AGE POLICY AND STATEGIES FOR MAINTAIN AT WORK IN HOSPITALS

CONTEXT

Located in Marseille since 1925 1945 : special status (anticancer Center) shared between 20 similar hospitals in France Private but… Non profit goal Public service mission Universitary hospital Includes a great research center Institute Paoli Calmettes (IPC) IPC

Located in Marseille since 1925

1945 : special status (anticancer Center) shared between 20 similar hospitals in France

Private but…

Non profit goal

Public service mission

Universitary hospital

Includes a great research center

Dedicated to oncology On all aspects (cure, tracking, prevention, research, training, medical teaching) Varied fields…

Dedicated to oncology

On all aspects (cure, tracking, prevention, research, training, medical teaching)

capacity : 292 beds and places (surgery, hematology, medical oncology) Complete technical unit (imagery, laboratories, operating theaters, radiothérapy, nuclear médecine, réa, endoscopy, marrow treatments…) Average Stay duration : 6,5 days 100 000 days treatment (32 000 ambulatory) 42 000 medical consultations 6000 new patients each year Fundamental and transfer research Main activity relevant datas

capacity : 292 beds and places (surgery, hematology, medical oncology)

Complete technical unit (imagery, laboratories, operating theaters, radiothérapy, nuclear médecine, réa, endoscopy, marrow treatments…)

Average Stay duration : 6,5 days

100 000 days treatment (32 000 ambulatory)

42 000 medical consultations

6000 new patients each year

Fundamental and transfer research

BUDGET : 110 M€ operationnal budget in 2007 + 15 M€ equipments social perimeter : 1100 direct staff, 1200 persons working on campus More than 150 different jobs Many subcontractors (bio-cleaning, meals, laboratories, waste treatment…) High level of training and skills Vocationnal training: more than 2000 sessions each year 70% are women in this sector Volumes

BUDGET :

110 M€ operationnal budget in 2007 + 15 M€ equipments

social perimeter :

1100 direct staff, 1200 persons working on campus

More than 150 different jobs

Many subcontractors (bio-cleaning, meals, laboratories, waste treatment…)

High level of training and skills

Vocationnal training: more than 2000 sessions each year

70% are women in this sector

220 nurses 160 doctors 90 nurse’s aides 60 secretaries 60 laboratories technicians 70 non medical managers … 1 priest, 1 aesthetician, 1 hairdresser, 1 librarian… 60% of the hospital added value is due to workers ! Hospital diversity

220 nurses

160 doctors

90 nurse’s aides

60 secretaries

60 laboratories technicians

70 non medical managers

…

1 priest, 1 aesthetician, 1 hairdresser, 1 librarian…

60% of the hospital added value is due to workers !

PROJECT

Reducing discriminations in hospitals, specialy due to age all over the career Strategies and tools to maintain people and performance at work in Sanitary sector Project EQUAL 1 (2002-2005) Etic

Reducing discriminations in hospitals, specialy due to age all over the career

Strategies and tools to maintain people and performance at work in Sanitary sector

New training methods description of new jobs or new missions in sanitary units. New professional profiles Evolutions in the systems of recognition improving transfers of knowledge Management tools related with skill validation procedures (definition of professionnal path, skill descriptions…) young workers's integration and tutoral methods solutions to avoid discrimination of old workers Objectives of the project Etic

New training methods description of new jobs or new missions in sanitary units. New professional profiles

Evolutions in the systems of recognition

improving transfers of knowledge

Management tools related with skill validation procedures (definition of professionnal path, skill descriptions…)

young workers's integration and tutoral methods

solutions to avoid discrimination of old workers

IS AN AGE POLICY NECESSARY IN HEALTH SECTOR ?

Why ? Hospital Demography The number of young people is decreasing. Health sector is not so attractive for women France hasn’t enough doctors, nurses, aid-nurses to replace the people in retirement The number of old people is increasing (ageing) Older people (need to) work longer > the legal age of retirement in France is now 60 but this age is being delayed each year till probably 65 yo in the next decade WE MUST ATTRACT AND KEEP !

The number of young people is decreasing. Health sector is not so attractive for women

France hasn’t enough doctors, nurses, aid-nurses to replace the people in retirement

The number of old people is increasing (ageing)

Older people (need to) work longer > the legal age of retirement in France is now 60 but this age is being delayed each year till probably 65 yo in the next decade

WE MUST ATTRACT AND KEEP !

