Objectives of the Future Health and Social Services Centre programme: Improving the equality, accessibility, timeliness and continuity of services (part 1/5)
Challenging planning and development work is being carried out in the preparations of the Western Uusimaa Wellbeing Services County as the turn of the year draws near. The national programme for the Future Health and Social Services Centre is one important tool during the preparations stage. We will publish a series of articles about the objectives of this programme, offering a situational review of the preparations stage and the views of the Wellbeing Services County’s residents concerning these objectives.
The programme for the Future Health and Social Services Centre develops both basic level social services and healthcare services. The accessibility of services will be improved and the services will be adapted based on people’s needs. The programme aims to reform the operations of social services and healthcare and develop people-oriented service units. The cooperation between professionals of social services and healthcare will be strengthened to allow a more comprehensive assessment of a client’s situation so that they can receive the necessary help or support through a single contact. The programme has five objectives:
- improving the equal accessibility, timeliness and continuity of services
- shifting the focus of operations from heavy services to preventative and predictive work
- improving the quality and effectiveness of services
- ensuring multidisciplinary, well-coordinated services
- mitigating the growth of costs
(Source (in Finnish): https://soteuudistus.fi/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma1(extrernal link))
Equal accessibility, timeliness and continuity of services from the perspective of residents
We asked the residents of the Western Uusimaa Wellbeing Services County what do these objectives mean to them and what kinds of expectations and concerns they have regarding the matter. The preparations for the Wellbeing Services Count seem like a long-term process for the residents, many of whom only start to pay attention to the related news when the matter affects their own life or their loved ones.
When we talk about the objectives of the programme for the Future Health and Social Services Centre regarding equal accessibility, timeliness and continuity, the thoughts and expectations of residents are naturally quite close to their daily experiences and practices.
According to Petra Vairimaa from Kirkkonummi, both the location and service hours of services are key matters in accessibility: where to go, how and when can one contact the healthcare services? At the moment, when booking an appointment at Kirkkonummi, clients can only leave a call-back request, and answering the phone when the healthcare centre calls back may be difficult.
Naturally, inadequate resources are a national problem that is currently visible everywhere in the operations. “I have quite a tight schedule, too, and if I cannot answer a call right away, it quickly becomes a back-and-forth situation with phone calls, which is frustrating,” Vairimaa says.
Vairimaa also links preventative work to timely services, for example – “People can easily find an accessible channel through which they can get the right kind of advice and are referred to the right professional even at an early stage,” she describes.
With regard to continuity, she sees it challenging that people with long-term illnesses may not always know who to contact. They may end up calling around healthcare centres and hospitals, especially if they are unfamiliar with the system and are dealing with the affairs of their elderly relatives, for example. Local services have a major role when someone has to have laboratory tests taken frequently, for example.
With regard to the entire reform, Vairimaa believes that ‘change is a new beginning’, which means that she considers the transition to Wellbeing Services Counties as a good opportunity to do things in a more resident-oriented manner and more effectively while allowing the professionals of the field to change the operational models.
For Sari Virta from Kauniainen, access to treatment is also an important factor in accessibility. In her experience, though, the difference between private and public healthcare sectors may be quite significant in some cases and municipalities: “I am concerned, and I hope that this reform of social and healthcare services could offer us solutions, so that access to treatment would not be as dependent on whether you have access to occupational healthcare, an insurance or loud enough voice and the ability to stand up for yourself,” Virta states.
Virta brings up proactivity as an important factor in timeliness in treatment needs assessment. She believes that the professionals should be trusted and that adequate resources, competence and mutual support should be secured for them.
With regard to continuity of care, Virta brings up system-level connections – “Of course, the person treating you will sometimes change, but the patient information should still be available. It feels strange that even though we have Omakanta and Apotti and other systems, private sector doctors cannot see all the information even if they have your consent!”
Virta considers the transition to wellbeing services counties as an opportunity to receive a high-quality service in regional locations, and believes that the potential mobility of staff within the region could provide flexibility to utilising the resources.
The accessibility of treatment is important to Terhi Haataja from Karjalohta as a concrete matter. Naturally, as a rural resident, she and her family are used to long distances to obtain services, but she hopes that the distances would not grow any longer. An hour’s trip to a maternity clinic or a doctor’s appointment is too long. “Remote services have their place, but they cannot be used for everything,” Haataja says, describing what she thinks about digital services.
Haataja believes that the timeliness of services is largely linked to the accessibility of treatment – “So that treatment is available when you need it.” In her view, preventative services that are not bound to law are highly underused in the social service field, for example, in relation to how much they could benefit people.
Regarding the continuity of treatment, Haataja feels that the solutions of patient information systems are somewhat lagging behind in relation to the development around them. If some information is missing in the system or not available to all parties, this can even lead to severe situations. “If something is missing that would completely change the situation, this could lead to the wrong treatment measures.”
When Haataja considers the entirety of the Wellbeing Services County’s preparation work, she thinks that the fact that the operations – both politically and operatively – are centred in the largest city in the region, Espoo, is slightly concerning with regards to equality. In terms of equality, she believes that a comprehensive view should be maintained in decision-making and that matters should be considered holistically instead of just as equalised profitability analyses.
