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Finnish Journal of eHealth and eWelfare (FinJeHeW), http://www.finjehew.fi

FinJeHeW on Suomen Telelääketieteen ja eHealth-seuran ja Sosiaali- ja terveydenhuollon tietojenkäsittely-yhdistyksen yhteisesti vuodesta 2009 alkaen julkaisema tieteellinen lehti. Lehti kuuluu julkaisufoorumi-luokkaan 1. Lehden ISSN-tunnus on 1798-0798.

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Tieteelliset artikkelit

Improving the productivity and efficiency of an integrated mental and addiction care – an application of the theory of constraints and five-focusing step to evaluation of adult ADHD patients: An application of the theory of constraints and the five-focusing step to evaluation of the adult ADHD patients en

Kemppinen, Juha; Korpela, Jukka; Elfvengren, Kalle; Polkko, Jussi

Vol 9 Nro 1 (2017)s. 18-30doi: 10.23996/fjhw.58720Open Access

Abstract

This paper suggests that the productivity and efficiency of social and health care services can be improved considerably by redesigning and streamlining the processes. The paper presents the theory of constraint (TOC) and five-focusing step (5FS) solution to the productivity and efficiency problems of an integrated mental and addiction care outpatient clinic (MTPA-model) team. The MTPA is an integrated walk-in clinic where clinical decisions on key patient groups are supported by a clinical decision support system (CDSS). One of the critical service processes of the MTPA is a CDSS-assisted adult ADHD diagnostics process.

The aim of the paper is to describe the improvement of productivity and efficiency of a typical multidiscipline team of MTPA-model. A combination of the action research approach and design science research was applied to solve the emerging service process problems and create a CDSS. The paper outlines the principles of the TOC applied for the established CDSS-assisted adult ADHD diagnostics process. The bottlenecks or constraints of an adult ADHD process are defined. The data from the designed CDSS and the currently used electronic health record provided material for applying the 5FS methodology for improving the productivity and efficiency of the adult ADHD process.

We suggest that applying the 5FS-process of TOC to mental and addiction care processes generally, and to the multi-professional team especially, is an effective way to negotiate constructively about the bottlenecks or constraints of the process and improve the productivity and efficiency of integrated mental health and addiction care services and operations. Based on the results, a general framework for improving the productivity and efficiency of a multi-professional team and health care services organization by applying the 5FS methodology is proposed.

Tiivistelmä (suomi)

This paper suggests that the productivity and the efficiency of social and health care services can be improved considerably by redesigning and streamlining the processes of an integrated mental health and addiction services. The paper presents the theory of constraint (TOC) and five-focusing step (5FS) solution to the productivity and efficiency problems of an integrated mental and addiction care outpatient clinic (MTPA-model) team. The MTPA was in 2010 established integrated walk-in clinic (24/7/365) for both mental health and addiction care, patients, where clinical decisions of some key patient groups supported by a designed software artifact - Clinical Decision Support System (CDSS). One of the critical service processes of the MTPA is a CDSS-assisted adult-ADHD diagnostics process, which had typical multidiscipline team´s inefficiencies and process constraints, which eliminated by applying the Five-Focusing Step (5FS) system methodology of the theory of constraints (TOC). 5FS provide a generic method to focus on solving the problems of system constraints of the multidiscipline team that is hindering the system achieving its goal.

The aim of the paper is to describe the improvement of productivity and efficiency of a typical multi-disciple team of an integrated mental health and addiction care outpatient clinic (MTPA-model) in southeast Finland. The combination of the action research approach and the design science research applied to solving the emerging service process problems and creating the solution artifact, clinical decision support system (CDSS). The paper outlines the principles of the theory of constraints (TOC) applied for established CDSS-assisted adult-ADHD diagnostics process, which is one of the key service processes at the MTPA-model. TOC is a theory, which assumes that every system has at least one constraint, which is precluding the system to achieve its strategic and operational goals. The Five-Step Focusing (5SF) Process of the TOC is to identify, exploit and remove the key constraints in any systems or processes. The bottlenecks or constraints of an adult-ADHD process defined. The data from the designed software artifact- the adult-ADHD CDSS – and currently used electronic health record (EHR, Effica)- provided material applying the 5FS methodology for improving productivity and efficiency of the adult-ADHD process.

We suggest that applying the 5FS-process of the TOC to mental and addiction care processes generally and to the multi-professional team especially is an effective way to negotiate constructively about the bottlenecks or constraints of the process and improve the productivity and the efficiency of an integrated mental health and addiction care services and operations.

