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 Ilyas
Health Care Consultant Ruby Med PlusHealth Care Consultant Ruby Med Plus

1.- THE EUROPEAN UNION EMPLOYMENT
STRATEGY (EES)
Objectives:
1. Full employment
2. Improving quality & productivity at work
3. Strengthening social cohesion & inclusion

1.- The EES Guideliness 10 policy
priorities
1. Active and preventive measures for the unemployed
2. Job creation
3. Change, adaptability and mobility in the labour
market
4. Development of human capital and lifelong learning
5. Increase labour supply and active ageing
6. Gender equality
7. Combat discrimination against people at
disadvantage
8. Incentives to enhance work attractiveness
9. Transform undeclared work into regular employment
10. Address regional employment disparities

2.-The employment situation in health care2.-The employment situation in health care
sector.sector.
1.1. The ageing process: demographic and epidemiologic dataThe ageing process: demographic and epidemiologic data
2.2. Undersupply and shortage of professionalsUndersupply and shortage of professionals
3.3. Globalization of the health labour marketsGlobalization of the health labour markets
4.4. Regional inequalities in servicesRegional inequalities in services
5.5. Future challenges for Health Care Employment in the Basque CountryFuture challenges for Health Care Employment in the Basque Country

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

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)

sector.sector.
2.2.- Labour supply deficit.2.2.- Labour supply deficit.

sector.sector.
2.2.- Labour supply deficit.Labour supply deficit. N. health careN. health care
workers.workers.

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.,
2002)

sector.sector.
2.3.- Globalization of health labour2.3.- Globalization of health labour
marketsmarkets• 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

sector.sector.
2.3.- Globalization of health labour markets.2.3.- Globalization of health labour markets.
Flows.Flows.

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...)

sector.sector.
2.5.2.5. Future challenges in the BasqueFuture challenges in the Basque
CountryCountry• 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.

sector.sector.
2.5.2.5. The Basque Country futureThe Basque Country future
challengeschallenges
• 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.

sector.sector.
2.5.2.5. The Basque Country futureThe Basque Country future
challengeschallenges
• 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.

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 efficencyAllocation 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 facilitiesProviding more educational facilities
(TRAINING)(TRAINING)
Mainly:Mainly:
1.1. Promoting the RETENTION of existing staffPromoting the RETENTION of existing staff
2.2. 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-3.1.- Retention strategies and work related well-
being:being:
The health sector responsability to show excellence as anThe health sector responsability to show excellence as an
employeremployer1. Effective healthcare leadership
2. Communication and team building
3. Motivation and empowerment
4. Decrease of work-related stress and bournot
5. Policies for reconciling parenhood and employment
6. Flexible and family-friendly working practices
7. 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 leadership
Tasks have been replaced byTasks have been replaced by emphasis on peopleemphasis on people
issuesissues
• Networking
• Trust
• Emotional intelligence
• Empathy and relationship skills
• Cultural intelligence

3.1.2.- Communication and team building3.1.2.- Communication and team building
Analyzing effectiveness,,a critical step in a team-buildingAnalyzing effectiveness,,a critical step in a team-building
processprocess
Team effective criteria:Team effective criteria:
1. Common goals and objectives
2. Conflict is dealt
3. Share leadership roles
4. Use of resources
5. Roles, responsability and authority
6. Control and procedures
7. Problem solving and decision making
8. Experimentation and creativity
9. Self-evaluation
10. Interpersonal communication

What´ 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

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 health3.1.3.- Motivation and retention of health
workers in developing countriesworkers in developing countries
7 major motivational factors:
1. Financial
2. Career development
3. Continuing education
4. Hospital infraestructure
5. Resource availability
6. Hospital management
7. 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 healthWork-related health
problemsproblems
Work- and Organizational Psychology- KUN
Workrelated healthproblems 1995- 2000
Source: European Foundation for theImprovement of Living andWorking Conditions (2001)
13
20
28
30
33
13
12
15
2323
28
Backache Stress Ov erall
fatique
Neck &
Shoulders
He adaches Up pe r limbs Lowe r limbs
1995
2000%

Promoting the mental health of health-Promoting the mental health of health-
workersworkers
Sources 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 &Consequences of Stress &
BurnoutBurnout
Organisational functioningOrganisational functioning
 Job satisfaction ( work effectiveness,  turnover)
 Org commitment ( turnover intent,  job
involvement)
 Turnover
Worker health & wellbeingWorker health & wellbeing
Depression
Psychosomatic complaints
Health problems
Client outcomesClient outcomes (Garmen et al., 2002)

