Dissertation: The regional reform of health care and social services will not succeed without ...
Although the previous Finnish government's plan to reform health care and social services fell through, the need for reform – for client-oriented, better-organised health care and social welfare services – has not gone anywhere. Kari Lappalainen MSc (Econ.), MSc (Admin.), tackles this issue in his doctoral dissertation on public administration. He proposes the tool of a Creative Governance model, which can enable the administration and development of value networks for the regional provision of health care and social welfare services.
The planned health care and social services reform of Finland, known as "sote" reform, had the principal aim of providing citizens with health care and social welfare services seamlessly and at the correct time. When health care and social services service providers collaborate at an early stage, they can effectively prevent the client's condition from deteriorating and reduce the need for expensive specialist services. This can only succeed if the providers in the regions have common goals and mutual coordination.
"There is broad awareness in society that the ageing population, poor accessibility of health care and social welfare professionals and rapid development of technology will require substantial reform of health care and social welfare provision. By creating a regional value network, service providers will be better equipped to address the challenges they face jointly," says Lappalainen, who is defending his doctoral dissertation at the University of Vaasa on 30 August.
The essential aspects of developing cooperation appear to be transparency, openness and trust between health care and social services actors. By improving cooperation and developing coordination, it should be possible to prevent hidden frictions within the network, such as professional and functional silos, which maintain partial optimisation.
Value means better service for clients and cost savings for taxpayers
Lappalainen's Creative Governance model is based on reconciling the value network idea with an idea of continuous development. The 15 sub-areas specified in the model can help to understand the administration of health care and social services and some of the untapped opportunities in various regions.
The management of value networks is examined through planning, steering and knowledge management. The continuous development of activities is described from the perspectives of strategic management, the management of service provision and innovation management.
According to Lappalainen, the value network idea in the model helps people to understand how regional service providers can create more value through coordinated cooperation than by operating individually.
"In practice, value means better service for patients and clients, cost savings for taxpayers and greater occupational well-being for health care and social services professionals. These represent significant challenges for joint service provision, but they also represent significant opportunities," emphasises Lappalainen.
According to Lappalainen, too much attention is currently being paid to the costs of health care and social welfare services rather than what outcomes the services can achieve.
"The attention should focus on the value of services. The impact created for citizens and society as a whole – the value – is determined by the relationship between the benefits realised and the resources consumed. This can rarely be realised with the accomplishments of just a single service provider; generally, value is created by synergies between several actors.
Poorly-realised competition increases the fragmentation of services – good competition encourages actors to move in the right direction
According to Lappalainen, competition that takes account of local conditions encourages organisations to push management practices in a positive direction with regard to personnel and make service provision more client-oriented.
Conversely, poorly-realised competition increases the boundaries between service providers, weakening the chances of developing integrated services.
"Weak coordination threatens to lead to services becoming fragmented and unevenly distributed, and to rampant growth in demand and, therefore, costs.
Under Creative Governance, competition may also take place between public sector actors, so competition is not the same thing as privatisation. The Creative Governance model calls for competition to be measured according to the local conditions and for every member of the value network to be rewarded for success.
Lappalainen says that investments in information technology are also required to promote transparency and the flow of information between organisations. With the correct implementation, it will also be possible to resolve the challenges related to data protection for individuals, which has been the topic of much debate in recent years.
A platform economy mindset to help with the health care and social services reform
Lappalainen proposes using the platform economy as a tool for developing the cooperation of value networks. The "owner organisation" of the platform economy would provide the digital platform for other product and service providers to use jointly. The platform is capable of giving rise to greater demand than an individual actor as it offers products and services to end customers in a more flexible, accessible and cost-efficient way.
"Network technologies of the platform economy type could help to implement radical, long-overdue service innovations that could accelerate the targets of the health care and social services reform," Lappalainen states.
The position of owner organisation would provide the public sector with a tool for managing service provision on the platform for the health care and social services value network. In such cases, it is important to keep in mind that excessive regulation and oversight could hinder the creativity of the value network, thereby weakening its capacity for continuous renewal. Lappalainen says that, at present, the critical challenge facing the promotion of a platform economy mindset is the poor state of development of legislation applying to the platform economy.
Public defence
The public examination of M.Sc. (Admin), M.Sc. (Econ.) Kari Lappalainen’s doctoral dissertation ”Luova hallinta sosiaali- ja terveydenhuollossa – alueellisten arvoverkkojen uudistumiskykyä edistämässä”will be held on Friday 30 August 2019 at 12 o’clock in auditorium Nissi (Tritonia). The field of dissertation is Public Management. The defence will be held in Finnish.
Professor Elias Pekkola (University of Tampere) will act as opponent and Professor Esa Hyyryläinen (University of Vaasa) as a custos.
Further information
Kari Lappalainen, tel: +358 40 5805675, email: kari.lappalainen(at)live.fi
Lappalainen, Kari (2019). Luova hallinta sosiaali- ja terveyden- huollossa - Arvoverkkona johdettava alueellinen järjestelmä uudistamisen lähtökohtana, Acta Wasaensia 427, Doctoral dissertation. Vaasan yliopisto. University of Vaasa.
Publication pdf: http://urn.fi/URN:ISBN:978-952-476-875-7
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