Print version ISSN 1668-8708
Vis. futuro vol.15 no.1 Miguel Lanus June 2011
Human Development for Staff Involved in Institutions from Tertiary Health Care: Health Services and Labor Welfare Medellin, Colombia, 2007
Gladys Irene, Arboleda Posada
Universidad de Antioquia.
Facultad Nacional de Salud Pública.
Calle 62 - No 52-59 - Oficina 310 - Medellín - Colombia
The study describes the conditions of human development according to labor welfare and satisfaction with healthcare services from staff employed with an indefinite term contract before January 1997 in health institutions of tertiary care in the city of Medellin (Colombia). It was performed a cross-sectional study designed to measure these components of human development through surveys applied on the staff with the described conditions, without any difference of academic, socioeconomic status or type of position. It was included a population of 1622 persons from five institutions, with a final sample of 242.
Among the key findings is highlighted the high degree of staff satisfaction related to received in healthcare services for both, the worker and their beneficiaries; as well as the supply of medicines and diagnostic aids; besides the satisfaction with the work performed in the company and the feeling of being useful and important to it, they find out it is difficult to have promotions by merit and recognition for their work. As factors to strengthen in these institutions are the establishing clear policies for promotion and recognition.
KEY WORDS: Human Development; Health Services; Labor Welfare; Job Satisfaction; Health Workers.
The dynamics of legislation in health sector and in the labor and social security field have brought different changes to workers of the sector that have impacted positively and negatively on the development of institutions and on their employees in the professional and personal context. The reforms which have had a major impact on health workers have been the Act 50/90 (the Congress of Colombia, 1990). This reform changed the severance payment (not retroactive and create pension funds and severance pay). Act 100 of 1993 (the Congress of Colombia, 1993) reforms the complete general social security system in Colombia. Act 789/02 (Congress of Colombia, 2002) Colombian labor reform, reduces night shift and vary the form of settlement of Sundays and holidays and reduce the settlement of compensation for unfair dismissal; and the Act 909/04 (Congress of Colombia, 2004) creates the administrative career and public management.
The conditions of human development and life quality in people occupationally linked to the healthcare sector can be affected by aspects such as disincentive for promotions and advancement in the career ladder, job dissatisfaction provoked by the restrictive access to training, the unavailability time and economic resources provided by employers to access higher education, besides the lack of labor incentives.
Precarious employment is associated with deterioration of health (life quality of nursing professionals), diminishing of the income of health personnel (health conditions Law 100), and as the case of nurses, these only reach the satisfaction of their own survival needs and their families' by 85%, ignoring other needs such as training supplement that represents only 22%, 14% of leisure and the affect only 5%. It can be assumed that these conditions will affect satisfaction and will strongly influence on their job satisfaction.
The dissatisfaction of staff can lead to a decrease in work quality, inefficient processes and procedures of employees, loss of sense of belonging, dispersion in assigned duties; aspects that would impact on the quality of care for the external user.
Health services are working to achieve high levels of efficiency and effectiveness and to be highly effective. People make this possible and they have been considered as a resource, a talent, capable of being conditioned, handled, trained, upgraded, refocused, displaced, and rejected whenever the circumstances required from the organizations that they belong to.
To join the social security, the staff of the health sector prefers other institution instead of public ones. The 86.6% are affiliated to Health Providers companies rather than Cajanal Social Security Institute (ISS). They also have the perception that the quality of health services has been deteriorated (74.6%) after implementation of Act 100 (Florez Atehortua and Arenas, 2009). In Mexico, 68.3% of health professionals are satisfied with the received health services (Cabrera, Franco Gonzales, Parra, Vega, Iñiguez 2004). In Colombia, no studies were found that specify the degree of satisfaction with healthcare that third level hospital care workers receive.
Organizations must manage the Human Development for staff "find its own essence and power, to offer itself to the organization and to society as a complete and competitive person and committed to its own reality, finally a happy person" (Santa, T., 2004, p.25) (1)
Rarely, healthcare sector organizations in our country and others in similar conditions of development, have realized that the development of people does not depend on detailed control of the processes and the rigor of the indicators of production or productivity, but primarily from set of recognized skills, encouraged and implemented in those people at the service of an institution.
The institutions have a social responsibility to create favorable conditions for the development of potentiality of their workers in a context of fairness, opportunity to build a life project, and through it, the development of the institution, applying the concept of development in them.
