Interprofessional Emergency Service
This case was submitted as part of the Call for Innovations, an annual partnership initiative between OPSI and the UAE Mohammed Bin Rashid Center for Government Innovation (MBRCGI)
A customer-friendly emergency service model from Finland where the public can find all the assistance they need at one point of service, instead of across several sites. In addition to somatic emergency services, psychiatry, substance abuse and violence prevention, crisis and social work, and child protection are available. The interprofessional model means collaboration towards a shared goal. The operational model, available anywhere in the world, improves emergency services.
The South Savo Social and Health Care Authority comprises 9 municipalities with a total population of 105,500. The population is decreasing, the rate of ageing in the region is high, and the proportion of older people is the highest in Finland. The decision was made to integrate basic healthcare, special healthcare and social services into a single functional whole in Southern Savonia. It required development of functional processes and the operational environment. The inter-professional emergency service model was developed within a project funded by the Ministry of Social Affairs and Health (2013–2016) to support functional integration. A core aim of the project was to integrate the social work and healthcare emergency services into one system. As a result, the interprofessional emergency services were implemented on 1 Jan. 2017.
In the beginning of the project, the functionality of emergency services was studied. We discovered that the customers in need of the services were scattered across the system in an impractical manner. Problems were identified in allocating services matching customers’ needs. Customers were often offered help within a medical framework, regardless of their primary service need. The results formed a basis for the structure of interprofessional emergency services.
After the analyses, actual work to design the operational model began. The work progressed in phases. An important tool in the development was an interprofessional workgroup with participants representing all emergency services players: healthcare, social services, the police, the emergency response centre and NGOs. We used Service design in the development work. To create the operating model, 2 major collaboration meetings were held in summer 2015, and an interprofessional working group met 7 times by spring 2016. The groups covered themes such as interprofessional customer situations, the core tasks of different players and the common working area, starting customer processes, crisis communication, revising experiences from the emergency service trial, and revising the draft for the model.
Between the working group meetings, the project coordinator met with different players, gathering material for the model. Meetings were also held with different working groups such as nurses from acute workgroup, emergency social workers, the team responsible for initial evaluation in child protection, and psychiatric workgroups. In addition to working with the groups, the coordinator benchmarked the 24/7 social and crisis services in Espoo and Kouvola.
Major functions that supported the drafting of the operating model were trials with an acute psychiatry nurse working on weekends (9/15) and social workers’ on-call duty on weekends (2/16). The trials facilitated customer-facing work in future operating environments, work in interprofessional pairs and testing and developing collaboration. During the trial, customer situations were monitored using interviews carried out by the duty acute psychiatry nurse, Webropol monitoring of the emergency services and evaluation meetings between those involved in the trial and their supervisors. A survey of emergency service personnel was also carried out during the pilot. The trial showed that a revised service provision changed the customer base structure that contacted the services, and the number of face-to-face meetings between customers and workers in social emergency services increased. Customers received a more complete service while the personnel felt that their work was easier and the customer service chain smoother. The operating model for emergency social and crisis work was finalised in spring 2016, and its implementation on 1 Jan. 2017 was approved by the Board of the municipal consortium on 9 June 2016. Mental health and substance abuse emergency service and child protection on-call duty during office hours were integrated into the emergency social and crisis work. The operating model responded to changes to the national act on emergency services and the section on emergency social services in the act on social welfare being drafted.
Towards the end of the project in autumn 2016, implementation of the model was supported by development meetings organised with executives in the service industry. The project coordinator also continued analysing the results of the emergency service trial, developed recording practices and communication, and implemented hands on customer work with interprofessionality in mind. As for the innovation, the model is in use. However, a lot of work is still needed before the benefits of interprofessionality can be reaped in full. The development of the model continues based on reflection with workers, monitoring KPIs and collecting customer experiences. The operating culture in emergency services is becoming interprofessional.
What Makes Your Project Innovative?
From the customers’ point of view, interprofessional emergency service differs from the traditional model in that they can find all the assistance they need at one point of service instead of visiting several sites, regardless of the fact that the organisation has to divide the service need into smaller parts. From the professional’s point of view, a variety of complex services form a single, controllable whole that addresses the customer’s service needs in mutually agreed collaboration. So far, it has not been possible to address a customer’s somatic service needs at the healthcare emergency service. Instead, they have been referred onwards, the issue has not been dealt with, the customer has been sent away or they have received overlapping and redundant services. In a unified operational model, each professional’s role is a part of the whole, making the customer experience smooth. The current model helps avoid organising overlapping services and improves the customer experience.
