Breaking boundaries 2008 Annual Report
Careum Foundation, 2008 Annual Report
Images of boundaries The series of images contained in this report illus trates the idea of ‘boundaries’ in many different and sometimes unusual ways. In viewing the images, people cannot help but ask themselves what the point in having boundaries is. Where does one stop and the other begin? Can the act of breaking or even doing away with boundaries actually strengthen the whole? When is it appropriate to draw clear boundaries? And when is it appropriate to tear them down? Can the desire to abolish restrictive bound aries really be fulfilled?
Table of contents
5 Breaking boundaries: Helping to shape the healthcare world of tomorrow 7 Hypothesis 1 8 Supporting new professions with new textbooks: Careum Publishing 9 The end of an era: Careum School for Healthcare Professions DN II closes its doors after 126 years 11 Targeted advanced training delivered in modules at the Careum Institute 12 Healthcare professions of the future: The need for qualified personnel is on the rise 15 Hypothesis 2 16 Practicable knowledge and skills with problem-based learning 19 Hypothesis 3 21 Overcoming professional boundaries: Learning and working in an 足interprofessional context 23 Hypothesis 4 24 Information literacy in the healthcare sector: Careum Explorer and CareOL 27 Hypothesis 5 28 Looking ahead to the healthcare world of the future: Drivers of change 32 Board of Trustees and Committees 34 Organisational chart
4 Careum Foundation, 2008 Annual Report
Breaking boundaries: Helping to shape the healthcare world of tomorrow
If we are to take a comprehensive approach to healthcare in the future and create a healthcare sector that operates across boundaries, then these attributes will also need to be applied to training strategies and the healthcare profes sions. If we do not base the education we provide today on the needs of tomorrow, we will find ourselves unable to make a valuable contribution to the future of healthcare. This is why the Careum Foundation takes account of current trends, provides inspirational ideas and makes its contrib ution to shaping the healthcare world of tomorrow. In 2008, the Careum Foundation reached another im portant milestone: at its meeting of 8 May 2008, the Board of Trustees officially approved all the buildings on the Careum Campus, noting with great satisfac tion that the construction work had not only come in on budget and on schedule, but also that all the build ings had been fully leased following their completion. The new buildings are now full of people eager to learn more about their chosen profession. The vision of a lively campus that is home to all the different professions within the healthcare sector and all age groups is becoming more of a reality day by day. On an average day, over 1,000 students are on the campus, where they have the opportunity to come into contact with employees of the healthcare institutions which are also housed on the site, whether they come across each other in Careum’s medical library, the skills labs of the Careum Training Centre or the beautiful campus courtyards. The Careum Campus is increasingly being used as a venue for forward-thinking events, helping it to de velop into an institution with a national profile. Since 2002, the Board of Trustees and the managing committees have had to focus a great deal of their at tention on managing the campus construction project. With building work now complete, the resources that have been freed up are being channelled towards the Careum Foundation’s core activities: Accordingly, dur ing 2008, both the Management Committee and
Board of Trustees worked intensively on the strategic focus of the Foundation. The healthcare sector is currently experiencing radical change, leaving it facing some great chal lenges. Healthcare has become comprehensive, with services operating across boundaries. Therefore, if the approaches and models applied in the health care sector are to be fit for the future, they must meet these same demands too, while also taking a raft of additional factors into account, such as training strategies and modules, markets and expect ations, socioeconomic trends, new technologies and research. This opens up new opportunities and creates new strengths, with the result that the traditional boundaries between disciplines, profes sions, institutions and countries are shifting or disappearing altogether. The boundaries between the range of services on offer and citizens, as well as between market and regulation, doctor and patient, and service provider and consumer are also being redefined. This year’s annual report has been created against this backdrop of continuing change in the healthcare sector and has taken its lead from the associated idea of ‘breaking boundaries’. The various ways in which the Careum Foundation works and the ap proaches it takes are illustrated by means of four cur rent and future developments that were discussed in the book published to commemorate its 125th anniversary, “Pushing the boundaries – essays on the future of healthcare education”. There then follows a new, fifth hypothesis, which outlines the healthcare world of tomorrow and analyses the relevant drivers of change. This fifth hypothesis will form a basis for Careum’s future activities.
Hans Gut, Chairman Ilona Kickbusch René Kühne Beat Sottas Management Committee
6 Careum Foundation, 2008 Annual Report
Hypothesis 1 A shared foundation, enhanced by specialist modules
Education is given a clearer structure and made more efficient
In the near future, the demands made in terms of the efficiency and effectiveness of healthcare education will rise sharply. On the one hand, the need to attract more people to work in the healthcare sector will increase, due to higher demand and the shorter working life of many female employees in the sector. On the other hand, time spent on training will have to be optimised for reasons of cost; this can be achieved by creating the right mix of depth, breadth and length in terms of educa足 tion provision.
This will lead to the shared ground between all healthcare professions being kept to a practical minimum, but without impairing the quality of training. The essential aspects of the curriculum, such as the basic functions of the human organism and an understanding of cultural, ethical and economic issues, will be taught to the various professional groups together, as preparation for their subsequent working lives where colleagues from different healthcare professions have to cooperate with one another.
Specialist training modules will then build on these foundations. They will be much more focused on the specific area and therefore considerably shorter than the op足 tions available at present. Additional training courses will enable practitioners to change their field of expertise by following clearly defined paths.
