Health and Well-being FROM BIRTH TO OLD AGE

Kainuun sote

A FORERUNNER The Kainuu region is a forerunner in combining social and health care services: the in-tegrated social and health care model, soon to be introduced throughout Finland, was implemented in Kainuu as early as 2005.

Kainuun sote (the Kainuu Social and Health Care Joint Authority) is responsible for the provision of social and health care services for a region with some 75,000 inhabitants. The joint authority has seven municipal members (Hyrynsalmi, Kajaani, Kuhmo, Paltamo, Ristijärvi, Sotkamo, Suomussalmi), and the municipality of Puolanka is a partial member. At the end of 2015, Kainuun sote had some 3,500 employees.

In the Kainuu model, social and health care services are provided by the same organi-sation, organised in accordance with the lifecycle model. The Kainuun sote consists of a hospital district (specialised care), primary care, a special welfare district (services for the

disabled), services for the elderly, social services and environmental health care. The joint authority provides the region’s municipalities with all data management services and part of the financial and personnel administration. Well-functioning co-operation between primary and secondary care and policies favour-ing outpatient care have inhibited the rise in costs, so the finances of Kainuun sote are in balance. At the same time, access to services has improved and the modes of operation have become harmonised across the entire region. According to surveys, both custom-ers and employees are satisfied.

Currently, the primary targets of development include the central hospital reform, elec-tronic services, and further improving customer understanding. Well-functioning care and treatment processes have served as the starting point for the planning of the central

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hospital. The purpose of electronic services is to support self-care of Kainuu region inhabitants, so that the resources could be targeted in a more appropriate manner than before. The customer perspective is taken into account in all service devel-opment, and joint authority strives to involve experts by experience and developer customers in the planning of changes and reforms from the very early stages.

One Hour from HelsinkiKainuu is located in the middle of Finland. The region, almost the size of Belgium, has approximately 80, 000 inhabitants. The regional centre is Kajaani. Kainuu is known for the ski resorts of Vuokatti and Ukkohalla, Kuhmo Chamber Music, Kajaani Poetry Week, Hyrynsalmi swamp soccer and Sotkamo Angry Birds Park. Families that have moved into the region have been particularly happy about how easy and effortless everyday life can be. In Kainuu, it is possible to fulfil the dream

of having a single-family home by the lake in the middle of the town.

Maire Ahopelto, Director, Kainuu Social and Health Care Joint Authority:

“We are tasked with promoting the well-being and inclusion of Kainuu region inhabitants and organising the services we are responsible for in a customer-oriented, efficient and effective manner.”

Family Centres Providing Support forFAMILIES WITH CHILDRENFamily centres are a modern way of supporting smooth running of everyday life in families with children. In Kainuu, they constitute a central part of the social and health care service entity, with every municipality having its own family centre.

All local services for children, young people and families with children, with the ex-ception of day care, have been gathered together in the family centres. Maternity, child health and family planning clinics, family counselling, and social services for families with children can all be found on a one-stop-shop basis. The operation of family centres is also part of preventive child welfare work.

Kainuu region inhabitants deliver their children cosily in the Kainuu Central Hospital. The own hospital’s expertise in children’s diseases and 24-hour emergency service also provide safe background support for families with children.

In the future, families with children can increasingly take advantage of the electronic services, currently under development. For example, the Omasote eHealth service enables flexible and easy communication with the child health clinic.

Focus from Remedying to Preventive ServicesIn social and health care services, we increasingly aim at preventing the need for assistance requiring heavy support measures from emerging in the first place. In Kainuu, the services for children, young people and families with children consist of a diverse network of family services. In recent years, we have made more than av-erage-level investments in family work, and we have improved the access to family work and housekeeping assistance. This has reduced the number of families need-ing support measures of child welfare open care.

Kainuun sote also provides the school and student health care services for young people. In Kainuu, special attention has been paid to mental health work at schools. If necessary, young people can seek help from a school nurse, a psychiatric nurse, or youth psychiatry services.

Social services for families with children have the kind of competence needed for supporting the everyday life of families even when they encounter problems. Kainuun sote arranges emergency social services as its own operations.

Health Care, Medical Care and Social Welfare UNDER THE SAME ROOFThe barrier between primary health care and specialised care was removed in the Kainuu region as early as 2005. Back then, all social and health care services within the region were brought into the same organisation. At the same time, the region implemented the principle of the freedom of choice, which has now spread all over Finland. For the past ten years, Kainuu region inhabitants have been able to choose the health centre they prefer regardless of municipal boundaries.

The uniform patient information system for the whole region has been in use since 2011, which has significantly supported the seamless co-operation between health centres and the central hospital. The regionally integrated health care system has made finan-

cial management and management development easier. Employees, on the other hand, have benefited from the possibility of transferring from one task to another in the service of the same employer. For example, it has been possible to plan in advance tailored spe-cialisation paths from primary care to secondary care for resident physicians.

