Today I was honored to represent Rotary District 5580 and St. Joseph’s Area Health Services at the Lapin Sairaanhoitopiiri (Lapland Hospital District) in Rovaniemi. I was able to spend the entire day with Director of the Hospital District Jari Jokela and his colleagues who not only tolerated but actually encouraged my questions and fueled my enthusiasm!
A Bit About Healthcare in Finland
There are 320 Municipality districts in Finland. The Lapland Hospital District aims to provide the highest quality in specialized health care to the over 118,000 residents of the 15 northern most municipality districts in Finland. The hospital in Rovaniemi was established in 1895, currently has 250 beds, and employs around 1,600 people. The public healthcare system is funded by the municipalities/ taxpayers money. The government provides direction and monitoring by creating legistation and stating benchmarks. Recent research continues to indicate Finland is the leader in providing high-quality, cost-effective healthcare compared to other Nordic countries.
I had flash backs to my Principles of Management class this morning as we discussed the complex nature of organization in Finnish healthcare. The municipality council (politicians who are elected every 4-years) meet 2-3 times per year to establish goals and the budget. The next level is the board which is made up of 7 members each from a different political party. The board meets once per month to deal with operational decisions. The Director, or CEO, is next (Jari Jokela). The Director then oversees a management group (CFO, director of nursing, quality, patient safety, development…), and Divisional or Departmental Managers (MD’s who have limited management/leadership education). There are currently 150 managers at the Lapland Hospital District and most of them must report to two different people. There has been significant conversation in streamlining the management and leadership structure within the operation. Reorganization by moving toward a process orientated structure is likely in the near future as Mikko, the Development Director, looks to current managers to lead the change. With all change, staff resistance is always a concern and it is no different here in Finland. Staff buy in and crossing department/division lines requires openness to a new concept in patient centered, process orientated care.
Lapland Hospital District has implemented the lean method to reduce waste and improve productivity. 20 employees are selected to multidisciplinary teams to evaluate current processes and discover waste in productivity. The first year of the program employees were able to successfully implement change that saved the organization over 500,000 Euros. Staff was reported to appreciate permission from upper-level management to develop work processes and were motivated by the increased efficiency allowing increased time for direct patient care.
Humanly Efficient Hospital
There are four sections to a “Humanly Efficient Hospital”.
1. Education: Evaluating Capabilities
2. Leadership and Management Structures
3. Knowledge: Professionals at various stages of their careers sharing their knowledge
4. Internal Motivation: Employee Satisfaction
After a 3-year research project focusing on improving employee satisfaction, the Lapland Hospital District discovered the number one issue was employees wanted more time with their patients and less non-patient orientated work. (Sounds a bit like home!) Changes have been implemented including increasing support services to allow patient care providers to have more time with patients. Several other changes have also been implemented including Department Pharmacists. The goal of creating a “Humanly Efficient Hospital” is in it’s infancy but is exciting and positive.
Technology: Outreach Services
The Lapland Health Care District is the largest by area in all of Finland. 90% of patients live within a 100km of Rovaniemi but others drive nearly 500km… that is a really LONG way to have a baby!!! Agreements have been negotiated with both Norway and Sweden to provide care for Finnish citizens who chose to cross borders for healthcare. Norway is a popular choice for many Sami people in northern Finland.
Development of technology to better serve patients who would have to travel a significant distance has been a goal within the organization for quite some time, actually since 1995. After pilot projects, TEL LAPPI III was launched bringing video conferencing, data security, emergency medical service system (imagine a neurology consult in the ambulance in route!) electronic referral and more importantly a feedback system from the specialist to general practitioner, digital imaging, and image transfer and archiving. The goals of this project have been achieved and the 2.2-million Euros invested seems to be well worth it when looking at the outcome and effectiveness measures.
Challenges in Healthcare: Common Across the Globe
I asked Director Jari Jokela about the challenges his hospital faces. The list was so familiar.
1. Financing: The possiblities are always more than the budget can support.
2. Aging Population: The baby-boomers are retiring, decreasing the workforce and increasing the patient load.
3. Long Distances: Outreach to surrounding communities is very important.
4. National Political Issue of Health and Social/Welfare Reform: Trend is form larger municipalities to increase effieciency and cost-effectiveness.
I feel so fortunate to have the opportunity to participate in the Rotary Foundation Group Study Exchange. Today I had the honor of spending the entire day networking with leaders in the medical field… not just a quick hello… but personal attention and an investment in me as a person and also in my professional development. I was able to collaborate, exchange ideas, and create lasting professional relationships. I need to thank all of you back home who have made this experience possible for me… My awesome club in Park Rapids who encouraged me and have believed in me every step of the way, DG Don for inspiring me and mentoring me, the district GSE-committee for selecting me and working SO hard to give my team this chance, my co-workers who have been supportive of my desire to be part of something bigger than myself, and my friends and family who have sacrificed, pitched in, and shown me love and understanding.
I ended my time with Jari by asking him if he had any advice for me. He was quiet, then a smile crossed his face before he said “Trust yourself and take the chance Melissa. When God gives you a job he gives you the sense.” I haven’t stopped smiling since!
The view from Ounasvaara over looking Rovaniemi
My new buddy Diva! She even understands English, yes, a bilingual dog!
*** Tomorrow GSE Team Finland will visit the Polar Circle and meet SANTA CLAUS before traveling 85km to the east to Kemijarvi. Thanks for following our journey!