On the way to a county-based social and health services

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Linna building, auditorium K 103, address: Kalevantie 5.

Jouko Luukkonen

Doctoral defence of M.Sc. (Admin.), MBA Jouko Luukkonen

Matkalla maakunnallisiin sosiaali- ja terveyspalveluihin : Tutkimus maakunnallisten sosiaali- ja terveyspalvelukuntayhtymien syntyprosesseista (On the way to a county-based social and health services : The research on the foundation processes of the county joint municipal authorities in social and health services)

The field of science of the dissertation is Local Governance.

The opponent is professor Juha Kinnunen (University of Eastern Finland). Professor Arto Haveri acts as the custos.

The language of the dissertation defence is Finnish.

What the foundation processes of the county joint municipal authorities can teach us for the county reform process

The results of the study on the foundation processes of the county joint municipal authorities in social and health services started year 2017 can be applied to the the foundation processes of the new counties. The doctoral research of HM, MBA Jouko Luukkonen points out that there should be a clear leadership and a supporting core team in the preparation of new counties. The representation of the trade unions and  the citizens should be involved in the process. Luukkonen recommends especially that the key officials of the new counties should be named as early as possible.

The subject of the doctoral research is the foundation processes of the county joint municipal authorities in social and health services (special health services, basic health services and social services) which started in the beginning of 2017. The subjects of the research were South-Savo (Essote), Central Ostrobothnia (Soite) and Northern Karelia (Siun sote). The foundation processes of the joint municipal authorities in these regions were studied from the documents made in the preparation and from the interviews of 20 key persons.

It was possible to identify various similarities and differences in the foundation processes of the joint municipal authorities. The similar aspects of the processes were, for instance, a similar result (joint municipal authority), quite a similar organization of joint municipal authorities, reasons that started the processes (external threat and economy of the municipalities) and partnership of the staff. At the same time the processes differed from each other because of different juridical forms of the joint municipal authorities (new or old), the different partnerships of the people and the organizations of citizens and the different time table and the procedure of recruitment.

The leadership in the processes studied was seen more as leadership (leading people) than management (managing things). The change leadership was seen as the leadership of special key persons and key teams who led the processes. In all processes the decisive importance and leadership of a couple of key preparation persons were discerned. In addition to these persons, the key team was mainly formed of chief executives (mayors). The processes were quite municipal-driven.

Luukkonen notes especially the role of the larger cities: They represented in a way which united the process: on one hand they took a strong role in the process, leaded and pointed the direction, but on the other hand they well acknowledged the opinions of the smaller municipalities.

The institutional side of the processes opened up four dimensions. Having your own central hospital was an institution to defend, Eksote and Kainuu were an institutional example and the integration of social and health services was an institutional belief. Encouraged by these issues, the regions of study themselves tried to rise to an institution which they thought could point the direction for the whole national reform. Luukkonen summarises the framework of the institutional change: when the change process can combine the fear of losing something important, and the belief of a new operations model with examples of organizations using the new model, a process in the organization can be started which aims at a better future. Fear, examples and belief create hope.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2396, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1905, Tampere University Press 2018.

The dissertation can be ordered at: Juvenes e-bookstore or by e-mail: verkkokauppa@juvenesprint.fi.

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