Integrating Service User and Workforce Involvement: Slovakia Marta Kahancová and Mária Sedláková Final conference, Brussels, With financial support of the EC

Research questions and data Impact of user involvement on which actors are represented within systems of social dialogue Are new forms of direct user involvement encouraged? What implications for traditional representative voice? How is the scope and agenda of social dialogue changing? Are the interests of service users compatible with the interests of social partners? What are the consequences for the social partners and workplace practice? 25 semi-structured interviews (patients’ organizations, educational councils, school boards; trade unions, employer associations, government representatives and experts)

Drivers of user involvement  Transition from state socialism to democracy Growing importance of civil society and civic participation  New public management reforms user involvement in a bottom-up perspective (competition - focus on service quality, hospital independence from public services, school self- governance); top-down perspective: Healthcare Surveillance Authority  NGO initiatives for efficiency and transparency in public services

Public services social dialogue EDUCATION: Bargaining coverage within public services 100% Independent multi-employer bargaining without collective agreements New actors: trade union fragmentation HEALTHCARE - HOSPITALS: Bargaining coverage 95% (independent from public services) Multi-employer bargaining, dualization New actors: trade union fragmentation Shift away from traditional bargaining to protests, strikes, political action

Forms of user involvement Slow institutionalization Structure inherited from socialism (education) or newly developing (healthcare) Real practice: started only upon NPM reforms, mid- 2000s National level: interest fragmentation; underdeveloped collective representation of users Establishment level: micro-level platforms of user involvement, individual user involvement better developed (healthcare), collective user involvement increasingly important (schools)

Impact on social dialogue  Actors: diversity of interests, thus users’ influence on the established actors in social dialogue is limited  Processes: little interaction between user involvement and social dialogue; Sector level: distinct channels of influence Establishment level: modest formalization (user feedback – hospital) to limited formalization (direct interaction of users with teachers – school)  Outcomes: some overlap in agendas, establishment level – work organization and working time adjustments due to user pressures

User pressure without user involvement  Dominant trend in Slovakia  Until present – limited direct impact on social dialogue, but potential impact  NGO initiatives facilitate a better understanding for users of the connection between service quality and the quality of working conditions in schools and hospitals  Empowering users to exert pressure on quality of public services directly and through social dialogue

I NEKO experience in running internet portals evaluating Slovak schools and hospitals Peter Golias INEKO Director January 30, 2015 Brussels, Conference on integrating service user & workforce involvement in public services

INEKO portals  Education (2012):  Health care (2014):  Starting points, ideas behind: Need for higher quality and efficiency of public services „You cannot manage what you do not measure“ Money should follow quality and efficiency Need for better information available to the public Existing but hidden/unavailable data Increasing computer power enabling processing of big data

Goals Attract public attention to discussion about quality and efficiency of schools and hospitals Inform public about how different schools and hospitals meet selected quality & efficiency indicators Through better information (and subsequent choice of providers) increase public pressure on improving quality & efficiency of schools and hospitals

Indicators Primary and secondary schools: Standardized tests results Unemployment rate (only for secondary) Exceptional results (e.g. in national competitions) Other: State inspection, teacher/pupil ratio, etc. Hospitals: Patient opinion (from surveys) Patient complaints Official quality indicators (e.g. mortality, waiting lines) Other: Financial health, transparency, etc.

Target groups & Experience  Target groups: Consumers (parents, students, patients) Journalists Providers (schools, hospitals) Policy makers and regulators  Experience: Publishing data helps to improve their quality State is often reluctant to cooperate (conflict of interest, mistaken data) Many providers do not like to be evaluated There is much room for improvement of data and methodology

Thank you for your attention!