Ikääntyvän yhteiskunnan uudistuva palvelurakenne Erkki Vauramo Matti Anttila Jenni Hölttä Aalto-yliopisto Sotera Instituutti Helsinki1.9.2010 Yhteistyötahot, tavoitteet, odotetut tulokset: 1.Eksote: piirin rakenne ja uudisrakentamistarve 2.Keski-Suomen shp: korjataanko vanha vai rakennetaan uusi 3.Rovaniemen kaupunki: keskussairaalaan psykiatria ja terveyskeskus 4. Varsinais-Suomen shp: uusiokäyttö vanhalle talolle
European gradation in health and health facilities Expectations of People Personnel Politicians cost operating area for health care systems Policy aims Affordability? Social development needs Economic needs Unsustainable - socially Unsustainable - economically Source: EuHPN, Barrie Dowdeswell
How to solve the Problem of Ageing Society? Kymenlaakso model COST of service sy ystem Cost development with current model if nothing would be changed (would require 2x current staff not possible!) elderly care 1 comprehensive restructuring of the elderly service system: current number of staff has to take care of twice the number of elderly acute care 2 increased productivity and cost- Reduced tax paying capacity: effectiveness will achieve the Required cost development -10 % required 10 % saving in costs 2005 2035 Source: Eklund, Vauramo, Autio, Kjisik, 2007
From STAND-ALONE HOSPITALS to SERVICE NETWORKS STAND-ALONE HOSPITAL ISOLATED, PROFESSION-CENTERED Focused on organisation by medical speciality (2-3 hospitals for 200 000 inhabitants) REGIONAL SERVICE NETWORK INTERCONNECTED, CUSTOMER-CENTERED Focused on solving problems collaboratively (350 producers for 200000 inhabitants) EDUCATION ELDERLY SERVICES SERVICE HOUSING SERVICES for FAMILIES SOCIAL CARE REHABILI TATION ACUTE CARE SENIOR HOUSING HOME CARE WEL- FARE OUTPATIENT SERVICES HOUSING Health SHOPPING MALL
Regional network interaction- a zero growth game Network in theory (ideal) varying degrees of collaboration and isolation Network in practice (reality) high level of network-wide collaboration conflict of interest Maximal regional resources available are decreasing (can be identified) A Network is being constantly changed to meet the requirements of the society With limited overall resources, an increase in one service will mean a decrease in another
From separate budgets and organisation to pooled resources Separate resources organised by levels of care separate hierarchy Shared resources organized by focus areas, vertically integrated services Highly Specialised Care Special Care Institutional Care Primary care integration vertical nhighly specialised care Special care Knowledge centres Processes Chronic disease management Home care Acute Elective Self-care Etelä-Karjalassa l hallinto on yhdistetty, tt nyt on toiminnan i vuoro
From ISOLATED ORGANISATIONS to SERVICE NETWORKS SEGREGATED SILO ORGANISATION REGIONAL SERVICE NETWORK ISOLATED, PROFESSION-CENTERED Focused on organisation by medical speciality INTERCONNECTED, CUSTOMER-CENTERED Medical specialities are focused on solving problems collaboratively flow Keski-Suomi, Rovaniemi, Etelä-Karjala
From Stand-alone Hospital to Health Service Centre STAND-ALONE HOSPITAL ISOLATED, PROFESSION-CENTERED HEALTH SERVICE CENTRE as a part of the WELLNESS PARK INTERCONNECTED, CUSTOMER-CENTERED CENTERED The Wellness Park is a Hub in the Regional Service Network, combining the Hospital with other services Regional Service Network SENIOR HOUSING ELDERLY SERVICES SERVICE HOUSING SERVICES for FAMILIES Wellness Park HOME CARE WEL- FARE EDUCATION SOCIAL CARE REHABILI TATION ACUTE Health CARE Service Centre OUTPATIENT SERVICES HOUSING Health SHOPPING MALL Varsinais-Suomi, U-sairaala
Integrating Care from stand-alone institutions back to Society Stand-alone elderly care institution Passive, work-intensive environment Integration into multifunctional urban blocks Active environment supporting self-care Home care services based on the needs of the elderly living in the area Common spaces Housing for the elderly Care home Housing Common Services and spaces café school shops services Varsinais-Suomi, U-sairaala, ym
