hus annual report 2012

A dayin the lifeANNUAL REPORT 2012

HUS | VUOSIKERTOMUS 2012 | TOIMITUSJOHTAJALTA2

A large hospital

organisation

has the capability

to deliver high-quality services

cost-effectively.

Aki Lindén

Aki Lindén, CEO of HUS:The year 2012 was the busiest year ever in the history of HUS. Services provided increased by 2.5% on the previous year and exceeded the performance goals of the 2012 budget by 2.6%. In the structure of the services provided, there was a shift of focus towards outpatient care. This was particularly apparent in psychiatry, where inpatient care decreased by 6.2%. Despite increases in services provided, however, we did not manage to improve the situation of those queuing for treatment in 2012. An extensive debate was launched in 2012 on the reform of local government and the social welfare and health care service structure prescribed in the Government Programme. HUS took an active role in this debate. It is the considered opinion of HUS that a large hospital organisation where expertise can be clustered has the best capability to deliver high-quality services cost-effectively. • continued on page 5

3

40 Working at full strength and

on budget

41 Expert Anne Priha

42 Construction investments

44 HUS in figures

50 Financial statements

Care Work Science Responsi-bility

Indispensable professional skills

6 The key question: “How are you doing now?” 7 Expert Markku Kuisma 8 Rapid response saves Emma

12 Demanding emergency care

14 Department of Oncology

is the epicentre of Finnish

cancer treatment

16 Alternatives to coercion

20 1 in 3 babies are born at HUS

HUS | ANNUAL REPORT 2012

EvERy dAy is A dAy Of mANy sTORiEs AT HUsHUS is a place where people are examined, treated and operated on, people are born and people die, day in and day out all year round. In the course of a year, HUS affects the lives of thousands of people. It is a companion in life’s greatest joys and sorrows. What we are trying to say here is that there is more to HUS than just numbers. HUS is above all the sum of its employees: expert professionals committed to their work.

The sum of the expertise of individuals

22 Apotti project brings

patient information together

23 Expert Outi Sonkeri

24 Finland’s most active

workplace

26 Subs are born to roam

HUS spearheading research

28 Nordic cooperation

29 Expert Lasse Viinikka

30 Important teaching and

research institution

32 Cartilage replacement

surgery develops

For people and for the environment

Balancing growth and costs

34 A safe hospital

35 Expert Tapani Hämäläinen

36 Patient safety is about

anticipation and prevention

38 Eco-efficient operations

5 Review by the CEO 5 Review by the Chairman of the Executive Board

Finance

4 HUS | ANNUAL REPORT 2012

Ulla-Marja Urho, Chair of the Executive Board:

HUS aims to provide patients with good care, to ensure a high level of quality in teaching and research, to improve cooperation with basic health care and to be effective and competitive.

5HUS | ANNUAL REPORT 2012

THE TRicky EqUATiON Of 2012HUS began the year 2012 in a difficult financial situation. The budget allowed for an increase of only just over 1% compared with the annual accounts for 2011.

Cost increase trends seemed unusually robust early in 2012 compared with 2011, but these trends evened out in the course of the year. The comparable growth of operating costs year on year was 4.4%. Non-discretionary net costs exceeded the budget by 2.1%. This excess was the smallest seen in five years. Invoicing from the member municipalities increased by 2.8%. The population in the catchment area grew by about 1%. Member municipalities’ average contributions per resident, as measured by the deflated hospital cost index, decreased. The operations deficit for 2012 was EUR 21.6 million, as opposed to the goal of EUR 12 million. One of the items contributing to the deficit was the increase in the holiday pay reserve resulting from the provisions of the new collective agreement for local government civil servants and employees: signed in November 2011, the agreement added about EUR 14 million to the deficit. The deficit eventually totalled EUR 35.5 million, absorbing previously accumulated surpluses for a cumulative deficit of about EUR 10 million. The productivity of service provision, as measure by the price of one DRG point, improved by 0.9%; however, measured by the number of DRG points per person-year, productivity actually declined by 0.4%. An improve-ment of 1.5% had been set as the goal for both these figures. The year 2012 was the final full year of service for HUS officials elected in 2009. I would like to take this opportunity to thank them for their diligent and selfless efforts in executing the demanding duties assigned to them in managing HUS, the flagship of Finland’s specialist medical care.

HUs ANd HUcH mUsT bE kEPT iNTAcTHUS updated its goals and operating programme, i.e. its strategy, for 2012–2016. The goals may be summarised in four points:good care for patients; high-quality teaching and research; better cooperation with basic health care; and effective and competitive operations. How did we do in 2012?

More patients were treated than ever before. Waiting lists remained largely within the statutory limits, and no conditional fines were imposed. Patients were pleased with the care they received. The finances of the Joint Authority are a cause for concern. HUS has gone to great lengths to improve productivity, and these efforts have been successful: the costs of specialist medical care per capita in this hospital district are the lowest of all hospital districts in Finland. The budget for 2012 turns out to have been overly optimistic. Costs exceeded revenue, and the annual accounts show a substantial loss. The year under review included decisions on launching major investment projects. The trauma-tology centre that will replace Töölö Hospital will be housed in a new facility at Meilahti, as will the children’s hospital. The construction work will begin as soon as the renovation of the Tower Hospital is completed. It is difficult to recruit competent physicians for basic health care. Closer cooperation between HUS and basic health care will improve this situation, but there is still a lot to be done. Better cooperation is needed to benefit patients, and mutually compatible information systems will contribute to this. The procurement of such systems was launched in a joint municipal effort. The strength of HUS is in its expert personnel and its strong links to university teaching and research. The year under review saw the end of a local government electoral period. Both at the beginning and end of its tenure, the HUS Executive Board unanimously declared that HUS and HUCH must be retained intact as a comprehensive functional entity. Whatever the structure of local government may be, the providing of specialist medical care at a high level of quality and efficiency – especially its most demanding disciplines – requires a large population base. This also applies to the organising of university-level teaching and research in medicine and other subjects too. If it ain’t broke, don’t fix it. If an organisation works well, let it develop instead of breaking it apart!

FROM THE CHAIR OF THE EXECUTIVE BOARD | ULLA-MARJA URHO FROM THE CEO | AKI LINDéN

HUS | VUOSIKERTOMUS 2012 | TOIMITUSJOHTAJALTA66 HUS | ANNUAL REPORT 2012 | CARE

Listening and talking

when encountering

a patient is the foundation of

a care relationship.

Sari Hytönen

Sari Hytönen, nurse, neurosurgery intermediate care, Töölö Hospital:In a nurse’s job, listening and talking when encountering a patient is the foundation of a care relationship.For a nurse to find time even just once during a shift to sit down beside a patient and ask them “How are you doing now?” demonstrates genuine caring and creates a sense of security for the patient. One can always find time for such a moment however busy the day may be. In intermediate care, I cannot always have a conversation with my patient. In such cases, the care relationship evolves largely in interaction with the patient’s family members. It is important to give family members time and to listen to their accounts of the patient’s feelings and habits before being hospitalised. It is just as important to listen to and support the family members. Every encounter is unique and individual, and one has to have a psychological eye for them. It is not always easy to encounter patients and family members, but every moment of being actively present and talking to people empowers me for the next such encounter.

Hoito

7HUS | ANNUAL REPORT 2012 | CARE

THE 22 HOsPiTALs Of HUs TREATEd

497,826 PATiENTs1,580,702 outpatient visits452,998 individual patients in specialist medical care89,455 surgical procedures18,099 deliveries

PREHOsPiTAL EmERgENcy cARE sERvicEs TRANsfERREd TO HUsPrehospital emergency care services are responsible for performing

urgent triage on and providing first-response care to patients who

have fallen acutely ill, for instance at home or in a public place.

The new Health Care Act transferred the responsibility for provid-

ing prehospital emergency care services from local authorities to hos-

pital districts. At HUS, this change was implemented in two stages.

Prehospital emergency care services were transferred to HUS in the

Porvoo and Hyvinkää Hospital Areas as of the beginning of 2012, and

the other hospital areas followed suit one year later.

The HUS catchment area is divided into seven prehospital emer-

gency care sub-areas. Prehospital emergency care services are organ-

ised by the Hospital District alone or in cooperation with the local res-

cue services or private enterprises offering patient transport services.

What does this major administrative change entail in practice?

Even before the new regime, prehospital emergency care services in

the HUS catchment area were of a high quality, and cooperation with

member municipalities was close. The top priorities in planning pre-

hospital emergency care include ensuring equal access to the ser-

vices and for the service to reach patients requiring prehospital emer-

gency care within the regionally specified time limits. Broader regional

planning will facilitate successful co-operation with the Emergency

Response Centre, the rescue services, the police and other officials

and agents.

From the patient’s perspective, the change had scarcely any di-

rect impact and was not meant to. In the long term, the change will

equalise the quality of treatment and service, improve patient safety

and raise the level of competence of first-response care personnel.

Patients will see this as a clear improvement in services.

Patient-orientated and timely treatment and care. This phrase in the HUS strategy for 2012–2016 describes one of the most important goals for HUS operations. The huge scale of the strategic goals becomes apparent when one considers the statistics from the year under review: nearly 500,000 individual patients, some 90,000 surgical proce-dures and 18,000 deliveries. There are 97 stated strategic goals for medical care, of which 16 were selected as key goals for 2012. There were three key goals for care: comparable quality of treatment results, availability of care and patient safety. How well did we attain the key goals in the first year of the strategy period? A new tool was introduced for comparing treatment results with the launch of the international BM programme. Availability of care fulfilled expectations: the num-bers of performances exceeded the levels set in the budget.

However, reduction of the number of patients waiting for treatment and examinations fell far short of that which was planned. The number relative to population of patients waiting for inpatient care for more than six months at HUS surpassed the comparable figure for all other university hospital districts in the course of the year under review. By comparison, the goals of the patient safety programme were largely attained. Naturally, even in medical care the attainment of goals is monitored using indicators. Behind these figures is the day-to-day care work on which all HUS operations are based. We can only attain our strategic goals if we treat every single patient we admit as the most important patient we have ever had. It is the encounter with and treatment of an individual patient that is the event that generates the results that we then see in the big picture.

Markku KuismaChief Physician, Prehospital Emergency Care

A pediatric cardiac operation almost every day

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8 HUS | ANNUAL REPORT 2012 | CARE

TUEsdAy

30 OcTObER

Emma Kuukka falls off her pony in Porvoo

17.45

Back home, Emma begins to feel sick

18.30

A 112 emergency call is placed to the East and Central Uusimaa Emergency Response Centre

18.38

ONE LifE, mANy sAvERsRotor blades churn the air as a helicopter lands at the edge of a field. The red ambulance helicopter has ‘FinnHEMS 10’ painted on its side in large white letters. The thumping noise of the helicopter breaks the calm of the low-rise neighbourhood. It signals that something bad has happened, that someone’s life is in danger. For Kari Kuukka, the sound is a relief: a doctor is coming to look at his young daughter Emma.• TexT: Paavo Holi

9

Rescue Services ambulance receives emergency dispatch

18.40

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HUS | ANNUAL REPORT 2012 | CARE

It is an ordinary Tuesday evening in October at a riding stable a couple of kilometres outside the city centre of Porvoo. Emma Kuukka, 8, is seated on a pony with a helmet on her head, enjoying the ride. Emma guides the little pony around the outdoor manege calmly along with other riders. Suddenly, a noisy group of joggers emerges from the surrounding darkness. Some of the horses are frightened and set off on a gallop. Emma’s pony is one of those startled. Unable to control her mount, she falls from the saddle and hits the ground. Yet almost immediately she gets up again and seems not to be hurt. Half an hour later, the mother of one of Emma’s riding

friends brings her home in a car and tells Emma’s mother, Sari Orkomies, what has happened. Emma is still dazed from the scare she had but seems otherwise fine. Emma’s father, photographer Kari Kuukka, comes home and tries to talk to his daughter about the incident. “Why are you talking to me?” Emma snaps. Kari takes Emma into his arms, but at that moment she begins to vomit. It’s concus-sion, Kari thinks, we have to get her to hospital.Then Emma’s gaze begins to drift to the upper left uncon-trolledly. Kari, who used to study psychology and neuro-sciences at university, immediately realises that something is terribly wrong. “Call an ambulance!” says Kari to his wife. An ambulance from the Itä-Uusimaa Rescue Services arrives within seven minutes of the 112 emergency call, and only five minutes after receiving the dispatch. By fortunate chance, the ambulance happened to already be in the neighbourhood. The paramedics assess Emma’s condition, check her breathing, fit her with an IV and give her oxygen. Emma begins to lose consciousness; her gaze wanders. The paramedics decide to call in an ambulance helicopter, which lands in a field nearby some 15 minutes later. The emergency care physician brought by the helicopter begins treatment. Emma is fitted with a neck truss, and because of her loss of consciousness, she is sedated and hooked up to a ventilator. Watching the treatment being given his daughter, the father sees that Emma is in good hands. The crowd in the yard includes the flying doctor, the HEMS assistant, three paramedics and the four-man

Ambulance arrives at the scene

18.45

FinnHEMS 10 ambulance helicopter receives emergency dispatch at Helsinki-Vantaa Airport

18.58 Helicopter lands in Porvoo

19.17Flying doctor arrives at the scene

19.23

crew of the fire engine that arrived to safeguard the landing of the helicopter. The latter crew happens to include a former neighbour of the Kuukka family, who is a shift manager with the Itä-Uusimaa Rescue Services “That’s your Emma?” he asks Kari with empathy. By 8 o’clock Emma has been put in an ambulance that is taking her swiftly to the traumatology centre at Töölö Hospital. The normal alert call that a seriously injured patient is on the way has been made. Kari follows in his car. Sari stays at home with Emma’s younger brother Joonatan, 5, known as ‘Tintti’. By the time Kari arrives at Töölö Hospital, Emma has already had a CT scan of her head taken in radiology. The neurologist on duty tells Kari that Emma has a bruise on the right side of her frontal lobe, and blood is trickling into her brain. Her skull is not broken, but the impact •

“Call an ambulance!” says Kari to his wife.

