Satu Paatela, Soila Karreinen, Moona Huhtakangas and Liina-Kaisa Tynkkynen
In Finland, a major health and social service system reform was implemented in 2023. The reform introduced macro-level organizational integration of health and social services as…
Abstract
Purpose
In Finland, a major health and social service system reform was implemented in 2023. The reform introduced macro-level organizational integration of health and social services as the responsibility for organizing the services was transferred from c. 300 municipalities to 22 well-being services counties which get their funding from the state. The purpose of this study is to describe different leadership actions to promote integration at the meso- and micro-levels of the service system after the macro-level organizational reform.
Design/methodology/approach
The qualitative study utilized semi-structured interviews (n = 25) collected from the upper-level leaders of the well-being services counties. The study participants represented 11 well-being services counties in Finland. The data were collected in May–August 2023. Inductive content analysis was used for data analysis.
Findings
Four leadership actions to promote integration at the meso- and micro-levels of the service system were identified: (1) service user-based leadership actions, (2) partnership-based leadership actions, (3) service system-based leadership actions and (4) knowledge-based leadership actions. Most of the interviewees combined several different leadership actions in their recount.
Originality/value
The study highlights important information of the focus points set for leading integration in the unique context of reforming health and social services. With this paper, we provide a new way of comprehending integration from the leadership point of view. The conceptualization through the different leadership actions may facilitate forming a shared vision for integration among leaders and managers.
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Outi Jolanki, Liina-Kaisa Tynkkynen and Timo Sinervo
Integrated care policies have been at the heart of recent health reforms in many European countries. The purpose of this paper is to study the integration from the perspective of…
Abstract
Purpose
Integrated care policies have been at the heart of recent health reforms in many European countries. The purpose of this paper is to study the integration from the perspective of health care personnel working in primary health care clinics.
Design/methodology/approach
The study employs data from interviews collected in a research project examining patient choice and integrated care in primary health care clinics in Finland. The interviews were conducted in five cities in Southern Finland in 17 primary health care clinics in Autumn 2014. Among the interviewees there were both doctors (n=32) and nurses (n=31).
Findings
The typical problems hindering integration were, according to the workers, poor communication and insufficient information exchange between professionals, unclear definition of responsibilities between professionals, and lacking contacts and information exchange between health and social care professionals. To secure availability and continuity of care, doctors and nurses did extra work and exceeded their duties or invented ad hoc solutions to solve the problem at hand. According to professionals, patients were forced to take an active role as coordinator of their own care when responsibilities were not clearly defined between professionals.
Originality/value
This paper highlights that successful integration requires taking into account the requirements of the day-to-day work of health care clinics, and clarifying what facilitates and what hinders practical collaboration between different actors in health care and between health care and other service providers.
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Soila Karreinen, Kristiina Janhonen, Laura Kihlström, Henna Paananen, Marjaana Viita-aho and Liina-Kaisa Tynkkynen
Local health systems form the basis for health system resilience. Leaders’ standpoints are crucial in advancing resilience capacities and change. This study analysed how local…
Abstract
Purpose
Local health systems form the basis for health system resilience. Leaders’ standpoints are crucial in advancing resilience capacities and change. This study analysed how local health system leaders’ approaches to change reflect health system resilience capacities. Furthermore, we explored what triggers and hinders change during a crisis.
Design/methodology/approach
The data consist of purposively sampled interviews with 14 local Finnish health system leaders during the COVID-19 pandemic. Using abductive content analysis, examples of resisting, absorbing, adapting and transforming were identified. Contextual triggers and hindrances for the initiation of change processes were analysed to support understanding of health system resilience capacities at the local level.
Findings
Resilience capacities were manifested by doing standard things faster (absorption), engaging in collaborative reflections (adaptation) and reforming organisational boundaries and services (transforming). “Resisting” leaned on varied levels of reflection, with mixed responses. Triggers and hindrances varied situationally and highlighted the roles of a changing operational environment, existing practices and the social dimension (e.g. building a shared understanding).
Originality/value
Leaders’ standpoints and their approaches to change are rarely the focus of attention in system-centred conceptualisations of health system resilience. Leaders’ awareness of their approaches to change can affect organisational responses and health system resilience. This should be more clearly acknowledged in theoretical frameworks, leadership training, preparedness planning and crisis governance. Health system resilience capacities form intertwined, nonlinear processes that are reshaped throughout a crisis. Analysis of resistance can enrich the understanding of local-level processes.
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Laura Kihlström, Moona Huhtakangas, Soila Karreinen, Marjaana Viita-aho, Ilmo Keskimäki and Liina-Kaisa Tynkkynen
The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the…
Abstract
Purpose
The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland.
Design/methodology/approach
The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis.
Findings
The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions.
Originality/value
Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.
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Liina‐Kaisa Tynkkynen, Kari Hakari, Timo Koistinen, Juhani Lehto and Sari Miettinen
This case study aims to introduce a novel home care service integrator model called “Kotitori”. In the model the City contracts with a private provider, which, in turn, works with…
Abstract
Purpose
This case study aims to introduce a novel home care service integrator model called “Kotitori”. In the model the City contracts with a private provider, which, in turn, works with public, private, and third sector providers in order to meet the customer needs in a personalised way.
Design/methodology/approach
The case study draws from key policy documents and stakeholder interviews.
Findings
The study introduces a unique form of public‐private partnership in Finland, and describes the basic elements of Kotitori, the development process of the model, and the model's distinctive features compared to more traditional ways of home care service delivery.
Research limitations/implications
The Kotitori model is still in its early stages of implementation and reliable data on performance are limited.
Practical implications
The transferability potential of the Kotitori model is good both nationally and internationally. The model is potentially beneficial for countries with an interest in developing integrated care in general, as it reflects a form of “accountable care organisation”.
Originality/value
This is the first study describing the Kotitori model for an international audience.