Landspitali University Hospital: role and future vision a physicians perspective

1
Landspitali University Hospital role and future
vision a physicians perspective

• Sigurður Ólafsson MD
• Division of Gastroenterology and Hepatology,
  Landspitali University Hospital
• Secretary, Medical Staff Council

2
Landspitali University Hospital role and future
visionOverview

• Role within the health care system
• Progress in recent years
• Specific issues and obstacles
• Future vision
• Urgent tasks

3
Landspitali University Hospital

• Established by a merger of two major teaching
  hospitals in Reykjavik in 2000
• The nations first University Hospital
• Merger hotly debated
• Clear potential for advancement
• Stronger clinical services
• Enhancing teaching and research
• More cooperation with the University of Iceland
• Potential for economical gain

4
Role of Landspitali University Hospital (LUH)

• Tertiary referral center for the entire country
• Some medical specialties only located at LUH
• A community hospital for Reykjavik and
  surrounding areas
• Relatively limited ambulatory care services
• mainly provided by primary care physicians and
  specialists in private practice
• Major teaching hospital for the University of
  Iceland
• Growing role in biomedical research

5
What are the characteristics of a university
hospital?

• Provides clinical services of highest quality
• Seeks excellence in education and research
• Recruits the best physicians and other health
  professionals
• Competition for positions
• Ambition and pride among staff

6
Landspitali University Hospital progress in
recent years

• Reorganization of hospital administration and
  clinical services
• Medical specialties
• Role and position within the hospital system
  better defined
• Greater emphasis on leadership role of specialty
  chiefs
• Larger units allow further subspecialization

7
Landspitali University Hospital progress in
recent years

• Medical education
• Clinical clerkship of medical students reformed
• Postgraduate training program reorganized
• Development of a formal training program in
  Internal Medicine
• Potential for training programs in other
  specialties
• Stronger collaboration with the University of
  Iceland
• Contract between LUH and the University
• Medical research
• Contracts with private research institutions
• Science policy intruduced

8
Landspitali University Hospital Specific issues
and obstacles

• Hospital policy and mission
• Defining range of services
• Geographical location
• Medical specialties
• Quality of care
• Morale and ambition
• Funding

9
Does the hospital have a clear policy and mission?

• The exact role of the hospital within the health
  care system remains unclear
• Which services to provide and which not
• Implications for funding
• The hospital should construct and propose its
  own policy and present to health authorities
• Combined effort of leaders of medical specialties
  and hospital administration important
• Such a policy should recognize the key role of
  clinical services in the hospital activities

10
Spectrum of services

• What range and amount of ambulatory services
  should the
• hospital provide ?
• Wide range of services already provided by
  private physicians and clinics
• The Icelandic Medical Association has emphasized
  the development of ambulatory services outside
  the hospital
• Medical specialties should be involved in
  defining range of services
• Ambulatory services should be sufficient to
• Provide comprehensive care to patient with
  complex medical problems
• Support educational activities

11
Medical specialties

• Patients go to acute care hospitals to seek
  services from physicians
• Therefore, medical services are a key function of
  such institutions
• Medical specialties need strong organization and
  leadership
• Organization of services incomplete
• Facilities still substandard
• Specialty offices lacking
• Space for variuous clinical activities inadequate
• Poor secretarial services

12
Geographical location

• Two separate campuses for acute care facilities
• Specialties distributed between the two campuses
• Two major emergency wards
• Disadavantages of the current arrangement
• Impairs quality of care
• Impairs comprehensive approach to patient
  problems
• Negatively affects the quality of medical
  consultations

13
Quality of care

• Iceland has one of the best health care systems
  in the world
• Based on health statistics
• Conclusions cannot be made regarding quality of
  care at LUH
• Quality of care at LUH
• Department of Quality Management recently
  established
• Lack of data in many areas
• Some indicators of substandard quality
• Waiting lists
• Continuing medical education of physicians poorly
  organized
• Recent survey indicates that majority of staff
  physicians consider quality of care substandard

14
Morale and ambitions

• Important feature of a university hospital
• May affect quality of care
• Evidence for poor morale among physicians at LUH
• Supported by a recent survey
• Dissatisfaction with management of the hospital
• Many consider leaving or reducing work LUH

15
Funding

• Budget deficit problems
• Insufficient funding for fundamental clinical
  services
• Minimal funds allocated for research and
  education
• Funding method Global budget
• Health care expenditures in Iceland among the
  highest in the Western world
• Are funds appropriately allocated within the
  health system ?
• Are funds appropriately allocated and efficiently
  utilized within LUH ?

16
Future vision for Landspitali University Hospital

• A hospital which is comparable to respected
  university hospitals in the Western world
• Excellence in clinical services, research and
  teaching
• Continue to serve as a tertiary referral center
  for the country as well as a community hospital
  for Reykjavik
• Provide full range of high quality medical care

17
Urgent tasks

• Single location for acute care services
• Define the role and mission of the hospital
  within the health care system
• Organize further and strengthen medical
  specialties
• Establish a system to monitor and enhance quality
  of care
• Change the funding system of the hospital to a
  activity related budget