Annual report
2011 1
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HUS annual repor t 2011
Contents
Key figures
Key figures 3 Review by the CEO 4 Review by the Chairman of the Executive Board 5 Record number of patients treated in 2011 6 Record year for organ transplants 12
92,027
1,567,593
surgical procedures in 2011.
outpatient visits in 2011.
21,322
1,584.7
employees, making HUS the second largest employer in Finland.
EUR 1,584.7 million in operating costs for the entire hospital district in 2011.
466,665
1,545,034
individual patients in specialised medical care in 2011.
population of HUS catchment area as at 31 December 2011.
New ventricular assist device improves patients’ quality of life 15 Dad gave his kid a kidney 17 18,606 babies 18 New helipad opened 19 High-quality research is a requirement for good medical care 20 Heart disease is an adulthood risk for those born prematurely 23 Stereo EEG helps locate severe epilepsy 24 HUS infertility treatments concentrated at the Women’s Hospital 24 There is always room for improvement 25 Cancer treatment with world-class performance 27 Historic achievement of Heikki Joensuu 29 Psychiatry goes online 30 Obesity weighs heavily on the mind 33 24 h cardiology for heart attack patients 34 Heart valve defects can be corrected without cutting 34 A year of novelties in cardiac surgery 35 New treatment for severe hypertension 35
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Meilahti Tower Hospital vacated 36 Orthopedic referrals to a single address 39 Image of HUS as an employer improved 40 First stage of Hyvinkää Acute Hospital completed 43 Organisation and representative bodies 44 Council members 46 Members of the Executive Board and Committees 47 Profit and loss account: Group and Joint Authority 48 Cash flow statement: Group and Joint Authority 49 Balance sheet: Group and Joint Authority 50
Cover: Topi Konttas saved the life of his son Runo by donating a kidney to him in March 2011. Both recovered well from the surgery. Clinical photographer Mikko Hinkkanen took this picture of father and son for the Annual Report at Meilahti. On this spread: The renovation of the Meilahti Tower Hospital began in autumn 2011.
Texts: Laura Grönqvist, Niina Kauppinen, Johanna Kojola, Markku Kupari, Katri Laukkanen, Riitta Lehtonen, Janne Rapola, Johanna Saukkomaa, Jenita Sillanpää, Outi Sonkeri, Ilkka Tikkanen, Lasse Viinikka Pictures: Tero Hanski, Mikko Hinkkanen, Ville Kärpijoki, Ari Laine, Timo Löfgren, Jarmo Nummenpää, Liia Pienimäki
EUR 861 spent on treatment per resident on average in 2011.
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HUS annual repor t 2011
A busy year, a new strategy
HUS wants to be a reliable partner
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he year 2011 was the busiest year ever in the history of HUS. More patients were treated than ever before: the number of individual patients treated was 466,665. In a new function, health centre emergency care services were provided to more than 50,000 individual patients. All indicators for volume of patient care showed an increase. The number of outpatient visits was 1,567,593, and the number of DRG treatment periods was 593,301. The annual total of DRG points, which reflects how demanding the activities are, increased by 5.6% on the previous year. The number of patients who had waited for treatment for more than six months remained close to zero, and the total number of patients queuing for treatment decreased by 23% in the year under review. The number of patients who had waited for an outpatient examination for more than three months also decreased significantly. The number of MRI and ultrasound examinations performed increased greatly, which cut down on their queuing times. The comparable growth of operating costs year-on-year was 4.8%. Invoicing from
the member municipalities increased by 4.7%, coming in at 2.6% over budget. Invoicing from clients other than member municipalities increased by 8%, which is a positive development. Nevertheless, the deficit for the financial period increased from the expected EUR 6 million to EUR 16 million due to the new recognition requirement for holiday pay imposed at the end of January 2012. An important achievement in 2011 was the hospital district strategy reform. The new strategy embraces the principles of the new Health Care Act that entered into force at the beginning of May 2011: a patient-oriented approach, quality and accessibility of treatment, highquality scientific research and teaching, partnership with primary health care, and efficiency and competitiveness. Key requirements for attaining the strategic goals set include a competent and motivated personnel, a balanced economy, well-functioning premises and equipment, creative management, and the confidence of the shareholder communities. The strategy contains 97 individual goals in all, which will be pursued during the years 2012 to 2016 through measures timetabled for each year and each level of the organisation separately.
t is the job of elected officials to make decisions based on proposals submitted to them and to supervise the smooth running of patient care. We also need to intervene if care chains or economic plans are not being adhered to. Now we have also been charged with the requirement of supervising co-operation between primary health care and specialised medical care. Being discharged from hospital is a critical point in a patient’s treatment. Enhanced further care to support convalescing patients must be provided at the municipal level, by local authorities. An efficient discharge process shortens transfer delays at all junctures. The operations of HUS are being closely scrutinised by the authorities and by the media. The conditional fine imposed in 2010 secured the availability of treatment to the level required by law a year ago, but in the spring the National Supervisory Authority for Welfare and Health (Valvira) announced that it was considering imposing a further fine for delays in examinations and treatment. HUS disputed the fine as being unfair, and eventually the decision was overturned. In spring 2011, the National Institute for Health and Welfare published statistics on patient queues by hospital district, which revealed that HUS was the best of Finland’s 20 hospital districts in this respect. HUS wishes to be an efficient and reliable partner to its member municipalities financially, too. The hospital district’s financial performance in 2011 was moderately good. According to the statistics of the Association of Finnish
Aki Lindén Chief Executive Officer
2011
Local and Regional Authorities, the cost of medical treatment per resident in the HUS catchment area has been and still is the lowest in the country. The productivity of HUS patient care has continued to improve. The Meilahti campus is now a highly challenging workplace, as the renovation of the Tower Hospital began last summer. Employees cannot have had an easy time coping with this, but patient care has never been compromised. The hospital sector is becoming increasingly networked, adopting new concepts and finding alternative service providers entering the field. In 2011, the decision was made to set up a limited liability company named Hyksin kliiniset palvelut Oy (HUCH Clinical Services) and to launch a Heart Centre. Patients will have full freedom to choose where to be treated as of 2014, which will change how hospital services are used. The Joint Authority is a good model for a smoothly running service organisation employing a large number of people. This kind of organisation cannot be run as a decentralised network. Billions of euros in savings cannot be squeezed out of Finnish primary health care and specialised medical care for funding the local government reform. The media maintain a continuous interest in conditional fines imposed because of treatment queues and in how patients are treated. There has also been a lot of news about HUS finances, and positive news at that. Working with both the authorities and the media has been gratifying. Ulla-Marja Urho Chairman of the Executive Board
HUS IN BRIEF The Hospital District of Helsinki and Uusimaa (HUS) is the largest hospital district and the second largest employer in Finland. HUS provides specialised medical care services for the more than 1.5 million residents of its 26 member municipalities. HUS also has nationwide responsibility for certain specialised medical care services such as organ transplants. Nearly half a million patients are treated each year at the 21 HUS hospitals. The operating income of the Joint Authority is more than EUR 1.6 billion. HUS employs more than 21,000 health care professionals. In addition to the HUS Joint Authority, there are also independent limited liability companies in the HUS Group.
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HUS annual repor t 2011
RECORD NUMBER OF PATIENTS TREATED IN 2011 In 2011, more patients were treated than ever before in the Hospital District of Helsinki and Uusimaa. Nearly half a million Finns used HUS services in the course of the year.
M
466,665
The number of individual patients who used HUS services in 2011 was 466,665.
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ore patients were treated than ever before at HUS in 2011. A total of 466,665 individual patients used HUS services, compared to 456,591 in 2010. Adding to this the visits to health centre emergency care services handled by HUS brings the patient total to nearly half a million. In other words, one in three residents of the HUS catchment area used services provided or organised by HUS in 2011. This represents an increase of 5.9% on the previous year. In specialised medical care, the trend is from inpatient care towards outpatient care. The number of outpatient visits recorded in 2011 was 1,567,593, an increase of 2.7% on the previous year. Correspondingly, the number of inpatient care days decreased by 10%. The number of referrals received by HUS also increased: in 2011, HUS received 256,089 referrals, an increase of 2.9% on the previous year. Of these referrals, 60% came from health centres. Referral processing times were shorter on average than in the previous year. HUS had brought patient queues under control by the end of 2010, and this positive trend continued in 2011. The number of patients who had been waiting for treatment for more than six months was 128 at the end of the year. The number of patients who had waited for an outpatient examination for more than three months also decreased significantly. This queue
stood at 1,132 patients at the end of the year, as opposed to 2,803 in 2010. Increased costs A busy year also meant higher costs. Operating costs increased by more than anticipated, 4.8% on the previous year. The financial statements show a deficit of EUR 16.1 million. The largest part of this deficit (EUR 10.2 million) was created by the recognition after the fact of holiday pay in the financial statements for 2011. Not only did the number of patients increase; the percentage of demanding and expensive treatments rose sharply. For instance, organ transplants were performed on a record 275 patients. There was a particularly high number of liver transplants. Lung transplants, rare earlier, were performed on no fewer than 23 patients. Helsinki University Central Hospital (HUCH) has national responsibility for organ transplants: all other hospital
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2011 H US annual repo r t
districts send their transplant patients to Helsinki. The costs of specialised medical care are assessed on a perresident basis, the figure for the HUS catchment area being EUR 861 per resident. This represented an increase of 0.4% on the previous year. New strategy completed Preparation of a new strategy was begun at HUS in spring 2011. A wide range of HUS employees and shop stewards contributed to the drafting of the strategy. The HUS strategy had to be revised because the operating environment in health care had changed, introducing new areas of responsibility. Forthcoming changes to the structure of local government will also have an impact on HUS operations. The new strategy, confirmed by the HUS Council in October 2011, will govern the hospital district’s activities for the next five years, 2012–2016.
HUS annual repor t 2011
The strategy focuses on the patientoriented approach. It incorporates 97 goals, of which 16 are designated as key goals for 2012. HUS values were defined as: human equality; patient-oriented approach; creativity and innovation; high quality and efficiency; and transparency, trust and mutual respect. Hyksin Oy founded In October 2011, the HUS Council decided to set up a clinical services company, Hyksin kliiniset palvelut Oy. The purpose of this limited liability company is to provide treatment for patients whose care is paid for either
by the patients themselves or their employer or insurance company. The company may also treat foreign patients. Ownership of the company is divided into holdings as follows: HUS will own 70% of Hyksin Oy shares, the Orton Foundation will own 20%, and the Varma pension insurance company will own 10%. The limited liability company has a Board of Directors with representatives of HUS employees and shop stewards, other shareholders and the City of Helsinki. At its first meeting, the Board of Directors decided to recruit a managing director for the company. Hyksin Oy rents its premises and equipment from HUS. Its personnel consists of HUS physicians and nurses who work for the company in their spare time. The intention is for Hyksin Oy to focus its activities on evenings and weekends, when HUS premises and equipment are less used.