Emma, now anes-thetised, is put in an ambulance that will take her to Helsinki

19.58Ambulance arrives at Töölö Hospital

20.19Emma is examined in radiology

20.33 Lab tests completed

20.55

Emma has woken from anesthesia, and her intubation tube has been removed

22.00

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• caused a slight intracranial hemorrhage. The decision is made to bring Emma out from the anesthesia to gauge the severity of the situation. The surgical team is standing by in case Emma does not wake up. When the anesthesia is removed, Emma quickly recovers and is transferred to the intermediate care at the neurosurgery department at Töölö Hospital with extra oxygen. Just over four hours have elapsed since she fell off her pony. She squeezes her father’s finger and falls asleep again. In the morning, Emma’s duty nurse tells Kari that the girl woke in the night and said to her: “You know, you look just like [Finnish champion figure skater] Kiira Korpi.” Emma wakes on Wednesday morning feeling refreshed and manages to eat some breakfast. She is transferred to pediatric surgery ward K5 at the Children’s Hospital. Emma is examined by a pediatric surgeon, a neurosurgeon and a neurologist. Kari spends the night on the ward with his daughter. On Thursday, Emma is given an MRI, which reveals that the fall from the pony has caused no permanent injuries. Sari comes to the hospital to pick up her daughter

at 17.00, and on Monday Emma returns to school. About one month later, Kari writes about the incident in his generally photography-themed blog, titling the article ‘About gratitude’ (www.karikuukka.com/kiitollisuudesta/). Within a short space of time, the article receives more than 20,000 hits and more than 4,000 shares. In the article, Kari thanks the dozens of health care professionals who contributed to his daughter’s treatment: “Someone might say that they were just doing their job or even that that’s what they’re paid to do. I’m sorry, but I just don’t buy that. I completely disagree. These people actually care,” writes Kari and goes on: “There is a lot of talk these days about health care costs. I can only say that these people are not machines and could never be replaced by machines. They are not cost centres. They are actual human beings. Although I dislike paying taxes as much as the next man, I hereby swear that I will never complain about them again. There is a lot of good in our society. I have a healthy second-grader at home, thanks largely to these incredible people and the system we have in place.”

Emma is trans-ferred to the neu-rosurgery interme-diate care unit at Töölö Hospital

22.10

Emma wakes feeling refreshed and manages to eat some breakfast

9.00

Pediatric surgeon checks on how Emma is doing

12.15Neuro-surgeon meets Emma

8.00Neu-rologist talks to Emma

10.55

WEdNEsdAy

31 OcTObER

THURsdAy

1 NOvEmbER

So who exactly did take care of Emma? Initially, there were three paramedics, a flying doctor and a HEMS assistant involved, plus the neurologist on call. Thereafter, several physi-cians and nurses at the neurosurgery intermediate care unit and ward K5 at the Children’s Hospital participated. There were other health care professionals in the treatment chain at all times: radiologists, radiology nurses and lab technicians. All this was made possible by instrument maintenance specialists, cleaners, clerical staff and many other people working at HUS hospitals. Some 20 health care professionals were actively involved in Emma’s treatment, assisted by a similar number of other HUS employees.

Emma is transferred to ward K5 at the Children’s Hospital in Meilahti

10.30 Emma is taken to MRI

13.38Statement on the imaging is completed

14.27

Emma’s mother picks her up at the Children’s Hospital, fully recovered

17.00

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And what about Emma and horses?Emma was boldly back in the saddle as soon as her exercise ban ended, two weeks after being discharged from the hospital. A couple of months later, however, Emma said that she did not want to ride any more. Her fall had left her with an underlying fear of riding that was difficult to overcome. But despite this, her neighbourhood stable remains a favourite place of hers: whenever she passes by, she goes to see whether her favourite Shetland pony Bosse is out on the manege.

Kari Kuukka:

I have a healthy second-grader at home, thanks largely to these incredible people and the system we have in place.


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Emergency care is required by patients for every imaginable reason. The trickiest cases are brain injuries requiring neurosurgery. Their treatment may easily involve dozens of people.

Ambulances and paramedics are the archetypal medical rapid-response force. In 2012, some 150,500 ambulance missions were recorded in the HUS catchment area. Of these, 7,400 involved a life-threatening situation. Additionally, the HEMS ambulance helicopter stationed at Helsinki-Vantaa Airport was called in for support in 2,050 cases. Out of the patients with life-threatening injuries in 2012, 793 were treated in what is known as the ‘shock room’ at the traumatology unit at Töölö Hospital; 273 required neurosurgical treatment, and 120 of them had a brain injury only.

mEdicAL

RAPid-REsPONsE fORcE

Miika Hokkanen, Chief of Emergency Medical Services in the Porvoo Hospital Area, travels by ambulance to wherever emergency care is needed.

13

New services for patientsPatients discharged from the neurosurgery unit often need further monitoring or rehabilitation. It was for this purpose, to help patients make the transition back to everyday life and work, that the Brain Injury Outpatient Clinic was set up in October 2012. The Clinic is a multi-discipline expert team that improves early diagnostics and rehabilitation referral functions. At the beginning of 2013, HUS also introduced a 24-h pediatric neurosurgery pool which is responsible for all children in southern Finland that need a neurosurgery consultation, operation or other treatment.

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Every case is uniqueSpecialist Martin Lehecka from the neurosurgery clinic at Töölö Hospital explains that the condition of patients with brain injuries is widely variable. “Some walk out of here in a couple of days, while those with severe injuries may need to spend several weeks in the intermediate care ward. Further care and rehabilitation may take anything up to several years.” The number of people participating in the treatment of a patient arriving through the emergency services varies depending on the time needed for treatment and recovery, and also on the number of procedures, lab tests and imaging tests required.

Surgery within an hour There is a neurosurgeon on call around the clock at Töölö Hospital, attending to every patient who arrives with a brain injury. “We often get basic information on the injuries even before the patient arrives. But the main thing in brain injury cases is the CT or computer tomography scan of the head. We do this next door to the shock room, and for head scans we get the results in a matter of minutes. In some cases, the referring unit sends us their images in advance,” says Martin Lehecka. If the diagnosis indicates that the patient requires surgery, an operation is organised within about an hour, even in the middle of the night. The operating theatre team includes the neurosurgeon on call, an anesthesiologist, an anesthesia nurse and two scrub nurses. “A five-member team like this can cope with any patient requiring acute neurosurgery arriving from the HUS specialist medical care area. But we can bring another team in at short notice if required.”

Eeva Mikkonen is a nurse at the intermediate care ward of the neurosurgery clinic at Töölö Hospital.

Specialist Martin Lehecka (left) and Aki Laakso, Administrative Deputy Chief Physician of the neurosurgery clinic at Töölö Hospital. CT scans of the head are a vital tool in the treatment of brain injuries.

•

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“Every nurse in treatment manages six patients a day. In the course of the day, we also prepare six patients for the next day. We receive a varying number of phone calls per day,” says Sissonen. Smiling in spite of worries For the patient, cancer is not just a physical problem which gets treated or whose progress is curbed with clinical procedures. It is a disorder that has a psychological impact too. In the course of treatments, nurses must be able to observe and fulfil the patient’s needs and wishes across the board. Even little things are important. “Our care relationships with patients vary in length from months to years. We get more deeply involved with some of our patients, but I do not really see myself as a friend to any one of them. We have to listen to the patients and support them. And, if necessary or if the patient wants it, we say nothing at all and just carry out the treatment.”

1 iN 3gETs cANcER

The HUCH Department of Oncology at Meilahti in Helsinki is the epicentre of Finnish cancer treatment. Each year, some 13,000 individual patients receive treatment at the department, which works out at about 500 patients a day. Every patient is different, their conditions are unique, and every course of treatment must be planned separately.

“A POsiTivE ATTiTUdE TO LifE is sOmETHiNg yOU REmEmbER”Statistics show that one in three Finns will develop cancer at some time in their lives. Such a diagnosis is often a life-changing event, sometimes completely upsetting daily routines.

But for many the situation is much better than it used to be: cancer treatments are constantly improving, and more and more patients recover. For instance, more than 90% of those diagnosed with breast cancer are completely free of the disease five years later. “Cancer is no longer a death sentence. With better treatments, many people recover completely or at least gain more good-quality life,” says Minna Sissonen, a nurse at the Department of Oncology. At the heart of the HUCH Department of Oncology are its highly competent professionals, whose work makes a crucial difference to many people’s lives. Sissonen is one of those professionals. Her job includes patient-specific orders for cytostatic or cell-inhibiting drugs, preparation of customised treatments, and monitoring of the patient’s condition and blood values before, during and between treatments. Sissonen also provides patient advisory services by phone and makes treatment bookings.


The Department of Oncology is highly respected in the scientific and care communities, both in Finland and inter-nationally. Sissonen believes that nurses hold the depart-ment in high esteem too and that it is a desirable workplace. More important than the achievements of the department, however, is the strength of its workplace community: the work is mentally strenuous, and the support of colleagues is at times absolutely vital. “I am happy with HUS in general and the Department of Oncology as a workplace in particular. The atmosphere is good and the work is varied. This is important for the ability to cope at work.” Although one might not guess it, the same positive attitude may be found in patients too. When one is in good hands, it is easy to smile however difficult one’s life situation may seem. “I remember many patients simply because of the brilliant attitude they had to life and their future, keeping up their spirits,” says Sissonen.

Nurse Minna Sissonen:

We have to listen to the patients and support them. And, if necessary or if the patient wants it, we say nothing at all and just carry out the treatment.

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HUs PsycHiATRy– THE fULL cycLE Of LifEMental health problems are often dependent on the life stage and age. • child psychiatry • youth psychiatry • adult psychiatry • geropsychiatry • forensic psychiatry • addiction psychiatry


As the development of psychiatry progresses at a fast pace, outpatient care is a real possibility for an increasingly demanding range of mental health problems. As hospitals get smaller, the patients in inpatient care tend to be increas-ingly complicated cases. How can this equation be resolved so as to not increase the use of coercive measures but instead to decrease it? The response of HUS Psychiatry is the Vaihtoehtoja pakolle (Alternatives to coercion) project. Its purpose is to cut down significantly on the use of coercive measures: the goal is to achieve a 40% decrease from the 2011 level by 2015. According to project manager Raija Kontio at HUS Psychiatry, alternatives to coercion are surprisingly easy to find. If one spends time with the patient, one gets to know them and to anticipate any tricky situations that may arise. And if a previously unknown patient is brought in from home in an agitated and aggressive state, that patient must be encountered calmly and with respect. There must be more than one person meeting the patient.

AimiNg fOR TREATmENT WiTHOUT cOERciONCoercive measures have historically been used in psychiatric care in Finland rather more than in the other Nordic countries. Vaihtoehtoja pakolle (Alternatives to coercion) is a HUS Psychiatry project whose purpose is to cut down significantly on the use of coercive measures.

