The digital healthcare transformation journey in Region Gävleborg, Sweden

The healthcare transformation in Region Gävleborg in Sweden is sometimes described as radical, what is the background?

The region was in an incredibly tough situation, it was in the top three in Sweden in short term staffing consultant and the care availability was poor. We also have a very high proportion of elderly people and a large reduction in the working population over the next 20 years. In this situation, the local government took the rather radical decision to implement a digital transformation of the entire healthcare system, with the region offering a digital route into the entire healthcare system. When we received the mandate from the politicians, we realized that the system had to be rebuilt so that healthcare could be sufficient for more people and more accessible. We came to the conclusion that we need a system that can guide patients with the greatest needs to the right recipient in an automated way. And not to the lowest level according to LEON, but to the best effective level of care.

In other words, automated triage does not just direct patients to medical hotline or to primary care, but directly to the place where they can best be helped. For example, a diabetes patient might go directly to a diabetes nurse. We want to try to steer clear of what in many cases become intermediaries in healthcare and which do not create any value for patients. We also need to be able to set urgency levels that match how we prioritize in physical care, it should not be a fast lane for those who apply digitally.

One of the features of the platform, in addition to triage and the ability to seek care digitally, is an asynchronous chat between healthcare professionals and patients. What does this feature mean for you in Region Gävleborg?

– The possibility of an asynchronous chat is a way to offer a more accessible and efficient service for both patients and healthcare providers. An asynchronous chat is a permanently open channel between patient and healthcare professional to deal with non-urgent issues. The chat is set up on the initiative of healthcare professionals for the patients they know well. It allows for continuous and accessible communication, which is particularly valuable for patients with chronic conditions and for those who need continuity of care. After all, the vast majority of contacts a patient has with the healthcare system are for non-urgent matters, where continuity of care is crucial.

How does it work in practice?

– We have said that those who want to try it can offer a chat to their patients they know well and often have a dialog with. Many have discovered that they can handle a lot in the open chat on an ongoing basis and that a lot of standardized return visits can be avoided. Patients with chronic diseases are often called for annual checks, but with this chat where you can easily follow up and perhaps monitor different values, the annual checks are not needed in the same way. It means more time for a physical visit when the patients need it instead, regardless of whether it is time for an annual check-up or not. I truly believe that this relieves the burden on the healthcare system while giving the patient greater security and good continuity. And this doesn’t just apply to the relatively young, often elderly people with multiple illnesses can benefit just as much from an always-available chat with the healthcare professionals who know them best.  

All midwives in Region Gävleborg have decided to switch entirely to offering a nine-month asynchronous chat to pregnant women who come in for a check-in appointment. Through the chat, the midwives can easily deal with many of the questions that often arise during a pregnancy. 

It works really well! The midwives say that the phones have stopped ringing all the time, which has created a calmer working day. At the same time, we see units that have barely opened a single chat, probably because of the challenges of changing ways of working and how different cultures we can have in our workplaces.

What impact has chat had on the working environment of clinicians?

– In cases where the change has been successful, healthcare professionals are able to deal with patent issues more efficiently and avoid unnecessary visits, which has led to an improved working environment and less stress. Being able to handle questions via chat instead of having constant phone calls reduces stress.

But we also see that the units that have not yet succeeded in their transition only experience “one more inbox” to keep track of because they do not notice any reduced inflow in, for example, telephone, which risks leading to more stress. Our focus now is to get the units where change is going slowly to dare to change and be able to recoup the benefits we see.

What do patients say?

– Those who have tried it are usually satisfied. The chat is an easy way to have a dialog and creates security. In fact, many patients who come from maternity care center to children’s care center when the baby is born wonder if they can continue chatting with children’s care center as well. It’s great that we have a patient-driven expectation of how contact with healthcare should be!

The Swedish newspaper Dagens Medicin recently described that Region Gävleborg is at the forefront of the digital transition, why has the development in Region Gävleborg come so far?

– I believe that the political sponsorship and focus from the administration have been crucial. In Region Gävleborg, the transition is not a side project handled by an IT administration; it is the health care management that owns this and in all steering groups there are four to six operations managers and chief physicians. I think the fact that we are driving digitalization in the regular management system and not as a side project has been the key to speeding up the transition.

How do you work with follow-up and measurement?

– That’s a difficult nut to crack. We’re so used to counting visits produced and measuring availability in terms of number of visits. But if we look at the most confident patient, for example, who has an accessible chat when needed and is happy with it, then not nearly as many visits are created for that patient. The solution thus creates security and continuity but no traditional production and thus we do not create any accessibility, according to the current way of measuring. Here we need to find better measurement methods. 

– The same applies to measuring how person-centered the care is, then we usually ask if the patient was satisfied with the visit. Perhaps what we should be asking instead is whether the patient is safe and whether they feel they have access to care when they need it. It is not the number of visits that creates value for the patient, but rather a perceived safety, accessibility and independence. We also do not have a good method in healthcare to evaluate self-monitoring solutions. These solutions create greater patient autonomy and better adherence, but they don’t create as many visits, which is the idea. We need to find a better way to measure and evaluate this.

Finally, what are the main challenges and opportunities of the digital transformation Region Gävleborg is undertaking?

– The biggest challenge has been to change the mindset from focusing on the number of visits produced to really looking at the needs of each patient and what creates real value for each unique patient. There is also the challenge of getting everyone in healthcare to feel comfortable with the new digital tools. And the opportunities are enormous. We can provide better and more accessible care, increase patients’ autonomy and quality of life, while making care more efficient and sustainable.