Careum Foundation, 2008 Annual Report
Supporting new professions with new textbooks: Careum Publishing
The huge changes taking place in the health and social care sector also affect professional edu cation at upper secondary school level, i.e. voca tional training. New professions are coming into being, while existing ones are being restruc tured and reclassified. Careum Publishing is making a vital contribution to this process by developing new textbooks. Just a few short years after its introduction, the ‘healthcare specialist’ profession is currently the sixth most popular career choice in Switzerland – and it could even move up to third place in the near future. Thanks to its clear structure, this new profession will develop into an important – if not central – pillar of the Swiss healthcare sector. The gap between finishing school at 16 and starting training at 18, which proved particularly problematic for many school leavers entering the degree courses in healthcare offered previously, could be closed with the healthcare specialist training course, as it is open to students aged 16 and above. This greatly improves the efficiency of healthcare training. In only its third year of existence, a combination of entrepreneurship, professionalism and a lot of hard work have enabled Careum Publishing to take on a central role in the provision of textbooks for several health and social care professions. Part nerships with regulatory bodies and national em ployer organisations form the basis for a highly efficient operation, clear structures and the wide spread recognition which its textbooks have achieved. Working in conjunction with the OdASanté healthcare organisation, a nationally recommended textbook was produced for the new healthcare specialist profession, which is already being used for 80 percent of vocational courses to great success. The year 2008 saw work begin on translating this textbook into all of Switzerland’s official languages. The Swiss Confederation only ever supports trans lations into other official languages if the relevant
areas of the country, in this case Western Switzerland and Ticino, deem the textbook to be worthwhile. The textbooks for care workers and pharmaceutical assistants are two other products created in part nership with the appropriate national employer or ganisations – SAVOIRSOCIAL and Pharmasuisse. Both textbooks have been recommended to voca tional colleges as official texts and will be available in three official languages for the start of the 2009 academic year. At tertiary level, Careum Publishing worked together with the Careum Competence Centre to further develop the existing textbooks for nursing in order to improve the level of standardisation, to give them a clearer structure and to make them more ef fective as a result. However, Careum Publishing and the Careum Competence Centre also address the lesser known professions, such as the technical medical and therapeutic careers, which textbook publishers who are focused on turning a profit would not deem very attractive. By developing textbooks for use in these fields, the two Careum departments are really reflecting the Foundation’s true objectives and making a lasting contribution to these smaller, but no less valuable, professions. As there is always a vast amount of information to process, the success of each project rests not only on the project managers and administrative staff of Careum Publishing, but also on a team of around 100 authors, specialist editors, proofreaders and digital media designers. This is the only way to ensure that the content of the textbooks is kept up to date, that it is of a consistently high quality and that it is continuously adapted to new education structures.
Felix Dettwiler Manager of Careum Publishing
The end of an era: Careum School for Healthcare Professions DN II closes its doors after 126 years
After providing education for 126 years, 2009 saw the Careum School for Healthcare Professions DN II enter its last few weeks. These were years that were marked by quality, efficiency and continual adaptation to the current training climate. In spring 2009, the Foundation’s school will close its doors for the very last time. The year 2008 marked the start of the last full year of operation for the DN II school; 126 years after the Foundation and the school were established in 1882. Changes to the education system at Confederation level and the shift in responsibility from the health department to the education department at canton al level meant that all 26 schools established in accordance with former laws in the Canton of Zurich and other parts of Switzerland lost their service mandate. It is for this very reason that Careum’s DN II school will close in spring 2009.¹ The Foundation’s current school and its predecessors have always offered traditional training courses, producing nursing staff over the years with a variety of specialisms for employment in the Swiss and, in particular, the Zurich healthcare sector. For an insti tution that was active in the healthcare sector for over a century and that wanted to remain successful, the challenge was to keep moving with the times in order to meet the ever-changing needs of society in general and of the healthcare sector in particular. Were new training courses needed, or did existing ones need to be supplemented somehow? Were the options on offer structured in a way that made them attractive to potential students? How could measures for maintaining and improving quality be anchored in the school’s basic principles? In addition, training courses in regulated fields have to meet the requirements of the appropriate regula tory body in order to achieve national and, if appli cable, international accreditation. The training courses offered at the Careum School for Healthcare Professions DN II always strove to meet the needs of the time, to set trends and to
¹ Training courses will now be provided by the Careum Training Centre, of which the Careum Foundation is a majority shareholder.
make a lasting contribution to shaping the health care sector of the future. For many years, the school achieved these goals, not only in terms of education, but also as regards the structure of training courses. As well as main training courses, it also offered supplementary further and advanced educa tion in the form of conversion and transfer pro grammes. These programmes gained increasing numbers of imitators and some are still available on the training market, albeit in a modified format. The closure is now almost upon us, yet the DN II school was still able to award 50 new nurses with their degree certificates during its last full year of operation. The stated objective of the Foundation, the school’s management team and the teaching staff was and still is to run a well-regulated, superior quality school right up until the last class has gradu ated. Those involved have managed it so far and they are determined to continue to deliver until the school is finally closed. All those who have helped to reach this difficult goal of maintaining a well-run school during a period of closure deserve sincere thanks, particularly the students, teachers and sponsors.