Ages pyramid IPC

Ages pyramid : aid nurses

in our dutch hospital partner age structure JBZ (IPC Hospital partner) Age 1996 1997 1998 1999 2000 2001 2002 <20 1 1,1 0,8 1,4 1,3 1,9 1,6 20 t/m 29 30,9 29,7 29 26,7 25,6 24 21,9 30 t/m 39 34,2 34,6 34,1 34,2 32,5 32,1 31,4 40 t/m 49 24,2 24,4 25,2 25,7 26,9 27,3 28,9 > 50 9,7 10,2 10,9 12 13,7 14,7 16,2 Total in per cent of the number at 31 december of the year.

age structure JBZ (IPC Hospital partner)

Age 1996 1997 1998 1999 2000 2001 2002

<20 1 1,1 0,8 1,4 1,3 1,9 1,6

20 t/m 29 30,9 29,7 29 26,7 25,6 24 21,9

30 t/m 39 34,2 34,6 34,1 34,2 32,5 32,1 31,4

40 t/m 49 24,2 24,4 25,2 25,7 26,9 27,3 28,9

> 50 9,7 10,2 10,9 12 13,7 14,7 16,2

Total in per cent of the number at 31 december of the year.

Different reasons are moving toward the necessity of working on better employability in this sanitary sector : growth of work technicity in the sanitary field new needs from patients new technical, social or sanitary fields more work because of great increase of older patients with more complex clinical frame highest technicity on treatments more penibility in sanitary jobs new hard responsabilities (in management, in the relationship with patients) results count now more than means the ambulatory systems (day hospital, home care…) has for result to concentrate hard treatments and depending patients in hospital the financial difficulties of the systems increase the productivity and quality approaches Why ?…new needs Etic

Different reasons are moving toward the necessity of working on better employability in this sanitary sector :

growth of work technicity in the sanitary field

new needs from patients

new technical, social or sanitary fields

more work because of

great increase of older patients with more complex clinical frame

highest technicity on treatments

more penibility in sanitary jobs

new hard responsabilities (in management, in the relationship with patients)

results count now more than means

the ambulatory systems (day hospital, home care…) has for result to concentrate hard treatments and depending patients in hospital

the financial difficulties of the systems increase the productivity and quality approaches

The R.O.I (return on invest) is now very long on some jobs : >> the training path of nurses, doctors…needs more and more efforts (time, money, flexible organization…) >> it ’s a great spead of energy to loose such efforts with too much staff departures And also… Etic

The R.O.I (return on invest) is now very long on some jobs :

>> the training path of nurses, doctors…needs more and more efforts (time, money, flexible organization…)

>> it ’s a great spead of energy to loose such efforts with too much staff departures

The productivity and performance must be maintained at least, or increased The future is to maintain all the staff and specially the older Good new… More work + less people Etic

The productivity and performance must be maintained at least, or increased

The future is to maintain all the staff and specially the older

Good new…

They stay… A large part of our staff is staying longer in our hospital : 50 % of the IPC’s staff say that they want to stay till retirement ! And more in the second part of career

A large part of our staff is staying longer in our hospital :

50 % of the IPC’s staff say that they want to stay till retirement !

And more in the second part of career

But in which condition ? Problems : 77% want to be maintained in the same unit 78 % want to stay in the same job

Problems :

77% want to be maintained in the same unit

78 % want to stay in the same job

Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

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Do you think mobility is useful…

Objectivate differencies Our internal surveys show specific characters on two categories of workers : Less than 45 More than 45 Two examples

Our internal surveys show specific characters on two categories of workers :

Less than 45

More than 45

Two examples

results in illness absenteism (2004) ETIC X 2 (approx)

results in accidentology at work ETIC X 3

PART TIME, CHOICE OR NECESSITY

 build an age conscious policy  manage all ages with common basis tools  but consider specially (positive discrimination) two targets, stategic : - young workers - elder workers Transfers : 3 ideas

 build an age conscious policy

 manage all ages with common basis tools

 but consider specially (positive discrimination) two targets, stategic :

- young workers

- elder workers

BUILDING AGE CONSCIOUS POLICY

Age- conscious personnel management Is focused on differences between employees and how to deal with these differences Differences in various fields careerphase ambition physical condition relation work- private Not identical for everyone So it’s ‘ custom made’