“Of course, it is a matter of professional skill to be able to tell for instance when a psychotic and restless drug user is really dangerous. Some psychosis patients do benefit from isolation,” says Grigori Joffe, Chief of the Department

of Psychiatry at HUCH. The ‘Alternatives to coercion’ project is a continuation of efforts undertaken in recent years that are now bearing fruit. For instance, the number of cases where isolation has been imposed has decreased by 39% at Jorvi Hospital over the past four years and by an impressive 66% at Peijas Hospital. This has not been a steady decrease, however. Some parts of the organisation – Lohja, Länsi-Uusimaa and Porvoo – have a longer history of little use of coercive measures. At HUCH and at Kellokoski, the figures have typically been higher, because the patients’ conditions are more difficult. •


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Mental health rehabilitee Eve, 17, described her experiences of coercive measures in hospital in Husari 4/2012.

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The ‘Alternatives to coercion’ project is a continuation of efforts undertaken in recent years that are now bearing fruit.At HUS Psychiatry departments in all five hospital areas – HUCH, Hyvinkää, Lohja, Länsi-Uusimaa and Porvoo – the numbers of cases where isolation and restraints have been used have decreased, as has the average duration of the measures imposed. Some parts of the organisation – Lohja, Länsi-Uusimaa and Porvoo – have a longer history of little use of coercive measures. But even with a low baseline, the number of cases and their duration were further somewhat reduced in 2012. In the HUCH area and at Kellokoski Hospital, isolation and restraints are far more commonly used than elsewhere. However, in the year under review the number of cases involving isolation and restraints have been reduced significantly at HUCH and Kellokoski too, and particularly the duration of the measures.

Raija Kontio, Deputy Head of the Department of Psychiatry in the Hyvinkää hospital area


• Coercion can only be eliminated with the patient’s helpCoercive measures leave the patient with a deep-seated memory. However confused, psychotic and aggressive they may be, every patient certainly remembers how they were received at the hospital and how many nurses were involved in dragging them into restraints. There has been a sea change going on in psychiatric medical care for a decade, and it is now being implemented at the ward level. In this grand service structure reform, the rights of the patient, participation and role enhancement are of key importance. “Thirty years ago, there was a behaviourist tendency in society at large, the idea that people need the stick and the carrot. Now we no longer have the stick: punishments are absolutely forbidden. However defiant and brazen a patient may be, he or she is nevertheless a suffering human being who must be helped,” says Joffe. “Without the coopera-tion of the patients, it would not be possible to cut back on coercive measures,” says Kontio. He wrote his nursing science dissertation on alternatives to coercive measures.

Good care is human and negotiation-based. Patients and their family members are now listened to more closely than before. The patient is in full possession of his or her rights when arriving at the hospital, and these rights may only be infringed if the patient’s condition so requires. The care concept is centred on the patient as a human being. “It is important for the nurses to spend time with the patients on the wards, listening to their thoughts and wishes,” says Kontio. Personal primary nurses are expected to be the most familiar with their patients’ background, situation and resources.

Treatments change over timeEven the most extreme coercive measures, such as isola-tion and restraints, were originally conceived as treatments. Their motivation was to calm the patient down by elimi-nating outside impulses. Although times have changed radically in this respect, no one is blaming physicians and nurses for practices that used to be mainstream treatments. “Medical personnel back in the day acted according to the best information and instructions available at the time.

There are treatment methods in somatic medicine too that have fallen by the wayside,” says Joffe. For a real change to happen, almost everything has to change: management, training, tools and means of evaluation. Eliminating random actions requires evidence-based information, patient participation and debriefing. “Debriefing is a stressful process for the patient and the personnel, but it is important to give the patient feedback to explain that we do not condone violence,” says Kontio.

The final resortCoercive measures can probably never be completely abandoned. They continue to be available as a last resort if the aggression of a patient who is a danger to himself or herself and others cannot be defused in any other way. “We must be honest about situations involving violence. Some of them are really serious, even potentially lethal. It is important for the personnel to have all the support and help they need,” says Kontio.

Restraints % Isolation %

cUmULATivE dURATiON Of cOERcivE mEAsUREs (isOLATiON ANd REsTRAiNTs) iN RELATiON TO THE NUmbER Of TREATmENT dAys, kELLOkOski

2009 2010 2011 2012

Goal 2015 0.5%

Goal 2015 0.1%

THE gOAL LEvEL fOR REsTRAiNTs HAs ALREAdy bEEN PAssEd

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ONLiNE mENTAL HEALTH cENTRE gETTiNg biggER ANd bETTER

The online service known as Mielenterveystalo (Mental Health Centre) developed at HUS will continue to be maintained but will also be expanded for nationwide coverage.

• www.mielenterveystalo.fi • www.nuortenmielenterveystalo.fi


Hoito

PAss AROUNd THE ExPERiENcE“Finally people are beginning to ask mental health rehabilitees themselves what they want,” says Annikka Niinikoski.

She is a mental health rehabilitee with personal experience of a psychotic disorder. She has also undergone

experiential expert training provided under the National Development Programme for Social Welfare and Health Care (Kaste). She is a member of the experiential expert group at the Rehabilitation Clinic at Peijas Hospital. The purpose of the group is to leverage its collective experiences to help improve psychiatric services in Vantaa and Kerava. “The quality of services will certainly improve with the contribution of experiential experts,” says nurse Kristiina Kuusi. She is the liaison employee for the experiential expert group, which meets once a month.

Annikka Niinikoski is helping to improve psychiatric services

20% Of yOUNg PEOPLE sUffER fROm mENTAL HEALTH PRObLEmsMental health problems are a major and expensive social issue.

HUS will be partnered in this project by the hospital districts of Lapland, North Ostrobothnia, Central Ostrobothnia, Vaasa, South Ostrobothnia, Tampere Region and Kanta-Häme. Contact information for treatment and service locations in all participating hospital districts will be added to the two Mental Health Centre portals, one for adults and the other for young people. The expansion of the online service is made possible by a grant of EUR 1.35 million from the National Institute for Health and Welfare. The Nuorten mielenterveystalo (Youth Mental Health Centre) portal was completed for launch in 2012. This service provides young people with matter-of-fact information in an accessible form about mental health, mental health problems and how to deal with them.“The point of the Mental Health Centre is to provide reliable information. Young people are used to finding informa-tion on the Internet, and there is a lot of stuff online about mental health issues. However, relevant information is not always easy to find, and it is not necessarily reliable,” says nurse Marko Muukka.

CareCareCare


Ask THE midWifE – kATRi TUURA ANsWERs “The most frequently asked questions in the Kysy kätilöltä (Ask the midwife) online service have to do with the poster’s own pregnancy or delivery experiences,” says Katri Tuura.“There are also a lot of questions about pain relief.”

Katri Tuura is a midwife at Hyvinkää Hospital.“I like the rapid-fire pace of the delivery room, where you have to put yourself and all your expertise on the line.” She lists the qualities required of a midwife: “Alertness, humility and a willingness to help people.”

1 iN 3 bAbiEs ARE bORN AT HUs6 maternity hospitals. 18,333 babies born in HUS hospitals in 2012Over 25 % of Finnish women of childbearing age live in the HUS catchment area

Katri Tuura’s diverse job description includes managing the popular ‘Ask the midwife’ online service together with physicians. Users post questions and comments about pregnancy and delivery. “I try to make time to read the e-mail on every working day. I post answers to questions about once a week if I can.” Katri Tuura and the physician on call ensure that the answers are factually correct. They are also more generally concerned with the quality of the service.“The things people ask about are very personal and sometimes extremely difficult for them. We have to respect our clients in carefully considering the tone and language of our answers.” Katri Tuura points out that the online service is specifically intended for non-urgent matters.“It is not an emergency response service. If you are having contrac-tions or your waters break, or if you have issues with foetus movements, you need to contact a maternity clinic.”

Hoito

21

5,671 HUCH /

Kätilöopisto Maternity Hospital

5,729HUCH / Women’s Hospital

3,420 HUCH / Jorvi Hospital 1,702

Hyvinkää

982 Lohja

829Porvoo

bAbiEs bORN AT HUs iN 2012 In 2012, a total of 18,333

babies were born at HUS. One of them was this new resident of Karjaa born at Lohja Hospital in December, 12 hours old when this photo was taken.

The number of babies born was 273 fewer than in 2011. Deliveries increased at Hyvinkää Hospital and in Porvoo but decreased at other hospitals.


• The Amor basin is a fixture in one of the delivery rooms at Lohja Hospital. Smaller basins are fitted in the other two delivery rooms.“Water is excellent for soothing pain,” say Jaana Laine and Anna Sariola.

LOHjA PREPAREd fOR 1,000 dELivERiEsThe renovated maternity ward at Lohja Hospital was opened in December.It was expanded as well as renovated, now having 19 beds.

“We can now deal with more than 1,000 deliveries per year,” says Anna Sariola, Head of the Department of Gynecology and Pediatric Care. The number of deliveries at Lohja Hospital has increased since the closure of the maternity ward at Länsi-Uusimaa Hospital, now standing at more than 900 per year as compared with the earlier 700 or so. The renovation of the maternity ward involved stripping every-thing right down to the external walls. Patient wellbeing is of particular importance. Every patient room has its own toilet and shower. The rooms are designed as single or twin rooms.“And we can turn any room into a family room,” says Sariola. The maternity ward also has a neonatal observation ward, enabling the parents

to remain close to their baby even when the baby requires monitoring after birth. Midwife Jaana Laine notes that the renovation was completed at just the right time.“The timing was excellent considering the renovation and expansion undertaken at the Women’s Hospital. Now if they have a buildup in Helsinki, they can refer women to us for delivery.” The maternity ward will gain even more beds in the second stage of the renovation (scheduled for 2014–2015).

CareCareCare

22

Every program

has a different logic,

and they don’t talk

to one another.

Tinja Lääveri

HUS | ANNUAL REPORT 2012 | WORK

BRIEF FACTS ABOUT THE APOTTI PROjECT• the project involves HUS and the municipalities of the Helsinki Metropolitan Area (except Espoo, which opted out in 2013)• the goal is to create a shared information system for social welfare and health care services• the cost estimate is eUR 350 to 450 million over ten years• current information systems cost EUR 500 million to maintain over ten years

Tinja Lääveri (left) and Marja Valjus work at the Apotti project office as project manager and press officer, respectively.

Tinja Lääveri, a HUS Head of Department, has been an expert consultant in the planning of a shared client and patient information system for municipalities in the Helsinki Metropolitan Area and HUS. The new information system has been christened Apotti. “It would be vital to get a shared patient information system used by both primary health care and specialist medical care, as treatment paths commonly cross organisational boundaries. Currently all treatment plans and patient records run up against these boundaries. Details on medication have to be entered several times as patients move from one organisation to another. This takes time and compounds the potential for error,” says Lääveri, explaining why the much-publicised Apotti system is vital. • continued on the next page

23

fiNLANd’s LARgEsT mEdicAL cARE ORgANisATiON

21,738 ExPERTs

12,160 nursing staff 5,759 other employees 2,783 physicians 1,036 special employees

Work


fOcUs ON sUPERvisORsAll indicators for supervisor work in the Working Life Barometer showed a positive development in 2012. Target levels were not yet attained, but the trend remained promising. The three-day supervisor coaching courses that were well received were continued, and current affairs days for supervisors were also held. More extensive supervisor and management training courses were also launched in 2012. Development discussions are a tool for operations planning and management. The instructions and forms pertaining to development discussions were revised in 2012. Particular attention was given to the situation of specialists in training and of special employees. The number of development discussions increased slightly, and the Working Life Barometer indicated that employees consider these discussions useful. The findings of the Working Life Barometer show that on average employees consider their working capacity to be good. Absences due to illness have decreased, as has the number of employees retiring on a disability pension. This is due partly to early support practices and to cooperation between super-visors, employees and occupational health care as prescribed in the Työkyvyn tuki (Working capacity support) programme. Various wellbeing-at-work projects were launched or continued in various departments in 2012. In 2012, the HUS Joint Authority received the Most Active Workplace in Finland award.

• Tinja Lääveri’s job in the Apotti project is to acquaint herself with patient information systems used in other countries and to chart the needs of the various sectors involved. The current situation is a jumble of systems that Lääveri finds unattractive. “Information is now fragmented and stored in a variety of different systems. Physicians sometimes simply have to guess where a particular item of information may be found, if at all. HUS users have to be conversant with several different systems. Physicians use four or five different programs all the time. And they all work according to a different logic,” complains Lääveri. HUS physicians waste precious time trying to discover exactly what was done in primary health care to a patient

referred to specialist medical care. The information resides in a completely different software application and is grouped according to a different logic than in the HUS system. Looking at the big picture is decidedly difficult. If a unified patient information system is ever achieved, the patients will benefit the most. “When there is only a single set of data and a single treatment plan for physicians and nurses to look at, instead of them having to root around in a variety of systems trying to piece together the information, the patient will get better and more efficient care. In an advanced information system, patients will be able to book their own appointments and update their own patient information,” says Lääveri.