Tower Hospital renovation started The renovation of the Meilahti Tower Hospital has been designated a strategic spearhead project in the HUS investment programme. Work on the Tower Hospital started in October 2011. Before that, the entire enormous facility had to be evacuated. This move to temporary premises was a huge effort even by international standards. The exodus was begun at the end of 2010, when the Department of Medicine relocated to the newly completed Meilahti Triangle Hospital. The organ transplant unit also relocated there from the Surgical Hospital. At the same time, the urology clinic was relocated to Peijas Hospital in Vantaa. In April 2011, the breast surgery unit relocated from Jorvi Hospital to the Women’s Hospital. The space thus
Profit and loss account (EUR 1,000)
HUS HUCH
NordDRG products Inpatient day products Visit products Invoiced patient events Operations Births Number of individuals using HUS services (own activities) Hospital beds Number of staff Operating income, EUR million Operating expenses, EUR million Population of HUS area as at 31 Dec 2011 Member municipalities’ average contribution, EUR per resident
593,301 474,544 249,173 116,753 1,640,790 1,200,303 2,483,264 1,791,600 92,027 73,466 18,328 14,873 451,038 3,106
359,449 2,129
21,322 1,674.9 1,584.7
11,514 1,217.8 1,209.5
1,545,034
1,131,372
861.0
663.2
Financial statements 2007
Financial statements 2008
Financial statements 2009
Financial statements 2010
Budget 2011
Financial statements 2011
Operating income 1 404 447 totalt Sales proceeds 1 334 307 Payments income 50 240 Subsidies and grants 7 671 Other operating 12 229 income Operating expenses 1 320 542 total Personnel expenses 849 036 Purchased services 174 607 Materials, supplies 256 950 and consumables Subsidies 540 Other operating 39 409 expenses Operating margin 83 905 Financial income 10 152 and expenses 73 753 Result before depreciation and extraordinary items Depreciation and reductions in value 65 894 Annual result 7 859
1 490 522
1 547 869
1 584 430
1 617 306
1 674 917
3,6 %
5,7 %
1 425 532 49 328 7 028 8 634
1 479 476 52 874 6 256 9 263
1 512 931 56 916 5 873 8 710
1 546 450 56 281 5 599 8 976
1 598 822 57 052 9 822 9 221
3,4 % 1,4 % 75,4 % 2,7 %
5,7 % 0,2 % 67,3 % 5,9 %
1 405 882
1 451 925
1 485 920
1 520 974
1 584 651
4,2 %
6,6 %
893 934 195 499 274 248
922 647 201 406 285 544
953 389 202 978 287 606
980 651 207 894 287 854
1 009 998 219 299 310 422
3,0 % 5,5 % 7,8 %
5,9 % 8,0 % 7,9 %
546 41 655
553 41 775
443 41 504
475 44 102
875 44 057
84,4 % 0,1 %
97,5 % 6,2 %
84 640 11 831
95 944 13 759
98 510 13 599
96 332 15 273
90 266 12 793
-6,3 % -16,2 %
-8,4 % -5,9 %
72 809
82 186
84 911
81 060
77 473
-4,4 %
-8,8 %
75 521 -2 712
82 181 5
85 711 -800
97 667 -16 606
93 573 -16 100
-4,2 %
9,2 %
1 481 403
1 534 106
1 571 631
1 618 641
1 678 224
3,7 %
6,8 %
Total operating expen- 1 386 436 ses and depreciation
8
Key indicators in 2011
The company will begin to accept patients in autumn 2012.
Change %, Change %, Financial Financial stastatements tements 2011 2011 / / Financial Budget 2011 statements 2010
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HUS annual repor t 2011
Jäsenkuntien palvelutulot tulosalueittain
Service income income from member Service membermunicipalities municipalities Other service service and sales Other sales income income Special state state subsidies subsidies Special Payments income income Payments Other operating operating income income ans Other anssubsidies subsidies
Distribution of the operating income of HUS Joint Authority in 2011
10
Investoinnit ja poistot 2007 - 2011
160 140 120 100
2007
2008
50 45 40
2009
Loan portfolio
Debt portfolio and equity ratio 2011
2010 Gearing ratio
2011
120
55
35
80 80
95 94
180
Investoinnit ja poistot 2007 - 2011
120
113
60
86
200
95 94
Psychiatry tends towards outpatient care Major structural reforms were made at the HUS Department of Psychiatry in 2011. Institutional care was downshifted, and resources were re-allocated to outpatient care. Once outpatient care becomes more developed and has more resources available, some inpatient wards can be closed down. The most significant change came with the dramatic reduction of beds at Tammiharju Hospital in the Hospital Area of Länsi-Uusimaa. After this,
109 113
78,6 %
78,6 %
86 82
14,8 % 14,8 %
Joint health centre emergency care services introduced at Jorvi Responsibility for the joint health centre
109
3,4 % 1,1 % 2,1 % 3,4 % 1,1 % 2,1 %
82
jakauma vuonna 2011
emergency care services at HUCH Jorvi Hospital were assumed by HUS at the beginning of 2011. The nursing personnel was provided by HUS, and the GPs were recruited from a private service provider through competitive tendering. The reason for setting up the joint health centre emergency care services function was that with this system triage and urgency assessments on patients can be planned more effectively. The joint service adopted a shared IT system, which has improved
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HUS-kuntayhtymän toimintatuottojen HUS-kuntayhtymän toimintatuottojen jakauma vuonna 2011
Tammiharju will only accept patients from its own Hospital Area and Swedish-speaking HUS patients. HUS advanced psychiatric rehabilitation was centralised at Kellokoski Hospital, which belongs to the Hospital Area of Hyvinkää. Previously, rehabilitation services had been provided at both Kellokoski and Tammiharju.
83 76
Distribution of the operating expenses of HUS Joint Authority in 2011
Kauniainen sub-area; and the Vantaa and Kerava sub-area. The Hospital Areas of Hyvinkää and Porvoo put their first-response care systems into place so promptly that they were able to launch the new system at the beginning of 2012. In Hyvinkää, these services are jointly provided by the Keski-Uusimaa Rescue Department and the personnel of Hyvinkää Hospital. In Porvoo, these services are provided by Itä-Uusimaa Rescue Services.
Assistive Device Centre introduced In December 2010, the HUS Executive Board decided to set up an Assistive Device Centre to cater to the entire HUS catchment area. Its purpose will be to provide the assistive device services required in the HUS catchment area and by HUS member municipalities and to outsource all assistive devices and maintenance services required. Preparations for the setting up of the Assistive Device Centre were carried out throughout 2011: The HUCH Assistive Device Unit and the Children’s and Adolescents’ Assistive Device Centre were incorporated into the new unit. The Assistive Device Centre will open at the end of 2012, and it will be expanded gradually.
90
Personnel expences Personnel expences Purchase of medical services Purchase of medical carecare services Purchase of other services Purchase of other services Medicines medical equipment Medicines andand medical equipment Other materials, supplies consumables Other materials, supplies andand consumables Other operating expences subsidies Other operating expences andand subsidies
66
3,4 % 3,4 %
New Act brought added responsibility The new Health Care Act that entered into force at the beginning of May 2011 brought new responsibilities to HUS. The Act stipulates, among other things, that hospital districts must provide first-response care services in their catchment areas as of the beginning of 2013. These services may be provided by the hospital district itself, organised in co-operation with local rescue services or outsourced from an outside service provider. The reform will improve patient equality and prompt access to treatment. Getting help will no longer depend on which municipality the patient happens to live in. HUS made preparations for the providing of first-response care services before the new Act had even entered into force. In January 2011, the HUS Executive Board decided that firstresponse care services in the area will be divided into seven sub-areas. The Hospital Areas of Hyvinkää, Lohja, Länsi-Uusimaa and Porvoo will manage first-response care services in their respective areas. The HUCH Hospital Area was divided into three firstresponse care sub-areas: the Helsinki sub-area; the Espoo, Kirkkonummi and
90
10,410,4 % %
Jarmo Patja and other medical device technicians repairing assistive devices at the new HUS Assistive Device Centre at Ruskeasuo.
66
63,7 %% 63,7
16,316,3 % %
Milj. euroa
2,8 2,8 % % 3,3 3,3 % %
Milj. euroa
HUS-kuntayhtymän toimintakulujen HUS-kuntayhtymän toimintakulujen jakauma vuonna 2011 jakauma vuonna 2011
194,7
Service income from member municipalities by profit area
177,1
HUCH Hospital Area Länsi-Uusimaa Hospital Area Lohja Hospital Area Hyvinkää Hospital Area Porvoo Hospital Area Group Administration
More than 3,000 service vouchers distributed HUS began to hand out service vouchers to cataract surgery patients in March 2011. The value of the voucher is EUR 660, and the price ceiling for cataract surgery performed by private service providers is EUR 750. The patient’s deductible is thus EUR 90 at most. The patient may select where to have the surgery from a list of service providers that have signed up as HUS partners. Seven private service providers have signed up to date. By the end of 2011, 3,407 service vouchers had been given out. The customer satisfaction survey indicates that patients have been highly satisfied with this solution. HUS, on the other hand, was able to cut down on surgical procedure queues.
189,6
2,8 %
monitoring but has not been wholly unproblematic.
138,7
77,8 %
4,8 %
vacated was occupied by the endocrine surgery unit leaving the Tower Hospital. In June, a completely new 120-bed ward hospital was completed next to the Tower Hospital. In the course of the year, it became apparent that the new ward hospital would not be able to house all of the units formerly occupying the Tower Hospital; more space was required. The surgery units that could not be relocated away from the Meilahti campus were housed in a wing of the Tower Hospital, while the remaining surgery units relocated to the Surgical Hospital, Jorvi Hospital and the Eye and Ear Hospital. The renovation of the Tower Hospital is scheduled to be completed in 2015. Its cost estimate is EUR 90 million. Other major projects in the HUS investment programme include developing patient information systems and ensuring sufficient radiation treatment capacity.
118,7
4,0 % 1,4 % 9,2 %
40
40 0
0
TP2007
2007
TP2008
TP2009
Investoinnit
2008
TP2010 Poistot
Investments
2009
TP2011
2010
2011
Depreciations
Investments and depreciation 2007–2011
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HUS annual repor t 2011
RECORD YEAR FOR ORGAN TRANSPLANTS A record number of liver and lung transplants were performed in 2011. HUCH is the only hospital in Finland that performs organ transplants, and its treatment results are among the best in the world: the five-year survival rate for transplant recipients is more than 80%.
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n 2011, 275 organ transplants were made at HUCH, including a record number of liver and lung transplants: 56 patients received a new liver and 23 received new lungs. There were also 177 kidney transplants, 18 heart transplants and one pancreas transplant. HUCH is the only hospital in Finland that performs organ transplants. Finland’s organ transplant record is of high international quality: the five-year survival rate for transplant recipients is more than 80%. The number of lung transplants in particular is increasing every year. As recently as in the 1990s, lung transplants had a poor reputation due to various complications and infections. Treatment outcomes have improved rapidly in the 2000s, and now Finland is a world leader in lung transplants. Other university and central hospitals in Finland now refer patients to a transplant more actively. “The process has improved hugely compared with where we started,” says specialist Pekka Hämmäinen from the HUCH heart and thorax surgery clinic. The process involves not only surgeons but a large number of specialists in various fields: respiratory specialists, organ transplant coordinators, radiologists, cardiologists, anesthesiologists, infection specialists and many nursing and rehabilitation professionals.
organ transplant at HUCH. When the Act on the Medical Use of Human Organs and Tissues was amended in 2010, this was expected to increase the number of donated organs by 10% to 15%. In Finland’s other hospital districts, the number of organ donors did indeed increase, but in the Hospital District of Helsinki and Uusimaa it decreased, and the number of donors nationwide remained the same as in previous years. In 2011, there were 92 brain-dead organ donors in Finland. The largest number of donated organs came from Turku University Central Hospital, from a total of 20 donors who provided organs for 57 different patients. The highest number of donations relative to the population of the catchment area came from Kuopio University Hospital, with 14 donors.
Shortage of donated organs At any given time, there are between 350 and 370 patients waiting for an
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New ventricular assist device improves patients’ quality of life Some two dozen heart transplants are performed at HUCH each year, and there are a further two dozen patients in the queue at any given time. For some of the waiting patients, heart failure may become life-threatening, and in such cases a ventricular assist device (VAD) is required. A VAD mechanically helps the heart to function and blood to circulate. In December 2011, the first ‘third-generation’ VAD was installed at HUCH. This differs from earlier models in terms of its mechanism and its size. The new VAD is no larger than a pacemaker and can be installed wholly within the pericardium. The VAD produces a constant flow, so the patient has no pulse. Because of its small size, the device can even be installed in child patients if they are aged 6 or more and weigh at least 15 kg. A VAD can be used in three different ways: “VAD treatment can be a stepping stone on the way to a heart transplant on the one hand or to full recovery on the other, or it can be a permanent treatment used instead of a heart transplant,” says Head of Department Karl Lemström from the HUCH heart and thorax surgery clinic. A VAD improves the prognosis and quality of life of patients waiting for a heart transplant. The patients’ quality of life, mobility and rehabilitation improve considerably because the patient can move around freely; the VAD batteries are light and can be carried in a bag. New research findings suggest that the risk of complications is lower with the new VAD compared to earlier models. However, the new VAD is only suitable for assisting the left side of the heart. When both sides of the heart need support, an older model must be used.
275
organ transplants in 2011.
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In the HUS catchment area, there were 16 donors. “What is crucial is that the donor hospitals actively identify organ donors. We need continuous training in all hospital districts to improve organ donor recognition,” says chief physician Helena Isoniemi from the HUCH organ transplant and liver surgery clinic.
Organ transplants are expensive, but with the treatment outcomes achieved nowadays they can guarantee many years of a goodquality life to the recipient. Kidney transplants are the most cost-effective of all when the costs of the transplant are compared to those of prolonged dialysis treatment.
