LAUSR

Introduction As integration of health and social services has been an outspoken policy in Finland, several initiatives have been launched to enhance integration on regional level. Some counties have started to restructure their care and services towards organizational integration. In this study, we explore views on health and social care integration among top managers in four different organizations. . Methods We conducted semi-structured interviews with 32 top managers from four different organizations between 2017 and 2019. One area had already implemented integration several years ago, one had just recently started integrating their systems and two other areas were in the beginning of the implementation. The interviews were tape recorded, transcribed verbatim and the data was then analyzed using qualitative content analysis where data was first coded, then formed into sub-themes and finally into broader themes. Results In total, four themes emerged from the analysis: 1. Change, 2. Future competencies, 3. Task shift and 4. Leadership. The sub-themes for Change were success in change, resistance to change and organizational structures. Future competencies theme had sub-themes of client-oriented approach, changes in education and self-management. For the Task shift theme the sub-themes were new professions, division of labor and emphasis on rehabilitation, and for Leadership theme strategic leadership, change management, multisectoral and multidisciplinary leadership and helicopter perspective.  Discussion According to our results top managers highlighted that also workers in an integrated care system need new competencies and that the change is needed on all levels of the organization, not just on the top. The answers of the top managers were similar with each other despite the differences in stages of the integration process. Top managers emphasized knowing the organizational strategy and that also middle managers need to adopt this into their leadership. For workers, broader competence across own professional silo is needed to be able to e.g. cross organizational boundaries and to handle the new tasks, and further to aim for more client-oriented care. Conclusions According to the top managers in organizations with different stages of integration, both workers and middle managers in health and social care services need skills to handle broader areas than just within their own professional role. Lessons learned Personnel in all levels of the organization need new competencies in the process of integrating care and services. Limitations Differences between areas and reasons for integrating the services (voluntarily vs. involuntarily) may have affected our results. Suggestions for future research In the future, it would be important to investigate workers’ views on integration to better understand the challenges and barriers the workers might face during the integration process.