Making it easier Toimintakykyisenä kotona to cope at home esittely...data. €131,591,360 ... –...

Toimintakykyisenä kotona Making it easier

to cope at home

EKSOTE | 2 | 22.5.2018

INTEGRATED STRUCTURE

DIGITALIZATION LOW THRESHOLD

CENTRALIZATION DECENTRALIZATION

MANAGEMENT PROCESSES

New stand-by urgent care models

New hospital and other institutional care

New outpatient care models

Support for living at home, new

rehabilitation models

CUSTOMER

Eksote

EKSOTE | 3 | 22.5.2018

Integrated structure – Digitalization – Management

EKSOTE | 4 | 22.5.2018

Phases of service development

Separate hierarchy Administrative integration Ecosystem Functional integration

Added value from hierarchies

• Focus on the organisation and professionals

• Municipality-based

Municipality 1

Municipality 2

Municipality 3

Municipal mergers and

larger municipalities

Integrated structure – Digitalisation – Management

Hospital Hospital

Added value from the economy of scale


• Integration based on cooperation

Added value from information

• Focus on citizens

• Structural integration

Added value from analysing shared information

• Shared customer data

• Ecosystems

http://www.vero.fi/fi-FI

EKSOTE | 5 | 22.5.2018

Phases of service development

Separate hierarchy Administrative integration Ecosystem Functional integration

Added value from hierarchies


• Municipality-based

Municipality 1

Municipality 2

Municipality 3

Municipal mergers and

larger municipalities

Hospital Hospital

Added value from the economy of scale


• Integration based on cooperation

Added value from information

• Focus on citizens

• Structural integration

Added value from analysing shared information

• Shared customer data

• Ecosystems

New stand-by urgent care

models New hospital and other institutional

care

New outpatient

care models

Support for

living at home, new

rehabilitation models

CUSTOMER


http://www.vero.fi/fi-FI

EKSOTE | 6 | 22.5.2018

Overview of digitalisation: integrated

organisation and decentralised

wellbeing

CENTRALISATION • Special skills • Special equipment

DECENTRALISATION • Self-care for chronic conditions • Remote services • Mobile services • Prehospital care / home services • Personal services • Robotics and smart services

ntegrated structure- Digitalisation - Management

DIGITALIZATION IS CENTRALIZATION

AND DECENTRALIZATION

Integrated structure- Digitalisation - Management

EKSOTE | 7 | 22.5.2018

Overall view of digitalization

NEW SERVICES New roles

SERVICE SYSTEMS • Information systems • Data transfer

LIVING ENVIRONMENT HOUSING • Robotics • Virtuality

CITIZENS • Sensors • Monitors

Integrated structure- Digitalisation - anagement Integrated structure- Digitalisation - Management

EKSOTE | 8 | 22.5.2018

Digitality supports the development of the

entire service system

A single patient and customer

information system

Significant customer benefits: freedom to choose

within the region and all services available also in

small municipalities

A shared knowledge base

A significant cost and

quality factor: complete chains such as

rehabilitation and stroke treatment can be

managed within the region

Target group -specific

reporting and cost monitoring in each service

throughout the region.

Online services to home

Remote monitoring,

online nurse, scheduling appointments, online

health checks, risk tests, and many other services

are available to customers 24/7

Light operations control solutions

Process and operations control with own light,

browser-based SAS tools: reveales any bottlenecks

and helps eliminate them.


EKSOTE | 9 | 22.5.2018

VALUES

VISION

STRATEGIC GOALS

DAILY MANAGEMENT,

REWARDS

INDICATORS REPORTING

Common rules, culture

Common goal

Indicators tied to the goals, reporting, analyses, efficiency, forecasts

Everyone has management-approved goals

Identifying strategic goals, a rewards system

Strategic management


EKSOTE | 10 | 22.5.2018

Information based

management model

The model supports health benefits thinking, facilitates integrations, interventions and impact monitoring, and generation of comparison data.

