Finnish Public Health Care Research Articles

Optimizing Neurosurgery Clinic Operations: A Comparative Study of Interventions in Finland's Public Healthcare System.

The Finnish public healthcare system aims to ensure equal access to health services for all but faces challenges in meeting the demand for specialized care, such as neurosurgery, due to resource constraints. This study investigates interventions to increase resources at a neurosurgery outpatient clinic to improve patient care without compromising waiting times for diagnoses and treatments, leveraging Finland's unique healthcare landscape. The study was conducted at Kuopio University Hospital's Department of Neurosurgery, the sole provider of neurosurgical care in Eastern Finland. Two interventions were designed to optimize clinic operations: one focusing on dynamic resource allocation through continuous monitoring and the other on establishing a fixed additional neurosurgeon slot. Process capability and regression analysis were employed to evaluate the effects of these interventions on the number of outpatient visits and the variability in daily patient numbers. The preliminary analysis showed an average of 9.3 outpatient visits per day (SD 5.2). The introduction of an additional neurosurgeon led to an increase of 5.014 visits per day, according to the regression analysis performed before the interventions. Following the interventions, the clinic observed an increase in the average number of daily outpatient visits to 9.8 after the first intervention and 11.6 after the second, with corresponding improvements in the number of neurosurgeons present. The second intervention, which established a predictable additional resource, resulted in a more significant improvement in process efficiency and stability. After the interventions, the number of new neurosurgical first patient visits increased by 7% (97 patients). This study demonstrates the importance of structured and predictable resource allocation in enhancing the efficiency of specialized healthcare services, particularly in neurosurgery. It also underscores the potential of planned interventions to manage and improve patient care in a publicly funded healthcare system, despite the challenges posed by limited resources and the need for prioritization. Moreover, the findings highlight the necessity of ongoing measurement and analysis of development projects to ensure sustained improvement and avoid regression in process quality.

Comparing the effectiveness of competition as a method of reminding primary oral health care dentists to record diagnoses with two alternative methods used to enhance the recording of diagnoses in primary health care

ABSTRACT The purpose of this study was to investigate whether competition is an effective method to remind primary oral health care dentists to record diagnoses (RRD). The effectiveness of competition was examined in comparison with financial group bonuses (FGBs) and electronic reminders (ERs) of the electronic health record, together with superior-subordinate or development discussions. Putative differences in the diagnosis recording cultures of Finnish public health care physicians and dentists were studied. This was a retrospective quasi-experimental observational study in which the effects of the interventions on the rate of recording diagnoses were identified using a general linear regression model and proportions of visits with recorded diagnoses. The rate of increase in the recording of diagnoses in dentists was 0.995 ± 0.273%/month (mean ± SEM) after the implementation of RRDs and this did not differ from that obtained after starting FGBs (0.919 ± 0.130%/month) or ERs with superior-subordinate or development discussions (1.562 ± 0.277%/month) in physicians. As the rates of increase did not differ none of the applied methods seemed to be more effective than the others when trying to influence the behaviour of primary health care clinicians. Altogether, public primary health care physicians were more active than respective primary oral health care dentists to record diagnoses.

National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study.

BackgroundeHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities.ObjectiveThe first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020.MethodsData for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable.ResultsAll the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations.ConclusionseHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies.

Deep carious lesions and their management among Finnish adolescents: a retrospective radiographic study

ObjectiveThe objective of this retrospective study was to find out (i) the prevalence of deep carious lesions, both untreated and previously treated, among 14- and 15-year olds and (ii) how deep carious lesions were managed in a Finnish public health care setting.Materials and methodsA random sample of 278 patients was taken from 3990 patients at the oral health care of the City of Helsinki. Radiographic subsample consisted of patients with bitewing and periapical radiographs (n = 128, 46% of the total sample). Deep carious lesions (extending to at least the inner half of dentine), deep restorations, direct pulp cappings, root canal treatments, and extractions in permanent premolars and molars were recorded from the radiographs. Patients with untreated deep carious lesions were followed up for 24 months.ResultsIn the total sample 12% had at least one untreated deep carious lesion, 10% at least one deep restoration, and 19% at least one untreated or previously treated deep carious lesion. The follow-up cohort included 48 deep carious lesions in 26 patients. Complete excavation was the most frequently chosen method (81% for lesions reaching the inner half of dentine and 56% the inner third or deeper), followed by stepwise excavation (19% and 37%, respectively).ConclusionsOne-fifth of 14–15-year-olds had at least one untreated or previously treated deep carious lesion. The choice for the carious tissue removal did not follow the current recommendations for less invasive methods.Clinical relevanceContinuing education is needed to improve the diagnostics and management of deep carious lesions.

