Transcript Workshop health care

Workshop ‘Care and welfare’
Marseille Meeting
May 21-22th. 2008
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Outline of the workshop
• Introduction round (5 minutes)
• Theoretical plus methodological overview for 21
occupations (20 minutes).
• Job territories according to the questionnaire (30
minutes)
• Contextual factors and low wage work
explorations (presentation and comments 30
minutes)
• Maturing into the job (10 minutes)
• Outlook
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Part one
• Theoretical overview
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21 occupations
1. Ambulance attendant
2. Carer for the disabled
3. Carer for the elderly
4. Charge nurse
5. Community or social service worker
6. Dental hygienist
7. Dental prosthesis technician
8. Dietician
9. General practitioner GP
10. Health service manager
11. Hospital nurse
12. Medical laboratory technician
13. Midwifery professional
14. Nursing aid
15. Optician
16. Personal carer in an institution for the elderly
17. Personal carer in an institution for the handicapped
18. Personal carer in private homes
19. Physician assistant
20. Scanning equipment operatorwww.euroccupations.org
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21. Surgeon
Overall aims euroccupations
project
• To facilitate reliable ‘measurement’ of the
occupational variable
• To gain insight in the comparability of
occupational structures
• Policy implication for international
occupational labour markets
• In-depth comparative description of the 21
occupations
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Jobs and occupations: arbitrary
concepts
• The occupation: a similar set of tasks that are
performed independently of the corporate context
• The job is more detailed than the occupation, tasks
that are performed within a corporate context
• Comparative analysis: the degree of formal
regulation of the job, according to:
– the law,
– educational requirements,
– professional associations, job classification systems
(job titles)
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The job
• mutual satisfaction, ‘at will’
• core: specifying the variable form of
transaction that would give sufficient
protection to either party against possible
opportunism by the other.
• tacit knowledge: we know more than we say
• work measurement on the shop floor is
negotiation
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Occupational dimensions
• Knowledge
– Implicit
– Explicit
• Skill
– Production vs non-production (blue-white collar)
– General vs firm vs sector specific (transferability of
skills)
– Required vs. available
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Competency
• Defined as a coherent set of observable
performance dimensions, including cognitive
dimensions (knowledge), functional ones (skills),
and social and meta-competence (attitudes and
behaviour)
• Applied both in occupational and in HRD contexts
• Quality competency measurement increases when
tasks of the occupation are included
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To deliver or to buy a service
main contractor
<employer>
sales contract
<supplier>
employment contract
<employee>
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Expert research: Measuring
occupational dimensions
Problems:
• Occupational workers tend to assess the
level of their occupation higher than it
actually is.
• Workers may respond what others think the
content is, instead of describing the actual
content of the occupation
• The corporate context matters for workers
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What do we measure?
•
•
•
•
•
•
Required educational level
Field of education
Required on-the-job-training in months
General vs specific skills
Responsibility (autonomy, supervision)
Required mental and physical effort
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Sources for definitions of tasks
• European: Dutch, Belgium, British, French,
German, Polish, Spanish, where available
• American (O-net)
• Canada
• Australian
• Alphabetical index of occupations ISCO88
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Methodology
• 21 occupations, appr. 10-12 tasks each
• Round of feedback/ revisions (anglo-saxon
bias)i
• Arbitrariness of order of tasks
• Preciseness of tasks distinguished
• 5 experts per country for each of the
occupations
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Problems in data-gathering
• Via direct networking, emailing, ask organisations
to recruit experts, distribute info in news letters,
distributing web-links etc.
However:
• Experts versus professionals responding
• Investigation, inquiry iso. survey (population of
experts is not known)
• Reliability of information has been questioned
• Difficulty in understanding the questions
• Survey fatigue, usewww.euroccupations.org
of internet may be limited,
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Overall aims comparison
1. The average expert score in the 7 countries
2. The heterogeneity of expert judgements in 7
countries
3. The generalised variance (to compare ‘stable’,
internationally comparable occupations and
occupations that vary greatly between countries
in terms of skills or required competencies).
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Match between our classification
and national statistics
Open question: Does the revision of national
statistics in any of the countries facilitate or
hamper this process of data collection?
Value added has been questioned at national
level, not at international level
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Part 2. Evidence
• Some examples
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Nr.16 Charge nurse
1.
2.
3.
4.
5.
6.
7.
supervise nurses and other hospital staff in the unit
monitor symptoms and changes in patients’ condition
assess patient health problems and needs
develop, implement and evaluate nursing care plans
create and maintain medical reports and records
assist the patients in daily living activities
administer medication orally, via rectum, subcutaneous and
intramuscularly
8.
prepare patients for operations and assist with examinations
and treatments
9.
monitor and adjust medical equipment used in patient care
and treatment
10. consult and coordinate with health care team
11. monitor the quality of patient care
12. manage the unit, e.g. staffing, financial resources and
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division of rooms
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Nr 17.Hospital nurse
1. undertake a comprehensive nursing history of the patient
2. plan and carry out appropriate care to meet the needs of the
patient
3. assess the medical history of the patient
4. provide nursing treatment and therapy
5. administer and monitor medications and intravenous drugs
6. record important changes in the condition of patients
7. create and maintain patients’ records
8. educate patients and their families about health needs
9. check the equipment and supplies
10. arrange for patients to have treatment and care after they
leave hospital
11. work together with other health care professionals to ensure
the quality of care
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Nr 18. Nursing aid
1.
