Health and social care is significantly changing. The COPE sub-project described here is exploring the kind of management, decision-making and management competence that will be required in the change.
- To explore what kind of reform is required in organising, administering and managing health and social services at the national and local level when the service system is undergoing transition.
- New service entities and organisations are being created in the health and social services reform process. This will require new ways of working and new knowledge also in management, steering of operations and decision-making.
- The sub-project is establishing what kind of administration and management is required in order to reach the goals and how the reform should be managed as the processes progress.
- The study is analysing various types of health and social care organisations from the perspectives of strategic and competence management. In addition, the forms of steering in various ministries and the cooperation between ministries are being studied.
- Individual and group interviews conducted at the national, municipal and regional level are being used as research materials. Strategy documents are being used as materials, too.
- The material is being collected according to the principle of cumulative data collection. This means that the results are discussed and reported to the health and social care organisations being studied at various stages of the study. At the same time, new research material is collected. In this way, it is possible to identify reform processes, methods, how the reforms progress, the significance of various operating environments and decisions, and critical areas. On the basis of the results, the study progresses to the next phase. A mixed method, combining various forms of material acquisition, is used in the analysis.
Health and social care reforms and management
Since the 1980s, a number of health and social care reforms have been carried out in Finland. A major health and social care reform and a new regional government administration are planned for the end of this decade and the early 2020s. The reforms and change processes constitute part of decision-making and management both nationally and at the regional level. The aim is to create new types of decentralised and network-like organisations as well as new kinds of operational entities. They can be network-like, multiprofessional entities, and work communities. At the same time, traditional and fairly strong sectoral boundaries in health and social care will be broken. Human resources will be led towards a new operational culture, which will nevertheless need to be predictable and reliable.
The sub-process is focusing on how the organisation of health and social services as well as their management and decision-making concerning the social and health care sector will undergo reform as the process progresses. What kind of management will be required in order for the reformed services to meet the desires and needs of residents? When work undergoes reform, it is also expected that the operating practices and management of the organisations will undergo reform too.
Professional boundaries will change
The management of multi-professional work communities will become more important than before and will require a new attitude. Management competence is emphasised when employees in the work community represent strong occupational groups typical of the social and health care sector. Management also encounters authority and professional boundaries. Professionals in the sector are also frequently accustomed to managers being part of the same occupational group as themselves. In a multi-professional work community, this brings new, interesting aspects to managerial work and undoubtedly new management competence requirements. This impacts on education in social and health services and management.
Different forms of decentralised and multi-sectoral hybrid type organisations will increase. Managers should be able to identify the distinctive features relating to these. Management will obtain genuine new content, as a decentralised organisation can include various networks, work taking place in different places at a different time – or at the same time. The whole may include various structural and cultural dimensions. At the same time, the role of employees is changing in the direction of more of an active developer, i.e. organisational citizenship. A more independent approach to work is expected from employees, and management should provide room for this. Management also reflects changes in attitudes, values and political power relationships.
Conflicting pressures of management
There are very different, sometimes conflicting expectations towards managers and management work at various levels in the social and health care sector. Municipal services are subject to very different objectives and various types of steering nationally and at the local level. Services are also an instrument of national social and health policy and reflect changes in policy and the economy.
The influence of the Ministry of Social Affairs and Health on steering in the health and social care reform will probably become stronger. At the same time, cooperation between the various ministries will undergo reform – or it will be expected that they undergo reform.
Health and social care organisations also provide statutory services. In the future, health and social care organisations will become a meeting point for private and public operating models and perhaps also for network partnerships.
Effectiveness is also expected from public sector services. In order to evaluate effectiveness and quality, new evaluation methods and measures are needed and are under development. Use of these will require expertise from managers. Work communities, too, need to understand what effectiveness means and how it is assessed. Likewise, the production and use of data almost in real time in decision-making will probably be emphasised both at the national and regional level.
Incorporation of municipal health and social services organisations or establishment of municipal enterprises also constitute a major process. Along with duties, attitudes and operating practices will undergo reform – or at least they will be expected to undergo reform.
Research on changing activities
This sub-project is evaluating the management of health services and the implementation of the reforms in new, multi-professional and decentralised organisational structures. How will the competence of managers and employees correspond to new operating practices and goals? Will effectiveness, genuine health and social care integration and the goals of multi-professional work be achieved? What other new operating and professional interfaces will develop? What shape will the interface between services at municipal and regional government level, where the customer moves between these different level services, take?
