Publish date: 2023-01-26 – 08.45
Chronicle: Borg Marit Andersen, Professor Doctor of Medicine. and former Head of Infection Control at Oslo University Hospital (OUS) Ullevål
Parliamentary politicians own It allocated nearly 30 billion for the first construction phase of Rikshospitalet and Aker (New OUS), but on a flawed basis.
The new OUS – which consists of the new Aker and the new Rikshospitalet while Ullevål Hospital is closed – is based on ‘earnings’ or uncertain savings. This is demonstrated by a new economic impact analysis from Oslo University Hospital (OUS).
savings obstacles. Preliminary analysis shows that by cutting 1,250 job years at Nai Aker and New Rikshospetalt, the “full year effect” – consisting largely of job cuts – could save NOK 1,387 million in “earnings”, according to the report. But most departments, such as emergency medicine, surgery, orthopedics, gynecology, psychiatry, and radiology, cite the serious danger of space constraints; Any practical space to work with patients in – and in separate locations. This prevents saving.
The starting point for the proper operation of the hospital should be the availability of sufficient beds and rooms for activity in the two new hospital departments. There is no obvious solution here
Other risks are skill flight, lack of technology, lack of participation, and overload. Also, not many know where to create the new partitions. Plans are incomplete, and there is no basis for evaluations.
alternate zero. The entire basis of the financial report is the savings in connection with the current activity – the “zero alternative” – of all clinics and departments. But the “zero alternative” itself is not presented in the 1,385-page financial report. The starting point is not known as the current number of hospital beds, day care centers and outpatient clinics in various specialties within physical medicine and psychiatry, as well as the number of human years in various specialties. How much will this be when the two parts of the hospital are finished? Will the project owners keep the “zero alternative” out of the public eye?
actual shortage. To show how wrong this is, medical clinics are presented with “profit” schemes (page 128 of the report). The medical clinic consists of nine departments: emergency medicine, internal medicine, cardiology, gastroenterology, geriatrics, pulmonary, nephrology, infection, and endocrinology and has the most patients in OUS. The report lacks facts about key areas such as capacity needs, district needs, workplace and finances – today and in 2030, for all departments and the entire clinic.
The clinic will save NOK 74 million by reducing a total of 92 man-years to 1,252 man-years in 2030. This is without taking needs into account, and without counting existing staff.
shortest time to spend? Emergency medicine and geriatrics in particular are being curtailed – despite the fact that “elderly people make up a significant portion of the clinic’s patient group” – and a “significant increase in demand for hospital services is expected from this group”. The solution has been outlined as “shorter length of stay” – with greater problems for the primary health care service, as well as relegating older people with complex illnesses to “lower health levels”.
The “win-win” requirement is, among other things, sufficient land to operate the department, “efficiency of patients and relatives” – and new operating concepts such as “health logistics” and “OUS at home” (p. 134) in the report). “Self-medication” – with an increased risk of being discharged from the hospital.
Except for job cuts, there is no increased earnings or activity at the new medical clinic (pp. 141 and p. 144).
Waste of money? The planned billion dollar expansion of Rikshospitalet and Aker is, in my view, a waste of money – and could lead to cumbersome and expensive operations.
- The duplication of work is not clear. Of the nine departments of the medical clinic, at least six must run hospitals in both Nye Aker and Nye Rikshospitalet (p. 128). Outpatient activity will also be distributed in both hospitals.
- Waste of time and money It occurs due to the large transportation costs of patients and staff, unnecessary use of time and waste of experience in travel activities between parts of the hospital. In this system, the need for more functionality may quickly emerge if the two new hospitals do not become completely separate hospitals, complete with separate diagnosis, clinics, treatment, work schedules, and follow-up for patients.
- What is the serving size? Who is the population to be served? The National Hospital’s new medical clinic aims to serve 200,000 residents in 2030 – “the rest” will go to the new city of Aker, compare page 130 of the financial report. Nobody knows what the “rest” will be.
- Where should patients lie? The Nye Medisinsk Clinic lacks the calculations for the number of beds, space and staff needed for inpatient, outpatient and daytime treatment at Nye Rikshospitalet and Aker. Narrow plot spaces are the problem. The starting point for the proper operation of the hospital should be the availability of sufficient beds and rooms for activity in the two new hospital departments. There is no obvious solution here.
- Rikshospitalet special functions And specialized expertise is resolved. Regional and local jobs are distributed. For example, advanced medical functions of the heart must be present in Nai Aker. The new Rikshospitalet will be a mix of ‘a little bit of everything’.
- High risk costly rebuilding. Risk analysis in the clinic shows ‘high risk associated with bed plans, daytime and intensive therapy – medium’ – with ‘grouping of beds across departments’. The clinic warns that new concepts such as the family’s “internal co-existence potential” could cause “permanent operational defects” as “there remains considerable doubt about the overall effectiveness of the activity being transferred to Nai Aker”. It is assumed that “these operational shortcomings are dealt with by the general financial considerations of the hospital” (p. 129). But then the building is set—and changes can lead to expensive rebuilding.
The cat in the bag? Did Parliament buy “the cat in the bag”? Entrepreneurs completely ignore the basics; That patients, staff and equipment should have designated areas to move around.
There is no point in building new hospitals if the most important things – the need for capacity, patient base, ergonomics and safety – are not explained by the builders. This is why politicians – for lack of information and transparency – set aside NOK 30 billion for a sand castle project with airy analyses, which no normal planning and building agency, not even the Oslo planning and building agency, would approve of.
Declared conflict of interest: The author of the article is former interim chair of the Redd Ullevål Hospital Campaign.
Today’s medicinefrom the Facts and Debate section of the 02 edition
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