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User involvement at Bornholm’s Hospital

On March 30 we held a CHI Morning where two experts and a user shared their knowledge and experiences regarding the involvement of staff, users, patients and relatives in the development of Bornholms Hospital. If you missed the morning meeting, you can learn about their experiences and reflections in this summary:

Our visitors at this CHI Morning session were:

  • Charlotte Westh, program manager at Development Hospital Bornholm
  • Azadeh Grønbæk Afsar, special consultant at the Capital Region’s Unit for Evaluation and User Involvement
  • A patient from Bornholm’s Hospital who wishes to remain anonymous.

See the slides from their presentation here (in Danish).

Bornholm as a Testing Environment

In 2016, Bornholm’s Hospital was set free – free of rate management where it is e.g. the number of completed operations that determine the hospital’s financial latitude. As part of a two-year trial, Bornholm is now a Development Hospital and is free to test new methods and procedures focused on doing the things that create the highest value for patients.

Here, the size of Bornholm is an advantage. With a hospital, a municipality and 29 practicing physicians, the island is small, but representative, and offers good opportunities for testing of new methods to strengthen the cross-sectional collaboration.

In addition, Bornholm is rather typical in relation to the major health challenges which all regions and municipalities are struggling with: More Danes contract chronic diseases, but at the same time they live longer so they are increasingly expensive for the healthcare sector, and in this respect, Bornholm occupies an unwelcome spot at the forefront, says Charlotte Westh, who presented the overall introduction of the Development Hospital and the projects.

Start Small

Development Hospital Bornholm has embarked on eight sub-projects which in various contexts aim at increasing the value for patients. The approach is that the ideas are scaled and first tested on e.g. one patient, prior to being adjusted and scaled up to include more patients. The efforts are focussed on the areas which witness the highest expenses, i.e. especially the elderly and the chronically ill.

User Involvement from Day One

The entire user involvement process is designed with assistance by Azadeh Afsar Grønbæk from the Unit for Evaluation and User Involvement for the Capital Region. The first ideas for the sub-projects came after an initial kick-off last year where relevant players, citizens, employees and policymakers attended. In addition, theme days and a simple mailbox in the staff canteen have helped to uncover ideas and needs during the start-up.

All Input Must be Included

Besides, all projects have ongoing user involvement. As an example, patients are included as active project participants and can thus provide input to the projects. “As a patient, I am overall pleased with the involvement that is going on. It makes us feel heard as users, and we have been able to contribute with ideas and input. But I have had to get used to the rather slow pace. I would like to see faster decisions in order that we can proceed with the many ideas”, says the patient representative with a smile to Charlotte and Azadeh.

The user involvement also takes place through workshops, feedback meetings, public meetings, interviews and user surveys and evaluations, so there is plenty of data.

“We receive a lot of input. It also means that we enjoy great agility in the process. As soon as something comes up, we can dive into it and see what other data shows or supplement with other methods that can uncover it. The challenge is how to get it properly transformed”, says Azadeh Grønbæk Afsar.

She has strong focus on supporting the project managers in their work so that they collect input that is relevant and valuable for the projects – and ensure that the user feedback is applied in the further work.

User Involvement Adds Value

There is no doubt that it is challenging for both users and staff to engage and be involved. As an example, users may suddenly have to consider issues where they do not usually have any influence, and for the staff it may be a challenge that the patients are suddenly invited inside – all the way into the engine room.

Although it is challenging to involve the users, it is the experience of Azadeh that the hospital has already come a long way. “There are users in all project groups and that adds value.” As an example, the involvement has revealed a number of simple improvements that might easily be implemented. Also, they receive input which is helpful when considering solutions that need to be worked on. In addition, involvement contributes to a change in the perception of patients. This creates another form of motivation, but also skepticism among the employees because it is impossible to predict which value it will add when you start changing the ways in which things are usually done.

Sharing of Experiences

All the experiences which Development Hospital Bornholm accumulates now and over the next year will not only benefit Bornholm. The experiences will be collected and presented to the other hospitals in the Capital Region. “Other hospitals have already shown an interest. We will be happy to share our experiences and evaluations and thus ensure that the good solutions also get a life elsewhere”, says Charlotte Westh.

Den Europæiske Socialfond