Study Visits/Co-learning

Every year, Qulturum – the center for learning and innovation at Region Jönköping County in Sweden – hosts a variety of study visits. The visits are not only a way to provide our visitors information about our improvement work and methods, but also an opportunity for us to learn from the experiences of others. We welcome visitors from both Sweden and abroad and together we are creating, not only a worldwide network of engaged and inspired Health Care workers, but also an environment of co-learning.

What do we mean by Co-Learning meetings?

A Co-Learning meeting is a type of meeting where people exchange their experiences, use different tools and methods to build their knowledge, they reflect upon it and successively build a deeper understanding of what they have heard and learned about.
At Qulturum, we believe that the best means of building and developing the deepest understanding is through dialogue.
A dialogue allows us to exchange ideas and to create new ones. Ideas that can even prove to be revolutionary. We do wish for this kind of revolutionary exchange of ideas with our guests and this is why we prefer to call study visits co-learning meetings. In the co-learning spirit we live by the saying "It takes two to tango", therefore we wish you to exchange your experiences with us.

If you wish to come to us in order to learn from one another you should let us know about it at least three months in advance. We treat each encounter individually and, therefore, we need time to be able to prepare co-learning visit in the best possible way.

Areas of interest

At Qulturum we have several years of experience of co-learning meetings. We have identified some areas that usually are of most interest for our visitors:

Qulturum is a name we created ourselves. QUL in the name Qulturum stands for Quality, Innovation and Leadership. These elements are interdependent and they need to interplay for a better performance of an organization.

The first letter in Qulturum's name stands for Quality as it is one of Qulturum's most important focus areas. Quality is the business strategy of health care systems in our county and, therefore, it saturates the whole organization.

Quality as a business strategy
The history of Region Jönköping County and its healthcare is over one hundred years old. However, the development of the Quality as Business Strategy in the Region has taken place during the last two decades and is now a powerful tool for steering and improvement of the healthcare delivered to the region's population.
Quality as a Business Strategy includes various concepts, philosophies and specific methods which are converted into action and implemented into managing a business and quality improvement within an organization. This strategy can be applied in all types of organizations, in both private and public sector and it has two main goals: one is to enable the organization to produce products and services that will be in demand and the other one is to provide a workplace where all the employees greatly enjoy and take pride of their work.

Focusing on quality enables achieving other goals, such as increased profits and share of market, growth, better educated citizens, cleaner environment, lower cost etc.
There are four important approaches to achieve higher quality:

  • Co-design a new process, product or service
  • Redesign an existing process, product or service
  • Improve system as a whole
  • Share and collaborate with a known improvement and diffuse the innovation

Co-designing new processes, products or services or redesigning the existing ones doesn't usually cause too much trouble. It is improvement that is much more complex and demands more innovation and creativity. Qulturum's role is to help the organization achieve this goal by facilitating improvement and by sharing and diffusing of innovation.


"The big difference is that we are not only working with quality control, we are improving  it".
Göran Henriks, Chief of Learning and Innovation

Improvement and Innovation are other very important components of our organizational strategy. In Region Jönköping County we say that everyone has two jobs; one is to perform your daily work and the other is to improve it. According to W. Edwards Deming ( (Extern länk)) you need profound improvement knowledge in order to improve your work. Profound Knowledge is a complex term for various theories and sciences that are used to achieve changes that will lead to lasting improvements, development and innovation of businesses and practices. This body of knowledge which is necessary for making improvements contains:

  • An appreciation of a system, which means understanding and embracing system thinking
  • Knowledge about variation
  • The theory of creating new knowledge
  • Change psychology

In order to achieve the highest value for the patient both Professional Knowledge and the Improvement/Profound knowledge as well as the knowledge of patient experiences and co – production is needed. Improvements in diagnostics and treatment need to be matched with improved processes and systems in order to reach best possible results. (source: Batalden)

In the Health and Social care system improvement knowledge is a joint area of competence of healthcare professionals, patients, economists, planners etc. and the challenge lies in integrating and developing together. It is a shared and continuous effort to make changes that lead to improved patient/person outcomes, better procedures and better learning.

