Muutos psykiatristen avohoitokäyntien toteutuksessa ja johtajien kokemukset etäasiointia estävistä ja edistävistä tekijöistä COVID-19 aikakaudella

Vertaisarvioitu. English abstract.Peer reviewe

Sense of coherence and diabetes: A prospective occupational cohort study

<p>Abstract</p> <p>Background</p> <p>Sense of coherence (SOC) is an individual characteristic related to a positive life orientation leading to effective coping. A weak SOC has been associated with indicators of general morbidity and mortality. However, the relationship between SOC and diabetes has not been studied in prospective design. The present study prospectively examined the relationship between a weak SOC and the incidence of diabetes.</p> <p>Methods</p> <p>The relationship between a weak SOC and the incidence of diabetes was investigated among 5827 Finnish male employees aged 18–65 at baseline (1986). SOC was measured by questionnaire survey at baseline. Data on prescription diabetes drugs from 1987 to 2004 were obtained from the Drug Imbursement Register held by the Social Insurance Institution.</p> <p>Results</p> <p>During the follow-up, 313 cases of diabetes were recorded. A weak SOC was associated with a 46% higher risk of diabetes in participants who had been =<50 years of age on entry into the study. This association was independent of age, education, marital status, psychological distress, self-rated health, smoking status, binge drinking and physical activity. No similar association was observed in older employees.</p> <p>Conclusion</p> <p>The results suggest that besides focusing on well-known risk factors for diabetes, strengthening SOC in employees of =<50 years of age can also play a role in attempts to tackle increasing rates of diabetes.</p

Leadership in digital health services:protocol for a concept analysis

Abstract Background: Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective: The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods: The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results: An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions: A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services

Identifying the roles of healthcare leaders in HIT implementation:a scoping review of the quantitative and qualitative evidence

Abstract Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders’ roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O’Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders’ roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation

Primary healthcare managers’ perceptions of management competencies at different management levels in digital health services:secondary analysis

Abstract Purpose: The purpose of this study is to describe primary health-care managers’ perceptions of management competencies at different management levels in digital health services using the management competency assessment program as a framework. Design/methodology/approach: A secondary analysis study involving 21 semi-structured individual interviews was conducted among Finnish primary health-care managers at different management levels (frontline, middle and senior). The deductive framework method was used to analyze the data. Findings: Similarities and differences were found in management competencies between different levels of management. Competencies related to the use of digitalization were highlighted by managers at all management levels. Managers at all management levels were involved in developing digital solutions and supporting employees in using digital solutions in their work. Frontline and middle managers emphasized more issues related to day-to-day management and communication with employees, whereas senior managers highlighted the management of large entities. Research limitations/implications: In the secondary analysis, data were used for purposes other than originally intended. Therefore, the data are subject to limitations of the methodology applied and should be transferred to other contexts with caution. Practical implications: Identifying the management competencies needed to manage digital health services is important to target managers’ training according to needs in the future. Social implications: The results could be used to develop the management of digital health services, as well as improve digital health services and their deployment. Originality/value: Previous literature mostly examined managers’ informatics competencies and paid little attention to other management competencies. This study discusses more broadly the management competencies that digital health services require from managers at different levels of management

Perusterveydenhuollon johtajien kokemuksia koronaviruspandemian vaikutuksista digitaaliseen työkulttuuriin ja sen johtamiseen

