This post is an automatic translation from a text written in Slovenian. Translation is generated with use of DeepL Pro tool. Original text is postaed and available here: https://paradim.si/category/slovensko-zdravstvo-2022-23/

In making these following descriptions, I draw on the content of the media, specifically RadioTelevizija Slovenija (RTV Slovenia) and a review of the programmes Tarča, Odmevi and Studio at 17:00, which dealt with the topic of health care. The content is primarily aimed at primary health care and family doctors.

Changed context

As a first and in some ways fundamental theme, I would like to highlight the message that change is initiated and triggered by external factors. When we talk about ‘external factors or agents’, this refers to things that are beyond our reach and beyond our control. This means that we have to adapt to them. In order not to blur the clarity of this message, I will focus on the central change highlighted: the ageing of the population and the increase in demands on the health system.

To put it another way: for the same number of inhabitants and the same number of patients on a family doctor’s ‘own list’, there are more visits to the doctor and more treatments than in the past. As medicine advances, life expectancy is increasing. At the same time, we have new knowledge, new procedures, new treatment options; more and more diseases can be successfully treated, more and more deteriorating health conditions can be (successfully) addressed and turned around. Expectations and demands on the healthcare system – the list of questions and needs we have when we go to see a doctor, and the frequency of visits – have increased.

The need to keep up with changes in work

The existence of medical advances and new possibilities for us as patients is (sometimes) obscured by the resulting workload, which reduces both the treatment time and (quite humanly, of course) the focus that can be achieved by the doctor treating us. The current situation is entirely due to the fact that the external change described above has not been followed by an internal one. The internal environment, on the contrary, is one that is within our reach and that we shape ourselves.

In the current situation, we see that the rules of the system of the past no longer work today. Watching the broadcasts, I have heard some ‘calls’ for a return to the example of the past, including the example of the old common state. To return to that image would mean a highly labour-intensive activity. This means that we would have to recruit a huge number of additional staff who could (in the same way as before) serve the increased needs of the population. This of course means an increased monetary investment (these funds have to come from somewhere), but at the same time we can question the other part: can we get the staff we need from somewhere?

Maintaining the models of the past could therefore be extremely costly, extremely consuming. Another possible solution is change and new models.

What lies ahead – personal level

Change is externally triggered or initiated and internal adaptation is a necessity. Rok Ravnikar, a family doctor and also chairman of the Primary Health Care Committee at the Medical Chamber, calls on the general public to self-reflect and embrace change when implementing change (and thus the renewal of our health care). What does this mean?

Self-reflection means a kind of personal reflection: on the situation and how we experience it. It is aimed at each of us personally, but also at our relationship with health professionals. In terms of content, it means that we want to raise awareness about what is happening in healthcare, about who we expect what from, awareness about ourselves, our emotional experience and our relationship with others. For example, if we direct anger and pressure unfairly at healthcare staff (or anyone else), we are unfortunately only exacerbating the burden and the existing problem and contributing significantly to the problem.

Embracing change can mean taking the time to monitor change. To be informed about the situation and the change: to gain an understanding of the causes of change and the need for change, to gain insight into the current functioning of health facilities and staff, to gain an understanding of the new solutions (what they are, how they are used and what I can get from them), so that we can also get all the help and value that the new form offers us.

What lies ahead – system activities

Let’s look at the system level. I have gathered some of the key areas where there is talk of activities and different changes.

Recruitment

The first, “instant” action is recruitment abroad. Among the contributions, recruitment in BIH, attracting other doctors (including retired ones), and the “firefighting project” in the form of new clinics for the unidentified can also be placed here. In this area, reference is made to the legal facilitation of procedures for recruitment from abroad. I have seen references (ideas) for additional rotation of specialists (from all fields of specialisation) in family medicine departments and a desire to attract young people to study medicine in this field. All forms of attraction have, of course, a great deal to do with the general improvements in working conditions addressed by other areas.

Increasing work efficiency by improving organisation

“More will have to be done with the staff available. The organisation will have to be improved.” I will deal with this point in more detail in a future note. For the time being, I will stick to the main points: transfer of administrative activities to the Health Insurance Fund, transfer of sickness management to occupational, transport and sports medicine, inclusion of more support staff in outpatient clinics (the concessionaire model and the Estonian model are mentioned), transfer of competences to nursing staff (i.e. more responsibility, more tasks to make more use of the expertise of these members of the medical teams), improvement of management and leadership through compulsory training, consistent fulfilment of medical duty by all doctors, and non-substitution of work.

Other initiatives or expectations mentioned were, for example: reduction of work channels (current face-to-face, e-mail, e-portal, telephone treatment), equal working conditions with concessionaires, equalisation of duties of doctors from the public network and concessionaires (concessionaires do not have the burden of on-call and emergency care), more flexibility and room for self-organisation of work (not specified).

Simplification of work through digitisation

The essence of digitisation is to simplify or speed up work (either the performance of a work activity or the transfer of information) and to shift the burden of performing an activity from a human to a (designed and created) programme. As such, digitisation is the second necessity (besides organisation) if we want to do more and create more value with a given workforce. What is mentioned in this area?

