staff retention in socio- sanitary structures
Transcription
staff retention in socio- sanitary structures
STAFF RETENTION IN SOCIOSANITARY STRUCTURES The findings presented in the study have been brought together by an transnational partnership with the support of the European Social Fund for the Equal program and carried out in three countries: Italy, France and the Netherlands. The transnational partnership studied three lines of research: - the evolution of needs in the socio-sanitary sector the modes of retaining socio-sanitary sector workers in the labour market the new modes of distance learning This section of the study, carried out by the French team, concentrates on staff retention in socio-sanitary structures. The primary aim of this document is to bring together and formalise the partners’ data for the benefit of the transnational partnership. Equally, this study is to be circulated though the national networks of the three countries involved. The findings or analyses contained in this study do not purport to be a representative sample of the entire situation of the sector but rather to provide an informative example of the situation in the field which is potentially similar or reproducible. The study aims to put forward examples of the thoughts, attitudes and good practice on the subject. Transnational Project FSE Equal ETIC Contribution : France Page 1 Presentation of the structures studied: The inter-hospital partnership involved in this study interestingly brings together three very different structures in the socio-sanitary field : Institute Paoli-Calmettes: The Institute Paoli-Calmettes (IPC) in Marseilles, is an Anticancer Centre. A private institution but part of the public health system, the Institute Paoli-Calmettes has a university role specialising in the study of problems relating to the treatment of cancer. Both a hospital and a centre for research and training, the IPC employs a staff of approximately one thousand two hundred in an area of nearly 150 metres. Jeroen Bosch Hospital: The hospital group “Jeroen Bosch Hospital” is a private foundation status hospital with a public health role. The Dutch working code governs the management of a personnel of 5000. Azienda Sanitaria Locale, Brindisi: The ASL Brindisi (AUSL BR/1) unites the social and health services in the Brindisi region (Southern Italy – Pouilles). The study focused on the health sector through analysis of two hospital structures: the local hospital of San Pietro Vernotico and the regional hospital of Perrino (Brindisi). The combined staff of these two structures reaches a total of almost 1500. For the purposes of this report the above structures were visited and data collected on each. Transnational Project FSE Equal ETIC Contribution : France Page 2 Introduction On a European scale the challenges of the job market are changing. The shortage of a qualified workforce is becoming a major concern for businesses who are facing the prospect of a massive series of departures once the post-war baby-boom generations reach retirement age in 2006. Due to the regular decline in the birth rate across Western Europe, the generations entering the workforce will not be able to offset the impact of this phenomenon. Certain sectors are particularly affected by these demographic changes. The combination of a higher volume of retirees with an increase in needs, and therefore of labour, means that such sectors will be particularly vulnerable to recruitment difficulties. In France, the hotel & catering industry and health sector are already concerned by these difficulties posed by these issues, which will only become more severe in the years to come. At the same time, the widespread increase in the pensionable age should ease the volume of departures. The age at which one receives the maximum pension is gradually being increased by those European countries who are facing a budget deficit in their pension funds. In France, where the average retirement age is one of the lowest in Europe due to its generous pre-retirement schemes for the under-60s, the last three years have prompted a radical change in policy. Thus, schemes for phased-in retirement have either become stricter or disappeared. For example, at the end of 2002 France abolished phased-in retirement in the public sector. According to the ARPE, the scheme for total early-retirement had been almost completely stopped in the private sector by 2001. 2003 marks then end of progressive early retirement (part-time) in the private sector. As in other structures, hospital demographics are now experiencing a period of ageing and the situation is similar across Europe. The prosperous post-war years saw huge development in hospital structures: in building, equipment and personnel. Since then, buildings have been renovated and equipment replaced, yet the personnel has remained largely unchanged and has aged. Consequently, hospitals are today faced with the problem of functioning with a personnel who are older than ever, in an environment where age and work have increasingly become factors of exclusion. During the 90s a very dynamic development of techniques resulted in the entire age groups, namely the over-55s and even over-50s, leaving the labour market. The repercussions of this policy are evident today: the younger generations entering the workforce view any extension of the working life as unbearable. Working time Transnational Project FSE Equal ETIC Contribution : France Page 3 reductions, introduced in France, have done nothing to negate the belief that future generations will be the big losers in the working time issue. The extension of careers by several terms or years will once again become a reality, despite the resistance of employees to accept such a fact. However, human resources is the key issue in a social and health sector where human investment represents near to 80% of the value added. It can therefore be understood that there is a double reality driving this issue: - businesses in the health sector are going to fight to retain their potential of qualified staff these businesses are going to face a general ageing of their personnel staff and will have to break new ground in order to retain their older workers This study is based on these two premises: The first part endeavours to describe the factors which are working towards sustainable retention and the life-long development of employees and their professional skills. The second part will focus on a more specific analysis of the retention in work of older employees. Both parts report the tools, methods and concepts, some of which are traditional others more innovative, which will enable the goal of sustainable staff retention in the socio-sanitary sector to be reached. Transnational Project FSE Equal ETIC Contribution : France Page 4 1. The strategies and tools for life-long staff retention The health sector is faced with an increasingly tight labour market, particularly in the qualified professions, the so-called “core profession” (nurses, doctors, technicians, paramedics, etc) This shortage translates into problems of recruitment and of the nomadic behaviour of recruited staff. Employees are led to compare and seize the advantages of one structure over another in a highly competitive market. This situation is particularly fierce in the nursing profession where there is a shortage throughout Europe, with the exception of a few countries such as Spain. Hospitals must therefore continually invest more to encourage staff loyalty among staff in the more competitive sectors. In other sectors, where staff generally remain in their positions for a significant number of years, hospitals must react against life-long factors of exclusion which are a product of time. It is noticeable that, not only do the three structures involved in this study demonstrate similarities in their strategies for retaining staff, but they have their own particular strategies. In HR management, commercial practices are either rejected or adapted for the hospital environment or schemes created specifically. There is a significant disparity is the existence and application of these tools between the three structures. 1-1 A variable staff retention strategy Interest in a staff retention strategy Firstly, the authors of this study examined whether the aim of long-term retention was included in the objectives of the organisation and, if so, whether the approach was general or targeted to specific sectors or professions It should be noted that the policies for staff retention are closely linked to the state of the labour market where local factors can be significant. For example, the hospitals studied in southern Italy do not have any recruitment difficulties. On the contrary, the demand for work outstrips supply and the on-going restructurings (hospital mergers, reorganisation and rationalisation of activities) result in the number of positions being cut, thus reinforcing the current situation. Consequently, the staff retention policy in place is less voluntarist. In northern Italy, however, the shortage of professionals is comparable to that seen in France. Transnational Project FSE Equal ETIC Contribution : France Page 5 Hospitals in France are facing a shortage in certain core positions such as nurses, doctors, diagnostic radiographers, nursing auxiliaries and physiotherapists. As in Italy, this shortage varies according to sectoral and geographical factors. On a sectoral level, cancer, the core occupation of the IPC is not the most immediately attractive sector for nurses: likewise psychiatric and geriatric nursing. For technicians, radiotherapy is generally less attractive than radiology or, more recently, nuclear medicine. On a geographical level, the south of France is an area renowned for its climate and quality of life, factors which facilitate recruitment to the area. Conversely, Paris has been subject to a drain of its professionals and is now facing serious recruitment difficulties. In Holland, shortages in the healthcare professions vary according to the attraction of these professions compared with other professions which are seen as worthier but which carry greater risk in times of crisis (the banking, commercial and business professions). The shortage of doctors is beginning to be felt in the large cities which, in times of difficulty, have recourse to foreign professionals. On the other hand, the common concern is that of the longevity of the staff. The notion of a job for life is still alive in Italian hospitals, both for doctors and for the non-medical staff. This is similarly the case in France and in Holland. At the JBZ, staff remain in their job for a significant length of time and this is combined with a low level of departures. The challenge is therefore to find the levers and motivation which will encourage a professional to remain long-term in the same structure. Competition also has an impact on the issue of staff retention. Thus, Italian hospitals have been prompted to demonstrate a greater and increased production within a change in financial management which, with a background of service and establishment objectives, places greater emphasis on the link between finance and production. Against this background, the retention of high-performing staff should be a lever for development in this healthcare structures. Competition with the private sector, government regulated or not, is particularly strong. The IPC is acutely aware of this logic : reforms in hospital financing which are expected to take effect in 2004, will define the major part of the hospital budget in accordance with its activity. Therefore, the performance of each structure, and in turn its staff, will become strategic. Mechanisms of termination of employment contracts Transnational Project FSE Equal ETIC Contribution : France Page 6 Any examination of staff retention also calls into question the flexibility or rigidity of the rules governing redundancy and the practice of such in the health sector. Redundancy is almost unheard of in Italian hospitals which must compromise with employees in long service and unfailing loyalty. Like the majority of Dutch hospitals, the JBZ has little recourse to the forced termination of employment, outside of cases of disability. Of the three locations analysed the Institute Paoli-Calmettes has the highest turnover. However, this is due to voluntary departures such as resignations, retirement, early retirement, disability, sabbaticals etc. rather than enforced departures. In reality, termination of employment contracts in the socio-sanitary sector are more often initiated by the employee (for personal or professional reasons) than by the employers who have a tradition of staff retention. Contrary to the profit-making sectors, the character of the public service and its corollaries, the public financing limits the research of the financial performance but also of the performance, pure and simple! The restructuring practices of the profit-making sector impact on employment which is considered variable according to economic performance. Such practices are almost unheard of in the hospital sector. The tools for termination of employment either on an individual or collective basis (outplacements, economic redundancy) are rarely implemented. In conclusion, it can be said that the while the problem of staff retention is evident everywhere it leads to two very different questions: 1) what must be done to retain an employee and to keep precious skills? This first question is especially applicable to those workers who have the possibility to leave the hospital, in positions where the offers of employment exceed the demand. 