€131,591,360

15,584

€80,629,374

33,389

€48,372,598

26,455

€31,944,079

1,739

€23,997,467

54,031

€25,974,251

9,635

€22,235,429

5,766

€13,641,455

24,634

€12,657,784

35,652

€7,927,435

11,565

€7,818,235

1,296

Nursing and care services

Demanding special healthcare services

Services for children, youth and families

Services for the disabled

Appointment services

Social services for adults Mental health and substance abuse services

Stand-by urgent care services

Dental healthcare Medical rehabilitation Prehospital care

Gross expenses and customer volumes per service package

= €5 million Gross expenses

= 2,000 customers


EKSOTE | 11 | 22.5.2018

Customer group-specific examination: e.g.

customers using services for the disabled

• Budget of services for the disabled: approx. €36.6 million

• Total cost of customers using services for the disabled in all services approx. €76 million

Care, acute hospital care and rehabilitation account for 38% of total costs

Total cost of services for the disabled in 2016


6 % 2 %

4 %

46 %

0 % 0 %

0 %

2 %

24 %

16 %

Rehabilitation

Family services

Psycho-social services for adults

Services for the disabled

Working life services

Support for management

Support for development

Outpatient healthcare services

Care

Acute hospital care

EKSOTE | 12 | 22.5.2018

Annual increase (%) in social and healthcare

expenses in South Karelia*


Annual increase in gross operating expenses

Member municipalities before Eksote Eksote Lin. (member municipalities before Eksote Lin. (Eksote)

EKSOTE | 13 | 22.5.2018

New models for promoting wellbeing

EKSOTE | 14 | 22.5.2018

Wellbeing centres as part of the service

network

Multidisciplinary services under one roof: get more done during one visit


SOCIAL SERVICES HEALTHCARE SERVICES

THIRD SECTOR

Close cooperation Low-threshold service clusters

ISO APU SERVICE CENTRE

HOUSE OF CHILDREN AND YOUTH

ADULT CENTRE

Low threshold Service instructing without an appointment: help, instruction, advice

Emphasis on self-care and involvement

Results Reducing the number of wasted and excessive visits, development across professional boundaries

EKSOTE | 15 | 22.5.2018

Mobile work

Other mobile services: Liito mental healthcare services for adults, all family services

Mallu, Malla and Taho vehicles • Services for many needs, flexibly and

equally • Part of the service system • Supplementary services

Work provided by professionals in the home and growth environment (daycare centres, schools)

Stand-by urgent care at home, enhanced home healthcare and prehospital care

Productive Idea 2011, Junior Chamber International Finland

Successful development project, Maaseutugaala 2012


EKSOTE | 16 | 22.5.2018

Online services 24/7

• Online nurse, scheduling appointments, online health checks, laboratory results, chat

An online risk test is completed before continuing to services

• Online training • Links to health portals • Service information

Identification and saving the results in the health file

• Right to schedule appointments

• A professional is notified

Identification • Right to schedule

appointments • A professional is

notified

RISK TEST


EKSOTE | 17 | 22.5.2018

• Houses of children and youth

• Low threshold, no referral needed: anyone can come and tell their worries without having to know what kind of help they need or where to get it – a plan is prepared together with the customer

• Focus on multidisciplinary low-threshold initial assessment

• Working together across unit boundaries

• A responsible person model is used

• Services are provided in the growth and development environment (mobile services) and specialised services are provoded close to everyday life and basic services (we help together)

• In preventive services, communal activities to promote wellbeing and local multidisciplinary activities have been strengheted

Family services


EKSOTE | 18 | 22.5.2018

Family services

The number of urgent placements in foster care remains below national average and alternatives developed

No queues to psychiatric examination or treatment of children or young

persons. Focus on cooperation with the child, family and other adults in the growth environment (daycare centre, schools, educational institutions).

Child protection • The need for institutional care has reduced

• The family care support team model that is based in systemic team work is unique in Finland. Team offers intensive support for family carers, but also works closely with the child and their next of kin.

Reduced need for inpatient care In child psychiatry, inpatient care has been replaced with intensive services provided in the home. Clear care processes, high-quality cooperation/networking and related management has been promoted.


EKSOTE | 19 | 22.5.2018

Services for the disabled are

being developed

In social work for the disabled, the focus is on autonomy and participation. Supporting mobility, assessing the need for personal assistance, and personal budgeting have been developed.