A mixed method, combining various forms of research material acquisition, is used in the acquisition of research materials and in analysis. This aims to identify the multidisciplinary nature of the areas and theme and the rapidly changing features of the activities. Cumulative data collection is used in collecting material. This enables process-like interaction with the subjects.
The material for the study consists of national and local strategy document analyses. Individual and group interviews will be conducted both on central government and on municipal and regional organisations. The data available on the COPE project’s questionnaire is also in use. Scientific publications and professional articles will be written at various stages of the sub-project. In addition, the results of the sub-project will be reported at regional, national and international seminars and conferences.
- Bevir, Mark. 2011. Key Concepts in Governance. Sage, Los Angeles.
- Christensen, Tom Lagreid, Per 2011. Complexity and Hybrid Public Administration—Theoretical and Empirical Challenges. Public Organization Review. 11(4),407–423 .DOI 10.1007.
- Duncan, Carrie M. & School, Mecan A. 2015.Talking Across Boundaries: A Case Study of Distributed Governance. ISRT, Voluntas 26, (731-755) DOI 10.1007/s1266-014-9453-2.
- Jääskeläinen Aki & Sillanpää ,Virpi 2012. Overcoming challenges in the implementation of performance measurement: Case studies in public welfare services. Case studies in public welfare services International Journal of Public Sector Management. 26(6) pp. 440 – 454.
- Eteläpelto, Anneli & Vähäsantanen, Katja & Hökkä, Päivi & Paloniemi, Susanna (2014). Miten käsitteellistää ammatillista toimijuutta työssä? Aikuiskasvatus 3 (34) , 202-214.
- Laulainen, Sanna 2014. Aktiivisista organisaatiokansalaisista uudenlaisia pelaajia sosiaali- ja terveydenhuoltoon. Fysioterapia 6, 44-48.
- Lumijärvi, Ismo & Leponiemi, Ulrika 2014. Strategic Management in Finnish Municipalties. In Paul Joyce & Anne Drumaux (eds.) Strategic Management in Public Organizations. European Practices and Perspectives. Routledge, New York, 41-56
- Mair, Johanna & Mayer, Judith & Lutz, Eva 2015. Navigating Institutional Plurality: Organizational Governance in Hybrid Organizations. Organization Studies 36(6), 713-739.
- Niiranen, Vuokko (2016). Uudistuvat verkostot ja yhteistyörakenteet johtamisessa. Julkaisussa Antti Syväjärvi ja Ville Pietiläinen (toim.) Inhimillinen ja tehokas sosiaali- ja terveysjohtaminen. Tampere Universty Press, Tampere. 297-318.
- Niiranen, Vuokko (2016). Johtaminen moniammatillisuuden maailmassa. Pro Terveys (43), 5, s.12-13.
- Niiranen, Vuokko & Joensuu, Minna 2014. Political Leaders and Public Administrators in Finland: Key Values and Stumbling Blocks in Decision Making and Interaction. In Paul Joyce & Anne Drumaux (eds.) Strategic Management in Public Organizations. European Practices and perspectives. Routledge, New York, 95-114.
- Niiranen, Vuokko. & Lammintakanen, Johanna. 2014. Johdanto. Julkaisussa Vuokko Niiranen & Minna Joensuu & Johanna Lammintakanen & Mervi Kerkkänen (toim.) Johtajana muutoksissa. ACTA 253. Suomen Kuntaliitto, Helsinki, s. 18-22.
- Ospina, Sonia M. & Saz-Carranza, Angel. 2010. Paradox and Collaboration in Network Management. Administration & Society, 42 (4), 404-440.
- Quinn Robert .E. 1988. Beyond Rational Management. Mastering the Paradoxes and Competing Demands of High Performance. Jossey-Bass Publishers. San Fransisco.
- Seppä, Matti-Esko & Virolainen, Harri. 2014. Henkilöstön kokemuksia yhtiöittämisen mukanaan tuomista muutoksista. Kunnallistieteellinen aikakauskirja 42(1), 83-101.
- Vartiainen, Matti & Kokko, Niina & Hakonen, Marko 2004. Hallitse hajautettu organisaatio. Paikan, ajan, moninaisuuden ja viestinnän johtaminen. Talentum, Helsinki.
Article written by Vuokko Niiranen on 6th April 2017.