Present and Future challenges for Health care Employment: Europe Experiences

Present and future challenges for health care employment. Present and future challenges for health care employment. European experiencesEuropean experiences

Shoeb Ahmed IlyasShoeb Ahmed IlyasHealth Care Consultant Ruby Med Plus Health Care Consultant Ruby Med Plus

1.- THE EUROPEAN UNION EMPLOYMENT STRATEGY (EES)

Objectives:

1. Full employment2. Improving quality & productivity at work3. Strengthening social cohesion & inclusion

1.- The EES Guideliness 10 policy priorities

1. Active and preventive measures for the unemployed2. Job creation3. Change, adaptability and mobility in the labour market4. Development of human capital and lifelong learning5. Increase labour supply and active ageing6. Gender equality7. Combat discrimination against people at disadvantage8. Incentives to enhance work attractiveness9. Transform undeclared work into regular employment10. Address regional employment disparities

2.-The employment situation in health care 2.-The employment situation in health care sector.sector.

1.1. The ageing process: demographic and epidemiologic data The ageing process: demographic and epidemiologic data 2.2. Undersupply and shortage of professionals Undersupply and shortage of professionals 3.3. Globalization of the health labour marketsGlobalization of the health labour markets4.4. Regional inequalities in servicesRegional inequalities in services5.5. Future challenges for Health Care Employment in the Basque CountryFuture challenges for Health Care Employment in the Basque Country

The employment situation in health care The employment situation in health care sector.sector.2.1.- The ageing process2.1.- The ageing process

The employment situation in health care The employment situation in health care sector.sector. 2.1.- The ageing process2.1.- The ageing process

_X = 60, 9X = 60, 9

Retirement age variance related factors:

• Higher or lower retirement age• Presence/absence of incentives to prolong• Variation in the extent of early retirement systems• Individual preferences (satisfaction at work & health status)

(Börsch-Supan et al., 2005)

Labour supply deficit:

Incoming (15-24)

Age class exiting(55-64)

The employment situation in health care The employment situation in health care sector.sector. 2.2.- Labour supply deficit.2.2.- Labour supply deficit.

The employment situation in health care sector.The employment situation in health care sector. 2.2.- Labour supply deficit.Labour supply deficit. N. health care workers.N. health care workers.

The employment situation in health care The employment situation in health care sector.sector.

2.2.- Undersupply adverse consequences.Undersupply adverse consequences. • Lower quality and productivity of health services• Closure of hospital wards• Increasing waiting time• Diversion of emergency department patients• Reduced number of staff beds• Underutilization of trained individuals (Zurn et al.,

The employment situation in health care The employment situation in health care sector.sector.2.3.- Globalization of health labour markets2.3.- Globalization of health labour markets• The global shortage (4 million) is divided unequally (EU and States employ half physicians & 60% nurses)

• The main source countries in EU aren´t european• In many countries the flows go in both directions• Previously colonial ties determined the migration flows

The employment situation in health care sector.The employment situation in health care sector.2.3.- Globalization of health labour markets. 2.3.- Globalization of health labour markets. Flows.Flows.

The employment situation in health care The employment situation in health care sector.sector.2.4.- Regional inequalities2.4.- Regional inequalities

• Global imbalances (ratio professionals)• Lack of resources in less developed areas• The regions responsability varies from country to country• Demographic trends affected by social & economic development• Distributional imbalances different types (geographic, gender, occupational, institutional...)

The employment situation in health care The employment situation in health care sector.sector.2.5.2.5. Future challenges in the Basque CountryFuture challenges in the Basque Country

• The aging of the population combined with the efficiency of treatment increases the emergence of coping with the chronic diseases and

disabilities.• A decrease in the support provided by the family network.• Permanent medical innovations.• Implementation of new services, programmes and technologies.

The employment situation in health care The employment situation in health care sector.sector. 2.5.2.5. The Basque Country future challengesThe Basque Country future challenges

• Cultural diversity, technological and idiomatic education of users.• Patients are behaving more like consumers.• Increased relevance of health protection and promotion.• Fostering of healthy lifestyles.• Abundant and accessible information enabled by advances in technology and information systems.

The employment situation in health care The employment situation in health care sector.sector. 2.5.2.5. The Basque Country future challengesThe Basque Country future challenges

• Changes in patients’ expectations and demands.• Aging of professional personnel.• A shortage of professionals to cover current needs and assure generational change.• Professional pressure to bring salaries in line with Europe.