Felix Dettwiler School Principal
10 Careum Foundation, 2008 Annual Report
Targeted advanced training delivered in modules at the Careum Institute
The professionalisation of healthcare education is also reflected in the advanced training offered at university level. The WE’G Hochschule Gesundheit (a college of nursing science) and the Careum Institute have joined together to pioneer the de velopment of such training in German-speaking Switzerland. Further and advanced healthcare training was some thing of an anomaly until the reforms made to the Swiss education system in 2002 changed that. Now, the healthcare sector comes under the same stand ard framework of reference applied to education for other professions in Switzerland. After an initial re structuring phase, professional healthcare education has been rounded off with the establishment of training centres and healthcare universities of applied sciences. This has created clear structures for basic healthcare education, which is primarily geared to wards training ‘generalists’ in the nursing professions. However, these structures are not fully equipped to meet the many and varied needs of employers in the healthcare sector, which is why it is so important to provide the additional specialist expertise requir ed in the form of advanced training options that
f ocus on nursing professions at higher-level voca tional colleges and universities of applied sciences. Careum has shown its commitment to further devel oping the provision of specialist professional nursing education through its involvement in the WE’G Hoch schule Gesundheit college of nursing science and the associated training offered at the Careum Institute. In January 2009, the Careum Institute in Zurich suc cessfully launched its first training courses in the fields of palliative care (which has a strong emphasis on working with colleagues from different healthcare pro fessions) and oncological care. Following a period of intensive preparation, these two courses, combined with the other training courses provided by the WE’G Hochschule Gesundheit (see below), represent the first advanced training courses available at university level in German-speaking Switzerland. Thanks to the modular nature of these courses, students and healthcare specialists can structure what they learn according to prior knowledge and their specific training needs.
Courses at the WE’G Hochschule Gesundheit – Bachelor of Science in Nursing (BScN) – Master of Science in Nursing (MScN) by Applied Research – Master of Advanced Studies (MAS) in Managing Healthcare Institutions – Master of Advanced Studies (MAS) in Geriatric Care – Master of Advanced Studies (MAS) in Care Management – Master of Advanced Studies (MAS) in Oncological Care – Certificate of Advanced Studies (CAS) in Palliative Care – Foundation Course in Palliative Care – Advanced Course in Palliative Care The courses are modular in form. The following qualifications are achieved by combining compulsory and optional modules: – Master of Advanced Studies (MAS): 12 modules – 60 ECTS credits (1,800 hours of study) – Diploma of Advanced Studies (DAS): 6 modules – 30 ECTS credits (900 hours of study) – Certificate of Advanced Studies (CAS): 3 modules –15 ECTS credits (450 hours of study)
Careum Foundation, 2008 Annual Report
Healthcare professions of the future: The need for qualified personnel is on the rise The most recent Careum Forum, held on 5 Febru ary 2009, dealt with the concerns currently being experienced by health professionals in Switzer land under the title “Qualified and committed! Can my degree act as a stepping stone or will I be left behind?” This title expressed the self-con fidence felt by health professionals and the satis faction they find in their work, but also the nagging doubts that are fuelled by debates sur rounding pay and standards. Over the past few years, the training concepts and qualification designations used in the healthcare professions have undergone rapid change. Time and again, seemingly effective measures were jettisoned and replaced by new methods. To those affected, it appears as though the only constant is change itself. But this change was brought about by outside forces, since it is the result of two paradigm shifts that have been implemented in European and Swiss legisla tion: now, the objectives and structures of healthcare education, as well as the curricula followed, are determined by industry and by the public health pri orities of the Swiss Confederation. Particularly in terms of the healthcare sector, these changes repre sent a distinct break from what has gone before and necessitate a shift as regards how health profes sionals see themselves. They make practitioners feel unsure and inadequate. In his welcome speech to the 2009 Careum Forum, titled “Change we can believe in”, Beat Sottas, Member of the Management Committee, explained the causes behind and the dynamics of these changes. According to the OECD, developments in the healthcare sector can be put down to three driving forces: demographic change, progress and the availability of financial resources. All three drivers have a significant impact on healthcare training strategies. Financial resources The healthcare sector is the growth industry of the Swiss economy. In Switzerland, around one billion Swiss francs are spent annually on continuing profes sional development for health professionals, with the medical sector accounting for three-quarters of this amount. What is more, this expenditure looks
set to rise further still, owing to the fact that the guidelines on patient safety, improving quality and increasing benefits and efficiency are becoming ever stricter. Since the mid-1990s, the healthcare professions have been gradually integrated into the Swiss education system. In line with the movement launched to offer young people better training and job prospects upon finishing their education (“Kein Abschluss ohne Anschluss”), all further and advanced training op tions were repositioned. On the one hand, all school leavers can embark on a career in the healthcare in dustry as soon as their compulsory schooling is over; on the other, all professionals wishing to undertake further education have practically limitless advanced training opportunities available to them. In view of the rapid changes taking place in the healthcare sec tor, advanced training and lifelong learning are key resources not only for practitioners, but also for com panies. Today, the Swiss education system is set out in such a way that it can offer attractive training packages to all health professionals. Demography At the end of 2008, the Swiss Health Observatory predicted that the need for qualified healthcare per sonnel would increase much more quickly than the rate of population growth would suggest. The ageing population is one of the most important factors behind this prediction: by 2020, the propor tion of the population over 65 years of age will have risen by 14 percent, while the proportion of those over 80 will have increased by 35 percent. Another reason for this forecast is the individualisation of
2009 Careum Forum
Monika Schäfer Vice President of WE’G Hochschule Gesundheit
Rolf Gilgen Director of Waid City Hospital, Zurich
Irene Campi Occupational psychologist
s ociety, which is leading to a distinct drop in the number of people practising self care or being cared for by relatives. As a consequence, the healthcare industry must create jobs that are attractive to young people and which will encourage significantly more of them to pursue a career in the healthcare sector than is currently the case. This is something of an emergency situation, as the number of nursing and therapeutic professionals required should rise by 13 percent by 2020, and by as much as 30 percent by 2030, from 174,000 staff today to 226,000 staff by 2030. In conclusion, it is clear to see that there is a great need for health professionals. Progress Since courses in human medicine, dentistry, vet erinary medicine and pharmacy offered at universitylevel institutions have undergone a transformation as part of the Bologna process and now result in Bachelor’s and Master’s degrees being awarded, Master’s training is now also the final stage of educa tion available at healthcare universities of applied sciences. Around 25 healthcare professions are cur rently regulated in Switzerland, but this is only the beginning. The challenges that lie ahead provide great scope for development: • The introduction of diagnosis-related groups (DRG; system of flat-rate financing to be introduced in 2011) will lead to new clinical pathways and care procedures.
