Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services

Olli Halminen

Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services

Julkaisun otsikon käännös: Lyhyt- ja pitkäaikaispalveluita sisältävien mesotason hoito- ja hoivajärjestelmien suorituskyvyn analyysi

Olli Halminen

Tuotantotalouden laitos

Tutkimustuotos: Doctoral Thesis › Collection of Articles

Abstrakti

Sosiaali- ja terveydenhuollon johtamisessa tarvitaan erilaisia logiikoita riippuen siitä, johdetaanko yksittäistä hoito- tai hoivaorganisaatiota, useiden organisaatioiden verkostoa tai kansallista järjestelmää. Yksittäisen organisaation tasoon ja kansalliseen tasoon viitataan usein mikro- ja makrotasoina, ja näiden välissä olevaan useiden organisaatioiden verkoston tasoa kutsutaan mesotasoksi. Suomessa käsillä oleva alueellinen sosiaali- ja terveydenhuoltouudistus tulee entisestään korostamaan mesotason järjestelmän johtamisen tärkeyttä. Mesotason sosiaali- jaterveydenhuolto-järjestelmien johtamista on kuitenkin tutkittu kansallisten rekisteriaineistojen avulla vähemmän kuin mikro- ja makrotason järjestelmiä. Myöskään sosiaali- ja terveydenhuoltojärjestelmien johtamisen tutkimus ei ole kovinkaan perehtynyt mesotasonjohtamiseen. Tässä väitöskirjassa tarkastellaan sosiaali- ja terveydenhuollon johtamista systeemiteoreettisesta näkökulmasta, ja pyritään valottamaan johtamisen kannalta relevantteja mekanismeja mesotason hoivajärjestelmissä. Väitöskirjan tavoitteena on luoda mesotason sosiaali- ja terveydenhuoltojärjestelmän analyyttinen viitekehys, ja testata sen soveltuvuutta järjestelmän analysointiin kansallisesti kerättyjen rekisteriaineistojen avulla. Väitöstyön empiirisenä kontekstina on Suomen mesotason ikääntyneiden hoivajärjestelmä.Kansallisesti kerätty rekisteriaineisto sisältää tiedot 65:stä Suomen kunnasta ja yhteensä yli 300000:sta yli 74-vuotiaasta ikääntyneestä, ja sitä on täydennetty sosiodemografisella taustatiedolla potilaiden avioliittohistoriasta ja tulotasosta. Väitöstyön osatutkimukset tarkastelevat erilaisia mesotason järjestelmän suorituskykyyn vaikuttavia mekanismeja. Työn synteesiosassa yksittäiset löydökset koostetaan induktiivisen analyysin avulla mesotason johtamisen logiikoiksi. Työn löydöksenä mesotason järjestelmän johtajan on löydettävä tasapaino järjestelmän yksittäisen pitkäaikaistilan kustannusten ja lyhytaikaisen palvelunkäytön välillä. Organisaatioiden välisellä koordinaatiolla ja hoidon kriteerien yhtenäistämisellä voidaan vähentää pitkäaikaisen palvelutarpeen ja -tarjonnan eroista johtuvaa yli- ja alihoitoa sekä palvelutarpeen kriisiytymistä. Mesotason viitekehys mahdollistaa kokonaisvaltaisen palvelujen käytön jakauman analyysin sekä potilas- että järjestelmätasolla, mikä on erityisen tärkeää ikääntyneiden palveluiden kaltaisessa monia toimijoita ja erilaisia aikajänteitä sisältävässä kontekstissa. Analyyttisen viitekehyksen tarkka määrittely, luonti ja johtaminen on kuitenkin toteutettava yhteistyössä järjestelmän kaikkien toimijoiden kanssa. Ikääntyneiden palvelujärjestelmän lisäksi vastaavat mesotason mekanismit vaikuttavat relevanteilta myös mielenterveyspalveluiden sekä lastensuojelun johtamisen konteksteissa ja tulosten yleistämistä näihin hoiva- ja hoitokonteksteihin tulisi harkita.