Kari Koljonen from Kangasala, who suffered from chronic obstructive pulmonary disease, received a new pair of lungs in autumn 2011. “It was incredible to discover that I could breathe properly again,” Koljonen said happily after the operation. In addition to Koljonen, 22 other patients received new lungs at HUCH in 2011. Nexhat Ahmeti (left) and Timo Nieminen were discharged from the Meilahti heart surgery ward wearing new ventricular assist devices on their belts.
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Dad gave his kid a kidney Topi Konttas donated a kidney to his son Runo in March 2011. Children’s organ transplants have been performed at the Children’s Hospital for 25 years, and the results have been excellent. In addition to Runo, 20 other children received a new organ in 2011.
21
children received an organ transplant in 2011.
16
Runo Konttas, now 2, was only a few weeks old when he contracted hemolytic-uremic syndrome (HUS) caused by EHEC bacteria. He was hospitalised first at Vaasa Central Hospital and then at Tampere University Central Hospital, and eventually ended up at the HUCH Children’s Hospital, where he remained for months. The condition damaged his kidneys, and he required dialysis treatment. His family were given training in how to perform peritoneal dialysis at home. Even after being discharged, he had to return to hospital periodically for hemodialysis. “We flew from Vaasa to Helsinki three times a week for the dialysis,” says Topi Konttas. After several months of this, a transplant was suggested; the Konttas family decided to go with a donation from a family member. The father turned out to be the most suitable donor. Topi never hesitated to donate a kidney despite the risks involved, as he is intimately familiar with organ transplant surgery through his work as a nurse at the anesthesia and operating unit at Meilahti Hospital. The donor surgery and the transplant to Runo in March 2011 went well. The boy spent four weeks in hospital recovering. Majority of transplanted organs are kidneys As with Runo, the first organ transplant to a child ever performed in Finland was a kidney transplant. Even today, the
majority of children’s organ transplants are kidney transplants, which has been the case throughout the 25-year history of organ transplants at the Children’s Hospital. In 2011, there were 21 children’s organ transplants, more than half of them kidney transplants. “Today, the survival rate for child patients is 80% to 95%, and they generally continue to grow and develop normally after the surgery,” says Head of Department Hannu Jalanko from the children’s organ transplant clinic. In 2011, the number of children’s organ transplants performed in Finland exceeded 400. Organ transplants are generally performed on children for different reasons than on adults. They are often motivated by a congenital defect or illness, in which case the need for a transplant becomes evident during the first months of life. At HUCH, children’s organ transplants are concentrated at one department and with one highly specialised team of surgeons, anesthesiologists and pediatricians. “We have been pleased with this arrangement. This concentration has helped accumulate experience and expertise,” says Jalanko. Major shift of values Runo’s condition shifted the value base of the Konttas family. Ear infections seem like no big deal now, and there is joy in every good moment of every day. Looking at how energetic Runo is, one could hardly imagine what he has been through in the early stages of his life. Anti-rejection drugs and regular checkups are a part of the family’s life, which is otherwise fairly normal. “When everything suddenly turns upside down, you look at life from a different perspective. There were a lot of different emotions along the way, including fear, but we tried to stick together through the difficult times,” says Topi Konttas and adds: “When we left hospital, we were very happy that everything had gone so well and that our child had recovered.”
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HUS annual repor t 2011
From chopper to scalpel
18,606 BABIES In 2011, there were fewer births in the HUS catchment area than in the previous year. Only Lohja Hospital recorded an increase in the number of births on previous years. This is partly because following the closure of the Tammisaari Maternity Hospital, many mothers in Länsi-Uusimaa have chosen to have their baby at Lohja.
pregnant women from Länsi-Uusimaa were directed to HUCH,” says Head of Department Anna-Paula Sariola from Lohja Hospital. Lohja Hospital managed 989 births in 2011. This was also the first full year of operation for Vaava, the neonatal monitoring ward at Lohja Hospital. The ward recorded 111 treatment periods during the year. “Vaava has clearly reduced the need for transferring infants to HUCH for treatment. Without this facility, we would probably have had to transfer 50 to 60 of these infants,” says Sariola.
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Babies born in temporary premises The renovation of the maternity and neonatal ward at Lohja Hospital began towards the end of 2011. It is scheduled to be completed in just over one year. In the meantime, births are managed in temporary premises nearby. The rooms that will be used by the gynecology outpatient clinic and for surgical procedures are already completed, and they are being used as delivery rooms during the renovation. “The maternity and neonatal wards will be modernised in the renovation.
he last baby delivered at the Tammisaari Maternity Hospital of Länsi-Uusimaa Hospital was born at the end of May 2010. When the closure was planned, it was thought that pregnant women would go to Lohja and to the HUCH maternity hospitals to give birth. The popularity of the maternity ward at Lohja Hospital was a positive surprise: nearly two out of three pregnant women in Länsi-Uusimaa chose to go to Lohja Hospital. The rest went to the HUCH maternity hospitals. “Lohja Hospital is what is known as a low-risk maternity hospital, so some
The gynecology and pediatrics outpatient clinics will be renovated in the second stage. At that point, we will need to make operating changes,” says Anna-Paula Sariola. Fewer babies at Kätilöopisto Maternity Hospital In 2011, a total of 18,606 babies were born in the Helsinki and Uusimaa Hospital District. There were 18,328 births at the six HUS maternity hospitals. The number of births was down by 333 on the previous year, and the number of babies was down by 369. The number of births increased by 59 at Lohja Hospital and decreased by 113 at Kätilöopisto Maternity Hospital. At the other HUS maternity hospitals, the number of births remained more or less the same.
“Meilahti reading you loud and clear, come on down! The helipad is clear.” Rescue helicopters were first welcomed to the new helipad at Meilahti Hospital at the end of September 2011. Built on the roof of the Triangle Hospital, the helipad has lift access directly to the operating rooms. Some 200 patients are brought to Meilahti Hospital by helicopter each year.
Births by hospital 2011 Kätilöopisto Maternity Hospital 5,768 Women’s Hospital 5,641 Jorvi Hospital 3,464 Hyvinkää Hospital 1,656 Lohja Hospital 989 Porvoo Hospital 810
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The Helsinki and Uusimaa Hospital District recorded 369 fewer babies born than in the previous year. 18
Katri Alén and Ismo Loskin from Nummela went to Lohja Hospital for the birth of their son.
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HIGH-QUALITY RESEARCH IS A REQUIREMENT FOR GOOD MEDICAL CARE Finnish clinical medical research is among the finest in the world. HUS is introducing research financing in order to secure patient diagnosis and treatment using the latest methods.
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innish clinical medical research is of a very high quality. A comparative study published a few years ago showed that Finnish clinical medical publications were referred to more often on average than clinical studies from any other country. The Helsinki Academic Medical Centre, formed by HUS and the University of Helsinki, undertakes a large portion of the medical research done in Finland: almost as much as all the other university hospitals combined.
The Meilahti research community is at the cutting edge by international standards. By the number of references, the Helsinki Academic Medical Centre ranks fifth in Europe – behind institutions such as Oxford and Cambridge. High-quality scientific work lays the foundation for high-quality patient care, because there is an undeniable link between the quality of clinical research and the quality of specialised medical care services. One of the goals stated in the HUS strategy adopted in 2011 is research that, when successful, leads to fundamental new knowledge, improved diagnostics and better patient care. However, the potential for clinical medical research has declined, for instance because government funding has been radically cut. To correct the situation, HUS introduced research funding in its new strategy, and an appropriation for research is already included in the budget for 2012. This was a historic decision: no hospital district had ever before set aside funding specifically for research. In practice, this decision will translate into better diagnostics and treatment. HUS scientists win awards HUS scientists engage in a wide range of research, publishing nearly two thousand articles in scientific periodicals every year. Today, an Biobank operations give researchers access to high-quality tissue samples. The availability of samples for research purposes allows experts to develop more effective medical treatments in a shorter time than before. Senior Laboratory Technician Siv Knaappila removes a rack of tissue samples from a freezer at the biobank.
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A total of 119 HUS employees completed a doctorate in 2011, 67 of them physicians.
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increasing number of them are cutting-edge studies that aspire to the very highest elite of medical research. A case in point is the full-length article on stem cells published in Nature magazine by the working group headed by Professor Timo Otonkoski in 2011. HUS scientists also gained widespread international recognition last year. For instance, Ulf-Håkan Stenman, Professor of Clinical Chemistry, became the first Finn ever to receive the IFCC Distinguished Clinical Chemist award. Mikael Knip, Professor of Pediatrics, received a grant of about EUR 8 million for diabetes research from the National Health Institute in the USA. In another HUS first in 2011, Development Manager Riitta Meretoja was given the title of Docent of Nursing. Training numbers remain steady The numbers of physicians, dentists and nurses trained in the hospital district have remained more or less stable. The medical graduates from the University of Helsinki in 2011 comprised 119 Licentiates of Medicine, 27 Licentiates of Dentistry, 162 specialists in specialities represented in HUS, and 10 dental specialists.
A total of 119 HUS employees completed a doctorate in 2011: 67 physicians, seven dentists, one health scientist and 44 natural scientists. A total of 4,000 nursing students spent a total of about 19,000 weeks in training at HUS hospitals. Shortage of specialists is looming The ageing of the population and the increasing rate of retirement of specialists currently working have raised the spectre of a shortage of specialists in the HUCH expert responsibility area. A survey of specialist training needs up to 2025 conducted in 2011 showed that the specialist situation is still rather good. The numbers of trainees in most specialities proved to be consistent with demand, at least in the near future. The shortage of specialists is currently the most acute in psychiatry, physiatry and to some extent geriatrics too, where the shortage will become acute rather soon. In other fields, problems will not begin to emerge until the 2020s, so there is still time to do something about it. However, the number of specialists in itself will not solve all problems, since the smallest hospital districts in the HUCH expert responsibility area – Carea in Kymenlaakso and Eksote in South Karelia – already have significant problems with the availability of specialists.
Heart disease is an adulthood risk for those born prematurely A study that has lasted more than 30 years has been following the lives of small premature infants from incubator to adulthood. In 2011, it was found that some of those born prematurely might be at risk of neuropsychiatric symptoms, cardiovascular diseases and osteoporosis in adulthood. About 6% of Finns are born prematurely, i.e. with a birth weight of less than 2.5 kg. One in six premature infants are even smaller than that, weighing less than 1.5 kg. The first generations of those who survived premature birth thanks to modern intensive care have now reached adulthood. Last year, two doctoral dissertations focusing on the lives of small premature infants were completed. Sonja Strang-Karlsson, who is specialising in pediatrics, studied the cognitive skills and characteristics of persons born prematurely. Pediatrician Petteri Hovi focused on risk factors for cardiovascular diseases and osteoporosis. The subjects of both their studies are participants in the monitoring study on small premature infants, which was launched in 1978. This monitoring study was initiated by Anna-Liisa Järvenpää, a pediatrician at the Children’s Hospital. The premature infants included in the study were born between weeks 24 and 36 of pregnancy. Premature infants are at risk of hypertension Petteri Hovi found in his study that, compared to the control group, those
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who are born as small premature infants tend to have a higher than average blood pressure, a lower insulin sensitivity and a lower mineral density in their bones when they reach adulthood. By contrast, no difference could be found in cholesterols, triglycerids or the endothelial function test, which measures how well the arteries are working, or in carotid artery wall thickness. “These research findings may indicate that small premature infants are at a higher risk than infants brought to term of developing type 2 diabetes, hypertension or a cardiovascular disease. They are also at a higher risk of osteoporosis and bone fractures later in their adult life,” says Petteri Hovi. He received the dissertation prize of the University of Helsinki for his study. Premature infants grow up to be morning people Studies of children born prematurely show that those born as small premature infants perform below average in cognitive tests. They also tend to have more ADHD symptoms and other neuropsychiatric disturbances in childhood than those who were born at full term. These differences, however, even out with age: “In studying adults who had been born as premature infants, we found that they perform somewhat less well in cognitive tests than the control group even in adulthood but that the incidence of ADHD symptoms decreases over time,” says Sonja Strang-Karlsson. “With small premature infants, intrauterine growth retardation would seem to be a greater risk factor for ADHD than premature birth in itself.” In the study, ADHD symptoms were noted more frequently in those children whose birth weight was lower than expected given the week of gestation.
Small premature infants may be susceptible to cardiovascular diseases and a number of other problems when they reach adulthood. Premature infants are cared for at the neonatal intensive care unit at the HUS Children’s Hospital.
On the other hand, people who had been born as small premature infants yielded interesting and very positive special characteristics. They smoked and used drugs less than the control group, and their diurnal rhythm seems to be earlier on average than that of the control group. Several dissertations and publications derived from the small premature infant monitoring study are in the pipeline for the years to come, and the project continues. “We are carrying out further research on the findings so far, but we are also formulating completely new approaches,” explains Sonja Strang-Karlsson.
