utvikle en blodbaserttest for tidligdeteksjon avtarmkreft.Inven2 turning top science into businessPhoto: Rolf I. Skotheim, Ragnhild Lothe and Arild NesbakkenAdding to clinical excellence andavailability of knew knowledge. 29. IdpoliklinikkenEpigenetic research tools 5-hMCProfesor Arne Klunglandforsker p mekanismer forgenreparasjon og regulering.En av de mest aktiveforskningsomrdene innenforgenregulering er epigenetiskregulering, deriblant gjennomkjemisk modifikasjon avgenene, som er kjent bidratil kreftutvikling ogdifferensiering.En nylig identifisering av denbiologiske rollen til denmodifiserte DNA-basen5-Hydroxymetylcytosin harutlst et stort behov forforskningsverkty for pvise modifikasjonen, ogskille den fra en annen nrtbeslektet form. Gruppen tilprofessor Klungland harfunnet opp 3 separatemetoder for deteksjon avdenne modifiserte basen,med ulike egenskaper oganvendelses-omrder.Den frste oppfinnelsen blelisensiert av Inven2 til ZymoResearch i juli 2012, og etprodukt var p markedetallerede i september 2012.De to andre oppfinnelseneer under aktivkommersialisering.Inven2 turning top science into businessA large portiofolio and market for research tools. 30. IdpoliklinikkenAcute illness in the elderly- in home careFlere skrpelig eldre borhjemme i egen bolig.Oppflging av hjemme-sykepleierog kt srbarhetfor forverrelse avhelsetilstand. Noen moppdage funksjonsvikten,noen m varsle og noen msette i gang tiltak.Utfordring: Stort tidspress og mangelfullkontinuitet ihjemmetjenestenMangelfull samhandlingmellom hjemmetjenester ogfastlegerMangelfull samhandlingmellom kommunen ogsykehuset.For sikre tidlig oppdagelseav funksjonssvikt, er det isamarbeide mellomhjemmetjeneste, fastlegerog sykehusleger utviklet ensjekkliste SAFE (SubakuttFunksjonssvikt Hos Eldre).Denne benyttes n avhjemmetjenesten, og demest srbarehjemmeboende eldre blirregelmessig og systematiskunderskt med tanke p omdet er skjedd endringer.Idpoliklinikken har lagetundervisningsvideo i bruk avsjekkliste og utfrerverdivurderinger.Idpoliklinikken din id gir verdi! 31. If the patient could decide- diagnosis and treatment of breast cancer 32. ChallengesRandom referrals Several diagnostic routes for patients consequences forwaiting times Often referrals with incomplete informationNon-standardized Diagosis and treatment of breast cancer at Oslo University Hospitalfollowed several routes Prolonged waiting times for pasients with clinical problem-relatedbreast diagnosis Newspapers reported waiting times of 12 weeks or moreSeveral locations Diagnosis and treatment both at Ullevaal and Radiumhospitalet Postponed plans for Breast Cancer CenterKilde: Rapport Optimalt pasientforlp for pasientermed klinisk problem bryst i OUS. Oppdragsgivere: Klinikkledere i KDI og KKT 33. Help from Service designersto provide New ServiceGoal: Reduce waiting times 75 % Reduce diagnostic insecurity &gt; 50 % To create an understanding of theconcept patient-centered care To create a model that can beimplemented and communicated inother hospitals 34. ApproachPatient focus:Patient interviews, not thesystem-approachThe total process as viewed byemployees, management andpatients. Employee interviews. 35. The stepwise project process 36. Summing up employee insightsNoise and interruption disturb our workingprocedures Time spilled Prolonged waiting timesWorking conditions less satisfactoryInterpretative delaysWork duplicates Follow-up of those who wait for answers Prolonged patient flow 37. Summing up patientinsights The waiting time feels awful when you are uninformed. The first meeting with Oslo University Hospital is characterized by non-personalinformation, lack of contact and precision between professionals andthe patient. The patient have confidence in the professional competence of the hospital,but feels responsible for the progression of her own patient care. Diagnostic transitions are the key bottlenecks. Once the cancer diagnosis is communicated, the patients report that follow-upand further communication is satisfactory and positive. 