1. What benefits did St Bridget’s get from adopting first a continuous improvement and then a lean approach???? When Denize Ahlgren arrived at St Bridget’s, one of the main hospitals in the Götenborg area, she knew that it had gained a reputation for fresh thinking on how healthcare could be organised to give better public care at lower cost to the taxpayer. In fact, that was one of the reasons she had taken the job of its Chief of Administration (COA). In particular, Denize had read about St Bridget’s ‘Quality Care’

(QC) initiative. ‘Yes, QC is obviously important’, explained Dr Pär Solberg who, in addition to his clinical duties, also headed the QC initiative, ‘but don’t think that it is only about “quality”. We don’t just throw money at improving the quality of care; we also want to improve efficiency.

Any money saved by improving efficiency can then be invested in improving clinical outcomes.’

‘It all started with quality’

Although run by a private company, St Bridget’s is little different from any other Swedish hospital. To its patients, treatment is free following payment of a minimal charge that is universal in Sweden. St Bridget’s gets virtually all of its revenue from the government. However, in terms of how it organises itself, it is at the forefront of implementing ideas that are more common in private business. ‘It all started with our efforts a few years ago to be systematic in how we measured quality’, said Pär Solberg. ‘We felt that quality must be reported on a systematic and logical basis if it is going to be meaningful. It should also be multifaceted, and not just focus on one aspect of quality. We measure three aspects, “reported patient experience” (RPE), what the patient thinks about the total experience of receiving treatment, “reported patient outcome” (RPO), how the patient views the effectiveness of the treatment received, and most importantly “reported clinical outcome” (RCO), how the clinicians view the effectiveness of the treatment.

Of course, these three measures are interconnected. So, RPO eventually depends on the medical outcome (RCO)

and how much discomfort and pain the treatment triggers.

But it is also influenced by the patient’s experience (RPE), for example, how well we keep the patient informed, how empathetic our staff are, and so on.’