Recipes for Systemic Change - Helsinki Design Lab

D5—Government Initiatives and ReformsCurrently, there is considerable desire for reform at all levels of the welfaresystem, from the highest levels of government to the most local cornersof the care network. There are many systemic changes now in various stagesof design and implementation, from legislative actions to municipal pilotprogrammes to local initiatives.Such reforms are relevant to this studio because they represent themost meaningful attempts at producing the kind of results necessary forthe improved welfare of the elderly population in Finland.The nature of these reforms differ depending on which part of the welfaresystem they are targeting. They include “bottom-up” reforms aimedat improving the horizontal functioning of the municipal system, “topdown”reforms focused on vertical structures of the national government,and “local” reforms that target particular structures within the finer grainof the welfare system.D5.1 Bottom-Up Reform: Municipal MergersAt the municipal level, regional oversight mergers and innovative carecooperatives are attempting to bridge perceived gaps in horizontal communicationsand inefficiencies in delivery networks. Such mergers are anattempt to counteract the fragmentation that occurs at the finer scale ofmunicipal agencies, as compared to the necessarily large scale of social andmedical care delivery.The Kainuu regional governance experiment is one of a number of suchexperiments in improving organization, structure, and communication atthe municipal level of the welfare system. Others examples include the currentintegration of Health and Social Services in Helsinki and Sitra’s ongoingMunicipal Programme.D5.2 Top-Down Reform: Fighting ‘Siloing’ In TheMinistriesAt the ministry level, government reforms driven by“performance management” and “information steering” areattempting to overhaul the operation of the upper tiers ofthe welfare system. Such ministerial reforms are tasked withbreaking down communication barriers that hamper effectiveness.The Kainuu RegionIn an attempt to combat the ineffective “siloing” of programmesthat results from intensive vertical control withinministries, these reforms embrace value- and result-basedapproaches, rather than procedural and hierarchal ones. For300