Merja Tepponen of South Karelia Social and Health Care District (Eksote) explains why integration is a cornerstone of the organisation’s customer-oriented service development
South Karelia Social and Health Care District (Eksote) is a municipality-owned public sector social and health care provider, with a yearly budget of approximately €450 million. Also, over 4,000 employees provide health services, family and social welfare services, and services for senior citizens that promote health and everyday wellbeing and functioning. Eksote comprises nine municipalities and the population in the area is approximately 130,000.
The integration that led to the founding of Eksote in 2010 focused on removing administrative and organisational borders between nine municipalities’ service provision (social and health care services), social and health care services and primary and secondary health care.
Eksote ensures that the expense development remains steady and the regional service needs are fulfilled in suitable ways. The upcoming population structure changes are anticipated, and services, as well as the service structure, are already modified accordingly: this means that the independence of citizens and the possibilities to use e-services and low threshold services enabling such independence are of great importance.
The critical examination of social and health care premises in conjunction with operational models influences investment decisions in South Karelia (Finland) concerning possible renovation and extension needs. Outsourcing and privatisation should be done not until after the premises resolutions and operations are regionally defined – the focus should, instead, be on partnership development.
The ageing population is not the only factor that is increasing the pressure to the expense development – new statutory obligations in social and health care (for example, the transportation services for the disabled, dental health care emergency duty), as well as other factors (such as the increase in child protection), have an influence on the expense development.
Administrative and functional integration towards value-based management
One of the main reasons for establishing Eksote was the need to ensure the availability of adequate social and health services to all citizens within the region with the limited financial resources of the participating municipalities. Instead of providing local services themselves, municipalities entered into service contracts with Eksote, based on the needs of their residents.
The Finnish health care system has up to now, been largely structured around municipality-based units. Integrating the social welfare and health care services of municipalities within a region responds to the challenges and opportunities that lie in questions concerning economy, efficiency and service quality in a customer-oriented way, (such as, equal access, continuity, client-orientation, and need-based services). The integration improves the balance and coordination between primary care, social services and hospitals, coordination in strategy, financing and investments by the owner municipalities, common use and the recruitment of staff, and possibilities to meet the future challenges. The integrated framework enables developing truly integrated care processes and service network within the whole region. Due to this integration, for example, the same electronic patient record system is used in the health care centres and hospitals of all municipalities belonging to Eksote.
Towards service integration ecosystem and value-based management
Eksote has developed from municipal-based service structure into an administratively and increasingly functionally integrated service structure and is preparing for the future and being part of a service ecosystem. Through integration, Eksote has achieved a functional and an operational form which allows social and health care services to be optimised in the South Karelia region, leading to better-coordinated care processes to citizens. The aim is to participate actively in building a future social and health care ecosystem where national entities are tightly integrated to the proactive support of a citizen’s wellbeing.
Eksote is beginning gradually to shift from hierarchy-based steering, into knowledge/value-based management that yields even more value. Together with different actors from public, private and third sectors, the organisation is, for example, actively searching innovative answers for service guidance, personal budgeting, unemployment, care and rehabilitation etc. Eksote has also created innovative public contracts.
Eksote’s vision emphasises a citizen’s functional ability and wellbeing in daily life
Eksote’s vision, “Making it easier to cope at home” accentuates the active role of customers and patients in maintaining their health and wellbeing and leading their own kind of life. It signals the need to renew operating models, service chains and structure in social and health care that enable to be the case in a much better way than was previously possible.
The vision is based on a view that home is the best place for everyone and it should be made possible to return there as quickly as medically possible and with ease, (instead of staying in institutional care or hospital if is not medically necessary). Eksote provides a continuously growing number of services that are available at home, to support living there and to provide home rehabilitation, if required.
In the Eksote region, many new services have been tested and partnerships with many voluntary bodies have been very useful and encouraging. Especially in the area of digitalisation, which gives many new tools to improve the results of prevention and wellbeing. Robotics and artificial intelligence (AI) provides a totally new vision for the development of efficient services for citizens.
In Eksote, the integration of structures and clinical practice is completely implemented. As a result, it has been possible to create and develop new kind of “out-of-hospital” services, which brings new value to all parties of care. On the Internet, you can watch an interesting video presenting Eksote’s “out-of-hospital” services and financial results of these new services.
A health care strategy, like any good strategy, involves a sequence of steps over time, rather than an attempt to change everything at once. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal by doing what is right for the patient.
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