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Stereo EEG helps locate severe epilepsy In 2011, HUS became the first hospital district in the Nordic countries to introduce stereo EEG examinations to help find epileptic loci; these examinations are performed jointly by the HUCH neurosurgery clinic and the Children’s Hospital epilepsy unit. The method is excellent for examining activity in the deep areas of the brain during an epileptic seizure. The examination yields a better image of the electrical networks in the brain and how seizures are propagated. Epilepsy surgery can be planned in more detail than before using the stereo EEG imaging. The method is helpful particularly for those patients with severe epilepsy for whom medication is not sufficient. Compared to earlier intracranial examination methods, stereo EEG is considerably less unpleasant for the patient: Instead of a massive cranial aperture, small boreholes are sufficient for inserting the electrodes. Also, the registration period can be extended from one week to anything up to four weeks with the new method. “We have a lot of patients with severe epilepsy for whom the pinpointing of epileptic loci with stereo EEG will be a huge benefit,” says specialist Atte Karppinen from the neurosurgery clinic. The neurosurgery clinic has also prepared for the introduction of deep brain stimulation (DBS) in the treatment of epilepsy. The equipment and methods used for DBS and stereo EEG are similar in their principles.
HUS infertility treatments concentrated at Women’s Hospital Demand for infertility treatments has increased steadily over the past ten years, as can be seen by the growing queues for outpatient appointments at HUS. Over the past two years, infertility examinations and treatments at HUS have been reorganised; for instance, outsourced infertility treatments were discontinued. Now all HUS infertility treatments are provided at the Women’s Hospital. “We no longer examine or treat infertility patients at Kätilöopisto Maternity Hospital. Jorvi Hospital still provides these basic examinations and treatment,
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but ovulation induction treatment and advanced infertility treatment planning were transferred to the Women’s Hospital,” explains Head of Department Aila Tiitinen. The numbers have grown substantially: the annual number of egg harvests was 376 in 2009 but had risen to 560 two years later. Over the same period, the annual number of frozen embryo transfers increased from 363 to 506. The Women’s Hospital is one of the largest infertility treatment facilities in Finland. The total number of visits to the outpatient clinic per year increased from just over
11,000 in 2010 to more than 14,000 in 2011. “The changes have been rapid, calling for quick action and planning on part of our staff. And it looks like 2012 will be even busier,” says Tiitinen.
560 egg harvests in 2011.
There is always room for improvement Waiting times to magnetic imaging at HUS Radiology shortened even though the number of examinations increased. At HUSLAB, processes were revised and the workplace environment cleaned up. Both enterprises employ the lean management principle of ‘more with less’. The outlook for public health care is troubled. “In the near future, we will have more and more patients but fewer nurses. We have to be more efficient,” says Tommi Jokiniemi, Development Manager at HUSLAB. Boosting efficiency has a nasty ring to it, but according to Jokiniemi this is not about working harder; it is about making distances shorter. A synonym for ‘lean’ is ‘thin’. If operations are thin, there is nothing unnecessary. It is about doing the right things at the right time. The lean management philosophy is based on continuous improvement of operations and producing added value for customers. HUSLAB and HUS Radiology have been going lean for some time now. And with good results, according to Jokiniemi and Esko Korhonen, project manager at HUS Radiology.
actually shortened, from five and a half weeks to four weeks on average. Performing the magnetic imaging examination and returning a statement on the images took five days on average last year; earlier, this process took two and a half weeks. “The point in lean management is that efficiency measures are planned and executed in situ, together with the department employees,” says Korhonen. The first priority in development is to change those things that can be changed immediately and that will have the greatest impact. All ideas are welcome. One substantial improvement in the magnetic imaging process was to ask patients to arrive for the examination 15 minutes before the assigned time. This allows time for signing in and preparing for the procedure, and hence means less waiting for the patient and more efficient use of the expensive equipment. “It is all about improving customer satisfaction and making our job easier. We don’t change things for the sake of
changing them; we change things to make them simpler,” notes Korhonen. Philosophy of continuous improvement Tommi Jokiniemi observes that specialised medical care has not been considered as an overall service chain from the patient’s perspective. The medical procedures are honed almost to perfection, but in between procedures there may be unnecessary waiting. “We have been working to improve our operations for some 20 years, but the focus has been on managing the examinations. The priority now should be to make the entire service chain more agile,” says Jokiniemi. Following lean management principles in the reception of samples at the Meilahti laboratories, unnecessary items were removed and frequently used ones were made more readily available. The entire workplace environment became clearer. Jokiniemi and Korhonen believe that the entire hospital district would benefit from introducing lean management.
Shorter waiting times to magnetic imaging In 2011, the number of magnetic imaging examinations at HUS Radiology increased by 17% on the previous year. But thanks to lean management development, patient waiting times Lean management lead to HUS Radiology patients being invited to arrive for examinations 15 minutes before the assigned time. This allows time for signing in and preparing for the procedure, and hence means less waiting for the patient and more efficient use of the expensive equipment.
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CANCER TREATMENT WITH WORLD-CLASS PERFORMANCE Major strides were taken in cancer treatment and research in 2011. A hematology biobank was set up at HUCH, a new and more versatile radiology device was acquired, and the cancer research conducted by Academy Professor Heikki Joensuu attracted considerable attention worldwide.
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he newest addition to the radiology arsenal at the HUCH oncology clinic enables more precision in cancer treatments, sparing healthy tissue. A high-end tomography function is a standard feature on the device. “With a 3D image of the patient’s anatomy, we can pinpoint radiology treatment regardless of where in the body we need to aim it,” says Senior Physicist Mikko Tenhunen. The properties of the new radiology device will be leveraged mainly in the treatment of brain tumors, minor lung tumors and other minor tumors. “We have the first linear accelerator in Finland with a robot table that corrects rotation errors,” says Tenhunen. The magnetic resonance simulator, meanwhile, enables precise imaging while the patient is in the position for radiology treatment. The device is used particularly for the treatment of cancers in the head, neck and pelvic areas, and for prostate cancer. “Our magnetic resonance simulator is the first new-generation device based on scanning tunnelling in Europe,” says Tenhunen with pride. Radiation therapy delivered as chemotherapy In isotope treatment, the patient is given a compound that seeks out cancer cells and has an attached
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isotope the radiation from which damages the cancer cells, delivering a strong local radiation dose. Two new isotope treatments were introduced at the oncology clinic in 2011: lutetium octreotate radiopeptide treatment for neuroendocrine tumors and selective internal radiation therapy for liver metastases. Octreotate is a somatostatin analogue that is attracted to the surface of neuroendocrine tumors. “Previously, if patients required this treatment we had to send them to Uppsala, but now our clinic can provide this to patients from all over Finland,” says Head of Department Hanna Mäenpää. Selective internal radiation therapy (SIRT) is used when a patient has a cancer that has metastasised only to the liver and is inoperable. SIRT involves injecting microspheres coated with yttrium into the blood vessels supplying the tumours. The microspheres block the blood vessels, while the yttrium delivers radiation locally to the cancer cells. Liver metastases may occur in patients with colon cancer, choroidal melanoma or hepatocellular carcinoma. “New chemotherapy drugs were also introduced, so we are confident that our treatment outcomes will remain at the top of the world league,” says Petri Bono, Chief Physician of the Clinic Group of Oncology.
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In 2011, HUS Radiology became the first unit in Finland to introduce a device that can remove small tumours from the breast in a procedure similar to a needle biopsy. The procedure is simpler than ordinary surgery, lasts no more than half an hour and can be done under local anesthetic. The patient can be discharged on the same day.
The newest statistics show that the clinic’s five year survival rate even for high-risk breast cancer patients is 90%. Biobank improves treatment outcomes for blood disorders In 2011, HUCH began collecting tissue samples from patients with
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The five-year survival rate for high risk breast cancer patients is 90 %.
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blood disorders for the Finnish Hematology Register and Biobank (FHRB) together with the Finnish Institute for Molecular Medicine (FIMM) and the Finnish Red Cross Blood Service. Initially, blood and bone marrow samples are being taken from patients with blood
disorders who have particularly poor prognoses. Successful treatment of leukemias is increasingly based on finding an individual drug therapy suitable for the patient. This depends on information on the genetic defects causing the particular type of cancer in question
or other distinguishing features of the cancer cells being found early, at the diagnostic stage. “Our goal is to double or triple the number of surviving patients with recurring acute leukemia,” says Chief Physician Kimmo Porkka. The tissue samples are frozen to -180 degrees using liquid nitrogen. Initially, the biobank will have space for 400,000 samples, but the facility can be expanded to accommodate 1.2 million samples. HUS is funding the handling and archiving of biobank tissue samples at the hematology clinic. FIMM is in charge of the storage and management of the hematology biobank tissue samples. The Blood Service is responsible for the transport and handling of samples nationwide. The FHRB combined with the hematology register is the first Finnish tissue bank set up pursuant to the proposed Biobank Act and one of the first such national projects in the whole of Europe. Geriatric oncology developed A geriatric oncology outpatient service was set up at the oncology clinic in 2011 to specialise in the treatment of elderly cancer patients. With the ageing of the population and cancer becoming more common, the percentage of elderly people among cancer patients will increase. In 2011, one in four patients at the oncology clinic was aged 75 or more, and one in ten was past 80. In this age group, the incidence of the most common cancer types (prostate cancer, breast cancer and intestinal cancers) is increasing the most. Patients over the age of 80 who come to the geriatric oncology outpatient service for evaluation of chemotherapy are referred to an oncologist and a geriatrician. Half of the patients thus evaluated were started on cytostatic drugs. “Initial experiences of this service are positive. We need a service like this, because a significant percentage of our elderly patients are well enough to receive treatment, and they benefit from a geriatric evaluation,” says Chief Physician Tiina Saarto.
Historic achievement of Heikki Joensuu Academy Professor Heikki Joensuu has been one of the brightest lights in clinical cancer research worldwide for a long time. His research on gastrointestinal stromal tumours (GIST) and breast cancer has raised him to the top of his profession. He focuses specifically on cancer mechanisms and predictive factors. Heikki Joensuu made history in oncology by being the first in the world to treat a GIST patient with a smart drug called imatinib. He also initiated research into the use of imatinib as a post-operative adjuvant treatment for GIST. This research showed that a three-year adjuvant treatment using imatinib considerably reduced the risk of recidivism in patients estimated to have the highest such risk. Heikki Joensuu presented these findings as the keynote speaker at the world’s largest cancer conference. The method he studied has already been approved as a standard treatment in the USA. The research conducted by the Finnish breast cancer team led by Joensuu are also at the top of their field. Joensuu was the first in the world to study the use of trastuzumab as an adjuvant treatment for a short, nine-week period together with cytostatic treatment. Combined with cytostatic drugs, trastuzumab can prevent recidivism in about one in three cases of breast cancer. This smart drug treatment may become the new standard for HER2positive breast cancer worldwide. At the moment, trastuzumab treatments are being explored at 70 hospitals in a study co-ordinated by Joensuu. Joensuu has headed the oncology clinic since 1994 and is currently a Research Professor with the Academy of Finland. He has been doing cancer research for 25 years.
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PSYCHIATRY GOES ONLINE HUS continued to pursue its tried and tested policy in psychiatry in 2011. Outpatient care was increased throughout HUS, and hospital beds were reserved for the most difficult cases only. As a result, an increasing number of psychiatric patients are receiving outpatient care, and access to treatment is now faster.
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rgent cases are admitted to the outpatient clinic immediately. It used to be the case that in non-urgent cases patients had to wait for up to two months, but now adult patients at Jorvi and Peijas can get an appointment in two weeks,” says Grigori Joffe, Head of the HUCH Department of Psychiatry. Over three years, some 130 employees have been transferred to outpatient care. The HUCH outpatient clinics, which used to be at several small units, were concentrated at four locations. According to Joffe, there were no cost impacts from this. “With thin outpatient care and long waiting times, many patients have had a difficult time coping. All too often they have ended up in hospital even though they could have done very well with outpatient care, if properly managed. This is wrong, in both human and economic terms.” Some employees have called on their patients at home or at school. The guiding principle in mental health work is early intervention, by going to the persons who need help.
the entire Helsinki region: Espoo, Kauniainen, Kirkkonummi and parts of Helsinki. Initially, the portal only contained information on psychiatric care in Keski-Uusimaa, Kerava and Vantaa. A patient entering the portal first has to enter his or her place of residence. Then the portal asks the patient what the problem is and refers him or her forward. There are six degrees of symptom severity: at level 3, the patient is referred to a health centre, and at level 6 to a hospital emergency clinic. In case of substance abuse, however, the correct address is an A Clinic.
