The Decree on Emergency Care that entered into force in 2017 requires emergency services to be provided jointly by basic health care and specialist medical care on a 24/7 basis. In the Helsinki metropolitan area, this was easiest to achieve if the emergency services to be merged were already in the same organization.

The emergency clinics and support services of the City of Helsinki were integrated into Helsinki University Hospital. At HUS, the emergency clinic services and internal medicine wards to be integrated were managed by the HUS Emergency Medicine and Services, HUS Children and Adolescents and HUS Internal Medicine departments.

In all, 537 employees were transferred from the City of Helsinki to HUS, most being allocated to the HUS Emergency Medicine and Services and HUS Internal Medicine and Rehabilitation departments. The resulting unit, Finland’s largest emergency services clinic, opened in early 2019.

Personnel was supported in change

Project teams set up for the integration managed their respective areas of responsibility. Anitta Karioja, Nurse Director at HUS Emergency Medicine and Services, was responsible for nursing personnel matters in the integration.

“The aim was to improve emergency clinic services. Integration guarantees uniform operating procedures; we are also improving training and streamlining the patient processes. This improves that quality of care and patient safety.”

The change was a substantial one for the employees transferred from the City to the Joint Authority HUS. Not everyone felt good about the change. The new organization had a different operating culture and different IT systems.

A coaching company was enlisted to train employees to become agents of change in their respective units. Agents of change informed employees on how the integration will affect their everyday lives. HUS was also involved in codetermination talks held by the City of Helsinki, where questions about the integration were answered.

Efforts were made to familiarize the new employees with the organization in advance of the transfer. An orientation course was held in autumn 2018 for all employees to be transferred. The info day included a review of HUS practices, particularly the from the perspective of HUS Emergency Medicine and Services. New managers introduced themselves, and people learned how to use the IT systems together.

Learning about the job through mentoring

Nurse managers and deputy nurse managers play a vital role in supporting employees in their transition to new practices and a new organization. At HUS, deputy nurse managers have various job descriptions, specializing in teaching, administration or development. The City of Helsinki had no corresponding job titles, so selected employees were appointed to grow into these roles with the aid of mentoring. The aim is to clarify job roles and to facilitate the learning of a new job description.

Functions and practices still being tweaked

While the integration has been completed, it takes time to unify practices and functions. This is usual after a reorganization due to a transfer of business.

“We are still tweaking our practices, and both sides are sharing what we have observed and learned,” says Karioja.

A wellbeing at work survey was conducted at the Helsinki University Hospital level to explore differences in job satisfaction between the old and new units. The survey did not indicate wellbeing at work having been significantly adversely affected by the transition.

More backup personnel with integration

The integration has been helpful for nursing personnel resourcing. A joint pool of backup personnel has been set up at the Meilahti campus to cover for sudden personnel shortages and peak demands at all five units. The option of entering the pool of backup personnel has been offered to everyone interested.

“Our people are enthusiastic. They study and improve themselves and are looking for new experiences. When there are more units available, it is easier to go on job rotation. People have enjoyed this. They gave positive feedback in the free text in the workplace barometer survey too,” says Karioja happily.

She feels that the goals set for the integration of the emergency clinic services have been attained.

“We still have work to do to make the patient processes more streamlined. I am sure that development work will continue for as long as we’re running this emergency clinic. Integration was definitely a worthwhile project because it yielded many benefits for both patients and personnel.”