Workshop ‘ Care and welfare’

1. Workshop ‘Care and welfare’ Marseille Meeting May 21-22th. 2008 For communication: marc.vandermeer@uva.nl www.euroccupations.org www.euroccupations.org marc.vandermeer@uva.nl

2. 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 marc.vandermeer@uva.nl

3. Part one • Theoretical overview www.euroccupations.org marc.vandermeer@uva.nl

4. 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 operator 21. Surgeon www.euroccupations.org marc.vandermeer@uva.nl

5. 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 marc.vandermeer@uva.nl

6. 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 marc.vandermeer@uva.nl

7. 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 marc.vandermeer@uva.nl

8. 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 marc.vandermeer@uva.nl

9. 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 marc.vandermeer@uva.nl

10. To deliver or to buy a service www.euroccupations.org marc.vandermeer@uva.nl

11. 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 marc.vandermeer@uva.nl

12. 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 marc.vandermeer@uva.nl

13. 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 marc.vandermeer@uva.nl

14. 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 marc.vandermeer@uva.nl

15. 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 www.euroccupations.org marc.vandermeer@uva.nl

16. Overall aims comparison • The average expert score in the 7 countries • The heterogeneity of expert judgements in 7 countries • 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 marc.vandermeer@uva.nl

17. 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 marc.vandermeer@uva.nl

18. Part 2. Evidence • Some examples www.euroccupations.org marc.vandermeer@uva.nl

19. Nr.16 Charge nurse 1.supervise nurses and other hospital staff in the unit 2.monitor symptoms and changes in patients’ condition 3.assess patient health problems and needs 4.develop, implement and evaluate nursing care plans 5.create and maintain medical reports and records 6.assist the patients in daily living activities 7.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 division of rooms www.euroccupations.org marc.vandermeer@uva.nl

20. 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 marc.vandermeer@uva.nl

21. Nr 18. Nursing aid 1.observe and report changes in the condition of the patient 2.apply practical intervention procedures for dementia or behavioural problems 3.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 medications 6.provide patients assistance in activities such as walking, exercising, and moving in and out of bed 7.turn and reposition bedridden patients, alone or with assistance, to prevent bedsores 8.feed patients who are unable to feed themselves 9.bath, groom, shave, dress, or drape patients to prepare them for surgery, treatment, or examination www.euroccupations.org marc.vandermeer@uva.nl

22. 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 marc.vandermeer@uva.nl

23. 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 marc.vandermeer@uva.nl

24. 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 marc.vandermeer@uva.nl

25. 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 marc.vandermeer@uva.nl

26. 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 marc.vandermeer@uva.nl

27. Part 3 • Contextual factors • Examples from our work on job territories based upon our comparative low wage Europe study www.euroccupations.org marc.vandermeer@uva.nl

28. 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 marc.vandermeer@uva.nl

29. 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 marc.vandermeer@uva.nl

30. Changing work organisation • Team work • Multi-skilling • Functional flexibilisation • Numerical flexibilisation • Decentralisation • Task separation? www.euroccupations.org marc.vandermeer@uva.nl

31. 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 marc.vandermeer@uva.nl

32. 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 marc.vandermeer@uva.nl

33. Assist-project: 3 in 1 Cleaner/ house keeper Nurse-assistant Nutrition assistant www.euroccupations.org marc.vandermeer@uva.nl

34. Part 4 • Maturing in the job • Time it takes to become a compete professional expert www.euroccupations.org marc.vandermeer@uva.nl

35. 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 marc.vandermeer@uva.nl

36. 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 marc.vandermeer@uva.nl

37. Next steps • Distribution of presentation and minutes • Organisation of feedback procedure • Dissemination of results www.euroccupations.org marc.vandermeer@uva.nl