2) what must be done to maintain the level of performance of a staff member who is likely to remain 30 or 40 years in the same structure? This is the most frequently faced problem in the socio-sanitary sector due to the tradition of a “job for life” While these complementary and simultaneous questions are evident in each hospital the emphasis placed on each differs between structures; the IPC, for example, finds itself clearly faced with the first question in the case of its nursing or medical staff (a strategy of retention to counter the shortages) and with the second question for the other occupations (retention strategy to face the problems of “usury”). Transnational Project FSE Equal ETIC Contribution : France Page 7 This double question leads the hospitals to develop human resource policies and tools which are adaptable to the double objective of the attraction and retention on the one hand, and the maintenance of performance on the other. 1-2 The tools of staff retention The tools in play in the three organisations with the aim of retaining staff can be grouped into six categories: • • • • • • • Systems of integration and tutoring Progressive management of workers and skills Continuous development Skills management Recognition and satisfaction The sharing of information and knowledge The addressing the work-family life balance 1-2-1 Systems of Integration and Tutoring The tools used in the integration phase are centred on the short-term retention, of young hires. For the national division of Project Equal, the IPC has invested a great deal in the creation of a course of progressive integration for young nurses, beginning in 2002. In 2001, the nursing profession had an extremely high rate of departures following recruitment : almost one in two nurses recruited remained less than one year in the hospital. Investigation revealed that the difficulty of the job coupled with the brutal transition from school to the workplace was one of the factors of this drain. Nurses are now taken care of much earlier through a process which aims to ease their introduction to the reality of life in the cancer division. Nursing colleges have furthered this approach by integrating into their course alternating periods of study and work experience in hospitals. However, this does not yet go far enough to cope with the complexity of the job requirements. The IPC’s considerable effort has enabled the following to be established: - integration tutors responsible for overseeing the first steps of the new recruits a period of dual training, in various sectors of the IPC integration period with reduced responsibilities specific plan of evaluation during this professional phase Results have surpassed all expectations and fully justify the high cost of the plan: 91% of the nurses recruited since its implementation have remained at the IPC. The policy of integration requires not only the means but also a total control of the recruitment process in order to be effective. Transnational Project FSE Equal ETIC Contribution : France Page 8 In Italy, recruitment is not carried out by the individual hospital but by the ASL (Azienda Sanitaria Locale). Candidates are therefore imposed on the hospital. In addition, the ASL chooses whether or not to offer a position and, during periods of restructuring, can also decide to freeze a position. Professionals are thus placed in a precarious position and replacements are ensured before definite posts come free. These conditions do not facilitate integration. Indeed, after six months the lack of a position will force a substitute nurse to accept another position thus completely negating any integration effort. 1-2-2 Changing occupations and progressive personnel management Structural changes in employment are, unfortunately, more often endured than planned. The shortage of nurses across the three hospitals gives rise to creative reactions to avoid increased workloads leading to departures: - in France, the recruitment of foreign nurses increase in student nurse places (France) development of support staff for nurses (Socio-sanitary operators in Italy) and doctors (teams of nurse practitioners in Holland) These reactions, however, occur most frequently on a national level as a result of circumstantial pressure. Therefore it is necessary to encourage the local level development of a forwardthinking analysis of the changing occupations. The Italian national project is a good illustration of this how the analysis of changing socio-sanitary needs can lead to a consideration of new socio-sanitary occupations adapted to accommodate these changes. Likewise, the National Federation of Anticancer Centres has set up an observatory of employment and skills. Their mandate is to anticipate, address and, indeed, incite changes in the sectoral occupations. The observatory analyses skills areas as diverse as : - clinical dosimetry skills sharing between doctors and paramedics clinical or biological research On a hospital level, analysis of the three hospitals shows that new occupations and skills areas are emerging in the following areas: - the organisation and sharing of knowledge (knowledge management, elearning) Transnational Project FSE Equal ETIC Contribution : France Page 9 - transversality at the heart of the hospital organisation, marked by vertical and hierarchical relations: quality, network creation, local relations, treatment coordination patient information (diagnosis given by nurses, creation of patient committees, etc) introduction of new technologies (clinical dosimetry, biological research, internet etc.) Through the systematic exploration and needs analysis of emerging occupations, employees are immediately able to start developing their skills and take advantage of the new perspectives of professional change. 1-2-3 strategies and systems of continuous development Continuous development remains one of the key elements in staff retention. Study reveals that while all hospitals have recourse to continuous development, access to it is very unequal. Staff in Italian hospitals do little training outside the job. Indeed, ASL funding for training is limited. Doctors have easier access to training and often pass on what they have learnt to their colleagues. However, 2002 saw the implementation of a more voluntarist policy with the creation of the L’Education Continue Medicale for the continuing medical education of doctors and paramedics. The scheme requires that a mandatory number of continuous development points are accumulated over a period of five years. Yet, the system has quickly been abused : the deliberate over-valuation of some courses, in terms of points awarded, has led to the number of courses being limited. Training budgets are too limited and it is often the case that the employee has to foot the bill for travel, lodging, indeed the entire course. A single training plan, valid for all the hospitals, is carried out by the ASL training department. This system is overly centralised and discourages individual needs. Finally, the absence of any real training program on a hospital level and, more importantly, the lack of financial investment are considerable obstacles for any progress to be made in this area. This situation is all the more damaging because reforms currently being considered plan to link access to longer service to mandatory training. This move towards the recognition of skills acquisition will only achieve its objective through adequate financial investment and a flexible approach in its management. The study shows that continuous development can reach its potential when: - it is linked to evaluation practices, collective or individual needs are outlined in advance Transnational Project FSE Equal ETIC Contribution : France Page 10 - the presentation and content of the training course match the needs of the employees (custom made) 1-2-4 Skills management Attention to the development of the employee’s skills focuses on a series of complementary tools but which are often set up in a disjointed and incoherent manner. Moreover, skills management can only be achieved well if the following tools are in place: - a clear vision of the organ grams, the job content and of the expected skills a formalised and regular evaluation accompanying tools (training, mobility, new objectives, coaching etc) life-long skills development Clarity is not always present even though this could sometimes have a structuring effect. For example, general decrees governing skills exist in Italy and in France for government regulated professions but job descriptions are rarely used. On the other hand, Italy has recently repealed old decrees governing nursing skills without replacing them with any new outlines. The current transitional period leaves room for a degree of freedom and fresh interpretation of which the nursing profession is taking advantage to assume new roles delegated by doctors. While areas of responsibility remain they have since become more general and hazy. In France, Anticancer Centres have introduced job descriptions and profiles for all medical and non-medical ancillary staff. Mobility is an important factor in staff retention. Well managed it can combat boredom and encourage the permanent development of training and the ability to adapt to change. It should be encouraged and developed. Unfortunately, it is all too often the case that some professional categories have insufficient access and other, no access at all (head physicians in Italy cannot change hospital). The policy of mobility must be clearly integrated in HR management policy. Indeed, when mobility is rarely encouraged it is endured as a constraint, even as a punishment (Italy). The end result can be problematic, leaving the less appealing sectors with little or not possibility of recruiting staff. Mandatory mobility, a measure accepted by the ASL, can get round this problem but in doing so creates another: staff who are forced to move bitterly resent the unwanted change. Transnational Project FSE Equal ETIC Contribution : France Page 11 In other respects, mobility can develop hospital occupations and avoid the disadvantages