Finland's primary health care system often makes people feel they don't matter, a university researcher has concluded after spending 450 hours observing three health stations. Laura Kihlström, a doctoral researcher, dedicated months to ethnographic fieldwork at stations in North Karelia, Ostrobothnia, and the Vantaa-Kerava wellbeing services county, watching, interviewing, and simply sitting still to understand the patient experience. Her central, recurring observation was that individuals felt insignificant within a system designed to help them. "The first thing people looked for was interaction with someone," Kihlström said, highlighting a fundamental human need unmet by streamlined processes.
The Quest for a Human Connection
Kihlström's research method involved immersion. She did not just conduct interviews but witnessed daily operations and patient reactions firsthand. This approach revealed that the initial and most critical point of failure or success was the moment a person entered the health station. Before any clinical consultation, patients sought a simple point of contact—a person to ask for direction or reassurance. This need for immediate human acknowledgement frequently collided with reality. Kihlström noted specific incidents that caused clear frustration, such as one station closing its information desk for three hours in the middle of the day due to budgetary savings. This action physically removed the primary point of human contact during peak hours, leaving patients adrift in the facility.
Systems Over Individuals
Her observations point to a systemic tension between efficiency and empathy. The study suggests that operational decisions, often made to save costs or optimize staff resources, can inadvertently communicate to patients that their presence is an administrative burden rather than a person seeking care. Closing an information desk is a tangible example, but Kihlström's work implies the issue is more pervasive, woven into the environment and flow. The feeling of not mattering arises not from a single negative clinical outcome but from the cumulative effect of these small, impersonal interactions—or lack thereof. The health stations, as gateways to Finland's much-discussed sote (social and healthcare) system, set a tone that can define the entire care experience.
The Weight of Small Failures
Kihlström's 450 hours documented how these small failures accumulate. A patient confused by signage with no one to ask, a person waiting anxiously without status updates, or a family member trying to navigate services for a relative—all these scenarios were observed. The research does not blame individual healthcare workers, who are often operating under significant pressure and staffing constraints, particularly within the new wellbeing services counties. Instead, it illuminates how the structure and resourcing of front-line services can create an environment where transactional efficiency overshadows relational care. The patient's journey begins not at the doctor's door, but at the main entrance, and that journey's quality is shaped by the first few minutes.
A Broader Challenge for Sote Reform
The findings arrive during a period of profound structural change in Finnish public healthcare, with the transition to autonomous wellbeing services counties aimed at improving care and controlling costs. Kihlström's work presents a crucial human-centric metric for that reform's success: do people feel seen? The study argues that the technical success of a system—seeing patients on time, following treatment protocols—is undermined if the process erodes a person's sense of dignity and agency. The evidence from the three stations indicates a widespread risk of this erosion. It suggests that alongside medical and financial metrics, the new county administrations might need to measure and manage the quality of initial human contact.
Listening to What Wasn't Said
A significant part of Kihlström's methodological strength was passive observation. By sitting and witnessing, she gathered data on non-verbal cues—the slumped shoulders of a person leaving a closed information desk, the confused scanning of corridors, the resigned patience in waiting areas. These moments, where no official complaint is filed but frustration is palpable, represent a silent feedback loop often missing from performance data. They indicate a gap between how the system is designed to function and how it is actually experienced. The 450 hours revealed that for many, the healthcare system feels like a place where you are processed, not welcomed.
The Path from Observation to Action
The research, while academic, carries direct implications for policymakers and service managers in the wellbeing services counties. The solutions it hints at are not necessarily expensive technological overhauls but may involve re-evaluating basic service design. It questions whether saving a few hours of staff time at an information desk is worth the cost in public trust and patient anxiety. It advocates for viewing the reception area not as a cost centre but as a vital component of care, where a calm, informed human presence can de-escalate worry and guide people effectively. In an era of digital portals and automated phone lines, Kihlström's work is a potent reminder that the most accessible and reassuring interface for many remains another person.
Laura Kihlström's study ultimately frames a simple but powerful question for Finland's healthcare leaders: if a researcher sitting quietly for hundreds of hours can see people feeling invisible, what changes are needed to make them feel seen? The answer will determine whether the reformed system succeeds in its core mission of maintaining population health and wellbeing, not just treating illness. The 450 hours of observation suggest that achieving this requires a cultural shift that prioritizes human connection as a non-negotiable element of care, starting from the very first moment a citizen seeks help.