Barbara Gassmann Vice President of Swiss Nursing Association (SBK/ASI)
Beat Sottas Member of Management Committee of Careum Foundation
• New, customer-focused models of basic care are on the horizon. • The challenges of long-term care call for systematic nursing and care management. • E-health and the processing of data streams represent another growth area for the industry. In line with the therapeutic and technological de velopments taking place, the professionalisation of health practitioners is also improving at a rapid rate: new fields of expertise with new profiles are coming into being, from which new job descriptions will also develop. The 2009 Careum Forum examined the effects of these changes and the asso ciated uncertainty felt by health professionals. Speakers from the Swiss Nursing Association (SBK/ ASI), from the fields of occupational psychology, and from the world of education and advanced training shone a light on this topic from many different sides. The general conclusion reached was that there is absolutely no need for uncertainty, as the demand for qualified health professionals continues to grow unabated and will rise sharply in the future. However, health professionals must also recognise their own responsibilities in this regard. The dividing lines which mark out the different professions must make way for a greater focus on process thinking and interprofes sional networking.
14 Careum Foundation, 2008 Annual Report
Hypothesis 2 Health trainers as opposed to carers for the sick
Education must focus more on the increasingly complex relationships between patients and professionals The relationship between medical professionals and patients will never be the same again. Soon, it will be almost impossible to assign clear roles to the two parties, as the
level of knowledge, plus the personal and cultural situations of individual patients will differ much more strongly than they do today, thus demanding that professionals
become more flexible in their approach. Recognising these sets of circumstances
properly and consciously taking on the ‘correct’ role will be of central importance for health professionals. The ability to motivate patients to be proactive in preventing an
illness from occurring or in maintaining good health requires quite different social
skills to those needed in today’s health professions, which have a much stronger em phasis on actual care. A large component of the education and training provided will
deal explicitly with such issues, with teaching staff moving away from imparting
knowledge and heading more towards sharing experience and insights. They will also take on an increasingly advisory, assisting role.
Careum Foundation, 2008 Annual Report
Practicable knowledge and skills with problem-based learning
In modern 21st century society, the role of the individual is being redefined all the time – and it is becoming more and more varied. A person is a citizen in the healthcare community, a consum er in the healthcare market and a patient in the healthcare system. The term ‘patient’ refers to a person who is suffering. It includes the notion of a certain state that restricts a person’s quality of life. If a patient’s health is the cause of their suffering, sooner or later they will make use of healthcare services. Our ideas about what a patient’s role involves have de veloped over the last 50 years. • In 1960, the talk was of the ‘patronised patient’, who would have information about their diagnosis withheld from them, particularly if the condition was serious or life threatening. • In 1970, the idea of the ‘informed patient’ arrived from the USA. The patient now had the legal right to give informed consent to medical procedures. This was a significant move in two ways, as it also provided the doctor with legal protection. • The year 1980 saw the rise of the ‘responsible pa tient’, who was allowed to have a certain amount of input into their treatment, but was also obliged to take responsibility for it. • In 1990, the responsible patient was superseded by the ‘autonomous patient’, who acted as a partner in determining their own state of health. The common theme running through these four stages of development is that the patient’s role is largely defined by their relationship with others: with the doctor, health professionals, the judiciary, polit icians or health insurance providers. At the turn of the century, however, a completely new aspect be gan to emerge: the patient’s relationship to oneself. Now, added to the questions and demands that the patient has for others, are the questions they must also ask themselves. It is no longer just about rights, but about responsibilities as well. Building on the existing concepts, the talk since the year 2000 has been of the ‘competent patient’.