Help is online The Mielenterveystalo (Mental Health House) online portal contains information and shows where to find help. Soon it will be able to convey psychiatric care as well. In 2011, the Mielenterveystalo portal was expanded to cover
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The portal covers the principal categories of mental health problems: substance abuse related disorders, psychotic and mood disorders, anxiety disorders and personality disorders. “The idea here was to create a consultant service that can tell the patient where to go,” says Joffe. The National Institute for Health and Welfare (THL) awarded its TERVE-SOS prize 2011 to the Mielenterveystalo portal. The jury noted: “This service is exactly what users need. Customers are able to find high-quality information and service advice themselves, which reduces confusion, waiting in lines and getting lost in the network of services.” The doctor will see you now Video consultations cut distances and make psychiatrists more accessible, for instance at a consultation room at a health centre. In these cases, the patient talks to the psychiatrist over a video link and is accompanied by a nurse in the same room. In other words, the patient and a nurse sit in a room with a videoconferencing facility. The psychiatrist sits in a similar room somewhere else. “The conversation usually begins with the psychiatrist talking about the video equipment and asking how the patient feels to be sitting on the other side of the screen. It usually picks up quite well from there,” says Assistant Chief Physician Pekka Jylhä. Jylhä is employed at the outpatient clinic in Leppävaara but has been seeing six patients at Kirkkonummi health centre by video link. He considers that many patients are more comfortable with a video consultation than with a traditional appointment,
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Mobile psychiatry in Tammisaari A mobile psychiatry unit has been set up in the Länsi-Uusimaa Hospital Area. It involves employees in acute, rehabilitative, geriatric and youth psychiatry working together with other local service providers. The aim is to reduce the need for psychiatric hospital care. Patients are treated at home and at other care units instead of at hospital. The treatment includes traditional methods and also networking. Working with primary health care is very important in this effort.
Children’s psychiatry deployed in Porvoo Preparations were made in the Porvoo Hospital District for the deployment of children’s psychiatry beginning in 2012. A working group was set up for the purpose, for instance to help children whose anxiety is so great that they cannot attend school at all. The working group consists of an occupational therapist, a psychologist, a social worker and a nurse. They give help where it is needed: in families, at schools and at day care centres. There are many children from the Helsinki metropolitan area in foster care in and around Porvoo. The working group also supports foster family members. A working group that makes home visits to families with infants was set up in 2011.
as they do not have to travel from Kirkkonummi to Leppävaara. Video consultations have been done in Vantaa in addition to Espoo. In autumn 2011, video consultations were extended to youth psychiatry at HUCH. “The teacher, the young patient and the parents are at the school, and our employees are at the outpatient
employees in the Department of Psychiatry have been transferred to outpatient care over the past three years.
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clinic for the video consultation,” says project co-ordinator Anne Rissanen from the Valo project. The Valo project, run by the HUCH Department of Psychiatry, is part of the Key to the Mind project for developing mental health and substance abuse services in Southern Finland. The HUS Mental Health House portal: mielenterveystalo.hus.fi
OBESITY WEIGHS HEAVILY ON THE MIND
Obesity has become a major public health issue and a burden on the national economy. Obesity increases the risk of chronic disorders that often require extensive hospitalisation and medication.
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n the HUS catchment area alone there are 34,000 overweight people of working age who have diabetes, and a further 63,000 overweight people have an elevated risk of developing diabetes. Within one year, 4,400 of them will have developed diabetes if they do not lose weight. Even a weight reduction of as little as 5% would reduce the number of those developing the disorder by two thirds. Resources for addressing obesity should increasingly be targeted at preventive and conservative care, which is considerably cheaper than obesity operations. The treatment costs for the 630 patients who attended weight control groups in 2011 were EUR 126,000, whereas the treatment costs for the 260 patients who underwent obesity surgery were EUR 3.3 million. The surgical treatment for obesity is a gastric bypass procedure. In 2011, 65 more such procedures were performed
in HUS than in the previous year: 260 as opposed to 195 in 2010. Towards the end of 2010, HUS investigated the treatment practices and resources addressing obesity in primary health care in its area. It was found that the group treatments offered for obesity by health centres were of a high quality, but that only seven out of the 26 HUS member municipalities offered such services. Patients admitted to these groups had symptoms of metabolic syndrome, decreased sugar tolerance, hypertension or a fatty acid metabolic disorder. “It is difficult for healthy overweight people to gain access to these groups, even though they are the ones who would benefit the most from weight loss. For overweight people, the risk of developing type 2 diabetes is between 10 and 30 times higher than for people of normal weight,” says Kirsi Pietiläinen from the HUS obesity research unit. Lifestyle guidance, if begun in time,
planned well and implemented over several sessions – preferably in a group – would prevent overweight people from gaining more weight and thereby reduce the number of patients ending up having to have obesity surgery. Occupational health care and health centres play a crucial role in this, and HUS co-operates closely with these services. HUS is also working towards setting up a centre of expertise in obesity care to manage treatments for morbid obesity and consequent disorders, and to co-ordinate municipal care and training. In 2011, HUS organised weight control group instructor training for health care professionals from 14 municipalities. The health promotion unit has also been involved in planning obesity treatment service chains in the Tehokas planning group, whose spearhead project focused on exploring obesity treatment chains in the city of Helsinki.
DISORDERS ASSOCIATED WITH OBESITY
Depression, dementia
Cerebral infarction Sleep apnea
Asthma Pulmonary embolism
Coronary heart disease,
Attention is being paid in health promotion to key groups of endemic diseases: arterial health, with spearhead projects on obesity and diabetes mental health and substance abuse musculoskeletal disorders and injuries infections, with spearhead projects on chronic obstructive pulmonary disease, asthma and hygiene
atrial fibrillation Fatty liver disease Gall bladder and pancreatic disorders,
Diabetes Hypertension
kidney disorders
Infertility Cancers: prostate, pancreas, uterus, Arthritis Venous thrombosis
ovary, kidney, breast, colon, esophagus, gall bladder; leukemia
Gout
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24 H CARDIOLOGY FOR HEART ATTACK PATIENTS In 2011, 613 cases of lifethreatening myocardial infarction caused by coronary embolism were treated in HUS. Of these patients, 71% were from the HUS catchment area, 26% from other hospital districts and 3% from abroad. HUS also handles heart attack patients from the Kanta-Häme and Päijät-Häme Hospital Districts outside normal clinic hours. A cardiologist and a nursing team are on call around the clock at Meilahti Hospital; this cardiology emergency care service has been in place for 10 years. In 2011, the HUCH cardiology clinic performed 4,560 coronary angiographies and 1,830 angioplasty procedures. Of these coronary angiographies and angioplasties, 64% were performed as emergency procedures due to acute coronary syndrome. At Peijas and Jorvi Hospitals, 35% of these procedures were emergency procedures. There is no cardiology emergency care service at Peijas or Jorvi. HUS has an impressive track record in treating heart attack patients. Effectiveness is measured by patient mortality within 12 months of hospitalisation. In 2009, one-year mortality was 17.2% in HUS, compared with 20% in the entire country.
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myocardial infarctions treated in 2011.
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A year of novelties in cardiac surgery
Heart valve defects can be corrected without cutting In April 2011, Finland’s first ever catheter procedure to correct mitral valve regurgitation was performed at HUS. Prior to this, the only option for heart valve defects had been open heart surgery, which is not suitable for everyone. The mitral valve is located between the left ventricle and left atrium of the heart. If it does not seal properly, blood can flow through the valve in the wrong direction. This causes shortness of breath and if untreated can lead to heart failure. In the catheter procedure used at the HUCH cardiology clinic, a clip about 1 cm long is delivered to the
heart through blood vessels and used to grasp the two leaflets of the mitral valve to bring them together. 3D ultrasound technology is used to facilitate the procedure. The patient is under general anesthesia during the procedure, and the only external mark left is an incision about 1 cm long in the groin. The patient is discharged from the Meilahti Hospital cardiology ward within a few days of the operation. It is estimated that 15 to 20 mitral valve repair procedures by catheter will be performed per year from now on.
The year 2011 was a year of novelties at the HUCH cardiac and thorax surgery clinic: the ‘home to operation’ procedure for cardiac surgery patients was introduced, and the first robot-assisted cardiac surgical procedures were performed. During this first year, almost 350 patients came to their cardiac operation directly from home. HUCH is pioneering the ‘home to operation’ procedure for cardiac surgery patients; so far no other university hospitals have introduced this system. “We save one hospital day by having the patient report to the
hospital on the morning of the day of the operation. This system has been a great help to cardiac surgery during the Meilahti Hospital renovation, because we are chronically short of beds in the temporary premises in the ward wing,” says Chief Physician Kalervo Werkkala. In principle, there is no reason why the majority of cardiac surgery patients could not walk straight into the operating room from the street; exceptions to this are urgent and emergency cases, which account for 20% to 30% of all operations. With the opening of the patient hotel,
patients travelling from further away can also wait until the morning of the day of the operation to enter hospital. One day before the operation, the patient is invited to a preoperative visit to meet a nurse, a physiotherapist, an anesthesiologist and the surgeon who will be performing the operation. Robot-assisted operations were introduced in heart surgery in spring 2011, beginning with mitral valve repairs and coronary bypass operations. “This is good for patients, because robot-assisted keyhole surgery instead of open heart surgery cuts down significantly on recovery time,” says Werkkala.
New treatment for severe hypertension A new catheter procedure was used to treat patients with severe hypertension for the first time in Finland at HUCH in 2011. In this intravascular procedure, sympathetic nerve hyperactivity around the renal arteries is inhibited. Some 3,000 patients have been treated with this procedure worldwide, and the results have been good. Apparently the kidneys perpetuate hyperactivity in the sympathetic nervous system, which contributes to hypertension. In this procedure, an intravascular catheter is threaded through the femoral artery in the groin to both renal arteries, and low radio frequency energy is fed into the catheter to inhibit the surrounding nerves. This catheter treatment of renal neural pathways lowers blood pressure, after which hypertension is easier to control with medication. This treatment also improves the patient’s blood sugar and insulin sensitivity. Hypertension is a problem for 1.5 million Finns. The new catheter method enables treatment of patients whose blood pressure is very difficult to control.
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MEILAHTI TOWER HOSPITAL VACATED The most modern hospital in Finland when it was completed in 1965, Meilahti Hospital was due for a comprehensive renovation and was evacuated in summer 2011. Patients were taken along as the departments moved from the Tower Hospital to temporary premises. The renovated Tower Hospital will be reopening in 2015.
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reparations for the renovation of the Tower Hospital actually began at the end of 2010 when the Triangle Hospital was completed on the Meilahti campus. The Department of Medicine relocated to the new building. At the same time, adults’ organ transplants were concentrated at Meilahti: the organ transplant, liver surgery and kidney transplant units that had been at the Surgical Hospital relocated to the Triangle Hospital and the Eye and Ear Hospital. The urological surgery unit had been relocated to Peijas Hospital earlier in autumn 2010. Accommodation in the ward wing The Tower Hospital was completely empty in summer 2011, and the renovation began in October 2011. The massive move over the summer affected the HUCH Department of Surgery in particular, most of whose functions are situated in the Tower Hospital near the operating rooms and the support functions for demanding treatment. The 24 h emergency clinic, operating rooms, recovery rooms and two intensive care units will remain at the foot of the Meilahti Tower Hospital for the duration of the renovation. Relocating an entire hospital was a puzzle with a huge number of moving pieces: to make room for vascular surgery at Jorvi Hospital, breast surgery had to be moved from Jorvi to the Women’s Hospital. In 2013, breast surgery will relocate again to the Surgical Hospital as the renovation and
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extension of the operating suite of the Women’s Hospital begins. To support surgical operations, a temporary ward wing was built beside the Triangle Hospital. It contains 120 beds, of which 100 are for surgical patients and 20 for neurological patients. Moves one year in the planning It took more than a year to plan the practical execution of the vacating of the Tower Hospital. Once the new locations had been worked out under the leadership of Caj Haglund, Head of the Clinic Group of Visceral Surgery, practical planning of all things great and small involved in the move began. The head nurses were key employees in the move. One of them, Margit Pesonen, was relieved of her other duties in order to be in charge of the day to day running of the move. “We approached the planning of the move by considering how we can uphold safe patient care, working conditions and hospital functions. By hospital functions I mean all the support services and numerous details that go into ensuring good patient care,” says Pesonen. Informing patients, stakeholders and HUS staff of the new locations was a huge effort. Patients were informed of the renovation in their letters of invitation to appointments. Information was also sent out to physicians who refer patients to HUS, to first responders, to taxis and to other partners. Employees have accepted the move and the temporary premises with equanimity.
