Exploring Customer-Oriented Service Offerings in Public Health: Developing Integrated Health Care Services for Rural Areas

V��est��n ik����ntyminen pakottaa yhteiskunnan ja julkisen terveydenhuollon muutoksiin. Jotta ik����ntyvien ihmisten kotona asuminen voidaan mahdollistaa, palveluj��rjestelm��n pit���� mukautua muuttuvaan tilanteeseen. T��m��n diplomity��n tarkoituksena on tunnistaa asiakasl��ht��isi�� l��hell�� asiakasta tarjottavia palvelukokonaisuuksia. Tutkimuksen teoreettinen viitekehys muodostuu asiakasarvon luomisesta ja palvelutarjoamista. Tarkasteluryhm��n�� on Etel��-Karjalan alueen 60���90-vuotiaat ja k��ytetty aineisto on ker��tty vastaajilta postitse l��hetetyll�� kyselyll��. Tutkimus on eksploratiivinen ja tulosten tulkinnassa on hy��dynnetty m����r��llisen tutkimuksen ja verkostoanalyysin menetelmi��. Ty��n keskeisimm��t tulokset ovat tunnistetut asiakassegmentit ja heid��n tarpeidensa pohjalta muodostetut palvelupaketit. Tulokset indikoivat asiakkaiden tarpeita ja tuloksia on analysoitu my��s tuottajan n��k��kulmasta. Empiiristen tulosten lis��ksi teoriaviitekehyst�� on kehitetty eteenp��in, jotta palvelukeskeiset teoriat voidaan ymm��rt���� yritysten n��k��kulman lis��ksi asiakkaan n��k��kulmasta.

Mobile clinics in public health care: Integrated service offerings for rural elderly

This research is an analysis of the value and content of local service offerings that enable longer periods of living at home for elderly people. Mobile health care and new distribution services have provided an interesting solution in this context. The research aim to shed light on the research question, ���How do we bundle services based on different customer needs?��� A research process consisting of three main phases was applied for this purpose. During this process, elderly customers were segmented, the importance of services was rated and service offerings were defined. Value creation and service offering provides theoretical framework for the research. The target group is South Karelia���s 60 to 90-year old individuals and the data has been acquired via a postal questionnaire. Research has been conducted as exploratory research utilizing the methods of quantitative and social network analysis. The main results of the report are identified customer segments and service packages that fits to the segments��� needs. The results indicate the needs of customers and the results are additionally analysed from the producer���s point of view. In addition to the empirical results, the used theory framework has been developed further in order for the service-related theories to be seen from the customer���s point of view and not just from the producer���s point of view.

In search of information systems value : a case study of the EHR benefits realisation efforts of three Swedish hospitals.

The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants��� perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants��� perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to one���s role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants��� drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.

Evaluation of novel programs in health counseling ��� their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the signi���cance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly ��� rstborn children, while children born in 2006 formed the historical control. The ��� rst of the new programs emphasized oral hygiene and use of ��� uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental bio��� lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father���s advanced level of education and child���s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present ��� ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

IN DUBIO PRO NATURA? A Philosophical Analysis of the Precautionary Principle in Environmental and Health Risk Governance

In this book, I apply a philosophical approach to study the precautionary principle in environmental (and health) risk decision-making. The principle says that unacceptable environmental and health risks should be anticipated, and they ought to be forestalled before the damage comes to fruition even if scientific understanding of the risks is inadequate. The study consists of introductory chapters, summary and seven original publications which aim at explicating the principle, critically analysing the debate on the principle, and constructing a basis for the well-founded use of the principle. Papers I-V present the main thesis of this research. In the two last papers, the discussion is widened to new directions. The starting question is how well the currently embraced precautionary principle stands up to critical philosophical scrutiny. The approach employed is analytical: mainly conceptual, argumentative and ethical. The study draws upon Anglo-American style philosophy on the one hand, and upon sources of law as well as concrete cases and decision-making practices at the European Union level and in its member countries on the other. The framework is environmental (and health) risk governance, including the related law and policy. The main thesis of this study is that the debate on the precautionary principle needs to be shifted from the question of whether the principle (or its weak or strong interpretation) is well-grounded in general to questions about the theoretical plausibility and ethical and socio-political justifiability of specific understandings of the principle. The real picture of the precautionary principle is more complex than that found (i.e. presumed) in much of the current academic, political and public debate surrounding it. While certain presumptions and interpretations of the principle are found to be sound, others are theoretically flawed or include serious practical problems. The analysis discloses conceptual and ethical presumptions and elementary understandings of the precautionary principle, critically assesses current practices invoked in the name of the precautionary principle and public participation, and seeks to build bridges between precaution, engagement and philosophical ethics. Hence, it is intended to provide a sound basis upon which subsequent academic scrutiny can build.

Dental Health in Primary Teeth after Prevention of Mother-Child Transmission of Mutans Streptococci. A Historical Cohort Study on Restorative Visits and Maternal Prevention Costs