brought on by over-specialisation in one job. The route of specialisation (indeed hyper specialisation) is often plebiscited in hospital occupations. A doctor who, following many years of study, becomes the uncontested specialist in a particular discipline is considered the model of a successful career. The results of an opinion poll carried out among the staff at the Institute PaoliCalmettes found that 87% of those interviewed (all hospital occupations) believed that “to specialise in one professional division…is a good thin”. Hospitals must therefore understand that the expectation of specialisation is one factor of retention. Hospitals could, for example, design tools for the development and recognition of expertise or their own fields of reference to encourage staff retention. Thus, within the frame of its “transfers” project, the IPC has created “referent” missions for nurses and nursing auxiliaries enabling them to work in a job which has a recognised expertise. This expertise is, however, for a fixed-term and other workers must be able to have access to the same conditions. Its aim is the sharing of knowledge and a critical consideration of practices. Within this general idea of life-long job development, appraisal meetings also have a place. These are one way of demonstrating the interest that a company has in its staff. The study shows that, despite being generally accepted as useful, the tool is used unequally. It is not yet used in the Italian hospitals involved in this study. It is being developed in the Dutch hospitals and is in general practice in the Institute PaoliCalmettes (MDs and PhDs). In France, the CLCC, for its part, has been involved in developing the validation of professional experience (VA.P. validation des acquis professionels) for non-medical staff since 2002. This step aims to energize and recognise the progressive acquisition of skills by staff throughout their career. This scheme, coupled with the an annual appraisal has largely contributed to the installation of a process of skills management in the Centres. 1-2-5 Systems of recognition and motivation Staff retention is also as a result of tools to value and recognise the efforts and performance of staff. Transnational Project FSE Equal ETIC Contribution : France Page 12 In this context, salaries (and its various add-ons) remain an important element in motivation. However, research into other forms of recognition and satisfaction are in progress. In the majority of sectors, salaries are increasingly made up of variable remuneration packages linked to individual or collective performance, such as annual results etc. With an objective of long-term retention, other methods of remuneration are being developed such as benefits contributions, bonuses for long-service, progressive pension fund contributions, save-as-you-earn schemes In general, the variable parts of salaries are rarely implemented in hospitals as the following example in Italy demonstrates: head physicians in Italy (the “primario”) have a remuneration package where part of their salary is linked to their strategic dimension. In addition, they receive a bonus linked to their speciality. However, variable salaries remain marginal. Other than in the case of doctors, salaries in Italy only change with length of service or, more rarely, promotion. Local variations are almost nonexistent as salaries in Italy are fixed at the same level for all ASL. In the health sector, salaries are far from being the key element effecting retention, at least in comparison with other more money-driven sectors of the economy such as electronic or computer engineering, pharmaceuticals, commerce etc. In addition, it must be remembered that a hospital does not only employ those who are directly involved in healthcare and, elsewhere it finds itself in direct competition in sectors where there is a tight labour market such as catering and IT. In these sectors which are peripheral to the hospital’s core occupation, salary holds greater importance. Hospitals must develop other factors of recognition. Recognition must come from a remodelling of the forms of hierarchical organisation and staff responsabilisation. Autonomy is an important factor for managers and, increasingly so, for non-managerial staff who equally aspire to management relations founded on professionalism, responsabilisation and trust. To this end, there is increased research into tools for a more concerted and participatory decision-making process. In Italy, there exists a very centralised management structure where the local health and administrative hospital directors are hugely dependent on the decisions made by the General Management of the ASL. Notably, the main decisions concerning personnel, recruitment, future mobility, training, and career etc, which should be made as to the field as possible, are, in reality made by the ASL. Transnational Project FSE Equal ETIC Contribution : France Page 13 Unfortunately, the only autonomy left to administrative directors is with regards to hours and improving working conditions. Research for satisfaction, retention and performance. Less directly expensive than salaries but more difficult to put in place as they are often individualised and multiform, policies for satisfaction require an HR Management which is attentive, reactive and flexible. This approach is focused on pleasure, whether deriving from the job itself, from the environment or from the atmosphere of the structure. The “start-ups”, which enjoyed a period of euphoria from 1999-2001, understood and quickly refused this principle by creating working conditions and an environment that was able to attract and retain the best staff. Hospitals can also work based on factors of consideration and satisfaction. However, they first need to introduce such factors by looking closely at local hopes and needs. Methods of analysing the satisfaction of the “internal client”, the employee, are being developed. Assessing satisfaction is through detailed qualitative inquiries conducted by the structures. The transnational work of Project Equal has been particularly useful in that it has enabled this type of assessment to be tested in the hospital environment in at least two of the structures studied. (see annexe: the PC internal questionnaire and the results of a opinion poll carried out by JBZ) 1-2-6 finding the work-family balance Time management has become an important issue because it strongly effects the professional-personal life balance that everyone wants. In socio-sanitary structures which are often open 24/7 and where flexibility and availability in a staff member are particularly valued, the management of work schedules is a growing concern. Firstly, the reduction of the working week has been introduced in various health systems: In French, the working week is 35hr for day shift workers and 31.5hrs for night shift workers. Staff in Italian hospitals have a 36hr working week. Transnational Project FSE Equal ETIC Contribution : France Page 14 Against the favourable background of a reduced working, greater emphasis must now be placed on time management. Flexibility and variety in the organisation of work is a strong advantage compared with a uniform and rigid application with little consideration for individual circumstances. Part-time working is gaining ground: in JBZ, the majority of staff work part-time and it is a situation which is perfectly accepted, even encouraged. Positions can be created to cope with the demand for part-time positions (in Italy, there is morning part-time shift, and in Holland, a four-day week) At the Institute Paoli-Calmettes, part-time staff represent 20% of the workforce. In Italy, it is also relatively widespread particularly amongst women and those who are new to the labour market. Hospital involvement in facilitating a personal life is a route which should be explored if hospitals want to retain their staff: • • • • childcare schemes transport assistance information services logistic services offered to staff (concierge, financial reductions for home internet) There is a trend towards Information Systems in HR aimed at developing the “employee relation management (ERM)” by developing information given to the staff, particularly through IT means (intranet, mail, etc) The interconnection of information networks and the speedy sharing of that information are contributing factors in the bid to retain staff because they reinforce a feeling of belonging within the company. The IPC is, for example, firmly rooted in this concept and is advancing in the following two ways: - the creation of a comprehensive intranet which integrates the informative and interactive potential decentralised management schemes either for the managers (time management) or for the entire staff (electronic platform for documentation and training) 1-2-7 Methods for the sharing of knowledge Is knowledge documented? What is the role of IT in the sharing of knowledge? Transnational Project FSE Equal ETIC Contribution : France Page 15 The transmission of knowledge is an important factor today for a number of reasons: - the volume of knowledge required to work in a socio-sanitary structure is constantly increasing the performance of these organisations is largely dependent on its ability to manage and share a considerable volume of information on a daily basis the younger generations, following their initial studies, have a great need for knowledge and, more so than in the past, to be supported in the early stages of their careers the policy of postponing the retirement age offers opportunities for older workers to spend more time sharing knowledge. This could also play a critical role in keeping older workers motivated, often a difficult task towards the end of a career (see second part) The sharing of knowledge is still, traditionally and in the main, done by peers. The three hospitals in the study all recognised that it is wise to concentrate on the new systems of electronic distance learning or e-learning. A new electronic association is slowly developing which will support the human tutoring experience. These systems are particularly suitable for IT, technical and linguistic training as well as pre- and post-training testing. In addition, they are also means of sharing and offering information in a way which is compatible with the individual demands of the hospital (24hr availability, regularly updated, accessibility etc) For its national Equal project, the Jeroen Bosch Hospital has developed a university platform distance-learning system with a content relating to : - parenteral nutrition (target audience: nurses) new information systems (target audience : all JBZ staff) The sharing of knowledge and practices does not only happen through computer or electronic channels. Mechanisms of tutoring: older member > novice or expert > non-specialist need to be developed. These will lead to the creation of mechanisms of attachment to the company resulting in adhesion and staff retention. The Equal project conducted by the IPC has also led to the characterisation and development of this tutoring processes: - through analysis of the sharing of knowledge carried out by the Centre for research on qualifications (Centre de Recherche sur Les QualificationsCEREQ) through tutoring experiments in the laboratory sector where oral communication and experience are difficult to replace by written means and even more so by IT processes. Transnational Project FSE Equal ETIC Contribution : France Page 16 2 – Specific aspects linked to the retention of older workers (over 50s) To date, the average retirement age of the three countries involved in this study is low: • • • 58 years in France 59 years in Italy Less than 59 years in Holland France is particularly badly placed in this area; of all the countries in the OECD, it has the sad record of the lowest employment rate in the 55-64 age