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Karolinska needs to save a further half a billion

Karolinskas new hospital director Björn Zoëga, has only been in the service at the hospital in eight days. On the way through the bright large entrance hall on the famous hospital, he says that it is glamorous, but very surfaces. The new assignment is prestigious, and he didn't have to think long before he said yes. Now he has already managed to have a meeting with the hospital managers. Several changes that he thought that he would get the time to put into realizing he must be done now.

" We have an incredibly difficult economic situation. After the first three months of this year, we have seen that we have additional needs for savings of 500 to 600 million, says Björn Zoëga, and continues:

" We need to stop the bleeding and ensure that we deliver a good care so that it does not completely fail.

a piece of paper with the pictures of the economic review that was done in the hospital a few days earlier.

– There are no secrets, " says Björn Zoëga, and stresses that there is transparency.

– It is very important that everyone understands the situation. I think you may have been lacking a little in information to the managers – of which quite a number are new. And when I say heads I mean, not the hospital administration. You will get nowhere with sweeping things under the carpet.

the DN has previously reported that the Karolinska for the 2019 has a forecast deficit of 1.1 billion. The evidence Zoëga refers to it is clear that the planned savings that have been in the hospital – a total of 626 million that were placed during the year –not in phase. The dossier also shows that the costs continued to increase, with 387 million addition to the budget during the year's first three months. The forecast deficit after the year's first three months is significantly greater than in the past – and is now estimated to 1,487 billion if nothing is done.

– the action Plan was not as robust as you thought it would. And the first three months we had increased cost. We are bleeding. There is more to personnel costs and drug costs. The number of hired personnel. And switching costs have been greater than estimated.

”the action Plan was not as robust as you thought it would,” says Björn Zoëga. Photo: Paul Hansen

the increase in costs and the runaway budget is thus a fact. The region has shot to a total of eur 725 million as extraordinary measures, to save the Karolinskas economy in 2019. Of these, 280 million to Karolinska allowed to go in deficit during the year, a sum which then has to be repaid. But it is not enough.

" We have ideas and we have an agency that goes through how it goes financially. But we have also started to think about what we can take cross-cutting measures in order to be in phase. We need three weeks before it is clear and I have said this to the hospital managers.

What the savings will mean concrete can Zoëga not answer today.

– It is not enough, but I can't say if this means that additional services should remove, or whether we should cut down on the production – we do not want, we must clear our mission and think about the patient. This can not come from the top down in the hospital, but all must take responsibility for this.

realized that it is not possible to wait to make changes in the Karolinskas organization, the new operating model. A review of the hospital board presented in January, showed the blurring of mandates in the chefsrollerna, to the narrow diagnosflödena was cost-related and to patients with multiple diagnoses at risk of falling between the cracks.

" I had thought that I would start teaching me things, but I realize that it is not possible. It is in a hurry. It is, inter alia, to clarify responsibilities and mandates.

" I notice in conversations with people at the hospital that they feel that it does not have enough mandate to carry out care and savings. We also notice when we look at the production and economy, that it is something which is not true.

It is about how the hospital's employees find the opportunities to affect the economy, which belong together with the information ows. That the DN previously told the new organisation in place without it support was in place to support the new structure, and the economy can not be controlled at lower management levels in the streams, in the manner it was meant in the value-based care, the management model introduced at the Karolinska, with the help of the Boston Consulting Group.

– In some chefsled have not sufficient information. At the moment I can not say that now have it in place. I can get a picture of the location but they are on the floor can not get a complete picture. I hope that we shall be able to deliver it within four to six months, " says Björn Zoëga.

value-based care, " says Björn Zoëga is a method among others.

– value-based care is a method that has a certain function, but to operate the hospital so I don't think that it works fully. If you mix it with other methods so I believe that the work to develop health care.

to add to the plan for changes in the organizational model, and have it finished 1 July to then be able to start the changes from 1 september. He's talking about screwing, but to recreate the clinics, which, despite strong criticisms have been abolished in the new organization, and that had a major impact on the ability to keep together the specialities and organize the doctors ' training is not current.

" I'm not going to turn up and down on it all over again. We have made a journey from A to B. I want to C not back to A. We have a completely different mission and I think we can make it good in the new and take into account the areas where the clinics filled a function.

As an example, he mentions that the specialitets - and the participation of research managers appointed within the new organization.

To the question of how education should be organised, it has also been noticed that the new highly specialized mission makes to the influx of regular patients become so small that the nursing staff do not receive sufficient great mix to work out on. It applies, above all, in Solna, where intensivakuten only takes in patients with rare diseases.

" It's something we may look at in the future. But we hope that we intensivakuten at the end of the year, will receive 20 000 patients. We will see if it is enough for the through its training mission. If it does not, so must the region help us to educate physicians so that we have a competent läkarförsörjning.

as a specialist in orthopaedic surgery. As well as Birgir Jakobsson, who was the hospital director at Karolinska in the seven years before Melvin Samsom he is an icelander, and he has previously been head of the Iceland's university hospital. They do not know each other previously, but now they have had contact.

" We were on at easter, more of a coincidence, but then we spoke about the system on the Island.

Zoëga comes from vårdkoncernen GHP, and has also served on the board of directors for the subsidiary that operates hospitals in Ajman in the United arab Emirates, where the Caliber previously revealed that unmarried mothers are monitored by the police in connection with childbirth, and forced to give birth in handcuffs. When the DN previously confronted Björn Zoëga with the task, he said first that he resigned from his board position in march of this year, were not aware of the Caliber reported, a statement he later backed away from.

" Honestly, I misunderstood the question. I got it via sms when I was on the trip, "he says now, and continues:

" I knew about it when I sat in the board of directors, and the reason was that the women had it so much better by GHP been there. We have made an incredible advantage.

both the Swedish Society of medicine and Swedish society of nursing has made ethical decisions about the Swedish health professionals presence in the dictatorships. Swedish society of nursing advises nurses and midwives from Sweden to work in hospitals where they can not follow human rights. At the Sahlgrenska university is also the question lifted that prohibit an employee at the hospital to be on leave to work in the United arab Emirates.

On the question whether the discussion should be updated also at the Karolinska, says Björn Zoëga:

– If there is to be such a such a decision, so it must be done at the regional level.

Karolinska have huge problems keeping beds open in the absence of nurses. In recent months, several groups of specialist nurses at the hospital handed in his resignation or threatened to resign in protest against a new arbetstidsavtal, which then can mean that they stop just in time for summer. Already last summer was very strained with 700 or half of all the beds closed.

" There are two things. When it comes to arbetstidsavtalet we are still working to find a solution. We are looking, among other things, on a model introduced in the transition at the Södersjukhuset hospital.

According to Zoëga it is about finding a model that compensates for the previous model points to the inconvenient hours that fall away in the new.

– When it comes to sommarplaneringen so we are not ready. The summer is always stressful, but I have been told that the planning is going in the right direction.

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