Ilmari Rostila

The outcomes of regional healthcare information systems in health care: A review of the research literature

The resulting regional healthcare information systems were expected to have effects and impacts on health care procedures, work practices and treatment outcomes. The aim is to find out how health information systems have been investigated, what has been investigated and what are the outcomes. A systematic review was carried out of the research on the regional health information systems or organizations. The literature search was conducted on four electronic Cinahl Medline, Medline/PubMed and Cochrane. The common type of study design was the survey research and case study, and the data collection was carried out via different methodologies. They found out different types of regional health information systems (RHIS). The systems were heterogeneous and were in different phases of these developments. The RHIS outcomes focused on the five main areas: flow of information, collaboration, process redesign, system usability and organization culture. The RHIS improved the clinical data access, timely information, and clinical data exchange and improvement in communication and coordination within a region between professionals but also there was inadequate access to patient relevant clinical data. There were differences in organization culture, vision and expectations of leadership and consistency of strategic plan. Nevertheless, there were widespread participation by both healthcare providers and patients.

Differentiation of organizational climate and culture in public health and social services in Finland

AimThe aim of the study was to examine the differentiation of organizational contexts within Finnish public health and social services both at the workplace and at the local governmental (municipality) level.Subject and methodsWe focused on climate, comprising individual level experience, and on culture, comprising collective level as “the way things are done in organization”. Climate, as “the way people perceive their work environment”, was interpreted to reflect personally relevant professional and moral concerns. As an exploration of antecedents of climate and culture, we compared the scale of contextual differences among workplaces with the extent of differences at the municipal level. We also examined by multilevel hierarchical linear models (HLM), the importance of observed differentiation of workplaces in terms of impacts of both climate and culture on employee morale.ResultsThere existed different organizational climates and cultures within Finnish public human service organizations both at workplace and upper organizational level. Differences in terms of climate were somewhat bigger than differences in culture.ConclusionBoth climate and culture should be highlighted in the effort to specify the characteristics of organizational social contexts, as well as their antecedents and consequences in public human services.

Promoting the Use of Single-Case Designs: Social Work Experiences from England and Finland

The main contribution of this article is to critically analyze the use of single-case evaluation by social work practitioners in Finland and England and to assist in the development of this methodology in practice. We examine the experiences from both countries where attempts were made by academic researchers to encourage social workers to use single-case designs in the evaluation of their practice. The interventions used by the researchers in the universities at Tampere in Finland and Huddersfield in England to promote the use of single-case evaluation by practitioners are described in detail to enable replication and to develop the potential to learn from the interventions used by others.

Organizational social context in primary health care

The recognition and assessment of organizational social context (culture, climate and morale) is particularly valuable in primary health care. Both culture and climate have been shown to be associated with work morale and to predict job satisfaction, organizational commitment and voluntary turnover of employees in nursing. This study aims to describe the social contexts of primary health care centers from the viewpoint of health care professionals. A descriptive study using an organizational social context instrument for data collection was undertaken. From 29 teams in 18 public primary care centers of one Lithuanian county, 344 health care professionals participated. The results of the study show that different organizational cultures, climates and levels of morale existed in primary health care centers, at both team and organizational levels. The differences between teams were significant in terms of culture rigidity and resistance. Climate differences were found at both team and organization levels in regard to stress and functionality. A variance of about 7% in work morale was seen in teams and organizations. Managers should recognize the different kinds of social contexts in which teams work, in order to enable them to co-work efficiently in evidence-based primary care settings.

Towards an Integrated Model of Practice Evaluation Balancing Accountability, Critical Knowledge and Developmental Perspectives

Abstract Against a backdrop of economic globalisation, where welfare practitioners find themselves caught between modernising policy reform and demanding practice realities, there is an urgent need to rethink the relationship between research, evaluation and professional practice. In this article three perspectives concerned with accountability, critical knowledge production and development will be examined as a basis for understanding the different methodological discourses on evaluation. The debate between evidence-based practice (EBP) and critical practice (CP) is deployed to highlight a choice facing both the practitioner and researcher between producing two competing kinds of knowledge for practice. The former is based upon technical know how and skills that may be equated with a ‘search for certainty’ and found increasingly in technocratic systems of accountability; whilst the latter is concerned with critical exploration and development in promoting more emancipatory forms of practice that may be equated with the ‘creative use of uncertainty’. Drawing on practice examples and research from the field of mental health, it is argued that balancing accountability, critical knowledge production and development offers a valid paradigm for achieving effective practice evaluation alongside a broader commitment to social justice.