Finding jobs for the partially disabled in community employment and the open labour market is being promoted. Job coaching and day-time activities have been developed, with improved customer participation. Diversity of housing solutions has been increased, to provide as many people as possible an opportunity to live independently. Housing planning is conducted in cooperation with various municipal operators and administrative sectors.

National quality criteria have been applied and people-oriented operating practices strenghtened.


EKSOTE | 20 | 22.5.2018

Psyco-social services for adults

• Mental health and substance abuse services have a 24/7 outpatient service model, in which customers can seek care without a referral.

• Basic mental health and substance abuse services and social services have been combined with the specialised healthcare unit

• Substance abuse work is everyone’s business

• Mobile services and services in the home: care and rehabilitation is provided in the everyday living environment of the customers

• Psycho-social services for adults are now centralised in the adult centres in Lappeenranta and Imatra. Low-threshold reception provides help and advice without diagnosis.


EKSOTE | 21 | 22.5.2018

Psyco-social services for adults

These measures have reduced days of psychiatric care by nearly half, with shorter care also

No more queues: recruitment of staff has become easier

Service housing for mental health and substance abuse service customers reduced by 30%

Non-voluntary measures reduced by over 90%

The number of beds in psychiatric wards reduced by 67%


EKSOTE | 22 | 22.5.2018

Excellent results from the rehabilitation of

stroke patients

Everyone is rehabilitated • Everyone who needs

rehabilitation receives it • The only criteria for treatment

is that the patient must benefit from the treatment

• No need for a payment commitment, no age limits, no maximum length of treatment

Seamless continuum from home to home • Multidisciplinary home rehabilitation, physiotherapist-occupational

therapist teams, modifications at home, and auxiliary equipment • A stoke monitoring system extends to every municipality that have their

own contact persons for stroke victims • Neurological specialist nurse will participate in various events • Peer support is made part of the treatment chain • Electronic operations control system (follow-up visits and their contents are

programmed in the system including checklists)

_MG_6605_latvala


EKSOTE | 23 | 22.5.2018

Services for memory disorder patients

• Has difficulties in coping in the increasingly digital world independently

• Needs solutions tailored specifically for the person’s needs

• One contact channel

– No referral needed, low-threshold appointments

– Unified criteria for treatment

• Quick access to professional assessment

– The target is that diagnosis is made within 60 days of first contact (currently 130 days)

– Where required, progress of the matter is ensured on behalf of the memory disorder patient

• A comprehensive geriatric assessment and rehabilitation plan for all patients

• A personal memory coordinator is appointed for all patients

– Support for independent coping

– Advicing and service instructing

• Assessment and instruction by a physiotherapist

– Support for coping at home

The patient Eksote’s memory disorder patient process


EKSOTE | 24 | 22.5.2018

New rehabilitation models and support for living at home

EKSOTE | 25 | 22.5.2018

Assessment of service needs in

rehabilitation


1. A uniform, centralized model for assessing the service need of new customers in the entire Eksote area

A multidisciplinary service and rehabilitation need-assessment team, 8 service instructors (socionom, nurse, elderly care professional, occupational therapist)

Comprehensive service need assessment: urgent cases in less than 3 days, non-urgent cases within 7 days

• The customer receives services that meet their needs and functional ability (no under- or over-dimensioning)

• Opportunities for functional ability and learning are identified and risk factors predicted

• Where needed, a rehabilitating assessment period is started (at present, max. 6 weeks; maybe longer in future)

• The service need reduces when functional ability increases, duration of regular customership is shortened, and need for 24h care put off until later

Discharging groups for discharging new customers in Lappeenranta and Imatra (5 nurses, 3 physiotherapists, 2 occupational therapists, 5 practical nurses). In addition, physiotherapist and occupational therapist interventions used in home rehabilitation (32 person-years).

2.

