‘Lean hospital a sign of Swedish welfare reform’

A Stockholm hospital saved from closure by private health care providers has been hailed by the Economist as one of modern's Sweden public-private success stories.

'Lean hospital a sign of Swedish welfare reform'

In a 14-page Nordics special, The Economist noted already in February that many notions once cemented in the Swedish conscience had been laid bare and dissected, or, as its correspondent noted, “the streets of Stockholm are awash with the blood of holy cows”.

One such holy cow, was, of course an ingrained suspicion toward private enterprise operating in state-funded industries, including health care.

Yet in 1999 the reigns of St. Göran’s hospital in western Stockholm were taken over by Capio, a Swedish healthcare management company owned by private equity firms. Today, 20 percent of hospital care across Sweden is run by private outfits in Sweden, a number that rises to 30 percent in the primary care sector.

“St. Göran’s is the medical equivalent of a budget airline,” The Economist wrote last week.

“The aim is to give taxpayers value for money. Hospitals should not be in the hotel business, the argument goes.”

Capio’s reform has, among other things, made the working relationship between doctors and nurses less hierarchical, the Economist explained. Small teams of medical staff work together. They make not only medical decisions together, but discuss work flow and how to manage everyday affairs – for example where the defibrilators should be kept so no one runs around looking for one while a patient flatlines in another room.

The term for focusing on work flow and quality in healthcare is “lean” and the liberal Economist is a key cheerleader for its virtues. A main aim at St. Göran was to cut short the amount of time patients spend in-house, a target that Sweden seems to be good at implementing nationally.

The Economist reported that the average length of a hospital stay in Sweden was 4.5 days. In France, it is 5.2 days, while Germans spend on average 7.5 days in hospital.

Sweden also has about half as many hospital beds per capita as France does, yet Swedes live to be a bit older than their French peers.

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Pregnant woman died in overcrowded hospital

A Swedish hospital pressured by a lack of beds and staff coupled with a winter increase in patients has reported itself to the healthcare watchdog after a pregnant woman died in its emergency room.

Pregnant woman died in overcrowded hospital
File photo of a pregnant woman not connected to the story. Photo: Hasse Holmberg/TT

The woman complained of headache and vomiting when she visited Mölndal Hospital in western Sweden in December, reports broadcaster SVT. It was decided to let her undergo a brain scan, but because of a lack of beds in the neurology ward she had to stay in the emergency room overnight.

During the night her condition deteriorated. She was taken to the neurology ward for emergency surgery, but her life could not be saved. The hospital filed a so-called 'Lex Maria' report to the healthcare watchdog, the Health and Social Care Inspectorate, suggesting overcrowding may have been to blame.

“Inadequate level of care, possible shortcomings in the transmission of information and delayed transport could be a contributory factor to the tragic course of events,” SVT, which does not state how far ahead the woman was in her pregnancy, quoted it as saying.

The hospital does not wish to comment during the ongoing investigation, but several staff members have voiced concern over a lack of beds in non-emergency departments at the Sahlgrenska University Hospital, of which Mölndal Hospital is part.

“Patients who really need care in the other wards end up staying in the emergency room. The staff then have to try to care for them there, while caring for a continuous stream of new patients,” Karin Frank, the healthcare union representative at Mölndal Hospital, told SVT.

The Local has previously reported on other incidents of overcrowding at Swedish hospitals. In December, three families from Uppland county had to travel to Finland to give birth because there was no room for them and their specific needs in the neonatal unit of Uppsala University Hospital.

Last year a baby died when a heavily pregnant woman was turned away from an overcrowded hospital in the south of the country, while in a high-profile case in 2014, a Swedish man had to help his fiancée give birth to their baby in the back of a taxi because the family was turned away by a midwife, who said there wasn't a hospital bed available for them in all of Stockholm.