Quality and Innovation in Finland

by Nadine Morris | Apr 01, 2016

The Pursuit of Perfection through Quality and Innovation:
Models of Care for Complex Patients

In October 2015, CFHI sponsored two leads from the Nova Scotia Health Authority (NSHA) that had participated in the Atlantic Healthcare Collaboration to visit health systems in Sweden, Denmark and Finland. Lynn Edwards and Tara Sampalli’s reflections on this trip provide the opportunity to explore the elements that make for a strong primary healthcare system and share results from their own improvements in primary healthcare and chronic disease management at NSHA.

This is the third of a three-part series. Read the first part (First Stop, Sweden) and second part (The Pursuit of Perfection…).

View of the Helsinki Harbour

View of the Helsinki Harbour

In October 2015, our week-long tour of Scandinavia bridged many connections across high-performing health systems and leaders in patient quality and safety. Helsinki, Finland, was one of three stops on our journey, which was supported, in part, by the Canadian Foundation for Healthcare Improvement (CFHI).

We spent a total of three days working with system leaders in Helsinki to learn and exchange on practices to support care for medically complex chronic conditions.

The Helsinki system is rooted in socialized medicine. Serving a population of approximately 5.5 million, the publicly funded and delivered health system is divided across 21 health districts with 192 health centres that provide primary healthcare services. Privately funded healthcare is also available but relatively small. Finland experiences high incidence of chronic conditions, including diabetes and mental health conditions, however; does report low hospital admissions for this population, reflecting the good performance of the primary care sector according to OECD findings.

Currently, the system is undergoing implementation of a national information services system as part of a strategy to shift from reactive care to a proactive care services approach. This system will include centralized patient information archiving and electronic prescriptions. Additional services will include patient information access for citizens in addition to patient summaries for providers. The information will be shareable with additional healthcare organizations with patient consent releases.

Helsinki is implementing interventions drawing on three different approaches. Interventions that address: 1) social determinants of health; 2) health behaviours and lifestyles; and accessibility and quality of care services. Often, geographical approaches to delivering interventions are common, for example, addressing needs in specific neighbourhoods or communities given that evidence and experience show individuals respond better to strategies that additionally benefit their community.

Quick facts – Primary Health Care in Finland

  • Primary care is offered in Health Care Centers by municipalities
  • Health Centers offer primary medical care and health promotion activities
  • General practitioners are gatekeepers for specialist care and other services which are offered in district hospitals

Exchanging lessons in rehabilitation for complex chronic care patients

Our group was invited to partake in a two-day workshop to discuss and exchange lessons related to innovative models of care that support functional health management and rehabilitation of individuals with complex chronic care conditions. We were joined by the Finnish Indoor-Air Patients’ Registered Association and the European Academy of Environmental Medicine (EUROPAEM) to share our experiences related to caring for complex patients.

We were thrilled to share our experiences related to the Integrated Chronic Care Service (ICCS) based in Halifax, Nova Scotia. This unit was the recipient of a 3M Healthcare Team Award in June 2015 for the model of care and the service was successful in getting individuals back to work while collaborating across care teams within the health system, across employers and other relevant stakeholders.

This workshop also combined the experiences and expertise of Dr. Peter Ohnsorge of EUROPAEM and Ms. Katia Pulkinnen, Project Leader with the Finnish Indoor-Air Patients’ Association. The workshop included knowledge exchange around improving health system responses and rehabilitation supports for these patients, building capacity of providers through community supports and education, and reducing costs related to disability through a collaborative rehabilitation model. Patients and providers shared their experiences and opportunities for improvement with us as part of this workshop.

Finnish group members

Katja Pulkkinen and Finnish group members (on the left), Lynn Edwards (PHC, NSHA), Dr. Peter Ohnsorge (EUROPAEM) and Dr. Tara Sampalli (ICCS. NSHA)

This two-day workshop brought forward a number of key elements to driving good quality and a safe healthcare system. As Katia said, “The attitudes of healthcare workers and their willingness to help patients are important to adding value to healthcare and quality. Multi-professional collaboration with other essential sectors of relevance to patients’ health and well-being (determinants of health) such as housing, social units, schools, workplaces and help in dealing with multiple problems caused by the illness are important considerations for quality and safety. Integrated ways of treating the patient’s situation, listening to patients, providing enough process time, enabling access to relevant knowledge and competencies for providers and health promotion and early prevention strategies are important traits of a good quality and safe health system.”

Other resources from Nova Scotia Health Authority:

Lynn Edwards

Lynn Edwards
Senior Director, Primary Health Care and Chronic Disease Management




Tara Sampalli

Tara Sampalli
Assistant Director of Research, Primary Health Care