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Page 765 – Stanford Medicine X

The design of an ambidextrous organization in health care

Fredrik Ohrn fredrik.ohrn@karolinska.se


The care of hepatitis C virus (HCV) infected patients has so far contained minor opportunity for the patients to choose individualized care, although such could provide positive impact on patient outcomes. The Center for Digestive Diseases at Karolinska University Hospital has identified an unmet need to improve and individualize the care of HCV patients. These topics led to a unique collaboration project that focuses on person-centered care, technical innovation, and compliance. In order to speed up the pace of innovation work, the project aimed to design and create an ambidextrous organization.
Health care in Sweden, as in many other areas, consists of silos and, in a publicly financed welfare system, there are also silos between sectors in society which make it difficult for patients to receive the best possible care. An ambidextrous organization can likely solve that by opening up new ways of working and working across borders.

The main objective of this project is to improve the care process and the quality of care of HCV patients through providing individualized care beyond what is currently standard of care, meeting patients where they are, not necessarily where health care normally is, and to enable improved compliance through extra support.

The nurse team runs an outpatient clinic, led by two registered nurses and one part-time administrator, in collaboration with physicians. The nurses provide a person-centered based health care based on the patient's individual care plan and lead the HCV treatments. Daily outpatient visits are combined with video-visits, text messages, and phone calls. Patients respond to the HRQL questionnaires, including measuring anxiety and fatigue during and after HCV treatment, and the results are discussed at clinical visits. Liver elasticity measurements pre- and after treatment are performed by the nurse team. All patient data are registered in InfCare and adverse events are reported continuously. The video-visits are evaluated regarding the patient’s satisfaction and feasibility.
In order to meet the need for care for a large group of patients the project has also managed to start collaboration with Swedish prison and probation service. The team meets the patient where they are at such as in prison and provides professional knowledge of how to best examine the patients. If the patients need to see a specialist, a video visit is arranged.

This is a project to enhance the care of HCV patients, with new pathways of delivering individualized care through a nurse team.
The setup of this project can provide a model for how to design cooperation models in order to build productive ambidextrous organizations to individualize the care and speed up the development process.
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