The Kainuu health care aims at operating in accordance with so called chronic care mod-el. Its cornerstones include a multi-professional approach, participation of the patient and their family members, and classification of patients according to their need for care.

However, the bases of the whole system lie in the promotion of health, self-care, and, in

the future, electronic services. Narrowing the differences in the health status between different population groups is one of the key targets of Kainuun sote. These principles also steer the planning of the Kainuu Central Hospital reform.

Attention to Provision of Long-term SupportIn Kainuun sote, organised in accordance with the lifecycle model, social services for adults as well as all services for the disabled and the intellectually disabled are part of the services for families. The social services for adults include social work for adults, income security, rehabilitative work activities, and a labour force service centre.Social work for adults aims at developing a systematic and goal-oriented way of working,

so that provision of long-term support for customers becomes an integral part of services alongside a mere resolution of crisis situations and granting of social assistance. Many pro-jects have also sought new ways of empowering customers and breaking their dependency on social assistance. Co-operation with the Guarantee Foundation enables granting of rea-sonably priced small loans to municipal residents.

The service entity for those with disabilities enables them to lead as independent life as pos-sible and plan their life so that it feels like their own. Versatile housing and work activity servic-es make life management easier, multi-disciplinary expert support helps in different everyday challenges, and families can be given support through short-term care arrangements.

Services for the ElderlyEASILY ATTAINABLEAt Kainuun sote, the starting point for the provision of services for the elderly is support-ing the customers’ own physical and mental resources and activating them, respecting their right to self-determination, and enhancing the participation of customers and their next of kin, if necessary. Key values also include fairness, equality and safety.

The treatment and care of each customer is based on an individual care, service and exercise plan made with the customer and their next of kin. In Kainuu, the seamless collaboration between social and health care services also enhances multi-professional co-operation in the care of the elderly.

From the employees’ perspective, work with the elderly is demanding but rewarding, because they usually obtain feedback on their work immediately. Caring for old people suffering from memory disorders in particular requires professional skills, flexibility and creativity, and, first and foremost, information on how the illness affects the person’s physical, psychological and social ability to function.

Services Supporting Living at HomeHome care of the elderly is changing and developing rapidly. Currently, some of the tasks are performed at the customer’s home using mobile devices. Home care requires

wide-ranging professional skills, so home care operates in multi-professional work teams that may include practical nurses, home aid, physiotherapists, social counsellors, public health nurses and nurses. Therefore, home care, or work performed at the customer’s home, is versatile, independent and rewarding.

24-hour Nursing ServicesKainuun sote has its own nursing homes and wards where nursing services are pro-vided 24/7. Living in a nursing home is comparable to living at home. This means that customers pay a rent for the apartment and furnish their rooms with their own furniture

and possessions. The customers pay for any support services they need – such as food, cleaning and clothes maintenance – according to a separate agreement.

Service Guidance and Outsourced ServicesCounselling and guidance of elderly customers constitutes an entity of its own. Each municipality has its own service counsellor. Kainuun sote also buys quite a lot of services from private service providers, so, in addition to providing service guidance to custom-ers, the services for the elderly also provides guidance and counselling to private service providers and monitors them.

Customer Orientation, Electronic Services & A HEALTH PROMOTING HOSPITALThe guiding light of the ongoing central hospital reform is to interweave central hospital operations, primary health care, social services and services for the elderly closely to-gether. Rehabilitation and out-patient care play an important role in the entity, because the goal is to keep in-patient treatment periods as short as possible.

Planning of the new hospital has been launched with a review of the current and future patient flows, and service and resource needs. The new buildings must support the operational reform and optimisation of care and treatment processes. The essential part of the reform is separating emergency operations, or “the hot hospital”, from non-emer-gency care. The division of wards will be based on the care intensity of patients, in other words the amount of care and treatment each patient needs; the aim is to get rid of the earlier division in accordance with the classification of diseases.

Care processes will guide construction planning in such a way that the patient flow from one hospital unit or treatment procedure to the next is well considered in advance and made as simple as possible. Employees can also flexibly serve in various service entities.

The intention is to implement the construction project using an alliance contracting mod-el, a generally used practice in numerous countries, where engineering and construction companies take a bigger responsibility for successful completion of the entity than is customary. Another special feature adding unique Kainuu quality is the goal of using as much of the important resource for the region, wood, in construction of the hospital as possible.

Electronic Services Offer New OpportunitiesPeople in Kainuu have enthusiasm and will courageously test new solutions. The devel-

opment and planning unit of the Kainuu Social and Health Care Joint Authority has for a long time been working in close collaboration with, for example, the National Institute for Health and Welfare (THL) on such issues as assessment of the human impact of de-cisions, and narrowing the differences in health statuses.

