Listened but not heard. Control requires leadership

In order to achieve more job satisfaction in the health service, Minister Conny Helder has reserved 500 million euros per year in the program Future-secured work market for care and welfare (TAZ). In light of the shortage in the labor market, the high absenteeism and the large outflow, this is much needed. For the sake of job satisfaction and staff retention, both the proper organization of employee control and management must receive much more attention.

In scientific studies, the relationship between control and job satisfaction and staff retention has been thoroughly investigated and demonstrated. Like the relationship between control and patient safety, quality of care and quality improvement in care. But organizing opportunities for formal control alone is not sufficient for this: control takes place in the dynamics between people and therefore requires (personal) leadership.

Vertical control

In the TAZ programme, the minister states that administrators and supervisors should facilitate and support greater participation by involving health professionals in policy and decision-making. (vertical control). This is now also legally guaranteed in the Act on quality of care, complaints and disputes, to which it is added that carers must have an influence on the primary care process and the care professional policy in the organisation.

Experience control

The question is, however, whether these formal opportunities for participation and influence are sufficient for the employees to actually experience that they have influence. Research within the Dignity and Pride at Location program shows that leaders and administrators of nursing home organizations are generally more optimistic about the opportunities for healthcare professionals to influence organizational policy than carers and nurses.

Feeling heard

The study analyzed data collected from approximately 4,000 Dutch healthcare professionals working in 180 nursing home locations. Although these figures also revealed a significant relationship between opportunities for control on the one hand and job satisfaction and retention on the other, employees often made comments in the disclosures such as: ‘I would not know how to influence policy’ or ‘I I never heard of a VAR. I don’t think there is one?’ This also happened in organizations where management and boards indicate that they actively use input and advice from employees and advisory councils. The analysis of these data therefore shows that managers and directors cannot simply assume that they sufficiently support and facilitate employee participation if there are formally sufficient opportunities for it. Let alone that the employees feel heard.

Horizontal control

The TAZ program is also aware of horizontal control. It’s about equality and the opportunity to have a say in your team. It is also a good idea because it benefits learning and improvement and cooperation in teams. Both the scientific literature and the data collected in Dignity and Pride of Place show that good teamwork and a team culture of learning and improvement are related to job satisfaction and staff retention, as well as to better quality of care.

Lower job groups

However, hierarchy does not only play a role at the organizational level, but certainly also in care teams. This also deserves attention in connection with control. For example, various studies have shown that especially employees in lower job groups are less likely to speak up. For example, because they feel they have less right to speak than others in the team, or because they feel less involved in the organization. Roles such as EVVs, quality nurses and nurse specialists are on the one hand helpful, but on the other hand they can encourage hierarchical relationships in teams. In the nursing homes, the care assistants, helpers and carers are the hands on the bed where there is such a shortage. The question is what, beyond sufficient time, is necessary for them to make their voices heard.

Soft boundary conditions

500 million per year for more job satisfaction and control in the healthcare system is a large and important initiative. But in order to reap the benefits, sufficient time and energy must also be invested in the soft prerequisites for control. This means good leadership in management, boards and supervisors for healthcare personnel. But it also requires personal leadership from the healthcare staff themselves, so that healthcare staff at all levels feel supported to make their voice heard and experience that voice being heard. In this way, control can actually contribute to more job satisfaction, staff retention and better quality of care.

Bellis van den Berg and Paulien Vermuntadvisors Vilans

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