Improving the equal accessibility, timeliness and continuity of services when transitioning to Wellbeing Services Counties – Service Area Director Markus Paananen
One of the objectives of the programme for the Future Health and Social Services Centre is to improve the equal accessibility, timeliness and continuity of the services. The reform aims to ensure that basic healthcare and social services are accessible to all in as timely a manner as possible. Even though the responsibility for producing the services will remain with the municipalities until the end of the year, sharing best practices and developing functional operational models will already be possible during the preparation stage.
In his work, Markus Paananen, the Service Area Director for health and social services of the Western Uusimaa Wellbeing Services County, considers the accessibility, timeliness and continuity of the services. There are several projects underway in the Wellbeing Services County that aim to improve the client experience and service quality. “In future years, we will assess which operational models will be prioritised in our county,” Paananen says.
The accessibility, timeliness and continuity of services are actually all interlinked, and only focusing on one issue takes attention away from the others. The timeliness of services is connected to their accessibility, and their accessibility is linked to continuity. Accessibility is often the first mentioned factor, but the different patient needs, for example, place the focus on timeliness and continuity. When assessing treatment needs, evaluating the urgency is important – in some cases, the timeliness of a patient’s care will be prioritised over the accessibility of non-urgent care.
Team health centres solve patients’ issues through teamwork
West Uusimaa is piloting several different team models that have improved the accessibility of care. The first team health centre started its operations in Espoo in November, and this model allowed the waiting periods for a doctor’s appointment to be shortened a great deal. This, naturally, also improved the situation regarding client feedback: “We thought that the inbox for feedback was broken, but no – we just didn’t receive as much of it as we used to,” Paananen says, describing the improved situation.
A health centre operating with a team model is a holistic concept of resource planning where a multidisciplinary team is in charge of the client’s treatment. The team usually includes 8–12 professionals, and the key factor is that they will attempt to review the client’s needs already during the first contact. If necessary, the treatment will continue under the leadership of a professional, either by phone or via appointments.
A key objective is to improve the accessibility of treatment and maintain the continuity of care, preferably with a professional who is familiar to the client. Many matters can nowadays be flexibly managed through remote services; clients requiring a face-to-face appointment will be guided to the health centre.
The operations will be closely monitored so that any deviations and issues with offering treatment can be intervened with quickly. The agility of operations is increased by the fact that the teams can independently develop the operations as much as possible, allowing them to create the solutions that work the best.
In addition to Espoo, this model is applied in Kauniainen, and Raasepori is also planning to introduce the team model. Some health centres outsourced to private service providers in the West Uusimaa region also apply a similar operational method. This model will possibly be applied in the whole region after transitioning to the Western Uusimaa Wellbeing Services County.
Continuity of care is an important part of the healthcare chain
However, Paananen believes that the continuity of care is the most important element of high-quality basic healthcare. Continuity of care refers to determining the duration of a treatment relationship. “Poor continuity of care means that a client has to see a different professional every time – good continuity means that the client can see the same professional and that they have an established treatment relationship,” Paananen says.
It is important to know from which kind of environment the person is coming to the appointment, what their life situation is like and what events may be related to their illness – the whole background has to be considered when new symptoms emerge. If this background needs to be reviewed again every time, this is quite inefficient – “In a way, it is more important to know what kind of a patient has the illness than what kind of an illness the patient has,” Paananen describes.
In addition to providing care, the perspective of information flow is also part of the continuity of care. Any problems with information flow may cause challenges for providing treatment, for example when the patient information system is not up to date when the patient comes in as a client of emergency services.
Staff at the centre of change
The preparation work for the Wellbeing Services County has both challenges and opportunities. Scheduling is a major challenge – the turn of the year is approaching quickly, so a gradually growing number of staff would be needed for the preparations, and finding these resources from among the municipal professionals is difficult. Managing the project organisation also has its own challenges, and the administrative organisation of the Wellbeing Services County is still in development.
The transition will offer a major opportunity for developing operational methods, which will be reviewed and assessed over the course of the process and will then be improved. The group services, which will only be available to the social and healthcare services and the rescue department in the future, could also help make the operations more efficient, even from a resident perspective.
Developing the digital services will also offer many different opportunities, but face-to-face appointments will always maintain their importance in healthcare. In some cases, treatment cannot be provided as a remote service.
Competent and professional personnel is a major factor, and there is national competition over the professionals. “The Western Uusimaa Wellbeing Services County must be able to offer good working conditions and flexible and diverse opportunities for professionals. It is important to create conditions for research work and developing one’s own work,” Paananen says, commenting on the attraction factors of the Wellbeing Services County as an employer.
Centralisation of services is a hot topic with many different points of view in the Western Uusimaa Wellbeing Services County. Paananen believes that it is not well-founded to systematically shut down smaller units and centralise the operations when transitioning to the Wellbeing Services County. He states that different perspectives should be taken into account in the matter:
- what services can be reasonably expected to be provided locally – there are different methods for providing the services, such as local appointments, mobile services and remote services
- the perspective of production efficiency; whether it is possible to provide the services in a more cost-efficient manner
- cumulative benefits: what kind of synergy benefits can be achieved from collecting different services under the same roof. Could this even lead to more efficient use of resources?
“The important thing is that the quality of the services must be maintained at least at the same level as now over the transition period – the development work itself will proceed more quickly over the upcoming years.”
Further information Western Uusimaa Wellbeing Services County’s Service Area Director for health and social services Markus Paananen, firstname.lastname@example.org