The employment situation in health care The employment situation in health care sector.sector.

In summary …In summary …• More money to be spent on health care with aging

population• The ageing process is expected to continue until the

next decade• This process cause a shortage of health care workers• The shortage of professionals is divided unequally• The main source countries in EU are not european• In many countries the flows go in both directions• Previously colonial ties as a determinant• Regional inequalities as an on-going problem

3.- ANTICIPATING WORK FORCE NEEDS

3.- ANTICIPATING WORK FORCE NEEDS. Retention strategies and work-related well-Retention strategies and work-related well-

beingbeing Contemporary recruitment strategiesContemporary recruitment strategies Managing changeManaging change Mobility of health care professionlsMobility of health care professionls Building a client-directed service cultureBuilding a client-directed service culture Allocation of scarce resources and efficency Allocation of scarce resources and efficency

improvementsimprovements Training and educationTraining and education Career development strategiesCareer development strategies

3.- How to solve the shortage problem?

1.1. Providing more educational facilities Providing more educational facilities (TRAINING) (TRAINING)

Mainly:Mainly:1.1. Promoting the RETENTION of existing staffPromoting the RETENTION of existing staff2.2. Promoting the inmigration (RECRUITMENT)Promoting the inmigration (RECRUITMENT)

(Buchan & Sochalski, (Buchan & Sochalski, 2004)2004)

Anticipating work force needs.Anticipating work force needs.3.1.- Retention strategies and work related well-being: 3.1.- Retention strategies and work related well-being: The health sector responsability to show excellence as an employerThe health sector responsability to show excellence as an employer

1. Effective healthcare leadership2. Communication and team building3. Motivation and empowerment4. Decrease of work-related stress and bournot5. Policies for reconciling parenhood and employment6. Flexible and family-friendly working practices7. Promotion attractiveness of work among the retiring age group

3.1.1.- Effective healthcare leadership3.1.1.- Effective healthcare leadership

“Leadership is a dynamic process of pursuing a vision for change in which the leader is supported by two main groups: followers within the leader´s own organisation, and influential players and other organisations operating in the leader´s enviroment”

(Goodwin, 2002)

3.1.1.- Effective healthcare leadership3.1.1.- Effective healthcare leadershipTasks have been replaced by Tasks have been replaced by emphasis on people issuesemphasis on people issues

• Networking• Trust• Emotional intelligence• Empathy and relationship skills• Cultural intelligence

3.1.2.- Communication and team building3.1.2.- Communication and team buildingAnalyzing effectiveness,,a critical step in a team-building processAnalyzing effectiveness,,a critical step in a team-building process

Team effective criteria:Team effective criteria:1. Common goals and objectives2. Conflict is dealt3. Share leadership roles4. Use of resources5. Roles, responsability and authority6. Control and procedures7. Problem solving and decision making8. Experimentation and creativity9. Self-evaluation10. Interpersonal communication

3.1.2.- Communication and team building3.1.2.- Communication and team buildingWhat´s your communication style?What´s your communication style?

• Assertiveness: effort to influence the thoughts/actions of others• Expresiveness: effort to control your own emotions and feelings when relating to others

3.1.2.- Communication and team building3.1.2.- Communication and team building

Typical comunication behavioursTypical comunication behaviours

Communication style strenghtsCommunication style strenghts

Communication style trouble spotsCommunication style trouble spots

Interacting with diferent stylesInteracting with diferent styles

3.1.3.- Motivation and retention of health workers in 3.1.3.- Motivation and retention of health workers in developing countriesdeveloping countries

7 major motivational factors:1. Financial2. Career development3. Continuing education4. Hospital infraestructure5. Resource availability6. Hospital management7. Personal recognition or appreciation

(Willis-Shatuck et al., 2008)

3.1.4.- Decrease of work - related stress3.1.4.- Decrease of work - related stress and bournotand bournot

Work-related health Work-related health problemsproblems

Work- and Organizational Psychology - KUN

Work related health problems 1995 - 2000

Source: European Foundation for the Improvement of Liv ing and Working Conditions (2001)

Backache Stress Ov erallfatique

Neck &Shoulders

He adaches Uppe r limbs Lowe r limbs

19952000%

Promoting the mental health of health-workersPromoting the mental health of health-workersSources of stress:• Direct relationship and contact with patients • Relationship with the organizational environment as a system.

