Integrated regional social and health services South Karelia, Finland

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1 Integrated regional social and health services South Karelia, Finland Pentti Itkonen

2 Hospitals in Finland Finland is divided into 20 hospital districts. Each municipality belongs to a particular hospital district, each of which contains a central hospital. Five are university hospitals. Every hospital districts have their own management and administration structure.

which contains a central hospital. Five are university hospitals.

3 Primary Care and Social Services in Finland Primary care and social services including services for elderly people are organized by the local municipalities. They can also organize them together with neighborhood municipalities. They can also buy a part of the services from the private sector. Every health center and social services have their own management and administration structure

They can also organize them together with neighborhood municipalities.

4 South Karelia Social and Health District Responsible for the whole Social and Health Care in the South Karelia Region. Population Budget 410 M Workers 4200 Helsinki or Petersburg 220 km

in the South Karelia Region. Population 132.

5 Why the new model was made Integration between the acute hospital, primary care and social services A new and better balance between primary care and hospitals Difficulties to have doctors and other special workers Better coordination in strategy, financing and investments by the owner municipalities Common use and recruit of staff. Share the resources Better possibilities to meet the future challenges

special workers Better coordination in strategy, financing and investments by the owner

6 The evolution of the service system from hierarchy to ecosystem Different units in hierarchy Administrative framework Functional integration Ecosystem Municipality 2 Municipal Function 2 Municipality 3 Municipality 1 Hospital Municip a 2 Municipa 1 Hospit al Function 1 Function 3 Municipal based structure. Added value from hierarchy Administratively integrated structure. Added value from economies of scale. Functionally integrated structure Added value from data. Functionally integrated ecosystem Added value from Big Data

Function 1 Function 3 Municipal based structure. Added value from hierarchy Administratively integrated structure.

7 Concrete integrations in administrative framework economies of scale Information systems Only one patient record system Financial systems Different systems in each municipality. Now only one. Personnel systems Replacements of the personnel Salary harmonization Decision making and management Political processes Managers replacement

8 How to move to functional integration Commitment of every stakeholder Is it enough to have only a new administrative framework? Are we pushing the present into the future? Are you all ready to move on into deeper integration?

9 To manage integration Municipal ownership Ownership strategy Strategy Regional investments, logistics Organization structure Support integration with new processes Management training Training of the managers on all levels

Organization structure Support integration with new

10 Municipal ownership It is a big issue to transfer the basic services from the municipals to larger regional organizations. When the services are moved the municipalities only count euros. They want to have big and immediate savings When the personnel move to new organization the municipalities expect that the number of workers can be decreased immediately.

When the services are moved the municipalities only count euros.

11 Integrated organization structure CEO Strategic support Family and social services Health and elderly services Rehabilita tion Support services Health promotion The evaluation of service needs Rehabilitation and home care

Rehabilita tion Support services Health promotion The

12 Investments The investments have a very important connection to savings and efficiency. Especially electronic services and citizen`s own care and other new communication tools degree the need of fixed buildings and emphasis the critical view of long term permanent investments. What are the critical investments to support efficient integration? What kind of new buildings we really need?

the need of fixed buildings and emphasis the critical view of long term permanent investments.

13 Logistics The growth of traveling costs Aging population Public transport and long term care are decreasing Services are centralizing and outsourcing is increasing New care possibilities and models need more traveling

decreasing Services are centralizing and outsourcing

14 Management training - Knowledge- and innovation management Knowledge and innovation management improves the capacity of social and health care by highlighting the processes to create, generate, organize and utilize the digital data. It is about processes and functions which support knowledge and digital data based value creation. The value of data realizes when the data is used to steer the function on individual or organizational level.

15 The benefits of regional integration Top Management Common: strategy, economy, personnel, organization structure and culture, managers training Middle management Strategy implementation, managers training, use of expertise Other personnel The integration is not substantial and visible to all workers in their daily work. Essential to keep expertise available. Integration is not a mixture of work

managers training, use of expertise Other personnel The integration is not substantial and visible

16 The development of person working years and long term beds in Person years Beds 352 beds and 182 persons

17 The development of short and longterm days in Longterm Short

18 The number of hospital days in psychiatry 25,000 20,000 19,696 18,194 18,124 15,000 14,152 10,000 9,862 5,000 2,656 2,542 2,571 2,521 1,700 1,591 1,089 1, PSYKIATRIA 74 NUORISOPSYKIATRIA 75 LASTENPSYKIATRIA

2,542 2,571 2,521 1,700 1,591 1,089 1,941 831 795 0 2008 2009

19 Regional Integration ORGANIZATION STRUCTURE TECHNLOGY Welfare station TRAINING LOGISTICS Homecare, Home rehabilitation Hospital rehabilitation Acute hospital INVESTMENTS

20 Future

21 Added value from digital data - Citizen s and professionals new role ON PRE In the doctors office In the hospital POST Before surgery at home Time reservation Paying Consent Pre information Hospital buildings Contacts Communication Follow-up treatment at home Viewing patient data Communicate with professionals

22 Added value from digital data new organization structure Hierarchy (single service ) Processes (Service components) Level 2 Level 1 Level 3 Level 3 Level 3 A A1 A2 B B1 B2 C C1 C2 Service chain made by professionals Service made by citizen

23 The service system in the future The service system is an ecosystem including less and less buildings fixed and more and more moving and virtual service components which form functional service wholes. Moving components in service system are citizens (customers and workers), physical service products, materials and aid components information interfaces and data systems 23

24 New Service Individual/patient plans own service Fixed services in buildings Digital services Moving services Transportation

25 The Future We are moving from the care chains made by professionals to services compiled from different components by citizens We are moving to system where also regional logistics costs are optimized. The payer sets conditions to occasional logistics. Regional logistics will be a support service What is the future of buildings?

26 Conclusions Decisions about the present are justified based on past knowledge rather than taking into consideration unknown, uncertain and unpredictable topics Pushing the present into the future From hierarchy to regional integration Knowledge and innovation management: control or motivation, money or values, hard versus soft, mind versus heart, sub- optimization versus wholenes, hierarchy versus network, development versus services cutting.

27 The most important is the Confidence

new services: the next step the group strategy is about new usages explosion of volumes and new usages emerging

new services: the next step Thierry ZYLBERBERG executive VP strategic marketing the group strategy is about new usages explosion of volumes and new usages emerging administration transport education citizen