The 21st century healthcare community is being shaped before our very eyes. Life expectancy has in creased and our societies are becoming home to more and more old people. Chronic illnesses de termine the clinical character of our society, but medical advances have made it possible for increas ing numbers of seriously ill people to be cured and for those with chronic diseases to play an active role in society. The societal changes of the 21st century outlined here mean that existing roles and frameworks need to be brought up to date: • Competent patients expect all health professionals to know at least as much about their illness as they know themselves. They expect to receive a package of evidence-based diagnosis, treatment, care and advice and to be given clear information about both conventional and complementary treatment options. • Competent students expect to be able to play an active role in managing their own learning process, focusing on the very latest developments in the profession and on patients’ needs. • Competent teaching staff expect to be able to support students throughout their learning pro cesses in their role as tutor or trainer, focusing on the very latest developments in the profession, on patients’ needs and on developing a professional manner. This is not just about a concept of teaching and learning, but also about the context of that learning process, taking the roles of those affected and involved into account, plus their expectations, obligations and structures. The processes associated with the paradigm shifts outlined above must be addressed primarily in terms of further and advanced healthcare provision. Against this backdrop, in 2000, Careum decided to adopt a new course: the educational and didactic approach of problem-based learning. With these ob jectives in mind, the Careum Competence Centre developed problem-based curricula, along with learning aids and teaching materials for providers of
healthcare education at tertiary levels B and A. The learning and teaching concept behind problembased learning takes as its starting point the fact that, in any given situation, an individual’s actions and responses will be directed by their subjective know ledge of the world around them, by their perception and interpretation of events. So ‘learning’ is viewed as a constructive, active, self-directed, problem-based and social process carried out by the individual. The focus is on the student’s learning process, not on the act of teaching. The corresponding learning aids and teaching materials, methods of self-assessment and the associated infrastructure support independent learning and can accommodate the learning style and speed of each individual. The self-study learning landscape promotes independence and individual responsibility, the use of IT resources, learning via dif ferent media and the development of a personalised way of learning. Integrated into this environment are opportunities for exchanging knowledge with stu dents from other professions, as well as with experts. The main aims of problem-based learning are to structure and gain knowledge which is based on a deep understanding of the issues involved and which can be called upon quickly at any time and ap plied to different situations. This knowledge should be combined with the ability to analyse and solve problems, to direct one’s own learning, to work as part of a team and with an ongoing curiosity and interest in continuous learning. The products of the Careum Competence Centre – the problem-based curricula and learning aids and teaching materials used to train health professionals – are an appropriate response to current and future edu cational trends that can be seen in the healthcare sys tem and in society as a whole.
Pia Riedo Manager of Careum Competence Centre
18 Careum Foundation, 2008 Annual Report
Hypothesis 3 Teamwork as opposed to a one-man show
Working in a team and across professional boundaries is set to become even more important
Today, we have successful teamwork to thank for curing diseases and improving patients’ health; in the future, the focus on working together will become even more important. On the one hand, increasingly complex care procedures are blurring the boundaries between the in-patient, out-patient and long-term healthcare sectors. On the other hand, higher quality requirements can only be met by working to gether. As a result, it will become standard practice, not to mention a necessity, to work together with colleagues from different healthcare professions in order to achieve the best possible effects, to increase efficiency and to improve patient bene fits and safety. Networks must be made more effective and more emphasis be put on operating within such networks in an efficient and target-oriented manner. Pro moting teamwork skills and creating unambiguous, clear and comprehensible docu mentation will play a major role in healthcare education. Practitioners must learn to recognise the boundaries of their own particular fields and know when to turn to colleagues acting in other fields. This means that each individual health profes sional must be flexible in meeting the demands of wholly different roles and pro cesses.
20 Careum Foundation, 2008 Annual Report
Overcoming professional boundaries: Learning and working in an interprofessional context
Learning and working in an interprofessional con text is the hot topic on everyone’s lips. This just goes to show the importance that the healthcare sector attaches to this issue in terms of both education and practice.
already created the first module – “Interprofessional collaboration in emergency situations” – which forms part of the curriculum. In addition to this, lectures and briefings that fall outside of the curriculum have also been developed.
Patients are often treated and looked after by members of different healthcare professions. If practi tioners are to be able to work together with col leagues from other healthcare professions for the good of the patient, a basic prerequisite is that all the groups of health professionals involved must ac knowledge the expertise of all the other groups. They must be willing and able to speak to one another about specific patient circumstances. Decisions must be made as regards how patients and their relatives should be dealt with. In addition, personal inter ests must come second to caring for patients in a responsible manner.
Careum has commissioned the Careum Competence Centre to further develop the concept of learning and working in an interprofessional context and to drive forward the creation of additional training courses. It is a matter of huge importance to promote the added value which working in a team and across professional boundaries brings in a committed and sustainable way.
In the healthcare sector, working with colleagues from other disciplines brings a number of benefits, including the following: • Individual practitioners are responsible for their part in the patient’s treatment and care. • The course of the patient’s illness is followed close ly, with therapeutic measures being better adapted to the situation at hand. • If practitioners work with colleagues both from within their own professions and from other health care professions in a respectful manner, this not only increases patient satisfaction, but also the sat isfaction that those practitioners derive from their work. To enable budding health professionals to experi nce learning and working in an interprofessional e context while they are still in training, Careum and the Medical Faculty of the University of Zurich have decided to develop compulsory and optional inter disciplinary learning and training modules. The aim is to really equip students from the various different courses with all the tools they will require in their fu ture working lives. The Careum Training Centre, working in partnership with the Medical Faculty, has
Pia Riedo Manager of Careum Competence Centre
22 Careum Foundation, 2008 Annual Report
Hypothesis 4 Learning how to learn as opposed to learning facts
Knowledge needs to be constantly updated
Knowledge gets out of date faster and faster these days. The prevalence of elec tronic networks and the way in which knowledge is distributed across them means that one constantly has to supplement and expand one’s own knowledge. The gathering and updating of knowledge becomes an endless cycle. Therefore, the training of tomorrow will have to tackle the issue of how to obtain the latest know ledge in an efficient and target-oriented manner. Learning strategies, problem- solving strategies and the ability to continually develop will play central roles.