Tiivistelmä Koronaviruspandemian aiheuttama kriisitilanne on muokannut työkulttuuria terveydenhuollossa, jossa on turvauduttu yhä voimakkaammin digitaalisiin ratkaisuihin koronaviruksen leviämisen ehkäisemiseksi. Koronaviruspandemian vaikutuksia digitaaliseen työkulttuuriin ja sen johtamiseen on tutkittu vähän ja tietoa tarvitaan muun muassa terveydenhuollon organisaatioiden toiminnan jatkuvaan arviointiin ja kehittämiseen. Tämän kuvailevan laadullisen tutkimuksen tarkoituksena on kuvata perusterveydenhuollon johtajien kokemuksia koronaviruspandemian vaikutuksista digitaaliseen työkulttuuriin ja sen johtamiseen. Tutkimuksen aineisto kerättiin puolistrukturoiduin yksilöhaastatteluin perusterveydenhuollon johtajilta (n=21) kolmesta kunnasta ja yhdestä kuntayhtymästä eri puolilta maata touko-marraskuussa 2020. Aineisto analysoitiin induktiivisella sisällön analyysilla. Tulosten mukaan koronaviruspandemian vaikutukset digitaaliseen työkulttuuriin liittyivät digitaalisen työkulttuurin kehittymiseen, muutokseen työnluonteessa sekä työyhteisön muutosvalmiuteen. Koronaviruspandemian vaikutukset digitaalisen työkulttuuriin johtamiseen liittyivät puolestaan muutosjohtamiseen, johtajan työn luonteen muutokseen ja johtajien muutosvalmiuteen. Johtopäätöksenä voidaan todeta, että koronaviruspandemia muutti nopeasti ja pysyvästi perusterveydenhuollon digitaalista työkulttuuria. Erityisesti digitaalisten työvälineiden käytön lisääntyminen muutti työssä tapahtuvaa kanssakäymistä. Johdon tuki koettiin tärkeänä digitaalisen työkulttuurin muutoksessa, sillä se stressasi ja kuormitti työntekijöitä. Tulevaisuudessa johtajien tulisi kiinnittää etäjohtamisessa huomiota suhteiden ylläpitämiseen työntekijöiden kanssa. Lisäksi niin työntekijöiden kuin johtajien IT-osaamiseen olisi syytä kiinnittää huomiota. Tutkimuksen tuloksia voidaan hyödyntää digitaalisten terveyspalveluiden ja työkulttuurin kehittämisessä, johtamisessa, koulutuksessa ja työyhteisöjen muutosvalmiuden tukemisessa.Abstract Ravelin, A., Laukka, E., Heponiemi, T., Kaihlanen, A., Kanste, O. Effects of the Coronavirus Pandemic on Digital Work Culture and Its Leadership: Primary Health Care Managers’ Experiences. Sosiaalilääketieteellinen aikakauslehti — Journal of Social Medicine 2021: 58: 220–234. The crisis by the coronavirus pandemic has shaped work culture in healthcare, which has ever increasingly resorted to digital solutions to prevent the spread of the coronavirus. There has been little research on the impact of the coronavirus pandemic on digital work culture and its leadership, and information is needed, for example, for the continuous assessment and improvement of healthcare organizations. The aim of this descriptive qualitative research is to examine primary health care managers’ experiences on the effects of the coronavirus pandemic on digital work culture and its leadership. The data for research was collected through semi-structured individual interviews of primary health care managers (n=21) in three municipalities and one joint municipal authory. Inductive content analysis was implemented for the analysis of data. The results suggest that the effects of coronavirus pandemic concerning digital work culture related to evolution of digital work culture, transformation in the nature of work, and readiness for change. The effects of coronavirus panpandemic concerning the leadership of digital work culture in turn related to change management, transformation of leaders’ work, and leaders’ readiness for change. As a conclusion, our results suggest that coronavirus pandemic rapidly and permanently changed the digital work culture in primary care. Especially the increased use of digital tools transformed the interaction at work. Leaders support seemed fundamental in digital transformation, which employees experienced stressful. In the future leaders should pay more attention to maintaining relationships with employees when leading remotely. In addition, organizations should invest in providing IT skills training for both staff and management. The results of this study can be utilized when developing digital health services and work culture, leadership, training and supporting change readiness

Mielenterveyskuntoutujien kokemuksia etäpalveluiden hyödyistä COVID-19-aikakaudella:laadullinen kuvaileva tutkimus

