Culture. Trust. Quality. Pride. A group of 25 American medical professionals visited Sweden in March 2015 as part of a postgraduate course comparing the healthcare systems of Sweden and the USA. And those four words were what group members repeatedly used to describe what distinguishes healthcare in Sweden. They probably would not have chosen those descriptors had they not to come to Stockholm.
The group of American medical professionals and professors came to Sweden from LeTourneau University and Central Michigan University to gain first-hand experience into how healthcare is provided in Sweden in order to compare it against care provision in the USA. The students — all of whom are certified healthcare professionals who maintain full-time jobs within healthcare administration at various American healthcare institutions, companies and — were taking a course offered in the Masters of Healthcare Administration programs of both universities.
Unique learning combines classroom and study tour
The course, combining online theoretical learning with an intensive five-day study tour to Sweden held over their spring break, was designed to provide students with the opportunity to develop cross-cultural references of international healthcare provision. The intensive, hands-on study tour was incorporated to enable the American students to gain practical insights and a deeper understanding of healthcare in Sweden.
Dr. Bryan C. Schneider, Director of Healthcare Management programs and an assistant professor at LeTourneau University, developed the program and course. Dr. Schneider is also a graduate of Central Michigan University and a former student of Dr. Lana Ivanitskaya, Professor of Health Sciences and Doctor of Health Administration at Central Michigan University. Dr. Schneider turned to a private company called Swedish Health Care to support him in designing, arranging and implementing the study tour in Sweden.
According to Dr. Lana Ivanitskaya, “Physical meetings and study tours are important as the bring together students who are healthcare administration professionals with many collective years of experience. They get to interact with each other educational faculty and others active in healthcare.”
Culture, trust and healthcare are clearly connected in Sweden
Gary Gainous, who works at the Center for Disease Control in Atlanta, Georgia, was a member of the group studying Masters of Healthcare Administration at Central Michigan University. He has experienced various national healthcare systems gained from a 24-year career in the U.S. Navy, which included living six years in the United Kingdom and three years in Italy.
Gainous describes the connections between culture, trust and healthcare, “After coming here, I find there is a culture that supports the healthcare system. There is a sense of trust that the system will work. In the US, there is not a lot of trust. So when the central government tries to implement things like the Patient Protection and Affordable Care Act, for instance, there is not a lot of trust and support like there should be.”
Cultural differences, meanwhile, underpin some the underlying aspects that make comparisons of healthcare systems difficult.
So explains a second group member was Steve Powell, who works as President and CEO of Synensis, an evidence-based training and consulting company based near Atlanta, Georgia that has supported more than 500 hospitals around the world. Powell explains how national culture impacts healthcare and social welfare models, “Welfare in our (American) context is very negative. The belief here is that people have a social right to social healthcare and welfare services. I don’t think we could have that same agreement quickly in the States.”
Gainous agrees, “Some things about the healthcare system in the US and Sweden you just can’t compare. Size is one example. However, I think the biggest difference — and why healthcare works so well in Sweden — is culture.”
Care quality secured by common infrastructure and rooted in Sweden’s values
Care quality was one area the American medical professionals felt that their Swedish colleagues had excelled. Doug Anderson, employed as an Adjunct, Health Care Administration at the Health Care Management and Administration Faculty of LeTourneau University and Doctoral student at Central Michigan University, said, “The US can learn a lot from Sweden. Your electronic initiative is nationally driven, your electronic charts and the registries. Most countries struggle with continuity of care. Having that continuity and common infrastructure in place can truly help improve the quality of care.”
Dr. Lana Ivanitskaya compared quality and onions when talking about healthcare in Sweden, “What’s most admirable to me is the quality of life orientation. In a way, healthcare in Sweden is a lot like onions. When you peel off layers from an onion you are left with the essential part. So what is at the center of Sweden’s healthcare onion — the part that is not to be peeled off — is universal needs provision for everyone in society. This ensures everyone has essential protection to live a worthy life.”
Direct meetings with Swedish colleagues
One member of the group of Americans who enjoyed a personalized look into how her Swedish equivalents manage their work was Catherine (Cathy) D. Robinson. A registered Medical Technologist employed at The American Society for Clinical Pathology, Robinson got to visit Allarus reference laboratory in Stockholm and speak directly with Swedish laboratorians and pathologists about the scope of their work and practices to better understand the similarities and differences of working in Sweden and the USA.
“The interaction on ground-level — let me see your equipment, let me see your quality control, your quality assurance — that was extremely valuable to me. I do a lot of work in developing countries. So it is interesting to see the differences with those countries and compare them against how practices are done in well-developed countries outside of the USA.”
“Coming from the US and seeing all that is going on in Sweden, and when you look at the big picture globally, then you can see why there are so many variations in the delivery and organization of healthcare,” continue Robinson. “It really is tailored to the social responsibility and cultural prioritization that is unique to every single country. So you get to see places where healthcare and social welfare is prioritized, like in Sweden, and where it is not in other countries. It is interesting to see those global patterns of how it all works together.”
Visiting Swedish clinics gives important insights
Veronica Carreon, an advanced practice nurse based in Houston, Texas studying the course at LeTourneau University, also described the importance of coming to places like Sweden to see how healthcare is applied in practice.
“We got to visit two clinics and two hospitals here. Coming here was very important because not only do you realize why the healthcare system works the way it does, you get to immerse yourself in Swedish culture and see why Swedish healthcare pactioners take pride in following that work pattern.“
Of course, Sweden’s healthcare system also has areas where it can learn from the USA. Carreon noted one such area, “For me it was an eye opener, especially for my career field. I’m an advanced practice nurse, a field that they do not even recognize here in Sweden. That means I actually see patients like a family or general practioner. I see that as a disadvantage here because I know a lot of the nurses here take on a lot of those advanced roles.”
Why compare Sweden and the USA?
Sweden is a relatively small country located in Northern Europe, with an estimated population of just over 9.6 million people in December of 2013. But Sweden is also renowned for fostering one of the world’s most generous and effective healthcare and social welfare systems; featuring universal coverage for all its citizens as well as high quality, economically viable care provision. Over the years, comparative analyses published by the likes of the Organization for Economic Co-operation and Development have consistently ranked Sweden as amongst as having the top healthcare systems in the world as well as noted the proficiency of Swedish healthcare professionals in delivering high quality, sustainable care.
Meanwhile, America’s healthcare and social welfare models are less praised in most international comparative analyses. One example: a 2014 comparative analysis report of the healthcare systems of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States of America. While the U.S. healthcare system was distinguished as being as the most expensive in the world, it ranked last overall as well as on most dimensions of performance.
The report, entitled Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally was published by a private American organization based in New York called The Commonwealth Fund. As important, their 2014 findings were consistent with other similar studies as well as the organizations own previous studies, performed in 2010, 2007, 2006 and 2004. So concludes its authors, whom include Karen Davis, the Eugene and Mildred Lipitz Professor in the Department of Health Policy and Management and director of the Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins University in the USA.
Clearly American healthcare professionals, institutions and authorities are dedicated to improving national, State and local processes — as well as achieving better patient safety and care quality. One means to achieve this: look to other countries in order to gain new perspectives.