Burnout - 3 Dimensions: Emotional Exhaustion Depersonalisation Reduced Personal Accomplishment (Maslach and Leiter, 1997)

Consequences of Stress & BurnoutConsequences of Stress & Burnout

Organisational functioningOrganisational functioning Job satisfaction ( work effectiveness, turnover) Org commitment ( turnover intent, job involvement) Turnover

Worker health & wellbeingWorker health & wellbeingDepression Psychosomatic complaints Health problems

Client outcomesClient outcomes (Garmen et al., 2002)

Need for Better Intervention Studies Need for Better Intervention Studies

We know that:-Stress & burnout is a problem -Negative repercussions for workers, organisations & clients

Intervention strategies have focussed on individual…We also need to intervene at workplace level

BUT there is a lack of large, high quality studies evaluating

organisation interventions (Edwards & Burnard, 2003)

Policy & Practice Policy & Practice ImplicationsImplications

Integrate and mainstream action into strategic EU activities to promote “more and better jobs” (Lisbon summit) and research programmes

Revitalise the EU framework directive and propose positive incentives for its implementation

Choose a holistic, stepwise approach using risk analysis and a combination of measures (work, worker, supporting policies) and evaluate interventions

Involve workers and engage in social dialogue and partnerships

Identify and disseminate Models of Good Practice

Action Action proposalsproposals

• Construct clarification: a shared view across EU

• Develop a set of indicators and tools

• Develop guidelines and technical documents

• Produce a catalogue of good practices and interventions; stimulate its application/ evaluation

• Promote partnership among different groups

• Promote research on burnout and on program implementation; enhance transference and use.

3.1.5.Policies for reconciling parenhood and employment3.1.5.Policies for reconciling parenhood and employment

Sustained change in Workplace Structure, Culture and Practice

New workplace cultures to replace the current ‘long hours’ work culture

An opportunity for moving towards ways of working that are more compatible with today’s families

A healthy Integration of work and family care

3.1.6. Flexible and family-friendly working practices3.1.6. Flexible and family-friendly working practices

• Maternity and parental leave benefits• Reduced-work options and Flexible work-time for specific periods• New types of jobs,...

DIFFERENT MODELS:• Support across the ages, the comprehensive but expensive Danish model

• The Japanese model: try to keep mothers in regular employment by one year paid leave – and return bonus, and workplace support until age 3

• The Dutch model: work parttime and get employers to pay one/third of childcare costs

3.1.7.Promotion attractiveness of work among the retiring age 3.1.7.Promotion attractiveness of work among the retiring age groupgroup Veto Finnish national programmeVeto Finnish national programme

BACKGROUND:

• The finnish population is ageing rapidly• More people is leaving the labour market than entering it• The dependency rate (population of working age without

income security benefit/ work) is rising

BACKGROUND:

• The finnish population is ageing rapidly• More people is leaving the labour market than entering it• The dependency rate (population of working age without

income security benefit/ work) is rising

Pension reform• Flexible old-age pension age

– Could be taken up at the age of 62-68– age-related pension accrual rate

• 18-53 = 1,5 %, 53-62 1,9 % and 63 4,5 %• no upper limit for the earnings-related pension

• Pension based on the entire career– Final pension would be based on the calculation that is more favourable to the employee

• Changes in early retirement pension– People can opt for semi-retirent from 58– No unemployment pension scheme any longer– Soma smaller correction

Some features of Finnish system:

• The employer must take out pension and accident insurance for all employees and to pay contributions

• Every workplace with more than 30 employee must have industrial safety delegate and committee

• Every employer must arrange occupational health care – Main stress on prevention

Objectives:

1. Entry into working life at an earlier age2. Work careers will be 2 – 3 years longer than today3. Sick absences will reduce by 15%4. Occupational accidents and diseases will be reduced by 40%

from the present figures5. Consumption of tobacco and alcohol among population of

working age will decrease

Five Different important themes:

• High working life quality and safety culture• Effective occupational health care and rehabilitation• Diversity and equality in working life• Income security and work incentives• Awareness raising

Focus on well-being at work

• Meaningful work important for well-being and quality of life• Minimum standard by legislation• Attractiveness of work to be improved• Boosting productivity and competitiveness• Main responsibility on workplaces• Supported by OSH system and health care services• Labour market organisations play an important part• At workplace level question of knowledge, willingness and skill

Target groups inVeto-programme

• People in working life age 45+• Middle management• Small and medium size enterprises• Occupational health care professionals• Occupational safety organizations

3.1.7.Promotion attractiveness of work among the retiring age group3.1.7.Promotion attractiveness of work among the retiring age group Veto Finnish national programme: Measures IVeto Finnish national programme: Measures I

– Working life trainers networkWorking life trainers network• In cooperation with the KESTO programme • Target group: occupational health care personnel, authorities + organizations• At the workplace, personnel management in enterprises, middle management.