Outi SonkeriHUS Human Resources Director

86%14%513%26%

56%

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24

Stig Stolt, Language Ombudsman

Everything that is done at HUS embraces human, soft values. I like that.

jouni Leimukoski, bioanalyst

What is interesting in this job is the people, both patients and coworkers.


Susanna Puumi, Occupational Safety and Health Manager

Anything at all can come up in the course of the working day, and then I have to find the answer.

THE sUm Of THE ExPERTisE Of PROfEssiONALsOccupational Safety and Health Manager, bioanalyst, Language Ombudsman, resuscitation coordinator, nurse, institutional catering cook. They described their jobs in the Yksi meistä (One of us) column in Husari in 2012.

Commu-nications Director

IT Management

Non-medical support services

Adminis-trative Chief Physician

Hyksin Oy

Medical support services

HUSLAB

HUS Medical Imaging

HUS Pharmacy

Assistive Device Centre

cEO jOiNT AUTHORiTy AdmiNisTRATiONChief Medical Officer

Chief Executive Nursing Director

Audit Director

Director of Adminis-tration

CFOHuman Resources Director

Subsidi-aries

Tytäryhtiöt

Ei sairaanhoidolliset tukipalvelut

HUS-Työterveys

HUS Occupational Health

Teaching and Research

HOsPiTAL AREAs

HUS Real Estate Ltd.

Uudenmaan Sairaalapesula Oy

Housing and property companies

HUSDesiko

HUSLogistics

HUSServis

HUSFacilities Centre

Ravioli

Department of Medicine

Department of Surgery

Department of Gynecology and Pediatrics

Department of Psychiatry

Heart and Lung Centre

HUCH Hyvinkää Lohja Länsi-Uusimaa

Porvoo

25

Laura Ahokas, institutional catering cook

People who say that hospital food is tasteless are stuck in the past.

Leila Saari, resuscitation coordinator

Everyone who works in health care should take a CPR test regularly.

Work


Riitta Majala, nurse

I love Kirra [the Surgical Hospital]. The atmosphere is great, and everyone knows each other.

HUs is THE mOsT AcTivE iN fiNLANdLast year, HUS received the Most Active Workplace in Finland award. The Finnish Sport For All Association chose HUS as the recipient for its merits in improving personnel exercise activities.

“This transport service helps us recruit employees at least for Raasepori,” says Tom Löfstedt, Chief Physician at Länsi-Uusimaa Hospital. Thanks to the company bus, young employees do not immediately need to relocate to a new community or buy a car. The bus is also a welcome option for other employees who do not wish to spend their commute driving. The bus is also available to hospital patients. The Helsinki–Raasepori–Helsinki bus departs from the bus stop outside Kiasma at 06.25 and arrives at Länsi-Uusimaa Hospital at 07.55. The return trip departs in the afternoon. HUS outsources the bus service by competi-tive tendering and provides it free of charge for passengers.

HUs bUs TO LOHjA, PORvOO ANd RAAsEPORiOn weekday mornings, HUS employees in Lohja, Porvoo and Raasepori can take the bus to work. For free.

CareWorkCareWorkCareWork

26 HUS | ANNUAL REPORT 2012 | WORK

Nurse Susanna Kiuru is a sub, or in-house substitute, by her job description. Her shift begins with her checking the online worklist to see to which ward she has been assigned. She may spend her day at Peijas Hospital on any of the surgical wards, at the emergency clinic or at the multi-clinic that handles Leiko (‘home-to-operation’) and preoperative functions. Susanna Kiuru’s career as a sub began with a coincidence: When she graduated 15 years ago, the employment outlook for nurses was poor. Substitute positions were the only ones that were on offer. She spent some time working on the various surgical wards at Peijas Hospital. She encoun-tered all kinds of patients from babies to the elderly and all kinds of conditions from ear infection to cataracts. Ultimately, applying for a position as a permanent temp seemed only natural. “I am privileged to be learning such a lot. I enjoy variety, and I don’t want to be caught short whatever I’m required to do. I am now familiar with the treatment of surgical patients from top to toe,” says Kiuru. To do well as a sub, one has to have a good memory, a curious mind and a flexible attitude. The induction training is lengthy, and Kiuru cautions aspirants not to expect too much of themselves too soon. “You have to be social and adaptable. You must be able to get along with various kinds of patients, physicians and a wide variety of other coworkers. A thirst for knowledge helps.” •

sUbs ARE mAdE TO ROAmIn-house substitutes, or ‘subs’, are permanent HUS employees whose job is to substitute for other employees in a number of departments.

Nurse Susanna Kiuru:

A sub has to be social and adaptable. A thirst for knowledge helps.

27

Work


• Alleviating concernsPatient safety and treatment quality goals dictate that a hospital must always have a certain minimum number of nurses; but someone is always off sick, taking care of a sick child or in training. Supervisors have to spend time finding substitutes, and if they end up having to turn to a temp firm, the cost is huge. Inexperienced substitutes do not even know what to do with demanding patients, and concern for the quality of care is at the back of everyone’s mind. When nurse Siru Lamppu began to consider what to improve at her workplace at Jorvi Hospital for her university of applied sciences thesis, human resources were the first thing that came to mind. Lamppu presented her idea of exploring and enliv-ening the system of in-house substitutes to Pia Keijonen, Manager, Human Resources at HUS, and she was immediately on board: this was something that would

have to be developed throughout HUS. While HUS had had a system of in-house substitutes or subs in place for some time, at many locations it was far from active. Sub appointments were used for instance to fill permanent personnel gaps on some wards. Now, a new permanent directive on subs has been published, providing clear guidelines on how subs should be employed and new positions created. When Lamppu asked the supervisors she interviewed the sub system should be improved, the response was unanimous: more subs. There was also a call for subs to be better paid. “If only I could have five or six more nurses! I would also like to see ward secretary subs competent for instance in handling IT and bookings, freeing up nurses to do what they do best,” says Tarja Särkioja, Head of Ward Group at Peijas Hospital.

Nurse Susanna Kiuru begins her shift as a sub by checking the assignment list, showing which ward Kiuru has been assigned to. She is booked for weeks ahead.

In-house substitutes or subs are permanent HUS employees whose job is to fill in for short-term temporary absences. The sub system was overhauled in 2012 to increase the use of permanent personnel at HUS and to reduce the use of hired labour. There are subs in almost all occupational groups, although the majority of them are nursing employees.

Working on several different wards requires a broad outlook and a wide range of expertise. Having worked as a sub for a decade, Susanna Kiuru has the creativity, social skills and willingness to learn new things that are required to do the job well.

Kiuru is familiar with the treatment of a surgical patient from top to toe and is comfortable with working in a variety of treatment environments. Many subs have been confounded by the fact that the storage rooms on every ward are organised in a different way. At Peijas Hospital, safety has been improved by applying the same scheme to every storage room.

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28

The Nordic countries

must work together

to create a sufficient

population base

for cancer research.

Petri Bono

Petri Bono, Head of the Clinic Group of Oncology:Because cancers are being analysed into ever smaller sub-groups, the Nordic countries must work together to create a sufficient population base for cancer research and thereby continue to acquire new early treatment drugs for testing. Norway will shortly become the first country in the world whose national health care system will include mapping the genome of every cancer patient. We will be adopting the same method in the future too. What this involves is that when a cancer patient is admitted to hospital, his genome is compared to a series of 30 to 40 panels to find out whether a biological smart drug is applicable. In ten or fifteen years from today, the routine in treating cancer patients will be to attack the driver that makes the tumour grow, not its anatomical locus.

HUS | ANNUAL REPORT 2012 | SCIENCE

29

134 specialists

iNTERNATiONAL LEAdERsHiP iN sciENTific REsEARcH ANd

divERsiTy iN TRAiNiNgIn 2012, 129 doctorates and 285 medical degrees were completed in the training provided by HUS and the University of Helsinki. Moreover, some 4,000 health care students received 20,000 credits’ worth of practical training at HUS. Scientific research continued at a brisk pace.

129 doctorates

Science


cLiNicAL mEdiciNE REsEARcH is WORTH iTThe reason why medical research is conducted is to reduce the number of situations where physicians have to say: “I’m afraid there’s nothing more we can do for you at this time.”

Research is viewed in different ways. While many under-stand how vital it is, there are opposite opinions too, even at university hospitals themselves. Hard data contrib-uting to the debate was obtained last year with the comple-tion of the report by Professor Pekka Karma on the impact of scientific research on treatments at HUCH. The impact proved to be highly significant: more than 80% of the researchers reported that their findings had led directly to the improvement of practical treatments, while 80% to 90% of nursing managers considered that research had improved the professional competence of their employees, the effectiveness of treatment and the productivity of operations.

Research is also financially worthwhile. For instance, the research group led by Professor Tari Haahtela made a discovery about how asthma develops, and the treatment practice was changed accordingly. The need for hospitalisa-tion and disabilities caused by asthma decreased substan-tially, and health care costs from asthma dropped by about EUR 300 to 400 million per year. In other words, the cost savings resulting from a single breakthrough by a single research group could fund all of the medical research being done in Finland today.

Lasse ViinikkaHUS Research Director

The Helsinki Academic Medical Center, formed by HUS and the Faculty of Medicine at the University of Helsinki, is an internationally respected research leader and a signifi-cant teaching facility. It produces nearly as much research as all other Finnish university hospitals combined, and almost half of Finland’s specialists are its graduates. The Helsinki Academic Medical Center is one of the top five medical research centres in Europe.

Training for physicians and dentists is provided by the Faculty of Medicine, but the hospital plays a vital role

in clinical training and specialisation training. The number of degrees completed in medical training is holding stable, and cooperation with health care schools in the Helsinki Metropolitan Area remains close. A survey of training needs up to 2025 based on attrition of physicians, nurses and health care special employees and on future patient care needs was conducted to provide background information for the work of the specialist medical care area training group recently set up.

41 dentists

102 physicians

8 dental specialists

CareScience

30

cLiNicAL mEdiciNE REsEARcH:mAssivE imPAcTs ON PATiENT TREATmENT


AT THE cORE Of cANcER kNOW-HOWFinnish cancer research and treatment are at the international cutting edge. In certain spearhead cancer research projects, Finland is a world leader.

Scientific research and patient treatment are inextricably linked. Research produces new types of treatment and improves existing ones. HUS is a uniquely diverse research environment in the Finnish context, where research is both an attraction factor for top-quality professionals and improves patient treatment. Moreover, research can be proven beneficial by other indicators than improvement of treatment: in the USA and the UK, for instance, research has been found to generate financial benefits many times greater than the funds invested in the research. Similar experiences have been reported in Finland. Finland has always been a net exporter of health care technology, which is largely due to the successful commer-cialisation of ideas and inventions originally discovered at research institutions. One of the specific goals of HUS for 2012 was to boost the status of clinical medicine research in Finland’s national science and research policy. To this end, active publicity was conducted for instance about a recent report, unique even in the international context, on the impact of research

conducted at a university hospital on patient treatment. The impact proved to be huge, and clinical medicine research was demonstrated to be of crucial importance for improving service development. Government research funding continued to decrease, and with the enactment of the Health Care Act, a substantial change was implemented in its allocation. Clinics no longer have access to basic funding not subject to competition: all government funding must be allocated to projects based on applications. Although the amount of other competitive funding obtained by HUS researchers actually increased, the situation would have become rather difficult if the hospital district had not allocated funding of its own to research. Scientific competence will probably become one of the criteria by which patients choose where to be treated in the future. To improve the availability of information, a daily updated website featuring publications by research groups at Meilahti was created (www.terkko.helsinki.fi/helsinkischolarchart/?articles). Go have a look.

These top results are grounded in the mundane yet high-quality work done every day for instance at the HUS Department of Oncology. More than 95% of the cancer patients in the HUS area are treated in public health care. “The strength of the Nordic countries is in that our public health care system is comprehensive and functions well,” says Petri Bono, Docent and Chief Physician in Charge of the Oncology and Hematology Clinic Group.“With cooperation between screening, primary health care, physicians and surgeons, we have created treatment paths whose outcomes are generally very good. We cannot claim to be better than the best centres in the USA, but we are not much worse either.” Finland’s extremely good reputation in this field is fuelled by research on breast cancer, prostate cancer and cancers of the gastrointestinal tract, and on excellent basic research. “It takes years to get to the top, because clinical cancer studies are very long-lasting projects,” says Bono.

Apart from running hospitals, HUS is one of the most important research institutions in Finland. It aims to ensure that the methods used to treat patients are always based on the most recent knowledge.

Petri Bono, Head of the Clinic Group of Oncology:

With cooperation, we have created treatment paths whose outcomes are generally very good.