group. Only 38% of men in this age bracket still work. In the health sector, employees have been taking advantage of the opportunities provided by certain schemes for a number of years: withdrawal at 55 for those in strenuous positions; schemes of phased-in retirement or early retirement in France. However, these statistics are evolving in accordance with the general impact of the ageing demographic within European societies. For example, in the three countries involved in the study, the age at which a retiree is entitled to a maximum pension has been increased over the last two years. The Italian retirement system is currently being reformed with a view to increasing the working period required to claim a full pension to 40 years. This phenomenon is not necessarily found in all the countries. For example, the average age for workers in Britain, Sweden, the USA and Japan to withdraw from employment is already over 60 (over 65 in Japan). This second section will therefore concentrate more specifically on the French system and will be more forward-thinking. The Italian and Dutch hospitals of the transnational partnership are not yet affected by a major staff ageing problem, unlike the IPC, which is more concerned with this problem in the years to come. On this subject, demographic assessments, along with age and service pyramids, enable a shrewd understanding of the extent of the ageing phenomenon in the hospitals concerned. The report brings to light a number of questions concerning: - the representations and the consequences of the ageing demographic the actions providing the older worker his full place in the hospital Transnational Project FSE Equal ETIC Contribution : France Page 17 2-1 Improving the perception of the challenges representations of the retention of older workers and the Defining seniors at work: is 50 the right age to start tackling problems of age in the workplace? Why should 50 be the relevant age to qualify the effects of ageing in the labour market? Social representations within the hospital are very significant and go a long way to explaining the discriminatory factors which can affect older workers. Moreover, these representations, which are fuelled by the external environment, tend to consider that the relationship between costs and benefits deteriorates from this age. Various factors, which are unfortunately objective, fuel and reinforce these intuitive perceptions. The frequency of health incidents in the over 50s is also statistically higher, particularly in the jobs where the physical or psychological stress is accumulative (nurses, nursing auxiliaries and, in general, in jobs which involve a high degree of patient contact). More precisely, for the IPC, statistical analysis shows that: - there is a higher rate of work absenteeism in the over 50s the number of part-time positions for whatever reason (disability, earlyretirement, flexi-time …) is very high in the over 50s “salary bonuses” are less developed in the over 50s In addition, figures show that, in the hospital sectors where managerial demands are less, mobility at this age is less and that investment in training diminishes over the remaining working years for a worker in his fifties. The subject is unfortunately consensual in so far as the representations are shared: - by the management, encouraged by public powers which provide incentives for the early withdrawal of the older workers by the social partners, which could have different interests in supporting these individual withdrawal plans by the other employees, the older workers generally have an awareness of their difficulties Transnational Project FSE Equal ETIC Contribution : France Page 18 It is important that companies equip themselves with the analytical tools to identify and prevent the factors evident in the seniorisation in work. These factors exist and should not be ignored: Human biology changes with age; the everyday consequences of the ageing body do not spare the professional sphere. Certain occupations are evidently more susceptible to this than others: it is easier to be effective in medicine at 50 than, at the same age, to want to become a champion tennis player. - The view of companies towards the effectiveness of the older workers still remains quite negative: less adaptability to change, less motivation for training (especially in new technologies) and, above all, higher salaries, are the main elements which are immediately cited by younger managers or employees. - The attitudes of the older workers themselves can reinforce these impressions : preference to stay in the same job, lack of interest in training, wanting “easier” positions In the transnational partnership, the age of 50 also has a symbolic value which is recognised by the partners of the project. Setting an age provides a precise point from which policies can be structured and actors energise, without falling foul to short-sightedness. From this point of view, the age of 50 provides a level which is neither too late, nor too early, and from where the latter years of the professional life can be best considered and guided. The challenge of managing older workers: rebuilding representations while avoiding all positive and negative discrimination Once the administrative parameters have been set, it is important to understand and analyse the professional expectations and difficulties of the older workers as well as the general behaviour of companies towards this category of workers. As this could result from gender issues, age should be factored into a company’s management schemes and tools and particularly through the following methods: - internal analysis of opinion and satisfaction statistical charts (training, salary, hours) analyses of absenteeism and working conditions The specific actions concerning the over 50s should be adapted to the individual situation of the workers and should not result in excessively positive discrimination for older workers. Transnational Project FSE Equal ETIC Contribution : France Page 19 Employment factors are not necessarily discriminatory for the older employees in work, indeed they are often cumulative: - higher salaries, stemming from individual and collective history key posts in the organisation higher tolerance stronger support networks (unions, etc) greater protection (against redundancy particularly) greater awareness of their social rights It would therefore be out of place to create a new ghetto through a new “statute for older workers” which would reject all other age groups. Moreover, the acceptance of a company age policy can only be put in place with the cooperative consensus, where the feeling of inter-generational equity prevails. It is advisable not to stigmatise older workers by focusing exclusively on policies and initiatives aimed at them. The solution lies elsewhere. The policy for the retention of the over 50s in employment must concentrate on extending measures which have been in place throughout the working life. One shouldn’t “lower the guard after 50” and continue to apply the same rules, in a continuum of the HR policy. In reality, failure to adapt does not arise at 50, 55 or 58 years but is evident throughout the working life. The corrective approaches are, in part, the acknowledgement of failure and the admission of the ineffectiveness of a tardy HR management policy. The work of the over 50s should continue to be developed. However, for the employees concerned, this new perspective of a longer working life, following years of a policy of early retirement, is difficult to implement and the results will not be felt immediately. In particular, the most difficult task is, undoubtedly, to change the social representations. This occurs through specific information and communication. The awareness of the relation between age and work is not consistent amongst the employees. Situating and expressing the problem at all levels of the hierarchy is one suitable way in which to change the social representation and to unlock solutions. The example should, understandably, come from the top and Management and the social partners must state their position on this subject. JBZ management has, for example, clearly displayed its interest in addressing this question by implementing a policy called “age-conscious personnel management” Transnational Project FSE Equal ETIC Contribution : France Page 20 Various concrete initiatives can support this voluntarist approach to communication: - training designed to make the managers more sensitive to the problem of age the involvement of the older workers themselves in the discussions and analyses relative to the place of the older worker within support including more initiatives from older workers in order to develop exemplary factors (training, career wishes, changing a position or service, tutoring etc) entrusting projects to older workers attention focused on the mixing of ages in projects or working groups Recruitment in the over 50s labour market is also a symbolic management decision which challenges the usual perception of the effectiveness of the older works. Age is not used as a limit or an exclusion factor in job offers. However, salary expectations when linked to age (once again linked to length of service) constitute a discriminatory factor in recruitment. Moreover, there are not sufficient incentives for the hiring of older workers in France. There is no significant aid favouring the recruitment or retention of older workers but, on the contrary, certain cases of enforced withdrawal such as redundancies incur penalties. This process of penalization “sanctuarises” difficult individual cases and thus contributes to the degrading of the image of older workers. It is considered that aspects of communication and image are important at work, but they are not the only management lever that should be acted upon. Work on the motivation and use of the oldest workers involves the implementation of the polices and tools which will reinforce them. 2-2 actions to develop and protect the over 50s workers The issue of age at work should be the object of specific support measures. Approaches which aim to be preventative should be favoured as long as they enable: … - the lack of interest in training to be curbed the development of training and particularly of certain strategic training (namely in new technologies) the recognition of the new “senior” functions the relaunch of the over-50 career (orientation, work appraisal…. adapted development and financial incentives “preventative” placements and the battle against stress 2-2-1 the reduction of absenteeism among the over 50s Transnational Project FSE Equal ETIC Contribution : France Page 21 Absenteeism among older workers towards the end of their working life is, unfortunately, one of the mechanisms used to regulate the withdrawal of older works, much like the schemes for early retirement. However, while certain schemes can sometimes be encouraged by employers, absenteeism is understandably largely prejudicial. Allowing it to develop gives credit to the idea that from a certain age onwards no other solution is available than the withdrawal from the labour market. The battle against the absenteeism must be brought forward, by connecting the social partners, occupational medicine, the managers, and social funding. Maintaining health and well-being at work should be particularly emphasised amongst the older workers and viewed differently from the younger generations. The idea of a complete health check up for the older workers, organised by the hospital could be offered to avoid or limit situations of incapacity. This assessment should be able to be extended to include all aspects of working life and address professional and social aspects. Overall, a complete older worker assessment could be offered to employees reaching the age of 50 covering: - the career and professional perspectives health social and family aspects Action on working conditions is also a way of limiting absenteeism. On this theme, the IPC has implemented a policy of involvement to be followed by the managers in order to ensure a quick response to the problem and to contribute rapidly to the solving of these problems. 