EKSOTE | 26 | 22.5.2018

50% At home without daily assistance

15% At home supported by rehabilitation or peer

activities

50 % Regular home care

customership

25% Rehabilitating

assessment period of

home care

10% At home supported by assistance from some

other service

provider

Goals of multidisciplinary service and

rehabilitation need assessment


EKSOTE | 27 | 22.5.2018

Eksote’s multidisciplinary service need

assessment and home rehabilitation facilitates

safe return to home and coping at home of

elderly customers

Success requires: • Multidisciplinary service need assessment immediately

after discharge

• Supporting functional ability and everyday life

is started immediately

• Support visits by practical nurses

• Intensive physiotherapy and occupational therapy sessions 2–4 times per week

• Sufficient effort and time input in the early stages

• Focus on enhancing quality of life and safety

• Seamless cooperation with home care

Multidisciplinary home rehabilitation model won the

Vuoden vanhusteko 2015 (Act of the year 2015 for the

benefit of the elderly) prize


EKSOTE | 28 | 22.5.2018

2011 2012 2013 2014 2015 2016 2017

Enhanced service housing 6525 7142 8568 6887 5446 4282 2678

Home care customers 3992 3888 4383 4030 3929 3013 1741

Family care 4568 4793 4877 4176 3246 3217 1345

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Operating expenses / customer (rehabilitation)

Enhanced service housing Home care customers Family care

Operating expenses per customer

(rehabilitation) €


EKSOTE | 29 | 22.5.2018

Rehabilitation

Constitutes a functional entity in Eksote that faciliates efficient further care and rehabilitation. Strong emphasis on home rehabilitation: a research project on the effectiveness of home rehabilitation is currently underway jointly with Kela.

Armila hospital is now a rehabilitation centre:

it won 2014 Lean Act of the Year award.

CENTRAL HOSPITAL

HEALTHCARE AND WELLBEING CENTRES

HOME CARE

Free instructing and advicing services are available at the specialized healthcare rehabilitation clinic without a referral

Instructory/first physiotherapist visit can be booked online without a doctor’s referral.

Instructing and advisory visits of rehabilitation services for elderly at Iso apu (”big help”) service centre

+ +


EKSOTE | 30 | 22.5.2018

Indicator Change

2014–2016

Time that generates added value to the rehabilitant (productivity) + 100 %

Number of persons discharged from the ward before 10 am 2013 2016

0 43 %

Proportion of rehabilitants who are at home 4 months later 2013 2016

+ 33 %

Number of discharged persons readmitted to hospital within one month of discharge 2013 2017

– 22 %

Patient injuries 2014–2016 – 24 %

Pharmaceutical injuries 2014–2016 – 42 %

Average duration of treatment periods 2013 2016 – 26.5 %

Number of patients treated at the ward per year 2013 2016 + 21 %

Wellbeing at work, management 3.6 4.1. Personal experience 3.2 3.5. Estimate of workplace satisfaction 2.5 3.0. Working ability 3.7 4.0. Resources 3.4 3.7.

Results of the Armila rehabilitation

centre


EKSOTE | 31 | 22.5.2018

Auxiliary equipment and functional ability

centre

”Bureaucracy” has been reduced, and equality of services increased.

Close cooperation with e.g. the services for the elderly and the disabled regarding auxiliary equipment and dwelling modifications supports independent coping of locals at home.


EKSOTE | 32 | 22.5.2018

Rehabilitants and development of social

and healthcare expenses

0

5000

10000

15000

20000

25000

30000

35000

REHABILITATION EXPENSES (€) PER CUSTOMER PER YEAR

Expenses per customer down by 34% (2011–2014)

30 948 €

20 427 €

2011 2014

Support for living at home and new rehabilitation

models

€


EKSOTE | 33 | 22.5.2018

0

20000

40000

60000

80000

100000

120000

140000

20

13

20

17

20

20

20

25

20

30

20

35

20

40In

stit

uti

on

al b

ed

s /

Enh

ance

d s

erv

ice

ho

usi

ng

24

h

Number of senior citizens not living at home 2013–2040 1. Present situation in Finland

2. Growth in Finland +85, need taken intoaccount

3. Present growth in Finland 87 %

4. Act on Supporting the FunctionalCapacity of the Older Population and onSocial and Health Services for OlderPersons 91 %5. Act on Supporting the FunctionalCapacity of the Older Population and onSocial and Health Services for OlderPersons 92 %6. Eksote's level 94 %

7. Eksote's level 97 %

Eksote’s new rehabilitation system:

a key to coping Kinnula Petra – Malmi Teemu – Vauramo Erkki (2015)