Careum Foundation, 2008 Annual Report
Information literacy in the healthcare sector: Careum Explorer and CareOL
New media not only influence our leisure time, but also how we learn and how we work. Along with the huge opportunities offered by the immense pool of knowledge that is the internet come major challenges. The Careum E xplorer and CareOL online platforms enable health professionals to use new media in the way that is most beneficial for them and their profes sional groups. In our society, the internet has penetrated every area of our lives. According to the Swiss Federal Stat istical Office, in the first three months of 2008, 68 percent of the Swiss population over 16 years of age used the internet at least twice a week. Around 80 percent of those were using the internet to research the symptoms of an illness or to find a diagnosis. It goes without saying that pupils and students make use of the internet everyday, and that it has long established itself as an essential tool within schools, colleges and universities. Yet, although the internet offers untold benefits, it also poses huge challenges. A certain degree of in formation literacy is required just to carry out meaningful research via a search engine: one needs to enter the right combination of the right search terms, and be able to assess and narrow down the re sulting hits. For many internet users, this is a tall or der. The concept of information literacy only arrived on the scene in schools, colleges and universities fairly recently, while in the working world, it is still usually seriously neglected. Careum carried out a small survey among nursing staff, asking what they considered to be the major problems when searching for specialist nursing infor mation. The responses enabled the following three key problems to be identified: the large amount of time consumed, a lack of research expertise and the difficul ty of assessing the quality and topicality of informa tion. This means that help needs to be provided at various levels. On the one hand, more training in information literacy is needed, and on the other, it must be made easier for health professionals to
a ccess specialist information in electronic format. This is where the Careum Explorer project, Careum’s specialist online portal for the healthcare profes sions, comes in. Careum Explorer has been online since September 2007 and its content and services are being constant ly expanded. The specialist structure on which the portal is based is fundamental to how this content is accessed, comprising as it does around 50 specialist categories relating to health professionals other than doctors. All content is assigned to these specialist categories, so users can focus their searches on sub jects such as oncological care, emergency care, physiotherapy or nutritional advice. Once they have selected the appropriate specialist area, users can run queries in nearly 20 external databases or browse available e-books and the portal itself. Infor mation in the portal includes the latest news in the field, conference and congress dates, book reviews, information on courses, specialist publications, art icles and a comprehensive range of links to further information on each topic. Most journal articles can still only be obtained on payment of a fee. The titles which are available in electronic format and that can be accessed free of charge can be called up directly via Careum Explorer, whereas those that require a fee to be paid can be ordered from a library. The next steps involve expand ing the portal’s content, in particular its multimedia features.
A user-friendly internet portal should offer the following: • Standard point of entry • Simplicity • Powerful search tools • Large amounts of data • Structured and edited information • Integration of additional functions • Personalisation • Communication and collaboration • Validation
“What a great idea! For me, the really important thing would be to be able to call up Careum Explorer meets all the criteria of a userfriendly internet portal, thereby providing users with a reliable anchor in a sea of information. The portal is being continuously updated, and both its content and services are being constantly expanded. The fact that knowledge is being superseded faster and faster all the time these days also has an effect on developments in education, as this is also a field that needs to respond to social change. Educational and didactic concepts such as problem-based learning focus on the act of learning itself, rather than on teaching. Learning packages based on this under standing enable students to organise their learning for themselves, to do so in an appropriate fashion and to come up with solutions when faced with new situations. Problem-based learning packages using multiple methods allow students to learn and be taught both face to face and online. With CareOL (Careum Online Learning), Careum has created an innovative multimedia learning platform that provides author ised users with a protected space in which to learn. The varied range of services available on CareOL offers students support in terms of their own learning processes, but also in terms of communi cating and collaborating with fellow students and teaching staff. CareOL is defined by the following main features: • Provision of knowledge: The bulk of the learning content is offered as PDF documents or HTML pages. Training films can be viewed online. Links are available to various topics. • Checking of knowledge: Interactive tests can be taken. • Collaboration and communication: A wide range of tools are available to facilitate teamwork (chat, e-mail, forums, Wikipedia, folders for data exchange). Summaries of learning outcomes, presentations. • Distribution of information: Students can use CareOL to access information and documents pro vided by their educational institutions and teaching staff.
care standards, prophylactic measures, links to other portals and lists (of diagnoses, for example). Of course, a clear, inviting and professional overall look would be a bonus.” Response of student who participated in survey
• Acquisition of media handling skills: Links to online learning modules help students to acquire learning strategies to enable them to use various media, particularly in terms of performing internet re search. With the CareOL and Careum Explorer online plat forms, Careum is encouraging health professionals to acquire the skills that will enable them to meet the challenge of change head-on.
Susanne Mayer Careum Explorer Project Manager Pia Riedo Manager of Careum Competence Centre
26 Careum Foundation, 2008 Annual Report
Hypothesis 5 Drivers of change
Looking ahead to the healthcare world of the 足future
What is driving the rapid changes taking place in the healthcare sector? Where is that dynamic force coming from? Four drivers are particularly significant in this regard: demographic change, medical innovations and technologies, economic factors such as rising costs and the growth of the market in healthcare services, plus the evolving role of the patient.
Careum Foundation, 2008 Annual Report
Looking ahead to the healthcare world of the future: Drivers of change
What is driving the rapid changes taking place in the healthcare sector? Where is that dynamic force coming from? Four drivers are particularly significant in this regard: demographic change, medical innovations and technologies, economic factors such as rising costs and the growth of the market in healthcare services, plus the evolving role of the patient. The healthcare sector is experiencing a period of historic change. New opportunities are opening up and conventional thinking is being challenged. Health is all pervasive; it is shifting and overcoming existing boundaries. In order to be fit for the future,
however, strategies and models created in and for the healthcare system not only have to take these developments into account, but also numerous other aspects, such as changes in education, training, care procedures and markets, socioeconomic trends, different expectations, new technologies and research. Below, the four major driving forces are examined in terms of their relevance for Careum’s strategic focus. They show that the Foundation can only achieve its objectives if Careum also looks at wider issues relating to the healthcare system as a whole.
