How health workers experience health system reform: A qualitative study from Finland

Abstract

Background: Health system reforms have been ubiquitous in high-income countries during the past decades, yet research on how reform implementation is experienced by the health and care workforce (HCWF) remains scant. This is a critical omission, given that the recruitment and retention of the HCWF is recognized as one of the key challenges of health systems globally, and one which health system reforms often set out to solve. Objective: To study how the implementation of a large-scale health system reform in Finland has been experienced by the HCWF in primary health care. Methods: Qualitative interviews mainly with physicians, registered nurses, and licensed practical nurses (n=48) were conducted in regions’ three primary health care (PHC) centers in Jan 2024-Nov 2024. Interviewees were identified through snowball and purposive sampling. The data were analyzed through an iterative process consisting of both deductive and inductive elements. Results: The results point to misalignment between the reform's intended policy objectives and on-the-ground experiences of the HCWF in PHC in Finland. This has led to a sense of demoralization among the HCWF and impacts how they interpret the legitimacy and legacy of the reform. The data also bring forward factors which strengthen the engagement of the HCWF in PHC which is crucial for overall system change and reform implementation. Conclusions: Our findings have critical implications for the implementation and leadership of health system reforms in PHC. HCWF involvement can be a win-win situation for the system and the workforce, and failure to involve them can further deepen the issue of HCWF shortages in PHC.