How to create an attractive and supportive …

1 POLICY BRIEF 15 HEALTH SYSTEMS AND POLICY ANALYSISHow to create an attractiveand supportive workingenvironment for healthprofessionalsChristiane Wiskow, Tit Albreht and Carlo de Pietro World Health Organization 2010 and World HealthOrganization, on behalf of the European Observatoryon Health Systems and Policies 2010 Address requests about publications of the WHOR egional Office for Europe to:PublicationsWHO Regional Office for EuropeScherfigsvej 8DK-2100 Copenhagen , DenmarkAlternatively, complete an online request form fordocumentation, health information, or for permissionto quote or translate, on the Regional Office web site( ).All rights reserved. The Regional Office for Europe ofthe World Health Organization welcomes requests forpermission to reproduce or translate its publications,in part or in designations employed and the presentation ofthe material in this publication do not imply theexpression of any opinion whatsoever on the part ofthe World Health Organization concerning the legalstatus of any country, territory, city or area or of itsauthorities, or concerning the delimitation of itsfrontiers or boundaries.

2 Dotted lines on mapsrepresent approximate border lines for which theremay not yet be full mention of specific companies or of certainmanufacturers products does not imply that they areendorsed or recommended by the World HealthOrganization in preference to others of a similarnature that are not mentioned. Errors and omissionsexcepted, the names of proprietary products aredistinguished by initial capital reasonable precautions have been taken by theWorld Health Organization to verify the informationcontained in this publication. However, the publishedmaterial is being distributed without warranty of anykind, either express or implied. The responsibility forthe interpretation and use of the material lies with thereader. In no event shall the World HealthOrganization be liable for damages arising from itsuse. The views expressed by authors, editors, or expertgroups do not necessarily represent the decisions orthe stated policy of the World Health policy brief is one of anew series to meet the needsof policy-makers and healthsystem managers.

3 The aim is to develop keymessages to supportevidence-informed policy-making, and the editors willcontinue to strengthen theseries by working withauthors to improve theconsideration given to policyoptions and :HEALTH PERSONNELPERSONNEL MANAGEMENTJOB SATISFACTIONWORKPLACE - organizationand administration -standardsAuthorsChristiane Wiskow, Independent HealthServices Specialist, Switzerland Tit Albreht, Centre for Health System Analyses,Institute of Public Health of the Republic ofSlovenia, Slovenia Carlo de Pietro, Centre for Research on Healthand Social Care Management, Bocconi University,ItalyEditorsWHO Regional Office forEurope and EuropeanObservatory on HealthSystems and PoliciesEditorGovin PermanandAssociate EditorsJosep FiguerasManfred HuberJohn LavisDavid McDaidElias MossialosManaging EditorsKate Willows FrantzenJonathan NorthCaroline WhiteGuest EditorsLeen MeulenbergsWilly PalmMatthias WismarThe authors and editors aregrateful to the reviewerswho commented on thispublication and contributedtheir messagesExecutive summaryPolicy briefPolicy issue.

4 Poor work environmentscompromise health-workforce supply and quality of care1 How can attractive and supportive workenvironments be described?4 What can be done to improve the health-sector work environment?6 Implementation considerations23 Summary25 References26 Annexes33No: 15 ISSN 1997-8073 How to create an attractive and supportiveworking environment for health professionalsKey messagesPolicy issue and context: poor work environments compromise health-workforce supply and quality of care Health policy-makers face the challenge of matching increasing demandfor health care with a sufficient supply of health professionals in timesof existing and projected health-workforce shortages. The work environment constitutes an important factor in the recruitmentand retention of health professionals, and the characteristics of thework environment affect the quality of care both directly and the work environment, therefore, plays a critical role inensuring both the supply of a health workforce and the enhancement,effectiveness and motivation of that workforce.