Emotional labour in the collaborative data practices of repurposing healthcare data and building data technologies

This article focuses on emotions, conceptualised as emotional labour, evoked during data practices used to repurpose and enable healthcare data journeys for Finnish public healthcare. Combined approaches from critical data studies and the sociology of emotions were used to contribute to a better understanding of the mundane but often invisible work of the emotions of experts involved in data practices, such as facilitating data journeys and building data technologies. The article is based on a two-and-a-half-year ethnographic study conducted in a Finnish regional public healthcare and social service organisation. The study results were derived from the analysis of 39 interviews and fieldnotes produced by observing 170 h of various meetings, events and work activities performed by experts. The results were organised into three forms of observed experts’ emotional labour related to three phases of healthcare data journeys: (a) caring for data production and preparing data for travel, (b) managing excitement and frustration in data processing for continually building the data management system, and (c) reassuring users in making sense of obtained data analytics. The results contribute to a greater understanding of the emotions and emotional labour generated by healthcare data journeys and in relation to the volatile nature of healthcare data and the collaborative character of data practices. This work advocates for a better recognition of the emotional aspects of data practices and their implications on data-based knowledge and datafication processes in healthcare.

A Discursive Sensemaking Perspective on Project-Based Work in Public Healthcare

This study investigates project participants’ sensemaking of lived work experiences during periods of organizational change within Finnish public healthcare. It introduces a discursive sensemaking perspective to investigate lived experiences, that is, reflexive practitioners’ situational thinking. Drawing upon 17 interviews, the study identifies diverse repertoires through which the lived experiences are considered meaningful. These are repertoires of: (1) transformation, (2) realism, (3) politics, (4) individuality, (5) reflexivity, and (6) senselessness. The results show that project-based work in public healthcare differs from project participants’ expectations because projects are perceived to increase rather than decrease bureaucracy and include unsustainable working conditions that have to be endured.

Efficacy-Based Budget Impact Analysis of Secukinumab Vs Adalimumab in the Treatment of Ankylosing Spondylitis in Finland

Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. We assessed the potential budget impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) versus adalimumab (TNF-alpha-inhibitor) in the treatment of AS in the Finnish public health care setting. The number of patients and current market share of different biologics were based on national reimbursement registry data. Patients were assumed to receive either adalimumab (40mg) or secukinumab (150mg) according to their approved dose. Among the included patients (n=827) 26% were estimated to begin their first biologic treatment, and rest were assumed to be on ongoing treatment. Response to treatment and subsequent switching was incorporated in order to take further treatment lines into account. Response rates were based on a previously published matching-adjusted indirect comparison (MAIC) between secukinumab and adalimumab. Patients not achieving response (ASAS20) were switched to another biologic treatment. All patients received full year treatment. Cost for second line biologic treatment was weighted with the corresponding market shares. According to the budget impact analysis, treating AS patients with secukinumab instead of adalimumab would lead to EUR4,8M savings within a 1-year time period. The annual total costs were EUR6,5M vs EUR11,3M with/without secukinumab, respectively. Potentially 74% more AS patients (1442 vs 827) could be treated with secukinumab instead of adalimumab under a given health care budget. The response rates for secukinumab were consistently higher compared to adalimumab, based on matching-adjusted indirect comparison. Considerably more patients could be treated more effectively with a biologic under rational allocation of resources. These results also suggest dominance of secukinumab compared to adalimumab as it gives higher treatment outcomes with lower costs in the treatment of patients with active AS in Finland.

LEAN thinking in Finnish healthcare.

Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

Developing customer-oriented service bundles: the case of Finnish public healthcare

Governments worldwide are addressing the challenge of ageing. The elderly will have a more worthwhile and independent life when they can live at home for as long as possible; a situation which would also decrease the costs of public healthcare. Therefore, service offerings should be modified on the basis of changing needs, and governments should offer genuine solutions that make it possible for the elderly to live at home. What must be understood is that the elderly require a variety of different services, which go beyond healthcare. In this quantitative and explanatory study, we formulated customer-oriented service bundles that would satisfy the needs of public healthcare customers, and therefore provide them with value.

