Quality and Innovation in Sweden

The Pursuit of Perfection through Quality and Innovation:
First Stop, Sweden

In October 2015, CFHI sponsored two leads from the Nova Scotia Health Authority (NSHA) team that had participated in CFHI’s Atlantic Healthcare Collaboration to visit Jönköping, a region of Sweden that has won many accolades for its high performing healthcare system, as well as health systems in Denmark and Finland. Lynn Edwards and Tara Sampalli’s reflections provide the opportunity to explore the drivers for a strong primary healthcare system and share results from their own improvements in primary chronic care services at NSHA.
This is the first of a 3-part series. Read part 2.

Lynn Edwards and Tara Sampalli

Lynn Edwards and Tara Sampalli with Pernilla Söderberg, Improvement leader at Qulturum.

The Swedish System

In October 2015, we embarked on a weeklong tour of Scandinavia, excited to learn from high-performing health systems and share our experiences leading improvements in primary care. Sweden was one of three stops on our journey, supported in part by the Canadian Foundation for Healthcare Improvement.

Sweden has been quick to adopt the value-based healthcare concept, defining value as patient outcomes divided by costs. Through their innovative system-wide approach and focus on quality, Sweden has created a reputation for outperforming, but not outspending, its peers.

The health system in Sweden is divided into 21 regions, one of which is the Jönköping region. This region is responsible for public health, healthcare and dental care serving a population of less than 340,000.

Göran Henriks, Chief Executive at Qulturum, an innovation and learning centre, first pointed out that “Jönköping is one of the leading healthcare organizations in the world. It provides a model for transformation that has been inspiring many international leaders in quality improvement”.

The region has demonstrated success in chronic disease management, seniors care, health system efficiencies and quality. Health system leaders in Jönköping decided that engaging management and front-line staff in continuous improvement and systems thinking in everyday work was essential to system-wide improvement.

Quick facts – Enablers for Quality Primary Care in Jonkoping:

  • Quality in Primary Care is guided by the "Book of Rules", outlining yearly priorities
  • Citizens can choose their primary care provider
  • Primary care practices are country funded to increase competition, patient choice and quality
  • Most GPs are salaried to support quality care

The Integrated Chronic Care Service (ICCS) at NSHA won a 3M Healthcare Team Award in June 2015 for this model of care.
Watch the video >>

Lynn Edwards presenting Nova Scotia Health Authority’s quality and research innovations to the Qulturum team.

Lynn Edwards presenting Nova Scotia Health Authority’s quality and research innovations to the Qulturum team.

A Meeting Place for Quality and Culture

Qulturum, which means “a meeting place for quality and culture” or “institute of language,” is a learning and innovation centre in Jönköping. Established in 1999, it embodies the incredible journey of this system in the pursuit of excellence.

Our quest for excellence in quality and safety brought us for a collaborative sharing and learning opportunity with quality leaders in the Qulturum. The centre supports sustainable and system-wide improvements through learning programs, sessions, conferences and consultative support. The centre is a free resource to all 10,000 employees in the Jönköping region, who can find support at Qulturum in solving a wide range of challenges and in developing innovative ideas.

As Göran Henriks pointed out, “Having a capacity to provide support for innovation in the system is a great enabler for safe and high-quality healthcare.” With Qulturum’s mission to train individuals and teams and support systems by teaching and coordinating system redesign and process improvement to ensure great capacity for health systems improvement. Having this capacity in the system becomes a great enabler to creating and achieving patient-centred care in a safe and reliable environment.

Our time spent with improvement leaders at Qulturum gave us the opportunity to learn about some of their key initiatives, including research in primary care, improving patient flow and coordination for seniors, the senior alert quality registry and making quality a vision at the point of care (all easily accessible via the Qulturum blog). During our day and a half visit with this innovative group, we learned about the importance and impact of system-wide commitment to quality in supporting a strong health care system and core values.

Our exchanges included sharing of some of our local primary health care initiatives from NSHA, including our improvement successes brought forth through CFHI’s Atlantic Healthcare Collaboration, such as the NSHA community health teams, frailty portal and integrated chronic disease prevention and management.

Lynn Edwards

Lynn Edwards
Senior Director, Primary Health Care and Chronic Disease Management




Tara Sampalli

Tara Sampalli
Assistant Director of Research, Primary Health Care