1. The major driver of change in the healthcare sector is demographic change. All over the world people are not only living longer, they are also staying healthy for longer or achieving a greater degree of independence while living with a chronic illness. This means that the aims and main areas of activity of the healthcare system also have to undergo a fundamental development. The healthcare system must adapt to: • An older population with more chronic diseases and, accordingly, different needs. • The increased incidence of mental illness – particularly in the elderly. • A growing population of very old people who require complex care packages. • A new way of dealing with dying and death. This presents the healthcare professions with new challenges and focal points, not all of which are medical in nature, and is resulting in new profes sional fields that require appropriate advanced training. All those involved in the healthcare sector are being called on to radically change their attitudes to the treatment of chronic illness and older patients. The healthcare profes sions are being given a new focus and are growing in importance. Those who work in this sector must also play their part in helping the healthcare system to adapt to these huge changes; they must be careful not cling to out-of-date attitudes to age which – at the start of the 21st century – no longer do older people justice. At the same time, demographic change also has another dimension: the pro fessionals themselves are becoming older and the training places available for the next generation can no longer be filled. This throws up a new problem in
terms of managing not only healthcare, but also education policy, and is close ly linked to other political spheres such as the promotion of economic devel opment and immigration legislation.
2. Medical innovation and technological change will change the face of the healthcare sector and the procedures associated with it. The close relationship between medical innovation and technological change will shape the healthcare world of tomorrow. On the one hand, the rapid development of information technology will enable new organisational proce dures and processes to be introduced to the healthcare sector, which in turn can lead to improved quality, safety and efficiency. Global access to expertise and the latest scientific findings are also bringing about a radical shift in terms of the information available to practitioners for the purpose of making diagnoses and other medical decisions. On the other hand, developments in medical technology and pharmacology are making it possible for those with chronic illnesses to lead independent lives, resulting in a new form of inter action between the medical system and the patient. Patients and professionals will increasingly communicate with one another remotely, with the support of IT facilities and networked monitors that constantly check the patient’s state of health and trigger an alarm if anything out of the ordinary occurs. For health professionals, this means acquiring a number of new skills that extend far beyond specialist medical and nursing expertise. They will become increasingly reliant on their IT skills, for example – which in turn represents a challenge in terms of education and advanced training. Furthermore, these developments will lead to a considerable shift in existing responsibilities and relationships among healthcare professions, as well as between practi tioners and patients.
3. The increasing economic importance of public health, rising costs in the healthcare sector and the rapid growth of the healthcare market are significant economic and political drivers. The high economic importance of health is being taken increasingly seriously, as a crucial aspect of a country’s human capital, as a significant factor in terms of demographic change and as a market for goods and services. In the ma jority of OECD countries, over 10 percent of all workers are active in the health sector – and that percentage is growing. Around 70 percent of the entire health budget is allocated to staffing costs. Innovation is an important factor here too; one which is bringing a number of different industries and compan ies together in new and exciting ways.
Careum Foundation, 2008 Annual Report
Almost every decision we make in our everyday lives has an impact on our health, resulting in consequences not only for us as individuals, but also for society as a whole.
Both the health expectations of the population and the relationship between the costs and results associated with different healthcare systems are providing the basis for more and more international comparisons and rankings. Regions define themselves as ‘health regions’ and cooperate on both research and care, sometimes even across national borders. This means that healthcare is becom ing part of some very diverse political spheres, such as in the fields of economic policy, tax, immigration and tourism. This development is leading to competition on an international stage, not only between different systems and models of care, but also between indus tries; it is also resulting in competition to attract health professionals and patients. A market which requires new forms of management and regulation, and has new needs in terms of information, is coming into being. Healthcare and education systems can no longer do their planning and thinking on a purely national level. In addition, the growing market in healthcare services is creating new areas of activity, such as health tourism, and with them, new opportunities. These opportunities manifest themselves in the form of increased choice for health professionals and the chance for them to improve their income. However, this also means increased pressure to perform and to relocate or commute long distances. New professions are being developed, with more and more importance being placed on qualifications that are recognised by different countries. As employees are becoming more mobile, the issue of making the healthcare system an attractive place for people to work is being taken more seriously too. Finally, the population’s growing interest in inno vative approaches to health, such as preventive healthcare and wellness, plus the need to have services that are easily accessible, are becoming increasingly significant factors when it comes to developing healthcare systems.
4. The most important social driving force is the changing role of the patient within the healthcare system. All the aforementioned drivers really come down to just one thing: the citizen/ consumer/patient. The healthcare community of tomorrow will require the individual to play an active and informed role in maintaining their own health, in dealing with chronic illnesses and in the growing healthcare market. Almost every decision we make in our everyday lives has an impact on our health, resulting in consequences not only for us as individuals, but also for society as a whole. More and more, the medical system is demanding that not only professionals, but also patients have the skills to interact with one an other in order to make the right decisions and to achieve successful treatment.
The opportunities for citizens and patients to gain these skills from an educational institution remain practically non-existent; but the professionals working within the healthcare sector are underprepared in this regard too. Healthcare systems are only just beginning to adapt gradually to this signifi cant new challenge. Patients and citizens, however, have reacted faster, not only by forming patients’ organisations and self-help groups, but also by making active use of the health information available to them, particularly on the internet. The market has responded to this need and now offers an over whelming volume of information, materials and services. As far as health professionals are concerned, this means that they must recognise the knowledge and expertise that the patient of today has. They must also play their own, increasingly active, part in promoting health literacy and patient skills. Various models have now been created that need to be introduced into all healthcare systems. In some countries, foundations have led from the front and actively taken up this challenge. The ‘mini med schools’ and ‘patient universities’ in particular are extremely popular, although more and more specially developed programmes for disadvantaged sections of the population are also coming into being. Without the full cooperation of patients, plus a significant democratisation of and increased transparency in healthcare systems, it will not be possible to achieve the objectives of 21st century healthcare, nor to meet the challenges it poses.
