Eastern Häme: Health centre emergency duty - A
description of an HuIA process
Need for Human Impact Assessment
The eastern Häme sub-region health care project (September 1,
2002 to December 15, 2003) was a national health project. Its aim
was to identify the social welfare and health care functions where
combined production or procurement would result in financial
savings, reinforce competence and guarantee local people equitable
access to services at a sufficient level of expertise.
The project team decided to proceed primarily by examining forms
of cooperation based on the needs of the sub-region and the goals
of the national health project. It was found that several local
authorities had the same improvement needs: health care emergency
duty, care services for the elderly, and opportunities for sharing
specialist employees. Having learned of the Stakes cooperation
option, the project team decided to use HuIA to examine the joint
emergency duty arrangements at health centres.
According to the emergency duty report, all the local
authorities in eastern Häme find it difficult to provide emergency
duty services using only their own medical staff. Issues of
personnel burn-out have also come up. The solution has been to use
temporary (temp) doctors. The municipality of Hartola has had to
patch up its medical staff with temp doctors even during normal
opening hours. There are altogether 25 health centre physicians'
positions in the municipalities of eastern Häme. In March 2003,
17.5 of these were permanently filled. Emergency duty visits mainly
occur between 16.00 and 18.00 at all health centres. After this
period, the occurrence of visits is considerably less, particularly
after 20.00. At weekends, the number of patients at the joint
emergency duty surgery for Sysmä and Hartola averages two per hour.
The figure in Heinola is two or three per hour. The occurrence of
visits decreases significantly after 15.00.
The process and its participants
The participants in the eastern Häme health project were the
City of Heinola, the municipalities of Hartola, Sysmä, Pertunmaa,
Luhanka and Joutsa, the Eastern Häme Association, the Päijät-Häme
Hospital District and the Rheumatism Foundation Hospital. The HuIA
was managed by a project team appointed for the project, consisting
of members representing five municipalities: two directors of
medical services, a director of nursing, a basic security manager,
a senior medical officer, a social services manager, and a project
leader and special expert from the intermunicipal authority of
Päijät-Häme Hospital District.
The HuIA was begun in February 2003. It was mainly processed at
meetings of the project team. The authors of the present report
attended three of these meetings. The purpose of the HuIA was to
examine the impacts of the selected emergency duty model and to
find ways to alleviate and strengthen selected impacts. The threats
and opportunities of the model were charted through interviews with
the project leader, and an initial identification of impacts was
made. A draft table with impacts and ways of alleviating or
strengthening them was drawn up. This table was discussed and
augmented at meetings of the project team. The HuIA was completed
in summer 2003 and included in the final report on the eastern Häme
health project.
See the
table
The model examined and its impacts
The HuIA examined the impacts of the model proposed by the
project team. In this model, emergency duty services are arranged
as follows: Sysmä has emergency duty on Mondays and Wednesday up to
18.00. Hartola has emergency duty on Tuesdays and Thursdays up to
18.00. Hartola and Sysmä refer people to emergency duty at the
Heinola health centre between 18.00 and 21.00, after which
emergency duty is managed by Päijät-Häme Central Hospital. At
weekends, Hartola and Sysmä manage emergency duty alternately until
15.00, at which time emergency duty is taken up by Heinola and
later, for the night, by Päijät-Häme Central Hospital.
This model was assumed to fulfil the goals set for emergency
duty arrangements, so attainment of the goals was not assessed
separately. The project team considered the impacts of the model
from the point of view of the individual, the employee and the
municipality. Ways of strengthening positive impacts and of
alleviating negative impacts were also discussed. Information on
actual impacts was gathered through surveys during the emergency
duty experiment. The survey was distributed both to patients using
the experimental joint emergency duty services and to
personnel.
Use and benefits of HuIA
The experimental joint emergency duty arrangement between
Hartola, Heinola and Sysmä was implemented between September 1,
2003 and February 28, 2004. The experiment involved emergency duty
services in Hartola and Sysmä. Residents of Heinola experienced no
changes in emergency duty services at this time. HuIA was used to
gather information on the impacts of the experiment and on ways of
strengthening and alleviating selected impacts.
Further information
Esko Hussi
Chief Medical Officer, Internal Medicine
South Carelian Central Hospital
Leena Valtonen
Project leader
Päijät-Häme Hospital District |