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Workshop ‘Care and welfare’ Marseille Meeting May 21-22th. 2008 For communication: [email protected] www.euroccupations.org www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] Part one • Theoretical overview www.euroccupations.org [email protected] 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 [email protected] 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 www.euroccupations.org [email protected] 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) www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] To deliver or to buy a service main contractor <employer> sales contract <supplier> employment contract <employee> www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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, technical [email protected] 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). www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] Part 2. Evidence • Some examples www.euroccupations.org [email protected] 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 www.euroccupations.org division of rooms [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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) www.euroccupations.org [email protected] Part 3 • Contextual factors • Examples from our work on job territories based upon our comparative low wage Europe study www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] Changing work organisation • • • • • • Team work Multi-skilling Functional flexibilisation Numerical flexibilisation Decentralisation Task separation? www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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) www.euroccupations.org [email protected] Assist-project: 3 in 1 Cleaner/ house keeper Nutrition assistant www.euroccupations.org [email protected] Nurseassistant Part 4 • Maturing in the job • Time it takes to become a compete professional expert www.euroccupations.org [email protected] 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 www.euroccupations.org [email protected] 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 [email protected] Next steps • Distribution of presentation and minutes • Organisation of feedback procedure • Dissemination of results www.euroccupations.org [email protected]