Conclusion The healthcare community is becoming more and more global. This development means that the traditional boundaries between disciplines and profes sions, institutions and countries are becoming blurred. The relationships between the range of services on offer and citizens, between the market and regulation, between the doctor and patient, and between the service provider and consumer are also being redefined. New strategic approaches and models for the healthcare sector must take all the varying demands of education and advanced training, market systems, socioeconomic trends, and new technologies and research into account in order to make a real contribution to the healthcare of tomorrow. Careum wants to show how these trends can be picked up and turned into concrete educational procedures. Its aim is to provide appropriate ideas and to highlight approaches for dealing with the healthcare world of the future, particularly in terms of healthcare education, and for playing an active role in shaping that world.
Careum Foundation, 2008 Annual Report
Board of Trustees and Committees As at April 2009
Gut Hans, Chairman, BoT, MC Dipl. Ing. ETH, MS Entrepreneur Herrliberg ZH (Trustee since 1999)
Birchler Urs, BoT, CC Dr. oec. publ. Managing Director of Inselspital, Bern University Hospital Bolligen BE (Trustee since 2003)
Bliggenstorfer Andreas, BoT Priest, Chairman of Founders’ Association (Stifter-Verein ) Dietlikon ZH (Trustee since 1993)
Brühwiler Barbara, BoT Head of Nursing and HRM of University Hospital Zurich Zollikerberg ZH (Trustee since 2001)
Burkolter Max, BoT Dr. theol. Priest Wald ZH (Trustee since 1999)
Buschor Ernst, BoT, AC Prof. Dr. oec. Former Government Councillor Dübendorf ZH (Trustee since 2003)
De Geest Sabina, BoT Prof. Dr. Managing Director of Institute for Nursing Science, University of Basel Basel BS (Trustee since 2006)
Gutzwiller Felix, BoT, CC Prof. Dr. med. Director of Institute for Social and Preventive Medicine, University of Zurich Councillor of State for Canton of Zurich Zurich ZH (Trustee since 2000)
Furler Lukas, BoT Vice Director and Head of Nursing of Waid City Hospital, Zurich Münchenstein BL (Trustee since 2001)
Holenstein Hildegard, BoT Dr. phil. Berne BE (Trustee since 2001)
Kühne René, BoT, MC Dr. oec. publ. Business Consultant Hurden SZ (Trustee since 2002)
Lauper Bernhard, BoT, AC Co-owner of construction and real estate consultancy firm Immopro AG, Zurich Feldmeilen ZH (Trustee since 2008)
Kickbusch Ilona, BoT, MC Prof. Dr. Dr. h. c. Director of Global Health Programme, The Graduate Institute, Geneva Brienz BE (Trustee since 2008)
Satrapa-Schill Almut, BoT Dr. phil. Head of Health and Humanitarian Aid Department of Robert Bosch Foundation, Stuttgart Grafenau, Germany (Trustee since 2008)
Sottas Beat, BoT, MC Dr. phil. Advisor for education and healthcare policy formative works Bourguillon FR (Trustee since 2008)
Weibel Peter, BoT, AC Dr. oec. publ. Member of Board of Directors of Credit Suisse Group, Zurich Zurich ZH (Trustee since 2008)
AC – Audit Committee BoT – Board of Trustees CC – Compensation Committee MC – Management Committee
Careum Foundation, 2008 Annual Report
Organisational chart As at April 2009
Board of Trustees Hans Gut, Chairman Urs Birchler Andreas Bliggenstorfer Barbara Brühwiler Max Burkolter Ernst Buschor Sabina De Geest Lukas Furler
Careum AG Training Centre for Health Pro fessions1) Representatives on the Board: Hans Gut, Chairman Barbara Brühwiler René Kühne
Peter Weibel Ernst Buschor Bernhard Lauper
Urs Birchler Felix Gutzwiller
Management Committee Hans Gut, Chairman Ilona Kickbusch René Kühne Beat Sottas
WE’G Hochschule Gesundheit AG 1)
Felix Gutzwiller Hildegard Holenstein Ilona Kickbusch René Kühne Bernhard Lauper Almut Satrapa-Schill Beat Sottas Peter Weibel
Representatives on the Board: René Kühne Beat Sottas
School for Healthcare Professions DN II
Careum Competence Centre
Felix Dettwiler (until 4/2009)
Associate of Careum Foundation
Assistant Paula Büeler
Careum Foundation Pestalozzistrasse 3 CH-8032 Zurich Phone +41 43 222 50 00 Fax +41 43 222 50 05 firstname.lastname@example.org www.careum.ch
Published by: Careum Foundation, Content/project management: Careum Foundation, Design: BieriDesign Zurich, Photos: Giorgio von Arb Zurich, pp. 12–13 Julia Brütsch, English version: Clíona Coyne, Printed by: Zürichsee Druckereien AG, Stäfa
Careum Foundation, 2008 Annual Report
Education is given a clearer structure and made more efficient Education must focus more on the increasingly complex 足relationships between patients and professionals Working in a team and across professional bound足 aries is set to become even more important Knowledge needs to be 足constantly updated Looking ahead to the healthcare world of the future