Education, Student Life
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Hälsovårdspersonalens viktiga roll inom digitaliseringen av tjänser – The crucial importance of health-care personnell in the era of digitalization

September 2, 2019

Följande bloggtexter är skrivna av masterstuderande våren 2019 inom temat Digitalisering, och ingår i Arcadas och Novias gemensamma utbildningshelhet Hållbart ledarskap. The following blogs were written by master’s degree students in spring 2019 on Digitalisation, and are a part of Arcada’s and Novia’s joint educational unity called Sustainable leadership (scroll down for English blog).

Personalen ett hinder för digitaliseringen?
Sonja Lindén

Finland är på toppen i världen när det kommer till användandet av olika digitala tjänster inom social- och hälsovården (SHM 2016). Artificiell intelligens (AI) och robotar möjliggör flera olika nya typer av digitala tjänster. Vi behöver en tankeomställning hos social- och hälsovårdspersonalen för att kunna arbeta utgående från klientens behov.

Redan nu erbjuds olika test och information för att själv kunna främja sin hälsa digitalt. Inom den offentliga hälsovården erbjöd år 2014 ca en tredjedel av serviceproducenterna dylika tjänster och hälften av producenterna inom socialvården (Hyyppönen & Ilmarinen
2016). I framtiden behövs mera och mångsidigare digitala tjänster. Ett första steg i digitalisering är möjligheten till videomottagningar. 2016 fanns videomottagningsmöjlighet vid 7% av hälsocentralerna (SHM 2016). Videomottagningen kräver nytt tänkande kring vårdarens uppgift. Historiskt sett har vårdare hängt bra med i utvecklingen under de senaste 100 åren, men nu går utvecklingen ovanligt snabbare fram.

Digitalisering kräver inte bara kunskap i användning av datorer och andra tekniska apparater, utan också nytänkande kring vårdarbetet, utbildning i virtuell kommunikation och mer kunskap i att bedöma situationer via virtuell kommunikation (Penny et al 2018). Befolkningen har goda förutsättningar att använda och ta i bruk olika digitala tjänster inom social- och hälsovården (Jauhiainen et al. 2014). Hyppönen och Ilmarinen (2016) listade upp olika hinder till att använda e-tjänster. De vanligaste orsakerna att väla med användandet av digitala tjänster är förmågan att använda tjänsterna, osäkerhet gällande pålitligheten, viljan och möjligheten att använda tjänsterna. Möjligheten att använda tjänsterna innebär bl.a. tillgång till dator och internet. En del av befolkningen är även misstänksamma gentemot servicen, kan e-tjänsten ersätta personlig kontakt?

Jauhiainen et al (2014) lyfter upp personalens betydelse i handledningen till de olika digitala tjänsterna. Personalens kunskap i att handleda till e-tjänsterna är central om vi vill öka användningen av dem. Nyutexaminerade vårdare känner sig dåligt förberedda inför användning av olika e-tjänster (Shin et al 2018). När vårdare själv är osäker i användning av digitala tjänster blir det också svårt att handleda patienter.

Kujala et al (2018) kom i sin undersökning i Finland fram till att personalens förväntningar ändå är positiva. Det är viktigt att få tillräckligt
med information och kunskap om digitala verktygen samt tillräckligt med tid och bra implementering i organisationen (Kujala et al 2018). Ledarskapets betydelse är här viktigt, utan bra ledarskap i organisationen blir inte ibruktagandet av digitala verktyg lyckat. Kujala et al (2018) kommer också fram till att professionella är osäkra på hur klienterna skall ta emot e-tjänster. Jauhiainen et al (2014) kom redan några år tidigare fram till att befolkningen upplever sig ha goda förutsättningar att ta i bruk e-tjänster, men ändå är personalen osäker.

Är det personalen som bromsar digitaliseringen? Många kanske funderar på hur det praktiska vård- och socialarbetet ändras när de olika digitala verktygen gör sin inmarsch. Att få med personalen på ett positivt sätt är en av de största uppgifterna i digitala utvecklingen inom branschen. Det är viktigt att ta med personalen redan tidigt i planeringsfasen av digitala verktyg och speciellt i tidigt i implementeringsfasen för att kunna nå goda resultat (Kujala et al 2018). Det räcker inte med att utveckla fina verktyg om inte hela tankesättet på vården ändras om.

KÄLLOR / REFERENCES
Hyppönen, H., & Ilmarinen, K. 2016. Sosiaali-ja terveydenhuollon digitalisaatio. THL
Jauhiainen, A., Sihvo, P., Ikonen, H., & Rytkönen, P. 2014. Kansalaisilla hyvät valmiudet
sähköisiin terveyspalveluihin. Finnish Journal of eHealth and eWelfare, 6(2-3), 70-
78
Penny, R. A., Bradford, N. K., & Langbecker, D. 2018. Registered nurse and midwife
experiences of using videoconferencing in practice: A systematic review of qualitative
studies. Journal of clinical nursing, 27(5-6), e739-e752.
Social- och hälsovårdsminiesteriet (SHM). 2016. Digitalisaatio terveyden ja
hyvinvoinnin tukenaSosiaali- ja terveysministeriön digitalisaatiolinjaukset 2025

 

The digital occupational health professional – renewal is key.
Maria Grotell

The day-to-day work in occupational health care in Finland is under turmoil. From having for quite a long time focused mostly on managing the physical and psychological occupational health risks in accordance with the Occupational Health Care Act (No. 1383/2001), it is increasingly shifting towards forms of case management and coaching that include all aspects of a worker’s life. Occupational health now focuses even more on health promotion from a holistic view as well as preventive actions concerning individuals and organizations, in better and closer co-operation with clients than ever before. At the same time, digitalization is happening, bringing some of the monitoring work regarding occupational wellbeing of companies and individuals online. Pauli Forma, director of the Finnish Institute of Occupational Health, writes in his blog about developing the digitalization of occupational health care “Renewal is necessary, as developing working life in a digital era is completely different than before”, in an effort to motivate actors within occupational health to embrace the future through change. As clients are moving into the digital era, so must healthcare.

