Challenge Your Ways of Working for a Successful Implementation of Digital Solutions

It might be tempting to take shortcuts and implement digital solutions without reviewing organisational structures, ways of working or patient flows. But, if you want to see improved efficiency, and a less stressful working environment, you need to have the courage to change the way you work, says Petter Tourda, M.D. and manager at Cederkliniken Piteå at Swedish primary care provider Praktikertjänst. Cederkliniken, situated in the northern town of Piteå, has gone through several major changes over the past five years and managed to turn the business around, reducing stress and sick leave among employees. Here he tells us how.

Do you want to start by telling us about your practice and your responsibilities?

Four general practitioners started the health centre Cederkliniken in Piteå in 2010. At that time, we were 13 employees. I started as an Resident doctor, and back then, four other business managers ran the health centre.­

It is tough to start a health centre. Patients who are dissatisfied with their care elsewhere tend to apply to the newly opened health centre. The care choice system’s financial logic is that the 90 percent who are healthy pay for te care of the 10 percent who are most ill. In the beginning, we mainly had patients with more significant care needs listed with us, so then the financials didn’t add up. This led to high stress and sick leave among our employees, and we had difficulty making the business work.

I joined as Deputy Operations Manager in 2015. When we received extra funding from the Norrbotten region, several employees and I attended a 1.5-year change management course in health care. Then we started three parallel change projects, we revised our processes around sick leave, launched an entirely new way of caring for patients with mental illness, and created a digital drop-in clinic.

It was a challenging journey, and our employees have subsequently expressed that even if change is good, it may not be optimal to run three major change projects at once! At the time, there were no alternatives for us. We would not have survived today as a business if we had not implemented these rather radical changes. The changes paid off. In a short time, we managed to reduce sick leave among our personal staff by half and doubled therapists’ availability. The drop-in reception quickly led to a reduction in phone calls and is still much appreciated by both our patients and staff.

In 2019 the clinic was moved to a premise twice as large, and we got some time to reflect on what to do next. Digitalisation became a natural next step to improve the health centre.

Since our staff had previous experience of changing their ways of working, the digitalisation initiative was met with enthusiasm from almost all of our staff.

What would you say are your short- and long-term challenges? 

The current challenge is to get the budget to add up. Covid-19 has meant that we have lost 30-40 percent of our visitor revenue and have therefore been forced to lay off several employees. Thankfully, due to the efficient digital tools we now have, we can still manage to maintain capacity, although we have reduced our staff. However, it is a problem for us that we only get paid for synchronous meetings, i.e. video. We currently do not receive compensation for chat consultations, even though we deliver the exact same type of care through them.

How do you work to guide patients to the digital platform, and what reactions have you received from staff and patients?

All callers who have a bank ID are referred to the digital platform. For patients who don’t have bankID, for exampleelderly patients , there is, of course, also the possibility of calling the clinic. Overall, the reactions have been positive because patients receive help much faster and more efficiently. Our staff are also very positive. The physiotherapists for example, no longer need to have any telephone contact, instead patients book the appointments themselves.

How has digitalisation affected your way of working?

We have changed our way of working in three different ways. First, the nurse can get advice directly from the doctor via the chat and not have to wait for the clinical round. This enables a much more efficient way of working, and, above all, the patient does not have to wait.

The second is digital. I start the morning with digital consultations, and if I have a patient who needs a physical examination I book them directly via chat. Sometimes the patient has to leave samples first. Before the physical examination, I have already sent them information and advice about the presumptive diagnosis so that the patient, in turn, has the opportunity to prepare their questions. I usually send out information about the probable diagnosis via the system before the consultation – the patient often has very few questions about his illness once we meet.

Then we return to the digital chat to give feedback on test results or treatment follow-up. The fact that we have ongoing contact for perhaps two weeks means that the patient’s experience better care, even though the time I as a doctor need to spend on the patient matter is less than before. The patient is also better informed about their disease, which I believe makes the patient calmer.

Finally, I feel that we, as doctors, get a better review and control. Instead of a patient being booked in with three different doctors depending on where there is an opening, we can distribute the case to the doctor who previously had contact with the patient directly in the system. It creates continuity of care and a sense of security for patients. Another advantage is for managing those patients who contact us because they have substance abuse problems and are looking for drugs. It is much easier for me as a doctor to say no in the chat than for the nurse to discuss it on the phone.

What do you think is important when you, as a care provider, start working digitally?

That you are willing to dare to make this disruptive change and go “all in”. If you only replace the phone with video, you will not see any significant changes. One must dare to make this radical change, which also means changing working methods to see any real results.