Hospital Plan 2007 Capital Region Summary of Hospital for the Capital Region Hospital Plan 2007 Capital Region
Summary of the Hospital Plan for the Capital Region MThe structure of local government in Denmark changed in 2007. The reform carried out that year reduced the number of municipalities, but eliminated the counties and instead divided the country into five new regions. One is the Capital Region of Denmark, which formally came into being on January 1st 2007 when Denmark s structural reform took effect. As of that date, the Capital Region assumed responsibility for providing the region s 1.6 million citizens in particular, and in some respects the Danes in general, with a hospital system that would be distinguished by its professionalism, cohesion, and good quality of service. The document summarized here, the Hospital Plan for the Capital Region, is the first step on the road to creating a truly unified regional health service. The Hospital Plan gathers a wide range of health services in fewer units. The aim of this is to reinforce the professional quality of care, and to provide a better basis for research and development. All hospitals in the region will continue to give research a high priority, and those hospitals that host specialized functions will have special research obligations. One focus area in the years to come will be research in the major endemic diseases affecting the Danish population. Besides ensuring better patient treatment and care, the Hospital Plan will help create an attractive and dynamic working environment for the Capital Region s 36,000 employees. We want our facilities to be the hospitals of choice for patients and staff alike. In November 2006 the Preparatory Committee for the Capital Region of Denmark reached a consensus on the fundamental principles upon which the Hospital Plan should rest. This consensus crystallized into the regional statements of intent on health policy. These documents constitute the political framework for the Hospital Plan, and they identify and explain various considerations that the plan must address. Although first and foremost intended to ensure the high quality of treatment and care, the plan also aims to meet the demands of various stakeholders for geographical proximity, continuity of care, optimized performance, research, development, education, a safe and pleasant working environment, and successful recruitment and retention of staff. The overarching goal of the Hospital Plan is to create the foundation for a hospital service that is equipped to deliver high-quality treatment and care, and to cope with the challenges of the future. That is why consultations with the professional health-care staff have played an essential role in the planning process. In the summer of 2006, the region appointed a total of 40 advisory health care committees. Each advisory committee was tasked with assessing the minimum size, and the optimum size, of the population base each department would serve, and was asked to map out and clarify how its own specialty interacted with other specialties. During the autumn of 2006 the region s subcommittee on hospital structure reviewed the advice of the committees, assessing each specialty individually. The subcommittee s findings were then compiled into a study that analyses the population base for, and the interactions among, the various specialties. The four planning districts The Hospital Plan geographically divides the Capital Region s hospital service into four planning districts: North, Middle, City, and South. These planning districts, which are applied in this Hospital Plan and in the corresponding Psychiatry Plan, will define the geographical layout of hospital treatment and care in the future. Citizens living within each of the four planning districts must be ensured a uniformly high level of quality and services. Each planning district has a population base of 310,000 to 460,000. This volume allows the most commonly occurring illnesses and diseases to be treated close to the region s citizens, while maintaining focus on providing a continuum of care for the individual and avoiding unnecessary transfers. Each planning district is equipped to handle emergency services involving surgical procedures, orthopaedic surgery, childbirth and pediatric care, anaesthesia and intensive care, and medical care in general, including neurology. The planning districts in the Capital Region follow the lines of the new municipalities and city precincts as defined by the structural reform of 2007. The resulting changes were necessary in order to create unambi guous lines of contact with the region s citizens, and with the municipal partners of the various hospitals. All hospitals in the region except Rigshospitalet (the national hospital) and Bornholms Hospital are associated with a planning district. The aim is that hospitals within a given district will cooperate to handle the hospital-related tasks that arise, thereby ensuring that patients receive appropriate treatment and care. Rigshospitalet holds an exceptional position in Denmark, because as a national hospital it hosts many highly specialiazed functions receiving patients from the entire country. However, it also handles a number of main functions for the City district. Similarly, Bornholms Hospital holds a special position because of the unique geographical conditions that characterize the island of Bornholm, and while it handles all common hospital-related tasks, it is organizationally linked to Rigshospitalet. Local hospitals Proximity to home is typically a major concern for medical patients. Each planning district therefore has one or two facilities designated as local hospitals. These local hospitals cooperate with the relevant district hospital which also serves as a local hospital to give patients proximity to their own homes and neighbourhoods during treatment and care. The local hospitals also work closely and constructively with the local municipal authorities. This means that in the major specialties of internal medicine, the four planning districts are subdivided into smaller catchment areas. Like the planning districts, the medical catchment areas follow the areas of the municipalities and city precincts, enabling the citizens in each municipality and precinct to be linked, at least in the first instance, to a single hospital. The local hospitals can receive some emergency medical patients from their catchment area, but their primary task is to carry out scheduled examinations, tests, treatments and procedures, sometimes in outpatient settings. To continue to offer citizens treatment for emergency