1. Investing in Europes 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 Policies Policy Dialogue, Leuven, Belgium, April 2010

2. 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

3. Links between work environment & quality of care

4. What is work environment / working conditions? No agreed definition Common aspects : Terms of employment Income Working time Safety and health Professional development Work organization

5. What is an attractive & supportive work environment? A general job quality model Job quality Employment quality Wages Type of contract Working hours Social benefits Participation Training & skill development Work quality: Work autonomy Physical working conditions Health variables Risk of accidents Speed Social work environment Source: adapted from Munoz de Bustillo et al, 2009

6. Purpose Attractive, supportive work environment Incentive to enter health professions and to stay Conditions that enable health workers to perform effectively Goal: Quality care

7. 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

8. Work life balance Promoting 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

9. 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

10. 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

11. 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 risks Health sector high exposure Stress Violence, harassment

12. Policy responses: OSH

13. Policy responses: prevention sharp injuries

14. 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

15. 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

16. 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 Trust o Credibility o Respect o Fairness o Pride o 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

17. 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

18. 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