2-2-2 capitalising on the experience of older workers The organisation of explicit and formalised tutoring positions which mobilises an older worker in the development of the skills of his successor can have positive results. The Institute has, for example, been able to trial a period of sustained tutoring between the experienced laboratory technicians, during the final year of their professional career and the novice technicians. In the context of a highly specialised occupation, in which skill is acquired slowly, the operation has accelerated the integration of the new hire. Advantages are also found in terms of motivation. Transnational Project FSE Equal ETIC Contribution : France Page 22 However, the senior-novice tutoring does not only have advantages; the cost is a major stumbling block. Tutoring involves freeing up a significant amount of time to create periods of apprenticeship. To double the whole or part of a position for a period, which could last from 6 months to one year, represents a significant investment the return of which must be analysed (less money spent on external training, increased quality, better productivity…). For this reason, tutoring should not be across the board but should be reserved for those occupations where the apprenticeship is long, complex and is developed more from hands-on training than from a classical training. In professional relations, experience at IPC has shown than tutoring could also have negative effects in isolating, for example, the tutor/student from the other employees. Tutoring could be viewed by other employees, who find themselves in less favourable conditions, with a degree of “jealousy” or annoyance. However, the steps taken by the IPC in senior-novice tutoring remain positive experiences which should be offered generally in the sectors where it could prove useful. 2-2-3 maintaining training in the over 50s The data analysed regarding training policy continues to provide evidence of several phenomena: • from 50 onwards, the amount of on-going training undertaken by an employee gradually declines to practically zero 2 or 3 years prior to retirement • the content of the training undertaken tends to degenerate • managers also appear to become less demanding of training for older workers It is therefore advisable to create or recreate training programmes for older employees which encourage them to: - evaluate their gaps and make their managers aware of such gaps to develop themselves to train or tutor younger employees to seize and look positively at opportunities for change to accept horizontal career moves rather than vertical moves: example of “atypical” changes or paths can be found at JBZ (see the enclosed document) or at the IPC. Analysis of the new health needs also provide new opportunities for experienced personnel in a structure. Analyses of this can be found in the work carried out by the USL Brindisi. Transnational Project FSE Equal ETIC Contribution : France Page 23 Undoubtedly, a more systematic evaluation of the effectiveness of the training of older workers is needed. 2-2-4 salary changes for the over 50s The salary for older workers is not the main lever which should govern reactions yet salary policy offers management possibilities including in the over 50s. Changes in salary for older workers are often limited, by the upper limit of the service-related part of the salary. An employee could accept the idea of a « levelled » salary which always remains higher than that of younger workers or those who have not been in service for as long. At this stage of the career, the variable salary (goal bonuses, mission expenses) could, on the other hand, be well applied, in developing the factors of the accumulation of experience such as: - expert skills the role of the tutor or the sharing of knowledge the roles of the project organisers or leaders At the very least, bonuses could encourage the retention or development of professional performance in the over 50s with various conceivable schemes: the development of variable salary schemes with a more marked reversibility for older workers (for example, the possibility of either losing a skills bonus if professional performance declines or retracting a responsibility-based bonus when changing to a less responsible position…) However, this approach is difficult to get accepted in a sector where salary increases are acquired and retained over time or with age and are never questioned. - - The increase in premiums for older workers, or of the abundance of timebanking, according to performance criteria rather than time. - A variable part providing financial encouragement for mobility and training The IPC employs this policy by linking the variable part of the salary to the maintaining of a good level of training and a high level of professional effectiveness 2-2-5 Supporting the transition by adjusting the working time between full time and retirement Transnational Project FSE Equal ETIC Contribution : France Page 24 For older workers time becomes one of the major social issues; having settled their material life and their salary, they are now looking for more spare time rather a development in salary. At this point it is useful to refer to the Dutch hospital which favours relaxing working hours for the older workers. For example, from 55 onwards, employees can comfortably work their hours in 4 days and retain the same salary. The Institute, in its national project, has also brought forward various forms of individualising and managing time for older workers: • • • • use of a time bank to form one or two sabbatical years adjustment over a period of several years to a part-time basis annual contracts on a large scale conversion of bonuses or a part of the salary into time The objective here is not to reconstitute the forms of early retirement which have clearly been abandoned today, but to implement a more individualised approach to the resources of hours and the money available to older workers. These particular changes and adjustments must be formalised and outlined in the contract between the employee and employer in order to form the chart of good practice for older workers and avoid absenteeism among older workers who are coming to the end of their careers. 2-2-6 organising an offer of employment adapted to reconversions for older workers Undeniably cases of illness, permanent disability or of resettlements are more common among older workers. As well as being more numerous, cases of incapacity are also more difficult to treat because they deal with: - workers where the cost of redundancy is too high older workers, often well-known and appreciated in the institution and for whom a “moral and social debt” has been incurred during a long service In general, these cases catch the HR Managers off-guard, as, in an emergency, there are never any protected or reserved positions available which are suitable for these employees on a temporary or permanent basis. Absence is therefore preferable and acts a convenient valve for personnel management. In general, this increases the subsequent difficulties of re-entering the Transnational Project FSE Equal ETIC Contribution : France Page 25 labour market and triggers a downward trend (on the skills of the worker, on motivation, on the desire of resettlement....) In these conditions, planning and preventative attitudes must play a significant role. The IPC is conscious of these pitfalls, and today intends to encourage preventative resettlement of workers in positions of great stress. Nursing-auxiliaries with a recognised occupational stress are particularly concerned by this scheme. An initial trial of this scheme has been implemented with older workers being resettled in positions of catering assistants. Transnational Project FSE Equal ETIC Contribution : France Page 26 CONCLUSION Strategies which encourage the early retirement before the age of 60 are gradually being replaced by policies which manage the skills and the motivation at all ages. These policies should be considered as necessary adaptation to the differentiation which settles in through the course of the working life. It seems that the situations of the young hires are marked by a greater homogeneity in the expectations and the HR management responses of companies. On the other hand, the older a worker, the greater the gaps which arise; in terms of health, ambition, career opportunities, and work-family balance, the situation of the employee becomes more individualised as his career progresses. This situation leads management policies to move away from collective approaches towards more individual solutions. However, the initial cost incurred by this mode of management is higher because it involves: - increased and longer training (with reconversion as the objective) increased salary costs investment in the improvement of working conditions compromises on hours However, these costs should be weighed up against the significant costs incurred by policies which are based on turnover, costs such as: - recruitment redundancy or early retirement loss of motivation severe loss of skills A company which involves itself in this type of action is naturally led to question the choice between a policy of regular replacement of its staff and a policy of the longterm retention of its employees. An analysis of the costs against the benefits remains relatively difficult to establish but risks becoming a minor consideration compared with the reality of the facts. Indeed, in the demographic context of the years to come, can a hospital really achieve its performance objectives and bypass an in-depth study on age management? Transnational Project FSE Equal ETIC Contribution : France Page 27 Recent bibliographical references Report by for the Conseil Economique et Social (Economic and Social Council) 2004 – author: Michel Pinaud « le recrutement, la formation et la professionnalisation des salariés du secteur sanitaire et social » Study by Bernard Brunhes Consultants – 2001 – les salariés seniors : quel avenir dans l’entreprise Report by Pr Matillon – Modalités et conditions d’évaluation des compétences professionnelles des métiers de la santé – 2003 Presentation from the seminar on age management « vieillissement, nouvelles technologies et organisation : accompagner le changement dans l’entreprise » Conseil Economique et Social (Economic and Social Council), Paris 17th November 2003. Annexes 1) IPC internal opinion questionnaire 2) JBZ age concious management 3) JBZ presentation and human ressources policy Transnational Project FSE Equal ETIC Contribution : France Page 28 ANNEX 1 : IPC’s EMPLOYEE SATISFACTION QUESTIONNARY MODALITES PRATIQUES Dépôt du questionnaire : Votre questionnaire rempli sera déposé dans une boîte aux lettres fermée, au standard de l’Institut. Cette boîte sera relevée exclusivement par la société Marketing Méditerranée qui exploitera le questionnaire. Engagement de confidentialité : Ce questionnaire est la propriété de Marketing Méditerranée et sera détruit après l’analyse statistique. L’Institut ne sera destinataire que des données consolidées. Merci de votre collaboration. Fiche signalétique (Réponse : un seul numéro) Q.1. Sexe : 1. Homme 2. Femme Q.2. Âge : 1. Moins de 30 ans 3. De 41 à 50 ans 2. De 30 à 40 ans 4. Plus de 50 ans Q.3. Vous êtes : 1. Médecin 2. Cadre non médical 3. IDE 4. AS 5. Secrétaire d’unité de soins ou médico-technique 6. Technicien de laboratoire 7. Manipulateur 8. Autre personnel soignant 9. Autre personnel médico-technique 10. Personnel administratif 11. Personnel technique ou logistique Q.4. Quelle est votre ancienneté à l’IPC ? 