31

nisms of cancer and to use that information for creating new cancer treatments, some of which will become permanent. Research activities at HUS will probably improve even further in the near future, as HUS is currently the only Finnish hospital belonging to the academic Nordic NECT network searching for patients to participate in 1st-stage and 2nd-stage cancer research. The other members of the network are university hospitals in Oslo, Stockholm and Copenhagen.“In the USA, it is relatively easy to find a population base of millions for a study. “The Nordic countries must work together to obtain a sufficiently large population base for research,” says Petri Bono. Jorma Keski-Oja hopes for better treatments for cancers


Sirpa Leppä, Head of the Department of Oncology:

Biomedicine knows a lot about cancer, but it is the job of us clinicians to find out how to beat it.

Although breast cancer and prostate cancer are the most common types of cancer, they are not the worst. An increasing number of patients make a complete recovery. Both are very well known, thanks to research, and they also respond to treatment better than the average cancer.“They are the ones that people talk about the most, but other diseases are far worse at cutting life expectancies. I would like to see Finnish research getting better to grips with types of cancer where the five-year survival rate is less than 10%. Cancer of the stomach, liver or pancreas kills quickly,” says Bono. Professor Jorma Keski-Oja says that the value of cancer research is in discovering the development mecha-

Science

34,900

cancer patients were treated at various HUS clinics in 2012.

• breast cancer• colorectal cancer• lung cancer

that typically present in young people: leukemias, neuroblastomas or tumours of the central nervous system and children’s tumours.

THE mOsT cOmmON TyPEs Of cANcER

iN THE HUs AREA iN 2012

• prostate cancer• lung cancer• colorectal cancer

Professor jorma Keski-Oja:

The Children’s Hospital already provides probably the best cancer treatments in the world.

32 HUS | ANNUAL REPORT 2012 | SCIENCE

Cartilage replacement surgery is a tiny speciality in the area

of orthopedics and traumatology. HUCH has concentrated

these operations at Jorvi Hospital. The area is subject to active

research and development, even though cartilage replacement

has already become an established

treatment method.

“It’s a marginal area of surgery with a very small patient

base. It’s a sort of developmental activity, and as such exactly

the sort of thing that university hospitals are supposed to do,”

says Juha Kalske.

20–30 patients per year

In any one year, there are 20 to 30 patients for whom cartilage

replacement surgery is suitable. “The aim of cartilage replace-

ment is to postpone the need for an artificial joint, but we do

not yet have findings to demonstrate that we have succeeded

in this,” says Kalske. “Besides, it would be difficult to create a

relevant research setup in the light of current knowledge. After

all, you would need to have a control group that would not be

treated,” says Teemu Paatela. What we do know is that if carti-

lage damage is not addressed in one way or another, the result

is devastating. Physically strenuous work in particular is greatly

disrupted by cartilage damage. In tricky locations such damage

can not only produce pain and swelling but even impede

walking.“The operation improves the patient’s quality of life and

functional capacity. It’s also a pain treatment method; all patients

have pain symptoms,” says Paatela.

Knee or ankle most common

Cartilage replacement surgery is indicated in very specifi-

cally defined cases of joint cartilage damage: it is not used to

treat arthrosis. It is, however, suitable for preventing arthrosis.

Damage caused by rheumatic infections can also not be treated

with cartilage replacement:

there is no point in replacing damaged cartilage with more of

the patient’s own cartilage when the patient has an autoimmune

condition where the body is attacking its own cells.

Those who are admitted to surgery are those whom it will

benefit the most: patients for whom the joint damage is a real

problem and leaving the problem untreated would lead to prema-

ture arthrosis at the age of only 20 to 40. Cartilage replacement

operations are most commonly performed on the ankle or the

knee. A number of hip operations have been done in Finland too.

Joints in the upper limbs, by contrast, are subject to much less

strain than those in the lower limbs, and any cartilage damage

there does not have nearly as much potential to disrupt the

patient’s life.

The first operation is keyhole surgery to evaluate the nature

of the cartilage damage. If the damaged area is sufficiently sharp

defined, a biopsy is taken of the cartilage. One million cells and

sixteen tubes of centrifuged blood are then flown to a specialist

laboratory in Sweden, where the cells are multiplied: two weeks

later, ten million cells return to Jorvi from Gothenburg.

At that point, the second operation is undertaken in open

surgery. The multiplied cartilage cells are installed at the

operated location. The aim is for the transplanted tissue to grow

healthy cartilage – the patient’s own. The process takes two

years, and the patient’s condition will slowly improve throughout.

Patients undergoing cartilage replacement surgery are

generally basically healthy and young, aged between 20 and

40. Joint cartilage damage in a person over 40 is often the first

symptom of arthrosis. However, age is not in itself a criterion for

selecting patients if the damaged area is sharply defined and no

tissue changes typical of arthrosis can be detected.

A scRAP Of cARTiLAgE fixEs A yOUNg kNEESurgeons Juha Kalske and Teemu Paatela at Jorvi Hospital are developing cartilage replacement techniques for treating knee and ankle joint problems. Their ambition is that in the future biological tissue transplants could postpone or evenprevent the need for artificial joints.

A sample is taken of the patient’s cartilage: one million cells and 16 tubes of centrifuged blood are sent from Jorvi to Sweden.

Gothenburg, Cell Matrix laboratory

Espoo, Jorvi hospital

At Jorvi, an operation is performed where the multiplied cells are transplanted into the damaged area. The goal is for the transplanted tissue to grow healthy cartilage – the patient’s own.

gOALcELLs fROm jORvi TO gOTHENbURg ANd bAck

jORvi,EsPOO

In two weeks, the laboratory multiplies the patient’s one million cells into 10 million cells, which are then flown back to Jorvi.

cELL mATRix,göTEbORg

10 miLLiON cELLs

33

Science

SLOW AND SILENT ARTICULAR CARTILAGEArticular cartilage is a slippery and flexible tissue that covers the articu-late surfaces of joints. Its purpose is to equalise pressures on the joint. Articular cartilage has a slow and silent life. Cartilage cells are few and far apart, and as far as is known they do not divide in healthy cartilage tissue. There are also no blood vessels in articular cartilage; the cells get their nutrients mostly from the synovial fluid. Articular cartilage, unlike bone, is not able to self-repair. Its cells cannot move or divide, which would be necessary for repairing damage.

12

5

3

4

Juha Kalske and Teemu Paatela are beginning an operation to repair local cartilage damage in a knee joint using the cartilage replacement technique. The operating theatre team at Jorvi Hospital also includes supervising nurse Marjo Kotila, anesthesia nurse Anu Perkkala and scrub nurse Eeva Valvio.

1 2

34

5


Eeva Valvio with a syringe contain-ing cartilage cells to be transplant-ed to a knee joint. There are mil-lions of cells in this 1 ml syringe.

CareScience

34

Security is an absolute must in hospital

operations.

Aaro Toivonen

Aaro Toivonen, HUS Head of Security:The security services unit at HUS Real Estate Ltd had 65 employees at the end of the year, most of them permanent and part-time security guards. Security guards are the ‘muscle’ in hospital security, used to defuse threatening situations and to ensure the safety of both patients and medical personnel. However, intervention by security guards should not be the only or even the primary way of addressing such situations. Violent encounters in a hospital environment generally ensue between patients and hospital personnel, and therefore every employee should have basic security skills competence. At present, basic vocational education in health care does not provide sufficient instruction on how to handle violent situations; health care personnel have to learn on the job. Psychiatry probably has the most advanced security procedures at this time; in somatic care, such procedures are only just being introduced, adapted for that environment.

HUS | ANNUAL REPORT 2012 | RESPONSIBILITY

35

HUs HANdLEs ALL ORgAN TRANsPLANTs iN fiNLANdIn 2012, 310 organ transplants were made.

Vastuu

HUs

Rovaniemi

Kemi

KajaaniKokkola

HämeenlinnaLappeenrantaKuusankoskiKotka

Mikkeli

Åland


Security is an absolute must in hospital

operations.

Aaro Toivonen

A sOLid fOUNdATiONPursuant to the Health Care Act, the HUS primary health care unit was launched on 1 November 2012. The purpose of the unit is to reinforce primary health care by bringing the primary health care perspective to the hospital district. The duties of the unit can be sum-marised in three points. The first is drawing up a plan for organising health care in the HUS area. We support and contribute to the drawing up of this plan, as required in the Health Care Act. Secondly, the unit harmonises the research, devel-opment, design of treatment and rehabilitation paths and continuing education in primary health care. The third major duty is to anticipate personnel needs and to coordinate specialist medical care, primary health care and, as applicable, social services. The primary health care unit is also involved in train-ing. The main goal is to ensure high-quality training for physicians and specialists and to facilitate a supply of competent and committed physicians for primary health care services. This is already being pursued together with the university and member municipalities. I would personally like to see the unit become a strong lobbyist for a network of regional development. This is particularly important now that the National Insti-tute for Health and Welfare is no longer able to support the Rohto network as extensively as before. There is a need for linking the development network created under Rohto to the primary health care unit.

Tapani HämäläinenChief Physician, Specialist in General Medicine, HUS primary health care unit

When a patient in Kuopio, in Rovaniemi or on Åland needs an organ transplant, the patient is referred to a HUS clinic in Helsinki. When a patient with a brain circulation dysfunction is admitted to South Karelia Central Hospital in Lappeenranta, HUS specialists assist in the treatment – where time is of the essence – through a

A direct video consultation link to HUS enables the delivery of thrombolytic therapy also in smaller hospitals.

sHAREd ExPERTisE is THE bEsT ExPERTisE

199 kidney

video link. When an infant requires open-heart surgery, HUS surgeons perform the operation. HUS top expertise plays a crucial role in other specialist procedures too. Having a hospital organisation the size of a small city means having a wide range of support functions, all of which work commendably at HUS.

52 liver

26 lung

1 heart-lung

22 heart

8 pancreas (simultaneous pancreas-kidney)

2 small intestine

Responsi-bility

36 HUS | ANNUAL REPORT 2012 | RESPONSIBILITY

Everything that is done at HUS aims to ensure that patients are given safe and high-quality treatment – performed effectively, correctly and at the right time. Care and the care environment are key elements in patient safety. “Patient safety is a component of care quality and one of the fundamental principles of our operations. Our employees are required to ensure that the methods used are tested and effective and that drug treatments are admin-istered safely, and so on,” says Sari Palojoki, HUS Head of Patient Safety. “In the best case, hospital safety is invisible: it is embedded in the facilities, management system, division of responsibilities, functioning processes and

above all expertise,” continues Aaro Toivonen, HUS Head of Security. Palojoki has a broad domain in ensuring patient safety. Toivonen, on the other hand, focuses on external factors, which includes employee security. Both share a clear vision of how to foster safety in a hospital environment. “A safe organisation can be described with the expression ‘alert uneasiness’, or a constant awareness of potential threats. This means dedicating part of your mind to considering whether things are OK, all the time,” says Toivonen. “We can avoid dangerous situations through anticipation and prevention,” says Palojoki.

PATiENT sAfETyis THE mOsT EffEcTivE WHEN iT is iNvisibLEThe new Health Care Act that entered into force in 2011 put added focus on patient safety. The purpose of the HUS patient safety plan is to ensure that the methods used or the hospital environment itself do not expose the patient to unrelated risks.

Sari Palojoki, Head of Patient Safety:

Anticipation and prevention are the cornerstones of patient safety.

37

Vastuu


HigH dEmANd fOR sAfETy TRAiNiNg

In safety training for HUS personnel, demand exceeds supply. Courses are fully booked almost immediately after they are announced, employees being eager to join. HUS employees well understand the importance of personal competence

Safety is everyone’s businessPalojoki notes that patient safety is the business of all occupational groups at HUS. Also, legislation stipu-lates that patients and their families and friends should always be engaged in the promotion of safe treatment. “At the organisation level, the HUS Executive Board adopts an annual plan for the hospital district based on statutory requirements. One key function is entering all events that endanger patient safety in the Haipro reporting system, and then reviewing these events and taking corrective action. The main thing is to achieve a transparent and constructive culture of patient safety throughout the organisation,” says Palojoki. The basics of safety are near at hand.“Safety stems from the competence and attitudes of individual people. Technology and systems are helpful, and they must be kept in working order. But safety should not be thought of as something that is separate from our work; it must be embedded in everything we do, day in and day out,” says Toivonen. Patient safety risks often become apparent through near misses. “A threat to patient safety often comes from a low tolerance for deviations in the treatment process. We have to consider why the near miss happened and address the underlying risk. Personnel competence is important to uphold in the organisa-tion from the risk management perspective too. Every employee in the health care sector must be able to identify the dangers inherent in human activities,” says Palojoki.

