| 4. In which ways is the initiative creative and innovative?
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We started a project in 1992 with seven instructors who were educated in moving and handling knowledge. The objective at that time was to reduce sick days related to accidents/diseases during patient transfer. The project was completed in 1994, and at that time a majority of the employees have had an education for five days in handling and moving knowledge.
After that the method has been developed continuously during the years, an in the middle of the millennium (2005 – 2006) we recognized that this way to handle and moving patient also support the patient safety. It showed up as a successful way to decrease the pressure ulcer!
From 2008 the overriding goals, expressed in the operational plan, were:
• No pressure ulcer occurs during the stay of any service user and
• No harm for our employees due to patient work
To achieve the desired goals various efforts have been made, examples:
• Continuous ‘moving and handling’ knowledge education for all staff including
prevention of pressure ulcers. We learn how to link knowledge about the patients unique need, ways and means, to moving and handling techniques.
• Training in the use of different types of mattresses and testing of the same.
• Introduction of pressure relieving foam mattresses throughout the organization.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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As we say above we first started this project as a working environment project. At that time the employees were the primary stakeholders, but of course also the hospital manager and the politician as we hoped to save money and suffering doing this.
Now a day our patients are the most important stakeholders!
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| 6. How was the strategy implemented and what resources were mobilized?
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By way of introduction we got about EUR 225 000 from a fund called Working Environment Fund. This money provide capital for the instructors education and also for the deputies during the initial education of our employees.
After that Karlskoga Hospital has been financing the costs, both for education and moving aids. Now a day we seldom have any deputies, as we organize the education so the ward can manage to let the employee come without any deputies. But still we are investing in moving aids and mattresses on the basis of need.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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We can show that at safe environment for our employees also leads to a safe patient care, which save money and suffering.
The incidence of pressure ulcer has been reduced from 9% in 2008 to about 1% in 2014. This value is to compare with the mean value in Sweden in 2014 at 15% of which about 7% started during the hospital visit, the other half started before the patient came to the hospital.
In Sweden we can save about EUR 165 million a year if all the hospitals have the same frequency as Karlskoga Hospital.
Numbers of sick days have been reduced from about 400 days/year in the period of 1990-1999 to about 10 days/year in the period of 2000 – 2010 and about 3.5 days/year for the last 4 years.
We have only had 14 sick days in total related to accidents/diseases during patient transfer for the period 2010 – 2013. The cost reduction for this increasing of sick days is about EUR 83 000/year for Karlskoga Hospital for the last 14 years.
Other successful outputs are increased participation, both from our patients and our employees which had result in more satisfied patients and employees. Our overall quality objective is to be a well working hospital. About 92% of our patients agree to this.
About 95% of the employees say that they can recommend a friend to work at Karlskoga Hospital.
About 92% of our patients agree to this and 98% of our patients say they can recommend Karlskoga Hospital.
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| 8. What were the most successful outputs and why was the initiative effective?
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Continual improvement is one of our keystones to be a well working hospital. We always want
to improve our processes based on objective measurement.
Here you can see some of our procedurers:
the authority and responsibility is defined for the processes and for each employee
risk analysis and safety analysis is a part of our task
measurable objectives
follow up and analyze results (all results are in our intranet)
Compare with other hospitals result from national register and open comparing systems
In this development project the measurable objectives are no pressure ulcer during the hospital visit and no sick days for our employees due to patient work.
The first objective is measured two times a year as a PPM and the second objective is measured continuous and presented once a year.
The overridden objectives concerning patient satisfaction and employee satisfaction are measured in a period of two years and as a complement we have focus groups interviews every year.
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| 9. What were the main obstacles encountered and how were they overcome?
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The main obstacles were that the education took too long time, that it was hard to get deputies and that the moving aids and deputies cost a lot of money.
To overcome that opposition we involved all our managers early during the project, and we choose the instructors from the wards and the employees who show most interest. Still, we offer the employee who shows a genuine interest the commission to be an instructor.
The first years it was hard to see the result in economic terms, but early we thought that this was a successful way to work to decrease the harm for our employees.
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