Improvement is not about a number of successful projects; it is about how you work systematically with improvements to get all processes in the system in motion and show results in a systematic way. In a system based on values, and under the right circumstances, we believe that people want to develop not only themselves but also their activities in order to create better care and better working place.
As a center for learning and innovation, Qulturum focus on developing improvement knowledge concerning patients, co-operation, interprofessional teams, leadership and the design and redesign of healthcare.

We use a multiple different methods in our improvement work and the most basic is the Model of Improvement with three questions and the PGSA cycle: What do you want to achieve? How do you know a change is an improvement? Wat ideas will we test?

The answers to the three questions are: 1) to set goals, 2) to decide what measurements to use and 3) to develop ideas and proposals for improvement and to test them.

Our aim is to invite patients to participate as partners in all improvement work we do. We do have improvement coaches as a natural part in all our work.

Person-centered care is about building bridges between health care providers, patients and their relatives. It is about creating a relationship based on mutual learning. The aim is to actively make use of patients and relatives experiences and knowledge while improving healthcare and managing patients' safety.

Steps to achieve greater person-centered care:

  • To educate not only health care providers but also patients and relatives
  • To develop new ways of working and a culture where patients and relatives' experiences are utilized in a better way
  • To develop models to increase patients and relatives' involvement in their own care and in the development of health care
  • To disseminate good examples


Some examples of Person-centered care Offerings:


Esther is a persona that clinicians in Region Jönköping County invented to help them improve patient flow and coordination for seniors in 13 of the County's municipalities. Care for the elderly is a critical issue in Sweden, one of the countries that have the world's oldest population (18% are aged 65 or older). Esther is an 88-year-old Swedish woman who continues to live alone in the community but has a chronic condition and occasional acute needs.

The ESTHER network's vision is to create a durable and energetic network in which Esther can feel confident and lead an independent life. Today ESTHER can be anybody in need of care from different providers. In the network ESTHER coaches keep this vision alive and they support continuous quality improvement. ESTHER network is nowadays growing on an international level.

More information about Esther (In English) (Extern länk) and for ESTHER coaches there is a group on Facebook (Extern länk).

Together/Co-learning with patients programme– Improving Health Care

Everyone who has in some way experienced health care has their own point of view on what was good and what could be better. Patients/relatives/citizens are still an underutilized resource in improving health care! How can we become better resources for each other? There is one simple answer: we need to do it Together!

The program "Together/Co-learning with patients" started in spring 2010 and it initially consisted of three teams from different departments and clinics and their patients and relatives: Dialysis Unit, Intensive Care Unit, surgical ward and the Emergency Department. In the spring 2011 the psychiatric ward became involved in the program.

"Together/Co-learning with patients" creates the possibility of strengthening patients trust for the personnel and, at the same time, it makes patients more involved in the care process. The greatest advantage for the staff is that taking part of the patients' experiences creates understanding and engagement which, in turn, results in a better and safer care.

The keyword for the better future of health care is ''Together''.

Self-Dialyses Unit at Ryhov County Hospital, Jönköping

Self-dialysis unit at Ryhov County Hospital is an epitome of patient empowerment. The unit has been created by and for the patients ‘'from scratches''.

Self-dialyses in Jönköping has revolutionized the view of care delivery. It has changed the process of care and has brought a different dimension to service in healthcare. (Extern länk)

The Self-dialyses unit at Ryhov County Hospital in Jönköping (Extern länk), 5:45 The patients do it themselves

Taste of water

The Taste of Water (2011) is an anthology about good care, treatment and ethics based on Anne-May Thorson's diary from her time as inpatient in health care. Added to Anne-May Thorson's story there are comments from professionals in health care which are the ground for a more complex discussion about the important factors for the high quality of care.

Anne-Maj Thorsson, a patient story (Extern länk)- about her experiences with healthcare, 4:15 min

Hjärtats Hus – House of Heart

Hjärtats Hus is an open meeting-place for everyone, who currently have or have previously had a cancer diagnosis. Relatives and friends are also welcome.

Hjärtats Hus - House of Heart is a place to come and chat and ask any questions you may have, in informal surroundings. We offer conversation, socializing, interesting talks and other activities, such as nice walking outdoor.

Hjärtats Hus is a part of the Health Café development project. Its activities are designed and run by volunteers who have personal experience of cancer.

”We get together as people with experiences, not just as patients with a diagnosis. We give each other tools to help us get the energy to live, to create health for life”, says Maggie Målevik, one of the enthusiasts behind Hjärtats Hus.

