Tiohundra in Norrtälje, Sweden

Health and social care where you are - a seamless chain

Tiohundra has a unique constellation with integrated healthcare and social care in the same organization. A partnership focus is the main driver to plan and carry out the care together with the patient, user and/or relatives.  It provides conditions for a seamless health and care chain for people.
Tiohundra AB is a collaboration between Norrtälje municipality, Region Stockholm and Tiohundra AB. It provides a health and care chain for citizens in Norrtälje municipality, which extends beyond traditional county council and municipal boundaries. 
Tiohundra was establish in 2006 as the merger between healthcare and social care in Norrtälje municipality. The mission included developing new and integrated services of operation to increase efficiency and create well-functioning care chains between healthcare and social care in the municipality.
In 2016 the last step was taken to merge primary care and the Norrtälje Hospital into a common area of activity within Tiohundra. The benefit of this merger was in line with the Swedish government healthcare proposal, to coordinate health and social care to improve innovation and develop effective health care for the citizens.
Tiohundra is owned by the Municipality Association for Health and Social care in Norrtälje (Kommunalförbundet Sjukvård och Omsorg - KSON) together with Region Stockholm. Funding comes from the same organizations (50/50) as all healthcare and care in Sweden, is based on contracts on either volumes or assignments.
The development of Tiohundra from 2006 to 2016 has subsequently been called the Norrtälje Model and is noticed both in Sweden and internationally and is highlighted by the Ministry of Social Affairs as a role model for other municipalities, county councils and regions in Sweden. A Norrtälje Model 2.0 was started in 20218 with focus on a more person-centered health care, and the patient’s needs where they are in life as well as physically – Health and social care where you are. 

The Norrtälje model

The Norrtälje model is a further development of the Tiohundra project.  The model supports and develops new cross-border methods for collaboration for the benefit of the citizen in the municipality. In addition, it has also laid the foundation for:
  • political cooperation by creating a joint municipal association with its own political leadership from both the municipality and the region
  • joint management and leadership training and quality advice that create a strong common culture
  • collaboration in recruitment which builds a strong employer brand. Tiohundra is the municipality’s largest employer
  • digitalization and welfare technology innovation, development, and cooperation in the IT area (as test bed for 5G, robotization etc.)
  • common focus areas for Equal care, Mental Health, and Children’s physical and mental health
  • improved citizen dialogue through joint investment in proposals from the citizens and forums for business development.
  • supports the cooperation and removes barriers that are not needed between public and private and between municipalities and regions.
The vision for the Norrtälje Model and Tiohundra is health and care where you are. The latter part of the phrase refers to both geographically and where the patient is in their life circle.
The vision reflects the focus on health and the wish to work preventively and ensure that as many of the citizens as possible receive help in good time so that they can stay at home longer and maintain a good quality of life. No one feels good about being in hospital unnecessarily, so when help from care or nursing is still needed, it should be done on the patients’ terms and if possible, at home. A partnership focus is the main driver to plan and carry out the care together with the patient, user and/or relatives. The vision also reflects the investment in digitalization, innovation and new technical solutions that make it easier to be a patient whether it is via a video meeting with the doctor or with digital aids for self-care.
The vision is also supported by the values which all employees in Tiohundra thrive to deliver a high quality in all efforts and actions through participation, good accessibility to creates security and equal treatment to show respect for the citizen.

Tiohundra collaboration and service deliverables

Tiohundra runs the emergency hospital, health centers, psychiatry, nursing homes, Child Care Center (BVC), Personal assistance activities (LSS), and home care - activities that were previously run respectively under the auspices of the municipality and the region.
Tiohundra works according to a long-term operative management plan that consists of clear goals and with focus on integrated health care combined with increased use of digital ways of working, change management and partnership with users and customers. The goals are updated annually based on the overall wish to be top ranked, cost-efficient care in time and no waiting lists no queues. There is a well formulated process to update and renew the goals and the strategic work behind it. When updated meetings and forums associated with the new goals set are launched on different levels of the organization to ensure anchoring and communication of the updated plans and strategies.

