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The Linnea Project Improvements achieved in the
care process between different care givers for
elderly citizens with multiple health problems
The 8th Annual Integrated Care Conference 2008
03 07
Per-Henrik Nilsson, Consultant Physician, MSc
Pedagogics, Head of Department of Internal
Medicine, Central Hospital, Kronoberg County
Council. Eva Wikström, Licentiates Degree in
Sociology, RNT, Research Supervisor in elderly
issues, R D Centre of southern Smaland.
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County of Kronoberg
Växjö
Ljungby
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Basic Facts about Kronoberg

• No of inhabitants 178 000
• Area 9 500 km2
• Municipalities
• Alvesta, Lessebo, Ljungby, Markaryd, Tingsryd,
  Uppvidinge, Växjö, Älmhult
• Industry
• Mostly small businesses - more than 75 of all
  businesses have less than
• 25 employees. Some very large international
  companies IKEA,
• Electrolux-Wascator, Alstom, SÖDRA, Volvo,
  Dynapac etc
• Communications
• E4 passes through
• Småland airport
• Railway links in all directions

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The County Council - throughout the county
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Areas of Responsibilities State - legislation
and financial policy County Councils - health
care, dental care, health care education and
training, support to handicapped people,
subsidies to regional development and to regional
culture Municipalities - education, social
services, urban planning and energy supply,
streets, parks, environmental management etc
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Members of the Steering Committee

• Laila Berg, RNT, Emergency Geriatric Care
  Department, Växjö
• Catrin Carlsson, Education Leader, Växjö
• Inger Henningsson, Care Developer, Primary Care
  County of Kronoberg
• Anne-Sofie Johansson, Care Developer, Primary
  Care County of Kronoberg
• Roma Lundh, Community Chief Nurse, Ljungby
• Per- Henrik Nilsson, MD, Dept of Internal
  Medicine, Central Hospital Växjö, Sweden
• Gunilla Olofsson-Hoff, Community Chief Nurse,
  Tingsryd
• Karin Svensson, Community Chief Nurse, Lessebo
• Hans Thulésius, MD Vc Strandbjörket/RD Centre of
  southern Småland.
• Eva Wikström, Licentiates Degree in Sociology,
  RNT, Research Supervisor in elderly issues, R D
  Centre of southern Småland.

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Who is Linnea?
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Why a Linnea Project?

• To create an active network of care for
  Linnea and to help Linnea to a safer and higher
  quality of life!

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RD - report 20044 Community Care in the
County of Kronoberg 2004.
Percentage of patients in community care that die
in hospital.
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Method

• Interviews with Linneas or case reports about
  Linnea.
• Groups consisting of representatives from the
  different care givers and medical professions
  from Linneas network of care.
• IHIs breakthrough series
• 3-4 learning sessions and work between the
  sessions.
• PDSA-cycle (Plan-Do- Study-Act)
• Homepage (www.ltkronoberg.se/linnea)

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Model for Improvement.
Goal!
What are we trying to accomplish?
Measurement!
How will we know that a change is an improvement?
Ideas?
What changes can we make that will result in
improvement?
Test!
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• Professional Knowledge
• Medical Science
• Personal Skills
• Ethics

• Improvement Skills
• System
• Variation
• Psychology of Change
• Innovation through Learning

Improvement in processes and systems in health
care.
Diagnostic and treatment improvements.

Maximum value for Linnea!
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Interviews with 92 Linneas
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Sense of fatigue (20)
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Eating Situation

• One out of three Linneas (2007) is
  dissatisfied with her eating situation. Most of
  the Linneas tell us about
• Bad appetetite
• Loneliness
• One out of three Linneas cannot prepare her
  own dinner. Help is provided through
  
• Food distribution
• Eating at a day-care centre

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68 of the Linneas have fallen during the last
year.
Falls during the last year (2007)
25 of 32 say that the fall led to injury
about 50 resulted in fractures. about 50
resulted in wounds and hemotomas. a
fear of new falls Moreover the falls led to a
need of more help a new environment in a
home for elderly people.
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To be heard
About one out of three Linneas says that nobody
talked to her about how it would be when she got
home after hospital care.
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Internal Factors
To meet Linnea as she perceives her health
situation
To organize for Linneas influence and
self-determination
Relation
Structure
To meet Linnea as she perceives her everyday life
To organize the environment around Linnea
Outside Factors
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The results from the Linnea Projects.

• Two Linnea projects with, in total, 100
  participants and 19 teams.

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Improvement Fields

• Care plans in connection with discharge from
  hospital.
• Nutrition
• Fall prevention
• Safe medical treatment routines
• Outdoor walks
• Discharge from hospital earlier in the day.
• Palliative care

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Results

• Myths were killed.
• Improved knowledge about Linneas network of
  care.
• Better understanding of the different fields of
  work in this network.
• New interfaces and contacts.
• Everybody was taught an improvement method.

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Results

• Linnea, in everyone's mind and on all lips in
  Kronoberg.
• Increased knowledge and understanding about
  Linnea among officials and politicians in the
  county and communities.
• Homepage and network about Linnea.
• RD Report 20075

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The real voyage of discovery consists not in
seeking new lands but in seeing with new eyes.
Marcel Proust