You will find more information on www.hjä (Extern länk) and facebook, instagram and twitter.

What is Patient Safety?

Safer care is something that we can all benefit from; patient feels more secure, employee satisfaction increases and extra cost for mistakes diminishes. We need to be able to learn from the mistakes we make in order to provide safer care. We all lose as long as we have a "guilt culture" where one is punished for making the "wrong".
Changing a culture sets values ​​and attitudes to the test. Increasing the quality of safety requires the organization to review its processes in which different needs can conflict with each other.
Our process of change is a non-punitive safety culture where system accountability and standardization are important concepts.

There is more and more focus on the patient safety worldwide. In the U.S., the number of patients who die from injuries during care and treatment is between 44000-98000 per year (Source: The Quality Chasm 1999). These are deaths which are deemed preventable. In Sweden there are still quite a few studies that demonstrate the scale. The Swedish National Board of Health and Welfare made a study of the incidence of medical injuries in somatic inpatient care.

What we do know is that there is 120 000 injuries registered only in LÖF's (County Council Mutual Insurance Company) database.

Patient safety is achieved when our health care system focuses on what is best for patients. Our vision is to create opportunities to do things correct from the start. Important milestones are:

 • preventing the occurrence of errors
 • make the incurred errors apparent for the purpose of learning
 • prevent the undesirable consequences of any problems arising

Examples of Patient Safety Offerings:

  • Safe Health Care – Every Time, All the Time

"Safe Health Care – Every Time, All the Time" is a program to increase patient safety. It is based on the IHI 5 million lives campaign. The program aims to support the improvement of medical care by for example significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality. 16 areas where improvement is needed are identified and measures are taken in order to improve patient safety.

More information: (Extern länk) (In Swedish)

Good leaders are of a great importance for the success of an organization. This is why Region Jönköping County offers a variety of different programs which aim to improve management and leadership.

Our permanent programs are:

  • Green, for front line leaders new in our organization
  • Blue, for front line leaders with long experience (more than 5 years)
  • Red, for service leaders (senior leaders) new in our organization
  • Black, for service leaders (senior leaders) in our organization
  • Learning Networks for all 550 leaders (Nätverk för engagerat ledarskap/Network for engaged leadership)
  • The future leadership (Framtida chefskap), for employees who have the curiosity about organization, quality improvement and leadership.

All of our programs are about:

  • How we achieve our vision “For a Good Life in an Attractive Region” through our thirteen fundamental values.
  • How we are using Quality Improvement as our strategy for future leadership
  • Our task of being a manager in a public founded organization; to create the best possible value based on our allocated budget
  • System thinking and our own part and responsibility in our big organization.

The goal for working with care prevention is to avoid that injuries occur during care and to guarantee all patients a safe and equal care. This is done by building a preventive way of work characterized by structure, systematics and transparent results. Jönköping County Council has chosen to develop a preventive way of work primarily within the areas: pressure ulcers, malnutrition and fall injuries. The reason for choosing these specific areas is that they have huge consequences not only financially for the County Council that provides the care, but also and most importantly for the patient. Therefore risk assessments are a key factor to achieve better prevention. By building quality registries where the patients that are most exposed to care injuries, such as for example the elderly and chronically ill, are assessed and registered is a key factor in achieving a safer care. Another way of achieving prevention is to make use of social movements to train and educate people to take care of their health and avoid unnecessary injuries.

Examples of Prevention Offerings:

  • Passion for life

"Passion for Life" is a program designed to encourage elderly people, while they are still active, to take responsibility for a healthy life. Social networks are set up within "Life Cafes" where groups come together to learn about the World Health Organization themes of healthy eating, socializing, physical activities and safety

More information: (Extern länk) (In Swedish)

  • Senior alert

Senior Alert (SA) is a national quality registry (one of 100 different registries in Sweden) aimed at preventing malnutrition, pressure ulcers, falls, poor oral health and bladder dysfunction in elderly care. With Senior alert, the goal is to develop new preventive working methods that increase the possibility of best possible care regardless of who provides it. The keeper of the Registry is Qulturum, the unit for learning and innovation within Jönköping County Council, Sweden.