 Based on the results, a general framework for improving productivity and efficiency of a multi-professional team and health care services organization by applying the 5FS logic and methodology proposed.

 Keywords: Clinical decision support system, social and health care, mental and addiction health care mental and addiction health care, theory of constraints, five-focusing step, productivity, efficiency, TOC, 5FS, CDSS, design research, action research

Avainsanat

Clinical decision support systemsocial and health caremental and addiction health caretheory of constraintseffiencycost-effectivenessTOCCDSS

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Seuran 30-vuotishistoriikki

30 VUOTTA KEHITYKSEN KÄRJESSÄ – Suomen telelääketieteen ja e-Health seura 1995-2025,  2025,
ISBN 978-952-65791-1-5 (PDF)

The Society’s 30-Year History

30 Years at the Forefront – The Finnish Society of Telemedicine and eHealth 1995-2025, 2025.
ISBN: 978-952-65791-5-3 (pdf)

Podcastit:

Suomen Telelääketieteen ja e-Health seura · Podcast

eHealth & Telemedicine Today – by STeHS

What’s happening in digital healthcare right now? In this podcast, STeHS brings you conversations on telemedicine, eHealth, and the evolving healthcare landscape—featuring voices from Finland and beyond.

Jakso 3 · 13.6.2026 · 33 min

Innovaatiot ja yrittäjyys suomalaisessa eHealthissa

This episode was recorded live at the eHealth2025 Conference, part of the 30th anniversary of the Finnish Society of Telemedicine and eHealth (STeHS). Hosts of this podcast are Titta Venho and Anna Saranlinna.In this discussion, Kalevi Virta, CEO of eWell Oy, and Arto Holopainen, Innovation Director at the City of Kuopio, share their perspectives on the development of the Finnish eHealth ecosystem, with a particular focus on innovation, entrepreneurship, and collaboration.The conversation explores how digital health has evolved in Finland over the past decades, highlighting key milestones such as mobile technologies, national digital health services, and international collaboration. The speakers reflect on the opportunities and challenges faced by startups and innovators in the health technology sector, including funding, regulation, and access to real-world testing environments.The episode also discusses the role of cities, ecosystems, and collaborative networks in supporting innovation, as well as the importance of early user engagement and cross-sector partnerships. Looking ahead, the discussion touches on future trends such as artificial intelligence, data-driven services, and the increasing demand for sustainable and scalable digital health solutions.Finally, the guests share practical advice for entrepreneurs and emphasize the need for stronger strategic leadership, long-term investment, and continued cooperation between public and private sectors to drive meaningful impact in healthcare.Note: This episode is in Finnish.Full transcript is available in https://www.telemedicine.fi/julkaisut/

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Jakso 2 · 6.6.2026 · 32 min

Vaikuttavuus digitaalisissa terveyspalveluissa

This episode was recorded live at the eHealth2025 Conference, part of the 30th anniversary of the Finnish Society of Telemedicine and eHealth (STeHS). Hosts of this podcast are Titta Venho and Anna Saranlinna.In this discussion, Mika Perttu, Director of Digital Transformation at the City of Helsinki’s Social, Health and Rescue Division, and Minna Saranpää, Customer Manager and Social and Healthcare Specialist at Vivago Oy, explore the topic of impact and effectiveness in digital health and care services.As digitalisation continues to reshape how healthcare services are delivered, used, and evaluated, the conversation focuses on how to ensure that digital solutions truly create value for patients, professionals, and society. The speakers discuss how effectiveness can be defined, measured, and integrated into service development and decision-making.The episode highlights practical examples from both public and private sectors, addressing challenges such as fragmented systems, limited resources, and the need for better data-driven leadership. It also explores the future role of digital tools, including artificial intelligence and remote care, in improving outcomes and enabling more proactive and personalised healthcare services.Note: This episode is in Finnish.Full transcript is available: https://www.telemedicine.fi/julkaisut/

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Jakso 1 · 31.5.2026 · 27 min

