Post cardiac arrest care and survivorship

Last week an international research conference Post Cardiac Arrest Care was arranged in Lund Together with Johan Israelsson, PhD and Resuscitation Coordinator in Region Kalmar County, I was invited to speak about peer support after cardiac arrest. Take part in our PowerPoint presentation here

It was a very special feeling to step into the conference room, which was the auditorium of the university hospital in Lund, the same place where many years ago I took my degree as a physiotherapist. This time I was invited to talk about my cardiac arrest and about the work that my wife and I engage in through the Swedish network for cardiac arrest survivors and their relatives.

Moderator at our seminar was Christian Hassager, a cardiologist and former director of a specialized cardiology intensive care unit at the University Hospital Rigshospitalet in Copenhagen and now Professor in this field at Copenhagen University. In September 2017, when I had my cardiac arrest and was treated at Rigshospitalet, he was the head of the department where I was treated. I was so glad to meet him and once again to express my thanks for excellent care.
My grandson Svante had an explanation, he was then three years old.
– ”Grandpa, your heart was broken, but now it’s mended” ❤️

Photo: Kristofer Årestedt

During our presentation, Johan presented current research and what efforts are underway in the area of ​​life after a cardiac arrest, and I talked about my cardiac arrest, about my fantastic lifesavers and about the entire care chain that gave me the possibility to continue living. When I had my cardiac arrest, I had a public role as the president of the Swedish Association of Physiotherapists, (a mission that I finished two years ago).
That made us immediately decide to be transparent about what happened and we have therefore told our story about the cardiac arrest publicly many times. We hope that in this way we will be able to help others who have suffered a cardiac arrest and their relatives.

I also talked about what my wife Annmargreth and I have done and learned in the past five years.First of all, we have learned to take advantage of every day, of the opportunity to spend time with children and grandchildren and to remember that every day is a gift.

Photo: Kristofer Årestedt

We have also learned that it’s important to do what I can do myself to have good living habits. We use at least one to two hours per day to exercise and to be out in nature.
We also work to spread knowledge about CPR, AEDs, SMS lifesavers and the 112 app.
And so it has become a habit to always check where the nearest AED is. It should go without saying that all conferences started with the brief information:
There is the emergency exit, there is the toilet – and there is the nearest AED.

I also talked about the Swedish network for cardiac arrest survivors and their relatives. At the beginning of 2021, we started a Facebook group. In the beginning, we were a few survivors and relatives who, together with the Swedish Resuscitation council and the Swedish Heart and Lung Association, founded the network.

Today we are 300 members and we are getting more every week. Nowadays, the request to join the network can come just a week after the person got a cardiac arrest, and it feels very meaningful to be able to share experiences and to be able to support each other.

In the network, it has become clear that there are shortcomings in the care of relatives. Of course, all the focus easily falls on the survivor, but next to the survivor there are always relatives, who are also hit hard and who need better attention. Here, too, our network can contribute to providing support to each other and to exchanging experiences.

The entire conference was filled with interesting talks and presentations of new research results. A presentation that made a particularly strong impression on me was a speech by Kelly Sawyer, an Emergency Medicine physician and Assistant Professor at the University of Pittsburgh, who herself had suffered a cardiac arrest eleven years ago.

She gave a very interesting overview of the whole field of cardiac arrest, and particularly emphasized the field of cardiac arrest survivorship.

It was instructive and very inspiring to participate in this conference. Many thanks to the organizers for the invitation and for a very well conducted conference.

*You can now find all the presentations on the website:’_presentations
The site will be updated as more presentations are submitted. 

My speech on the Leadership Symposium at WCPT Congress 2019

This is my speech on the Leadership Symposium at WCPT Congress 2019 in Geneva May 11. You can watch the whole Leadership Symposium here  and you can find my slides here

1. It´s great to be here, and it´s a huge challenge talking about leadership, both with you who are here in Geneva and you who follow thissymposium via the web.

2. I started as a leader after 3 years as a psysiotherapist, when I was 25 and I have worked as a leader since then, and today I´m 62.  