Currently, development of electronic services is one of the key goals of Kainuun sote. At the moment, Kainuun sote is in the process of launching an Omasote eHealth service to support self-care that will function on a one-stop-shop principle. In accordance with the basic idea of the Kainuu model, it will include the basic health care, specialised care and social welfare services as well. The region is also developing such solutions for its customers as a tray of services, combining public and private services that would enable comparison of different services.

Developer Customers and Experts by ExperienceKainuun sote is listening to the customers in all its development work. For several years, Kainuu has gained good experiences of the participation of developer customers and experts by experience in the planning of services. The future local services in the Kainuu region, for example, have been worked on in collaboration with Innovillage and the As-sociation of Finnish Local and Regional Authorities using the methods of service design. In addition, the voice of customers has been heard in the planning of the new hospital from the very start.

Customer feedback is also an essential part of quality assurance work, one of the key targets of which is enhancement of patient safety. Feedback can be given directly to the personnel or by responding to a continuously available feedback questionnaire, the responses to which are systematically reviewed. At the same time, Kainuun sote follows the development of customer satisfaction.

For Clean Foodstuffs andWELL-BEING OF ANIMALSEnvironmental health care promotes the health and safety of our living environment. Health inspectors supervise that the foodstuffs on sale are of high quality, and that the water for household consumption and swimming waters are clean. Health in-spectors also monitor the quality and safety of services provided to consumers by programme services, gyms, playgrounds, etc.

The indoor air quality of apartments and other premises affects human health, so environmental health care gives guidance and counselling related to that. It strives to reduce smoking by monitoring the sale and advertising of cigarettes. Environmental health care also prevents health hazards by collaborating with various authorities and giving statements in licensing processes of establishments requiring an environmen-tal permit.

Veterinarians take care of the basic health care of animals in the region and perform tasks related to the well-being of animals and the prevention of animal diseases. Practicing veterinarians serve their customers in issues related to health care and the nursing of small animals, horses and production animals. There are veterinary clinics in all Kainuu region municipalities except Ristijärvi, where services are provided from

Paltamo. The standard of equipment in each clinic varies in accordance with local needs. 24-hour veterinary emergency service has been organised for emergency sit-uations. Animal well-being veterinarians, on the other hand, perform duties related to animal protection and food production.

Centralised Support Services & INFORMATION SYSTEMSA special feature of the Kainuu region is that support services have been combined across municipal boundaries in such a manner that the Kainuu Social and Health Care Joint Authority is also responsible for the information systems of local municipalities and the Regional Council. Part of the financial and personnel administration is managed jointly. This makes the support service duties of Kainuun sote especially wide-ranging.

The common regional patient information system and other integrated social and health information systems enable efficient and safe flow of information

within social and health care. For business trips, Kainuun sote uses its own leased cars, some of which are in shared use with the municipalities.

The fact that employees can reserve meetings or order a shared car through the shared online calendar of the Kainuu Region municipalities, Kainuun sote and the Regional Council makes communication between municipalities and the joint authority easier. Municipal employees can follow the operations of joint authorities through an intranet built on a common platform, and some

of the information releases of the joint authorities are automatically transferred to municipal intranets.

Kainuun sote is also actively involved in the development of the future information system solutions for social and health care for the whole nation in collaboration, inter alia, with the Oulu University Hospital, the Association of Finnish Local and Regional Authorities, and the Ministry of Social Affairs and Health.

Own Hospital PharmacyThe support services for health care have also been largely arranged within the region. Kainuu has its own hospital pharmacy with its own drug preparation premises and a state-of-the-art automated medication dispensing machine. Textile services and other support services have been centralised at Kainuun sote in order to ensure that all areas can put their best expertise to use. Support services are actively and continuously developed, so that the professionals in social and health care would have as good conditions as possible for performing their work.

In Kainuu, Life Is Unique inA KAINUU WAYAt the moment, Kainuun sote has some 3,500 employees serving in different social and health care duties and their support services (personnel, financial and data administration services). There are almost one hundred work units in different parts of Kainuu.

We are the biggest employer in the Kainuu region, so we can offer employees interesting and challenging duties, and good and flexible fringe benefits, such as transfer of annual leave days accrued with the employee when they change work units. Coping at work is supported by employee benefits, and employees are urged to devel-op their competencies by offering good training opportunities. The feedback we have received reveals a relaxed and comfort-able working atmosphere, good collegial support, and flexible working hours.

Comprehensive Quality of LifeIn Kainuu, everyday living is easy. In local population centres, the distances from home to work, school and spare-time activities are short – compared to people living in big cities, Kainuu region inhabitants spend less time commuting. Housing is reasonably priced, and the alternatives range from new blocks of flats to lakeside single-family houses. Services for families function well and there are excellent opportunities to practice various activities for people of all ages.

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Kainuun sote