“Safety stems from the competence and attitudes of individual people. Technology and systems are helpful, and they must be kept in working order. But safety should not be thought of as something that is separate from our work; it must be embedded in everything we do, day in and day out. Safety is a feature of operations, not a separate function,” says Aaro Toivonen. In 2012, the security services unit of HUS Real Estate Ltd. organised 140 training events for personnel. The unit was also actively involved in the safety design of construction projects and building services. “Anticipation and planning are a must for undisrupted hospital operations,” says Toivonen.

Safety expert Mikko Helin teaching course attendees how to use a fire extinguisher.

Responsi-bility

38

of mixed waste delivered to a landfill has decreased to the national goal level of 20% because of waste sorting separating the energy fraction and the burning of mixed waste.

More than 1,000 trained environmental officersThe environmental officers working at various HUS units play a vital role in deploying the environmental programme. In the course of the year, HUS Environmental Centre organ-ised courses that trained 92 new environmental officers. The 1,000 mark was exceeded on the course held in March. More than 700 of the environmental officers trained are still working at HUS units. The courses have been going on for nearly 15 years. “The training has played a significant role in increasing awareness of and competence in environmental matters. Without a competent and committed personnel, we could not have attained these effectiveness figures,” says Virta.

smALL AcTiONs, LARgE ENviRONmENTAL imPAcTs

lines in March. This will improve both materials efficiency and energy efficiency during use.“In the Annex, environmental and energy efficiency are evaluated by product group, from textiles to pharmaceuti-cals and from medical equipment to furniture. The minimum requirements and evaluation criteria given in the Annex are applied to procurements on a case-by-case basis,” says Mirja Virta, HUS Head of Environment Management.

550,000 kg less wasteA special focus was put on materials efficiency in a product group specific monitoring of the use of photocopier paper and disposable items. The monitoring showed that the use of photocopier paper, kidney dishes and disposable plates and cutlery decreased in the course of the year under review, while the use of disposable clothing increased. In 2012, HUS generated 7,060 tonnes of waste, which is about 550 tonnes less than in 2011. The percentage


The long-term, systematic efforts of HUS to improve energy efficiency and the eco-friendliness of its operations continued apace in 2012. Energy efficiency and materials efficiency is on an upswing in accordance with the HUS environmental programme for 2011–2015, and energy efficiency goals have been defined in nearly all areas of the HUS Joint Authority’s operations. The halfway goals of the National Energy Efficiency Agreement signed in 2007 have been attained: the energy conservation achieved by early measures (conservation measures between 1997 and 2007) and further measures between 2008 and 2011 totals about 15 GWh.

Ecological equals economicalWhen well implemented, energy efficiency improvements are not only environmentally friendly but economically profitable too. In 2011, building services audits were conducted at various HUS hospital properties. Corrective action taken on the basis of the audits in 2012 resulted in an 11% reduction in heating consumption and a 3% reduction in electricity consumption. Like energy efficiency, materials efficiency is taken into account in all HUS operations: carefully considered procure-ment, use, waste sorting, recycling and waste management are all important. HUS Logistics, the joint procurement unit for the HUS Joint Authority, adopted an environmental annex to its procurement and competitive tendering guide-

Mirja Virta, Head of Environment Management:

In materials and energy efficiency, small savings have large environmental impacts because of the sheer size of HUS. The resources saved can then be allocated to our basic functions.

In an organisation the size of a small city like HUS, even small actions may have large environmental impacts. Along with looking at the big picture, HUS focuses on eco-efficiency in everyday routines.

39

In 2012, HUS generated 7,060 tonnes of waste, which is about 550 tonnes less than in 2011.

In October 2012, HUS held an energy conservation week focusing on active distribution of information about energy matters, training and a variety of special events. The HUS energy conservation week was also noted by the media.“Employees at the Women’s Hospital were

interviewed on the news on MTV3. Environmental forum discussions were held at Länsi-Uusimaa and Hyvinkää, and at Lohja they held an exhibition of art works by schoolchil-dren with valuable tips,” says Pirkko Väätäinen, a Senior Planning Officer at the HUS Environmental Centre. The annual energy conservation week is an excel-lent vehicle for raising awareness of energy topics. Energy conservation is an ongoing concern at HUS, both in large projects and in everyday actions. Energy conservation means savings, and that means more resources available for treating patients.

Vastuu


Rejuvenation of the Meilahti Tower

PiONEER iN ENERgy EfficiENcyThe largest renovation project in the history of HUS is currently in progress at Meilahti in Helsinki.

The renovation of the 16-storey Tower Hospital at Meilahti will involve a considerable improvement to its energy efficiency.“The new double-skin façade struc-ture, new insulation, new windows and heat recovery through the new ventilation system will significantly reduce energy consumption,” says Vesa Vainiotalo, Construction Management Manager at HUS Real Estate Ltd.

Energy conservation will be a consideration in all solutions employed in the design of the Tower Hospital renovation, to be completed in 2014, including selection of equipment and materials. Also, geothermal energy will be used for heating and cooling through an extensive energy well field with 49 wells. Solar collectors installed on the roof will be used for floor heating in wet spaces.

Senior Planning Officer Pirkko Väätäinen:

When more than 20,000 employees switch off their computers and turn out the lights at the end of the day, the savings in electricity consumption on the annual level are quite considerable. The adverse environmental and health impacts of the electricity production that is then not needed are also avoided.

dEcREAsE iN vOLUmE Of LANdfiLL mixEd WAsTE gENERATEd, 2003 TO 2012

mixed waste delivered to landfill

tonnes3 500

3 000

2 500

2 000

1 500

1 000

500

02003 2004 2005 2006 2007 2008 2009 2010 2011 2012

energy waste

mixed waste burned

Responsi-bility

ENERgy cONsERvATiON WEEk: iNfORmATiON TO mOTivATE AcTiON

40

We work at full strength;

that’s why we are always

on budget.juha Hernesniemi

Professor juha Hernesniemi, Chief Physician of the Neurosurgery Clinic, Töölö Hospital: We are a clinic with a high reputation, specialising in neurosurgery only. We have an excellent and committed personnel and a lot of guests from abroad. This translates into a continuous process of evaluation and information exchange, besides attracting patients requiring our special expertise from elsewhere in Finland and also elsewhere in Europe. We work at full strength; that’s why we are always on budget. The support of HUS administration has been particularly important for our development over the years. We are financially relatively independent due to the extra income we generate from beyond the HUS area. Good care and good results bring more patients. We are asked to admit more patients than we can handle – we would need a lot more resources to cope with the present demand. We will be getting new facilities and a wholly new hospital within five years, and we are looking forward to that. Neurosurgery will remain one of the strengths of HUS, an area worth investing in.

HUS | ANNUAL REPORT 2012 | FINANCE

41

cHALLENgE: gROWiNg dEmANd In 2012• population of the HUS catchment area was 1,562,440• there were 2,497,533 billable patient events• cost per resident were about EUR 866

Finance


We work at full strength;

that’s why we are always

on budget.juha Hernesniemi

HUs iNvEsTs iN THE fUTURE A major step was taken in the new hospital projects at Meilahti in autumn 2012. Three architects’ offices drew up parallel proposals for the placement on the campus of a building housing a children’s hospital, a traumatology hospital and a cancer centre. These proposals provided innovative insights into the environment where the most demanding kinds of specialist medical care provided at HUCH will be housed 5–10 years from now. They also embodied visions of what hospitals will look like in the 2020s besides pre-senting challenges for providing high-quality patient care more competitively than at present. The HUS Executive Board and Council made history by launching two hospital projects simultaneously and by adopting a financing solution for the children’s hospi-tal that is unique in the Finnish context.The traumatology and cancer treatment building is in-tended to form a new physical anchor for the national role of HUCH. The children’s hospital will be a major national un-dertaking, with a large number of movers and shakers in Finnish society contributing along with HUS personnel.The new children’s hospital is ambitiously scheduled for completion in 2017, the year which marks the cente-nary of Finland’s independence. The new hospital pro-jects have now been secured to such an extent that it is now time for HUS physicians, nurses and other experts to show their capabilities in reforming examination and treatment processes.

The year 2012 was the busiest year ever in the history of HUS. The costs of specialist medical care are constantly increasing with expansion of operations and general cost trends, posing a substantial challenge for local govern-ment finances. Despite this, HUS has been able to provide specialist medical care cost-effectively yet at a high level of quality. Compared with other university hospital districts, HUS has shown only a moderate increase in costs, and the deflated cost per resident of specialist medical care has actually gone down from 2006. HUS finances are based on the annual service plans drawn up with member municipalities. Most of the revenue consists of specialist medical care orders from local authorities: member municipalities are billed on

a monthly basis in advance, with adjustment invoices sent out four times a year based on actual treatment numbers. The HUS Joint Authority bills its patients’ home munici-palities at cost prices, as the Joint Authority is a non-profit organisation. Specialist medical care is a highly labour-intensive service. High-tech equipment does help, but without top-class experts nothing can be done. Of the total costs of HUS amounting to EUR 1.7 billion, 64% consisted of personnel costs. EUR 116 million was spent in equipment and building investments to improve hospital operations. Depreciations went up to nearly EUR 100 million.

Anne PrihaHUS Investment Manager

iNvEsTmENTs 2012 EUR 116 miLLiON2011 EUR 98 miLLiON

+18 m€

CareFinance

42 HUS | ANNUAL REPORT 2012 | FINANCE

HUcH, jORvi HOsPiTAL ExTENsiONExcavators dug into Espoo soil at the end of last year as work began on the Jorvi Hospital extension. Rock blasting was among the first things to be done.• alteration work at the day surgery department, 2011–2012 cost estimate EUR 636,000; actual 2012: EUR 447,000• additional building for emergency services, 2010–2015 cost estimate EUR 55 million; actual 2012: EUR 1.7 million• Renovation of pathology facilities, 2011–2013 cost estimate EUR 1.1 million; actual 2012: EUR 547,000• Pneumatic mail system renovation, 2012–2016 cost estimate EUR 1.4 million; actual 2012: EUR 53,000

RENOvATiON Of WiNgs E ANd f AT LäNsi-UUsimAA HOsPiTAL

Länsi-Uusimaa Hospital Area• 2010– 2012 • cost estimate: EUR 3.4 million• actual 2012: EUR 2.4 million

mAjOR cON-sTRUcTiON PROjEcTs Actual investments in 2012:• HUCH eUR 40.4 million • länsi-Uusimaa eUR 2.4 million• Hyvinkää eUR 8.4 million• Porvoo eUR 1.1 million• lohja eUR 3.6 millionThis analysis excludes projects of less than EUR 500,000; such projects totalled EUR 16.8 million in 2012.

Helsinki: Aurora HospitalHerttoniemi HospitalSkin and Allergy HospitalSurgical HospitalKätilöopisto Maternity HospitalChildren’s HospitalChildren’s Castle hospital

Lohja Hospital Area

Länsi-Uusimaa Hospital Area

HUCH Hospital Area

Hyvinkää Hospital Area

Porvoo Hospital Area

Lohja HospitalPaloniemi Hospital

Hyvinkää Hospital

Länsi-Uusimaa HospitalTammiharju Hospital

Jorvi Hospital

Peijas Hospital

Porvoo Hospital

Kellokoski Hospital

Karkkila

Siuntio

Vantaa

Kauniainen

Espoo

Hyvinkää

Pornainen

Askola

Porvoo

Lapinjärvi

Loviisa

Mäntsälä

JärvenpääNurmijärvi

Tuusula

Sipoo

Raasepori

Hanko

Inkoo

VihtiLohja

Kirkkonummi

Helsinki

Meilahti Triangle HospitalMeilahti Tower HospitalWomen’s HospitalPsychiatry CentreEye and Ear HospitalDepartment of OncologyTöölö Hospital

Kerava

43

Talous


LOHjAN HOsPiTAL• New psychiatry building, 2010–2015 cost estimate EUR 22.6 million; actual 2012: EUR 807,000• Renovation of patient ward 2, phase 1, 2010–2012 cost estimate EUR 3.4 million; actual 2012: EUR 2.8 million

HUcH, cHiLdREN’s cAsTLE HOsPiTAL The renovation of the elevation of Children’s Castle was exceptionally demanding.The International Working Party for Documentation and Conservation of Buildings, Sites and Neighbourhoods of the Modern Movement (DoCoMoMo) has named Children’s Castle as one of the landmarks of Modernist architecture.• elevation renovation, phase 1, 2009–2012 cost estimate EUR 2.5 million; actual EUR 1.1 millionChildren’s Hospital• Roof, B arch, 2010–2012 cost estimate EUR 2 million; actual 2012: EUR 1.5 million