Suunnittelu & rakentamisprosessi Yleissuunnitelma Toiminnallinen suunnittelu Rakentamisprosessin vaiheet % Raken- taminen Yleissuunnitelma Asiakas Tarve Master Kapasiteetti plan Suunnitelma Inventaario -OBS- (Suoritepohjainen mitoitus) Tilan Suunnittelu Rakentamis- ohjelmointi Kehitys asiakirjat Muutto Kiinteistön ylläpito Seuranta Terveys- politiikka. Tavoitteet Toininnallinen PTS Tontin käyttö 15-25 v perspektiivi Asiakas Tarpeen Yksityikoht- Arkkitehdin Rakennuttamis- Toteutus. Vastaanotto, kuvaa kuvaus tainen toteuttama asiakirjojen käyttöönotto toiminnassa tilainventaarion Huoneiden esisuunnitelma Valmistelu, tapahtuvat pohjalta toiminnallinen yhdessä Urakkasopi- muutokset/ Tulevan tilaajan mukset. uuden tilantarpeen toiminnallisten Toiminnan tilantarpeet määrittely Esisuunnittelun Kustannus- Arvion tekeminen Toiminnal- linen ohjelma tila suunnitelman pohjaksi. asiantuntijoiden kanssa Kustannusarvio Takuukorjaukset, ylläpito Aika Interreg 3C: Future Hospital
Suunnitteluprosessin vaiheet Suunnittelu Suunnittelu Suunnittelu Yleissuunnitelma 1 Vaihe 2 Vaihe 3 tämys projekteis ssa Tiet Inventointi Analyysi Synteesi Inventointi Analyysi Synteesi Inventointi Analyysi Synteesi Aika 2-4 vuotta Suunnitteluluupit helpottavat asioiden järjestämistä oikeaan vaiheeseen. Yksityiskohtainen suunnittelu, huonetilaohjelmat, laitteistot ja ohjelmistot kuuluvat konseptien suunnittelun jälkeiseen vaiheeseen
Suunnittelun tasot 1. Piirin i taso SHp suhde, tavoitteet kokonais-kustannuksille (-10%), päätös TK- ja shp yhteisestä tä rakennuksesta k 2. Osastoryhmä-taso Päätös hallinnollisista i yksiöistä, auki Uudet kombinaatiot mahdollisia 3. Osaston taso Prosessit määräävät tilat, auki 4. Työpistetaso t Panostettava erityisesti, identifioitava kehitystarpeet
Planning at four levels in programming the Kotka Hospital 50 000 m 2 1. Kotka Hospital 2. Medical and Functional Blocks Diagnostics Outpatient Planned Hot and services and Wards Hospital Operation Day hospitals Elective Care Limited by total regional resources e.g. 29 staff members / 1000 inhabitants Supporting services Rehabilitation EGION R 3. Block: Hot Hospital ICU CCU Patients in critical care Emergency Operation Stroke unit Resources at unit level 4. Unit: Operation Unit Rooms, spaces and work stations Processes Work schedules Logistic flows Unit level ee planning
Prosessien suunnittelunperiaatteet Suunniteltava suurille potilasvirroille ongelmakohtaisesti Standardipotilasta ei ole Rutiinipotilaita i til it on 80% Vaikeat tapaukset noin 20 % hoidetaan case managementilla Lääketieteellinen hoito on erotettava a tukipalveluista
Forming Process-oriented Knowledge Centres Clinical Specialities Collaborative Knowledge Centre Problem-centered, Pathway-oriented planning Su pporting Op perative Dia agnostics Internal Medicine Infections Surgery Neurology Others Medical Knowledge Centre Soft tissue problems Cancer Trauma Cardio vascular Chronic Disease Management etc.
Forming Process-oriented Knowledge Centres Management Support Functions Primary medical care Hotel Storaging IT Etc Asiakas
Forming Process-oriented Knowledge Centres Management Hotel Storage IT Etc. Support Functions Primary medical care Rehabilitation Key Performance Indicators (KPIs) Customer Patient
Forming Process-oriented Knowledge Centres Management Supp port Func ctions Hotel Storaging IT Etc Primar ry medica al care Customer Patient Primary care as case manager?
Kotka model acu ute Hot Hospital Emergency Operation Delivery Imaging ICU CCU Stroke unit Pti Patients t in critical care Supporting services 6 000 m2 Medical Knowledge Centre Internal Medicine Surgery Neurology Others Infections Soft tissue problems Cancer Trauma Cardio vascular Primary Services Knowledge Centre Chronic Disease Management elect tive 11 000 m2 10 000 m2 8 000 m2 Hotel 7 000 m2 08/2010