nfhk2011 mari hakkala_parallel9

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Vetovoimainen ja terveyttä

edistävä terveydenhuolto

The 10th Nordic Public Health

Conference 2011

Turku

”Strukturella reformer och hälsa/

Structural reforms and health”

Thursday 1030 Hakkala.ppt

Work Group: Piia Astila-Ketonen, Tuula Cornu, Mari Hakkala, Ritva Kosklin,

Minna Pohjola, Marita Päivärinne, Finland

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National 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)

http://www.thl.fi/en_US/web/en

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Further 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.

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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

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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

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‟Capable‟ front page

The menu: levels from abstract to concrete, ‟swim tracks‟ contain that level data

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Attractive and Health Promoting Health

Care – 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”

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Steering 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.

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Management, 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?

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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”

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National programs remain unknown...

Not considered (f)

Disseminated for information (f)

Put forward and discussed (f)

Discussed and decided on ac-tion (f)

Health promo-tion policy Ministry of So-cial Affairs and Health 2007

15

37

27

10

Health promo-tion quality rec-ommendation Ministry of So-cial Affairs and Health 2006

15

36

28

7

National action plan to reduce health inequali-ties 2008–2011 Ministry of So-cial Affairs and Health 2008

26

35

20

7

Respondents were total 94 Southwestern-Finland‟s health care and social

services executives, response rate 47.

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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.

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Similar patterns elsewhere

Jari Stenvall, HTT Professor, Lappi University, presentation on change management in municipality mergers

2007

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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!

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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 to

make use of their internal and external data reserves as they adapt to the changes

in their environment (A-V.Anttiroiko 2000)

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Finally...

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!

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Thank you very much!

nfhk2011 mari hakkala_parallel9

Health & Medicine