Nfhk2011 mari hakkala_parallel9


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Structural reforms and health. Mari Hakkala.

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Nfhk2011 mari hakkala_parallel9

  1. 1. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto The 10th Nordic Public Health Conference 2011 Turku ”Strukturella reformer och hälsa/ Structural reforms and health” Thursday 1030 Hakkala.pptWork Group: Piia Astila-Ketonen, Tuula Cornu, Mari Hakkala, Ritva Kosklin,Minna Pohjola, Marita Päivärinne, Finland
  2. 2. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoNational Development Program KASTE Linking intellectual capital, intangible assets and knowledge creation to HP management practices* (Tomi Hussi, (2004) "Reconfiguring knowledge management – combining intellectual capital, intangible assets and knowledge creation", Journal of Knowledge Management, Vol. 8 Iss: 2, pp.36 – 52), Prevention and early intervention (four major measures) Ensuring the sufficiency of staff and strengthening skills (three major measures), Social and health care services as an integral whole and effective models of operation (seven major measures),*Tomi Hussi, (2004) "Reconfiguring knowledge management – combining intellectual capital,intangible assets and knowledge creation", Journal of Knowledge Management, Vol. 8 Iss:2, pp.36 – 52)
  3. 3. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoFurther about the Kaste program The municipalities and joint municipal boards can obtain discretionary government funding for development activities for implementation, The National Institute for Welfare and Health + Institute of Public health & Finnish Institute for Occupational Health will provide expert assistance to the municipalities in carrying out the measures.
  4. 4. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Regional program: health and wellbeing by nursing management Integrating health promotion management into the structures and practices of nursing management by providing concrete policies and structures • Follow-up of the citizens‟ health and wellbeing and its determinants • Making health promotion plans • Promoting intersectoriality • Strengthening the role of health promotion in nursing practices
  5. 5. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Management Tools for Health Promotion Wellbeing indicators Wellbeing reports and barometres Health & Wellbeing accounting Health & Wellbeing strategies Impact analyses Quality recommendations National, regional & local programs and projects + the „Capable‟ tool developed by our project
  6. 6. VeTe Vetovoimainen ja terveyttä ‟Capable‟ front page edistävä terveydenhuoltoThe menu: levels from abstract to concrete, ‟swim tracks‟ contain that level data
  7. 7. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoAttractive and Health Promoting HealthCare – work in Turku Regional network of health promoting professionals Health on a Plate – training package PÄTEVÄ (capable) –tool = looking at the whole picture and management by knowledge Developing leadership and management by enabling data exploitation. Provision and use of data was central: “steering by information”
  8. 8. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoSteering by Information: A modern way of looking at the ability to create, research and build up health promoting activities; Health services are knowledge-intensive expert services; New economy and society are based on know-how and utilising knowledge • Challenges: globalisation and across-borders health care, utilising new technologies and knowledge, changing patient roles (e.g. expert patient); Knowledge of and understanding of our clients and the demands of their living environments (determinants); Continuum from documenting current situation (patient records) to revising practices and policies, to strategic plans.
  9. 9. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoManagement, knowledge, information,information society... Municipalities are bombarded by best practices, recommendations, quality guidelines, handbooks, performance indicators, statistics, education, training, letters, surveys, reports, publications, research results, bulletins, newsletters, seminars, development programs, policy guidelines and agendas, standards, etc. Government and national institutes intend these to help municipalities and their professionals to provide good quality services to citizens and, at the same time, to ensure good governance, Information in the form of national programs is meant to guarantee effective and equitable good decision-making and facilitate the processes by which the government‟s (national, regional and local) decisions are implemented. How do we use information to manage health promotion practices locally and regionally in Southwestern Finland?
  10. 10. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Current information & knowledge exploitation The assumption is that professionals are adept knowledge consumers, cf. the Finnish government‟s steering by information policies in the 1990‟s; Our Kaste subproject‟s initial survey targeted at leading local level health and social services functionaries showed that this is not always so; Exploitation of knowledge is weak and more training necessary - 72/80 wanted training on “Management tools targeted at promoting health and wellbeing”
  11. 11. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoNational programs remain unknown... Not considered Disseminated Put forward and Discussed and (f) for information discussed decided on ac- (f) (f) tion (f)Health promo-tion policyMinistry of So- 15 37 27 10cial Affairs andHealth 2007Health promo-tion quality rec-ommendation 15 36 28 7Ministry of So-cial Affairs andHealth 2006National actionplan to reducehealth inequali- 26 35 20 7ties 2008–2011Ministry of So-cial Affairs andHealth 2008Respondents were total 94 Southwestern-Finland‟s health care and socialservices executives, response rate 47.
  12. 12. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Results of our survey disclose further that: Implementation of national programs is infrequent, and 46% of respondents would like to get more training on them! Only 4% follow up the results (effectiveness) of health promotion work, but 80% wish to have more training on health promotion methods; The current HP themes reflect a public health - single risk control approach: low-fat, non-smoking, anti-alcohol measures; A majority of the respondents – disregarding their high rank in the organization – did not know what programs there were, or what indicators were used; Only ¼ of the respondents thought that the HP structures were clear in their municipality.
  13. 13. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Similar patterns elsewhereJari Stenvall, HTT Professor, Lappi University, presentation on change management in municipality mergers2007
  14. 14. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Random observations A deep gap between the government‟s policy-makers and the local and regional level implementors: • “according to audits the impact of quality recommendation as part of the Ministry of Social Affairs and Health‟s steering by information has been modest” (Office of the Chancellor on National School Health Quality Recommendation), • “Governmental officials also seems to believe that programs, giving ideas and information, can change municipals ways to organize services.” (Liisa Heinämäki, Abstract: Governmental Program Managing and Municipal Steering in Finnish Social Services, 2008), • The municipal level – the implementors – regard only acts and sets of laws compelling, whereas programs and recommendations are considered voluntary, • Too many programs = information over-flow in the municipalities, • The main focus on the local level is on the budget - contents and substance in the services are left to the professionals‟ individual discretion!
  15. 15. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuolto Steering by information is a socio- political control system Health promotion is identified as one of the strategic goals in municipal policy documents, but according to our survey there still is huge demand for training, effective methods, leadership, follow-up, clear structures… It will not be enough to steer resources only, i.e. ensure adequate staff, facilities, materials and budgets by obeying the laws; What is needed is that the municipal organizations assume leadership and management models based on making use of information** The effectiveness of municipal governments depend on how well they are able tomake use of their internal and external data reserves as they adapt to the changesin their environment (A-V.Anttiroiko 2000)
  16. 16. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoFinally... The WHO Nairobi 7th global health promotion conference states that the process (of health promotion) needs leadership • That understands the interdependencies of different causes, • That is able to create strategic alliances across sectoral borders, • That is able to justify the expenditure • That can effect change in the health systems and sustain appropriate infrastructures • That employs wide basis of knowledge associated with many professional and personal qualifications!
  17. 17. VeTe Vetovoimainen ja terveyttä edistävä terveydenhuoltoThank you very much!