Health system reform during poly-crises: perspectives of health and care workforce in Finland

Abstract Background Health system reforms have been ubiquitous in high-income countries during the past decades, yet research on how reform implementation is experienced by health and care workforce (HCW) remains scant. This is a critical omission, given that the contribution and agency of HCW is recognized as a relevant part of health system's ability to change. In Finland a large-scale health system reform was implemented in 2023 coinciding with poly-crises. The reform altered both the financing and organizing of the system. This study explores how the implementation of the reform was experienced by HCW. Methods This qualitative study was completed in three newly established regional organizations which are responsible for health services in Finland. Qualitative interviews with HCW (n = 49) and observations (450+ hours) were conducted in regions’ three primary care (PC) centers in Jan 2024-Nov 2024. Interviewees were identified through snowball and purposive sampling. The data were analyzed through an iterative process consisting of both inductive and deductive elements. Results The results indicate a mismatch between the reform's intended policy objectives and on-the-ground experiences of HCW in PC in Finland. While one of the reform's national policy objectives has been to strengthen PC, experiences of HCW show that the opposite has happened during first years of implementation. This has led to a sense of demoralization among HCW and impacts how they interpret the legacy and legitimacy of the reform. The data also bring forward factors which strengthen the engagement of HCW which is crucial overall system change. Conclusions HCW hold valuable knowledge of the implementation of health system reforms. This knowledge should be tapped into for the evaluation and further implementation of the reform. Involving the HCW can also improve the retention of the workforce. Key messages • HCW should be included in the implementation and evaluation of a health system reform. • HCW involvement can be a win-win situation for the system and the workforce.