Assessment of service integration in Finland – using SCIROCCO-tool in organizationally integrated health and social services

Background: In 2023, Finland initiaded a significant reformin health and social care, transferring the responsibility for all services from municipalities to Wellbeing Services Counties. While a major practical goal of the reform was to underline economy of scale and to form larger authorities for organising health and social services, a broad integration of health and social sevices has been considered to enhance efficiency. In addition service coordination and cooperation are expected to enhance care quality, safety, and worker well-being. The aging population, coupled with increasing multimorbidity a growing need for several health and social services demands for better service integration. However, a method to measure the level of service integration is currently lacking. The aim of the paper is to test the Scirocco tool in the Finnish context and particularly in an environment where both health and social services, and primary and specialised care are organisationally integrated. Methods: SCIROCCO is a tool for self-assessment and development, measuring maturity of integration in 12 dimensions, previously employed in various European countries. In Finland SCIROCCO was used in a pilot project accross four Health and Wellbeing Services Counties and four Work Ability Programme areas involving 133 managers and employees participated to the survey. The data were collected using a digital Webropol-survey comprising SCIROCCO-measurement and open-ended questions. The participants were able to comment on the dimensions of integration as well as the measurement tool. Results: The SCIROCCO-tool was deemed suitable for measuring maturity of integration. As each dimension of the tool consisted of several questions inside one question, respondent had some difficulties in answering. The maturity of integration varied between counties and professional groups. Top management perceived higher integration maturity than other managers and employees. Counties that had implemented the county-wide organization earlier had better scores for the maturity. The study also revealed that the large organizational changes in building the new Wellbeing Services Counties had heightened the barriers or integration. Conclusions: Given that service integration is a key objective of Finnish service reform, assessing integration within and between counties is crucial. SCIROCCO proved to be a useful tool in counties especially for self-assessment and highlighting the differences between professional groups for integration development. Further development is needed for comparing the maturity of integration between counties, especially when using it as a survey instrument. Future testing accross different health and social services sectors is essential. In this study we were able to use only a small sample. The study, conducted immediately after the organizational change, which may have influenced the answers warranting further research.