38. The solution One common referral center andimprove quality of referralinformation from GPs Radiologists prioritize referrals everyday according to a severity score The hospital takes responsibility for the patient from day 1 (informs GP) The hospital call the patients for appointment within 1-3 days All the investigative procedures take place within one day Agreement with private contractors in order to provide enoughradiological services (Aleris og Unilabs) Pasient coordinator follow-up through treatment Daily interdisciplinary meeting/video conference betweenRadiumhospitalet and Ullevaal 39. How to succeed while waiting for a nationalhospital referral system?Postadresse:Oslo University Hospital, UllevlHenvisningskontoret for bryst ogendokrinkirurgiPostboks 4956, Nydalen, 0424 OsloDirekte tlf nr 23 01 65 25Telefontid: kl 8:30-11:00 ogkl 12:00-14:00PrivatecontractorsFaks nummer tilhenvisningsmottaket:23 01 65 35 40. 90 % reduction in waiting time:12 weeks to 1 41. Implementation requires collaborative innovationThe challenge of implementationHow to spread and develop skills in innovationIdpoliklinikken 42. The challenge of implementationIdpoliklinikken 43. Evaluation of innovation projectsValuation focus 44. Innovations:what is the price tag of the problem andgenerated value?All innovations:Clear goalDefined measurements Pre- and post pilot estimates Motivate and engage innovatorteams*EmployeehealthvaluePatient healthvalue*mini-HTA InnovasjonSocietalhealth valueCost-effectivenesshospital/patient pathway*EntrepreneurialvalueOurvalue tags 45. Our value assessment routines focusing on patients &amp; employees,hospital &amp; community Problem clarification Objective specification Detailed process flowchart mapping, including information exchange,documents flow and patient pathway flow Selection of sub-item measurements Choice of methodological design (pre-post sampling, case-control etc) 46. IdpoliklinikkenAmbulant services decubitus treatmentINTRODUCTIONHvilken tjeneste behandlingved poliklinikk eller mobilsrbehandling er den bestefor pasient, ansatt, sykehus ogsamfunn?LSNINGSFORSLAG:Flytte spesialist-kompetansenfra sykehuset og ut tilpasientene. Det etableres etambulerende srteam somrykker ut ved henvisning tilsykehjem.NSKET RESULTAT:God informasjonsflyt mellomspesialistene og pleierne, ogbedre oppflging avpasientene.SAMARBEID:Oslo universitetssykehus ogsykehjemsetaten, OslokommuneVerdivurdering er utfrt avIdpoliklinikken:Stor pasientnytteGod kunnskapsoverfringRedusert antall kontrollerSamfunnsmessig gevinstP landsbasis ca 600 pasienterSamfunnsgevinst p ca 4,2 millkr pr rUtfordring:OUS fr netto-tap pr pasientmed dagens insentiver forpoliklinikkerIdpoliklinikken din id gir verdi!IdpoliklinikkenEURm 0.5 47. IdpoliklinikkenHomecare service nursesspecialized in wound care treatmentINNLEDNINGDet ble rekruttert4 sykepleiere fra bydelene.Disse fikk opplring isrstell fra Hudpoliklinikkenved OUS, og fikk deretteransvar forkunnskapsspredning til- ogoppflging av de andrepleierne i de respektivebydelene.Kontrollgruppe fra 6 andrebydeler.P basis av innsamlede data ipilotperioden er det beregneten konomisk gevinst forsamfunnet p ca 26000 kronerpr r pr srpasient ved innfringav ny praksis. P landsbasis vildette bety en konomisk gevinstp ca 60 millioner kr pr r.Pasientnytten er overbevisendeda antall ferdigbehandlede srer kt fra 7 i kontrollgruppen til20 i intervensjonsgruppen.Antall kontroller vedHudpoliklinikken gtt kraftig ned(58 %) og srene grodd raskerefor intervensjonsgruppen ennfor kontrollgruppen.Idpoliklinikken din id gir verdi!IdpoliklinikkenEUERURmm 88 48. IdpoliklinikkenTelemedicine - pressure ulcertreatment spinal cord injury patientsPilotprosjekt ledet avSunnaas sykehus i samarbeidmedkommunehelsetjenesten.Konsultasjonene besto avhjem...</p>