Innovation

1. «If the patient could decide»
- diagnosis and treatment of breast cancer
Oslo University Hospital
Innovation director Kari J. Kværner
Financed by the Norwegian Design Council (DIP-midler)
the Norwegian Research Council

2. Challenges
«Random» referrals
• Several diagnostic «routes» for patients  consequences for
waiting times
• Often referrals with incomplete information
Non-standardized
• Diagosis and treatment of breast cancer at Oslo University Hospital
followed several routes
• Prolonged waiting times for pasients with «clinical problem-related
breast diagnosis»
• Newspapers reported waiting times of 12 weeks or more
Several locations
• Diagnosis and treatment both at Ullevaal and Radiumhospitalet
• Postponed plans for Breast Cancer Center
Kilde: Rapport «Optimalt pasientforløp for pasienter
med klinisk problem bryst i OUS.» Oppdragsgivere: Klinikkledere i KDI og KKT

3. Help from Service designers to
provide «New Service»
Goal:
• Reduce waiting times 75 %
• Reduce diagnostic insecurity > 50 %
• To create an understanding of the
concept « patient-centered care »
• To create a model that can be
implemented and communicated in
other hospitals

4. Approach
Patient focus:
Patient interviews, not the
«system-approach»
The total process as viewed by
employees, management and
patients. Employee interviews.

5. The stepwise project process

6. ”The radiological answers
are not completed by the
time of the patient
colsultations.”
”Now we have to perform
several consultations
because the procsedure and
processing is unclear.”
”The bottleneck is not related
to radiological examinations,
but its result interpretation.”
”Patients and
clinicians call us.
Unfortunately the
clinicians say
”call the radiologist
directly for
answers.”
”I do not want all the
phone calls, I prefer
working with the medical
aspects of the disease.”
Employee insights…

7. Summing up employee insights
Noise and interruption disturb our working
procedures
• Time spilled
• Prolonged waiting times
• Working conditions less satisfactory
Interpretative delays
• Work duplicates
• Follow-up of those who wait for answers
• Prolonged patient flow

8. Patient insights…
”I know others that have been through
this… I have had recommendations from
others that I need to follow-up
thoroughly, otherwise I will get lost in the
mass.”
” I called my husband and drove
directly to Ullevaal with the X-rays –
you simply cannot wait more than
absolutely necessary…”.
”I have cheated to get
the name of the
person who schedules
appointments.”
”You sit there all
by yourself…”
”Under these
circumstances 8th
floor feels like the
valley of death.”
”The waiting time prior to the
first consultation feels so long
– it is like my life stops
completely.

9. Summing up patient
insights
• The waiting time feels awful when you are uninformed.
• The first meeting with Oslo University Hospital is characterized by non-
personal information, lack of contact and precision between professionals and
the patient.
• The patient have confidence in the professional competence of the hospital,
but feels responsible for the progression of her own patient care.
• Diagnostic transitions are the key bottlenecks.
• Once the cancer diagnosis is communicated, the patients report that follow-up
and further communication is satisfactory and ”positive”.

10. The solution
• One common referral center and
improve quality of referral
information from GPs
• Radiologistsprioritize referrals verey
day according to «severity score»
• The hospital takes responsibility for the patient from day 1 (informs GP)
• The hospital call the patients for appointment within 1-3 days
• All investigative procedures within one day
• Agreement with private contractors in order to provide enough
radiological services (Aleris og Unilabs)
• Pasient coordinator follow-up through treatment
• Daily interdisciplinary meetind/video conferences between
Radiumhospitalet and Ullevaal

11. How to succeed while waiting for a national
hospital referral system?
Postadresse:
Oslo Universitetssykehus, Ullevål
Henvisningskontoret for bryst og
endokrinkirurgi
Postboks 4956, Nydalen, 0424 Oslo
Direkte tlf nr 23 01 65 25
Telefontid: kl 8:30-11:00 og
kl 12:00-14:00
Faks nummer til
henvisningsmottaket: 23 01 65 35

12. Har du fått med deg at
Oslo universitetssykehus har fått NY
rutine for henvisning angående
utredning og behandling av klinisk
problem bryst?
NYTT FOR FASTLEGENE:
•Ett felles henvisningsmottak
•På OUS nettsider finner du:
• Sjekkliste for henvisning av «klinisk problem bryst»
• Direktenummer og faksnummer til henvisningsmottaket
• Informasjon til pasienten DU kan skrive ut og gi under
konsultasjonen
• Informasjon om etterkontroller
NYTT FRA OUS:
•Pasienten ringes 2 - 3 virkedager etter mottatt henvisning
•Alle nødvendige undersøkelser utføres samme dag
•Tverrfaglig vurdering av ALLE behandlingskrevende funn
•Videre behandlingsforløp avtales med pasient etter endelig diagnose
Hvor finner du dette?
http://www.oslo-universitetssykehus.no/fagfolk/henvisningsrutiner/Sider/bryst--og-endokrinkirurgi.aspx
Klikk deg inn via «henvisningsrutiner» på forsiden
Information sent
all GPs and other
referees

13. Henvisningsskjema utarbeidet
av radiolog ved OUS

14. Mission completed?
Reduce waiting times 75 %
• Waiting times is reduced from
12 to a maximum of 2 uker
• Mean waiting time is 7 days
(Nov 2013 - Feb 2014)
Reduce diagnostic insecurity > 50 %
• Diagnostic insecurity is hard to
measure, but the proportion of
patients claiming that «this has been
a straight-forward procedure from
the day of the appointment at my
GP», is increasing
The patient pathway was
implemented November 2013

15. Waiting times has been reduced 90 per cent
«Design glasses» from the
outside invaluable – but the
professionals performed and
carried out the difficulties of
changing practice

17. What are the public measures of
health care efficiency?
The department of health
waiting time:
from referral has been
received to the onset of
treatment
Patient waiting time:
from the GP visit to the
phone call from Oslo
University Hospital with the
scheduled appointment!

18. Lessons learned
•Changing habits require
continuous improvement
work and follow up
•We are impressed of the
energy and responsibility of
the professionals at our
hospital

19. Success criteria
• 1:1 contacts - it's all about people
• Make alliances
• Form networks to reduce "the silo organization"
• The first idea is fertilizer for new ideas and innovations
• Competitions and prizes
• Communicate and share the good stuff!
• Foster enthusiasts!
• Share information and foster co-work:
a web-portal is very useful!
• Assiduity
• Resources is necessary!

20. Questions?
Idépoliklinikken:
https://www.idepoliklinikken.no/
Tlf: 23 02 70 23
idepoliklinikken@ous-hf.no
A video of the project can be
found here:
https://vimeo.com/90355375