Managing client oriented processes in an integrated organisation

Why was this example implemented?

The number of older people (aged over 75 years) in South Karelia will double in the next thirty years from approximately 10,000 in year 2010 to over 20,000 in year 2040. Eksote needs to address the challenges the social and health services will face in the coming years.

Some problems in health and social care practice are common, such as shortcomings in the flow of information, in cooperation, and in the continuity of care. Further to this, there is a lack of clarity regarding responsibilities between different professionals and a lack of integration of services based on the older person's needs. Thus, the quality of care may decrease and the resources may not be used in an efficient way.

The integrated organisation and process development work enable services for the older people to develop with a multiprofessional, rehabilitative, anticipatory and preventive approach, treating older people as physical, psychological and sociocultural entities living at home. Eksote's aims are to support older people in need of help living at home and those discharged from hospital to maintain their quality of life and also to  produce care and services based on older people's needs. Services include preventive care, home care, sheltered housing, home nursing, day care and support services as well as hospital care.

The process development work aims to take into account the interfaces between different actors. The aim is to use the integrated structure of the organisation and create processes that span over different areas of expertise. The goal is to find the gaps between the actors and improve cooperation through agreements.

Description

The goal of this initiative is to develop service processes and agreements by capitalising on the possibilities created by the integrated organisational structure. Eksote’s professionals are currently working together to create new client oriented and cost-effective service processes that span over different professional areas. Finding the gaps between the actors and developing better cooperation are vital in order to be able to create improved processes.  Each process will have its own process owner who is responsible for it. The success and functionality of the developed processes are based on jointly agreed operational models and trust between professions.

Rehabilitation, for example, is one of the main processes that is currently being developed further. There have been gaps which are now being addressed.

A client-oriented process for rehabilitation of people suffering from memory disorders is being piloted. The development work is based on a tested model of memory rehabilitation where local actors (public, private and third sectors) are joining in the process using their expertise. The process emphasises prevention and supports people suffering from memory disorders to live at home longer. Technologial applications will be used in the process where beneficial. The role of the third sector is being drawn upon to provide peer support and to train the support team.

The second example is volunteer tutors in the discharge-process. There are for example volunteer tutors (third sector actors) who are supporting older people discharged from hospital to rehabilitation at home. A physiotherapist coordinates the activity and supports the volunteer workers who are also trained to do their tasks. There are currently approximately 60 volunteer tutors supporting the rehabilitation. Eksote gives an allowance of 800 euros per volunteer tutor per year to the third sector actor arranging the activity. The allowance is allocated to coordination work, training of the tutors and networking.

Eksote’s organisational structure facilitates agreement, coordination and cooperation between different forms of care and services (home care, sheltered housing services, rehabilitation, acute and long-term care) as well as between different professionals.

The integrated structure of the organisation and on-going development processes provide challenges to Eksote’s managers. Eksote has an on-going managerial training programme that emphasises process thinking. The training programme provides managers with new ways of thinking and new working methods.

What are/were the effects?

Eksote aims to define a new process model based on a ‘clean slate’ so that the old municipal or organisational borders do not affect the planning process, and, thus, a completely new concept that best serves the area's population can be realised.

The health and social services for older people in this new system are made more functional, cost effective and customer friendly by developing service processes that span over different areas of expertise and strengthen cooperation between actors.

Previously every municipality had their own criteria for the services for older people. Older people were in an unequal position as their services depended on the criteria of the municipality they lived in. Now common criteria are being used in all of the municipalities in Eksote’s area as well as common service rates.

The effects that can already be seen are the following. As there are common criteria for the services for older people the clients in Eksote’s area are now in an equal position. More care units are available as the integrated organisation can use the whole capacity available in the area. Service vouchers enabling the client to choose their services from a list of private sector service providers are being used. Eksote works in close cooperation with private companies to address certain gaps in processes.

When looking at the services from a process model point of view it is possible to address gaps between different actors. The services will be more cost-effective and functional as the roles of the actors become clearer. The customer will get more customer-friendly services as the possible gaps between the actors are addressed and the services become integrated. The number of clients has increased - easily accessible patient records have in their part enabled caring for a larger number of older people without increasing the costs or the number of employees.

What are the strengths and limitations?

Strengths

• The integrated structure of the organisation help to ensure the quality of life of older people while keeping costs reasonable.  
• Reaching agreement on services and care processes has assisted with better co-ordination and co-operation between staff.
• Gaps in service delivery have been addressed.
• There is more opportunity to harness the expertise of a wide range of professional staff and volunteers.

 Weaknesses

• Process development work takes time and demands resources.
• Due to its own success, there are potentially more older people to deal with and thus strain existing resources.

 Opportunities

• Functional and customer oriented processes can be developed.
• Regional integrated service organisation also help to offer services to those older people who live in rural areas where a narrow range or less services are available (more equal system).

Threats

• It may take time before the new way of process thinking is a natural part of the whole organisation. 

Credits

Author: Merja Tepponen, South Karelia Social and Health Services (Eksote) Teija Hammar, National Institute for health and welfare (THL)
Reviewer 1: Hannelore Jani
Reviewer 2: Georgios Kagialaris
Verified by:

External Links and References

• The Primary Health Care Act 66, 1972
• The Status and Right of Social Welfare Clients 812, 2000
• Mallu- The Mobile Clinic on the road, Results of a Client Survey, 28.72011
• "Ikääntyvien hyvinvointitarpeista palvelujärjestelmän uudistamiseen-research project" (Tekes)
• http://www.tekes.fi/ohjelmat/sosiaalijaterveyspalvelut/Projektit?id=10034929
• Vanhal, A., Immonen, M. & M. Pynnönen (2011). 'Developing an assistive service offering for aging citizens' in: Innovative Marketing, Vol. 7(2): 71-80.