More information:Senior alert - Senior alert (Extern länk)

  • Front VL

FRONT VL is an international and multi-professional innovation project where the user is central in order to design an individually adapted technology to promote good health throughout life, focusing on seniors. The method of achieving this is called Co-Design. In total, three countries participate in the project and all have different focus areas in the technology development for promoting good health throughout life; rehabilitation, physical activity and mental health. Sweden focuses on reducing the risk of falls by strengthening the balance of the elderly.

Qulturum, a center of learning and innovation has over the last 10 years developed a special competence in Coaching. We work in a strong relationship with our customers in our support of the improvement work. Our strategic aim is to, together with our customers, emphasize the positive effects of the process or work and, by doing that, to energize and accelerate the good habits and actions.

There are five strong values that we emphasize in our coaching programs:

  1. The customer has two jobs; one is to perform the daily work and the second one is to improve it.  We support doing both jobs in the best possible way.
  2. We build strong relationships over time and we meet with our customers both physically and at the virtual meeting places
  3. The world is global and the work and development has to be done locally. We are a bridge in supporting this.
  4. We are looking for a "positive deviance" and always try to energize the positive sides.
  5. We collaborate and emphasize the importance of collaboration because we know that it brings best results.

The art of coaching, co-learning and collaboration comes from a systematic approach where four features have to get in place:

  1. Structural approach
  2. Processes of quality and innovation
  3. Relentless search for good measures and tools for collecting the improvements and results
  4. Cultural understanding of the need of relationships as a search for support of excellence, excellence understood as each individual's attempt to do the best they can.

Co-learning is a concept which implies learning from one another and perceiving your partners as "critical friends".

Collaboration is an art in itself and should be perceived as something you execute when it is possible and needed. Good collaboration amplifies strength of acting together in search for new knowledge and understanding.

Working with process development

Process development

Process development is about getting an understanding about the processes within the organization at all different levels (macro, meso and micro). Everybody within a process needs to understand how the process works and how surrounding processes are connected. It is also important to have a common goal, measure the process continuously and work with improvements to reach goals that are set for the process. The organization and communication around the process need to be defined.

There are several ways to map processes depending on the purpose, for example System map, Person Centered Process mapping and Process flow.

Person Centered Process mapping (PCP)

Person Centered Process mapping (PCP) is a method for mapping a process with the person (customer, patient, user, student, client etc.) in center. The mapping provides a basis for raising awareness of needs, creating conditions for developing and designing processes that meet these needs.

The strength of the mapping lies in the fact that it is based on everyone who affects and is affected by the process. It provides a common understanding to identify gaps, risks and areas of improvement. PCP is also a good basis for identifying important measures related to the process.

Capacity- and Production Management (KPS)

Capacity- and Production Management (KPS) is a method to work in a systematic and fact-based approach with the organization's planning, management and follow-up, based on the needs of the residents. A key factor is to work proactively to get a balance between needs and resources providing our residents an available health care within time limit. This also affects the working environment in a positive way.

Transforming Qulture – to improve yourself and others

Fellowship at Qulturum offers experiential learning with support of our experts in different improvement areas. The learning is being applied at the participants' home organizations. This work within home organizations will help to firmly cement the strategic improvement knowledge and new ways of thinking that will be gained throughout the program.

Learning objectives:

  • Deepen your knowledge in quality improvement and patient safety
  • Learn how to lead system changes in quality, safety, and culture, including how to engage, influence, and impact culture change
  • Bring new ways of thinking and innovative ideas for improving the quality of patient care, reducing harm, and improving quality of care and patient-centered outcomes back to your organisation


  • 10-12 months programme in small affinity groups
  • Starts with a learning retreat at the Microsystem festival
  • Followed by Monthly virtual learning sessions
  • Strategic project scoping and individualized mentoring
  • The program builds on learning by doing, the fellows are expected to partly search knowledge and guidance on their own
  • Access to our communication platform


  • Leadership
  • Coaching
  • Patient Safety

Workshops on the future of Healthcare, facing the challenges and meeting new trends. 
To face the challenges and to keep the vision "For a good life in an attractive county" alive is our first priority. We put much effort in following the latest trends and even in creating new ones. Workshops with our guests allow us to prepare for the future together. We strongly believe that "two minds are better than one" and we have a deep trust in the power of cooperation. Our workshops are delivered in a true co-learning spirit.
Let's create memories for the future together!