Guest Post: Ali Damji (Canada) Week One Reflection – Why Jonkoping?

Hello from Canada! I am thrilled to be guest posting during my study visit.

My name is Ali Damji and I am a fourth year medical student and graduate student from the University of Toronto, Canada. I am currently working towards a Masters of Sciences in System Innovation and Leadership at the Institute for Health Policy Management and Evaluation at the University of Toronto, and am hoping to enter a career in family medicine and work as a physician-leader in quality improvement and health systems in my future.

I am here at Qulturum for a 6.5 week study visit, while also participating in a quality improvement and clinical experience at Eksjo Hospital.

This is my first time in Sweden and I am very excited to learn about Jonkoping, Swedish healthcare system, and Qulturum.

So why did I come to Jonkoping, of all places?

  1. Qulturum: At my university, Jonkoping region and specifically, Qulturum, stands out for its strong reputation as an incredible influencer in the realm of quality improvement in Sweden, and worldwide. This is particularly for its emphasis on person-centred care and using the patient experience and what matters to them to drive change across the healthcare system. By focusing on what matters to patients, health outcomes and system outcomes will improve too. Even more amazingly, Qulturum has successfully fostered this culture across not just the macrosystem but microsystems too. Unlike other systems, Qulturum also walks the talk, and this culture has produced tangible results. There are several key innovations that truly deliver person-centred care such as the Mobile Geriatrics Unit that delivers specialized services at patients’ homes on demand, and the Self-Dialysis Clinic where patients work with dialysis teams to take charge of their own care, to name a few. It is not just a mantra or a directive, but an actionable cause taken up by the frontline and the government and its agencies. I look forward to seeing these innovations first hand. Being able to work with and learn from the quality improvement leaders who coach frontline staff and help cultivate these fast-paced improvements in micro and macro systems will be an immense privilege and opportunity.
Reason Number One.

2. Person-Centred Care: Since my first day at Qulturum this past week, I have been really impressed with the emphasis on looking at the entire person, and the approach to person-centred care. In the Jonkoping region, education and employment and infrastructure are seen as critical components contributing to one’s health, and are under one umbrella with health in its governance structure. The question that is always asked when making changes to the system is from the perspective of a symbolic patient, named Esther. This patient is a complex elderly patient who requires coordinated care between hospital, primary care, home care, and community care. Improvements are made to the system by looking at  “What is best for Ester? What matters to her?” The system and improvement efforts must then build around those needs. This is a flipped way of thinking from the traditional mindset, and one that I believe should be spread to all health care systems including my own back home.

Ryhov Hospital. This is the hospital where I will be participating in several sites visits next week to learn more about their Rehabilitation, Psychiatric, Self-Dialysis, Mobile Geriatrics  and inpatient units in the coming weeks.

3. Try out some QI: The QI project I will complete here will be a great opportunity to practice and develop my skills in root cause analyses, value stream mapping, process mapping, measures, defect testing, PDSA cycles, and developing a plan for a quality improvement project. I am also looking forward to working clinically in a microsystem and working with the clinical team to design an improvement, with the support of Qulturum. It will be an exciting opportunity to learn in both the marco and microsystem and understand their interconnectivity. I also look forward to sharing some of the QI work I have been involved in back in Canada and participating in co-learning.

4. Microsystem Festival and Building International Networks: Qulturum will be hosting the Clinical Microsystem Festival from March 1-3, 2017. I am looking forward to meeting QI leaders from across the world and learning from the collective expertise in the room. I also look forward to meeting other students pursuing training similar to my own so we can learn from one another.

Like many health care systems in developed countries, from my studies I have found that Canada faces several similar problems faced by Sweden: difficulty in transitioning people out of hospital into long term care and home care, controlling costs and wastage in a universal health care system while eliminating unnecessary variation, addressing the social determinants of health (Sweden has an impressive range of strategies to address issues like low income and education, leading to less spending on health, for example), challenges in moving care outside of hospitals and into the community and preventative medicine, while still providing high-quality care in all settings. and supporting patients’ needs and wishes for their care (or as in Ontario, receiving the right care at the right time, in the right place).

I believe that these are complex challenges, and we must look to the global community to tackle them. That’s really why I am here. These first 6.5 weeks are a start to that journey for me and I can’t wait to see how they unfold.

Enjoying a wonderful Swedish tradition: fika! Hot drinks and snacks fuel morning conversations and allow different departments to informally meet and discuss projects.

Thanks for hosting me here, and I can’t wait to join the team from Singapore tomorrow as we visit several sites of innovation tomorrow.

Until next time!

Welcome Singapore Institute of Mental Health!

The entire group from Singapore (including those who only participated the second week – at the Microsystem Festival) gathered at the entrace of Qulturum.

We are happy to welcome a small group from Singapore Institute of Mental Health, which will visit us during February 20 – March 3.

The group met with several representatives from the psychiatric clinic, as well as from the Mobile Geriatic team & the Disease control unit at Ryhov County Hospital. They also had the chance to visit Höglandet Hospital in Eksjö during their stay with us. In Eksjö, the group from Singapore got to hear about the ongoing work with “Esther”.

Esther Network is a collaboration and cooperation between municipalities, primary care centers and the hospitals in Jönköping County. The common goal is to make Esther’s every day life as good as possible.

Meeting with the team at the Psychiatric clinic at Höglandssjukhuset in Eksjö. Photo:

Finally, the group also paid a visit to the Emergency Services in Jönköping where they met with the Commander in Chief, Göran Melin. Göran described how the Emergency Services work in close collaboration with Region Jönköping County to prevent potential suicides. The group from Singapore also got the chance to take a tour of the Fire Station and try the uniforms.

The team from Singapore Institute of  Mental Health at the Fire Station in Jönköping.

During their second week in Sweden, the group from Singapore Institute of Mental Health, went to Borås (Knowledge centre for Psychiatric health) and they also participated at the International Microsystem Festival at Qulturum.

Program – Singapore Institute of Mental Health