– Awareness raising seminarsAwareness raising seminars• 8 seminars in every OS-district

– Good practices and projects in different occupational sectorsGood practices and projects in different occupational sectors• Work Research Centre: “Developing and distributing practices to support

workers’ well-being at work in hospitals”, joint finance VETO and TYKES • Development programme• Next: the social and educational sectors

3.1.7.Promotion attractiveness of work among the retiring age group3.1.7.Promotion attractiveness of work among the retiring age group Veto Finnish national programme: Mesaures IIVeto Finnish national programme: Mesaures II

• Developing good occupational health care practice.- Pilot project by FIOSH: “Work-related upper limb disorders”

• Workplace Health Promotion network

• Developing municipal occupational health care systems .- Evaluation of different organisational and operational models

• Updating the book “Ageing workers in Finland and in Europe”

• Advice on opportunities for retirement and continuing working

3.1.7.Promotion attractiveness of work among the retiring age group3.1.7.Promotion attractiveness of work among the retiring age group Veto Finnish national programme: Mesaures IIIVeto Finnish national programme: Mesaures III

• Monitoring agreements on retirement and unemployed pathway to retirement

• Communication (home page, publications,etc.)

• Information campaigns- ”Don’t be a masochist!”– “Bring it up!” … working conditions, safety questions, unfair treatment,…– Campaign sites klinikka.fi

• discussions, occupational psychologists answering, good examples etc.– Examples of good experiences in one company

• Short presentation of the workplace• Companies present in the seminars their work concerning occupational health and safety

Concluding remarks, achievements:

• Finland has given high priority to a number of legislative reforms and ageing programmes to remove barriers to employment of older workers

• To design a coherent policy strategy• To engender political support that is sufficiently wide, deep,

and durable• To put into place effective administration

3.1.7.Promotion attractiveness of work among the retiring age 3.1.7.Promotion attractiveness of work among the retiring age groupgroup Veto Finnish national programmeVeto Finnish national programmeWhy success in Finland?– Economic recession in early 1990s was an awakening call; cutting

expenses was understood to be unavoidable– Information to central target groups with information and training

campaigns– Improved working capacity of older workers and prevention of

prejudice against ageing– Implementation of reforms in tripartite cooperation byemphasising

the benefits for the employees, employers and the society as a whole

– Research and development an important part of the reform– Legislative reforms that convince the public that this is a serious

societal reform and not only lip service

Anticipating work force needsAnticipating work force needs3.2.Recruitment strategies. 3.2.Recruitment strategies.

• Increasing students enrolling at training• Encouraging the professionals not to change for other fields of

activity• Encouraging others return (influence work conditions)• Looking abroad to recruit staff (intensive language training,

grants,...)• New technologies (internet, recruitment agencies,...)• Temporary work agencies

Anticipating work force needsAnticipating work force needs3.3. Managing change 3.3. Managing change

• Prepare healthcare workers to manage chronic conditions • Changing to evidence-based medicine• Managing change in a multicultural world• New teaching methods & innovative training models

Anticipating work force needsAnticipating work force needs3.3. Managing change. 3.3. Managing change. The challenge of chronic conditions The challenge of chronic conditions

“New competences”– Patient centred care– Partnering– Quality improvement– Information and communication technology– Public health perspective

Anticipating work force needsAnticipating work force needs3.4. Building a client-directed service culture 3.4. Building a client-directed service culture

• Coordinating continuous and timely care• Relieving pain and emotional suffering • Listening and communicating • Providing education and information • Sharing decision making and management • Preventing disease, disabilities, and impairments • Promoting wellness and healthy behaviour.

