New Challenges for public services social dialogue: Integrating service users and workforce involvement to support the

adaptation of social dialogueBrussels – January 30nd 2014

New Challenges for Public Services Social Dialogue: Integrating Service User and

Workforce Involvement in Italy

Stefano Neri and Lorenzo BordognaUniversità di Milano

VP/2013/0362

With financial support from the European Union

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Introduction

Since the 1970s, increased attention in Italian public debate and public policy to service user involvment, although framed

within different cultural and political discourses

1970s

•Key-word: democratisation (in line with the mass social movements of the period)•Emphasis on users as citizens and user involvement as a form of democratic participation/citizen voice

1990s and 2000s

•Key-words: consumer choice, transparency, performance evaluation (within an NPM-inspired discourse)•Emphasis on users as consumers and user involvement as a way to monitor and improve service quality

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Introduction

However

These two sets of principles – ‘democratisation’/citizen voice; consumer choice - proved their capacity to coexist in the actual experience of public services, after the fading away of the strong social movements of the 19970s

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User involvement in health care Current legislation - Overview

Current legislation: legislative decrees no. 503/1992 and no. 229/1999

1) At national level: no statutory forms of user involvement

2) At Regional level (NHS is highly regionalised): ten Regions created a regional board, including staff and users representatives, all appointed by the Regional Minister of Health

– Main functions: consultation on quality and service access policies

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User involvement in health care Current legislation - Overview

3) At single public healthcare organisation: «Consultative bodies» have been instituted within the single public healthcare organisations in the majority of Italian Regions.

– Consultative bodies include staff and user representatives, all appointed by the organisational managers

– Members are selected among patient associations, voluntary sector and rights protection organisations

– Main functions: «cooperation» in the definition, control and monitoring of the quality and service access standards

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User involvement in educationCurrent legislation - Overview

Current legislation: DPR no. 416/1974; legislative decrees no. 297/1994 and no. 233/1999

1) National level: user representation statutory boards (never existed)

2) Decentralized level: «Territorial bodies» («Province Councils», «School District Councils») of the 1970s, with elected user and staff representatives were abolished in 1999 and not replaced

3) Single school (or school institution): statutory «School Councils»

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User involvement in educationCurrent legislation - Overview

3) Single school (or school institution): statutory «School Councils»

•Members: parent and student representatives (for second-level secondary schools), staff representatives, headmaster

•User, staff and student representatives are directly elected

•Consultative and deliberative functions on various issues (financial and organisational matters, teaching general principles),

•Most relevant powers are in the organisation of extra-time activities and supplementary courses

Case study - Health The Imola Local Health Enterprise

Imola LHE covers an area with 135,000 inhabitants, in Emilia-Romagna (Centre-North of Italy). Staff: 1,700 employees

User involvement body: «Joint Consultative Committee (JCC)»

JCC: 26 members, all appointed by the LHE managers (19 voluntary and patient associations; 7 management and staff representatives)

Main activities (all performed in close cooperation with the LHE office for service quality control)

Participation in definition and direct monitoring of access and service quality standards (i.e. Patient’s Charter)

Definition and direct implementation of surveys on patient satisfaction Analysis of complaint reports

Impact on work practices and employment conditions

1. JCC recommendations may lead to «Improvement actions», whith an impact on work practices and employment conditions, mainly on work shift and working time distribution

Examples•Partial change in the work shift distribution of the mental health ward, to extend time for patients’ families and friends (2010)

•Partial change in working time organisation in the obstetrics and gynaecology outpatient service, to increase pre-maternity courses in the evening and in the week-ends (2012)•Current plan to extend to weekends the opening hours for outpatient services with very long waiting lists (2014-1015)

2. In some cases, JCC activity/suggestions contributed to standardisation and formalisation of hospital procedures (i.e. procedures for hospital admission and discharges)

Case study - Education The Leopardi school

First-level secondary school (11-14 year old students), with 500 pupils and 45 employees, in a small town in the Emilia-Romagna Region

Part of a «comprehensive school institution» (including kindergarten, primary and secondary schools), with 192 employees

• Parents’ involvement: the Leopardi Institute «School Council» 19 members (8 teachers, 8 parents, 2 janitors and the headmaster)

Parent and staff representatives directly elected

• Student involvement: «Council of Girls and Boys» (voluntary, not mandatory) 32 members, elected by all school classes; extended to the final year of

primary schools Relevant impact on some municipal decisions but not on school activity, so far

Impact on work practices and employment conditions

Main School Council activity concern

1) Organisation of extra-curricular activities or remedial courses

Increasing demands for extra-curricular activities in the afternoon led to some changes in janitors’ work shifts to allow them to keep the school open

2) Activities aimed at improving the relationship between school and families («Pact for corresponsibility»; Survey on school-family relationships)Impacts on working time organisation: demands to change the organisation of the weekly hours for parent-teacher meetings led the school to grant two hours a week for meetings and other changes in the organisation

User involvement and social dialogue

In both case studies, user involvement bodies and social dialogue institutions are separate entities

The Imola Local Health Enterprise JCC and the Leopardi School Council have no relationships with the trade unions

1) In the Imola Local Health Enterprise Only the LHE management deals with unionsMost user representatives don’t consider the JCC as a distinct and separate entity from the LHE, but as a constituent part of the organisation

2) In the Leopardi school The headmaster deals with unions; he/she may be the «intermediary» (mediator) between the School Council and unions

However, there are indirect links and opportunity for integration, given that user involvement has some influence on work practices and employment conditions, especially on working time organisation

Conclusions

1. Since the 1970s, increased attention to service user involvement, within two different cultural and political discourses:

• Democratization/citizen voice in the 1970s

• Consumer choice; transparency; performance evaluation in the 1990s and 2000s

2. Despite this increased emphasis and the creation of a dense network of user involvement bodies in the the two sectors under analysis, no formal, direct link exists with social dialogue institutions and procedures: formal, direct links are not designed neither in the institutional architecture of service user involvement nor in social dialogue architecture

Conclusions

3. However, the two case studies show that service user involvement has a significant impact on the organisation of the service and, in turn, on the organisation of work and employment conditions:

user representatives raise issues in the interest of patients, students and families (extension of opening hours for outpatient services with

long waiting lists; extended visiting hours for families; organisation of extra-currucular activities in the afternoon; different organisation of weekly hours for parent-teacher meetings, etc.), the solution of which requires changes in the organisation of work (especially working time and work shits) and employment conditions

4. The development of service user involvement may be a challenge to the traditional culture and strategy of trade unions: satisfying users’ demands might challenge the ‘vested interests’ of employees and union members. But it could also be an opportunity for the renewal of union action, and also for their stronger legitimation in a negatively oriented public opinion