Is focused on differences between employees and how to deal with these differences

Differences in various fields

careerphase

ambition

physical condition

relation work- private

Not identical for everyone

So it’s ‘ custom made’

Following statistics : “age conscious management” Monitoring datas of ageing in work : Specify the tools over age and specially : Absenteism at job Satisfaction survey Health job accidents Wishes specially time representation and welfare at work

Monitoring datas of ageing in work :

Specify the tools over age and specially :

Absenteism at job

Satisfaction survey

Health job accidents

Wishes specially time representation and welfare

at work

Experiment the solutions wich have an positive impact on maintaining staff at work and developping their employability, whatever the age avoid discrimination as far as it’s possible Managent tools for lee than 50 can be good also for 50+ ! Develop specific strategies at some key moments of the career (age related tools) Young workers Workers in their second part of career On this basis, two complementary approaches Etic

Experiment the solutions wich have an positive impact on maintaining staff at work and developping their employability, whatever the age

avoid discrimination as far as it’s possible

Managent tools for lee than 50 can be good also for 50+ !

Develop specific strategies at some key moments of the career (age related tools)

Young workers

Workers in their second part of career

ALL AGE LONG MANAGEMENT

All over the carreer, the objectives are : to maintain motivation and satisfaction at work to recognize the increase of technicity to prevent work damages to improve the communication to employees T o develop participation at work >> the dutch hospital partner satisfaction survey (2004) shows that the group of employees with more satisfaction at job are those who have possibility to participate to regular work meetings and benefit of an individual face to face individuel session every year For all ages Etic

All over the carreer, the objectives are :

to maintain motivation and satisfaction at work

to recognize the increase of technicity

to prevent work damages

to improve the communication to employees

T o develop participation at work

>> the dutch hospital partner satisfaction survey (2004) shows that the group of employees with more satisfaction at job are those who have possibility to participate to regular work meetings and benefit of an individual face to face individuel session every year

Evaluation New training methods (e-learning) Satisfaction surveys Instant shared internal communication (intranet…) IPC built different tools Etic

Evaluation

New training methods (e-learning)

Satisfaction surveys

Instant shared internal communication (intranet…)

>> operationnal since 1998 (non medical staff) and 2001 (medical staff) for : individual attempts (results objectives, personnal wishes…) collective treatments (training, work improvments, careers, job changes…) About annual evaluation Etic

>> operationnal since 1998 (non medical staff) and 2001 (medical staff)

for :

individual attempts (results objectives, personnal wishes…)

collective treatments (training, work improvments, careers, job changes…)

Identify but also reply to the attempts ! Etic

Special objectives Incitations to mobility Collect wishes Postpone assessment sessions (to measure possible evolutions) Develop the contents of jobs New tasks, new skills, new training needs By recognizing individual performance (variable part of salary) - wage bonus on acquisiting new skills - wage bonus on successful mobilities

Incitations to mobility

Collect wishes

Postpone assessment sessions (to measure possible evolutions)

Develop the contents of jobs

New tasks, new skills, new training needs

By recognizing individual performance (variable part of salary)

- wage bonus on acquisiting new skills

- wage bonus on successful mobilities

Provisional and dynamic administration of Jobs and Skills Define jobs characteristics and associated skills Anticipate and create new jobs change organisations to multiply individual opportunities Be attentive to changes and innovations in the workplace Secure the professional pathway Define the pathway (and the means to succeed Maintain the professionnal challenge step by step Regular assesment, on basis of experience For careers…necessary tools Etic

Provisional and dynamic administration of Jobs and Skills

Define jobs characteristics and associated skills

Anticipate and create new jobs

change organisations to multiply individual opportunities

Be attentive to changes and innovations in the workplace

Secure the professional pathway

Define the pathway (and the means to succeed

Maintain the professionnal challenge step by step

Regular assesment, on basis of experience

More and more knowledge, sooner and sooner (prerequisit before working !) Quality security Less time to train : training in hospitals must go toward Shorter sessions Multiple sessions Everytime training (night and day, home ?) New training methods related to new staff needs

More and more knowledge, sooner and sooner (prerequisit before working !)

Quality

security

Less time to train : training in hospitals must go toward

Shorter sessions

Multiple sessions

Everytime training (night and day, home ?)