Anticipating work force needsAnticipating work force needs

3.5.- 3.5.- New teaching methods /innovative training modelsNew teaching methods /innovative training models

“New learnings”• From a reactive care to proactive, planned, and preventive care.• Negotiate individualised care plans with patients, taking into account needs, values, and preferences• Support patients' efforts at self management• Organise and implement group medical visits for patients who share common health problems• Care for a defined group of patients over time• Work as a member of a healthcare team• Work in a community based setting• Design and participate in quality improvement projects• Develop and use available technology and communication systems to exchange information on

patients• Think beyond caring for one patient at a time to a "population" perspective• Develop a broad perspective of care across the continuum from clinical prevention to palliative care

Anticipating work force needsAnticipating work force needs3.6.- Mobility of health care 3.6.- Mobility of health care professionalsprofessionals

• Rooted in a growing global shortage of health professionals– Ageing population– Lack of training– Low fertility rates – Labour shortages in specialised areas (Bach, 2003)

• Other reasons (poor wage levels, no work, bad living or working

conditions, to scape wars, conflicts, chaotic circumstances,…)

(Berman, 2001)

Anticipating work-force needsAnticipating work-force needs 3.6.- Priorities throughout 3.6.- Priorities throughout Europe!!!Europe!!!

• Free movement of labour within its borders• Migration into certain regions• Liberalization of labour markets• Mutual recognition of qualifications• Increased cooperation between origin and receiving

countries• Measures to manage the mobility as a priority

Anticipating work-force needsAnticipating work-force needs 3.73.7.- Allocation of scarce resources and efficiency .- Allocation of scarce resources and efficiency improvementsimprovements

• Time-based management and work-in-progress techniques

• Patient-oriented approach (Patient process a patient episode)

Programme 27th October (18.00-20-Programme 27th October (18.00-20-30)30)

• (18.00-19.30)– Exercise 1: The employment situation in the diverse health care

systems

• (19.30 – 20.30)– Welfare, inclusive employment and social enterprises– Connecting employment to regional economies

4.- WELFARE MIX, INCLUSIVE EMPLOYMENT AND SOCIAL ENTERPRISES AS NEW PARADIGMS

4.-Welfare mix, inclusive employment & social enterprises

1.1. The long-term unemployedThe long-term unemployed2.2. The demand for social enterprises The demand for social enterprises 3.3. Welfare mix and employmentWelfare mix and employment4.4. Inclusive and supported employmentInclusive and supported employment5.5. Case studiesCase studies

4.-Welfare mix, inclusive employment, social enterprises The long-term unemployed

An ignored resource of the health work force:

• Unemployed due to structural change or after a long-term illness

• The mentally/physically disabled• Learning disabilities• Inmigrants and refugees• Ageing workers

4.-Welfare mix, inclusive employment, social enterprises 4.1. Welfare Mix and third sector models

Proposed to help employ people with difficulties to get employed

Driven by 3 broad principles (3Ds of reform):

1. Desinstitutionalization2. Diversification3. Descentralitation

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises4.2.-4.2.-The demand for social enterprisesThe demand for social enterprises

Social enterprise is an activity carried out by an organisation

that advances its social mission through entrepreneurial, earned income strategies.

BUSINESS WITH A SOCIAL PURPOSE

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises Social firmsSocial firms

TYPES OF SOCIAL ENTERPRISES

• Cooperatives and Mutual Societies• Credit Unions• Development Trusts• Housing Associations• Community Recycling• Social Firms

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises Social firmsSocial firms

• Origins: Italy and Germany in the 60´s• European networking started in the early 1980’s• Now the focus in Great Britain• Marked-led business set up specifically to create quality jobs for people severely disadvantaged in the labour market• Evidence of overall cost-benefit value• Evidence of impact on health and well-being• One of a variety of types of employment initiatives• Others: sheltered workshop,vocational training + supported employment

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises Social firms are Values LedSocial firms are Values Led

• ENTERPRISE: Social business that combine a market orientation + social mission• EMPLOYMENT: They are committed to the social and economic integration• EMPOWERMENT: Economic empowerment through the payment of market wages + Supportive workplaces and meaningful work

Social firms values

Empowerment• Workplace adaptations• Staff development a priority• Stress management• Commitment to staff confidentiality• Volunteer agreements• Appropriate awareness training• Emphasis on training for disadvantaged staff• Consultative approach to decision-making• Vocational training, time-limited and demarcation of responsibilities

4.-Welfare mix, inclusive employment & social enterprises4.-Welfare mix, inclusive employment & social enterprises4.3.-4.3.- Inclusive employment Inclusive employment• From the indiv. point of view help the disadvantaged get back into the

society

• From the employer/community include working towards:– Humane services– Work-life balance– Quality of life

• Born in 1991• Supported by the Europen Social Found (1995-

• Administrative council:• First Lady of Basque Country´s President (Mrs.

