The Swedish healthcare system shows excellent results, at least medically. When it comes to information campaigns and patient involvement, however, it’s a different story. Erik Eriksson, industrial doctoral student at Chalmers TME, has spent a lot of time analysing this in recent years.
One thing is clear, Eriksson says: the Swedish healthcare system needs a new approach.
“With the current organisation, we lose out on all the patients’ and family members’ resources to develop the patient’s care,” he says. “We can’t just deliver healthcare, we need to involve those who are directly affected by it. But our system is terrible at that.”
Patients as sources and evaluators
Eriksson’s thesis points out the importance of a broader perspective on healthcare, which also embraces family members, others close to the patient and the local community. He introduces the concept of service management in his healthcare research – a concept where co-creation is an important part.
“Patients must be given the opportunity to play different roles in healthcare. If nothing else, we need to see them as sources and evaluators, and make use of their experiences.”
Not including the patient, family members or the local context is a huge waste of resources, Eriksson says. This perspective is a common theme throughout the three projects that form the basis of his doctoral thesis.
One of them, the 2012 information campaign ‘Bring a Friend’, was awarded the prestigious Golden Scalpel by the medical journal Dagens medicin. The campaign, headed by Eriksson and Malena Lau in the County Council for West Sweden, led to a dramatic increase of 42 percent in the number of foreign-born women who went through cervical screening.
The key is to build on local strengths and networks to spread oral information, rather than just translating existing written material into multiple languages. Doulas – women who work as birthing coaches and support for new immigrants in the area – were particularly important here. The campaign largely hinged on them spreading the word.
“One important conclusion is that we need to be more outgoing and think more creatively to reach out. We need to understand that we are targeting many different groups. Currently, the healthcare system provides the same information to everyone, regardless of their age or country of birth. But if the system is only adapted to those born in Sweden and socialised to open envelopes and to come when summoned by authorities, then we’ll miss large groups of people that the system has difficulty reaching.”
"We can’t just deliver healthcare, we need to involve those who are directly affected by it. But our system is terrible at that"
Making assumptions about what patients need, rather than asking those affected or those who live in the area, leads to a lot of lost effort, Eriksson says. And yet we have built-in obstacles to prevent new approaches.
“You can’t sit there in your office making up new healthcare strategies – yet there is a resistance to leaving the safe walls of the municipal offices or hospitals and getting out and talking to people,” he says. “Even though the solution may be relatively simple – such as involving the doulas.”
The two other projects on which the thesis is based also emphasise the importance of listening to those affected. One project analyses the vast differences in opinion regarding motherhood in women born in Somalia, women born in Sweden and nurses at the children’s health centres.
“The idea is to get the different target groups involved, to see how the children’s health centres can best be adapted to their needs.”
A narrow perspective on health
The final project focuses on family members in cancer care. Family members are often excluded in many ways from helping and supporting the patient.
“We have a very narrow perspective on health today,” Eriksson says. “It is important to understand that the healthcare system is only one part of people’s health and well-being, and it can’t deliver everything.”
Eriksson also presents a different perspective: the importance of being aware of the norms and structures that may affect interactions with patients and their family members – such as gender stereotypes.
“The Swedish healthcare system has difficulty seeing people’s expectations, and seeing what norms we may be incorrectly attributing to the patient.”
Eriksson hopes that his thesis will contribute to changing perspectives on recipients of healthcare.
“I hope my thesis can become part of a movement to give patients and their families a greater say, and an opportunity to take an active part in their own care. That we will no longer see patients as sick and passive individuals, but as having many kinds of resources.”
Text: Ulrika Ernström
Erik Eriksson is an industrial doctoral student at Chalmers TME in the Service Management and Logistics Division of the Technology Management and Economics Department. He is also linked to the Centre for Healthcare Improvement (CHI).
The title of his thesis is: “A service management perspective on healthcare improvement: integrating social context”.
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