What is the current status of your innovation?
The development of the model continues. As part of our emergency services we started (2017) a telephone service provided by experienced General Practioners outside office hours. Our analysis showed that the need for referrals to emergency care reduced remarkably in elderly care. See more attached poster.
In 2018 we started children emergency care process with the aim not only to cure somatic problems but also aid families with the social aspects of life. All these function work in the same premises and are adjacent to each other.
As a reward leading Finnish healthcare magazine Mediuutiset named the innovators social care project coordinator Katja Saukkonen and Chief Physician Santeri Seppälä as the number one influencers on Finnish healthcare on their list of 100 most influential healthcare people in Finland. Still a lot of work needs to be done to integrate acute care in social and healthcare.
Collaborations & Partnerships
A strong network has been built around the interprofessional emergency service. We partnered with:
- The local Crisis Centre
- Pastoral care at the hospital
- Medical and healthcare social work, municipal and organisational social services
- mental health services, acute psychiatry and substance abuse work, partners
- violence prevention organisations
- The emergency response centre and police as state representatives
- Emergency care
Users, Stakeholders & Beneficiaries
The innovation was developed in close cooperation with customer-facing workers, supported by the management:
1. Initial analysis and a draft of the structure of the interprofessional emergency service
2. Individual and collective meetings with players
3. An interprofessional workgroup that all the participants, network players and process owners took part in
4. Experiments and assessment
5. Decision on resourcing and implementation by the ESSOTE Board
Results, Outcomes & Impacts
So far the surveys carried out during trials in particular have shown that organising social emergency services within the framework of shared emergency services increases the number of face-to-face encounters with customers and active work. The time invested in the service can be used more efficiently to meet the customer and assist them as necessary, instead of wondering where to handle the issue.
The results obtained from the trial enforce the view that services are most useful for the customer when the interprofessional collaboration works and all the parties understand and consider not only their own field but the whole service the customer needs and receives. The survey revealed that without a ‘one-stop-shop’ approach, 25% of the customers would probably not have contacted the emergency social worker or mental nurse at all, despite a clear need for the service. This was most pronounced in the case of substance abusers and patients with multiple illnesses.
Challenges and Failures
A challenge during development was securing broad commitment amongst middle management. The model was drafted rapidly, but the pilot and implementation were delayed because not all middle management personnel saw any need for change within the proposed time frame. A significant factor here was the lack of qualified social workers, particularly in the field of child protection. However, the project was advanced purposefully by realising practical trials with the support of higher management. The delay turned out to have a positive impact. It gave us more time to drive the change step by step with the support of the project coordinator and to learn practical interprofessional operations with customers. During implementation, a high worker and supervisor turnover slowing down the change was a challenge. The development unit and the strong commitment of the emergency service management helped with the implementation.
Conditions for Success
A common understanding of the need for change and necessary measures are required for this kind of an innovation to succeed. Plans must be made according to identified problems, and challenges must be solved together with employees with managerial support. Political decision-makers must be informed and updated during planning stages. Before implementation, resources must be reserved, necessary decisions made and a common understanding of the grounds, goals and means of implementation for the change ensured. We recommend commissioning bottom-up, i.e. by learning interprofessional methods. The benefits of the innovation should be analysed regularly, and operating models should be revised according to the feedback received from employees and customers, if necessary. In addition, new employees should be initiated into the interprofessional operating culture that differs from traditional on-call duty.
This could include replicability of the problem (i.e., widespread public challenges), as well as replicability of the solution (i.e., the ease at which the solution can be adopted by others) Challenges related to emergency services are similar around the globe. Crises, mental disturbances, substance abuse, social issues and somatic illnesses exist everywhere. Would it therefore not be wise for us to make it possible for our customers to seek help for all these issues in one place? The interprofessional emergency service model can be implemented anywhere in the world. Implementing it requires learning about interprofessional operations in the local operating environment, change in the operating culture and patience in waiting for results.
The need to refer customers from one worker to another has decreased and a wide variety of customer needs can now be addressed at the emergency unit. This requires workers being able to collaborate to pursue common goals together. We recommend practising collaboration in real-life customer cases. Collaboration helps everyone learn about each other’s work and realise that collaboration creates more added value for customers. This reduces the amount of overlapping and partly redundant work. Our operating model was developed in long-term collaboration with customer-facing workers to guarantee its success.