Collaboration at all levels

The management of Tiohundra is organized in a management board with a CEO and representatives from all part of the operations in the organization (healthcare, social care, primary care, psychiatric care etc.) including research, development, HR, and IT. In total there are 13 Operation Managers and the CEO in the board and the operation managers are reporting directly to the CEO.
The management board is meeting up weekly (Mondays) to cooperate about the current challenges, needs, knowledge sharing for the operation of Tiohundra. The main characteristic about the Monday meetings is that everyone is taking part in solving challenges across the different operations.
The operation managers are then sharing the information to their areas the following day, to ensure that the organization is fully aware of activities and actions happening in the company.
In addition, there is a monthly full day meeting with colleagues and managers of the organization to follow up on certain perspectives on work e.g.: economy, safety, improvement work, new assignments, occupancy etc.  

New working methods

Based on the partnership and collaboration in the operation of Tiohundra, several new working methods have been developed, which both promote patient safety and increase efficiency. Many are based on the use of technical solutions, which is far from self-evident in health and care. Some of the examples of technical solutions that have been implemented to improve health services and efficiency are mentions below:

Mobile way of working with new technology

Nurse assistants in nursing homes has been equipped with Smartphones to be able to document, for example, wounds. The nurse then sent the pictures to geriatricians at the hospital for assessment.
Similarly, the district nurses at a care center were equipped with reading tablets. This way, they always have the patients' medical records available for home visits, which increases patient safety and saves precious time. This process has attracted a lot of attention and has been awarded several awards.  

Cohesive medical record system

At the start of Tiohundra, eleven different record systems were identified in the municipality, which did not communicate with each other.   Today there is a cohesive medical record system for both primary care and hospitals as well as psychiatry. However, there is still work to be done in this area as part of the continuous digitalization transformation, and with a focus on using the same system in social and care services, which is highly needed.

Digital drug management

To make drug management safer at care and nursing homes paper drug lists have been replaced with a digital tool, easily accessible to employees with the help of a standard tablet.

Restaurant pucks reduce stress

At Norrtälje Hospital, the so-called restaurant pucks are now an obvious part of the business. When a patient is ready for an X-ray and is going back to the care ward, the puck flashes in the care staff's pocket.
However, for Tiohundra digitalization is the engine for development, but they do not need to be front runners or develop solutions themselves but are satisfied by buying existing solutions that will bring added value to the organization and the user and customer. This is an important strategy choice not always being a development partner but a user champion. It is also, right not possible to manage and drive the digital development themselves because of lack of resources in the organization. 

Generate and learn from insights

One of the main components in the success of Tiohundra is the willingness to collaborate and share with each other across functions and units. When talking to representatives from the organization the common denominator is working in partnerships and cooperate to achieve a common understanding of the challenges and needs at the citizen and not at least the organization.
The picture below illustrates how Tiohundra work with partnership, employees, and management on one side, and how to involve, create safety and respect on the other side. Getting this right will create innovation and possibility for growth.

Success factors

The key success factors and reflections from the Tiohundra up until now are many and below are some of the major findings and components identified:
  • Be brave. To sit in the boat and keep your head clear even though you do not know what the next step is. Ensure that the processes are clear and that there is a common agreement about where to go and what the goal is. Be humble and learn from others at all levels in the organization from top to bottom – both the success stories but also the not so good experiences – and learn from both.
  • Be communicative. Be open and communicate to all by motivating, engaging and be honest in everything you do. Ensure to share goals even though the steps to get there not always is known.
  • Participation. Make sure to understand the needs by all interested parties – patients, employees and loved ones. Involve all necessary interested parties and co-create ideas, challenges and problem solving together. Cooperation is very important and can often be done by sitting together around a table and share.
  • What have others done. Investigate what others have done and learn. Ensure to measure the effects and communicate them. Create small iterative projects, and design, build and test in short incremental circles. Based on insights bring forward the good solutions and make them into guidelines and processes for others to use.

Statements for citizens and health professionals

Health professionals

“Our patients are not guests in our organisation, we are guests in their lives”

Facts about the model area

Name of regional network
Tiohundra 10100
Area in km2
2.000 km2
Population – number of inhabitants
When the network was established
Number of municipalities in the network
1 municipality
Number of hospitals in the network
1 somatic
Target group
All citizens, customers in home care and elderly living in homes
Number of users
All citizens in the municipality and double during summer

Useful links

Below you will find links to documents or platforms that could be useful to dive into for more details.