Improvement of visits in Multiple Sclerosis as a value chain

Improvement of visits in Multiple Sclerosis as a value chain

Improvement of visits in Multiple Sclerosis as a value chain

Background: Multiple sclerosis is an inflammatory disorder affecting the central nervous system with typical onset in young adults. The section of Neurology at County Hospital Ryhov has been part of an international learning network (ICoHN Value Creation Community of Practice) based on Fjeldstads theories about “value chain,” “value shop,” and “value network” to improve the value of the given care. Outpatient visits were identified as an area in need of improvement both from the patients’ and caregivers’ perspectives.

Method: Based on the value creation theories, a self-assessment of care processes was performed. Both professionals’ and patient’s experiences were included. The improvement work followed PDSA cycles with small scale testing and follow-up involving persons with patient experience and professionals.

Result: Physicians estimated that they spent, on average, 42 minutes per visit, even though the visits were scheduled to take 30 minutes. They were frustrated that they did not have the time necessary for the evaluation and documentation. Most patients were satisfied with the visits, but some patients reported that they did not achieve what they expected before the visit and often had unanswered questions. Patients also reported that they were fatigued after the visits and had costs for travel and income loss. Patients had high satisfaction with the support of nurses over the phone.

Summary: Both caregivers and patients were frustrated that they did not get the time they needed during the visit. Simultaneously, there is a shortage of available visits at the neurology section, and it is not possible to have more extended visits. After discussions in the ICoHN network and with patient representatives, it was suggested that the patients should get a form by mail before the visit to be better prepared and to finish the visit with a written summary/agreement (patient contact) documented plan. The form and contact will be presented at the meeting.


Presenter/s: Jonas Lind (County Hospital Ryhov, Jönköping and Linköping University, Sweden) , Sofia Persson (Department of Public Health and Health Care, Region Jönköping County, Sweden)