Gloria Urtiaga) • Bilbao Bizkaia Kutxa Bank• Bizkaia Provincial Council• President of Confebask• Promoters: Mr. Ozamiz and Mr. Beramendi

Eragintza Foundation: origins

Services1. VOCATIONAL REHABILITATION CENTRE

1. User information 2. Intake and assessment3. Social training and job training4. Job club5. Supported employment

2. OCCUPATIONAL CENTERS

3. SOCIAL ENTERPRISE: Lavanindu S.A. (Industrial Laundry)

4. TRAINING PROGRAMME FOR PROFESIONALS

Vocational Rehabilitation Centre__________________________________________

Intake• Direct / indirect derivation• Reception interview

Informing Data collection Derivation criteria Risk areas

1. Minimum requirements2. Risk areas3. The user´s resources4. The user´s needs

Assessment

Assessment1. Medical/Psychiatric report2. Psychological/social report3. Tests4. Interviews (user, familly, mental health

professional, job supervisor,…)5. Behavioural and situational assessment

Current enviroment Job situation

Assessment Collecting data:

• Functional assessment• Vocational profile• Interview (user and family)• Direct observation in his/her enviroment• Observation in a real work situation

•Communication techniques

•Social skills training

•Coping with stress

•Vocational guidance

•Job-hunting techniques

Social training & job training

Job Club1. Training activities (culture, languages, computer course,

2. Leisure activities (art works, painting, board games,…)

Occupational Centers__________________________________________

BookbindingGardeningCooking

1. Search for jobs suiting the user´s training and experience2. Assessment of the user´s performance at the work place3. Direct support if necessaryIncludes:

Marketing of the programme Analysis of the job market A search for suitable jobs available Contact with enterpreneurs Analysis of the job

Supported employment__________________________________________

Job hunting

Supported employment_________________________________________

Placement

• Task analysis• Selection of assessment data• Compatibility analysis of the job and the users• Once the candidate is selected_discussion with

the family, derivation centre,...• Go over interview techniques

Supported employment________________________________________

Training in the workplace

• Phases:–Guidance ans assessment–Initial training and skills acquisition–Stabilisation

Supported employment_________________________________________

MonitoringComponents:• Case control• Performance analysis

– Instructional information supervisor´s assessment– User´s self-assessment– Information from colleagues at work– Observation at the work place– Visit outside the working enviroment– Telephone contact

• Application

Social enterprise__________________________________________

Industrial laundry (Lavanindu S.A.)30 workers with long-term mental health disabilities

_________________________________________________

In total about 300 persons with long-term illness were benefit

_________________________________________________

Training Programme__________________________________________

Job Coaching Training Programmme

Attatchment Theory and its application to prevention and rehabilitation in mental health matters

Transnationality work

ACCEPT networkOverall aim:

Assessment, Counselling and Coaching in Assessment, Counselling and Coaching in Employemnt, Placement and Training for Employemnt, Placement and Training for

individuals with mental ill healthindividuals with mental ill health

EUROPEN PARTNERSEUROPEN PARTNERS

DIE BRUCKE

MENTAL HEALTH MATTERS

STAKES-CONSORTIUM

ERAGINTZA

TRANSNATIONAL ACTIVITIES

1. Exchange of information and benchmarking practices (study visits to all participating organizations, transnational workshops and thematic focus groups).

2. Transferring and adapting existing tools to situations in other Member states.

3. Jointly developing transnational products (reports and handbooks describing strategies for supported employment and social firms creation, a guideliness for job coaching,…).

4. Applying transnationality as a stimulating learning enviroment for the staff

The impact of Transnationality

On participants:

New vocational skills, attitudes and knowlwdge + staff learned to act in an international enviroment

On the organisation:

Changes in the core activities + preparation for future co-operation

Let´s have a look to the second experience ...

It is a project finanzed by the Goverment of Cantabria (Spain), and developed by three different institutions:

•Padre Menni Hospital

•AMICA

•ASCASAM

INICIA PROJECT

• For people with long term mental illness who have special difficulties to work in the open labourmarket

Let´s go back,...• Born in 1998 as a vocational rehabilitation

programme for people with mental illness.• Finanzed by the local goverment and the Social

Found (Horizon III).• There were no more similar experiences in

Cantabria before.