Need for Better InterventionNeed for Better Intervention
StudiesStudies
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 & PracticePolicy & 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

ActionAction
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 and3.1.5.Policies for reconciling parenhood and
employmentemployment
 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 age3.1.7.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

groupgroup

groupgroup
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

groupgroup
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

groupgroup
Objectives:
1. Entry into working life at an earlier age
2. Work careers will be 2 – 3 years longer than today
3. Sick absences will reduce by 15%
4. Occupational accidents and diseases will be reduced by 40%
from the present figures
5. Consumption of tobacco and alcohol among population of
working age will decrease

groupgroup
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

groupgroup
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

groupgroup
Target groups inVeto-programme
• People in working life age 45+
• Middle management
• Small and medium size enterprises
• Occupational health care professionals
• Occupational safety organizations

groupgroup
Veto Finnish national programme:Veto Finnish national programme:
Measures IMeasures 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

groupgroup
Mesaures IIMesaures 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

groupgroup
Mesaures IIIMesaures 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

groupgroup
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

groupgroup
Why 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 needs
3.2.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

3.3. Managing change3.3. 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

3.3. Managing change.3.3. Managing change.
The challenge of chronic conditionsThe challenge of chronic conditions
“New competences”
– Patient centred care
– Partnering
– Quality improvement
– Information and communication technology
– Public health perspective

3.4. Building a client-directed service3.4. Building a client-directed service
cultureculture
• 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.

3.5.-3.5.- New teaching methods /innovative trainingNew teaching methods /innovative training
modelsmodels
“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

3.6.- Mobility of health care3.6.- 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,
…)

Anticipating work-force needsAnticipating work-force needs
3.6.- Priorities throughout3.6.- 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 unemployed
2.2. The demand for social enterprisesThe demand for social enterprises
3.3. Welfare mix and employmentWelfare mix and employment
4.4. Inclusive and supported employmentInclusive and supported employment
5.5. 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. Desinstitutionalization
2. Diversification
3. Descentralitation

4.-Welfare mix, inclusive employment & social4.-Welfare mix, inclusive employment & social
enterprisesenterprises

4.2.-4.2.-The demand for social enterprisesThe demand for social enterprisesSocial enterprise is an activity carried out by an
organisation
that advances its social mission through entrepreneurial,
earned income strategies.
BUSINESS WITH A SOCIAL PURPOSE

Social firmsSocial firms

TYPES OF SOCIAL ENTERPRISES
• Cooperatives and Mutual Societies
• Credit Unions
• Development Trusts
• Housing Associations
• Community Recycling
• Social Firms

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

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

enterprisesenterprisesSocial 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

4.3.-4.3.- Inclusive employmentInclusive 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-
1998)
• 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

Services
1. VOCATIONAL REHABILITATION CENTRE
1. User information
2. Intake and assessment
3. Social training and job training
4. Job club
5. 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 requirements
2. Risk areas
3. The user´s resources
4. The user´s needs
_______________________________________
___ Assessment

_____________________________________
_____ Assessment
1. Medical/Psychiatric report
2. Psychological/social report
3. Tests
4. 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 Club
1. Training activities (culture, languages, computer course,
…)
2. Leisure activities (art works, painting, board games,…)

Occupational Centers
_____________________________________
_____
Bookbinding
Gardening
Cooking

1. Search for jobs suiting the user´s training and experience
2. Assessment of the user´s performance at the work place
3. Direct support if necessary
Includes:
 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

____________________________________
_____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

___________________________________
_____Training in the
workplace
• Phases:
–Guidance ans assessment
–Initial training and skills acquisition
–Stabilisation

____________________________________
_____
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 network
Overall aim:
Assessment, Counselling and Coaching inAssessment, Counselling and Coaching in
Employemnt, Placement and Training forEmployemnt, Placement and Training for
individuals with mental ill healthindividuals with mental ill health

EUROPEN PARTNERSEUROPEN PARTNERS
DIE BRUCKE
ITO
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.-
ASSESSMENT1. Clinical status
2. Health and daily live issues
3. Social and community participation
4. Training
5. Work experience
6. Motivation and expectations
7. Searching skills
8. Social status
9. Work habits and social skills at work placements

Famil
y
• Family structure and relationships
• Family needs
• Family expectations

Standarized
tests
USER:
• 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

Benefit
s• 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)

Recommendatio
nsCommissioners 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

Recommendatio
nsManagers 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.

Recommendatio
nsStaff 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

Recommendatio
nsCampaigning 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 regional5.- 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

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