How improved access to healthcare was successfully spread across Sweden.

BACKGROUND Swedish healthcare has an internationally high standard, but is often criticized from a patient perspective owing to access problems to primary and specialist care. The waiting time to get in touch or get an appointment with a doctor, nurse, or physiotherapist is often too long. Access problems also create stress for employees when there are too few appointments to offer. In addition, too much time gets spent on the administration of long waiting lists, which adds no value to patients. Jönköping County Council was not satisfied with this situation and decided to make an attempt to improve access in the whole system. PURPOSE To describe how access was improved in Jönköping County council and how the concept was spread nationally. METHOD A conceptual model for improved access and reduced queues in Jönköping County called Bra Mottagning (BM) ("Good Clinic" in Swedish) was developed in 1999. It was built on logistic principles and collaborative learning. The program consisted of 4 learning sessions over a period of 8 to 9 months. The process of learning, team development, leadership, and spread of a change concept for improved access in Sweden has evolved through repeated improvement cycles, from small tests to larger pilots and finally to a standardized concept. RESULTS Since 1999, 2 new BM collaboratives have been started every year. The first 11 teams from the county council of Jönköping, which participated in BM1 to BM3, reduced their median waiting time from 90 to 7 days in 8 months, an improvement of 93% (83 days). The results have been sustainable over the last 7 years. In the county council as a system, advanced access was achieved in 40% of the 179 units in 2006. Since the national spread started, 2200 employees in 316 professional teams from 16 county councils in Sweden have participated in BM collaboratives. Of these, 80% improved access for their patients and 32% reached advanced access in 8 months. CONCLUSION The described development and spread of a concept for improved access in Sweden has been successful. A general impression is that the spread was more successful in the counties where the top management was strongly committed to the mission and the concept. Important factors for the national spread have been the establishment of a broader planning group as a network, the education of access coaches, the standardization of methods, and scientific assessments of the concept. Our experience is that both leaders and employees need to share a holistic view and systems thinking and also develop a deep interest in learning about strategies for access improvement.