| 4. In which ways is the initiative creative and innovative?
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The project began in October 2010 with a survey of the current situation. We then proceeded by looking at how other county councils and organisations/businesses dealt with the registration and payment process. One of the county councils that we visited had implemented an invoicing system with successful results. In order to put a system in place within a reasonable timeframe, we chose to change from card payments to invoices. Because we were going to invoice all patient fees, we would also be able to keep track of our patients’ high-cost and free passes. As we had solved the issue of payments and high-cost and free pass management using a digital solution, we were also able to implement a self-service registration system. In order to prove that the system would work, we conducted a Proof of Concept (POC). This was then used as the basis for the final decision and further development. Once the decision for further development had been made, the project was divided into three parts: invoicing, free pass system and self-service. The development of the project began in September 2011 and the implementation of the invoicing system of all patient fees and the free pass system took place on 1 April 2012 throughout the entire County Council of Värmland. The self-service kiosks were put in place in November 2012.
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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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The initial project team consisted of co-workers from all units involved in the process: the finance department, customer service, IT, purchasing unit and the primary and institutional care units. Progress was reported with regular intervals to the project steering group, which consisted of County Council officials and politicians.
We had an ongoing dialogue with the pensioner and handicap organisations throughout the project. These meetings provided us with a lot of useful input.
One of the first tasks of the project was to investigate whether there were other county councils who had done something similar. We found a few county councils that had removed cash payments and implemented a free pass database. We went to visit them and made valuable connections. Relatively early on, we were able to establish that no county council had changed the entire process from initial appointment letter and registration to payment and management of high-cost passes.
We were up for a challenge!
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| 6. How was the strategy implemented and what resources were mobilized?
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The project has been financed by the County Council of Värmland. The initial budget was roughly SEK 3 million. This was to cover the development of the systems and hardware with the help of external suppliers. The final cost was more or less in line with the budget. However, the main investment was the time that the staff spent on the project. Participating staff included the IT department, the finance department, receptionists and a number of other units.
(68 words)
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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 now forget all about the hassle of physical high-cost passes, cash and long queues. Patients can register their appointment in a self-service kiosk, all appointments are invoiced on a monthly basis and we keep track of the patient’s high-cost pass. This means a more efficient registration process for the patient at the same time as the staff can focus more on providing good service.
Throughout the project, we have focused on the patient’s experience. We can conclude that the new system has had a very positive impact on the patients. In fact, the outcome has exceeded our expectations. Here are the biggest advantages from a patient perspective:
• The use of invoices has meant that more time can be spent on helping the patient with other queries
• The implementation of a free pass system and a system free of cash and payment cards have led to faster registration and therefore shorter queues
• All patients are treated equally from a payment point of view, which makes for a more just system
• Patients do not have to keep track of receipts to obtain a free pass
• The patient has access credit
From an organisational perspective, we have been able to cut a lot of costs and administration time. More time can now be spent on patient care and conducting a more detailed administration, such as writing chart notes to increase patient safety.
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| 8. What were the most successful outputs and why was the initiative effective?
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In order to achieve the targets set up for the project, the project leaders met regularly to synchronise the different parts of the project. In addition, the project reported back to a steering group on a regular basis. A time plan with tasks was used to organise the operative work of the project.
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| 9. What were the main obstacles encountered and how were they overcome?
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Process modelling – current situation
In order to establish the current situation, we used process modelling. To do this, we gathered people who had knowledge of the separate processes in one way or another. After a few days of workshops it was concluded that the process was very complicated, for example in terms of complex payment flows. We identified a lot of problems; however we also saw great possibilities to improve the current process.
Process modelling – future situation
Using a highly creative process with the project team, “no stone was left unturned” – nothing was sacred! For some, this was a somewhat overwhelming experience. The result was that invoicing would be the only payment method, a free pass system was to be implemented and self-service kiosks were to be used as an alternative registration option. This meant that we would diverge significantly from the project directive laid down by the steering group. We therefore had to swiftly revise the project directive. And we had to make a convincing case!
Proof of concept (POC)
In order to test/prove that the concept was viable, we conducted a so-called POC.
As the project progressed, more light was shed on the current system and the project team saw ways of improving the process and thus making the administration more efficient and cutting costs. The direction changed when the team realised that the project ought to carry out a bigger change in terms of payment methods than was originally planned.
The result of the POC showed that it would be possible to develop and implement the concept. Thus, a decision to implement the new systems would be well-founded.
Communication plan
We realised early on the value of identifying important parties for a successful implementation of the project: Both those who would be active in the project, as well as other parties such as user organisations (pensioner or handicap councils), politicians, senior civil servants of the County Council, union representatives and the media. We therefore outlined a communication plan at the start of the project with the purpose and aim. Further, we added the different tasks and assigned responsibilities.
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