Developing customer-oriented service bundles: the case of Finnish public healthcare

Developing customer-oriented service bundles: the case of Finnish public healthcare

Primary care physicians' perceptions of medication errors and error prevention in cooperation with community pharmacists

Background Physicians and community pharmacists play a major role in safe use of medication in primary outpatient care. Still, little is known about primary care physicians' perceptions of medication errors and error prevention and how they would like to cooperate with community pharmacists in error prevention and management. Objectives To explore primary outpatient care physicians' perceptions of medication errors and error prevention and to examine physicians' perceptions and expectations of cooperation with community pharmacists in error prevention and management. Methods A national mail survey containing structured and open-ended questions to a random sample of 15% of Finnish public health care physicians and occupational health physicians (n = 639) was carried out. Results A total of 179 responses were entered into the study (29% response rate). The potential causes of medication errors were most often related to physicians (39%), followed by the causes related to the organization (23%) and patient (19%). The factors concerning physicians' unawareness of patients' comedication arose as the major causes of medication errors. The respondents considered workload as a primary cause for medication errors. The most frequently mentioned actions to prevent medication errors were related to the physician (31%), organization (28%), and information technology (22%). The respondents expected more contacts from community pharmacists than actually occurred, particularly in the cases of potential drug abuse and problems in drug use. Conclusions Problems related to polypharmacy because of physicians' unawareness of patients' entire current medication were considered as most challenging in medication safety. Many of the problems were contributed to communication and coordination issues, which could be ameliorated by appropriate use of information technology. The study also indicated a need to develop the cooperation between primary care physicians and community pharmacists to enhance medication safety.

Long Waves of Decentralization in Public Management: A Case Study of Finnish Public Health Care

Long Waves of Decentralization in Public Management: A Case Study of Finnish Public Health Care

Shifting NPM agendas and management accountants' occupational identities

PurposeThe purpose of this paper is to illustrate how the occupational identity of management accountants working in the public sector is influenced by a change in management accounting and control systems as well as the underlying management agenda.Design/methodology/approachFrom interviews with management accountants and their associates in five public hospitals, the paper illustrates how a change in new public management (NPM)‐related managerial agendas interacts with how the management accountants perceive their professional roles.FindingsIt is argued that the focus of the NPM agenda in Finnish public health care has shifted from a “down grid agenda”, emphasising private sector accounting and control methods, to a “down group agenda” that emphasises accountability, visibility and comparability. This change in agendas has materialised in the implementation of the diagnosis‐related groups (DRG) system, and the resultant abandoning of activity‐based costing (ABC) systems. Health care management accountants who rely on private sector ideals for constructing their occupational identity may resist the implementation of DRG if they interpret it as a shift in managerial discourse.Originality/valueThe paper links two different and sometimes contradictory agendas within the NPM framework with the occupational identity of management accountants. The observed reaction to the shifting agendas has implications for understanding why some accounting systems carry more appeal than others.

Changes initiated by a nursing supervision programme: an analysis based on log‐linear models

The paper discusses the effects of a nursing supervision programme on nursing practices, more specifically on how nurses take their patients' needs into account. The analysis is based on the need theory by Yura and Walsh and examines the changes initiated by the programme on the basis of the subjects' own experiences. The study was carried out in three Finnish public health care organizations. A total of 26 specially trained nurses took part in the supervision programme. The data were collected by a questionnaire immediately before and after the programme and, in order to evaluate long-term effects, 1 year later. Log-linear models were the main method of analysis. The results indicate that the programme had some very favourable effects. According to the nurses involved, their freedom of action and willingness to act, as well as nursing activity itself, had greatly improved. The change was most noticeable in the case of willingness to act. The nurses also felt that the programme had helped them to understand better the relationship between these three components. The results provide some useful clues with regard to the effects of nursing routines and the organization's nursing culture on the nurse's job and her activity.

Cutting Oneself on Too Sharp an Administrative Knife: Problems of Implementation in Finnish Health Care Planning

Finnish public health care planning is a multi‐level five year planning system which is heavily bureaucratized. The planning process is formalized and is supposed to work according to fixed time‐tables. Here the system is seen to display a conflict between technical planning assumptions and the political and pluralistic setting of the system. This conflict is seen to generate bureaucratic inertia. Empirical evidence indicates that the system does not work according to the a priori set schedules and it is doubtful whether it will keep up to schedule even after the reforms that have been made.