but minor injuries in reasonable proximity to their homes, the local hospitals will maintain their emergency rooms. These emergency rooms will be open round the clock for patients presenting themselves for care. The district hospitals will have a triage function, so that any doubts concerning patients dialling the Danish emergency number (112) can be resolved jointly by the ambulance team and the triage nurse. The local hospitals do not carry out emergency surgery. However, they do have elective-surgery clinics for certain courses of treatment, which offer clinical pathways for a scheduled procedure and follow-up programme, and which focus on professional quality and patient service. In order to cope with the anticipated pressure on the available surgical capacity, which is partly a result of the Danish government s national one-month treatment guarantee, each planning district will make a coordinated effort to plan and distribute the electivesurgery tasks among its district hospital and local hospital(s). District hospitals Each of the four planning districts has one district hospital, which handles emergency surgical and medical treatment. The location of each district hospital is well suited to its district-wide function in terms of geography and traffic. The physical framework and capacity of each district hospital has a potential for expansion that will enable it to handle treatment for the whole district at main-function level, and to host certain selected special functions. All district hospitals will establish a joint admission for emergency medicine (EM) for the entire planning district. This makes the district hospitals the primary entry point for patients with illnesses and diseases that require treatment, both for citizens presenting themselves personally and for citizens whose first contact is through the emergency number 112. The joint AEM functions cover the previously existing emergencyroom and reception functions, and in accordance with the recommendations from the National Board of Health, each emergency departement is organized as the only entrance to the hospital for emergency cases. A district hospital handles all of the district s emergency admissions for surgery and medical cases, and for births, with one exception: The maternity depart- 2
ment for the City district is Rigshospitalet and not Bispebjerg Hospital, which serves as the district hospital in other respects. There are also special provisions for the local hospitals in Gentofte and Glostrup. Besides their local-hospital functions, they will handle certain selected main and special functions in the fields of cardiac and pulmonary medicine (Gentofte Hospital) and neurology, neurosurgery, and neurorehabilitation (Glostrup Hospital). Generally, the hospital profiles in the new regional structure are as follows: Hillerød Hospital (local and district hospital for North) Helsingør Hospital (local hospital for North) Frederikssund Hospital (local hospital for North) Herlev Hospital (local and district hospital for Middle) Gentofte Hospital (local hospital for Central) Hvidovre Hospital (local and district hospital for South) Glostrup Hospital (local hospital for South) Amager Hospital (local hospital for South) Bispebjerg Hospital (local and district hospital for City) Frederiksberg Hospital (local hospital for City) Rigshospitalet (highly specialiazed function hospital) A number of the changes in the new distribution are self-evident. The district hospitals must have the specialties necessary to handle the reception, admission, and treatment at main-function level for citizens with acute illnesses and diseases that require immediate treatment. This means emergency surgery, emergency orthopaedic surgery, emergency internal medicine (cardiology, pulmonary medicine, gastroenterology, endocrinology,geriatrics, infectious diseases, and rheumatology) as well as anaesthesiology and intensive care. Ancillary functions include diagnostic radiology, clinical biochemistry, pathology, clinical physiology, and nuclear medicine. In addition, the district hospitals with birthing facilities must have gynaecology and obstetrics and a paediatrics department with a neonatal function. Bornholms Hospital (local hospital for the island of Bornholm) Pre-hospital care One aim of the Hospital Plan is to ensure coherence and cooperation between the Capital Region s daily emergency care and medical preparedness in generel. Emergency care include patient access to the emergency call number 112 and the on-call general practitioners services. Emergency care also includes the Emergency Medical Dispatch center, Emergency Medical Services (EMS), and the Major Incident Command Center (MICC). The MICC is in charge of command and control in case of a major incident and liaise with police and rescue services. The chief emergency physcician is in charge of all medical care at scene. As part of the hospital plan all emergency planning is going to be handle in an integrated medical dispatch center. The Hospital Plan will be supplemented with a special plan for the Capital Region s contingency services and pre-hospital care. Allocation of specialties among the hospitals in the Capital Region The Hospital Plan merges a large number of specialties into fewer units. The new allocation of specialties reflects the Capital Region s new division into more sustainable planning districts, resulting in a new between the district hospitals and local hospitals. It also reflects the region s general wish to gather the specialties in fewer locations with the aim of ensuring a high and uniform quality. The specialties are distributed among the region s hospitals as set out in the table below. The specialties fall into two categories: Main functions, which include the most common interventions within the given specialty, and special functions, which include rare, expensive and/or complicated interventions. The specialties within internal medicine, in particular, must retain the right to organize themselves differently depending on local conditions and functions, including the composition and volume of their specialties. This means that the internal-medicine functions can either be organized in independent departments for each relevant specialty, or be grouped together in departments as appropriate. Functions marked off in Table 1 indicate that the specialty is covered at the hospital in question, not that it has its own independent department. Each planning district will ensure the professional coordination among internal-medicine specialties by setting up cooperation forums with participation from the relevant hospitals.