It is necessary that people find in their jobs not only sources of income to satisfy their basic economic needs, but it is the appropriate place to satisfy their self-esteem and accomplishment needs, both personally and professionally. The workplace is where they can grow, mature and develop their capacities and potentialities. The institutions (administrators) are responsible for creating the right conditions for its employees do not feel as employees, but as part of the institution, "that they identify themselves with it and feel and act as responsible for the achievement of its objectives " ( Yepez, F., 1991, p.8) (2)
All people tend to their own development and this occurs especially through the work. It is the responsibility of institutions to create conditions for the development of people to grow their qualities, abilities and attitudes. The administration of the institutions is responsible for facilitating this development, this is achieved if the staff is given a decent job, if the payment stimulates and generates development and greater responsibilities, according to Yepez (1991).
Worker satisfaction in the performance of their duties has been considered as a determining factor in the quality of the provision of health services. A person who is satisfied and motivated by the work performed allows the user to perceive the quality of the received service (Garcia et al, 2007).
Considering that having a good health is a basic skill, the level of human development and life quality will improve when a person is satisfied with provided health services, both in quality and timeliness in providing services, medicine supplying and diagnostic aids, as expressed by Nussbaum and Sen (1993).
Job satisfaction and work welfare reflect the sum of several operations, such as: having an adequate income, be motivated and recognized by the institution, to have a position according to their professional level and have in the institution the access to superior education and training programs.
The present study aimed to identify the level of development of the population with an employment relationship with public and private institutions of tertiary level of healthcare in Medellin, in areas such as: satisfaction with health services received by staff and their beneficiaries, as well as some aspects about work welfare. The analysis of these factors enables the assessment of staff's Human Development with an employment relationship and shows the differences between public and private sectors. The results may be used by administrators of health institutions with similar characteristics that allow a better development of their staff; in turn they may be used by the public administration to draw welfare policies in the health sector work.
Materials and methods
A descriptive transversal study, which aims to measure some components of human development, from satisfaction with received health services by the worker and his family, as well as labor welfare of people with employment contracts for an indefinite term entered before 1997 and active at the time of the investigation intended in providing healthcare institutions from tertiary level of care in the city of Medellin, Colombia, without distinction of academic training, socio-economic status and position. It was included a total of 1622 people from five institution from public and private sector, which accomplished all the criteria required for inclusion in the study, from this was taken a probability and proportional sample of 242 officials, using the formula for descriptive studies with finite populations, according to Londoño (2004).
A structured questionnaire was designed in such a way that addresses some aspects of human development from:
• socio-demographic variables: Institution, Sex, Age, seniority in the institution, position, marital status, education level, number of years completed at each level, Honors, Number of persons in the household, kinship, Head of family, economic dependence and socioeconomic status.
• Health: issues such as accessibility to health services and perceived quality, timeliness of care, provision of drugs, diagnostic aids, and satisfaction with health services received from involved staff and beneficiaries was considered.
• Degree of satisfaction and work welfare of workers attached to institutions: satisfaction with performance, job recognition, career advancement, sense of purpose in the institution, relationship between work performance and job training.
In order to submit the survey initially designed, a pilot test was achieved that allowed to make adjustments and corrections to the instrument.
The surveys were conducted by trained personnel from National School of Public Health at the University of Antioquia, with several days of training and an in-depth knowledge researching, the elected persons were professionals in the Area Health Services Administration, besides they were helped by the instructive designed for the survey.
The provided information will be confidential, only used for the proposed goals of this study. The omission of respondents' names was guaranteed. The questions asked did not play with the respondents' intimacy and reserve; therefore, did not require informed consent. As established by resolution 8430 of 1993 from Ministry of Health of Colombia, the Article 11 which classifies the research without risking as those where no intervention or modification of biological, physiological, psychological or social variables of individuals who participate in the study is intentionally done and were not identified sensitive aspects of their behavior.
The main findings in relation to satisfaction with received health services and the work performed are presented.
Table 1 shows the information about provided healthcare and perceived quality from their IPS (Healthcare Providing Institutions) for workers and their beneficiaries.
In relation to health services received by the respondents, it was found that the healthcare provided from their Service Providing Institution (IPS) consider that 78% of respondents think it is excellent or good in terms of quality in received services; the same percentage believes that it has been always or almost always a good care. Only 15 (6%) of 242, have additional plans and / or prepaid medicine.
From the respondents, a 74% (180) have dependents and, in a 78% of the cases, they affirm to receive an excellent and a good care. In the same way, they think about timing in services providing (80%), as well about the received care has been provided with quality (81%). Both, the drug supplying and diagnostic aids required by the worker, about 77% believe that these services were provided promptly, as 79% of beneficiaries (Figure 1).
