A health and social services reform that is unique by international standards is under way in Finland. The organisation of health and social services and, at the same time, primary and specialised level services, will be integrated in the counties’ responsibilities. A possibly even greater change will take place in service provision, in which a multiple provider model and competition between service providers will be stressed. While this is a significant transformation, extensive changes have already been carried out, albeit in a different way.
- The sub-project investigates key changes related to the health and social services reform and their impact on competence needs.
Key changes brought about by the reform:
- Health and social services will be integrated.
- Digitalisation will change both work in this sector and the services used by clients.
- Freedom of choice and private service providers will play an important part in the future.
- The division of duties between social welfare and healthcare professionals will be reorganised.
- The study looks at what types of health and social services sector solutions municipalities and regions have already implemented or are about to introduce, and how these solutions will influence competence needs.
- The study relies on interviews, surveys, statistics and document analyses.
- It compares different solutions implemented in regions that have formed extensive social welfare and healthcare catchment areas comprising the entire county.
Changes in the health and social services sector are a challenge to competence
A transition to a multiple provider system is to take place in service provision. In this system, services would be provided by both the public sector and private, public or third-sector organisations. The idea is that competition will increase efficiency and improve the quality and accessibility of care.
This sub-project investigates what the central changes in social welfare and healthcare sector will be and how they will influence competence needs. Decisions on the health and social services reform are being made right now. Consequently, the project looks at organisations that have introduced, or are about to bring in, regional service systems or similar. As the services in these organisations are organised and provided by the same entity, the difference between them and the system proposed in the health and social services reform is considerable. This is highly significant in such areas as the implementation of service integration.
Mere reorganisation is not enough to bring about service integration. New practices are needed to develop the services for clients. This requires a change of attitudes and the organisational culture, and possibly also a new division of duties and new competence. The new competence may be relevant to the reform of operating practices. In that case, we must examine the personnel’s competence needs and the methods by which competence and practices can be improved. On the other hand, we must assess whether or not the current qualifications and the competence they impart will work in the future.
Experiences of new division of duties
Changes in the division of duties have already been made in Finland. In health centres, nurses have taken on a much more prominent role. A similar change is also under way internationally.
The training of care assistants, a shorter pathway to the labour market than practical nurse programmes, is also a new feature. The training is directed at such groups as immigrants and those changing occupations. Care assistants may, for example, work in assisting tasks in services for older people. Other examples of changes in the division of duties can be found in rehabilitation. In the rehabilitation at home model, rehabilitation is brought to the client’s home, rather than taking the client to the place of care. An increasing number of physiotherapists work together with home care services and guide home care personnel in promoting the client’s rehabilitation.
- In the treatment of long-term illnesses, the client often only meets a nurse, who consults the doctor if necessary
- Acute clinics run by nurses, who consult a doctor if necessary
- Nurses have access to limited prescription rights
- The doctor’s role is becoming more consultative.
Freedom of choice: a major challenge to integration
One objective of the health and social services reform is to increase the client’s freedom of choice and the part played by private service providers. This sets its own challenge to the objective of integration: if you buy small fragments of services, creating new cooperation models becomes more complicated. Dividing the services between a public enterprise and companies will bring about essential changes in the cooperative relations and affect the way in which integration can be implemented.
Developing the integration of care and treatment is an international phenomenon, but there are major variations in the level and scope of its implementation. In the narrowest sense, it may refer to cooperation between a doctor and a nurse. At the other end of the scale is Finland’s objective of integrating the entire social welfare and healthcare system, which is exceptional by international standards.
Integration at the level of the organisation does not necessarily lead to a seamless care chain for the client. Action and changes in operating practices at the client level will be essential.
Treatment and care can be integrated and coordinated through both so-called care manager or care coordination models and multi-professional cooperation. This may have a crucial impact on the personnel structure and competence needs.
Different operating models in service integration:
- The model of multi-professional cooperation. Different services operate under a single management structure. Teams that respond to the client’s needs are formed with the services, and they work together.
- The multiple provider model. When all links of the service chain are not managed by a single organisation, someone has to coordinate a client’s services. Service coordination will be a challenge. For clients, this may mean service chains that work less smoothly.
No certainty of the new competence needs
So far, we have little understanding of the extent to which integration and the multiple provider model will require new competence. From the personnel’s perspective, critical areas will include team work skills and relying on the competence of other professionals. Team work will be stressed if integration takes place via the organisational route, by collecting a team of professionals around the client.
In the service coordinator model, the coordinator will guide the client in navigating in a service chain implemented by different organisations. This model is likely to stress wide knowledge of social and health services and network management.
Changes in the division of duties and integration will require skilful management and reconciliation of professional cultures. Relinquishing responsibility to another professional group may be experienced as a problem.
In Finland, joint municipal authorities, whose operation is similar to that of counties, have so far mainly used the full integration model, in which both the organisation and provision of services is in the hands of a single organisation. Private service providers have also been used, but to a limited extent. The planned freedom of choice model will change the situation, as services are integrated at the organiser level, while there are several providers.
The project aims to find out what types of concrete changes in organisation structures and operating practices will have been made and what requirements these changes place on personnel competence. In addition, an effort will be made to anticipate future changes and the requirements that they will bring in terms of competence needs.
Study in a nutshell
This study will investigate and compare local health and social service solutions that the regions have implemented and are in the process of implementing. The extensive social welfare and healthcare system integration initiated in Finland will create opportunities for completely new types of organisation structures and operating models compared to other countries.
The requirements that these solutions will place on personnel competence will also be examined.
The backdrop to the project is organisations that are preparing for the health and social services reform and probably also for the changes brought about by the freedom of choice. This will offer a possibility of investigating the impacts on organisations, operating practices and competence requirements.
The study analyses existing and emerging regional social welfare and healthcare solutions.
Regions to be analysed:
- Eksote, a region that has been operating for a longer period
- Siun sote, a region that has recently launched its operation
- The model planned for Hyvinkää hospital area (Central Uusimaa)
- A private service provider’s perspective.
The existing solutions and those about to be launched are examined by means of document analyses as well as focus group and individual interviews. The studies include interviews with the regions’ management, supervisors and employees as well as decision-makers at central government and social partner level.
Based on the interviews with management, sample cases will be selected: in other words, sectors where the changes have been the most noticeable. In these sectors, the operating models selected by different regions will be compared on the basis of the interviews. On a wider scale, information will be gathered through a survey addressed to some 5,000 professionals of the social welfare and health care sector. This will produce information on different professional groups and regions.
The survey will focus on changes in competence requirements, the personnel’s views of the integration, cooperation, and information flows between professional groups and organisations. The personnel will also be asked about their expectations of the reform.
Changes in the personnel structure will be investigated using the National Institute for Health and Welfare’s personnel statistics. In addition, earlier research data will be used, including interviews with personnel and management at health centres and a personnel survey addressed to employees in services for older people.
Article written by Timo Sinervo & Sini Silvàn on 16th June 2017.