PORvOO HOsPiTAL• Renovation of patient wards, phase 1, 2011–2014 cost estimate EUR 3.9 million; actual 2012: EUR 223,000• Construction of a waste station, 2011–2013 cost estimate EUR 1.2 million; actual 2012: EUR 904,000

HyviNkää HOsPiTAL• acute hospital annexe, 2009–2012 cost estimate EUR 9.9 million; actual 2012: EUR 3.1 million• endoscopy unit alterations, 2010–2013 cost estimate EUR 2.1 million; actual 2012: EUR 876,000• Central kitchen renovation, phase 1, 2011–2012 cost estimate EUR 1.2 million; actual 2012: EUR 815,000Kellokoski Hospital• Renovation of ohkola Hospital, phase 1, 2009–2012 cost estimate EUR 7.1 million; actual 2012: EUR 3.5 million• Renovation of ohkola Hospital, phase 2, 2011–2014 cost estimate EUR 3.6 million; actual 2012: EUR 74,000

HUcHEye and Ear Hospital• Backup power source project, 2011–2012 cost estimate EUR 830,000; actual 2012: EUR 766,000Women’s Hospital• annexe extension and renovation, 2010–2015 cost estimate EUR 42 million; actual 2012: EUR 3 millionKätilöopisto Maternity Hospital• alterations for department of child psychiatry, 2011–2013 cost estimate EUR 800,000; actual 2012: EUR 72,000Department of Oncology• Renovation and expansion of the northern section of the 1st floor, 2009–2013 cost estimate EUR 10.7 million; actual 2012: EUR 5 million• equipment facilities for linear accelerators 9–10, 2010–2014 cost estimate EUR 6 million; actual 2012: EUR 323,000

HUcH, mEiLAHTi HOsPiTAL • Renovation of Tower Hospital, 2009–2014 cost estimate EUR 90 million; actual EUR 21 million• Renovation of ground floor of TP wing, phase 1, 2012–2014 cost estimate EUR 1.1 million; actual EUR 11,000• Subterranean service yard, 2007–2014 cost estimate EUR 30.4 million; actual EUR 4.6 million• electricity distribution network connection upgrade, 2012–2015 cost estimate EUR 5.7 million; actual EUR 56,000

CareFinance

44

EUR/resident900

850

800

750

700

HUs mEmbER mUNiciPALiTy cONTRibUTiONs, EUR PER REsidENT, ANd PERcENTAgE Of cHANgE ON THE PREviOUs yEAR

Annual 2008 2009 2010 2011 2012accounts

EUR/resident, deflated

EUR/resident

Change, %

-0.3%

+2%

-3.1%

-0.5%

-1.8%

Costs to HUS member municipalities in 2012 averaged

EUR 866 per resident, 1.8% less than in 2011.

cARE sERvicEs

The overall volume of care services increased on the previous year. In 2012, there were 1,580,702 outpatient visits (+0.8%), 607,245 treatment periods (DRG) and 233,755 inpatient day products (-6.2%). Volume growth weighted by billing share was 2.5% on the previous year, over budget by 2.6%. At the level of HUS as a whole, the cost per resident for member municipalities averaged at EUR 866. Costs decreased by 1.8% compared with figures adjusted by the 2011 hospital price index (deflation coefficient 1.036). The productivity goal (1.5%) was not attained during the year under review, as the actual production was more expensive than estimated. Productivity trends are monitored using DRG-based indicators for somatic care service production. Compared with 2011, the produc-tivity of person-work decreased (-0.4%), while deflated DRG point productivity increased (+0.9).

A yEAR Of EcONOmisiNg


45

Talous

PATiENTs TREATEdThe number of individual patients treated in specialist medical care (including outsourced services), excluding health centre patients at joint emergency service clinics, was 469,921 (+0.7% compared to 2011). The number of individual patients using specialist medical care services produced by HUS itself was 452,998 (+0.5%). The total number of patients treated, including health centre patients at joint emergency service clinics, was 497,826 (+0.9%). Specialist medical care services included in service plans were used by 445,932 individual residents of member municipalities. This represented an increase of 0.5% on the previous year, as opposed to the 1.1% growth of the population of the HUS catchment area. About one in three residents of the member municipalities (29%) used specialist medical care services produced or organised by HUS in 2012. Use of services in relation to population varies significantly between municipalities.

Sipoo

Porvoo

Pornainen

Loviisa

Lapinjärvi

Askola

Tuusula

Nurmijärvi

Mäntsälä

Järvenpää

Hyvinkää

Vihti

Siuntio

Nummi-Pusula

Lohja

Karkkila

Karjalohja

Raasepori

Inkoo

Hanko

Kirkkonummi

Kerava

Kauniainen

Vantaa

Helsinki

Espoo

Average for

member

municipalities

PATiENTs TREATEd, PERcENTAgE Of POPULATiON by mEmbER mUNiciPALiTy Population 2012, prediction (Source: Statistics Finland)

20 22 24 26 28 30 32 34 36 38 %

HUS treated nearly

500,000 patients in 2012.The number of persons treated increased by 0.9%


CareFinance


AvAiLAbiLiTy Of TREATmENT, AccEss TO TREATmENT ANd TRANsfER dELAysThe number of external elective non-urgent referrals has been increasing in recent years and in the year under review increased by 1.7% on the previous year. Health centres send the most such referrals, accounting for nearly 60% of all referrals each year. The total number of patients waiting for treatment increased on the previous year. At the end of the year, there were 16,678 patients covered by the care guarantee waiting for admission to inpatient care. At the end of the year, there were 409 patients who had been waiting for treatment for more than six months (2011: 119). Of the patients waiting to be admitted to inpatient care, 76% had waited for less than three months. At the end of the year, there were 24,991 patients covered by the care guarantee waiting for admis-sion to outpatient examinations and treatment. The number of patients who had waited for an outpatient examination for more than three months also decreased significantly: at the end of the year, there were 964 such patients, 89 of whom had waited for more than six months. The number of transfer delay days in 2012 was 36,430 (+0.1% on the previous year). There were 8,227 transfer delay patients treated (2011: 8,136). The introduction of the billable transfer delay inpatient day as of 1 July 2011 has not affected transfer delays as anticipated. There were 11,341 billable transfer delay day products in the year under review, for a total billing of EUR 5.0 million.

iNdicATORsHUS HUCH

2012 2011 2012 2011

NordDRG products 607,245 593,301 485,952 474,544

Inpatient day products 233,755 249,173 107,589 114,173

Visit products 1,580,702 1,567,593 1,169,888 1,161,713

Health centre visit products 75,831 73,197 41,788 38,590

Invoiced patient events 2,497,533 2,483,264 1,805,217 1,789,020

Operations 89,455 90,705 71,234 72,416

Births 18,099 18,328 14,605 14,873

Number of individuals using HUS services (own activities, specialist medical care)

452,998 450,913 361,058 359,190

Hospital beds 2,935 3,106 1,988 2,129

Number of staff 21,738 21,322 11,690 11,500

Operating income, EUR million 1,747.6 1,674.9 1,251.5 1,217.8

Operating costs, EUR million 1,668.9 1,584.7 1,263.1 1,210.8

Population of the HUS catchment area 31.12.(Population 2012, prediction)

1,562,440 1,545,034 1,146,716 1,131,372

Member municipalities’ contributions, EUR per resident, average (non-deflated, population as at 31 December)

866.1 851.7 826.5 818.6

47HUS | ANNUAL REPORT 2012 | FINANCE

Talous

EUR 1,000 FS 2008 FS 2009 FS 2010 FS 2011Budget 2012 FS 2012

Deviation FS 2012/ Budget 2012

Change, %FS 2012/ FS 2011

Operating income total 1,490,522 1,547,869 1,584,430 1,674,917 1,711,642 1,744,580 1.9% 4.2%

Sales proceeds 1,425,532 1,479,476 1,512,931 1,598,822 1,632,714 1,668,651 2.2% 4.4%

Payments income 49,328 52,874 56,916 57,052 62,207 58,679 -5.7% 2.9%

Subsidies and grants 7,028 6,256 5,873 9,822 5,838 6,815 16.7% -30.6%

Other operating income 8,634 9,263 8,710 9,221 10,882 10,435 -4.1% 13.2%

Operating costs total 1,405,882 1,451,925 1,485,920 1,584,651 1,603,804 1,668,902 4.1% 5.3%

Personnel expenses 893,934 922,647 953,389 1,009,998 1,023,176 1,068,950 4.5% 5.8%

Purchased services 195,499 201,406 202,978 219,299 232,450 234,899 1.1% 7.1%

Materials, supplies and consumables

274,248 285,544 287,606 310,422 301,695 315,456 4.6% 1.6%

Subsidies and grants 546 553 443 875 827 785 -5.1% -10.3%

Other operating expenses 41,655 41,775 41,504 44,057 45,657 48,811 6.9% 10.8%

Operating margin 84,640 95,944 98,510 90,266 107,837 75,678 -29.8% -16.2%

Financial income and expenses

11,831 13,759 13,599 12,793 15,400 13,588 -11.8% 6.2%

Result before depreciationand extraordinary items 72,809 82,185 84,911 77,473 92,437 62,090 -32.8% -19.9%

Depreciation and reductions in value

75,521 82,181 85,711 93,573 104,437 97,597 -6.5% 4.3%

Surplus/deficit for financial year -2,712 4 -800 -16,100 -12,000 -35,507

Total operating expenses and depreciation

1,481,403 1,534,106 1,571,631 1,678,224 1,708,242 1,766,499 3.4% 5.3%

CareFinance

PROfiT ANd LOss AccOUNT

48

disTRibUTiON Of HUs OPERATiNg iNcOmE iN 2012

77.6%Member municipalities’ contributions

16% Other service and sales income

2% Special state subsidies

3.4% Payments income

1% Other operating income and subsidies

HUs fiNANcEs The operating deficit for the financial period was EUR 21.6 million (budget: EUR -12.0 million). The financial performance was encumbered by a cost of EUR 13.9 million caused by the annual holiday reform in the local government civil service and employment collective agreements. The total deficit for the financial period was thus EUR 35.5 million. Billing for medical care services from parties other than member municipalities (EUR 127.2 million) devel-oped favourably. The actual figure exceeded the budget by 5.3% and showed a growth of 8.0% on the previous year. The combined contributions of the member munici-palities (for specialist medical care services) exceeded the budget by 1.7%, being EUR 22.2 million. In terms of volume, the use of services by member municipalities exceeded the budget. However, the average billing for the services used was below budget. The operating costs exceeded the budget by 4.1% (EUR 65.1 million). The compatible budget excess in operating costs was 3.2% (EUR 51.2 million), taking into account the aforementioned increase in holiday pay liabilities due to the collective agreement amendment. The compatible budget excess in operating costs (3.2%) was larger than the budget excess in operating income (1.9%), hence the greater than budgeted deficit. Compatible growth of operating costs on the previous year was 4.4% (EUR 69.6 million), taking into account the costs of the emergency case services that began in 2012 and the impact of the collective agreement annual holiday reform in 2011 (EUR 10.2 million) and 2012 (EUR 13.9 million).


disTRibUTiON Of mEmbER mUNiciPALiTiEs’ cONTRibUTiONs iN 2012, %

77.1%HUCH

2.7% Länsi-Uusimaa

4.1% Porvoo

0.4% Assistive Device Centre

4.7% Lohja

9.5% Hyvinkää

1.4% Group adminis-tration

disTRibUTiON Of HUs OPERATiNg cOsTs iN 2012

64.1%Personnel expenses3.9%

Purchase of medical care services

3.2% Other materials, supplies and consuma-bles

3% Other operating expenses and subsidies

15.7% Drugs and medical supplies

10.2% Purchase of other services

See the HUS financial statements and annual report for 2012 at:www.hus.fi/HUS-Tietopankki/Hallinto ja päätöksenteko/Talous

49

AdEqUAcy Of cAsH fLOW

25

20

15

2008 2009 2010 2011 2012

23.4 days

Minimum target

HUs LOAN PORTfOLiO ANd EqUiTy RATiO

220

200

180

160

140

120

100

Debt portfolio

224.2 m€

Equity ratio

39.9%

iNvEsTmENTsHUS makes investments in the future, in the improvement of patient care and in the promotion of its competitiveness. Projects completed during the year under review include new facilities for acute care at Hyvinkää Hospital, alterations to the Day Surgery Unit at Jorvi Hospital, and the 1st phase of the renovation of the youth psychiatry facilities at Ohkola. The major HUS construction investments – the Meilahti Tower Hospital, the Women’s Hospital and the extension at Jorvi Hospital – progressed according to plan. Planning was initiated for new projects at Meilahti: the Children’s Hospital, the Traumatology Centre and the Cancer Centre. Investments in 2012 totalled EUR 116 million, of which EUR 73 million in new construction and renovations. Research and medical care equipment investments safeguard sufficient capacity for treatment andimaging of cancer and cardiology patients, leveraging emerging technology. In 2012, nearly EUR 22 million was spent on examina-tion and treatment equipment. HUS Information Manage-ment invested about EUR 19 million in the development of patient information systems, various ERP and reporting systems and basic IT services in 2012.

