Investing in Europe’s health workforce of tomorrow: Scope for innovation and collaboration

How to create an attractive and supportive working environment for health professionals?

Christiane Wiskow, Tit Albreht, Carlo de Pietro

European Observatory on Health Systems and PoliciesPolicy Dialogue, Leuven, Belgium, April 2010

Why the working environment matters

• Employment: • 10 % EU employment in health sector

• Competitive labour market:• challenge to recruit and retain enough health

professionals for increasing and changing demand

• Working conditions influencing quality of care• Challenge to support effective performance

Links between work environment & quality of care

What is ‘work environment’ / ‘working conditions’?

• No agreed definition • Common aspects :

• Terms of employment • Income • Working time• Safety and health • Professional development • Work organization

What is an attractive & supportive work environment?A general job quality model

Source: adapted from Munoz de Bustillo et al, 2009

Purpose

Attractive, supportive work environment• Incentive to enter health professions and to

stay • Conditions that enable health workers to

perform effectively • Goal: Quality care

Policy options: How to create an attractive, supportive work environment

• What can be done: Examples: • Promotion of family-friendly workplace policies• Enhancing protection of health professionals’ health

• How to advance work environment issues: • Workplace assessment & certification • Intersectoral collaboration & social dialogue

Work life balancePromoting family-friendly workplace policies

Why: • General trend towards balance between work life and

non-work life Workforce is female with increasing feminization

To date, women bear major family responsibilities

What: general approach• Family-friendly workplace culture• Towards equal opportunities

Promoting family-friendly workplace policies (ctd)

• Flexible working time arrangements Reduced hours; less night shifts;

• Safe workplace • Child care facilities / arrangements

• Maternity protection• Job protection; Maternity leave; Financial compensation• Special measures

• Passage from regular to adapted workloads• Priority to less risk exposure (prohibition of certain exposures)• Parental leave• Special leave (care for sick child)• child care facilities / arrangements

Enhancing protection of health workers’ health

Why addressing safety and health ?• High exposure to risks • 32 % of HW perceive their health at risk because of their

work ⇒ may lead to premature exits / reduced work ability

• Many occupational diseases/accidents are preventable

Enhancing protection of health workers’ health

Examples of risks: • Biological risks

Infections: • new emerging (SARS, H1N1)• needlestick /sharps injuries: 1 million annually in Europe

(HBV, HCV, HIV)

• Psychosocial risksHealth sector high exposure• Stress• Violence, harassment

Policy responses: OSH

Policy responses: prevention sharp injuries

Strengthening intersectoral collaboration & social dialogue in health services

• Working conditions/work environment: Interface of labour and health policy mandates

• Multiple stakeholders to be involved• Lack of labour issues related capacity in health sector• Social dialogue: – positive correlation with positive impact on working

conditions – Lessons learnt on success factors:

– Participatory organizational culture – Mutual trust of stakeholders involved– Institutionalized dialogue & binding outcomes– Defined priorities, targets and tasks– Active commitment and competence of social partners

Workplace assessments and certification (1)The Magnet Recognition Program

14 Forces of Magnetism: • Quality of nursing leadership• Organizational structure• Management style• Personnel policies• Professional models of care• Quality of care • Quality improvement • Consultation of resources• Autonomy• Community and healthcare

organization• Nurses as teachers • Image of nurses• Interdisciplinary relationships• Professional development

Strengths: • Links work environment with quality

of care • Attract & retain nurses (magnet

effect)• Reduce burnout

Limitations: • Focus on nursing profession• USA based & hospital focused• Evidence on outcomes sometimes

weak

Workplace assessments and certification (2)The ‘Great Place To Work’ Model

Features of the Model• Workplace culture is decisive for

productivity• Employee orientation• Value-based:

o Focus on Trusto Credibility o Respect o Fairnesso Prideo Team spirit

• Germany: Benchmark survey & competition “Best employers in health sector”

Strengths: • Model easy to understand• Tools easy to use (employee

questionnaire)• Key concept of trust is important

for organizations with information asymmetries and professionals

• Assesses employee satisfaction

Limitations: • Developed and applied in

industries (private sector/ manufacturing)

• No assessment of quality of care or patient outcomes

Preliminary key messages

• Work environment important factor in recruitment & retention of health professionals

• Work environment influence quality of care• Policy responses:

multidimensional, cross-cutting & inclusive

• Solutions are contextual: priority on local /organizational level

Food for thought

• Paradox challenge: mobility and retention• Emerging new challenge: creating work

environment suiting elder health workers • Strengthen evidence on links between work

environment and quality care • Innovation/ collaboration: • Intersectoral dimension • Good place to work in the health sector: indicators? • Explore option of expanding the health sector

dimension within the European Working Conditions Observatory