To really understand the impact of Göran's career, it is important to understand the context in which he was working. Sweden is a country of 10.6 million people in northern Europe, making it the 5th largest country in Europe. Similar in some ways to the UK, Sweden is a constitutional monarchy, but the government operates as a parliamentary democracy. The capital city, Stockholm, is almost 800 years old and has a population of 2.4 million in the city and surrounding area. Sweden's economy, once largely dependent on timber and mining, is now well-diversified and has growing tech and pharmaceutical sectors. Sweden's population is not as homogeneous as sometimes thought, with 79% of Swedish ethnicity, but almost 1 in 3 inhabitants with at least one foreign born parent.

Göran's home city is Jönköping, a city of just over 110,000 inhabitants in southern Sweden, on the shores of Sweden's second largest lake, Vättern. Jönköping was once known for making matchsticks, but today is better known for its 2 universities and an innovative and cooperative small business culture. Much of Göran's career was spent leading Qulturum, a "center for the development of improvement knowledge and innovation in healthcare", which is also responsible for the delivery of healthcare services in the region.

Sweden's healthcare system is by law a nationally regulated but locally administered system. The national government sets high level policies, but regional and municipal governments are responsible for the design and operation of their local systems. Funding comes primarily from regional and municipal taxes, supplemented by grants from the central government. Regions and municipalities are required by law to create and operate within a balanced annual budget for all public services, including healthcare.

Enrollment in the public healthcare system is universal and automatic, and – with some minor variations between regions – covers inpatient care, outpatient care, dental care, mental health, long term care, and prescription drugs. Of note, the public system is operated around 3 core principles: human dignity and equality, those in greatest need take precedence, and cost-effectiveness. A small private healthcare sector began to grow in the early 2000s after some of the government reforms discussed below but today accounts for only about 13% of system spending. Overall, Sweden's spending on healthcare is approximately 11% of GDP, just over half of the proportion of GDP that the US spends and roughly 1/3 of US spending on a per capita basis.

What outcomes does Sweden achieve at that fraction of the cost of the US system? Life expectancy is 83.3 years and rising, as compared to 76.4 years and declining in the US. The number of years of life lost to preventable deaths per 100,000 population in Sweden is less than half of the US figure. Infant mortality rates in Sweden are also less than half those in the US. And medical bankruptcies rarely if ever occur in Sweden, whereas in the US they represent an estimated 60% of all bankruptcies. Impressively, the Jönköping regional system led by Göran Henriks has been leading Sweden in both financial and health outcome metrics for a number of years.

As a hybrid private-public system with some superficial similarities to the US, those outcome and cost differences are striking. The podcast contains much discussion of the differences between the two systems, but here we will move on to some of the important concepts raised in the interview that may be helping Jönköping achieve the best results in Sweden.

But first, a short non-healthcare diversion. The podcast episode begins with Göran's description of a famous Swedish ski race, the Vasaloppet, which is actually the world’s biggest cross-country ski race and had almost 60,000 participants last year. Held each year on the first weekend of March, the race conveniently has its own website where you learn about the ski race and all of the associated other events. The short version of the story is that the race commemorates a guy named Gustav Eriksson, who – just as Göran says – escaped the Danes, united Sweden and became King Gustav Vasa.  The race itself started in 1922, has been run annually ever since, and is deeply connected to blueberry soup. Really.

Also, early in the podcast the Swedish word for the black material that ice water swimmers once used for insulation is mentioned. The word is "tjära", which is pronounced "shair-rah" and means "tar" (not "whale fat"). Don’t let anyone tell you that Swedes are not made of tough stuff.

One of the many influences on Göran's work from the world of basketball is the phrase Festina Lente, which he says originally came to his attention courtesy of former Dallas Mavericks basketball coach Dick Motta. The phrase, which translates from Latin as "make haste slowly", dates back to at least the Roman Empire and was even adopted as the motto of the Roman emperor Augustus, who used this idea primarily in battle strategy but liked it so much that he had it printed on Roman coins. In the Renaissance era, the Medicis of Tuscany also took it as their motto and it appeared in the works of Shakespeare as well. Another version of this saying from the basketball world comes from legendary UCLA coach John Wooden, who was fond of saying "be quick but don't hurry."

The meaning of Festina Lente is that producing quality work requires a balance between speed and precision. While time matters, rushing to complete a task increases the risk of mistakes, waste and poor results. Techniques for balancing these conflicting imperatives include planning and practicing plays or strategies, leaving time for creativity and thoughtful problem-solving, but also paying attention to forward flow in a project and avoiding "analysis paralysis".

Applications of this idea in medicine are numerous. The thought that, like basketball, modern medicine is much more a team sport than an individual one has been discussed many times, including in this talk and other written pieces by Atul Gawande. The idea that medical teams need to practice to be able to operate efficiently under pressure is one of the key drivers of the recent growth of simulation training in medicine into a multi-billion dollar industry. And there is an excellent bit of Festina Lente-related leadership wisdom in Göran's comment that coaches can help players during practice, but during the game it is the players who must read the game and react — an assertion that also has echoes of the need more for thoughtful guidance than strict direction in steering complex adaptive systems (see our Episode 3 Rabbithole story for more on this).