1. De 0 à 5 ans 2. De 6 à 10 ans 3. De 11 à 20 ans 4. Plus de 20 ans Q.5. Vous travaillez : 1. De jour Transnational Project FSE Equal ETIC 2. De nuit Contribution : France Page 29 Votre poste de travail Q.6. Votre rôle (poste) actuel est défini : 1. Très clairement 2. Assez clairement 3. Peu clairement 4. Pas du tout clairement Q.7. Connaissez vous les objectifs assignés à votre équipe/service ? 1. Oui, totalement 2. En partie 3. Non Q.8. Pouvez-vous prendre des initiatives dans votre travail ? 1. Beaucoup 2. Suffisamment 3. Peu 4. Pas du tout Votre rémunération Q.9. Quels sont les principaux critères qui doivent déterminer votre salaire ? (Plusieurs réponses possibles par ordre croissant d’importance) 1. Initiatives et résultats individuels 2. Compétences le + important 3. Résultats collectifs 5. Diplômes 7. Pénibilité important 4. Ancienneté 6. Contenu du travail et responsabilités 8. Comportement et savoir être le - Q.10. L’institut doit-il continuer à développer les parts de salaire collectif comme l’intéressement ou l’épargne collective (abondement et plan d’épargne entreprise) ? 1. Oui 2. Non Q.11. Par rapport à un emploi équivalent dans une autre structure hospitalière équivalente, votre rémunération vous paraît-elle : 1. Supérieure à ce que vous pourriez obtenir 2. Egale à ce que vous pourriez obtenir 3. Inférieure à ce que vous pourriez obtenir 4. Ne sait pas Q.12. Connaissez vous les règles de rémunérations de l’IPC ? 1. Tout à fait 2. Suffisamment 3. Peu 4. Pas du tout Transnational Project FSE Equal ETIC Contribution : France Page 30 Vos conditions de travail Q.13. Les locaux dans lesquels vous travaillez sont-ils adaptés à votre travail ? 1. Oui 2. Non Q.13.bis. Si non, pourquoi ? ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………….. Q.14. Dans votre travail, vous disposez de l’équipement et du matériel nécessaires : 1. En totalité 2. En grande partie 3. Pas suffisamment 4. Pas du tout Q.15. Pensez-vous que l’Institut prend les mesures adaptées pour limiter les risques d’accident et de maladie dans l’exercice de votre activité professionnelle? 1. Oui 2. Non Q.15. bis. Si non, pourquoi ? ………………………………………………………………………………………… ………………………………………………………………………………………… ……………………………….. Q.16. Vos horaires de travail vous conviennent-ils ? 1. Oui 2. Non Q.17. Est-il facile de prendre vos congés aux périodes que vous souhaitez ? 1. Très facile 2. Facile 3. Difficile 4. Très difficile Q.18. Est-il facile de prendre vos RTT aux dates que vous souhaitez ? 1. Très facile 2. Facile 3. Difficile 4. Très difficile Q.19. Diriez-vous que vos conditions de travail se sont améliorées depuis deux ans : 1. Beaucoup 2. Suffisamment 3. Peu 4. Pas du tout Transnational Project FSE Equal ETIC Contribution : France Page 31 L’efficacité et l’intérêt du travail Q.20. Vous avez le sentiment que l’efficacité de votre travail s’est améliorée depuis deux ans : 1. Beaucoup 2. Suffisamment 3. Peu 4. Pas du tout Q.21. A propos de votre travail, diriez-vous qu’il vous plait : 1. Beaucoup 2. Suffisamment 3. Peu 4. Pas du tout Q.22. A quoi attachez-vous le plus d’importance dans votre travail (classer cinq propositions par ordre d’importance) ? 1. Horaires 2. Ambiance du travail 3. Patient et sa prise en charge 4. Rémunération 5. Hygiène et sécurité 6. Formations 7. Evolution professionnelle 8. Reconnaissance de votre hiérarchie 9. Autonomie et initiative 10. Autres à préciser ……………………… le plus important le moins important Q.23. L’ambiance dans votre travail est : 1. Très bonne 2. Assez bonne 3. Assez mauvaise 4. Mauvaise Q.26. Votre travail vous permet-il d’acquérir de nouvelles compétences ? 1. Oui 2. Non Q.27. Dans votre secteur, quels sont les dysfonctionnements sur lesquels il convient d’agir en priorité ? (Plusieurs réponses possibles) 1. Manque de personnel 2. Problèmes de communication 3. Problèmes d’organisation 4. Plannings 5. Matériel et équipement 6. Locaux 7. Hygiène et sécurité 8. Autres………………………………….. Transnational Project FSE Equal ETIC Contribution : France Page 32 L’entretien d’évaluation Q.28. L’entretien d’appréciation avec votre supérieur est-il: 1. Approfondi 2. Superficiel Q.29. Lors de ces entretiens, les objectifs qui vous ont été assignés étaient-ils clairs ? 1. Oui, totalement 2. En partie 3. Non Q.30. Ces entretiens ont-ils été l’occasion d’un véritable dialogue ? 1. Oui 2. En partie 3. Non Q.31. Ce temps vous a-t-il paru : 1. Suffisant 2. Insuffisant Les relations hiérarchiques Q.32. Dans votre travail, la répartition des responsabilités et de l’autorité entre vos différents responsables est : 1. Très claire 2. Assez claire 3. Peu claire 4. Pas du tout claire Votre cadre… Q.33 … planifie le travail d’équipe Très bien Assez bien Assez mal Très mal Q.34 … utilise au mieux les compétences de chacun Q.35 … résout les litiges dans le service Q.36 … vous informe sur votre travail et sur les orientations de l’hôpital Q.37 … vous aide si vous avez un problème Q.38 … vous fait confiance et reconnaît la valeur de votre travail Q.39 … vous conseille sur votre carrière (Mettre une croix dans les cases correspondant à vos réponses) Q.40. Vous arrive-t-il de parler avec votre supérieur hiérarchique direct de la manière d’améliorer le service ? 1. Très souvent 2. Assez souvent 3. Rarement 4. Jamais Transnational Project FSE Equal ETIC Contribution : France Page 33 Le parcours professionnel Q.41. Pensez-vous que pour votre carrière la mobilité (changement de poste) soit : 1. Très utile 2. Assez utile 3. Peu utile 4. Inutile Q.42. Souhaitez vous changer de service au sein de l’Institut ? 1. Oui 2. Non Q.43. Souhaitez-vous changer de métier au sein de l’Institut ? 1. Oui 2. Non Q.44. Etes-vous informé sur les postes vacants au sein de l’IPC ? 1. Tout à fait 2. Suffisamment 3. Peu 4. Pas du tout Q.45. Combien de temps envisagez-vous de travailler à l’lnstitut ? 1. De 0 à 5 ans 2. De 6 à 10 ans 3. De 11 à 20 ans 4. Toute votre carrière Q.46. Vos possibilités de promotion à l’IPC vous semblent-elles : 1. Très importantes 2. Assez importantes 3. Peu importantes 4. Pas du tout importantes Q.47. Etes-vous informé sur les possibilités promotionnelles au sein de l’IPC ? 1. Totalement 2. En partie 3. Pas du tout Q.48. Etes-vous informé sur le dispositif de VAP (validation des acquis professionnels)? 1. Totalement 2. En partie 3. Pas du tout Transnational Project FSE Equal ETIC Contribution : France Page 34 La formation Q.49. Connaissez-vous les possibilités de formation offertes par l’Institut ? 1. Oui 2. Non Q.50. Si oui, vous paraissent-elles suffisantes ? 1. Oui 2. Non Q.51. Si vous avez suivi des stages de formation dans le cadre de votre poste actuel, vous ont-ils été utiles dans votre travail ? 1. Oui 2. Non Q.52. Vos souhaits de formations sont-ils suffisamment pris en compte? 1. Oui, totalement 3. Peu Les formations… Q.53… favorisent-elles votre mobilité professionnelle ? Q.54… contribuent-elles à votre progression professionnelle ? Q.55… sont-elles organisées de manière satisfaisantes (lieux, déplacements, remboursements etc.)? Q.56… sont-elles compatibles avec vos plannings ? 2. Oui, en partie 4. Pas du tout Très souvent Assez souvent Rarement Jamais (mettre une croix dans les cases correspondant à vos réponses) Q.57. Qui contribue le plus à votre formation ? 1. Votre cadre 2. Votre agent de maîtrise (infirmier principal, technicien principal, etc.) 3. Un autre responsable hiérarchique 4. Le service formation 5. Autre à préciser: …………………………… Transnational Project FSE Equal ETIC Contribution : France Page 35 Services au personnel A propos des services sur votre lieu de travail… Cafétéria Restaurant Parking Aide au logement Aide au transport collectif (abonnement RTM) Médecine du travail Assistante sociale du personnel Psychologue du personnel Intranet Prestations du comité d’entreprise Q.58. Utilisez vous les services suivants ? Oui Non Q.59. En êtes vous satisfaits ? Oui Non (mettre une croix dans les cases correspondant à vos réponses) L’information sociale Q.60. Quelles sont les sources d’informations sur la gestion du personnel auxquelles vous vous référez le plus ? Classez les du moins important au plus important (1 représentant le plus important et 5 le moins important) 1. Votre supérieur hiérarchique le + important 2. Vos collègues 3. Les notes de service 4. Les panneaux d’affichage 5. Les représentants syndicaux 6. Le Bureau du Personnel 7. Intranet 8. IPC infos le – important Transnational Project FSE Equal ETIC Contribution : France Page 36 Opinion générale Q.61. En définitive, êtes-vous satisfait de travailler à l’Institut ? 1. Très satisfait 2. Assez satisfait 3. Peu satisfait 4. Pas du tout satisfait Q.62. Avez-vous d’autres commentaires sur votre travail que ce questionnaire n’a pas permis d’aborder ? …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… ………………………………. Transnational Project FSE Equal ETIC Contribution : France Page 37 ANNEX 2 : Age- conscious personnel management maart 2004 Saint- Veras slide 1 Age- conscious personnel management- an exploration. That’s the title of my presentation. And with a reason. Explorers are being send ahead to assess the far away situation, to collect data, on the basis of a specific purposeful action is taken. Exploring in relation with this subject means, trying to get in sight the expectations, wishes and possibilities from the individual employee and try to realize them in the organisation. That’s the kind of personnel management the Jeroen Bosch Hospital wishes. Therefore specific, purposeful, custom made slide 2 Demographic developments influences the labour market. As known the number of young people is decreasing and go to school longer. At the opposite, the number of old people is increasing ( ageing) and they work longer. Maybe need to work longer. Soon the average employee is 40 years. He needs to be active for at least 25 years. After the abolition of the regulation early retirement and because of the almost impossibility of stream out by the law work disability, are changes in pension rules, the law unemployment and incapacity for work rules, at that debet. Because of this the average age of the employee will rise vigorously. Slide 3 Just something about the ages structure in the Netherlands. As you see changes the figure of the populations structure of a pyramid model in a swimming tyre model. The bump of the swimming is caused by the after-war birth wave. The prognosis is, that the form later, around 2040, will be like an onion. Now 14% is older then 65 . Transnational Project FSE Equal ETIC Contribution : France Page 38 20 year from now it will be 19%. From 2010, if the baby boomers become 65, starts a period of approximately 25 year in which there will exists a false proportion between the number of 65 and older and the size of the adult population, that the economy and the health care must hold turning. The high point is around 2035. 25% is then 65 or older. SLIDE 4 Single figures of the Jeroen Bosch hospital. In 1996 yet 34% of our co-workers was 40 year or parent. In 2002 it’s already 45%. Of the employees above 50 the increase is 6.5%. SLIDE 5 On this slide you see the ages structure in the operation center. 