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ORTHOPEDIC REFERRALS TO A SINGLE ADDRESS
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Nurse Auli Määttänen treated Ann Karkulahti in the newly-completed inpatient ward wing.
“Our highly competent staff can manage professional patient care wherever they are located,” says Anna-Maija Kaira, Head of the Ward Group in charge of the logistics of the move. “We pulled it off with the tenacity and organisational abilities of Finnish women.” Patients relocated with their departments Patient care was never discontinued because of the move; the patients who were at hospital on the day of the move were physically transported from the Tower Hospital to the ward wing along with the rest of their department. Scarcely any patients had to be transported to other hospitals; treatment was continued flexibly on neighbouring wards, and after the move day new patients were received at the temporary premises.
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The majority of the functions that vacated the Tower Hospital will move back in once the renovation is completed in 2015, though not necessarily to the same physical locations. In 2015, the country’s flagship hospital will have 18 operating rooms, about 22 recovery room beds, a 10-bed heavy duty intensive care unit, a 16-bed intensive care unit and a 10-bed surgery monitoring unit. It was already known when the renovation plans were being drawn up that during the renovation there will not be enough beds considering the number of surgical operations that are performed at Meilahti. The Operating Room Groups now have to cope with constantly changing surgical procedure plans due to beds filling up, and there will be much ambulance traffic between the Meilahti operating rooms, the Surgical Hospital and Jorvi Hospital.
EXODUS FROM THE TOWER HOSPITAL To the ward wing: cardiac surgery, thorax surgery, vascular surgery, emergency gastroenterological surgery and neurology To the Triangle Hospital: Department of Medicine, organ transplants and liver surgery To the Eye and Ear Hospital: kidney transplants and pulmonary medicine To the Surgical Hospital: elective gastroenterological surgery To Jorvi Hospital: some vascular surgery, endocrine surgery and some emergency clinic functions To Peijas Hospital: elective urology and emergency urology
he orthopedics, traumatology and hand surgery clinic set up a referral centre at Töölö Hospital for centralised processing of elective, i.e. nonemergency, referrals from the HUCH catchment area. The centre receives more than 20,000 referrals a year from health centres, occupational health clinics and private medical clinics. The centralisation has made the processing of referrals clearer while ensuring that referrals are sent to their correct destination as precisely and quickly as possible. The clinic operates not only at Töölö Hospital but also at Jorvi, Peijas and Herttoniemi Hospitals. Joint replacement surgery patients are also guided to Porvoo, Tammisaari and Lohja Hospitals through the referral centre. The new operating model has cut down the time between the receiving of a referral and its processing by a specialist while eliminating the majority of re-referrals due to incorrect forwarding of referrals, and also most of the shuttling of referrals between units. Now a specialist can review the referrals in his or her area of expertise quickly and efficiently, ordering further examinations as required or returning the referral with instructions. “We have received positive feedback from referring physicians. Now they only need to know one address for orthopedics in the HUCH catchment area for sending referrals,” says Chief Physician Jarkko Pajarinen. The referral centre also supports the guidance of surgical procedures within the clinic. “When the referral traffic can be monitored at a single address, we can temporarily change our in-house arrangements if the production capacity of any unit should suddenly change.” A job for experienced nurses The referral centre is run by a team of five experienced nurses. They each go
20,000 The orthopedics referral centre processed 20,000 referrals in 2011.
through one day’s worth of referrals at a time and divide them up for forwarding to various units based on the indications and the domicile of the patient. The team goes through about 100 referrals every day. “The appraisal of referrals and their forwarding to the correct unit requires
the nurses to have a high degree of professional expertise, experience and confidence; it is not always clear why a particular patient is being referred to us. The physician in charge at the referral centre decides on the referrals that are still unclear after the first review,” says Pajarinen.
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IMAGE OF HUS AS AN EMPLOYER IMPROVED HUS has more than 21,000 employees, the majority of them women. HUS is Finland’s largest municipal joint authority and also an attractive employer: in 2011, there were nearly as many applicants for vacancies as there are HUS employees.
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t the end of 2011, there were 21,322 HUS employees, of which 78.6% in a permanent employment relationship. Nursing staff accounts for 55% of the employees, and physicians for 13%. The remaining 32% is made up of other personnel and special employees. The average age of staff last year was 43.4 years. In 2011, HUS advertised 2,380 job vacancies and received a total of 20,579 applications. In October, HUS introduced a new online recruitment site known as Kuntarekry. This is used by some 500 HUS employees who recruit new staff.
Growth was sought in the percentage of permanent staff through a system of in-house substitutions. The demand for in-house substitutes was surveyed, the scope of the system reviewed, and the Executive Board signed off on increasing the number of posts available. Temporary agency labour was used to the tune of EUR 14.6 million, above all in HUCH youth psychiatry, radiologist services at HUS Radiology, and emergency care services in the hospital areas. Recruitment development, good and close co-operation with educational institutions and positive media exposure boosted the image of HUS as an employer. Indeed, HUS was the preferred employer most frequently spontaneously mentioned by physicians in an image study commissioned by Mediuutiset in the spring. In 2011, 6.7% more permanent employees left HUS than in the previous year. This increase cannot be explained by retirement alone: the number of retirees was 419, only four more than in the previous year. The leading cause for leaving HUS was resignation.
Key figures Number of personnel Permanent Temporary, of whom Substitutes Acting/interim appointments Short-term employees (1 to 12 days) Personnel by personnel group Nursing staff Physicians Other personnel Special personnel
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Introducing incentive bonuses Salaries and fees paid at HUS in 2011 totalled EUR 1,010 million, which was 3% over budget. EUR 10.2 million of this excess was caused by the amended provisions on holiday rights in civil servants’ and employees’ collective agreements. New incentive bonuses were introduced in 2011: the ‘Nopsa’ bonus, the performance bonus and the clinical service production effectiveness bonus. Workplace atmosphere survey bonuses and ‘wellbeing at work’ allowances were paid to the top unit to promote development of wellbeing at work and a positive workplace environment. Physicians made the most use of continuing professional education HUS has the stated aim of planning and monitoring continuing professional education according to national recommendations. A total of 64,582 working days were spent in Nurse Maija Rintamäki (left) entering patient data on a computer and head nurse Tuulikki Sarilahti advising nurse Shariar Mahmud in the emergency care department office at Meilahti Hospital.
2007 2008 2009 2010 2011 21,202 20,956 20,909 21,171 21,322 16,917 16,749 16,757 16,742 16,763 4,285 4,207 4,152 4,429 4,559 2,652 2,675 2,641 2,792 2,826 1,404 1,465 1,439 1,481 1,627 229 67 72 156 106 21,202 20,956 20,909 21,171 21,322 11,999 11,658 11,725 11,854 11,878 2,519 2,551 2,571 2,649 2,683 5,734 5,768 5,603 5,678 5,737 950 979 1,010 990 1,024
Key figures
2007
2008
2009
2010
2011
Average age 42.9 43.1 43.3 43.4 Women 43.0 43.3 43.5 43.5 Men 42.1 42.3 42.3 42.4 Permanent 44.9 45.1 45.3 45.5 Temporary/fixed-term 35.0 35.2 35.2 35.5 Gender distribution women/men, % 85.7 / 14.3 85.7 / 14.3 85.8 / 14.2 85.9 / 14.1 Turnover of paermanent personnel 6 7 6 6 Training days per person 3.4 3.5 3.4 3.7 Salaries and fees (excluding social security costs) as a percentage of operating expenses 52,3 52,0 51.5 52.4 Temporary agency work In EUR 11,695,000 16,024,000 16,700,000 13,500,000 In person-years 210 288 278 225
43.4 43.6 42.5 45.6 35.5 85,7 / 14,3 7 3.7 51.7 14,620,000 225
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20,579 people applied for a job at HUS in 2011.
training in HUS last year. As in earlier years, the focus in training was on continuing professional education. In 2011, every HUS employee who was at work spent an average of 3.7 days in training: the average figures per staff group were 8.8 days for physicians, 3.4 days for nursing staff, 1.8 days for other personnel and 5.7 days for special employees. Induction training for new supervisors was provided to three groups. A new three day course was designed for experienced supervisors and first given in autumn 2011. A total of 160 supervisors attended these courses. Also, all supervisors were offered a one day course on health economy, employment relationship basics, development discussions and the management of wellbeing at work. “Job satisfaction is being satisfied at work” The theme for wellbeing at work in 2011 was “Job satisfaction is being satisfied at work”. Measures to promote wellbeing at work were developed pursuant to the HUS wellbeing at work programme. These measures were presented at supervisor briefings and in training sessions on the management of wellbeing at work. HUS received an honourable mention in the ‘Most active workplace in Finland’ ranking for an excellently organised exercise programme to promote staff welfare. Absences due to illness per person remained at the same level as in the previous year. The largest number of
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days absent during to disability were caused by musculoskeletal disorders, accounting for one fourth of all days absent due to illness. The occupational health care service launched an extensive workplace survey and organised seasonal influenza vaccinations and monitoring of biological exposure. A total of 523 workplace accidents were recorded during the year, along with 443 reimbursed accidents on the way to or from work. The latter number increased considerably in early 2011, partly due no doubt to abundant snowfall and slippery conditions. Improved results in the Working Life Barometer The response rate to the Working Life Barometer was 69% in 2011. The number of respondents increased on the previous year. The results of the survey have improved year on year in the past, and the year under review was Henkilöstö henkilöstöryhmittäin 2010 4,7%
26,8% 56%
12,5% Nursing staff Physicians Other personnel Special employees
Personnel by personnel group 2010
no exception. According to the Barometer, immediate supervisors are respected and viewed as reliable, fair and supportive target-oriented leaders. There is still scope for improvement in giving feedback and in developing wellbeing at work. Responses from the various units differed somewhat from each other, but less so than in previous years. Efforts to improve the work of immediate supervisors have focused on supervisor training, communications and improving the flow of information. Ground rules have also been discussed. In addition to supervisor training, units have organised team training and launched a variety of wellbeing at work projects. Female-dominated and bilingual The purpose of the gender equality plan for 2010–2013 was to highlight equality measures already implemented. HUS is a workplace where the majority of employees are women – no fewer than 85.7%. About 40% of the HUS senior management positions are held by women. The pay differences between men and women in comparable jobs are reasonably small, and there is no immediate need to address this issue. HUS employees are encouraged to use both official languages, Finnish and Swedish. Language training is provided and language bonuses paid. Language ambassadors are recruited to give out information on the HUS language programme and to promote positive attitudes to bilingual operations.
Acute Hospital nearing completion in Hyvinkää In December 2011, the first stage of the Acute Hospital – an extension of the enhanced monitoring unit – was opened at Hyvinkää Hospital. Each year, some 700 patients are treated in the enhanced monitoring unit, originally built in 1977, and its new extension. The enhanced monitoring unit is for patients recovering from major surgery, patients with pneumonia or other severe infections, and patients with serious cases of poisoning. The Hyvinkää Acute Hospital will be finally completed in August or September 2012. 43
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ORGANISATION AND REPRESENTATIVE BODIES
HUS Representative Bodies 2012 Changes were made to HUS representative bodies as of the beginning of 2012 when two enterprises, HUS ICT and HUS Medical Engineering, were dissolved.
COUNCIL AUDIT COMMITTEE EXECUTIVE BOARD
The HUS Group comprises the Joint Authority, subsidiaries and associated enterprises. The highest decision-making power in the Joint Authority is exercised by the Council. The Executive Board is responsible for administration and finances.
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he HUS Group comprises the Joint Authority of the Helsinki and Uusimaa Hospital District, subsidiaries and associated enterprises. The Joint Authority is made up of five hospital areas: the Helsinki University Central Hospital (HUCH), Hyvinkää, Lohja, Porvoo and LänsiUusimaa Hospital Areas. The Joint Authority further includes seven business enterprises that provide support services, the Group administration and Property Management Services, which are separate profit areas. Council and Executive Board Supreme decision-making power in the Joint Authority is exercised by
21
The HUS Executive Board had 21 meetings in 2011. The Council met three times.