Julkaisun otsikon käännös	Lyhyt- ja pitkäaikaispalveluita sisältävien mesotason hoito- ja hoivajärjestelmien suorituskyvyn analyysi
Alkuperäiskieli	Englanti
Pätevyys	Tohtorintutkinto
Myöntävä instituutio	Aalto-yliopisto
Valvoja/neuvonantaja	Lillrank, Paul, Vastuuprofessori Linna, Miika, Ohjaaja
Kustantaja	Aalto University
Painoksen ISBN	978-952-64-1105-7
Sähköinen ISBN	978-952-64-1106-4
Tila	Julkaistu - 2022
OKM-julkaisutyyppi	G5 Artikkeliväitöskirja

Tutkimusalat

terveystaloustiede
systeemiteoria
rekisteritutkimus
sosiaali- ja terveydenhuolto
mesotaso
ikääntyneiden hoiva ja hoito

YK:n kestävän kehityksen tavoitteet

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http://urn.fi/URN:ISBN:978-952-64-1106-4

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Valkonen, A. (Manager)
Kauppakorkeakoulu
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@phdthesis{d08a772fd95b4fcc968e877d50d7131f,

title = "Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services",

abstract = "Different managerial logics are relevant when managing individual care organisations, networks of interrelated care organisations, or national health systems. Individual care organisations and national health systems are often referred to as the micro and macro levels of management,whereas the networks of different organisations as the meso-level. The regional social and health care reform currently taking place in Finland will further accentuate the role of the meso-level of management. Meso-level social and health care systems have, however, received less attention inregistry-based studies than micro and macro level systems. Also, the literature on social and health care management has not focused at length on meso-level managerial issues. This thesis applies a systems approach on social and health care management to shed light on themanagerially relevant mechanisms on the meso-level. The goal of this thesis is to create ananalytical framework of meso-level social and health care system and test its applicability when analysing these systems with national routinely collected registry data. As an empirical context, this thesis studies the Finnish meso-level care system for older people. A nationally collected data set includes social and health care use of over 300,000 individuals aged over 74 years, in 65 Finnish municipalities, and is complemented with sociodemographic background information, including marital status and income level. The sub-studies included in this thesis analyse diverse meso-level system mechanisms that take place in the meso-level caresystem. The synthesis part of the thesis gathers findings from the sub-studies to create, via inductive analysis, meso-level logics of management. The results imply that the meso-level system's manager must find a balance between the costs of individual long-term states and the use of short-term services. Coordination between organisations and homogenous criteria for care can reduce the need for urgent care and the over- and under-carethat stem from discrepancy between long-term need for care and services provided. A meso-level framework enables comprehensive analysis of both the patient and system level service use distribution. This analysis is especially relevant for the care system of older people, which concerns diverse actors and time scales for care processes. The detailed definition, establishment, and management of the analytical framework must, however, be established in collaboration with all the actors within the system. Additionally, similar meso-level mechanisms might be transferable from the care management context of older people to mental health services and child welfare services, and the generalisability of the results and frameworks to these contexts of care should be considered.",

