Abstract
Background
Care integration has been an aim in government policies since 2000s in Finland. In 8 counties municipalities have created regional joint health and social care authorities in responsibility of all health and social services to boost service integration. Joint management gives possibilities to change organizational structures and organizing care paths in new ways. Most of these joint authorities suffer from severe budget constraints and layoffs has been done. Care integration has been seen as alleviating in budget constraints and to increase efficiency. In this study the views of top and middle managers and personnel on care integration as means to develop efficiency is explored.
Methods
A large, newly established joint authority of 200000 inhabitants participated the study. The joint authority had a large gap in its budget, hence layoffs were planned. We compiled a data of regional policy documents, carried out individual and group interviews of management (21) and a survey to employees (N = 2047). In the interviews, views of top and middle managers on how efficiency should be developed and on views of care integration in relation to efficiency were studied. The views of employees were explored in the survey.
Results
The joint authority was launched in a very short time and care paths were not planned before the organizational change. The managers saw that siloed practices created inefficiency and care integration increasing efficiency although the research evidence was seen insufficient. In the survey the views of the employees of developing efficiency and care quality were more negative than managers. Both groups, however saw that care integration was underdeveloped. Developing integration especially at primary level became also a key strategy of the joint authority.
Conclusions
Joint management creates a good basis for integration. The implementation of care integration, however, requires managers' collaboration and organisational culture supporting integration.
Key messages
In managers views care integration can increase efficiency. Joint management is a good basis for integration, but care processes have to be planned.
The (Non) Economic Properties of the Law