Case study 1: Jönköping County Council

Jönköping County Council, in Sweden, is an elected regional health authority that serves around 330,000 people. It is widely recognised for providing high-quality care. Over 20 years or so, it has pursued a population-based vision of ‘a good life in an attractive county’. This includes achieving strong financial performance and a commitment to continuous quality improvement in the delivery of health and social care.

It aims to deliver the best possible care outcomes for ‘Esther’, a fictional older resident. Creating her character enabled clinical staff to map a range of care pathways and explore how those could be improved to best meet Esther’s needs.

Working with international partners

County councils in Sweden have considerable autonomy by virtue of the devolved system of government in that country and their tax-raising powers. Jönköping’s work on quality improvement initially benefited from its involvement with the US-based Institute for Healthcare Improvement (IHI) in the Pursuing Perfection programme. Through this programme, leaders adopted a methodology for quality improvement and applied this to services in the county’s three hospitals and 34 primary care centres. The relationship with IHI was initially formed through contact from the top leadership team and was progressively extended to staff throughout the organisation.

Setting up an in-house training centre

Building on this experience, Jönköping established its own in-house centre for learning and improvement known as Qulturum. This centre delivers education, training and learning in quality improvement to the county council’s staff, drawing on links with international experts such as Don Berwick and Paul Batalden. Thousands of staff have taken part in the programmes run at Qulturum as an expression of the council’s commitment not only to quality improvement but also to becoming a learning organisation. The results of this work over many years are evident, as Jönköping compares favourably with other county councils on measures of quality of care in national rankings.

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