www.euroccupations.org [email protected] workshop ‘care and welfare’ marseille meeting may...

www.euroccupations.org [email protected]

Workshop ‘Care and welfare’

Marseille Meeting

May 21-22th. 2008

For communication: [email protected]

www.euroccupations.org


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


Part one

• Theoretical overview


21 occupations1. Ambulance attendant2. Carer for the disabled3. Carer for the elderly4. Charge nurse5. Community or social service worker6. Dental hygienist7. Dental prosthesis technician8. Dietician9. General practitioner GP10. Health service manager11. Hospital nurse12. Medical laboratory technician13. Midwifery professional14. Nursing aid15. Optician16. Personal carer in an institution for the elderly17. Personal carer in an institution for the handicapped18. Personal carer in private homes19. Physician assistant20. Scanning equipment operator21. 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


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)


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


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


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


To deliver or to buy a service

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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


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


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


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


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, use of internet may be limited, technical

problems


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).


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


Part 2. Evidence

• Some examples


Nr.16 Charge nurse

1. supervise nurses and other hospital staff in the unit2. monitor symptoms and changes in patients’ condition3. assess patient health problems and needs4. develop, implement and evaluate nursing care plans5. create and maintain medical reports and records6. assist the patients in daily living activities 7. administer medication orally, via rectum, subcutaneous and

intramuscularly8. prepare patients for operations and assist with examinations and

treatments9. monitor and adjust medical equipment used in patient care and

treatment10. consult and coordinate with health care team11. monitor the quality of patient care12. manage the unit, e.g. staffing, financial resources and division of

rooms


Nr 17.Hospital nurse

1. undertake a comprehensive nursing history of the patient2. plan and carry out appropriate care to meet the needs of the

patient3. assess the medical history of the patient4. provide nursing treatment and therapy5. administer and monitor medications and intravenous drugs6. record important changes in the condition of patients7. create and maintain patients’ records8. educate patients and their families about health needs9. check the equipment and supplies10. arrange for patients to have treatment and care after they

leave hospital11. work together with other health care professionals to ensure

the quality of care


Nr 18. Nursing aid

1. observe and report changes in the condition of the patient2. apply practical intervention procedures for dementia or

behavioural problems3. perform basic (medical) procedures such as taking blood

pressure and applying and changing dressings 4. collect specimens such as urine, feces, or sputum 5. assist with rehabilitation exercises and basic treatment and

medications6. provide patients assistance in activities such as walking,

exercising, and moving in and out of bed7. turn and reposition bedridden patients, alone or with

assistance, to prevent bedsores8. feed patients who are unable to feed themselves9. bath, groom, shave, dress, or drape patients to prepare them

for surgery, treatment, or examination


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& ca piel& gniarek


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


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


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


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)


Part 3

• Contextual factors

• Examples from our work on job territories based upon our comparative low wage Europe study


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


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


Changing work organisation

• Team work

• Multi-skilling

• Functional flexibilisation

• Numerical flexibilisation

• Decentralisation

• Task separation?


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


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)


Assist-project: 3 in 1

Cleaner/ house keeper

Nutrition

assistant

Nurse-assistant


Part 4

• Maturing in the job

• Time it takes to become a compete professional expert


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


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).


Next steps

• Distribution of presentation and minutes

• Organisation of feedback procedure

• Dissemination of results

www.euroccupations.org [email protected] workshop ‘care and welfare’ marseille meeting may...

Documents

service slide

negotiation slide

available slide

surgeon slide

minutes outlook slide

theoretical overview

job territories

personal carer