Leading system change and breaking cultural barriers in Sweden

By Katrin Hruska.

Click here for the video summary.

Read the review by Dafydd Hammond-Jones.

– President, Swedish Society of Emergency Medicine

Reviewer – Dafydd Hammond-Jones Speciality Trainee Year 6 Emergency Medicine (EM) Leeds Teaching Hospitals Trust (LTHT)


Systems, Culture, where emergency medicine fits into it all

Emergency Medicine in Sweden, Systems and Culture

Dr Hruska talked about how in Sweden Emergency Medicine is not an established speciality like it is in the UK and how she is working to make it more so. She used this to ask the question ‘why do we need change in a system?’ and ‘how do we achieve this?’ Change is not easy but if something can be done in a better way then perhaps we should try and achieve this. Culture makes a bad design seem normal. We except that just because something has always been done a certain way we should continue do it that way. If we perhaps take a step back we would realise that there is a better way.

Does the System fit the Problem?

Dr then used an analogy of cookie dough being medicine and the patients within it and cookie cutters being the specialities. There will always be some cookie dough left in between and where does Emergency Medicine fit in to this? Are we our own cookie cutter shape, do we take on the bits in between or perhaps both? This led on to her asking the question about whether we deliver system orientated or patient orientated care. What are we trying to achieve? We work within a complex system that needs structure and we often talk about system change, but we also talk about patient safety and being patient focused all the time, so which is it. Perhaps we should be trying to make the system efficient in order to become patient orientated.

Making Change

Dr Hruska then said that it is not possible to change the world in one fell swoop and that you should focus on changing yourself and your team before trying to change others. Emergency Medicine sits between Primary Care, Critical Care, Pre-hospital Care and Emergency Nurses amongst other groups. Perhaps we need to fit in amongst others to fill in the gaps so that we improve the system and therefore making it better for the patients.


My take home message was about system change and being patient focused.

I particularly liked Dr Hruskas use of visual representation that allowed her to talk freely about a subject that she is passionate about. Her understanding of Systems, Culture and how to make change happen is evident. This coupled with her enthusiasm means that she is the right person to strive Emergency Medicine in Sweden forward.


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