Graph 1 Percentage distribution of timing of drug delivery and diagnostic aids required
by the respondent personnel involved in healthcare institutions from tertiary level of care. Medellín, 2007
The information presented on the table below refers to care provided from the IPS by type of institution, sex, income, position and layer.
Table 2 Percentage distribution of care provided from the IPS, by type of institution, gender, and socioeconomic
status of respondent personnel involved in healthcare institutions from tertiary level of care. Medellín, 2007
Both, public and private institutions, more than three-quarters of respondents believe that the care provided by your IPS is excellent or good. In regard to sex, there is acceptance more in males than in females, with 85% and 78% respectively. In relation to socio-economic status they express greater satisfaction in high.
Over 75% of respondents expressed that they received quality services by their IPS always or almost always, in any institutions. Looking at the stratum is relieved that the services are provided with quality always or almost always, emphasizing this view in the upper stratum. In a same proportion, those investigated individuals, ranked by position, also expressed satisfaction with the received services. More than three quarters (75%) of the respondents in several institutions consider that medicines and diagnostic aids have been provided timely or very timely. No significant differences were found in the analysis with the position.
Only 15 of respondents expressed to have complementary plans, 13 of them are women, eleven of them are between 10 and 20 years old at the institution, ten belong to the upper stratum and the rest to the middle, eight manifested the supply of medicines is timely and nine have the same point of view with regard to diagnostic aids.
Over 50% of respondents believe that the care received by beneficiaries from IPS is good regardless of type of institution. In addition, more than 70% believe that this has been provided with quality always or almost always in all institutions.
Satisfaction and Labor Welfare
Respondents say that most of them (93%) are very satisfied or satisfied with the work performed at the institution.
A third part of respondents say they have occasionally been recognized for their work, 46% said they never or almost never have been recognized. With regard to promotion by merit rather than influence or other reasons, 45% think that it is never made with this consideration and 24% think it is made occasionally, a third party believes that it is done by merit, besides most people think they are important and useful for the institution (93%) (Figure 2).
Figure No. 2 job satisfaction and work welfare by recognizing for their work, promotion by merit and importance and usefulness
to the institution of workers from tertiary level of healthcare institutions in Medellín, 2007
93% of respondents state that there Is a high correspondence between training and work performed in the institution (Figure 3)
Graph 3 Correspondence between training and the work performance of the employee
of tertiary healthcare institutions in Medellín, 2007
Both, public and private institution, 93% expressed they were very satisfied or satisfied with the work performed in relation to seniority in the institution and the more satisfied are 10-20 years old employees with 95%, against 86% in older than 20 years (Figure 4).
Figure No. 4 Percentage distribution of satisfaction with the work performed by type of institution and the institution antiques,
surveyed staff involved in health institutions of tertiary level of care. Medellín, 2007
Analyzing the degree of satisfaction with the work performed in the institution crossed with different variables such as sex and age shows that more than 90% of cases are very satisfied or satisfied, perceiving that the higher age the lower degree of satisfaction.
The results of recognition in their work, regardless of type of institution, state that rarely or never had credit for their work by 46% in the public entity, 48% said they occasionally had it compared with 26% in private institution. It notes that in these institutions, 29% report having had this recognition always or almost always, and only 6% in public (Figure 5).
Figure No. 5 Percentage distribution of whether he received recognition for their work, by type of institution,
surveyed staff involved in health institutions of tertiary level of care. Medellín, 2007
Over 45% of respondents, regardless of sex, say they have not had recognition in their work. This perception is maintained in the different ranges of age; found that over 45 years old report having had occasional recognition. Of those who have stayed less than 20 years in the institution, 38% stated that this recognition has been occasional, while for those over 20 years of seniority in the institution, 44% say never.
Those who believe that from their position always provide to the institution with their knowledge, skills and experience, 32% say they have never been recognized for their work and those that usually provide, 63% say they have had occasional recognition.
Table 3 presents information on the consideration that the worker has about career advancement by merit, by position, educational background and socioeconomic status.
Table 3: Distribution of promotion by merit, not influenced by position or other reasons, academic achievement,
socioeconomic status of respondent personnel involved in health institutions in tertiary level of care. Medellín, 2007
Three of the six specialists believe that never rises by merit, as well 34% of assistants and nurses, while 38% of professional nurses argue that merit promotions are made occasionally. Over 30% of administrative staff, 51% of secretaries and 36% of administrative assistants and general services consider they get promotion by merit.
38% of professionals believe that the institution promote by merit, always or almost always, likewise say 40% of technologists, 25% technicians and 45% of those with only primary or secondary school.
In low socioeconomic status, more than a half say they never or almost never rises by merit, the same opinion have people from middle layer in a 46%, while 58% believe that the upper stratum is promoted by merit. With regard to those who have earned degrees in the last 10 years, the percentage is higher in those who think it never rises by merit.