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author = "Olli Halminen",

year = "2022",

language = "English",

isbn = "978-952-64-1105-7",

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TY - BOOK

T1 - Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services

AU - Halminen, Olli

PY - 2022

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N2 - Different managerial logics are relevant when managing individual care organisations, networks of interrelated care organisations, or national health systems. Individual care organisations and national health systems are often referred to as the micro and macro levels of management,whereas the networks of different organisations as the meso-level. The regional social and health care reform currently taking place in Finland will further accentuate the role of the meso-level of management. Meso-level social and health care systems have, however, received less attention inregistry-based studies than micro and macro level systems. Also, the literature on social and health care management has not focused at length on meso-level managerial issues. This thesis applies a systems approach on social and health care management to shed light on themanagerially relevant mechanisms on the meso-level. The goal of this thesis is to create ananalytical framework of meso-level social and health care system and test its applicability when analysing these systems with national routinely collected registry data. As an empirical context, this thesis studies the Finnish meso-level care system for older people. A nationally collected data set includes social and health care use of over 300,000 individuals aged over 74 years, in 65 Finnish municipalities, and is complemented with sociodemographic background information, including marital status and income level. The sub-studies included in this thesis analyse diverse meso-level system mechanisms that take place in the meso-level caresystem. The synthesis part of the thesis gathers findings from the sub-studies to create, via inductive analysis, meso-level logics of management. The results imply that the meso-level system's manager must find a balance between the costs of individual long-term states and the use of short-term services. Coordination between organisations and homogenous criteria for care can reduce the need for urgent care and the over- and under-carethat stem from discrepancy between long-term need for care and services provided. A meso-level framework enables comprehensive analysis of both the patient and system level service use distribution. This analysis is especially relevant for the care system of older people, which concerns diverse actors and time scales for care processes. The detailed definition, establishment, and management of the analytical framework must, however, be established in collaboration with all the actors within the system. Additionally, similar meso-level mechanisms might be transferable from the care management context of older people to mental health services and child welfare services, and the generalisability of the results and frameworks to these contexts of care should be considered.

AB - Different managerial logics are relevant when managing individual care organisations, networks of interrelated care organisations, or national health systems. Individual care organisations and national health systems are often referred to as the micro and macro levels of management,whereas the networks of different organisations as the meso-level. The regional social and health care reform currently taking place in Finland will further accentuate the role of the meso-level of management. Meso-level social and health care systems have, however, received less attention inregistry-based studies than micro and macro level systems. Also, the literature on social and health care management has not focused at length on meso-level managerial issues. This thesis applies a systems approach on social and health care management to shed light on themanagerially relevant mechanisms on the meso-level. The goal of this thesis is to create ananalytical framework of meso-level social and health care system and test its applicability when analysing these systems with national routinely collected registry data. As an empirical context, this thesis studies the Finnish meso-level care system for older people. A nationally collected data set includes social and health care use of over 300,000 individuals aged over 74 years, in 65 Finnish municipalities, and is complemented with sociodemographic background information, including marital status and income level. The sub-studies included in this thesis analyse diverse meso-level system mechanisms that take place in the meso-level caresystem. The synthesis part of the thesis gathers findings from the sub-studies to create, via inductive analysis, meso-level logics of management. The results imply that the meso-level system's manager must find a balance between the costs of individual long-term states and the use of short-term services. Coordination between organisations and homogenous criteria for care can reduce the need for urgent care and the over- and under-carethat stem from discrepancy between long-term need for care and services provided. A meso-level framework enables comprehensive analysis of both the patient and system level service use distribution. This analysis is especially relevant for the care system of older people, which concerns diverse actors and time scales for care processes. The detailed definition, establishment, and management of the analytical framework must, however, be established in collaboration with all the actors within the system. Additionally, similar meso-level mechanisms might be transferable from the care management context of older people to mental health services and child welfare services, and the generalisability of the results and frameworks to these contexts of care should be considered.

KW - health economics

KW - systems approach

KW - registry study

KW - social and health care

KW - meso-level

KW - elderly care

KW - terveystaloustiede

KW - systeemiteoria

KW - rekisteritutkimus

KW - sosiaali- ja terveydenhuolto

KW - mesotaso

KW - ikääntyneiden hoiva ja hoito

KW - health economics

KW - systems approach

KW - registry study

KW - social and health care

KW - meso-level

KW - elderly care

M3 - Doctoral Thesis

SN - 978-952-64-1105-7

T3 - Aalto University publication series DOCTORAL THESES

PB - Aalto University

ER -

Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services

Abstrakti

Tutkimusalat

YK:n kestävän kehityksen tavoitteet

Pääsy asiakirjaan

Sormenjälki

Laitteet

Aalto University Data Hub

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