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Establishing Joint Acute Wards (JAWs)

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(16)2010
Author(s): 
Anne Birgitte Christensen, Jeppe Plesner, Mickael Bech
Health Policy Issues: 
System Organisation/ Integration, Quality Improvement, Access, HR Training/Capacities
Reform formerly reported in: 
HC Sector Organization
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no yes no no yes no no

Abstract

Establishment of joint acute wards (JAW) involves that all emergency and acute patient admissions are congregated in one ward. The new JAW will alter the organizational structure, from specialty-oriented to process-oriented, trespassing professional as well as specialty barriers. The JAW is the latest development in the general policy movement with fewer, larger and more specialised hospitals and fewer hospitals with acute admission.

Purpose of health policy or idea

Establishment of joint acute wards (JAWs) involves that all emergency and acute patient admissions are congregated in one ward. This contrasts the previous organization where emergency and acute patients where received in a number of different wards depending on how and from whom the patients were referred. JAWs are a part of a larger policy tendency with larger sustainable units with high focus on quality and standadized treatment (HPM Report (14)2009, Christiansen).

The new organisation in JAWs is focussing on the patient`s flow through the system and thereby emphazising horizontal ledership. These horizontal leaders will be responsible for triage and flow mastering. The purpose of the JAW is to secure uniform, fast, high quality diagnosing, care and treatment for all acute patients, 24 hours a day. This is done by designing standardized time controlled diagnostic and treatment schemes, and by altering the organizational structure, from specialty-oriented to process-oriented, trespassing professional as well as specialty barriers. Finally, enhancing the quality of diagnosis and treatment is also pursued by having senior doctors from the specialties internal medicine, orthopaedics and anaesthesia present in first line at all times, with responsibility for the quality of the patient related activities as well as the education and supervision of younger doctors and other staff.

Main points

Main objectives

Improving quality of diagnosing and treatment of acute medical admission patients.

Type of incentives

Organizational change and education.

Groups affected

Doctors at all levels, nurses at all levels, additional clinical workers, e.g. physiotherapists, radiographers, bioanalysts

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent system-dependent system-neutral

Political and economic background

As a result of the 2005 report from the National Board of Health on the Danish acute admission system, a new health legislation was enforced in 2005 (rev. 2008) by the Danish Ministry of Interior and Health which instructed the Regional Governments to develop plans for the short- and long term improvement of the hospital sector, especially with regard to the acute and emergency admission system. In accordance, the regional governments have developed plans for establishing a uniform system of patient reception, diagnosing and initial treatment in Joint Acute Wards (JAWs). The overarching concept of JAWs is described in some detail in a national policy report (Sundhedsstyrelsen, 2007). Though some variations between the regional implementations are to be expected, the basic concept is as described above.

The Regional implementation plans are further described e.g. concerning the Region of Southern Denmark in reports, which are representative of the current state of implementation (Region Syddanmark 2009a and 2009b).

Change based on an overall national health policy statement

Sundhedsloven (Health Law) 2005; Sundhedsloven (Health Law) 2008, Specialeplanen (Specialty Planning) 2010

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no yes no no yes no no

Origins of health policy idea

The overall idea of JAWs as a vehicle for improving the reception, diagnosing and treatment of acute patients has come from a group of people consisting of local government representatives, people from the National Board of Health and from the Ministry of Interior and Health.

The subsequent details of the concept have been evolved by workgroups under the individual regional governments.

Initiators of idea/main actors

  • Government: The process is primarily driven by a relatively small number of central decision makers, who have formulated the politics, the overall concept and the implementation plan. Local implementations are largely delegated to the specific organizations.
  • Providers
  • Patients, Consumers

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Establishment of the Joint Acute Wards (JWAs) is part of a general policy formulated in the early 2000s where fewer hospital are expected to have acute emergency wards. This policy was formulated in a number of national policy reports and implemented in regional plans from around 2005 and onwards. The policy process has mainly been pushed by the National Board of Health and some of the medical specialty organisations. The policy process is supported by the Minister of Health.

There has been very few reactions in the past from professionals especially doctors, but recently some of the senior doctors have entered the debate as the consequence of the organisational change getting more concrete. There have been some critical reactions from local stakeholders, as they see JAW as a threat to the sustainability of some of the current specialties.

Actors and positions

Description of actors and their positions
Government
Minister of Healthvery supportivevery supportive strongly opposed
National Board of Healthvery supportivevery supportive strongly opposed
Local Government (Amtsrådsforeningen)very supportivevery supportive strongly opposed
National Board of Healthvery supportivevery supportive strongly opposed
Local Government (Danske Regioner)very supportivevery supportive strongly opposed
Providers
Danish Medical Associationvery supportivesupportive strongly opposed
Danish Nurses' Organizationvery supportivesupportive strongly opposed
Other Professionals org.very supportiveneutral strongly opposed
Local Senior Physician organizationsvery supportiveopposed strongly opposed
Patients, Consumers
Patients' organisationsvery supportiveneutral strongly opposed

Influences in policy making and legislation

The National Board of Health has been a major actor in the implementation. Lately in the national specialty planning where all specialised treatments have been allocated between hospitals in Denmark the National Board of Health has shown its influence on detailed planning in the Danish health care system including acute admission.

Actors and influence

Description of actors and their influence

Government
Minister of Healthvery strongvery strong none
National Board of Healthvery strongvery strong none
Local Government (Amtsrådsforeningen)very strongstrong none
National Board of Healthvery strongvery strong none
Local Government (Danske Regioner)very strongvery strong none
Providers
Danish Medical Associationvery strongweak none
Danish Nurses' Organizationvery strongweak none
Other Professionals org.very strongnone none
Local Senior Physician organizationsvery strongweak none
Patients, Consumers
Patients' organisationsvery strongnone none
Local Government (Amtsrådsforeningen)Minister of Health, National Board of Health, National Board of Health, Local Government (Danske Regioner)Danish Medical Association, Danish Nurses' OrganizationOther Professionals org., Patients' organisationsLocal Senior Physician organizations

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Review mechanisms

Final evaluation (external)

Expected outcome

The political process has been rather ambitious in the scope of organizational change it imposes. The results of the actual implementations remains to be seen. The outcome is likely to be affected by the reactions from the professionals' organizations, as the consequences of these alterations are realized by the stakeholders.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high

References

Sources of Information

Reform formerly reported in

HC Sector Organization
Process Stages: Policy Paper, Idea

Author/s and/or contributors to this survey

Anne Birgitte Christensen, Jeppe Plesner, Mickael Bech

Anne Birgitte Christensen and Jeppe Plesner are currently employed at the Region of Southern Denmark and affiliated with the Institute for Public Health at University of Southern Denmark. Mickael Bech is a Professor at the Institute for Public Health at University of Southern Denmark.

Suggested citation for this online article

Anne Birgitte Christensen, Jeppe Plesner, Mickael Bech. "Establishing Joint Acute Wards (JAWs)". Health Policy Monitor, Oct 2010. Available at http://www.hpm.org/survey/dk/a16/1