Tiivistelmä Suomessa on ylläpidetty ennennäkemättömiä sosiaalisen etäisyyden toimenpiteitä COVID-19-epidemian leviämisen estämiseksi. Etäisyyden pitäminen voi heikentää mielenterveyttä ja lisätä yksinäisyyttä erityisesti mielenterveyskuntoutujilla. Tutkimuksemme tarkoituksena oli selvittää, miten viestintäpalvelut sekä etäyhteydellä toteutetut sosiaali- ja terveyspalvelut tukevat mielenterveyskuntoutumista COVID-19-epidemian aikana. Tutkimusmenetelmänä oli kuvaileva laadullinen tutkimus. Aineisto koostui mielenterveyskuntoutujien (n=12) puolistrukturoiduista yksilöhaastatteluista. Haastateltavat rekrytoitiin kolmannen sektorin palveluista ympäri Suomen. Haastattelut toteutettiin puhelimitse COVID-19-epidemian toisen aallon aikana marraskuusta 2020 helmikuuhun 2021. Litteroidut haastattelut analysoitiin induktiivisella sisällönanalyysilla. Etäpalvelut mahdollistivat kuntoutujille sosiaalisen verkostoitumisen, mielenterveyden tukemisen, yksinäisyyden lievittämisen, sosiaali- ja terveyspalveluiden saamisen kotiin ja palveluihin helpottuneen pääsyn. Henkilökohtaiset syyt, kuten digitaidot tai koetut haasteet sosiaalisissa tilanteissa, sekä etäpalveluiden helppokäyttöisyys ja onnistunut toteutus lisäsivät kokemuksia hyödyistä. Toisaalta taas haasteet käytännön toteutuksessa, käytettävyydessä ja vuorovaikutuksellisuudessa estivät hyötymistä etäpalveluista. Haasteista huolimatta etäpalvelut ovat voineet lievittää COVID-19-epidemian haittavaikutuksia tukemalla kuntoutujien mielenterveyttä ja yksinäisyyttä. COVID-19-epidemian jälkeisessä yhteiskunnassa etäpalveluista saattavat hyötyä etenkin ne, jotka kokevat sosiaaliset tilanteet vaikeina. Palveluita kehittäessä on otettava huomioon, että onnistuneet etäpalvelut ovat helppokäyttöisiä, vuorovaikutteisia ja tietoturvallisia sekä edellyttävät yksityisyyttä kotioloissa. Fyysisten palveluiden ohella sosiaali- ja terveyspalveluita pitäisi voida hyödyntää monipuolisin tavoin etäyhteydellä, mikä voisi tukea eroja yksilöiden soveltuvuudessa ja valmiudessa käyttää etäpalveluita. Asiakassegmentointia tehostamalla voitaisiin paremmin tunnistaa haavoittuvassa asemassa olevien erilaisia tarpeita ja kohdentaa palveluiden toteutusta tarpeiden mukaisesti.Abstract Virtanen, L., Kaihlanen, A-M., Isola, A-M., Laukka, E., Heponiemi, T. Experiences of mental health rehabilitees on the benefits of remote services during the COVID-19 era: A qualitative descriptive study. Sosiaalilääketieteellinen aikakauslehti — Journal of Social Medicine 2021: 58: 266–283. Finland, along with the other countries in the world, has taken unprecedented social distancing measures to prevent the spread of the COVID-19 pandemic. Social distancing can affect mental health and increase loneliness for which mental health rehabilitees are particularly vulnerable. Our study aimed to describe how communication services and remote social and health services support mental health rehabilitation during the COVID-19 era. In a qualitative descriptive study, we interviewed mental health rehabilitees (n=12) recruited from third sector services across Finland. We analysed the data with an inductive content analysis. Remote services promoted the health and wellbeing of the interviewees by enabling social networking, mental health support, alleviation of loneliness, access at home, and easier access. Personal reasons, such as digital skills friendliness were elements promoting perceived benefits. Challenges in usability, interaction, and practical implementation, such as lack of privacy at home, hampered benefitting from remote services. Our results suggest that remote services may mitigate the adverse effects of the pandemic on mental health rehabilitees. However, the usability, interactivity, and security of services should be developed. Differences in the suitability and ability of individuals to use remote services highlight the need for providing services in various methods of remote delivery alongside physical services

The association between using a mobile version of an electronic health record and the well-being of nurses:cross-sectional survey study

Abstract Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses’ workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses’ well-being. Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses’ perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators. Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other). Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P&lt;.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P&lt;.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs. Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses’ well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses’ workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses

The effects of digitalisation on health and social care work:a qualitative descriptive study of the perceptions of professionals and managers

Abstract Background: Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work. Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals. Methods: We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach. Results: Digitalisation was perceived to have changed professionals’ 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems. Conclusions: The findings suggest that some of the effects of digitalisation on professionals’ work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals’ well-being and adaptation to changes, as well as the provision of quality health and social services