Share the decisions table: one more step in the patient's experience

Mònica Almiñana

During the past Christmas holidays, many of us have shared a table with family and friends. Can you imagine if we did it with our patients to decide how we should evaluate their diseases?

That is what the Karolinska Hospital in Stockholm (Sweden) effectively proposes: a whole revolution in the way of understanding the care process. For those who don’t know, the Karolinska is one of the largest and most innovative university hospitals in Europe. It serves a total of 1.5 million patients per year, with a newly built infrastructure that houses 1,600 beds and employs 15,800 people.

In recent years, we have progressed from a model in which medical professionals were autonomous, and decision-making was based mainly on their experience and knowledge, to a model in which professionals work in interdisciplinary teams, where decisions are based on the data and the patients desire to actively participate in their illness.

In the Karolinska Hospital they decided to transform their organization based on the concept coined by Michael Porter - professor of the Harvard Medical School- of value based healthcare (clinical practices of value - care focused on value). Thus, they abolished services and created 400 patient flow (clinical management units - patient flows), which in turn are grouped into seven major areas of knowledge: cancer, heart and vascular system, nervous system, advanced age, women and children , infectious and inflammatory diseases, traumatology and reconstructive surgery.

Each patient flow has a management team composed of a process leader, a manager or case manager, professionals involved in the pathology (specialists in psychology, rehabilitation, radiology, surgery, etc.), as well as management specialists economic, research and most recently a patient expert in his illness.

The novelty is that the patient participates in the teams on the same terms as any other professional. They are not present in all sessions but the function is to represent patients and family members suffering from this pathology and in no case should represent patient organizations or be part of the sessions in which the treatment of other patients is decided. They contribute their opinion to questions such as: what are the most important results from the perspective of the patient and their family that should be evaluated and measured? What improvement initiatives are important for patients?

It’s not only about guaranteeing that the patient is listened to during the entire process, to be respectful with their preferences, needs and values, but the process is designed incorporating their own perspective, with the main person sitting at the same table as the professionals who cares for them.

We will have to be attentive to the changes that have been implemented in the Karolinska, perhaps the solution is to all sit at the same table.