Talous


fUNdiNgDuring the financial period, HUS withdrew EUR 40 million in long-term loans and repaid EUR 10.5 million on outstanding loans. Adequacy of cash flow remained at the planned level (23.4 days). The HUS equity ratio was 39.9%. Net financial expenses (EUR -13.6 million) were EUR 1.8 million under budget. The average interest rate for the HUS loan portfolio in 2012 was approximately 1.9% (2011: 2.3%), and the average interest rate for money market investments was 0.9% (2011: 1.5%). The loan portfolio stood at EUR 224.2 million as at the end of the year, while liquid assets stood at EUR 116.5 million. At the time of the closing of the accounts, 32% of the interest risk in the HUS loan portfolio was hedged. About 70% of the interest risk in the net loan portfolio, taking short-term HUS liquidity investments into account, was hedged.

HUS makes investments in the future, in the improvement of patient care and in the promotion of its competitiveness.

120

100

80

60

40

20

0

HUs iNvEsTmENTs ANd dEPREciATiON

2008 2009 2010 2011 2012

2008 2009 2010 2011 2012

Financial statements



Investments

Poistot

116 m€

98 m€

CareFinance


PROfiT ANd LOss AccOUNT (EUR 1,000)

HUS Group HUS Joint Authority 1.1.-31.12.2012 1.1.-31.12.2011 1.1.-31.12.2012 1.1.-31.12.2011

Operating income Sales proceeds 1,675,597 1,605,250 1,668,651 1,598,822 Payments income 58,679 57,052 58,679 57,052 Subsidies and grants 6,822 9,826 6,815 9,822 Other operating income 15,392 13,776 10,435 9,221

1,756,491 1,685,904 1,744,580 1,674,917

Operating expenses Personnel expenses Salaries and fees -881,975 -836,259 -863,963 -819,346 Social security expenses Pension expenses -153,522 -142,933 -150,276 -139,849 Other social security expenses -55,756 -51,762 -54,712 -50,804 Purchased services -208,890 -194,796 -234,899 -219,299 Materials, supplies and

consumables -324,462 -319,305 -315,456 -310,422 Subsidies -785 -875 -785 -875 Other operating expenses -50,769 -46,425 -48,811 -44,057

-1,676,160 -1,592,354 -1,668,902 -1,584,651 Share of business enterprises’ enterprises’ profit/loss -95 299 0 0

Operating margin 80,236 93,849 75,678 90,266 Financial income and expenses Interest income 1,095 2,385 1,694 2,821 Other financial income 136 169 133 166 Interest expenses -3,997 -4,289 -3,670 -4,014 Other financial expenses -11,876 -11,960 -11,745 -11,766

-14,642 -13,694 -13,588 -12,793

Result before depreciation and extraordinary items 65,594 80,154 62,090 77,474 Depreciation and reductions in value Depreciation according to plan -99,820 -96,096 -97,597 -93,573 Extraordinary items 0 128

Annual result -34,226 -15,813 -35,507 -16,100 Tax reserves -1,613 -501 Minority share 1 13

Surplus/Deficit for financial year -35,838 -16,301 -35,507 -16,100

HUs jOiNT AUTHORiTy

operating income / operating costs %

result before depreciation and

extraordinary items / depreciation, %

2008 2009 2010 2011 2012

63.6

104.5100 %

HUs gROUP

operating income / operating costs, %

result before depreciation and

extraordinary items / depreciation, %

2008 2009 2010 2011 2012

65.7

104.8100 %

fiNANciAL iNdicATORs fOR THE PROfiT ANd LOss AccOUNT

51

2012 2011 2010 2009 2008

Investment cash 52.8 75.9 73.2 75.6 89.3

flow financing, %

Capital expenditure cash flow financing, % 68.6 90.0 66.0 68.8 77.1

Debt coverage ratio 4.4 4.7 5.3 5.6 4.2

Cash disbursements EUR million 1,828 1,728 1,645 1,603 1,531

Adequacy of cash flow (days) 23.8 26.1 25.6 27.7 25.6

HUs jOiNT AUTHORiTy 2012 2011 2010 2009 2008

Investment cashflow financing, % 53.6 81.9 76.0 75.4 88.3

Capital expenditurecash flow financing, % 47.1 65.7 65.3 68.2 75.6

Debt coverage ratio 4.6 5.0 5.4 6.4 5

Cash disbursements EUR million 1,820 1,719 1,634 1,589 1,521

Adequacy of cash flow (days) 23.4 25.8 25.4 27.6 25.4

• investment cash flow financing, % = 100 * Result before depreciation and extraordinary items / Investment self-acquisition expenses• Capital expenditure cash flow financing, % = 100 * Result before depreciation and extraordinary items / (Investment self-acquisition expenses + loans net increase + loan amortizations)• Debt coverage ratio = (Result before depreciation and extraordinary items + Interest expenses) / (Interest expenses + Loan amortizations)• adequacy of cash flow (days) = 365 days * Liquid assets Dec 31 / Cash disbursements during financial year

Talous


cAsH fLOW sTATEmENT (EUR 1,000)

HUs group HUs joint Authority 2012 2011 2012 2011

Operating cash flow Result before depreciation and extraordinary items 65,594 80,154 62,090 77,474 Extraordinary items 0 128 0 0 Adjusting items for cash flow financing 178 838 179 1,284Investment cash flow Investment expenses -124,176 -105,737 -115,818 -94,738 Investment expenses financing shares 0 116 0 116 Capital gains for fixed asset items 4,814 2,591 4,510 2,300

Operating and investment cash flow -53,590 -21,909 -49,040 -13,564

Financing cash flow Changes in loans Increases in loan receivables 0 -11 -9,000 -11,411 Decreases in loan receivables 8 99 3,399 572Changes in loan portfolio Increase in long-term loans 40,230 30,030 40,000 30,000 Decrease in long-term loans -11,663 -13,561 -10,540 -12,425 Change in short-term loans 0 0 0 0Changes in capital and reserves 0 0 0 0Changes in minority share 0 0 0 0Other changes in liquidity Changes in inventories 2,041 -633 2,031 -645 Change in receivables -8,361 -6,139 -8,594 -6,543 Change in interest-free debts 26,794 20,367 26,688 22,001

Financing cash flow 49,048 30,153 43,984 21,549

Change in liquid assets -4,542 8,244 -5,057 7,985

Liquid assets 119,103 123,645 116,489 121,546Liquid assets as at Jan 1 123,645 115,401 121,546 113,561

Change in liquid assets -4,542 8,244 -5,057 7,985

HUs gROUP

fiNANciAL iNdicATORs fOR THE cAsH fLOW sTATEmENT

CareFinance

52

ASSETS

NON-CURRENT ASSETSIntangible assetsIntangible rights 173 173 0 0Other long-term expenses 46,407 42,295 45,907 41,913Intangible assets 46,580 42,468 45,907 41,913

Tangible assetsLand and water 12,279 12,375 10,745 10,866Buildings 484,322 497,569 458,594 473,437Immovable structures and equipment 12,550 13,521 12,550 13,521Machinery and equipment 85,929 89,118 81,339 84,363Other tangible assets 761 813 138 138Advance payments and purchases in process 99,226 64,621 83,098 53,033

Tangible assets 695,068 678,017 646,465 635,358

InvestmentsBusiness enterprise shares and similar rights of ownership 14,649 14,927 14,716 14,766Other shares and similar rights of ownership and revaluation reserve 3,054 3,054 6,344 6,344Other loan receivables 516 524 29,976 24,376Other receivables 254 254 254 254

Investments 18,472 18,759 51,290 45,739

NON-CURRENT ASSETS 760,119 739,243 743,663 723,010

CONTRACT-RESTRICTED ASSETS 4,057 4,094 4,057 4,094

CURRENT ASSETSInventories 18,203 20,244 18,046 20,077Receivables Non-current receivables 577 586 577 586 Current receivables 78,275 69,905 78,099 69,496

Receivables 78,852 70,491 78,677 70,082Investments 44,071 56,792 44,063 56,783Cash in hand and at banks 75,031 66,853 72,427 64,763CURRENT ASSETS 216,158 214,380 213,213 211,705

TOTAL ASSETS 980,335 957,717 960,933 938,809


bALANcE sHEET (EUR 1,000) HUs group HUs joint Authority 2012 2011 2012 2011

53

2012 2011 2010 2009 2008

Equity ratio,% 40.1 44.7 47.6 47.8 50.4

Relativeindebtedness, % 30.7 28.6 27.9 28.2 26.1

Loan portfolio 31.12. (EUR 1,000) 238,568 210,001 193,532 206,713 157,505

Loan receivables 31.12. (EUR 1,000) 516 524 623 626 629

HUs jOiNT AUTHORiTy 2012 2011 2010 2009 2008

Equity ratio, % 39.9 44.7 47.8 48.1 51.2

Relative indebtedness, % 30.3 28.2 27.3 27.6 25.1

Loan portfolio 31.12. (EUR 1,000) 224,156 194,696 177,122 189,556 138,746

Loan receivables 31.12. (EUR 1,000) 29,976 24,376 13,547 7,551 5,190

• equity ratio, % = 100 * Capital and reserves / (Capital and reserves total – Advances received)• Relative indebtedness, % = 100 * (Liabilities – Advances received) / Operating income• loan portfolio 31.12 (eUR 1,000 ) = Liabilities – (Advances received + Trade creditors + Accruals and deferred items + Other creditors)• loan portfolio 31.12 (eUR 1,000 ) = Other loan receivables in investments

HUs gROUP

Equity ratio 40.1%

Talous


LIABILITIES

CAPITAL AND RESERVESSubscribed capital 391,253 391,253 391,253 391,253Other own reserves 1,031 1,031 0 0 Surplus/deficit from previous financial years 27,025 43,326 25,748 41,847Surplus/deficit for financial year -35,838 -16,301 -35,507 -16,100

CAPITAL AND RESERVES 383,471 419,309 381,493 417,001

MINORITY SHARES 2,599 2,600 0 0

DEPRECIATION AND UNTAXED RESERVESDepreciation difference 1,419 789 0 0Untaxed reserves 3,641 2,661 0 0

DEPRECIATION AND UNTAXED RESERVES 5,060 3,450 0 0

PROVISIONSProvisions for pensions 2,737 2,737 2,737 2,737Other provisions 38,212 36,692 38,212 36,692

PROVISIONS 40,949 39,429 40,949 39,429

CONTRACT-RESTRICTED CAPITAL 4,057 4,094 4,057 4,094

LIABILITIESLong-term interest-bearing liabilities 228,325 197,518 214,886 184,156Long-term interest-free liabilities 2 2 0 0Short-term interest-bearing liabilities 10,243 12,482 9,270 10,540Short-term interest-free liabilities 305,629 278,831 310,277 283,590

LIABILITIES 544,199 488,835 534,434 478,286

TOTAL LIABILITIES 980,335 957,717 960,933 938,809

bALANcE sHEET (EUR 1,000) HUs group HUs joint Authority 2012 2011 2012 2011

fiNANciAL iNdicATORs fOR THE bALANcE sHEET

Equity ratio39.9%

CareFinance

ANNUAL REPORT 2012 • Texts: Paavo Holi, Antti Kantola, Riitta Lehtonen, Sari Lommerse, Merja Mäkitalo, Johanna Saukkomaa, Totti Toiskallio, Lotta Tuohino • AD, layout: Teija Himberg, Zeeland • Cover image: Markus Sommers

• Pictures: Mikael Ahlfors, Eeva Anundi, Mikko Hinkkanen, Jussi Kirjavainen, Timo Löfgren, Jarmo Nummenpää, Liia Pienimäki, Matti Snellman, Markus Sommers, Kai Widell • Printers: Hämeen Kirjapaino, 2013

HUS is Finland’s largest provider of specialist medical care services and second largest employer. Our expertise is of an internationally high standard. We produce services for nearly 1.5 million residents and have nationwide responsibility in certain areas of specialist medical care. Every year, nearly half a million patients are treated at the 22 HUS hospitals. Employing about 21,000 health care professionals, HUS has a turnover in excess of EUR 1.7 billion.

HÄMEEN KIRJAPAINO OY 2011

441 209Painotuote

Stenbäckinkatu 9, PO Box 100, 00029 HUS, tel. +358 9 4711

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HUS is a non-smoking organisation.

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