A musical day

My first meeting today was at 8am with Marika from the customer service development unit. She is a forward-thinking and dynamic person. She is very pleased that the hospital district has moved its focus from the municipalities to the patient over the past 4-6 years. Her role involves improving the patient care / customer services. Last week she organised a patient event to find out from patients what information they needed when they came into hospital. They asked for feedback and comments on their map, website, patient invitation letters and general feedback. It was a very successful event with 140 patients attending. Marika mainly talked about "customer service" recognising that patients are customers with rights but also needing the care element too. She felt that many of the questionnaires that they used did not give the answers that service areas needed. They have adopted a service design approach which uses the concept of a board game. She outlined that process they had used for the first of these with patients who had a sarcoma.

Initially a hand-drawn service journey map was produced which showed the patient pathway. From this staff  were interviewed to include their views of this journey. The next stage was to produce a board game version of the journey starting with the patient's entry and ending with their discharge. Patients were then interviewed using this tool. They were asked to take wooden figures and place them on the board to show where people had been very good or bad - this was for all aspects of their life during this time, not just the hospital experiences. They also had wooden discs which represented events and they did the same with these. Marika and a colleague from the university then collated and analysed this information and from this developed design drivers to improve services in the future. This brief outline does not really do justice to her work as it was quite radical and very visual but certainly completely patient or customer focused and obtained real meaningful feedback and then implemented the findings.

I then met with Alpo Karila, a finance director. I was a little wary as my knowledge of finances is not great. However, it was really useful to understand better how the money comes from the municipalities. The municipalities carry out the basic healthcare at the health centres and the rest is in the specialist hospitals. Every municipality has to be a member of a specialist health care area. The municipalities join together to obtain these specialist services. Generally they are geographically decided but sometimes those on the edges of the groups can move to another group. The Tampere area - Pirkanmaa district is the second largest in Finland, being second to the Helsinki district. He showed me lots of balance sheets which generally showed that the district is in quite a good financial positions at the moment, but it could be better and like everywhere there are serious concerns for the future. They have started to discuss with the municipalities whether they need to introduce some cost-cutting measures.

My last meeting was at the Acuta (A&E). I met Timo who is second in charge of the unit. Timo is a nurse but he has now moved into management. He keeps his clinical skills updated by spending time with the paramedics at weekends. He explained the triage system that they have adapted from the American Emergency Severity Unit. As I mentioned before their Acuta treats both urgent and minor illness / minor injuries. The triage nurses are the most experienced nurses and they do get about an extra 100 euros for this work. They assess the patients as they arrive and decide whether they need to go to the basic health care or the specialised hospital care. They still have paper records that follow the patient so they have to print out all of their documents that they complete electronically but this is supposed to stop in January next year. As I had already had the tour of the unit Timo spent some time explaining to me the nurse education system in Finland. They have the two levels of nurses - the practical nurses who come straight from school and study for 3 years. In their final 6 months they can chose to specialise. They do not have the same academic requirements for their course and would not be able to administer medications or I-Vs. There are no untrained staff in the hospitals! Registered nurses go to the universities after completing high school or some go on from being practical nurses. They study for 3 years and then specialise for their last 6 months. Generally they decide what they want to specialise in when they begin their course. Some of the options are community health nursing - this is a health promotion role, working with pregnant women, families and children to the age of 18; midwifery; paramedics. Finland has only just adopted a national registration system - Valvia which records all health professionals qualifications (including massage nurses!). They do not have Emergency Nurse Practitioners but in the evenings and weekends they have nurses who are more qualified who can see certain conditions and manage some minor illnesses and injuries. Their main role is issuing work certificates  - for those people who cannot work due to ill health. They can issue these for up to 5 days. It is ironic that generally they do not have anywhere near the autonomy of English nurses, particularly Advanced Nurse Practitioners, but where we cannot issue sick notes they can! they are starting to develop specialist nurses but still have a long way to go.

My next appointment was with the piano in the dining area. For our presentation we have an Olympic theme and I am looking at some music so I had a play. I think the late diners were a bit surprised. No one said anything - they probably thought I'd wandered in and decided to play! It was really good to play the piano again.

I came back to my flat and cleared a lot of the paperwork I had been given. As I was on my luggage limit coming here I need to be strict what I take with me. I phoned my Dad to wish him a Happy Birthday. Then  Pirjo was picking me up to take me to a concert.

I went to the concert at the Tampereen Tuomiokirkossa (the Tampere cathedral). It is a very beautiful church and I later read that it has been voted as the most beautiful church in the country. It has a Finnish romantic style and is built from grey granite.

 It has amazing frescoes which were painted by Hugo Siomberg and Magnus Enckell. The latter painted the alter fresco - the resurrection (although it was not obvious to me that this is what it represented!)

The light does not do justice to the stained glass which was really attractive.

The Garland of Life

The Snake

The concert was being given by Thomas' music school - many of the players were from the senior school and were extremely accomplished musicians. This was their traditional end of term concert as the schools all finish tomorrow for the summer. They will be off for 10 weeks (sorry James and Hev, no we're not moving to Finland!). The concert included several pieces by Sibelius making me realise there is much more than Finlandia although there were similarities in style. There was a full string orchestra with flutes for Vaughan Williams' Fantasia on Greensleeves and also a trumpet group, recorders, guitars, piano accordions who played Bach's Prelude and Fugue in C, a piano, violin and vocal piece by Bach, two pianists, one of whom was incredible I am sure that he will become a professional and then the headmaster's orchestra. the concert ended with a trqaditional Finnish hymn which Pirjo explained is always sang at the end of the year and most of the audience joined in.

It was a really enjoyable evening and in a very lovely setting.