Transforming home care in Finland? Part 2

We are now 3/4 on our way through our mission of meeting a dozen Finnish home care providers. The purpose of these meetings is to explain the Buurtzorg model for home care (autonomous self-organizing nurse teams, more patient focused care and other improvements) and gauge the interest for implementing something similar in Finland.
Observations and learnings this far

  • Overall very positive response to the idea and the vision. The model resonates especially with people who have a nursing background, who clearly recognize the discrepancy between the current state and the ideal.
  • We now understand the market much better than a week ago. In essence, the market splits to
    • Medical care – includes tasks such as caring of wounds, and needs to be performed by a nurse. A “practical nurse” (lähihoitaja”) can take care of most of medical tasks, but for medication related topics a “registered nurse” (sairaanhoitaja) is needed. Hourly wage is around 13-15 EUR.
    • Non-medical care – includes e.g., helping the patient run errands, walk outside or cleaning the house. These can be performed without formal qualifications, and typically the wages are slightly above minimum levels at 8-11 EUR per hour.
  • Often patients have a mix of medical and non-medical care staff. Depending on the patient and the vendor, the non-medical care can often be provided on a fairly non-fragmented basis (same person, weekly schedule of care with 2-3 hour slots every second day or similar rhythm of ~30 hours per month) whereas the medical care visits tend to be as short as possible and are often fragmented.
  • Fragmentation is a real problem also in Finland. In one dataset I analysed, the customers receiving more than 6 hours / week of care (ie. requiring assistance beyond just non-medical care) had on average 14 different nurses visiting them within a 2 month time period, and their “primary nurse” (who saw them most) only made about 20% of the visits.
  • For non-medical care, customers who only need 2-5 hours / week of service are in a better position. Quite often the companies are able to plan for a single person to do all the visits.

In terms of barriers, most often we heard

  • The way that the services are purchased by the public sector. The competitions and RFQ’s typically ask for the lowest possible price per 20 minute nursing slot, depending on the time and type of “product” offered. Quality receives only minimal share in the weightings used, and even then it is more based on specific criteria (e.g., usage of mobile tracking system) or CV’s of the nurses – not the actual quality of the service. There are some exceptions, e.g., in Jyväskylä patients were given the opportunity to switch between two providers based on the perceived quality of the care.
  • The nursing tradition. Often nurses are accustomed to hierarchical organization models, where the culture favors “doing as told” rather than being a self-stater. I heard this especially from former nurses, whereas top management in many companies was more optimistic on the ability of nurses to become self-organized.

The journey continues still with two private sector meetings (two very big companies offering home care), and then with a few meetings with the purchasing side ie. municipal representatives. Meanwhile, three separate companies have expressed explicit interest in continuing discussions and piloting the Buurtzorg model in Finland – stay tuned!

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