Managing empowerment through digital channels
Personal experience in the field shows that an occupational health nurse needs skills in healthcare, medicine, psychology, ergonomics, economics, HR, ICT, project management– among various other areas. Can working behind a computer screen then somehow diminish the vast knowledge of an occupational health nurse, or any other professional? The lack of personal contact with clients may present challenges, and interestingly enough clients do tend to view face-to-face care as higher quality care in comparison to online care (Lupton, 2018). All the information occupational professionals have gained through studies and work experience is still nevertheless there, whether the client is sitting opposite in a physical or virtual meeting room. It is the method of conveying this expertise that might differ: it might be easier to create a social bond face-to-face, while it might demand more of an effort online. Trust, especially, is a key element in online communication – it may in fact even be more important in online communication than face-to-face, as online communication is of less personal nature and needs trust in order to be effective (Andreassen et.al., 2006).
Further, it seems that the more active role of the clients creates tension, as health care professionals have to change their traditional expert role and share control with patients (Kujala et.al., 2018 ). Autonomy in health care is something occupational health, nevertheless, needs to welcome. A self-observing client will surely be more involved and engaged in the aspects of their own health, thus easier for us to empower and to reach excellent goals with together. Clients also often respond emotionally to their own health data when it is presented visually, and can enjoy feelings of pride and satisfaction when presented with good results (Lupton, 2018). It is this type of data that occupational health professionals work with on a daily basis: digital health questionnaires, 24h health monitoring, digital apps where clients can, for
instance, save their blood pressure results for monitoring purposes, and so on. While digitalization puts pressure on ICT-skills for both the occupational health professional as well as the client, it also provides both with valuable data that we would not otherwise be able to analyze or utilize in the process of empowerment. At the same time, this data enables clients to make evidence-based choices concerning their own health (Eysenbach, 2001), possibly fortifying the will to make good choices.

Efficiency for companies of all sizes – and for the occupational health professional
The Finnish Ministry of Social Affairs and Health aims for a future where all companies in Finland have organized some form of occupational health care in 2025 (STM, 2017). They are especially focusing on the need of services that are better adapted to reach smaller companies and entrepreneurs, as well as reaching a better understanding of the constant changes of working life. This is where digitalization becomes even more important: digitalization lowers the barriers for getting in touch, also allowing efficiency through quick exchanges and consultations.
Efficiency is an important part of e-health and a method of reducing costs (Eysenbach, 2001). Both efficiency and costs are vital concepts in occupational health care: companies that buy occupational health care want value for their money, while paying reasonable sums. Through digital solutions, where for instance a 60-minute health examination by an occupational health nurse can be reduced to a 15-minute analysis of an online health questionnaire the client has filled in, time and money can be saved and used more efficiently for all parts. The company cuts occupational health costs, the client need not travel to any physical location and the occupational nurse frees up time in her calendar for another client. As such, the scarce resources have been utilized wisely, which is especially noticeable and important for smaller companies. Furthermore, digitalization can result in avoidance of duplicative or unnecessary interventions as well as improved communication between different health establishments, which both have positive effects on efficiency (Eysenbach, 2001).

100% digital?
Not all occupational health tasks can, or even should, be carried out digitally. Occupational health will always be an arena where some part of the care given or the preventive actions will happen in person, such as Workplace health assessments, at least as long as humans (not AI) are acting out this line of work. As an occupational health nurse I am not afraid of “going out of business” – realizing a need to adapt, to re-think and to come up with further innovations will keep me well and steady in the occupational health business. As healthcare in increasing amounts “happens at a distance” while simultaneously being “closer” than ever due to virtual monitoring (Lupton, 2018), clients will surely still need professionals to help understand the endless flow of health information and health data produced. I look forward to seeing where working life and occupational health care will be in 10 years, and how the educational field will be able to adapt to the required skills of future health professionals. Renewal is necessary – for all.

KÄLLOR/REFERENCES
Andreassen, H. K. et al., 2006. Patients Who Use E-Mediated Communication With Their Doctor: New Constructions of Trust in the Patient-Doctor Relationship, Qualitative Health Research, 16(2), pp. 238–248. doi: 10.1177/1049732305284667.
Eysenbach, G., 2001. “What is e-health?.” Journal of medical Internet research 3, no. 2.
Forma Pauli, 2018. Digitaalinen työterveysalan kehittäminen etenee. Työterveyslaitos. https://www.ttl.fi/blogi/digitaalinen-tyoterveysalan-kehittaminen-etenee/
Kujala, S., Hörhammer, I., Kaipio, J., & Heponiemi, T, 2018. Health professionals’ expectations of a national patient portal for self-management. International journal of medical informatics, 117, 82-87.
Lupton, D., 2018. Chapter 6; The lived experience of digital health. Digital health: critical and cross-disciplinary perspectives. Routledge. pp.94-107.
STM, 2017. Valtioneuvoston periaatepäätös: Työterveys 2025 – Yhteistyöllä työkykyä ja työterveyttä. Sosiaali- ja terveysministeriön julkaisuja 2017:1. Helsinki.