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Interdisciplinary Focus on Patients

'- Our guiding principle is the patient’s desires and proposed solutions – not a fixed preset programme dictated by doctors, says Martin Ridderstråle, Head of Clinic at Steno Diabetes Center.

Every Sunday, Martin Ridderstråle, Head of Clinic at Steno Diabetes Center, sends an email to almost 100 employees. The email contains both historical patient data and data on the patients who are visiting the clinic in the coming week.

– These are not just data from a computer, says Martin Ridderstråle.

– These data come from real people whom we will be examining in the flesh. This week 339 patients will be consulting a doctor at Steno, explains Martin Ridderstråle, pointing at the monitor.

– Achieving a common sense of the situation is important. We call this alignment, meaning that we work as a team with a common purpose. Although we may be very experienced and competent in treatment, my experience shows that we can get confused if we do not have a common direction, he adds.

Steno Diabetes Center is a specialized diabetes clinic that annually treats about 5600 people with type 1 and type 2 diabetes. The Clinic is an integrated part of Denmark’s publicly funded health care system and treats patients from the Capital Region of Denmark, one of Denmark’s five administrative regions.

At the Steno Clinic, treatment is based on a close working relationship between the various types of health care workers – always with the patient in focus.

– We have several interdisciplinary meetings each week at which nurses, doctors, dietitians and podiatrists jointly discuss a specific patient. Our teams are not organized by profession but are based on a patient’s needs, says Martin Ridderstråle, who has headed the Clinic since March 2013.

– We can also offer patients the opportunity to meet a group of therapists collectively: typically a younger and older doctor, a nurse and a dietitian. This situation is ideal because it involves all five people discussing how to find a solution. This is not only good for patients but also for the employees, who learn from each other and develop competencies, says Martin Ridderstråle.

Only 7% of the people with type 2 diabetes are managing their diabetes well at the first consultation, but after participating in a 9-month programme at Steno Diabetes Center, 32% manage well the three important parameters: blood sugar, blood pressure and blood lipids.


The innovative approach to patient care led to the independent magazine Dagens Medicin awarding Steno the Golden Scalpel Award (Den Gyldne Skalpel) in 2014 for its efforts in developing interdisciplinary and effective care pathways based on an individual patient’s data and personal resources.

– You have succeeded in improving the quality of care for each individual with diabetes so it fits their lives, said Nick Hækkerup, Denmark’s Minister for Health, at the award ceremony.

– We are extremely proud to receive this major tribute to our employees, says Martin Ridderstråle. Focusing on individuals also means that Steno can offer people group therapy so they can talk with peers about diabetes.

Steno has recently established a “My Steno” website at which patients can log into a personal web page and access all the important data and information in their medical records. They can also create and record their own treatment goals.

– Patients feel secure and free when they are given information about their condition and treatment. This is what guides my everyday work: how can we contribute to making patients feel secure and free? concludes Martin Ridderstråle.