February 2022

Implementing interRAI strategy in the new health and social care reform in Finland

The city of Jyväskylä is the regional centre and by far the largest city of Central Finland.


What does it mean, and what does it require?

In Finland, the responsibility for organizing public healthcare, social welfare, and rescue services will be transferred from municipalities to wellbeing services counties from 2023. The key objective of the reform is to improve the availability, cost-effectiveness, and quality of essential public services throughout Finland.
The future wellbeing county of Central Finland has 22 municipalities and 300,000 inhabitants, almost a quarter of whom are over 65 years of age. By 2040, the number of people over the age of 85 is projected to grow by around 135%. Rapid change will require, e.g., new service models and the use of technology.

Mervi Kivistö has worked as the interRAI coordinator in the Central Finland Wellbeing County Project since the beginning of 2021 and has more than 20 years of interRAI experience. Kivistö underlines the importance of cooperation, commitment, communication, enthusiasm, and encouragement. Enough time must be set aside for development and change. We need to move fast, but at a reasonable pace.

– From the start of preparing for the health reform, the use of the interRAI system has been purposefully linked to every project that has been launched, Kivistö states.

The planning started in 2020 with the interRAI system being linked to elderly services in 2021. The adoption of interRAI to mental health and disability services will start in 2022, and the child and youth instruments are possibly included in the following year. ICT developments with system integrations, data protection issues, and information management systems is proceeding rapidly in the county.

– When the responsibility of social and health care services are officially transferred to the new wellbeing county, we should have the whole package well together; the guidelines and development steps defined until 2026.

A significant part of the different projects supporting the reform is to improve communication, its importance cannot be overemphasized. Communication keeps the goals clear in our minds, helps implementing operating models, and keeps all actors on a shared journey. Communication must be continuous, diverse, open, and inclusive in every direction and at all levels of the organization.

Be concrete, results, and measurability

Mervi Kivistö likes to keep things concrete and visible with clear examples and measurable goals to motivate and push the reform forward.

Central Finland has already created indicators based on interRAI to measure and monitor achievement and targets. Strict goals have been set for completing assessments according to schedule, the person's involvement in care planning and daily living, and consideration of self-expressed goals.

– Our firm commitment is to clearly state the person's goals in each care and service plan.

– Prevention, active rehabilitation, maintenance of capacity, improving skills, and new technologies are essential. We have in our team a technology coordinator and a rehabilitation coordinator who are already making substantial use of interRAI data in their work creating new models and solutions.

Kivistö appreciates the real-time information provided by the RAIsoft.net solution and the opportunities it brings for decision support at all levels of decision-making.

– For example, customizable reports and care planning templates are great tools for identifying persons who benefit from technology services. For example, our rehabilitation coordinator is using the RAIsoft analytic tool to outline the care plan. I am also pleased with how managers and supervisors have posted indicators for strategic planning on their dashboards. The solution provides a view of the population served in entire wellbeing county with essential information.

In the spring of 2022, a new team working on informed decision-making with begin its work. Each municipality in the county has its own working group and interRAI coordinator.

Kivistö also feels the workload burden of performing assessments need to be reduced in the future.

– Part of this strategy we plan to bring in interRAI Self-assessment tools for client segmentation and to empower the person for better self-care and service needs assessments.

–We have also established a separate rehabilitative period for home care before assigning continuous home care services. The outcome of this initial service will be evaluated using interrail measures.

Time and goals

In service planning for community services Kivistö emphasizes the benefits comprehensive assessments and the needs of continuous follow-up assessments.

– Only yesterday, a case came to me where an elderly person used a pill dispenser for the first time. The person could initially not use the device independently, so home care was given to support the person. After practicing in using the pill dispenser it was concluded that the use of the dispenser was reliable and home care services could be ended due to this successful intervention. Without a systematic follow-up assessment, we would probably have maintained an unnecessary home care service.

Kivistö underlines the importance of change management how to get professionals involved and motivated to change. Could this be easier that we think when the benefits of comprehensive assessments are so obvious?

– It is essential to open what issues and aspects are involved with the implementation and proceed step by step. Then the enthusiasm kicks in. As the digital system is rolled out, support and time for Q&A is needed. The system needs to be justified to the users. It is good to bring in the big picture early on. Implementing piece by piece, discussing, scheduling, encouraging, but steadily moving forward with a clear goal.