3 %

6 %

€


EKSOTE | 34 | 22.5.2018

Home care: digitalisation and quality of home care

as part of operations development

• Video-based remote visits to replace part of traditional home care visits • Target: 3 % of visits implemented as video-based remote visits • This target was reached in 12/2017

• Home care operations control • Operations control aims to increase the proportion of time spent working

directly with the customer • The time spent by standard workers working directly with customers has

increased from 44 % → 53 % • The time spent by nurses working directly with customers has increased

from 27 % → 40 % • Developing home care customer relations management

• Shifting to using a team model in the home care areas • Supporting the responsible person model through the team model


EKSOTE | 35 | 22.5.2018

Support for living at home: Technology

• Toimiva huusholli (Functional home) has a selection of equipment to support coping at home; these aids can be viewed and tested.

• .

senior furniture

Small auxiliary equipment for

easier everyday life

Video connections

Home security

solutions

Lighting Information technology

• GPS positioning through a telephone alarm system and video connection through a tablet computer to support living at home

• A technology integration platform that provides professionals and the next of kin an overall picture of the coping at home and possible changes in functional ability of the customer will also be introduced


EKSOTE | 36 | 22.5.2018

Significance of service instructing

Service instructing and work description of service instructors are important areas of development.

Service instructing is a low-threshold service, because: • it is multi-channelled

(incl. digital channels) • it is easy to access, most often

without a scheduled appointment

• it is very practical, up-to-date, and based on customer needs

Service instructors must be:

customer-oriented and experienced with networking skills. Customer questions can concern e.g. social and healthcare services, Kela forms, retirement, or matters relating to the municipality’s technical department.


EKSOTE | 37 | 22.5.2018

New hospital and other inpatient care

EKSOTE | 38 | 22.5.2018

Eliminating institutional care

• Institutional care has been replaced with various kinds of housing services, and in child protection has been replaced mainly with foster care. Long-term institutional care has been eliminated in services for senior citizens and the disabled, in child protection, and in mental health and substance abuse services. The amount of outpatient services that support the functional ability and services provided in the home has been increased.

Long-term 24 h care of senior citizens has reduced, and coverage has dropped from 12 % to 5.6 %

Long-term institutional care of senior citizens has dropped from 6 % to 0.6 %


EKSOTE | 39 | 22.5.2018

The new K wing of the central hospital

• A stand-by urgent care clinic

• Wards

• Analysis laboratory

• Logistics, warehouses

• Will be taken into use in May-June 2018

• The size of the new building is ca. 19,900 gross m2

• Cost is about €55 M (incl. planning, foundation, construction, and equipping)

• Latest technology (e.g. RFID network) and building technology (reservation for using heat extracted from a lake)

• Art as a promoter of health partially integrated with the building (art on the ceiling, art wallpaper, art poles, tile patterns)


EKSOTE | 40 | 22.5.2018

The new K wing of the central hospital

• The wards are mainly one-bedroom, with an en suite bathroom for added privacy.

• Nurses will have smart phones, allowing patient information to be enteted into the patient data system in the privacy of their room.

• Each patient has a responsible nurse.

• Patients discharged from the hospital are given instructing on self-care before they leave the hospital, and efficiency of post-treatment is improved by calling certain patient groups once at home.


EKSOTE | 41 | 22.5.2018

The new K wing: healing power of art

• Customers can come to the stand-by urgent care clinic for any health reason and they are either treated immediately or an appointment is scheduled at a service point.

• Art has been integrated with the structures and interior design of the hospital.

• Different patient groups are taken into account, including children, hospice care patients, and those suffering from acute pain.

• Studies show that hospital art reduces stress and need for painkillers, lowers blood pressure, gives the patient hope, and increases trust


EKSOTE | 42 | 22.5.2018

A new model for artificial joint patients

• The aim is to ensure quick admission to care. The model for artificial hip and knee joint patients has been developed in cooperation with various professional groups based on the Lean method.

• Structured referral practice. Patients have completed the necessary instructory sessions with a physiotherapist and their dentition has been treated in accordance with recommendations. Once the referral has been received, a nurse working for the central hospital will call the patient and ensures that everything is in order.

• Once the decision to operate has been made, the patient will participate in a group information session on artificial joints. At best, the surgery will take place within one month.

