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Making Systemwide Improvements in Health Care: Lessons From Jönköping County, Sweden

Bodenheimer, Thomas MD; Bojestig, Mats MD, PhD; Henriks, Goran MBA

Quality Management in Health Care: January-March 2007 - Volume 16 - Issue 1 - p 10–15

Over the past 10 years, Jönköping County in Sweden has made impressive progress in improving its health care system. The motor of improvement work is Qulturum, an innovation and learning center within the health system. Qulturum has no responsibilities for clinical or administrative functions; its sole mission is improvement work. Qulturum's improvement strategy is based on 3 principles: (1) Learning is key to improvement, (2) Improvement needs to be broad and deep, and (3) Improvement must be both bottom-up and top-down. Based on these principles, Jönköping County has achieved timely access to primary and specialty care, has improved the care of a number of chronic conditions, and has accomplished these goals without increases in expenditures. The United States could benefit by instituting Qulturum-like centers of learning and innovation within health systems.

Department of Family and Community Medicine, University of California at San Francisco (Dr Bodenheimer); the Department of Health Care, Jönköping County Council (Dr Bojestig); and Qulturum, Jönköping County Health System (Mr Henriks), Sweden.

Corresponding author: Thomas Bodenheimer, MD, Bldg 80–83, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110 (e-mail:

Sara Syer PA-C assisted with the interviews and with the editing of the manuscript; many people working in the Jönköping County Council, in particular Annika Nordin and Anna Ringheim of Qulturum, gave their time and wisdom to this project.

©2007Lippincott Williams & Wilkins, Inc.