Table 1. Allocation of specialties among hospitals in the Capital Region Basically, each special function in the region will be brought together at a single location. Rigshospitalet will handle much of the highly specialized treatment, but other hospitals in the region will also offer specialized treatments in certain selected specialties. For some special functions the number of patients will be so large that it may be necessary to allocate these functions to two hospitals in the region. Conversely, it is true of certain main functions that patient volume indicates it would be suitable to centralize treatment, concentrating it at no more than two (or three) hospitals in the region. Rigshospitalet Bornholm Glostrup Amager South Hvidovre Frederiksberg City Bispebjerg Gentofte Herlev Central Frederikssund Helsingør Hillerød North Emergency care Trauma centre Emergency Room Birthing location Internal-medicine functions Endocrinology Gastroenterology Cardiology Pulmonary medicine Infectious diseases Geriatrics Rheumatology Nephrology Haematology Surgical departments Surgery (gastroenterological procedures) Vascular surgery Plastic surgery Thoracic surgery Urology Mammary surgery Paediatric surgery Orthopaedic surgery Other clinical specialties/functions Gynaecology and obstetrics Paediatrics Clinical oncology Neurology Neurosurgery Dental, oral and maxillofacial surgery Otorhinolaryngology Audiology Ophthalmology Dermatology venerology Allergology Occupational and environmental medicine Palliative unit Dementia unit Interdisciplinary specialties Anaesthesiology intensive-care unit Pathological anatomy and cytology Diagnostic radiology Clinical biochemistry Clinical microbiology Clinical pharmacology Clinical physiology and nuclear medicine Clinical genetics Clinical immunology Functions that are handled at two of the region s hospitals will preferably be located at one hospital in the North or Middle planning district and one hospital in the South or City district. The allocation table also shows that some hospitals will handle certain specialties as external or satellite functions. An external function is one that is handled at special-function level or main-function level by staff (often medical specialists) from another physical location. Such an external function can be based either on a fixed schedule or on an ad-hoc arrangement with supervision or consultation called upon as needed. A satellite function is one that is handled at special-function level by the hospital s own staff, but is under the responsibility and supervision of a corresponding specialist department at another physical location. One example of a satellite function is dialysis. Consequences of the new structure The Hospital Plan will mean that the neurorehabilitation functions existing today at the locations in Esbønderup and Hornbæk will be transferred to other hospitals in the region. This may enable the region to sell these two locations. All of the functions existing at the location in Hørsholm in 2007 will gradually be transferred and integrated into the other hospitals in the region, freeing up the physical location for use by the Capital Region s psychiatric services. Financial issues The aim of the Hospital Plan is to enable the region to optimize performance and effectively utilize the financial resources employed. Overall, bringing the functions together at fewer locations will result in operational savings, and simplifying the administrative and managerial organization will liberate resources that can be used for clinical work. In financial terms, projections say that when fully implemented the rationalization efforts embodied in the Hospital Plan may lead to savings in the range of DKK 250 300 million per year. A precondition for implementing the Hospital Plan is that significant investments are made in reconstructing and adapting the existing buildings and installations to suit their future use. This is particularly true of Rigshospitalet and the four district hospitals, where major investments will be needed to achieve an appropriate functionality and size. The capital investments expected to arise from the changes outlined in the Hospital Plan total roughly DKK 13 billion, distributed over a period of several years. About two-thirds of this amount arises directly from the restructuring stipulated in the plan, while about one-third is associated with necessary and, in some cases, planned renovations that would, and will, have to be completed in all events. *) For internal medicine at the local hospitals, the presence of specialist doctors in the internal-medicine function is marked. **) Tasks at special-function level must subsequently be allocated between or among departments.
Implementing the Hospital Plan The Hospital Plan cannot be implemented all at once. Some of the changes sketched out in the plan call for reconstruction and adaptation of existing physical facilities at the locations in question. Furthermore, relocation will sometimes involve several departments in an interlinked process since one department must be moved out in order for another to move in. The Capital Region aims to implement the Hospital Plan as quickly as possible, both out of consideration for the region s citizens and, no less importantly, out of consideration for the many hospital employees who will be affected as the new structure takes shape. The region expects to implement most of the Hospital Plan between 2007 and 2012. Management and employees The Capital Region appreciates that implementing the Hospital Plan is a complex process. Reallocating specialties and reorganizing the cooperation between hospitals, the plan will bring wide-ranging changes for many of the region s employees with respect to their job content as well as their physical working location, colleagues, and management. This will place great demands on the employees, while significantly increasing managerial and administrative challenges in the years to come. The Hospital Plan includes a series of general, staff-related initiatives aimed at ensuring flexible transitional arrangements during the reorganization process. These initiatives also aim to ensure professional, high-quality handling of hospital-related tasks throughout the planning period. They are likewise intended to promote the growth of a common culture and a shared identity across all four planning districts, thereby ultimately strengthening regional coherence. Cappital Region Kongens Vænge 2-4 3400 Hillerød Telefon: 48 20 50 00 E-mail: regionh@regionh.dk www.regionhovedstaden.dk