2.
3.
4.
5.
6.
7.
8.
9.
observe and report changes in the condition of the patient
apply practical intervention procedures for dementia or
behavioural problems
perform basic (medical) procedures such as taking blood
pressure and applying and changing dressings
collect specimens such as urine, feces, or sputum
assist with rehabilitation exercises and basic treatment and
medications
provide patients assistance in activities such as walking,
exercising, and moving in and out of bed
turn and reposition bedridden patients, alone or with
assistance, to prevent bedsores
feed patients who are unable to feed themselves
bath, groom, shave, dress, or drape patients to prepare them
for surgery, treatment, or examination
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Results charge nurse (nr.16)
• Fr: Cadre the santé, infirmier générale,
Surveillant d'unités de soins
• NL: Coördinerend verpleegkundige,
teamleider, gespecialiseerd verpleegkundige
• Poland: pca Dyrektora ds Pielegniarstwa;
Koordynuj&amp; ca piel&amp; gniarek
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Tasks for charge nurse
• Daily: Task 1, 10
• Never: Task 6, 7, 8
• Wide heterogeneity 2, 3, 4, 5, 9
• Many non-responding
• Competence performance many ‘major
importance’ and ‘of some performance’
• Change to more financial expertise
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Hospital nurse (nr.17)
• Fr: ‘Infirmiere diplome d’ Etat’, Infirmier de
service hospitalier, Infirmier de soins
généraux, Infirmier libéral
• P: Pielegniarka odcinkowa, Siostra, Gniarka
anestezjologiczna
• NL: Verpleegster, verpleegkundige
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Answering hospital nurses
•
•
•
•
•
•
•
Tasks 1-10: daily basis and non-responding
Large autonomy on the job
Much mental effort
Some physical effort
Routine to complex computer application
Transferability of skills: some to major importance
Question on cognitive vs practical skills remained
unanswered
• Change to more technical expertise
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Nursing aid
• Tasks apply for Dutch case, though variance
at task 2, 3, 4. Comment: Nursing aid not
responsible for any of the medical tasks.
• Task 2, 3,4 ,7, 9 do not apply for Polish case
(opiekunka, sanitariuszka)
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Part 3
• Contextual factors
• Examples from our work on job territories
based upon our comparative low wage
Europe study
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US hospital chapter (Appelbaum
Bernardt 2003)
• Comparison of traditional and enhanced
work organization
• Target occupations: house keepers (no
training), food service jobs (no training),
nursing assistants (six weeks of training)
• Enhanced organization has an effect on
turnover, but not on job satisfaction
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Contextual factors in Europe
•
•
•
•
Public sector work
Sheltered part of the economy
Privatisation: sale of shares into private ownership
Liberalisation: creation of a market process with
competition (‘quasi-markets)
• Creating incentives: Diagnosis Treatment
Combinations
• Coordinating the health care sector:
• Competition between insurance associations
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Changing work organisation
•
•
•
•
•
•
Team work
Multi-skilling
Functional flexibilisation
Numerical flexibilisation
Decentralisation
Task separation?
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European health care design
• All: General hospitals
• Fr/ UK: Public versus market sector
• Ger: Religious versus non-religious
ownership
• NL/Dk: Training versus non-training
hospitals
• All: Tight versus slack labour market
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Various portals of work
organisation
• First portal: only skilled nurses (NL/ Ger/
Poland)
• Second portal: nurses and skilled nursing
assistants (Fr/ Den/ Belgium/ UK)
• Third portal: nurses and skilled and
unskilled nursing assistant (US/ UK)
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Assist-project: 3 in 1
Cleaner/
house
keeper
Nutrition
assistant
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Nurseassistant
Part 4
• Maturing in the job
• Time it takes to become a compete
professional expert
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From school to work
• Vocational education
– Organised in schools
– In the working environment / hospital
• Maturing on the job
–
–
–
–
Apprentices
Coaching/ mentors
Having a career
Horizontal and vertical career paths
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Answer on competency and
updating on the job (q.16, 17)
• Charge nurse: after completing required formal
education, it takes a few months until more than 5
years.
• Hospital nurse: few weeks to a few years
• Nursing aid: few months
• Updating: continuous effort to yearly (question is
misunderstood). www.euroccupations.org
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Next steps
• Distribution of presentation and minutes
• Organisation of feedback procedure
• Dissemination of results
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