 When I was 32, I thought I had already learned most things that could be learned from life.  I was the manager, had a wife and three children, car, villa and dog.  What more could I learn from life?  But then my mother died, I was devestated, I missed her so much.  And I did understand that there was much more to learn from life.

After 15 years of clinical work including the assignment as head of the physiotherapy department, I was asked to become the hospital director, and was given the responsibility for 700 employees. It was 6 extremely challenging years, filled with new lessons and experiences.

I then got an assignment as chief of innovation and learning in the county council with responsibility for research and development and was trained in systematic improvement work in complex organizations. Now I started to understand the expression: “Every system is perfectly designed to get the results it gets”. If you want to achieve change, you must act in a new way, otherwise the result will be the same.

But although I had learned a lot in my clinical work as a physiotherapist, and as a leader at the highest level in county councils, I have learned most of all as a leader, when I have been a patient myself or a relative. 

Me and my wife Annmargreth followed my father’s last four years in life, when he had a lot of trouble before he died.  We also followed my wife’s aunt Karin, who became demented the last years of her life. Both I and Annmargreth have worked in healthcare throughout our professional life, one could say that we are a kind of experts.  Yet it was SO hard to be able to influence my dad’s and Karin´s care. I learned the importance of always looking from the perspective of patients and their families.  

I have learned to always ask the question What matters to you?  This applies both to patients and their families in the clinical work and to your employees as a leader. If you dare to ask the question, you will get the answers.
My family, my wife, children and grandchildren, we are a great crowd, have also greatly affected my leadership. They have helped me to understand what really matters to me.

But most of all I have probably learned from when I became a patient myself 18 months ago.  I got a cardiac arrest when we were out on a cycling holiday.  My wife Annmargreth saved my life when she, together with others, started cardiovascular rescue and alarmed ambulance. I was dead for 20 minutes, but now I´m here again, I got the chance to live again, I work full time and I can work out still more then before the cardiac arrest. I am of course very very grateful and have learned even more about what is really important in life. And now I use this knowledgein my leadership as president of our association.
My question to all of you today is: What matters to you? 

3. What are my experiences of leadership in the physiotherapy profession? I know there is incredible knowledge of the subject physiotherapy and treatment methods, but in my opinion less interest and knowledge of how complex organizations work. As physiotherapists we are often standing beside the influence of policy makers and stake holders, beside health care development, busy enough with our own professional development. I do believe that we need to tell the world the possibilities with physiotherapy and physical acitivity, we need to provide a movement!

 4. I would like to tell you about two good examples from my time as a leader.  

The first example is from my time as chief of innovation and learning at the County Council of Kalmar, where I started up and led a systematic improvement work called Every day a little bit better- the power of many. The improvement work started 12 years ago and it´s still working. Today the whole organisation are using storytelling, telling Every day stories, about positive improvement work from the perspective of the patients and their families. 

5. I had worked 20 years as a leader when I got an advice from my coach: You should probably attend this master’s course for a degree in improving health care.  Honestly, I thought he was joking with me.  What could I learn, I already had 20 years of experience in managing health care.  After all, I started the education, and after only one month I do remember that I wrote a paper: How would I be able to cope with my job without this education?  I now learned theories for what I had previously worked with as a leader.  It made me safer and better as a leader and I began to understand the conditions for leading complex systems

All the student’s essays were summarized in a book from the university,and my essay was about attention.  Attention is the currency of leadership.  

6. I got theories and knowledge, not least from the IHI, Institute for Healthcare Improvement in Boston, where I learned the importance of building will and understanding, building improvement knowledge in the complex organization and also ensuring that improvements are executed.

7. These seven points are a summary of lots of actions carried out in the IHI-campaign: Save 100,000 lives.  I had the opportunity to apply these seven points in the improvement work in Every day a little bit better– the power of many.  

Set an overall goal. Build strategies in the leaders’ hearts. Channel the management’s attention to all levels of the organization for improvement work.  It is very important what you as a leader are asking for.  What is the most important question? Is about the financial results?  Or are you asking for the Quality Score from the patient’s perspective?  And it plays a crucial role that there is a team, where patients and their families are the most important and central persons.