Vocational training must be : More targeted More massive Tracable (for individual or collective agreement) More assesment methods Reinforce classic training To refresh knowledge To prepare classic training sessions Improve training’s ressources disponibility ETIC

Vocational training must be :

More targeted

More massive

Tracable (for individual or collective agreement)

More assesment methods

Reinforce classic training

To refresh knowledge

To prepare classic training sessions

Place of e-learning in hospital IPC create a portal dedicated to : trace training pathes, manage the inscriptions, deliver interactive contents… Free access contents (interactive or pedagogic shared material ) Training is possible from inside (dedicated room or everyone work place) or outside (internet)

IPC create a portal dedicated to : trace training pathes, manage the inscriptions, deliver interactive contents…

Free access contents (interactive or pedagogic shared material )

Training is possible from inside (dedicated room or everyone work place) or outside (internet)

Interactive contents First, implementation of classic e-learning ressources (available in commercial market) Foreign language Bureautic. Hygiena and security Evaluation by our experts Own development for specific and non commercial tools

First, implementation of classic e-learning

ressources (available in commercial market)

Foreign language

Bureautic.

Hygiena and security

Evaluation by our experts

Own development for specific and

non commercial tools

General Satisfaction survey Each two years Concern all the staff Specific surveys Various thems : evaluation (1999) environment (2001 and 2003), transports (2003), information system (2004), tobacco (2005)… May only concern a part of staff opinion(s) survey(s) Etic

General Satisfaction survey

Each two years

Concern all the staff

Specific surveys

Various thems : evaluation (1999) environment (2001 and 2003), transports (2003), information system (2004), tobacco (2005)…

May only concern a part of staff

opinion poll among the workers study of the staff mobility analysis of the motivation factors to manage the expectations and the motivation through out the work life ETIC

opinion poll among the workers

study of the staff mobility

analysis of the motivation factors

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Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

Marketing Méditerranée Etude IPC PERSO 3 - Octobre 2006 Rapport de données brutes Marketing Méditerranée 06 158 Tous droits de reproduction réservés

transfer the knowledge (knowledge management) access to data and information on projects, processes, skills by internet “ e-learning ” platform : storage and dissemination of knowledge through ICT Avoid age ghettos : the working groups are mixed The cooperation between different generations of employees must be tracked and sustained Sharing knowledge ETIC

transfer the knowledge (knowledge management)

access to data and information on projects, processes, skills by internet

“ e-learning ” platform : storage and dissemination of knowledge through ICT

Avoid age ghettos :

the working groups are mixed

The cooperation between different generations of employees must be tracked and sustained

YOUNG AGE TOOLS

In the beginning of the carreer, the objectives are : to accelerate the transition between studies and work to create the best conditions of working and developping new skills to reduce the working risks and dangerous situation due to unexperience A younger age policy Etic

In the beginning of the carreer,

the objectives are :

to accelerate the transition between studies and work

to create the best conditions of working and developping new skills

to reduce the working risks and dangerous situation due to unexperience

Actions : - giving specific informations for new workers > training sessions dedicated to recent employees > welcome meetings > special information guide building tutorial programs Being attractive with new advantages accomodation help to install and face logistics questions Attractive programs for foreign workers (spanish nurses in France, Eastern or south african countries doctors (Holland) Young worker’s specifics Etic

Actions :

- giving specific informations for new workers

> training sessions dedicated to recent employees

> welcome meetings

> special information guide

building tutorial programs

Being attractive with new advantages

accomodation

help to install and face logistics questions

Attractive programs for foreign workers (spanish nurses in France, Eastern or south african countries doctors (Holland)

SPECIFIC APPROACHES IN THE LAST PART OF CAREER

1st action about working time organisation i : huge individual management of the working time during the ending years of the career by reducing job duration : France (35 hours/week), Italie and holland (36 hours/week). 32hours possible for people>55 yo in holland by saving time (in a special count) to anticipate retirement. (France, Holland) by changing money into time part time jobs by adapting plannings closer to workers wishes > less days on work (4 working days in JBZ for workers > 55 years old) > annual or pluriannual regulation flexible plannings > part-time plannings End of career Etic

1st action about working time organisation i : huge individual management of the working time during the ending years of the career

by reducing job duration : France (35 hours/week), Italie and holland (36 hours/week). 32hours possible for people>55 yo in holland

by saving time (in a special count) to anticipate

retirement. (France, Holland)

by changing money into time

part time jobs

by adapting plannings closer to workers wishes

> less days on work (4 working days in JBZ for workers > 55 years old)

