This is part of an ongoing series of audio profiles of front-line improvers.
Director, Quality Improvement Department
Federation of Swedish County Councils
My name is Marianne Olsson. I am from Sweden. I work there as the director of the quality improvement department at something called the Federation of Swedish County Councils.
The Federation is a membership organization for all the organizations delivering health care in Sweden. County Councils account for about 80 percent of all health care delivered in Sweden and local authorities for 19 percent. There is only one percent of all health care delivered that is financed privately.
At the same time that I’m proud of the Swedish system compared to other systems, I of course see all the things that need to be improved inside our system. One big area we are working on at the moment is improving care for people who have dementia. So we’re working both with nursing homes, with home health care, and with specialty care given at very advanced clinics. Amazing things are going on there.
If you had asked me five years ago what I would have done if I had been diagnosed with dementia, I would have been very clear on my plan to kill myself as quickly as possible. I’ve worked with dementia earlier on in life; it’s a very terrible disease to live with, both for the person who has it and for the family. And now I see people living until the final stages of dementia with good quality of life. And one of the frankly terrible things about it is that we have found out through research and through quality improvement, that some of the things that we thought were part of the dementia path, actually are side effects of wrong medication, of using medicines that have only been tested on people with other kinds of diseases, and that’s causing some of the confusion that we thought was a part of dementia. So enormous improvement of quality of life of people living in nursing homes, enormous improvement in the way we meet people with dementia when they are diagnosed — meet them and their family and help them prepare. To see to it that there is one person, or one phone number you can always phone. Even if it’s not them that helps you, they can find out who’s going to help you.
Working with nursing homes, I think there is so much improvement to be done there. You know, Sweden has a unique position because we are ahead of the rest of the world on the demographic curve. Partly because we weren’t part of the Second World War, so we started to have the aging population before the rest of the world. So we have some experiences that I think could be useful for other countries that are entering into that stage. And one of the things that we have worked on, and where we start to see results, is upgrading old people. This has led to or is leading to — I wouldn’t say that we are there yet — that even what we used to call long-term care is being upgraded. And lots of assistance has been moved from institutions, into the “you have the right to remain at home and have the services delivered to you at home.” This is a difficult transition because there are still people who think this has to do with cut-backs, or it’s cheaper for the state to keep people at home and not have enough nursing homes. But that’s not what it’s about.
Quality improvement was the answer to a problem; it wasn’t something in itself. I started working with “how can we do better, how can we deliver,” and that led me to the tools that quality improvement offers. Everybody has access to health care, everybody’s insured. But the things people have been talking about are queues and waiting times, and the way people are treated as persons. That’s been an issue for a long time. I was talking to a colleague who led a quality improvement project in intensive heart care, and she said to me, “I can’t talk about this at home because everybody in my family and my friends, they are perfectly assured that the quality of care is 100 percent. So if I tell them we were at 40 percent, they’d be so shocked. I can’t really talk about this.” So it is a problem. They are assured that the doctors know exactly what they’re doing. I don’t think people are aware of the lack of quality and the errors committed in health care.
We have a system that is perfectly designed to do quality improvement, but we haven’t used it for that to the full extent. But once we get around to doing it, I think we could achieve something extraordinary in a fairly short time. So I think we’re nearing that tipping point. And I hope, I would like Sweden to be the first country to really transform all of health care. I think we have a window of opportunity here that I would very much like us to use. When we teach Breakthrough Series, we put very much of an emphasis on teaching the methods so that people own the methods once they have been through a Collaborative. They can change whatever they feel that they need to change. And we put I think perhaps more effort on that side. We don’t spread ready ideas; we spread a method for continuous improvement. So the system would be a system that is at all times able to identify what doesn’t work and fix it.
*Marianne Olson is now the Director of Quality Improvement at Sahlgrenska University Hospital at the University of Gothenburg in Sweden (http://www.sahlgrenska.se/). The Federation of Swedish County Councils has merged with another organization to form the new Sveriges Kommuner och Landsting or The Swedish Municipalities and Counties. For more information: see http://www.skl.se/.