Six appointments, one question about capacity

Mandate

Make access dependable without relying on agency doctors, bring three regions' booking routines onto one model and make deviation reporting something staff trust.

Outcomes

• Cut agency-doctor spending from SEK 92 million in 2022 to SEK 38 million in 2024
• Kept nurse telephone triage beside digital contact; 52 percent digital and 96 percent same-day callback by 2025
• Raised deviations closed with documented action within sixty days from 48 to 79 percent
• Funded a permanent renewal team that brought median renewal turnaround to 1.8 days

Decisions in context

I became chief operating officer as Solvreten grew from thirty-six to forty-one health centres and as agency costs in the north became the board's leading concern. My organisation includes every clinic, our four regional contact hubs, workforce planning and the operating side of patient safety. The chief medical officer and I review deviations and access together each week, but clinical decisions and reports to the inspectorate are hers. I present operations at every board meeting and report to the quality committee each quarter. Several of my decisions reduced income or raised cost in the short term: fewer satellite opening days, telephone lines kept open, a renewal team that ended summer savings. I have tried to put those consequences in front of directors before they had to ask, together with the date by which each decision should show whether it worked.

Reason for the move

Still in post; a single non-executive seat would sit beside this role, not replace it.

Mandate

Integrate four acquired GP-partnership clinics and bring the region onto common booking, rota and deviation routines.

Outcomes

• Moved all fourteen clinics onto common booking and rota planning by the end of 2018
• Kept two clinics open after the region's 2019 payment reweighting cut their income per listed patient by about 3.4 percent
• Ran testing and, from January 2021, vaccination sessions on the region's assignment

Decisions in context

The western region was where Solvreten had grown by acquisition, and four of its fourteen health centres had been GP partnerships months earlier, including Grindvallen, which I had run. Each kept its own rota, telephone hours and way of handling renewals. I made booking, deviation reporting and rota planning common, and left decisions on each clinic's profile, such as child health or care for older patients, with its head of clinic. In 2019 the region revised its payment weighting, and two of our clinics lost about 3.4 percent of income per listed patient. We added nurse-led clinics and changed their staffing mix rather than close either one. During 2020 and early 2021 we ran testing and then vaccination sessions on the region's assignment, which tested our rotas harder than anything before or since.

Reason for the move

The board chose me for the operating chief's role after the previous holder left Solvreten in early 2021.

Mandate

Open a new health centre and run it so that its owners could spend their time on patients.

Outcomes

• Grew listed patients from 3,100 at opening to 8,900 by 2016
• Introduced telephone callback in 2012, ending the afternoon queue
• Passed the county council's follow-up visits with one remark on interpreter documentation, corrected within a month

Decisions in context

Three local GPs established Grindvallen when the county council, as the regions were then called, introduced its patient-choice system. They asked me to run it so they could spend their time with patients. I reported to the partners' board and left clinical decisions with their medical lead. Starting from an empty building, I hired the first nurses, set opening hours we could staff and built the rota around the population that listed with us rather than around anyone's preferences. Grindvallen grew from 3,100 listed patients at opening to 8,900 in 2016. A callback system introduced in 2012 ended our afternoon telephone queue. The council's follow-up visits found us compliant, apart from one remark on how we recorded interpreter use, which we corrected. When the partners sold to Solvreten, they asked me to see the clinic through the transfer.

Reason for the move

Asked by Solvreten to lead its western region after it bought Grindvallen.

Mandate

Run home visits, a nurse-led diabetes clinic and the telephone advice line, later leading the nursing team.

Outcomes

• Kept the telephone line open through lunch by staggering breaks
• Moved routine renewals into booked slots
• Gave each nurse a named list of home-visit patients

Decisions in context

Myrskogen was a county-council health centre serving 11,500 listed patients on the edge of a mid-sized town. As a district nurse I made home visits, ran a nurse-led diabetes clinic and answered the advice line. The evening when callers were still waiting at closing time changed how I saw the job. From 2007 I led the nursing team of nine and worked with the head of clinic on rotas. We staggered breaks so the line stayed open through lunch, booked routine renewals into fixed slots and gave each nurse a named list of home-visit patients. None of this required new money. It did require the team to agree a rota it could keep through holidays and illness. The GPs who later founded Grindvallen watched these changes from a neighbouring practice and asked whether I would run their clinic.

Reason for the move

Invited by three local GPs to open and run their new health centre.

Mandate

Triage arriving patients and, as coordinator, manage flow through evening and weekend shifts.

Outcomes

• Coordinated evening and weekend shifts in a department of about 52,000 visits a year
• Introduced a written shift handover sheet later adopted department-wide
• Completed a part-time district-nursing diploma in 2003

Decisions in context

The emergency department at Bredsjövik Hospital received about 52,000 visits a year when I joined. I worked as a triage nurse and, from 2001, as a shift coordinator responsible for flow during evenings and weekends. Coordinating meant deciding which patients waited and where, and negotiating beds with wards that had none to spare. It also showed me how many attendances began with a failed contact elsewhere: a clinic line that had closed, a renewal that had lapsed, a home-care visit that had not happened. I studied district nursing part time during 2002 and 2003, partly because I wanted to work where those failures started. The department taught me to decide with incomplete information and to hand over clearly at the end of a shift, two habits I still rely on as an executive.

Reason for the move

Moved into primary care after completing the district-nursing diploma.

Mandate

Provide ward nursing care for adult medical patients and learn safe practice under senior colleagues.

Outcomes

• Took responsibility for medication rounds on a thirty-bed ward
• Worked with district nurses and municipal home care on discharges
• Trained two newly qualified nurses on handover routines

Decisions in context

I joined the internal medicine ward at Bredsjövik Hospital two months after qualifying. It had thirty beds, many occupied by older patients with heart failure, chronic lung disease or diabetes. I learnt basic nursing practice under experienced colleagues, and I learnt how much of a ward's safety depends on handovers, medication rounds and clear ownership of unfinished tasks. Discharge planning brought me into contact with district nurses and municipal home care for the first time, and I saw how easily a patient could fall between the hospital and the community when nobody had confirmed who would visit first. After three and a half years I wanted quicker decisions and a broader range of patients, so in February 1998 I moved to the hospital's emergency department, where the consequences of those gaps arrived through the front door.

Reason for the move

Wanted faster decisions and a wider range of patients in emergency care.