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the Council. The Executive Board is responsible for administration and finances. The Executive Board and the Business Division that reports to it steer the Executive Boards of HUS enterprises and subsidiaries. HUS is managed by a 17-member Executive Board appointed by and reporting to the Council. The University of Helsinki appoints two Board members. The Executive Board focuses on attaining the strategic goals of the Hospital District and on balancing its finances. The Executive Board held 21 meetings in 2011. The Council, on the other hand, had three meetings instead of the usual two. The extra meeting was in October to decide on the new HUS strategy and on the setting up of a limited liability company, Hyksin Oy, to run a private hospital. Boards Each of the five Hospital Areas of HUS is led by a Hospital Area Board appointed by the Council for the duration of its term in office. Directed by the Executive Board, the Hospital Area Boards manage the operations of their respective
hospital areas. Hospital Area Boards are also required to implement the Group strategy and to exercise financial control. They prepare matters concerning their respective hospital areas to be submitted to the Executive Board or the Council for decision-making and manage the implementation of those matters once decided. In accordance with Section 18 of the Act on Specialised Medical Care, HUS has a Minority Language Board appointed by the Council for the duration of its term. According to the Charter of the Joint Authority, the Board ensures that within the HUS area, each patient receives specialised health care services in their own language (Finnish or Swedish). The Psychiatric Board, appointed by the Council for the duration of its term, assists the Executive Board in the development and co-ordination of psychiatric health care. The Audit Committee is supervised by the Council; the Board prepares issues concerning the administration and finances for submission to the Council, besides estimating how well the operational and financial targets set by the Council have been attained.
Group division PSYCHIATRIC BOARD
MINORITY LANGUAGE BOARD
HOSPITAL AREA BOARDS
ENTERPRISE BOARDS
HUCH Hospital Area Hyvinkää Hospital Area Lohja Hospital Area Länsi-Uusimaa Hospital Area Porvoo Hospital Area
HUS Pharmacy HUSLAB HUS Radiology HUS Desiko HUS Logistics Ravioli HUS Servis
HUS Group 2012 The HUS organisation changed as of the beginning of 2012 when two enterprises were dissolved: HUS ICT was incorporated into the Joint Authority administration, and HUS Medical Engineering was merged into HUS Radiology. The leadership of all enterprises was redistributed among the Chief Medical Officer, the CFO and the Director of Administration. The term ‘Group Administration’ was replaced with ‘Joint Authority Administration’.
COUNCIL (59 members) AUDIT COMMITTEE EXECUTIVE BOARD (17 members) JOINT AUTHORITY ADMINISTRATION
CHIEF EXECUTIVE OFFICER
Administrative Chief Physician
CHIEF MEDICAL OFFICER
Hospital Areas Medical support services
HUCH
Hyvinkää
Porvoo
Lohja
LänsiUusimaa
HUS Radiology
HUS Pharmacy Assistive Device Centre
Department of Gynecology and Pediatrics Department of Surgery Department of Psychiatry
Communications Director
CFO
Director of Administration
Human Resources Director
Support services
Subsidiaries
Occupational health care service
HUS Desiko
HUS Real Estate Ltd.
HUS Servis
Uudenmaan sairaalapesula Oy
Ravioli
Housing and property companies
HUSLAB
Department of Medicine
Chief Execu- Audit tive Nursing Director Director
Information management
HUS Logistics Property Management Services
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2011 H US annual repo r t
HUS annual repor t 2011
Executive Board members in 2011
Council members 2009–2012 According to the Charter of the Joint Authority, the municipal council of each member municipality appoints 2–5 Joint Authority Council members and their personal deputies. The term of the representatives is the same as that of municipal council members. The number of Council members is determined in proportion to the core capital percentage contributed by each member municipality. A municipality whose core capital ratio is less than 8% of the core capital is entitled to appoint no more than three Council members. A municipality whose core capital ratio is 25% or more of the core capital is entitled to appoint up to five Council members. Moreover, the University of Helsinki is entitled to appoint two Council members and their personal deputies. (HUS basic agreement as of January 1, 2010.)
Members Votes
Core Deputies capital ratio % Anna-Maija Lukkari
Karl-Erik Stenvall 2 0.224 Aino Villikka
Harri Sintonen
Lohja
Marjatta Smeds Mika Sistola
Askola
Tuula Jämsén 33 3.336 Kristiina Lundell Paul Packalén Petteri Åström
Juhani Korkatti 3 0.308 Jarno Lundberg Maritta Helin Eeva Oksanen
Loviisa
Espoo
Olof Gren Anja Järvinen
9 0.963 Pia Hydén Sinikka Heikkinen
Kari T. Nukala 175 17.550 Leena Rehn Jarkko Korpi Tarja Tallqvist Katja Koivumäki to 28 Mar Matti Metsäranta Ritva Snabb from 28 Mar
Mäntsälä
Hanko
Nummi-Pusula
Jouko Veikanmaa 7 0.767 Ulf Lindström Sture Söderholm Anja Roos
Aulis Mattila 6 0.628 Jyri Mela
Helsinki
Nurmijärvi
Maija Anttila 362 36.200 Anita Vihervaara Aatos Hallipelto Katja Ivanitskiy to 28 Sep Lea-Riitta Mattila from 28 Sep Seija Muurinen Ville Väärälä Kalle Könkkölä Aki Hyödynmaa Sirkku Ingervo Tiina Turkia
Minna Aittakallio 23 2.373 Irma Kulmala Petri Kalmia Timo Ojamäki
Hyvinkää Antti Rantalainen 34 3.484 Irma Pahlman
Karel McLeod Smith Sari Tani
Inkoo Barbro Viljanen 4 0.409 Heimo Hakala Marie Bergman-Auvinen Erik Holmberg Järvenpää Ulla-Mari Karhu 27 2.703 Pekka Luuk Christer Brännkärr Kaarina Wilskman Karjalohja Kari Lehtola 2 0.161 Jorma Roine Rolf Oinonen Tero Eskola Karkkila Maritta Salo 8 0.878 Sirkku Hopeavirta- Hanhinen Raino Velin Hannele Stenberg
Kaisa Laine 12 1.234 Anna Helin
Kalevi Heinonen Harri Krakau Mirka Järvinen Kari Kyttälä
Pornainen Risto Kuisma 2 0.270 Liljan-Kukka Runolinna Ulla Rainio Matti Kalsola Porvoo Berndt Långvik 33 3.377 Tapani Eskola
Susanne Ahlqvist Christer Björkstrand
Raasepori Ulla Dönsberg 24 2.407 Ritva Uhlbäck Bertel Sundman Jaana Tasanko Sipoo Hans Blomberg 13 1.321 Ari Oksanen
Monika Zakowski Anna Hyrske
Rabbe Dahlqvist 4 0.409 Börje Grotell to 27 Jun Marcus Nordström 27 Jun to 7 Dec Kaj Dahlström from 7 Dec Janne Laakkonen Tuula Elo Tuusula Arto Lindberg 23 2.302 Salla Heinänen
Gunnel Carlberg 6 0.655 Heikki Kurkela
Vantaa
Boris Kock Marianne Kivelä
Markku Pyykkölä 19 1.961 Tuula Lind
Jüri Linros Auli Lehikoinen
Kirkkonummi Marjatta Savilahti 21 2.192 Johan Karlsson
Kielo Leimi Ari Harinen
Ordinary members Deputies Ulla-Marja Urho (Coalition), Helsinki, Chair Tuomas Nurmela (Coalition), HeIsinki Seppo K.J. Helminen (Coalition), Helsinki Sirpa Asko-Seljavaara (Coalition), Helsinki Ilkka Taipale (SDP), Helsinki Reijo Vuorento (SDP), Helsinki Suzan Ikävalko (Greens), Helsinki Johanna Nuorteva (Greens), Helsinki to 15 Dec Riitta Wahlström (Greens), Helsinki from 15 Dec Henrika Zilliacus-Tikkanen (Swed.), Helsinki Hans Blomberg (Swed.), Sipoo Sanna Lauslahti (Coalition), Espoo Anja Roos (Coalition), Hanko Veikko Simpanen (SDP), Espoo, Vice-Chair Rolf Paqvalin (SDP), Kerava Kirsi Siren (Coalition), Espoo Tony Hagerlund (Greens), Espoo Johanna Larkio (Coalition), Vantaa Ari Oksanen (Coalition), Sipoo Säde Tahvanainen (SDP), Vantaa Eija Grönfors (SDP), Vantaa Pietari Jääskeläinen (Finns), Vantaa Timo Auvinen (Finns, ind.), Vantaa Irene Äyräväinen (Coalition), Lohja Karel McLeod Smith (Coalition), Hyvinkää Jari Oksanen (Greens), Porvoo Anna Cantell-Forsbom (Greens), Vantaa Harry Yltävä (Left), Raasepori Satu Manner (Left, ind.), Lohja Jukka Pihko (Centre), Nurmijärvi Marja-Leena Laine (Centre), Hyvinkää Mikko Salaspuro, University representative Elina Ikonen, University representative Jaakko Karvonen, University representative Pekka Karma, University representative
HUCH Hospital Area Board in 2011
Minority Language Board 2011
Ordinary members Deputies Reijo Vuorento (SDP), Helsinki Jouni Parkkonen (SDP), Helsinki Helena Sistonen (SDP), Espoo Helena Rytkönen (SDP), Espoo Pirkko Letto (SDP), Vantaa, Vice-Chair Tiina-Maaria Päivinen (SDP), Vantaa Anni-Helena Erolahti (SDP), Lohja Jouko Veikanmaa (SDP), Hanko Hanna Lähteenmäki (Coalition) Helsinki Antti-Jussi Räihä (Coalition), Helsinki Risto Ranki (Coalition), Helsinki Marjatta Laitila (Coalition), Helsinki Paula Viljakainen (Coalition), Espoo, Chair Pertti Airikainen (Coalition), Espoo Raimo Huvila (Coalition), Vantaa Paula Lehmuskallio (Coalition), Vantaa Riku Honkasalo (Coalition), Askola Virpi Vilkki (Coalition), Askola Thorolf Sjölund (Coalition), Silja Lappalainen (Coalition), Kirkkonummi Kirkkonummi Essi Kuikka (Greens), Helsinki Tuomo Jantunen (Greens), Helsinki Sirpa Pajunen (Greens), Vantaa Janne Kylli (Greens), Espoo Anita Antskog-Karstinen (Greens), Anna Pesonen (Greens), Kauniainen Kauniainen Bengt Lindqvist (Swed.), Espoo Johan Karlsson (Swed.), Kirkkonummi Kyösti Haukipuro (Centre), Kerava Eeva Kuuskoski (Centre), Helsinki Sari Laiho (Left), Helsinki Heli Karhu (Left), Kerava Marjo Pihlman (Finns), Espoo Toni Paussu (Finns), Helsinki Pekka Karma, Riitta Korpela, University representative University representative Harry Yltävä, Timo Auvinen, Executive Board representative Executive Board representative
Ordinary members Deputies Inger Östergård (SDP), Helsinki, Vice-Chair Hildur Boldt (SDP), Helsinki Viveca Lahti (SDP), Kirkkonummi Kjell Grönqvist (SDP), Sipoo Sunniva Strömnes (Coalition), Helsinki Philip Relander (Coalition), Helsinki Roger Weintraub (Coalition), Lohja Marianne Rosvall (Coalition), Porvoo Jan-Erik Eklöf (Swed.), Vantaa, Chair Monica Avellan (Swed.), Tuusula Werner Orre (Swed.), Raasepori Bodil Lund (Swed.), Porvoo Klaus Kojo (Greens), Vantaa Anniina Kostilainen (Greens), Vantaa Marjatta Donner (Greens), Helsinki Jon Lindström (Greens), Helsinki Christer Holmberg, Carl Gustaf Nilsson, University representative University representative Henrika Zilliacus-Tikkanen, Hans Blomberg, Executive Board representative Executive Board representative
Psychiatric Board 2011
Audit Committee 2011