5 The purpose of providing attractive and supportive work environments isto create incentives for entering and remaining in the health professions,and to provide conditions that enable health workers to perform effectively(to achieve high-quality health services). Policy options Given the complexity of the work-environment issues to be addressed,policy responses need to be multidimensional, cross-cutting and coherent policies, policy action has to be considered at four levels:international/regional level; national level; sectoral level; and local/organizational level. Effective solutions are context-related and thereforepriority has to be given to the local and organizational level. The otherlevels provide the legislative and regulatory framework and provideguidance and support for the development of workplace policies. Two examples of what can be done to improve the quality of the workenvironment in the health professions include policy approaches to promotea healthy balance between family life and work, and the enhancement ofthe protection of workers health.

6 In order to encourage health-sector employers to make a commitment topositive work environments, the development of workplace assessment/recognition programmes could be to create an attractive and supportive working environment for health professionalsImplementation considerations As many factors influencing the work environment operate outwiththe health sector, intersectoral collaboration is required. In particular,the interface between labour and health-policy mandates needs tobe strengthened. Here, the use of social dialogue can help to ensure sustainable and cross-sectional implementation with multiple briefExecutive summaryPolicy issue: poor work environments compromise health-workforcesupply and quality of careEuropean countries face common challenges in ensuring a well-performinghealth workforce in times of existing and projected shortages. One of themultiple aspects that determine the supply and performance of health workersis the work environment, which plays a critical the demographic changes expected in the coming decades, labourmarkets will experience increased competition for talent.

7 Recruitment andretention of health professionals are priorities in the health sector. Evidencesuggests that the work environment is an important factor in the recruitmentand retention of health workers. Furthermore, the work environment can influence the quality of care. Itscharacteristics affect organizational functionality, individual satisfaction, thebalance between work and family life, continuous development, and theorganizational culture. Poor work environments contribute to medical errors,stress and burn-out , absenteeism and high levels of staff turnover, which,in turn, compromise the quality of a working definition, an attractive and supportive workplace can be describedas an environment that attracts individuals into the health professions, encouragesthem to remain in the health workforce and enables them to perform order to develop coherent policies to ensure a work environment thatattracts and retains health professionals, policy responses have to be consideredat four levels: international/regional level; national level; sectoral level; andlocal/organizational level.

8 Improvement of the work environment will requirethe use of measures that are relevant to (and applicable in) the specific contextof a given health system. These measures should also observe internationalstandards and take account of regional harmonization solutions are context-related and therefore priority has to be givento the local and organizational level; the other levels provide the legislativeand regulatory framework, guidance and support for the development ofworkplace policies. Policy optionsOne main trend observed in the health workforce is the drive towardsan improved work life balance. A family-friendly work environment is ofparticular concern in the health sector because of the gender dimension ofthis issue. The majority of the health workforce is female, and an increasingHow to create an attractive and supportive working environment for health professionalsfeminization of traditionally male-dominated professions can be arrangements that allow a reconciling of family and work needs canenhance equal employment and career opportunities at times when familyresponsibilities are largely borne by women.

9 Similarly, maternity protectionis highly relevant with regard to the mainly female health workforce and thepotential exposure to health risks in this workplace sector. Thus, the promotionof family-friendly workplace options and the enhancement of workers health protection are domains in which concerted policy approaches canbe policy responses here include the use of flexible working -timearrangements, specific protection from exposure to occupational risks, jobsecurity, compensation for reduced employment, maternity/parental leave andthe provision of child-care opportunities. These areas primarily require actionat organizational level, with support from national policies and legislation. Additionally, health workers are exposed to a broad range of occupationalhealth risks because of the nature of their work: one-third of health workersperceive their health to be at risk because of their work.

10 Thus it is crucial toimplement policies to ensure that the health work environment is as safe aspossible. The following areas are of particular relevance to the health workplace:exposure to biological risks, including infections caused by sharps injuries;and psychosocial risks, including stress and violence at work. Consequencesat the organizational level include absenteeism, reduced productivity, accidentsand errors. There is a consensus that comprehensive occupational safety and healthmanagement systems are a solid way of establishing sustainable healthprotection at organizational level. Central to such systems are the preventionand control of health risks. In terms of helping to advance work-environment issues, a promising approachlies in the development and adoption of processes and tools capable of assessingwork environments at organization level, comparing them, recognizing bestpractice and applying them across the system.