Kampen on Karolinska: Konsulterna by Anna Gustafsson and Lisa Röstlund

If you haven’t read the book Kampen om Karolinska: Konsulterna (the battle of Karolinska: The Consultants) and you work with eHealth or health care – you should definitely read it!

The book is written by two journalists working at DN which is one of the large high quality newspapers in Sweden. There has also been a large series of articles in DN related to Nya Karolinska. In short the building of this hospital has cost Sweden billions of money and there are numerous scandals along the way. Today the hospital still has a serious crisis as staff has quit, patients have died and very few people admit to have had the responsibility for the situation.

When writing the book the authors have done more than 200 interviews, read thousands of documents and spent several years understanding the process. In the book they have chosen to present their findings through stories from interviews and the book has a long list of references,

Others have also found this book interesting and Läkartidningen writes: “A book that ought to be a compulsory read”. Managers and leaders in health care should read this book, according to Läkartidningen.

In short the book is about the building of a new university hospital in Stockholm, New Karolinska Hospital, and the events related to management and organisations that is quite a horrible read.

Five things I found especially interesting while reading was:

    Boston Consulting Group earned enormous money from the implementation of management ideas that were really not very well tested at all. Moreover, many of the consultants had no experience from health care and were very young. They have 16 000 employees in 50 countries. I think academia have problems with impact in health care with research results, but obviously these people had no problems with impact at all. What did they do to be heard and listened to?
    Some of the ideas from Value Based Care are indeed good, such as a focus on patient’s values. However, they seem no to dominante the processes when implemented and many of the managers seems to have forgotten the patients in the change process. In the summer of 2017 60 cancer patients at Karolinska did not get their surgery on time! A result from money connected to patient value could be that areas where patients are quite well will have high numbers on satisfaction/value and hence get more money whereas hospitals treating people with multiple and complex problems would get less money.
    The ideas with metrics based control in their management strategy is indeed crazy, and I don’t understand how this idea could continue to be attraktive after the failures of new public management? When measuring there is a risk that people pay more attention to what is possible to measure independently on if it is important or not. Things that are not possible to measure will be seen as less important.
    A process oriented organisation without clinics seems really risky to implement. Where did they get this idea from, and how could they base the management strategy on the core idea that one patient has one decease when we know that there is is large group of patients that has multiple deceases?
    There is an interesting tension between the laws in health care and innovation. Some of the things they implemented at Karolinska was really illegal and did not for example comply with GDPR. However, I also think that sometimes the laws need to be tested as they are not really made for a digitalized society.