Let´s go back ...• 98-99 INICIA Proyect developed psychosocial

rehabilitation programmes in combination with vocational rehabilitation activities and a family support program.

• It was the main contribution to the development of a

psychosocial rehabilitation network of centers finanzed by the local goverment.

• 2000-2006: finanzed by the local goverment

Derivation criteria• Long-term mental illness

– (no brain injury or addictive behaviours)• Age: 18 - 50 years old• Unemployed people or with severe difficulties

to acess to employment • No disruptive behaviour

1.- DERIVATION• ALWAYS ..... From a mental health professional

3 ways:• Mental Health Service

• CSM CRPS

• Psychiatric Hospitals

Vocational rehabilitation programme

2.- ASSESSMENT

1. Clinical status2. Health and daily live issues3. Social and community participation4. Training5. Work experience6. Motivation and expectations7. Searching skills8. Social status9. Work habits and social skills at work placements

Family

• Family structure and relationships• Family needs• Family expectations

Standarized tests

• AF5 (self-steem)• Social and vocational

adjustment questionnaire.• SFS-AI (Social performance

Scale).• CPS (Situational personality

questionnaire)• BPRS (Psychopathology)

FAMILY:

• Caregiver´s burdem interview (family stress and coping strategies).

• FQ (Problematic behaviours, stress and control)

• SFS-AI Familiar (Social performance scale).

3. INTERVENTION• Case discussion and taking decisions in group• Making a vocational rehabilitation programme

for each user• Matching his/her needs and the family´s needs.• Risk areas, resources and lacks.• Aims.

• Vocational profile

4. services• Vocational rehabilitation

• Vocational training• Sheltered employment• Employment in the open labour market• Occupational work• Vocational counselling

What works in vocational rehabilitation? (Cook et al. 2000)

They are more likely to get jobs and keep them if:.- are not impeded by poor social skills and negative symptoms.- have worked before.- have positive attitudes towards work.- situational assessment is used in the evaluation.- are place as soon as possible in a job of their choice.- receive preparation targeted at work.- receive ongoing support.- are not worse off financially as a result of working.- competitive/supported employment rather than sheltered/unpaid work

Benefits• For Service Consumers

– Alleviation of Poverty (Cook & Grey, 2002)– Therapeutic Gain (Bond et al., 2001; Lysaker et al., 1994)– Improvement in Quality of Life (Arns & Linney, 1993)

• For Society– Contribution to Economy (Cook et al., 2002)– Financial Return Via Taxes Paid (Rogers, 1997)– Reduction in Use of Benefits (CA DOR, 1995)– Reduction in Costs of Care (CA DOR, 1995; Rogers, et al., 1995)

RecommendationsCommissioners of MH services should consider:

Using employment as a key performance indicator

Ensuring access to a range of work-related provision

Specifying social inclusion as a criterion of acceptable employment outcomes

Procuring early intervention for people MH problems

RecommendationsManagers of MH services should consider:

Integrating vocational reh. with community MH teams, assertive outreach, crisis and early interventions.

Converting day centres to provid supported emplyment.

Training staff in its principles, as an evidence-based, pychosocial intervention.

Working collaboratively with voluntary organisations, with social services and Jobcentre plus to promote employment opportunities.

RecommendationsStaff should consider:

Getting access to expert benefits advice

Assessing service user´s work abilities on admision

Referring them quickly to an employment specialist

Treating negative symptoms

Preventing loss of social skills

Building work-related confidence and skills as part of the treatment

RecommendationsCampaigning organisations should consider:

Initiatives to promote acceptance of MH disabilities in the workplace

Researchers should consider:

Comparing the costs and effectiveness of vocational rehabilitational approaches in the each country context, paying particular attention to meeting individual needs.

5.- Conecting employment to regional 5.- Conecting employment to regional economies.economies.Factors that can promote the effectiveness of health care employment in improving regional economies:

• Decision making and financial-authority• Integrated approach to workforce development• Understanding principles and processes that are effective• Improving inclusive employment policies• Improving the attraction of working life

6.- 6.- ConclusionsConclusions

• Analyzed the challenges for sustaining a well functioning health care system as a driver for regional development.

• Main strategies discussed: retention and recruitment for personnel.

• Apart from means to find solution to workforce shortage welfare mix has gained ground as a way to lessen the burden by increasing the well-being.

Present and Future challenges for Health care Employment: Europe Experiences

Healthcare

Transcript of Present and Future challenges for Health care Employment: Europe Experiences

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