Upper-level leaders’ perceptions of integrating health and social care services after the structural reform in Finland: a qualitative study

Abstract

PurposeIn Finland, a major health and social service system reform was implemented in 2023. The reform introduced macro-level organizational integration of health and social services as the responsibility for organizing the services was transferred from c. 300 municipalities to 22 well-being services counties which get their funding from the state. The purpose of this study is to describe different leadership actions to promote integration at the meso- and micro-levels of the service system after the macro-level organizational reform.Design/methodology/approachThe qualitative study utilized semi-structured interviews (n = 25) collected from the upper-level leaders of the well-being services counties. The study participants represented 11 well-being services counties in Finland. The data were collected in May–August 2023. Inductive content analysis was used for data analysis.FindingsFour leadership actions to promote integration at the meso- and micro-levels of the service system were identified: (1) service user-based leadership actions, (2) partnership-based leadership actions, (3) service system-based leadership actions and (4) knowledge-based leadership actions. Most of the interviewees combined several different leadership actions in their recount.Originality/valueThe study highlights important information of the focus points set for leading integration in the unique context of reforming health and social services. With this paper, we provide a new way of comprehending integration from the leadership point of view. The conceptualization through the different leadership actions may facilitate forming a shared vision for integration among leaders and managers.