17% is older than 50 year. More important yet is the difference regarding the entire JBZ to the group 40 year and parent. Over the entire JBZ it’s 45%. For the OK is that 55%. This needs extra attention. Why? Think par example of the issuing of rules concerning irregular services. From the age of 55 year there is no more need to work irregular. Because the large number of older employees on a certain moment, a relative small number of colleques needs to catch these services. SLIDE 6 What do we mean by age- conscious personnel management? Age- conscious personnel management is personnel management which is directed on differences between employee. These differences can lie on various areas and isn’t resemble for every employee. Single differences can be: career phase, ambition, physical condition and proportion privately-work. An age- conscious personnel management is directed to these differences and utilize them. An employee that just ended his study will be more involved with the future and his career. An employee with 40 years experience has probable more affinity with stability and use of his experience as for example coaching younger persons. It is to be kept important both workers for the organization through spending attention at the needs and possibilities of workers in different phases of their career. Side 7 Transnational Project FSE Equal ETIC Contribution : France Page 39 What has in the Jeroen Bosch Hospital already been done? • We did research fit in a study labour- market- politics and human resource science. • An adviser human resource management did participate in a network around this theme • The HR- department wrote a note ‘age- conscious personnel management’ • Very recent a student HR- management made a report about vitality related to age- conscious personnel management. She developed an instrument to measure the fysical, mental en psychological- social capacities of the employee to relate the outcome to the job- demands with the objective to become a development design Slide 8 What did the Jeroen Bosch Hospital with these knowledgeenrichment? Deliver custom made. SLIDE 9 I give you a few examples of this measure work: • A nurse couldn’t manage her work anymore physical and mental. She was places as a secretary at a ward. • A unit- manager stepped back and became a nurse again. From a social point of view we call that a step back. I speak rather of a step further in the career line witch is bending off. • An operating- assistant that could no longer adept the tension of the work “at the table” worked the last period of her career as a general assistant. SLIDES 10 So continue then really. Naturally of course. Yet it will be clearly necessary to formulate more intensively, more specifically, preventive and per-active policy, considering the developments I Transnational Project FSE Equal ETIC Contribution : France Page 40 sketched before : shortage of young people and ageing and these consequences for the labour market situation in health care. Preventively by preventing, as far as possible, that problems arise and per-active through giving attention to this problem and creating conditions in which age- conscious personnel management can get figured. SLIDE 11 Vision: It’s of large interest that age- conscious personnel management is rooted is in the behavior and culture of the organization: a manner of looking and steering that is characterized through attention for the (age- conscious) chances and limitations of employees and through a complete and per-active manner of dealing with that. The management is responsible for the policy within the cluster. In the annual plan , spearheads and actions need to be formulated within the result territory “qualities of work “. \ A number of supporting instruments and conditions must be present: Good management information: area codes as ages structures, absenteeism information, for example : age-category and positions, internal mobility, need to be analysed to commit interventions .A new personnel data system, implemented in 2003 offers all possibilities. Financial space is to be funded for necessary specific trainings. Permanent training is an important instrument to hold employees usable long and broad . In relation with the creation of an image about the older employee it is necessary that this category employees becomes stimulated to follow courses and trainings. Permanent training, also of the older nascent employee, is important to keep up with the developments of the profession. Furthermore there are specific trainings, with increases the employability. This offers more possibilities in the seeking to other work when the present work no longer can be practiced. Means also in the conditions of employment. The cafeteria system that makes it possible to exchange for example free time for salary or turned around, is also a tool. Also b. v. by a position adaptation with a salary cutback regulation by which preservations of pension are guaranteed. Rewards possibilities by irregular services differently than the collective labour organisation prescribes. Par example above the 55 year. Transnational Project FSE Equal ETIC Contribution : France Page 41 Flexible regulations concerning working hours rules, adaptation of rest and pause times, creating regularity, dose physical work burden. Investigate possibilities of task-job adaptation. Particular tasks no longer. Other tasks right extra or adding new. Position or function differentiation can lead to level’s in positions in particular target groups. In the Jeroen Bosch Hospital has been arranged that every employee annually must get a performance interview. In the recent held job satisfaction survey did appear that many employees need such a conversation. In many cases however it did not take place. The performance interview offers the possibility for early recognition of problems around the self developing and more older nascent employee. Sufficient attention is needed serves for wishes related to the future, desired training and working conditions. It was very strange that in our pamphlet has been taken up that it was no more needed to hold performance interviews with employees from 55 year and older. That rule has scraped directly. A recent pilot in the JBZ concerning Personnel Development programs, did lead to an advice concerning a system for support personal development of employees. Recruitment and selection as much as possible, if the market permits it, is tuned and adapted to the ages structure of the division or target groups. SLIDE 12 To give good filling-out at age- conscious personnel management ,the employee also has to be ready to discuss openly the personal situation and needs to feel self responsibility for its development process and career route. It is not a problem of the organization alone and by the organization only to be solved. Willing to change is also necessary considering the circumstances. Concessions need to be accepted in advantage of the job satisfaction of the employee himself. Steps back must also can appointed and experienced can as steps forward on a bending off career. SLIDE 13 See text slide. SLIDE 14 A few months a go I read this article in my newspaper. Transnational Project FSE Equal ETIC Contribution : France Page 42 The Dutch professor Johann Groothof finds it absurd letting people work longer. He finds that there is insufficient eye for the health’s risk’s. With adaptation of the work at the stage of life, care leave, education, continuing education, yet the beginning is just made. If you can limit the number early drop outs ,you don’t need the workers of 60 and older necessarily. Topsport isn’t also to keep up on the long term. Yet, he also sees possibilities and advantages. Work is to be held easier longer through attention for good- fellowship, atmosphere and solidarity. Longer continue working has certain also the advantage that you remain integrated in the modern society. He sees olds also as useful as a mentor for their younger successors. It looks at the end that professor Groothof and I are coming really together. I reassured finished after that my presentation. By the way……….Groothoff is 58 year. Cor M. M. van Driel Adjunct directeur Jeroen Bosch hospital Maart 2004 Transnational Project FSE Equal ETIC Contribution : France Page 43 ANNEX 3 : Présentation du contexte du Jeroen Bosch Ziekenhuis (JBZ) Le groupe hospitalier « Jeroen Bosch Ziekenhuis » est une structure de statut privé, de type fondation, assurant une mission de service public. Le JBZ est assez représentatif des structures hospitalières régionales des Pays Bas Hôpital embrassant la plupart des spécialités médicales, le JBZ a une situation relativement monopolistique pour l’exercice du service hospitalier dans l’arrondissement de ‘s-Hertogenbosch (360 000 habitants) ; en effet, aucune autre structure hospitalière privée ou publique n’est présente dans cet environnement. Pour autant, les patients ont le libre choix de leur hôpital et peuvent se faire soigner dans les hôpitaux de villes voisines (Tilburg, Nimègue, Eindhoven, voire Amsterdam…). En outre, une concurrence quelque peu destructrice existe entre les sites hospitaliers du JBZ, tant que la fusion n’est pas pleinement réalisée. Le Groupe Hospitalier JBZ comprend 1120 lits et emploie 4000 agents non médicaux et 200 médecins. L’activité est principalement orientée sur le court séjour et la rééducation. Le budget avoisine les 210 Millions d’euros. Au titre de l’année 200, les principaux paramètres d’activité du JBZ étaient les suivants : 27 800 admissions 216 500 journées d’hospitalisation 316 500 consultations Ces activités se réalisent sur 5 établissements distincts : - 3 établissements à ‘s-Hertogenbosch o le Carolus Ziekenhuis o le Willem-Alexander Ziekenhuis o le Groot Ziekengasthuis - 1 établissement à Boxtel o le liduina Ziekenhuis - 1 établissement à Zaltbommel o le Bommels Gasthuis L’hôpital est engagé dans une profonde restructuration avec une fusion de ses 5 sites et une capacité en lits (800 lits à l’avenir). Cette évolution va de pair avec la volonté stratégique de hisser un certain nombre d’activités au rang de Transnational Project FSE Equal ETIC Contribution : France Page 44 « topklinish », statut hollandais reconnaissant un niveau élevé de référence et de qualité médicale aux spécialités concernées, pour des hôpitaux nonuniversitaires. La néonatologie et la neurochirurgie sont les principales cibles de cette évolution stratégique. Sans être encore trop fortement concurrencé, le JBZ observe une fuite de patients vers d’autres hôpitaux régionaux, au fur à mesure que le consumérisme médical se développe dans la population hollandaise. Ainsi, même si les généralistes de ville sont chargés d’orienter les patients inscrits chez eux, le « deuxième avis » (deuxième consultation) se développe Par ailleurs, sans être de statut universitaire, le JBZ est accrédité pour proposer des enseignements médicaux pour les jeunes médecins. POLITIQUE DE GESTION DES RESSOURCES HUMAINES Le code du travail hollandais est appliqué pour la gestion des personnels du JBZ (Récupérer le nombre d’équivalent temps plein + nombre de personnes) Le JBZ enregistre une durée d’emploi de ses salariés très importante (ancienneté moyenne à récupérer, si possible par catégorie d’emplois). Le turnover semble faible (voir les chiffres). Les départs sont principalement limités à des situations de départ volontaire (démissions) ou à des situations de maladie. Les départs à l’initiative de l’hôpital (départs négociés, licenciement) sont rarissimes (2 ou 3 par an concernent des problèmes comportemetaux). Organigramme des emplois Dans un département de soins, 7 niveaux d’emplois existent avec une hiérarchie sur trois à quatre niveaux niveau 1 : employés de ménage niveau 2 : agents d’assistance hôtellière (pas de contact avec les patients) : linge, repas… niveau 3 : aide de soins (toilettes…) niveau 4 : infirmière niveau 5 : infirmière principale niveau 6 : manager d’unité (unit hoofd) niveau 7 : cadre de secteur (cluster manager) Management Transnational Project FSE Equal ETIC Contribution : France Page 45 L’unité principale de gestion est le cluster (secteur ou département) sous la responsabilité d’un cluster manager . Ils sont responsables de l’organisation, des budgets et du personnel du secteur, en lien avec le médecin responsable du secteur qui est plus particulièrement chargé de la gestion médicale et de la communication externe. Ils pilotent l’évaluation de leur secteur, réalisée par les managers directs (d’unité). Chaque agent est évalué chaque année. Trois fois par an, une discussion collective est organisée dans chaque unité. Ces managers