Integrating Health and Social Services in Finland: Regional Approaches and Governance Models

Hanna Tiirinki; Juhani Sulander; Timo Sinervo; Saija Halme; Ilmo Keskimäki

doi:10.5334/ijic.5982

Figures & Tables

Table 1

Unintegrated and fully integrated administrations of regional health and social care authorities in Finland.

REGULAR (MUNICIPAL) ADMINISTRATION (N = 12)	REGIONAL JOINT HEALTH AND SOCIAL CARE AUTHORITIES (N = 8)
Statutory Special care authority = hospital district = municipal federation Independent municipal authorities for primary and social care (practices for integration vary) Planning responsibility with hospital district (disease-based care pathways often applied)	Voluntary – agreement by the municipalities (est. 20% of the Finnish population) All public specialized, primary and social care under one administration (HR, financing). Potential for integrated planning and work practices Often-shared electronic client information system Six of these organisations were founded between 2018 and 2019

Table 2

Data and analysis process.

	PHASE 1	PHASE 2
Aim	Analyse of governance of health and social care integration in Finland. Evaluate how Nicholson et al.’s (2013) framework can be applied to an analysis of integrated health and social care governance in Finland.
Data	Regional reports and documents pertaining to social and health care reform, other preparatory materials related to integrated care	Interviews of national health and social system evaluation officers (n = 5)
Methods	Qualitative deductive content analysis	Semi-structured interviews and mixed qualitative analysis
Frame of analysis	Elements for integrated health and social care governance (Nicholson et al. 2013)
Elements of integrated governance guiding the analysis	Joint planning: Joint strategic needs assessment agreed; formalising relationships between stakeholders; joint boards; promotion of a community focus and organisational autonomy; guide for making decisions collectively; multi-level partnerships; focus on continuum of care with input from providers and users Integrated information communication technology: Systems designed to support shared clinical exchange (i.e., shared electronic health record; a tool for systems integration linking clinical processes, outcomes, and financial measures) Change management: Managed locally; committed resources; strategies to manage change and align organisational cultural values; executive and clinical leadership; vision; commitment at meso- and micro-levels Shared health and social care priorities: Agreed target areas for redesign; role of multidisciplinary health and social care networks and/or panels; pathways across the continuum Incentives: Incentives provided to strengthen care co-ordination, such as pooling multiple funding streams and incentive structures (e.g., equitable funding distribution); incentives for innovation and development of alternative models Population focus: Geographical population health focus Measurement – using data as a quality improvement tool: Shared clinical population data to use for planning and measurement of utilisation focusing on quality improvement and redesign; collaborative approach to measuring performance provides transparency across organisational boundaries Ongoing professional development supporting the value of joint working: Inter-professional and inter-organisational learning opportunities provide training to support new methods and align cultures; clearly identifying roles and responsibilities and guidelines across the continuum Client/community engagement: Involve patient and community participation by use of patient narratives of experience and wider community engagement Innovation: Resources are available and innovative models of care are supported.
Level of maturity	Demonstrated (4) = in strategy and practice in the whole region Demonstrated (limited) (3) = in strategy and practice partly or in some municipalities Developed (2) = planned for implementation in the whole region Developed, limited (1) = planned for partial implementation or in some municipalities Nil (0) = none
Outcome	Descriptive analysis of integrated social and health care governance in Finland Evaluation of the feasibility of the integrated elements (Nicholson et al. 2013) for analysis of integrated social and health care governance

The level of integrated governance elements in different regions in Finland. (The light-blue columns indicate joint authority administrations; dark-blue columns indicate regular [municipal] authorities).

Overall picture of integrated social and health care governance in Finland. (The light-blue columns indicate joint authority administrations; dark-blue columns indicate regular [municipal] authorities).

Integrating Health and Social Services in Finland: Regional Approaches and Governance Models

Figures & Tables

Table 1

Table 2

Figure 1

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