> annual or pluriannual regulation flexible plannings

> part-time plannings

2nd action : developping work healthy conditions By reserving some jobs with low penibility to unhealthy workers preventive requalifications difficult in an intensive short stay hospital very few jobs are « cool » Defining priorities for example, assistant of nurses (in french : aide-soignants) is a group very damaged by « dorso-lumbagos ». If they can change of job early, they will have more chance to avoid those problems. By promoting an huge and active policy of reducing working risks : consolidation of individual evaluation results Care : antigrippal, antitobacco actions… End of career Etic

2nd action : developping work healthy conditions

By reserving some jobs with low penibility to unhealthy workers

preventive requalifications

difficult in an intensive short stay hospital very few jobs are « cool »

Defining priorities

for example, assistant of nurses (in french : aide-soignants) is a group very damaged by « dorso-lumbagos ». If they can change of job early, they will have more chance to avoid those problems.

By promoting an huge and active policy of reducing working risks : consolidation of individual evaluation results

Care : antigrippal, antitobacco actions…

3rd action : anticipate and prepare the second part of career (act before the « fatal » age !) Action : realize general assesment at some key moments of the carreer to re-orientate carreer and prepare the second and last part of professionnal life and sustain motivation in this difficult period. IPC main action : all employes more than 45 y.o. get an assesment and a personnal development program : the PIC (Projet Individualisé de Carrière / Personal career project) Objective : communicate clearly on end of carreer strategy and profile it (with a new contract or new deal wroten with the agreement of the worker) End of career Etic

3rd action : anticipate and prepare the second part of career (act before the « fatal » age !)

Action : realize general assesment at some key moments of the carreer to re-orientate carreer and prepare the second and last part of professionnal life and sustain motivation in this difficult period.

IPC main action : all employes more than 45 y.o. get an assesment and a personnal development program : the PIC (Projet Individualisé de Carrière / Personal career project)

Objective : communicate clearly on end of carreer strategy and profile it (with a new contract or new deal wroten with the agreement of the worker)

PIC Bilan patrimonial Bilan professionnel Bilan médical 2 à 3 RV à une quinzaine de jours d ’intervalle Une dizaine de rendez-vous Madame Lainé Liliane Xicluna et Elisabeth Bacholle Docteur Boufercha ou médecin au choix Ce bilan patrimonial est le bilan d ’entrée dans le dispositif et il permet d ’engager la réflexion sur la suite de la carrière Ce bilan médical est optionnel et au choix de la personne visité spontanée

PIC is part or attitude consisting to sustain the lately mobility of the old workers and secure it Warranty to back to initial job if failure no wage reduction on horizontal (or less than) mobilities End of career Etic

PIC is part or attitude consisting to sustain the lately mobility of the old workers and secure it

Warranty to back to initial job if failure

no wage reduction on horizontal (or less than) mobilities

4th action : a positive management for elder employees changing the traditional figures By maintaining as long as possible the same efforts in the management : - training - evaluation and objectives - individual part of wages We regulary control the evaluative action of managers, to not create discrimination By giving older employees special responsabilities tutoring, transmission of knowledge, expert, teacher or training conceptor (older workers must have a rule of conception and activive participation in training sessions) End of career Etic

4th action : a positive management for elder employees

changing the traditional figures

By maintaining as long as possible the same efforts in the management :

- training

- evaluation and objectives

- individual part of wages

We regulary control the evaluative action of

managers, to not create discrimination

By giving older employees special responsabilities

tutoring, transmission of knowledge, expert, teacher or training conceptor

(older workers must have a rule of conception and activive participation in training sessions)

Conditions for employee Flexibility Willing to change Change of attitude Maintain training Respect the “new deal”

Flexibility

Willing to change

Change of attitude

Maintain training

Respect the “new deal”

Results Permanent motivated personnel Higher quality of care (98% of satisfaction for patiens) Higher quality of work (hospital certified in 2005) Lower absenteism because of illness, specially for elder workers Less turnover and early resignations Saving costs

Permanent motivated personnel

Higher quality of care (98% of satisfaction for patiens)

Higher quality of work (hospital certified in 2005)

Lower absenteism because of illness, specially for elder workers

Less turnover and early resignations

Saving costs

Satisfaction of elder workers

SILENCE…BUT NOT ON THE AGE !