reconnaissent qu’ils ont une responsabilité de fidélisation de leur salariés. A leur niveau, cette fidélisation passe principalement par le développement d’une bonne communication avec les salariés (« responsable de l’ambiance »), par la formation et, à un degré moindre par l’action sur les conditions de travail. A noter que l’évaluation est sans lien avec le salaire qui progresse à l’ancienneté. La motivation des cadres passe par en premier lieu par la définition de projets professionnels, d’objectifs, de responsabilités, en en second lieu, par les actions de formation ou de participation à des congrès Attractivité / Recrutement / salaires Les phénomènes de pénurie de personnel sont encore assez faibles. Ils concernent essentiellement des postes d’infirmières spécialisées, dans certains services peu attractifs. Il est parfois difficile de recruter des masseurs-kinésithérapeutes. Au total, seuls 30 à 40 postes sont vacants dans l’hôpital. La concurrence du home care existe, bien qu’il n’y ait pas de différence de salaire. Mais, l’indépendance des infirmières de ville est un facteur d’attraction. L’Hôpital y répond en mettant en avant les possibilités de temps partiel. Des expériences de « job rotation » entre la ville et l’hôpital ont été tentées en vain, les différences de culture entre ces deux secteurs rendent difficile ce mode de fonctionnement. Du coup, des infirmières de liaison (ccordonatrices ?) existent pour faire le lien entre la ville et l’hôpital. Les services les moins attractifs sont la pneumologie et la neurologie. La charge de travail en soins, plus importante et le manque relatif de technicité décourage les infirmières de travailler dans ces secteurs. Toutefois, plus largement, aux Pays-Bas, on peut faire le constat que les professions hospitalières attirent peu les jeunes, même si cette attractivité peut être plus importante lorsque le chômage se développe. Ce manque d’attractivité des métiers hospitaliers pour les jeunes étudiants tient au moins à trois facteurs : - l’image faiblement valorisante ou valorisée du travail en milieu hospitalier par rapport à d’autres secteurs de l’économie (banque, informatique…) Transnational Project FSE Equal ETIC Contribution : France Page 46 - les contraintes liées aux conditions de travail de ce secteur (pénibilité, horaires difficiles…) le niveau des salaires, en général assez peu compétitifs par rapport à de nombreux autres secteurs. Sur ce dernier point, les pouvoirs publics ont réagi depuis cinq ans en revalorisant récemment les professions hospitalières. Aucune incitation n’existe de la part des pouvoirs publics pour recruter des salariés de plus de 50 ans, sauf pour les hôpitaux ou des opérations spéciales ont été organisées pour permettre le retour des infirmières ayant cessé de travailler. A titre d’illustration la rémunération brute moyenne d’une infirmière de base est de 2500 € par mois. Une infirmière plus expérimentée pourra gagner 2700 € par mois. Pour une infirmière spécialisée, le salaire pourra atteindre 3000 €. La politique salariale du JBZ est calée sur des grilles de salaire nationales, uniformisées en 2000 pour les emplois publics. Le JBZ n’a pas la possibilité de construire une politique salariale autonome et attractive pour la quasi totalité des personnels. Une évolution semble toutefois se faire jour pour les rémunérations médicales. Les difficultés de prise en charge des patients dans certaines disciplines (liste d’attente d’ un an par exemple en chirurgie plastique ou en chirurgie orthopédique) peuvent conduire à la création d’un secteur privé au sein de l’hôpital, pour ces spécialités. La mise en place du paiement à la pathologie à compter de l’année 2004 (sur la base des DRG’s) devrait aussi pousser dans cette direction, en donnant à l’hôpital la possibilité de produire plus, de récupérer des enveloppes budgétaires supplémentaires et de mieux rémunérer certains spécialistes médicaux. Les politiques de recrutement à l’étranger sont encore embryonnaires et concernent des expériences dans des hôpitaux de grandes villes (Amsterdam…) pour des médecins issus d’Afrique du Sud, des Philippines ou d’Europe du Sud. Ces expériences se sont souvent conclues par des échecs en raison de la double barrière linguistique et culturelle. Développement de carrière – formation La possibilité de faire une longue partie de sa carrière au JBZ est soutenue par une politique volontariste de formation (statistiques à récupérer). La Direction Générale estime que la formation est l’instrument principal qui permet de maintenir les salariés dans leur emploi. Le deuxième instrument de maintien dans l’emploi qui est avancé est celui de l’amélioration des conditions de travail. Transnational Project FSE Equal ETIC Contribution : France Page 47 La stratégie consistant à développer le rôle d’enseignement et de formation du JBZ participe également du souhait d’attirer et de maintenir les professionnels de santé. Le JBZ aspire en effet à devenir un des 17 meilleurs hôpitaux régionaux hollandais dans ce domaine en atteignant cet « academic level » qui confère à l’hôpital une vraie mission de « teaching hospital ». la Direction Générale considère que dette image nouvelle de l’hôpital peut constituer un élément de fierté pour les personnels et favoriser leur fidélisation. Dans le contexte concurrentiel évoqué plus haut et qui devrait se développer dans les années à venir,et dans l’optique d’un hôpital à la recherche d’un plus haut niveau de performance, le niveau de formation des personnels et le développement de leurs compétence devient stratégique. La Direction Générale reconnaît que l’aptitude au changement, notamment des salariés les plus anciens est lente à développer. En outre, le contexte difficile de la fusion brouille dans l’immédiat la politique des ressources humaines du JBZ. Beaucoup d’employés, dans cette période transitoire ne sont en effet préoccupés que par une question : « quelle va être mon devenir professionnel dans la fusion ? » La perspective de la fusion amène cependant le JBH à investir sur l’évolution de ses ressources humaines. Un consultant est spécifiquement missionné sur le long terme sur les thèmes suivants : - les programmes d’éducation avec un objectif de fidélisation - les conseils de carrière - le développement personnel et managérial Son action immédiate est toutefois axée principalement sur les études d’organisation liées à la fusion. L’évolution de carrière pour devenir cadre de soins reste limitée (5 à 6 formations par an sont octroyées, après entretien simple avec le consultant et un cluster manager). La formation pour être cadre apparaît plus souple qu’en France puisque des possibilités de formation en alternance sont possibles. L’alternance travail/formation existe aussi pour se former au métier d’ infirmière, tout en conservant son emploi. Toutefois les évolutions des niveaux 2 ou 3 au niveau 4 sont assez peu nombreuses (par contre, les évolutions du niveau 2 vers le niveau 3 sont de plus en plus fréquentes) L’aménagement du temps de travail Le temps plein est de 36H, la limite basse d’un temps partiel est de 9h (25% d’un temps plein) Le temps partiel apparaît très développé. La culture hollandaise explique en partie ce phénomène, notamment chez les femmes. A noter qu’il n’y a pas d’incitation salariale au temps partiel. Transnational Project FSE Equal ETIC Contribution : France Page 48 L’Hôpital a cependant une politique du temps de travail qui peut être différenciée d’un secteur à l’autre. Pour certains métiers, l’hôpital préfère du temps plein. Pour d’autres métiers, le temps de travail peut être laissé à la volonté du salarié qui « propose » un temps de travail. L’ Hôpital essaie alors de s’adapter au mieux à l’offre de l’IDE qui dispose de 10 heures de travail à fournir. Exemples : - le secteur de dialyse (Mme Broeders) emploie 70 employés pour l’équivalent de 52 postes temps plein. Ce secteur est toutefois attractif pour les IDE et le cadre ne favorise pas le temps partiel pour les IDE de son secteur - le secteur de neurologie (Mme Zontag) , peu attractif (malades plus lourds et plus dépendants) est plus favorable à l’embauche de temps partiel ; résultat : 200 employés se partagent l’équivalent de 114 postes à temps plein. - Le secteur pneumologie – cardiologie (Mr jan Delo) : 160 salariés pour 125 postes plein temps - Le secteur dermatologie/ophtalmologie/ORL/chirurgie plastique (Hôpital Carolus): 140 employés pour 110 postes temps plein Autres conditions de travail Le JBZ fait un effort pour les jeunes mamans : l’hôpital « achète » (terme à préciser) des places de crèche dans toute la région. La mobilité Elle est faible dans les régions rurales, plus élevée dans les grandes villes. La mobilité entre les sites du JBH est curieusement inexistante mais le projet de fusion ambitionne de la développer. L’offre de mobilité interne se réalise au sein de chacun des sites par appel à candidature. Les mouvements sont donc basés sur le volontariat et motivés par : - le souhait de développer ses compétences - le temps de travail - la perspective de carrière. Il est à noter que des salaires plus élevés existent en oncologie, en gynécologie, en pédiatrie (quels métiers ?) La gestion de la maladie L’invalidité concerne 1 million de personnes aux pays bas. L’hôpital prend en charge la maladie pendant 2 ans. 1% du personnel de l’hôpital est en longue maladie L’Hôpital et l’employé doivent tout faire pour le reclassement, selon un protocole précis (visite initiale, propositions…) Transnational Project FSE Equal ETIC Contribution : France Page 49 Au total, l’absentéisme maladie représente 6 à 7 %. Le JBZ propose des programmes spéciaux de réintégration des salariés au terme de longues périodes d’absence. La retraite L’age de la retraite à taux plein (76% de son salaire) est progressivement relevé pour atteindre 62 ans en 2005. Il est possible de choisir l’age de départ entre 55 et 65 ans mais le niveau de la retraite varie en fonction de cet age de départ. Aménagement des carrières des anciens Le JBH n’a pas aujourd’hui de politique globale spécifique de prévention des effets de l’age sur ses salariés. Le nombre de salariés agés, encore faible (voir la pyramide des ages) ne suscite pas une mobilisation encore importante sur ce sujet. Toutefois, la fusion, en mettant en relief les effets de génération sensibilise les responsables à cette problématique Certains aménagements particuliers sont toutefois privilégiés : - l’assouplissement du temps de travail : à compter de 55 ans, les salariés peuvent aisément grouper leur temps de travail sur 4 jours, en conservant bien sur une rémunération à 100%. Toutefois, cette concentration du temps de travail est en discussion dans certains secteurs dans la mesure ou elle intensifie la charge de travail. - Les salariés sont invités à revenir de jour après 50 ans - L’épargne de temps (jusqu’à 1 an) est possible A noter : Mme Carin Broeders (Dialyse) écrit un projet sur la gestion de l’ancienneté dans son cluster avec des éléments autour de l’aménagement du temps de travail : à approfondir en 2003. Formation Le gouvernement hollandais semble soucieux de développer une politique de motivation et d’assesment pour développer les compétences tout au long de la vie professionnelle. Ceci induirait une nouvelle approche du contrat avec les salariés et l’accès à de plus longues périodes de formation continue. Elle se réalise sur des modes classiques. L’offre d’e-learning en hollande n’existe pas pour le secteur hospitalier. Communication Il n’y a pas d’enquête d’opinion interne générale. Certains clusters peuvent éventuellement réaliser des enquêtes ponctuelles sur leur secteur. Transnational Project FSE Equal ETIC Contribution : France Page 50 La communication interne est faible pour un établissement de cette dimension mais la fusion devrait lui donner une nouvelle dimension. Transnational Project FSE Equal ETIC Contribution : France Page 51