• The “unfinished digitalisation” has brought about the parallel physical and electronic data entry, i.e. the use of electronic data sets, and at the same time the necessity of having physical records in the case of inspection. The time-consuming process of searching the records when visiting or treating patients is also time-consuming, which is estimated to amount to between 70 and 100 record searches per day per outpatient clinic. There is a call for the use of e-forms to be mandated or required, which is currently (partly or fully) free.
• The inadequacy of the information system is also mentioned. The transfer of data in shared patient care (substitute doctor, mutual assistance between doctors, specialist care) is not smooth, as the information systems are not linked. There are calls for a stable and single (central) repository or database and an e-cardboard.
• There are 16 software tools for data entry, which are not harmonised or standardised: they send data to the central repository or database in different formats or formats, which has resulted in some data drop-outs. Standardisation and cetrification of software is foreseen in this area.

Other

In this section I include other topics that have either been mentioned to a lesser extent or merely as problem areas, but for which no solutions have been mentioned.

• Internal relations. If I were to name three words that stand out in the treatment of health care issues, they would be: organisation, digitalisation and relationships. In the area of organisation, there are calls for better management (and other very specific measures already listed above), in the area of digitisation for the regulation of the e-cardboard and shared data storage, and in the area of relations, there are no specific solutions. Leadership (which is not the same as management!) and organisational culture in healthcare are topics that will be addressed in future articles.
• Relations with patients and other publics. The problem of public pressure and the burden it places on health staff is mentioned. The high perceived value of a good patient response to the care provided by healthcare staff is also mentioned. Soft, emotional content is very important (especially in times of chaos, overstretch and emergency). To this can be added the question of how inter-hospital and inter-departmental cooperation takes place, where poor relationships can increase the time taken to complete activities and increase the (emotional) burden of the work just as much. To what extent are these relationships important and would it make sense to think about professionalising this area with a public relations role, otherwise known (and defined) as a communication role in healthcare organisations? How important is the communication of information and the creation of appropriate, equitable awareness (among different groups)?
• A comprehensive model of health services. Who can take on the burden of on-call doctors? How many are “real” health treatments that need medically trained staff, and how many could be taken over by other staff? The call for other staff to be involved in the mission of healthcare is raised in the discussions – how far can we look here? The NIJH is a multifaceted, interdisciplinary organisation in the wider health system, and one possibility is to intensify communication activation by preparing and also properly presenting or promoting educational material that is part of preventive work on public health. I suppose the orientation is always: 1 prevents, 2 heals.

Conclusion

In this section, I would just like to briefly reiterate two key points:

• Change is a necessity, because the external circumstances are new and changed. Going back is not the solution, because a true return would require fewer options, less research and less help for the patient.
• Let us embrace change, let us inform ourselves about it, let us monitor change. Even if we have a mixture of feelings during the transition period, this is the right and necessary direction.

The following TV and radio programmes are sources of content on healthcare in Slovenia for the production of the notes:

Kogovšek, B. (editor) and Žnidaršič, E. (presenter). Iskanje zdravnika – loterija. Guests: D. Bešič Loredan in R. Ravnikar. Date of broadcasting: 1 December 2022.

[na posnetku ni podatka o uredniku] Žnidaršič, E. (presenter). Slovenski bolnik. Guests: Erik Brecelj, Brigita Skela Savič, Igor Muževič, Miha Kordiš, Alenka Forte, Tea Jarc. Date of broadcasting: 12 January 2023.

Malerič, A. (editor) and Starič, T. (presenter). Odmevi: Razpad zdravstvenega sistema? Guest: Daniel Bešič Loredan. Date of broadcasting: 29 December 2022.

Saksida, A. (editor) and Bergant, I. E. (presenter). Odmevi: Zdravstveni sistem pred kolapsom? Guests: Dušan Keber in Rok Ravnikar. Date of broadcasting: 4 January 2023.

Saksida, A. (editor) and Starič, T. (presenter). Odmevi: Jernej Završnik o kritičnem pomanjkanju kadrov. Guest: Jernej Završnik. Date of broadcasting: 5 January 2023.

Koren, K. (editor) and Starič, T. (presenter). Odmevi: Vrste pred bežigrajskim zdravstvenim domom. Guests: Daniel Bešič Loredan, Antonija Poplas Susič, Duša Hlade Zore. Date of broadcasting: 6 January 2023.

Saksida, A. (editor) and Pesek, R. (presenter). Odmevi: Pogovor z Zoranom Jankovićem o zdravstvu v Ljubljani. Guest: Zoran Janković. Date of broadcasting: 9 January 2023.

Nahtigal, M. (editor) and Pesek, R. (presenter). Odmevi: Politične stranke po protestih pacientov. Guests: Jani Prednik, Matej Tašner Vatovec, Janez Cigler Kralj, Karmen Furman. Date of broadcasting: 10 January 2023.

Saksida, A. (editor) and Pesek, R. (presenter). Odmevi: Kersnič in Stepanovič o težavah v zdravstvu. Guests: Boštjan Kersnič in Aleksander Stepanovič. Date of broadcasting: 11 January 2023.

Štolar, E. (editor) in Valjavec, U. (presenter). Studio ob 17.00: Razkroj javnih sistemov. Gostje: Marko Jaklič, Damijan Štefanc, Barbara Kobal. Date of broadcasting: 9 January 2023.

Štolar, E. (editor) in Ilijaš, S. (presenter). Studio ob 17.00: Zdravniške stavke ne bo, problemi zdravstva ostajajo. Gostje: Irena Vatovec, Nena Kopčavar Guček, Tatjana Mlakar. Date of broadcasting: 11 January 2023.