• Duration of ward care has been shortened and clarified. The patient is discharged 2–3 days after the surgery.


EKSOTE | 43 | 22.5.2018

The new K wing: a new shared stand-by

urgent care model 24/7

Patients needing care are treated within 24 hours, including patients who are at present being cared for at the Armila healthcare centre.

The new shared stand-by urgent care unit also has urgent social services and coordination of services provided in the home. Centralised coordination of ambulance operations, the mobile urgent care unit, enhanced home healthcare, and home hospice care facilitates more effective direction of patients to right care at the right time, while also optimising services and resources.

Professionals have a real-time and accurate knowledge of the overall situation of the patient and further care options within Eksote’s service system.

There is a separate stand-by urgent care unit for children with a separate waiting area and inspection rooms. The aim is to address children quicker than the adults.

The centralised telephone advice service number is 116117.


EKSOTE | 44 | 22.5.2018

Centralised stand-by urgent care

NOW

IN THE FUTURE

Appointments by telephone • Customer calls the

appointment number

• Leaves a call-back request

Call-back service • A nurse contacts

the customer by phone

• Need for care is assessed

• Invitation to the healthcare centre

Healthcare centre • Customer goes to the

healthcare centre • Quick CRP • A referral to a doctor

at the Armila healthcare centre

Armila healthcare centre • Customer is

examined by a doctor at stand-by urgent care

• Auscultation of lungs

• Referral to a pediatrician at South Karelia Central Hospital

South Karelia Central Hospital • Pediatrician

services • Urine sample • Referral to x-ray • Going to x-ray • Back to the

pediatrician • Antibiotics

prescription

Pharmacist • Buying

antibiotics and painkillers

Diverse contact options • Symptom assessment directs

the customer to the approproate service/provides the appropriate contact details (scheduling an appointment, self-care instructions, electrical contact form)

• Alternatively, customer can contact the call centre

• Or go to a walk-in wellbeing centre

Referral to services by a professional • Based on preliminary

information submitted online or on the telephone, or based on a meeting at the wellbeing centre

• Referral to joint stand-by urgent care services

Joint urgent care services • Customer meets a nurse • Quick CRP • Urine sample • Acute care doctor or

pediatrician services, x-ray where required

• Antibiotics prescription

Pharmacist • Buying antibiotics and

painkillers

( )


EKSOTE | 45 | 22.5.2018

• Consultations outside the hospital are an important part of caring for the patients

• Knowledge of the opportunities provided by the service system

• Enhanced, supported discharge from the hospital 24/7

• No unnecessary visits to the stand-by urgent care clinic, transportation or waiting at the emergency clinic

• Optimised use coordination of resources

• Care paths across sector boundaries –multidisciplinarity

• Prevention, early intervention

• Using technology – remote services

• Number of services provided in the home

is increased

• Ward beds are used flexibly throughout

the region

All service needs, guidance to further care, and monitoring of the patients are ensured. The impacts of medication, nutrition, and functional ability are considered.

Models of home services provided in the home

Centralised services provided at the hospital

Coordination Cooperation 24/7

From centralised services to

decentralised models

Shared knowledge

base


EKSOTE | 46 | 22.5.2018

• Prehospital care, enhanced home healthcare, and stand-by urgent care are combined into one unit (all main units that care for acute patients).

• Mobile urgent care units (one person unit) in Imatra and Lappeenranta are a fixed part of care and services provided in the home.

• Task coordination is centralised to the field management of prehospital care and to the stand-by coordinator, allowing for efficient use of resources and quick and purposeful treatment of patients.

• Over 40 % of the tasks are completed in location.

Stand-by urgent care at home:

Mobile urgent care unit, prehospital care, enhanced

home healthcare


EKSOTE | 47 | 22.5.2018

Enhanced home healthcare

• Specialized care in the home instead of inpatient care, or discharging patients from hospital earlier than before

• We do urgent stand-by action and care need assessment visits in homes and in service housing units when the condition of the customer changes suddenly

• We also facilitate home hospice care in cooperation with the next of kin and other services provided in the home


EKSOTE | 48 | 22.5.2018

Thank you!

Making it easier Toimintakykyisenä kotona to cope at home esittely...data. €131,591,360 ... –...

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