Background: new digital ecosystems for public services

There is a rapid and deep service logic revolution at work, due to the digital and platform disruptions. In private services we are used to buy food, flight, entertainment, new social experiences, etc. remotely on line, having the opportunity to select in one page from the entire global market, finding shop always open, looking at peers feedbacks, finding even new social contacts with strangers. All this is not just about finding traditional services on line, but having the opportunity to access to completely new service logics, with new added value experiences (home shipping, three click and got it, new social communities

The deep service logic transformation is spilling over in the public realm. Are PAs steering strategically this transformation, to increase public value, or is the revolution “emergent” with poor awareness about impacts in public services? It mostly depends on the first mover actors and their professional perspectives and interests.

The Primary Care Case

General Practitioners (GPs) provide medical care to their patients, making them the first point of contact between citizens and the National Health Service (NHS). In Italy today, there are a number of trends that are profoundly affecting their practice. Firstly, the demographic characteristics of GP patients are changing as the average age of the population increases. An ageing population entails the management of situations of chronicity, co-morbidity and socio-medical fragility. Secondly, general practice is the protagonist of a major generational change. In fact, on 31 December 2021, more than 50% of GPs will be over 60 years old, and a massive wave of retirements is expected in the coming years (Gimbe, 2023). It is also expected that new young doctors will enter the profession, but this will not be enough to compensate for the retirements. Finally, there are a number of systemic changes affecting general practice, involving new service models facilitated by the phenomenon of digitalisation. In fact, new patient access channels are proliferating: in addition to the more traditional telephone or secretarial contacts, others are gradually being added (email, Whatsapp, etc.), made even more topical by the recent COVID-19 pandemic.

In this panorama, it is essential to understand in depth the dynamics of change in GP services, as regions and health authorities have a responsibility to understand and support these changes with appropriate tools and processes.

Objectives

- To study the new methods of access to patients and to reconstruct the portfolio of activities carried out by GPs, considering the new ways of working also in relation to the other professionals with whom they collaborate (administrative and nursing staff) and the new ways of interacting with patients;

- To examine these changes from the point of view of Public Health Authorities, testing the extent to which they are aware of these changes and the types of tools they are using to support these dynamics.

Methods

A mixed qualitative-quantitative method will be used, consisting of desk analyses, interviews and surveys:

- To answer the first objective, a survey will be carried out among 70 GPs belonging to two different regional contexts (Lombardia and Emilia Romagna). In the survey, doctors will be asked to record all contacts received over 5 working days, noting: (i) the mode of contact; (ii) the service provided; (iii) some characteristics of the patient (sex, age, exemption). The survey will make it possible to map the new channels of access to patients and the new ways of working adopted by GPs;

- The second part of the research will involve desk analysis and semi-structured interviews with key informants. It will first explore the level of knowledge about the changes taking place, then discuss the results of phase 1, and finally explore the company or regional initiatives to support these changes (e.g. revision of integrative agreements with general medicine, construction of an adequate digital infrastructure...).

Collected Evidences

In average every GP consult 50 people per day, so 250 per week. In our first data collection we had access to data about 10.000 patients (40 GPs in one week work).

80% of patient ask for GPs’ services remotely and they respond remotely in 70% of the cases. Many answers are supported by digital tools and so delegated to administrative staff, even if the content is clinical. Digital access is independent of patients’ age: the elderly use remotely the service exactly like young people, maybe changing the device (Whatapp instead of an email). The same is for GPs: also, the older ones provide their services mostly remotely.

Existing public policies are inconsistent with this emergent digital services scenario. They rely on heavy infrastructural investment (2 Bil euros for 1350 new public buildings) for new primary care facilities in order to bring panel of GPs in the same building, having in mind a traditional physical service.

There is no public awareness of the service logic disruption and no. coherent public policy adaptation.

Public policies implications

Traditional tools and modes to influence civil servant or NHS professionals need to be reshaped. The digital environment is a strong nudging mechanism, as we all experience during our shopping journeys. The owner of the digital ecosystem has robust opportunities to influence users. The owner could be a private entity (a pharma company in the GP case, the GPs themselves, or a public tool). This is a competitive or regulatory game PAs have rapidly to assume.

Public service users are in a new digital ecosystem, which needs to be designed and regulated.

All this natively collects immediately data both about public professionals and public service users.

T

his is a new landscape for rethinking public strategies, services and their implementation modes.

Central Government in the UK have intervened in English local government and take over the direction of a local authorities’ functions for reasons of a scandal or a failure in service delivery. The legal power for Central Government in the UK to intervene in the running of an English local authority is set out in section 15 (6) of the Local Government Act 1999. Using this power, the relevant Secretary of State can nominate people (known as ‘commissioners’) to take control over the direction of a function of a local authority. This may be for a specified period. Afterwards the control is returned to the local authority.

See the full abstract for more details.

Crises situations portray focusing events attracting the attention of decision-makers and general public (Birkland 1998). Even more importantly, crises provide a testing ground for government capability for solving immediate and pressing threats. The management of Covid-19 pandemics showcases Finnish government ability to respond to sudden incident by using it’s mandate, policy tools and methods of adaptation to deal with changing situations. In the discussion of health, the strategic approach to managing pandemics often refers to containment and mitigation policies as two main strategies to fight against pandemics such as Covid-19. Containment strategies aim to minimize the risk of transmission from infected to non-infected individuals to stop the outbreak and mitigation strategies aim to slow the disease and to reduce the peak in healthcare demand (Anttiroiko, 2021). However, in administrative reality, the strategy used for coping with the crises cannot easily be distinguished from other government actions. Regardless of the outspoken aim of mitigation or containment, the crises response is most often a combination of pre-existing planning and emergent solutions, seeking acceptance from the public, adapting the practice to the environment contingencies and adjusting the scale of measures to available resources.

With the plethora of existing research on Covid-19 pandemic, this article aims to fill in specific research gap identified by previous research (Zaki and Mayenberg, 2023). The focus is on studying framework conditions for strategy and design which shape the conditions for preferences and enable policy learning and contribute to certain policy outcomes. The article contributes to the discussion of the responses to crises in the public sector, as well as the discussion of the implications of strategies in government and the formation of public policies. The article puts forward an image of political manoeuvring in which pieces of ready-made strategic tools are assembled together with new elements into a malleable policy object. The article responds to the question of how the Finnish government has employed measures to manage the Covid-19 pandemic. The article extends the discussion of tackling the pandemic with governments in Nordic countries (Christensen and Lægreid, 2020) and elsewhere (Troisi and Alfano 2022; Gao and Yu, 2020; Huang, 2020; Jansen and Voort, 2020).

The article is structured as follows: First, it presents framework for the examination of crises management from government point of view based on insights from discussion of the authorizing environment within government, strategic thought and policy design, distinguishing between prior planning and processual adaptation. The result section deals with the strategic developments of the Finnish government in orienting its actions to manage the Covid-19 pandemic, and the discussion provides further insight into strategy formation in government followed by conclusions portraying the role of authoritative environment, prior planning and processual adaptations.