8. By Maureen Bisognano, former CEO, IHI and o role model for me anmany others, I learned the importance of that all change starts with myself as a leader.  Leaders need to go ahead and as a leader you also need to transform your team, your organization and not least your profession. She also taught me the importance of Joy in work, and that you first must take care of yourself, before you take care of others. She said: You cannot give to others what you do not have yourself.

9. The second good example is about our improvement journey in the Swedish Association of Physiotherapists.  When I was elected new president in 2013, our association had already worked hard for many years with how obvious physiotherapists’ efforts are for sustainable health and welfare. A really good job, but it was not as well known in society and by decision makers. 

The new board set a new goal. We wanted to develop from a professional organisation that must chase to be listened to, into an organisation which is constantly in demand and obvious to the authorities. We took the strategy to our hearts, we focused on quality and patient safety work, we tried to be very transparent and active on social media and we started to build good relationships, we worked closely with patient organizations and other professional bodies, with decision makers and authorities and many others.  It took us 4 years of hard work to achieve our goal at national level. Today we are in demand as a union and professional body and we are also perceived to have great influence on Swedish healthcare.

10. What were the key issues? Well, we started with a new perspective from the outside and inwards and we learned from others.

11. We conducted dialogues and discussions with patient representatives, decision makers at national and local level, other professions and of course with our own members.  We photographed, used social media and showed our attention to our partners. We asked them for good advice, we listened and now they are carrying our message and our vision.

12. Based on the UN’s global goals and based on all the dialogues we have had, our congress adopted a new vision.  Everyone should be able to live healthy lives in movement and we also adopted a foundation of values ​​based on the equal value of all people and on the three words: in movement, trustworthy and together.

13. After the congress 2016, we conducted new dialogues with decision makers and patient representatives in what we called the physiotherapists’ health trip. We developed a program Three Boosts for Sweden and we spread this program on different influencing arenas.

14. As my fourth and final point, I want to give some good advice to you who are leaders or who are thinking of becoming leaders.
Always focus on Patient involvement and Joy in work. Choose your chief and get yourself a good mentor. Think and act sustainable and never forget to think outside the box, Be transparent and proactive in your communication, Try to understand the context and do remember that ”Attention is the currency of leadership” and ”It´s all about relationships”.

15. When I went to Singapore and WCPT Congress in 2015, we from the Swedish Association of Physiotherapists, brought a Pippi doll in ourluggage. We gave it to our incoming president Emma Stokes and gave her three words from Astrid Lindgren, the author of Pippi Longstocking, who came from my hometown Vimmerby.  The three words were responsibility, courage and imagination.

16. At this World Congress in Geneva I bring the message from the 16-year-old climate activist from Sweden, Greta Thunberg.  Greta Thunberg has received followers all over the world in a short time.  She has a clear message and struggles together with millions of people around the planet to save the earth from climate disaster.  We can learn a lot from Greta.  She speaks with an inner commitment, with a clear and simple language and she describes with absolute honesty what needs to be changed. She is a young, big leader who lives her vision.

 I met Greta a few weeks ago and, on the link, you can listen to her message to us regarding the climate in a short video. Her message is ”Sorry to disturb you – but it’s time to act. She begs us and all adults and people in power to act for the climate, for the sake of our children and grandchildren. 

In Sweden, some of our members have started a movement Physiotherapists for future, which every Friday shows Greta Thunberg their support in the fight for the climate #FridaysForFuture. Greta is onerole model for our work for a sustainable healthcare. Without sustainable development there will be no sustainable health and welfare. We do need a new more person centred and sustainable leadership.

17. Many years ago, I listened to Jim Easton, leader in healthcare in the UK.  His advice for being a successful leader is similar to the way Greta Thunberg has:

As a leader I ought to give unlimited recognition of what´s already good, absolute honesty about what needs to be changed and use improvement as the way from today to tomorrow!

18. Having role models is very important as a leader, but also to realize that you as a leader yourself are a role model to others
These three people has meant a lot to me as an improvement leader,

Helen Bevan, UK, a change agent in healthcare, talking about network and hierarchy,

Maureen Bisognano, US, a brilliant leader and former president on IHI, she has established the term What matters to you? globally, and Göran Henriks, chief of innovation and learning at Qulturum, Region Jönköping, Sweden, and also my coach for many years.