Overall, the question do you feel you important and useful to the institution, with any of the crossed variables, higher percentage are presented in those who say that they always feel important and useful.
A high proportion of respondents are run by private IPS (65%), a lower result than those reported in the study of Florez, Atehortua and Arenas (2009). A high percentage of health workers say they are affiliated to private IPS (86.6%). In this study the healthcare provided by the Private IPS is considered excellent by 20% more than the IPS public; in general, attention is viewed favorably, both in the private and public IPs (78.3% and 79.8% respectively), slightly higher than reported in Mexico in healthcare professional from third level, where satisfaction with health services reach 68.3% (Cabrera et al. 2004). This may show the development of private insurance companies from healthcare sector for Colombians, also understood as an increase in the privatization of health services in the country and, of course, the decline of state participation in the sector.
In relation of time of drugs supplying, only 7.1% of the members of public institutions see this as very timely, but a high proportion deemed appropriate. After the regulation of the sector for distribution and supply of drugs, is perceived a higher efficiency in private and public IPS. Diagnostic aids behave in the same way (Congress of Colombia, 2007).
It is noteworthy that three quarters of people surveyed believe the services received by beneficiaries are appropriate, the same as drugs and diagnostic aids.
In general, good health services provided by the IPS are appreciated, as well as their quality, medicine supplying and diagnostic aids, for both the worker and their beneficiaries. The low number of people with complementary plans or prepaid medical confirms acceptance, quality and timeliness of received services. This may reflect the requirement in accomplishing the current regulations in the sector as part of the system of licensing and accreditation of health services (Ministry of Social Protection, 2006).
Job satisfaction and well being
In general, respondents are satisfied with the work done, with greater satisfaction in employees with less than 20 years of service, the study of Mexico, satisfaction in performing their functions reached 80.3% (Cabrera et al. 2004). These high ratios have a positive impact for both the institution and the workers, also the contribution of their knowledge, skills and experience is productive for the institution. Most of respondents responded positively to these questions, a situation which has a favorable impact on the climate and organizational development, ensuring commitment to the institution and contributing to the achievement of institutional and personal goals consistent, according to Yepez (1991).
Regarding to the question whether they have received recognition at work is perceived a trend that has been very seldom to achieved, being felt by those who have greater seniority in the institution as well as in the older group. Reconnaissance reports have been made especially in private IPS. These results are lower than in the study made by Cabrera et al. (2004), where satisfaction with received recognition reaches 32.6%, these factors in Cuba are referred to the highest percentages of satisfaction with the stimulus, assessed as quite agree and strongly agree with 35% and 20.9% respectively by the expression "I am encouraged when I do things right '(Infante, Ochoa, Moret, Curbelo 2007). The recognition and achievement motivation at work and creative proposals are the key to institutional development. The job dissatisfaction is related to the non-emotional and material gratification.
In the analysis of promotion by merit rather than influence or other reasons, only about one-third reported that promotions are made by merit, but found it difficult to have promotions for accomplishments in their work. This can be discouraging for workers access to better training. In Mexico, a higher level of promotion, and promotions in recognition for their work is reported (40.6%), Cabrera et al. (2004).
Career advancement is the worst valued dimension and it is considered in several studies as one of the main reasons for job dissatisfaction, which reveals that are perceived as little development offerings and training (Molina, Avalos, Valderrama and Uribe, 2009) .
With regard to satisfaction and welfare, the high degree of ownership and commitment to the institution in most cases (93%) are highlighted, greater results than those reported in Mexico (73%) Cabrera et al (2004). This strong sense of belonging is a factor that motivates to the health worker to perform their tasks more efficiently and with higher quality.
There is a high correspondence between training and the work the employee performed in the institutions (82%), Cuban nursing study reports a 98.9% of correspondence between the training and work performed (Infante, Moret and Curbelo, I. (2007).
In resume, the staff feels is important and useful for the institution, it stands out as relevant correspondence between training and the work performed, as well as satisfaction with this. The lowest levels of satisfaction were given by the limited appreciation for the work performed, as well as promotions and merit promotions.
Consequently, work recognizing programs and merit promotion should be established or developed, that they are needed to stimulate the worker, allowing development of people through their work, remain the responsibility of administrators to create and develop programs that encourage initiative; achievement and results of staff that belong to the institution.
It is necessary an assessment of the factors that influenced positively and return these to analyze with less satisfied staff in order to define strategies to promote job satisfaction and staff in the institutions of the sector (Job satisfaction of health personnel).
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