Women around the world in health care digitalisation

This episode was recorded live at the eHealth2025 Conference, part of the 30th anniversary of the Finnish Society of Telemedicine and eHealth (STeHS). Hosts of this podcast are Titta Venho and Anna Saranlinna.In this discussion, Dr Michelle Griffith, President of ISfTeH, a physician specializing in internal, lifestyle, and integrative medicine with over 30 years of clinical experience, and Professor Pirkko Kouri, Vice President of ISfTeH and a Finnish expert in health informatics and digital health education, explore the theme Women Around the World in Healthcare Digitalisation.Together, they reflect on how gender shapes the development, leadership, and use of digital health services across different cultural and global contexts. The conversation highlights both the challenges women face in technology-driven environments and the critical role they play in designing more inclusive, holistic healthcare solutions.The episode also offers insights into international collaboration, leadership experiences, and practical advice for women aiming to make an impact in the rapidly evolving field of telemedicine and eHealth.Full transcript will be available in: https://www.telemedicine.fi/julkaisut/

Spotifyssa

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Konferenssijulkaisut:

  • XXXI Kansallinen ja kansainvälinen Telelääketieteen ja eHealth konferenssi, #eHealth2026: Effective digital solutions in health care and social welfare services, 2026, ISBN 978-952-65791-4-6 (PDF) 
  • XXX Kansallinen telelääketieteen ja eHealth seminaari, #eHealth2025: Strengthening Interoperability and Equality in Digital Health with Nordic Innovations, 2025, ISBN 978-952-65791-3-9 (PDF)
  • XXIX Kansallinen telelääketieteen ja eHealth seminaari, #eHealth2024: From Research to Impact on Digital Health and Welfare Services, 2024, ISBN 978-952-69224-9-2 (PDF)
  • XXVIII Kansallinen telelääketieteen ja eHealth seminaari, #eHealth2023: Human oriented approach in eHealth and digital services, 2023, ISBN 978-952-69224-8-5 (pdf)
  • XXVII Kansallinen telelääketieteen ja eHealth seminaari, #eHealth2022: Digital Health – from Research to Applied Solutions, 2022, ISBN 978-952-69224-6-1 (PDF)
  • XXVI Kansallinen telelääketieteen ja eHealth seminaari, #eHealth2021: eHealth in a Lifecycle, 2021, ISBN: 978-952-69224-4-7 (pdf)
  • XXV Kansallinen telelääketieteen ja eHealth seminaari, eHealth2020: From Dream to Reality, 2020, ISBN: 978-952-69224-2-3 (pdf)
  • XXIV Kansallinen telelääketieteen ja eHealth seminaari, eHealth2019: Data-Driven Health, 2019, ISBN: 978-952-68112-9-1 (pdf)
  • XXIII Kansallinen telelääketieteen ja eHealth seminaari, eHealth2018: Health communities facing cyber transformation, 2018, ISBN: 978-952-68112-8-4 (pdf)
  • XXII Kansallinen telelääketieteen ja eHealth seminaari: Win-Win-Win, voittaako kansalainen, ammattilainen ja yhteiskunta?, 2017, ISBN: 978-952-68112-6-0 (pdf)
  • XXI Kansallinen telelääketieteen ja eHealth seminaari, Nordic eHealth2016 Kokeilukulttuuri ja digitalisaatio, 2016, ISBN: 978-952-68112-4-6 (pdf)
  • XX Kansallinen telelääketieteen ja eHealth seminaari: eHealth, muutoksen moottori, 2015, ISBN: 978-952-68112-2-2 (pdf)
  • XIX Kansallinen telelääketieteen ja eHealth seminaari: Matkalla vaikuttavaan eTerveyteen, 2014, ISBN: 978-952-67213-9-2 (pdf)
  • XVIII Kansallinen telelääketieteen ja eHealth seminaari: Teknologiatalkoilla parempiin hoitotuloksiin, 2013, ISBN: 978-952-67213-8-5 (pdf)
  • XVII Kansallinen telelääketieteen ja eHealth seminaari: Tietoa tarpeeseen, 2012, ISBN: 978-952-67213-6-1 (pdf)
  • XVI Kansallinen telelääketieteen ja eHealth seminaari: Maalta maailmalle – Aluemalli terveyspalveluiden kehittämisessä, 2011, ISBN: 978-952-67213-4-7 (pdf)
  • XV Kansallinen telelääketieteen ja eHealth seminaari: Katse yli rajojen, 2010, ISBN: 978-952-67213-2-3 (pdf)
  • XIV Kansallinen telelääketieteen ja eHealth seminaari: Terveyttä verkosta ja verkostosta, 2009, ISBN: 978-952-67213-0-9 (pdf)
  • XIII Kansallinen telelääketieteen ja eHealth seminaari: e-Health kansalaisen palveluksessa, 2008 (pdf)
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