Ordinary members Deputies Kaarina Pärssinen (SDP), Tuusula, Vice-Chair Hilkka Pokki (SDP), Vantaa Antti Karila (SDP), Helsinki Heidi Hertell (SDP), Helsinki Aira Suvio-Samulin (Coalition), Helsinki Jaakko Ojala (Coalition), Helsinki Sirpa Peura (Coalition), Vantaa, Chair Pertti Airikainen (Coalition), Espoo Jouni Vilkki (Coalition), Askola Eeva Huikko (Coalition), Järvenpää to 15 Dec Hanna Kiljunen from 15 Dec Kai Järvisalo (Greens), Espoo Eero Untamala (Greens), Vantaa Pirkko Telaranta (Greens), Helsinki Eija Lönnroth (Greens), Helsinki Tuula Sjölund (Swed.), Kirkkonummi Lisbeth Konttinen (Swed.), Espoo Jouko Lönnqvist, Kristian Wahlbeck, University representative University representative Kirsi Siren, Jari Oksanen, Executive Board representative Executive Board representative
Ordinary members Deputies Maija Anttila (SDP) Helsinki, Vice-Chair Kari Lehtola (SDP), Karjalohja Tuula Lind (SDP), Kerava Auli Lehikoinen (SDP), Kerava Markku Pyykkölä (Coalition), Kerava, Chair Raimo Huvila (Coalition), Vantaa Aatos Hallipelto (Coalition), Helsinki Seija Muurinen (Coalition), Helsinki Kari T. Nukala (Coalition), Espoo Anna Helin (Coalition), Mäntsälä Varpu-Leena Aalto (Greens), Vantaa Marjo Varsa (Greens), Vantaa Ulla Dönsberg (Swed.), Raasepori Olof Gren (Swed.), Loviisa
Siuntio
Kauniainen
Kerava
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Core Deputies capital ratio %
Lapinjärvi
University of Helsinki Kari Suokko to 12 Oct 96 Esa Hämäläinen from 12 Oct Erkki Vuori to 12 Oct Olli Ritvos from 12 Oct
Members Votes
Merja Kuusisto Harto Palén
Raimo Huvila 119 11.930 Teemu Räty Mari Niemi-Saari Tarja Pesonen Varpu-Leena Aalto Marjo Varsa Vihti Tiina Noro 19 1.956 Pekka Viljanen Raimo Pilvi –2.9. Anu Rajajärvi Matti Waara 3.10.–
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Profit and Loss Account
Cash flow statement
HUS Group HUS Joint Authority (EUR 1,000) 2011 2010 2011 2010 Operating income Sales proceeds 1,605,250 1,523,689 1,598,822 1,512,931 Payments income 57,052 56,916 57,052 56,916 Subsidies and grants 9,826 5,905 9,822 5,873 Other operating income 13,776 8,954 9,221 8,710 1,685,904 1,595,464 1,674,917 1,584,430 Operating expenses Personnel expenses Salaries and fees -836,259 -794,878 -819,346 -777,845 Social security expenses Pension expenses -142,933 -134,362 -139,849 -131,315 Other social security expenses -51,762 -45,186 -50,804 -44,229 Purchased services -194,796 -177,076 -219,299 -202,978 Materials, supplies and consumables -319,305 -298,618 -310,422 -287,606 Subsidies -875 -443 -875 -443 Other operating expenses -46,425 -42,718 -44,057 -41,504 -1,592,354 -1,493,281 -1,584,651 -1,485,920 Share of business enterprises’ profit/loss 299 114 0 0 Operating margin 93,849 102,297 90,266 98,510 Financial income and expenses Interest income 2,385 1,637 2,821 1,762 Other financial income 169 326 166 321 Interest expenses -4,289 -4,083 -4,014 -3,919 Other financial expenses -11,960 -11,934 -11,766 -11,764 -13,694 -14,054 -12,793 -13,599 Result before depreciation and extraordinary items 80,154 88,243 77,474 84,911 Depreciation and reductions in value Depreciation according to plan -96,096 -88,284 93,573 85,711 Extraordinary items 128 140 Annual result -15,813 99 Tax reserves -501 -647 Minority share 13 -1 Surplus/Deficit for financial year -16,301 -549 -16,100 -800 FINANCIAL INDICATORS FOR THE PROFIT AND LOSS ACCOUNT
2011 2010 2011 2010
Operating profit / operating loss, % 105.9 106.8 105.7 106.6 = 100*Operating profit/Operating loss Result before depreciation and extraordinary items/depreciation, % 83.4 100.0 82.8 99.1 = 100*Result before depreciation and extraordinary items/Depreciation and reduction in value HUS Group 2011 2010 2009 2008 2007 Operating income/Operating expenses, % 105.9 106.8 106.8 106.2 106.6 Result before depreciation and extraordinary items/Depreciation % 83.4 100.0 101.1 96.0 111.4 HUS Joint Authority 2011 2010 2009 2008 2007 Operating income/Operating expenses, % Result before depreciation and extraordinary items/Depreciation %
48
105.7
106.6
106.6
106.0
106.4
82.8
99.1
100.0
96.4
111.9
HUS Group (EUR 1,000)
H US Joint Authority
2011
2010
2011
2010
Operating cash flow Result before depreciation and extraordinary items 80,154 88,243 77,474 84,911 Extraordinary items 128 140 0 0 Adjusting items for cash flow financing 838 -2,071 1,284 -1,782 Investment cash flow Investment expenses -105,737 -121,914 -94,738 -113,104 Investment expenses financing shares 116 1,409 116 1,411 Capital gains for fixed asset items 2,591 1,732 2,300 1,388 Operating and investment cash flow -21,909 -32,461 -13,564 -27,177 Financing cash flow Changes in loans Increases in loan receivables -11 0 -11,411 -6,500 Decreases in loan receivables 99 3 572 504 Changes in loan portfolio Increase in long-term loans 30,030 273 30,000 0 Decrease in long-term loans -13,561 -13,454 -12,425 -12,434 Change in short-term loans 0 0 0 0 Changes in capital and reserves 0 0 0 0 Changes in minority share 0 0 0 0 Other changes in liquidity Changes in inventories -633 -3,617 -645 -3,634 Change in receivables -6,139 24,636 -6,543 24,600 Change in interest-free debts 20,367 18,529 22,001 17,929 Financing cash flow 30,153 26,369 21,549 20,465 Change in liquid assets 8,244 -6,092 7,985 -6,712 Liquid assets as at Dec 31 123,645 115,401 121,546 113,561 Liquid assets as at Jan 1 115,401 121,493 113,561 120,273 Change in liquid assets 8,244 -6,092 7,985 -6,712 FINANCIAL INDICATORS FOR THE CASH FLOW STATEMENT 2011 2010 2011 2010 Investment cash flow financing, % 75.9 73.2 81.9 76.0 = 100*Result before depreciation and extraordinary items /Investment self-acquisition expenses Capital expenditure cash flow financing, % 90.0 66.0 65.7 65.3 = 100*Result before depreciation and extraordinary items /(Investment self-acquisition expenses + loans net increase + loan amortisations) Debt coverage ratio 4.7 5.3 5.0 5.4 = (Result before depreciation and extraordinary items +Interest expenses)/(Interest expenses+Loan amortisations) Cash disbursements, EUR million 1,728 1,645 1,719 1,634 Adequacy of cash flow (days) 26.1 25.6 25.8 25.4 = 365 days x Liquid assets Dec 31/ Cash disbursements during financial year HUS Group
2011 2010 2009 2008 2007
Investment cash flow financing, % Capital expenditure cash flow financing, % Debt coverage ratio Cash disbursements, EUR million Adequacy of cash flow (days) HUS Joint Authority
75.9 90.0 4.7 1,728 26.1
Investment cash flow financing, % Capital expenditure cash flow financing, % Debt coverage ratio Cash disbursements, EUR million Adequacy of cash flow (days)
81.9 65,7 5.0 1,719 25.8
73.2 66.0 5.3 1,645 25.6
75.6 68.8 5.6 1,603 27.7
89.3 77.1 4.2 1,531 25.6
83.4 71.9 4.2 1,447 21.8
2011 2010 2009 2008 2007 76.0 65,3 5.4 1,634 25.4
75.4 68,2 6.4 1,589 27.6
88.3 75,6 5.0 1,521 25.4
82.8 73.2 4.8 1,438 21.6
49
2 011 HUS annual repo r t
HUS annual repor t 2011
Balance Sheet HUS Group HUS Joint Authority (EUR 1,000) 2011 2010 2011 2010 ASSETS
HUS Group HUS Joint Authority (EUR 1,000) 2011 2010 2011 2010 LIABILITIES
NON-CURRENT ASSETS
CAPITAL AND RESERVES Subscribed capital 391,253 391,253 391,253 391,253 Other own reserves 1,031 1,031 0 0 Surplus/deficit from previous financial years 43,326 43,875 41,847 42,648 Surplus/deficit for financial year -16,301 -549 -16,100 -800 CAPITAL AND RESERVES 419,309 435,610 417,001 433,100 MINORITY SHARES 2,600 2,613 0 0 DEPRECIATION AND UNTAXED RESERVES Depreciation difference 789 950 0 0 Untaxed reserves 2,661 2,034 0 0 DEPRECIATION AND UNTAXED RESERVES 3,450 2,984 0 0 PROVISIONS Provisions for pensions 2,737 3,264 2,737 3,264 Other provisions 36,692 32,961 36,692 32,942 PROVISIONS 39,429 36,225 39,429 36,206 CONTRACT-RESTRICTED CAPITAL 4,094 3,833 4,094 3,833 LIABILITIES Long-term interest-bearing liabilities 197,518 180,052 184 156 164,696 Long-term interest-free liabilities 2 1 0 0 Short-term interest-bearing liabilities 12,482 13,480 10 540 12,425 Short-term interest-free liabilities 278,831 258,465 283,590 261,588 LIABILITIES 488,835 451,998 478,286 438,710 TOTAL LIABILITIES 957,717 933,263 938,809 911,849 FINANCIAL INDICATORS FOR THE BALANCE SHEET 2011 2010 2011 2010
Intangible assets Intangible rights 173 173 0 0 Other long-term expenses 42,295 37,152 41,913 37,002 Intangible assets 42,468 37,325 41,913 37,002 Tangible assets Land and water 12,375 12,516 10,866 11,003 Buildings 497,569 508,921 473,437 488,868 Immovable structures and equipment 13,521 13,711 13,521 13,711 Machinery and equipment 89,118 88,290 84,363 85,809 Other tangible assets 813 913 138 138 Advance payments and purchases in process 64,621 49,584 53,033 40,631 Tangible assets 678,017 673,936 635,358 640,160 Investments Business enterprise shares and similar rights of ownership 14,927 14,661 14,766 14,799 Other shares and similar rights of ownership and revaluation reserve 3,054 3,278 6,344 5,733 Other loan receivables 524 623 24,376 13,547 Other receivables 254 243 254 243 Investments 18,759 18,805 45,739 34,322 NON-CURRENT ASSETS 739,243 730,066 723,010 711,484 CONTRACT-RESTRICTED ASSETS 4,094 3,833 4,094 3,833 CURRENT ASSETS Inventories 20,244 19,611 20,077 19,432 Receivables Non-current receivables 586 11 586 11 Current receivables 69,905 64,341 69,496 63,528 Receivables 70,491 64,352 70,082 63,539 Investments 56,792 26,935 56,783 26,926 Cash in hand and at banks 66,853 88,466 64,763 86,635 CURRENT ASSETS 214,380 199,364 211,705 196,532 TOTAL ASSETS 957,717 933,263 938,809 911,849
50
Gearing ratio, % 44.7 47.6 44.7 47.8 = 100*Capital and reserves/ (Capital and reserves total-Advances received) Relative indebtedness, % 28.6 27.9 28.2 27.3 = 100*(Liabilities - Advances received)/Operating income Loan portfolio Dec 31 (EUR 1,000) 210,001 193,532 194,696 177,122 = Liabilities-(Advances received+Trade creditors+ Accruals and deferred items+Other creditors) Loan receivables Dec 31 (EUR 1,000) 524 623 24,376 13,547 = Other loan receivables in investments HUS Group 2011 2010 2009 2008 2007 Gearing ratio, % Relative indebtedness, % Loan portfolio Dec 31 (EUR 1,000) Loan receivables Dec 31 (EUR 1,000) HUS Joint Authority
44.7 28.6 210,001 524
Gearing ratio, % Relative indebtedness, % Loan portfolio Dec 31 (EUR 1,000) Loan receivables Dec 31 (EUR 1,000)
44.7 28.2 194,696 24,376
47.6 27.9 193,532 623
47.8 28.2 206,713 626
50.4 26.1 157,505 629
52.8 25.3 140,300 633
2011 2010 2009 2008 2007 47.8 27.3 177,122 13,547
48.1 27.6 189,556 7,551
51.2 25.1 138,746 5,190
54.0 23.8 118,724 1,344
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HUS JOINT AUTHORITY Stenb채ckinkatu 9 Po box 100, fi-00029 hus, finland tel. +358 9 4711 www.hus.fi