<b>Mutansstreptokokkitartunnan ehk��isemisen pitk��aikaisvaikutukset maitohampaiden terveyteen. Kohorttitutkimus korjaavan hoidon m����r��st�� ja kariesehk��isyn kustannuksista. </b> Tutkimuksen tarkoituksena oli selvitt���� varhaisen mutansstreptokokki (MS)-kolonisaation ehk��isyn pitk��aikaisvaikutuksia korkean kariesriskin omaavien lasten maitohampaistossa sek�� tarkastella MS-tartunnan est��misen kustannuksia. Tiedot lasten hampaiden terveydest�� ja hammashoitotoimenpiteist�� syntym��st�� 10-vuotiaaksi sek�� ��iteihin kohdistuneen kariesehk��isyn kustannuksista ker��ttiin Ylivieskan terveyskeskuksen asiakirjoista. Tutkimuksessa oli mukana yhteens�� 507 lasta, heist�� 148 oli osallistunut aikaisempaan Ylivieskan ��iti-lapsitutkimukseen, jossa verrattiin ��itien k��ytt��m��n ksylitolipurukumin ja ��idille tehtyjen fluori- tai klooriheksidiinilakkausten vaikutusta pikkulasten hampaiden terveyteen. Maitohammaskariesta esiintyi 10-vuotiaaksi asti merkitsev��sti v��hemm��n lapsilla, jotka eiv��t olleet saaneet MS-tartuntaa alle 2-vuotiaana, heid��n maitohampaansa s��ilyiv��t 3,4 vuotta kauemmin t��ysin ehjin�� (p<0.001) ja he tarvitsivat v��hemm��n maitohampaiden korjaavaa hoitoa (p=0.005) kuin lapset, joiden hampaisto oli kolonisoitunut MS-bakteerilla jo 2-vuotiaana. Koska ksylitoliryhm��n lasten MS-kolonisaatio oli v��h��isint��, heid��n maitohampaissaan oli v��hemm��n kariesta ja korjaavan hoidon tarvetta kuin kahden muun korkeariskisen ryhm��n lapsilla. ��itien k��ytt��m��n ksylitolipurukumin kustannukset olivat yhteens�� 116 euroa ja lapsen maitohampaiden s��ilyminen t��ysin ehjin�� vuoden pidemp����n maksoi 37 euroa. Kun MS-tartunta oli saatu estetty��, korkean kariesriskin omaavien lasten hampaiden terveys oli samalla tasolla kuin keskim����rin koko ik��kohortilla. Lapsen maitohampaat s��ilyv��t tervein�� pidemp����n ja korjaavan hoidon tarve v��henee, kun MS-kolonisaatio alle 2-vuotiaana saadaan estetty��. Lapsen MS-kolonisaatio v��henee merkitsev��sti, kun ��iti k��ytt���� ksylitolipurukumia lapsen ollessa 0-2 vuoden ik��inen, siten pikkulapsen ��idin s����nn��llinen ksylitolipurukumin k��ytt�� saattaa olla julkisen tereydenhuollon kannalta tarkoituksenmukainenterveytt�� edist��v�� menetelm��.

���THE PATIENT SURVIVED DESPITE THE TREATMENT���. A study of Finnish health policy and New Public Management. Case: The Government Resolution on the Health 2015 public health programme.

Internationally, Finland has been among the most respected countries during several decades in terms of public health. WHO has had the most significant influence on Finnish health policy and the relationship has traditionally been warm. However, the situation has slightly changed in the last 10-20 years. The objectives of Finnish national health policy have been to secure the best possible health for the population and to minimize disparities in health between different population groups. Nevertheless, although the state of public health and welfare has steadily improved, the socioeconomic disparities in health have increased. This qualitative case study will demonstrate why health is political and why health matters. It will also present some recommendations for research topics and administrative reforms. It will be argued that lack of political interest in health policy leads to absence of health policy visions and political commitment, which can be disastrous for public health. This study will investigate how Finnish health policy is defined and organised, and it will also shed light on Finnish health policy formation processes and actors. Health policy is understood as a broader societal construct covering the domains of different ministries, not just Ministry of Social Affairs and Health (MSAH). The influences of economic recession of the 1990s, state subsidy reform in 1993, globalisation and the European Union will be addressed, as well. There is not much earlier Finnish research done on health policy from political science viewpoint. Therefore, this study is interdisciplinary and combines political science with administrative science, contemporary history and health policy research with a hint of epidemiology. As a method, literature review, semi-structured interviews and policy analysi will be utilised. Institutionalism, policy transfer, and corporatism are understood as the theoretical framework. According to the study, there are two health policies in Finland: the official health policy and health policy generated by industry, media and various interest organisations. The complex relationships between the Government and municipalities, and on the other hand, the MSAH and National Institute for Health and Welfare (THL) seemed significant in terms of Finnish health policy coordination. The study also showed that the Investigated case, Health 2015, does not fulfil all necessary criteria for a successful public health programme. There were also several features both in Health 2015 and Finnish health policy, which can be interpreted in NPM framework and seen having NPM influences.

Interoperability for IoT Health Systems Using HL7 Standard

Internet of Things or IoT is revolutionizing the world we are living in, similarly the way Internet and the web did few decades ago. It is changing how we interact with the things surrounding us. Electronic health and remote patient monitoring are the ways of utilizing these technological improvements towards the healthcare. There are many applications of IoT in eHealth such as, it will open the gate to provide healthcare to the remote areas of the world, where healthcare through traditional hospital systems cannot be provided. To connect these new eHealth IoT systems with the existing healthcare information systems, we can use the existing interoperability standards commonly used in healthcare information systems. In this thesis we implemented an eHealth IoT system based on Health Level 7 interoperability standard for continuous data transmission. There is not much previous work done in implementing the HL7 for continuous sensor data transmission. Some of the previous work was limited to sensors which are not continuous in nature and some of it is only theatrical architecture. This thesis aims to prove that it is possible to implement an eHealth IoT system by using sensors which require continues data transmission, such as respiratory sensors, and to connect it with the existing eHealth information system semantically by using HL7 interoperability standard. This system will be beneficial in implementing eHealth IoT systems for those patients, who requires continuous healthcare personal monitoring. This includes elderly people and patients, whose health need to be monitored constantly. To implement the architecture, HL7 v2.5 is selected due to its ease of implementation and low size. We selected some open source technologies because of their open licenses and large developer community. We will also review the most efficient technology available in every layer of eHealth IoT system and will propose an efficient system.