19. Finally, it is important to remember that the most important thing is how we as leaders act, not just what we say.  It may be illustrated by my son Ludvig and my grandson Sixten.  Thank you!

 If you want to read more, this is an debate article THERE IS A NEED FOR A NEW LEADERSHIP IN HEALTHCARE

There is a need for a new leadership in healthcare

Before the Symposium on Leadership that I will participate in at WCPT Congress next week, I publish here the English version of the article of debate that I wrote together with Cecilia Winberg, Vice President. It was published in the Swedish newspaper Dagens Medicin on April 4. You can follow the Leadership Symposium on the web on livestream May 11th 4 pm CEST.

”The Swedish healthcare system needs to overcome the challenge of a future population increase, which includes a growing ratio of children and the elderly. All this together with the increase of noncommunicable diseases (NCDs). There is a need of change in leadership – at all levels. Healthcare is the occupational sector with the highest level of sick leave and we cannot continue to do as we always have done if we want to see improvement.  Therefore, a new leadership is needed that demands, follows up and creates conditions for new working methods, but also a new health-promoting leadership.

Sweden has signed the UN’s global goals and Agenda 2030, where goal number three stipulates to ensure healthy living and promote well-being for everyone, which is absolutely a beautiful sentence in its right, but to realize this we need to make the change.  An increasing proportion of employees in the health care sector feel that they are unable to see and meet the patients and their family’s needsethical stress is a well-known concept. Competition for personnel is increasing due to lack of health care employees and a considerable innovative approach will be required to be an attractive employer.

Last year, the Swedish Agency for Health and Care Analysis presented the report From recipients to co-creators, a knowledge base for a more person-centred healthcare. The report describes the need for a more person-centred approach, not only in meetings with patients and their families, but throughout the hole organization.  The organizational culture within healthcare is characterized by a hierarchical approach and has been for decades.

We believe that we must create a culture in which employees work for patients and their families, not for the management.  This can only be reality when politicians, stake holders and senior management as well as the business-related management themselves have the person-centred working method, demand, follow up and use this as conditions for their leadership.

The culture and leadership that characterize the healthcare organisations also permeates in meeting with patients and their families. One cannot give to others what one does not have, therefore leaders should ask the question to their employees: ”What matters to you?”.  In the broader perspective, this is about creating the conditions for sustainable health and working life.  For this to become a reality, four changes are needed in leadership.

1. Clearer person-centred and sustainable managementOrganizations must be organized on basis of the people you are there for and not on basis of a certain profession.  If we want to see results, we must encourage, ask for and follow up results.  This applies to both clinical treatment results and to sustainable health for employees.  Otherwise, we can’t expect any improvement.  The leaders need to take precedence in the sustainability work and live by its own device, otherwise no one else follows.

2. Use the possibilities of digitalization. Through digitalization people can be given the opportunity for treatments and information through completely new tools and applications. The health care must take on the challenge and be a part of the development in the way that the patients demand.  Organisations must have well equipped digital systems and software, which are user friendly to both personnel and patients.

3. Focus on competence supply in organisations. Employees ability to develop competence is a matter and guarantee for patient safety. Today many health care organisations are failing in their responsibility to secure competence. In Sweden this responsibility is given to the first line manager, but in a stressful everyday life it is not easy for competence development to be prioritized.  In 2019, according to a political four-party agreement, the new government will introduce a national coordination with assignment to long-term planning of personnel and competence supply in healthcare.  

4. Together. In a person-centred healthcare, all patients are entitled to the right competence. It is necessary to cooperate between employees within different professions and employers.  

Barriers to collaboration must be removed, between both systems and in the remuneration systems that regulate large parts of the private healthcare system.  

It can never be the patient’s responsibility to coordinate what healthcare to get from different professions. The caregiver is a guest in the patient’s life, not the other way around.

For several years, we have been talking about the importance of the participation of patients and their families.  Now there is a need to move from words into action. Managers and leaders must take their responsibility and always work towards a person-centred health care, for the benefit of patients and their families”.