EQAVET Sectoral Seminar Quality Assurance in the Healthcare sector in Europe Background paper Introduction Ensuring that the Quality Assurance National Reference Points are supported to engage with stakeholders and draw on the experience of quality assurance in the sectors will make an important contribution to the effective implementation of the Recommendation of the European Parliament and Council on the establishment of a (EQAVET), in initial and continuing VET. The EQAVET Sectoral Seminars provide an opportunity to bring together Social Partners, Quality Assurance National Reference Points and representatives of the Healthcare sector in order to reflect on how quality assurance of VET is addressed and managed within this sector. Conclusions will be drawn on the challenges or conditions to succeed in this context. This first Sectoral Seminar focusing the quality assurance of training in the healthcare sector main objective is to analyse topics of crucial importance with a view to formulating guidelines and/or principles for supporting quality assurance of VET or its process in the continuing education training sector and involving the Social Partners in quality assurance procedures for the provision of VET. Healthcare sector and quality assurance This short paper focuses on the key challenges in relation to quality in vocational education and training within the European Healthcare sector and on how the EQAVET Recommendation can support the development and improvement of national Healthcare education and training systems. The aims of the paper are twofold: 1. To provide a short introduction to quality assurance in the Healthcare sector. 2. To raise a number of questions and issues to participants in their preparation for the seminar. The main objective of the seminar is to consider issues of crucial importance in the view of formulating guidelines and/or principles for supporting quality assurance of VET or its process in the continuing education training sector while also involving the Social Partners in quality assurance procedures for the provision of VET inline with the EQAVET Framework. The focus will be on how quality assurance of VET is addressed and managed within the Healthcare sector in Europe and how the EQAVET Recommendation can support the development of VET quality assurance processes in relation to VET provision for the Healthcare sector. It is our hope that the different national representatives will inspire and be inspired by each other, and use this inspiration in the development and implementation of quality assurance in the Healthcare sector in their own countries. 1
The Healthcare sector in Europe The Healthcare sector in Europe covers a wide range of types of vocational education and training. Healthcare is concerned with the provision, distribution and consumption of healthcare services and related products. It is a complex sector due to the significant differences in existing subsectors as well as in the type of training provision between countries. In line with NACE classification, the sector includes human health activities (hospital, medical and dental practice), residential care (residential nursing, residential care for mental retardation, health and substance abuse for elderly and disabled) and social work activities. As European society ages, healthcare and related social services are becoming increasingly important. This growing demand for services, provided by the public sector in many Member States, is creating unprecedented pressures on health and social care systems. To cope with these pressures, the sector needs a workforce with the right skills and competences. Member States are facing skills shortages in healthcare occupations such as nurses, medical specialists, and health technicians. To cover these shortages, vocational qualifications can help facilitate entry-level career opportunities and open pathways to higher education. The health sector in the European Union (EU) employs (according to OECD 2007) almost 10% of the total workforce and corresponds to almost 9% of gross domestic product (GDP). Health spending is rising faster than GDP and it is estimated to reach 16% of GDP by 2020 in OECD countries. The European Commission (2007) expects that by 2050, that the average public spending for health and long-term care in countries of the Organisation for Economic Cooperation and Development (OECD) to rise to about 10-13% of the Gross Domestic Product. This emerging situation will not be sustainable unless action is taken at all levels to change the way that healthcare is delivered. According to the European Commission, action is required at all levels to change the way healthcare is delivered. As the proportion of people over 65 is expected to be almost double by 2050, more elderly people will require prolonged medical care and assistance to ensure that they live independently. European healthcare labour markets are dynamic. They have to respond to demographic change, general economic conditions, health sector reform and funding, relative earnings and career prospects, and regulatory change such as worktime directives. Responsibilities and powers in almost all countries have shifted from one government level/body to another, this in some cases being accompanied by large-scale restructuring. The shift in administrative responsibilities has often had an impact on the way healthcare and hospitals are financed and controlled by governments. In any case, changes in legislation have direct impact on the organisation and management of healthcare services and hospitals. For instance, there is a trend in several countries to merge smaller hospitals into larger ones to save costs. In most countries, the number of private healthcare providers is growing. In some cases this is a response to demands for care which cannot be adequately met by public providers. It is still difficult to assess the exact effects that these developments will have on the organisation of healthcare in general, and on training and qualifications for health professionals specifically. It seems that most private healthcare providers tend to focus on just a few specialist diagnostic or treatment services. Political demand for accountability and control nowadays requires healthcare staff to carry out far more administrative tasks than in the past. Examples of this include: treatments need to be specified and labelled 2
with different codes before they can be invoiced; costs need to be specified according to different accounting structures; referral systems for specialised or follow-up treatment are more formalised and complicated; archiving and filing use different systems and programmes etc. These tasks are time-consuming and often become a burden. There is need for better organisation which provides a skills mix and which frees up medical staff time for patient treatment. Generally, the finance, management and economic aspects of healthcare have grown to a point that medical considerations are not always seen as the main priority. Most countries are trying to reduce the duration of hospital stay, shifting focus gradually to out-patient care. The way out-patient care is organised varies from country to country but is becoming more important in all countries. This is a trend toward individualised treatment using generalised care pathways. Healthcare approaches, not just hospitals, emphasise whole patient care both before and after hospitalisation. This demands more specialised medical skills and often close cooperation between the hospital, institutions in the municipality, and nursing schools. Most countries find it difficult to recruit and retain people, this leading to significant shortages in staff. Reasons for this vary but are usually related to working conditions and the long period of training required for many of the jobs. Ageing health workers are also a problem in several counties. There is the additional problem of operating advanced technical equipment, requiring governments to increase training opportunities in the health professions, and to develop workforce planning models. Migration within the EU and especially cross-border flows have partially helped reduce these imbalances in some countries. Healthcare sector and quality assurance Quality has been a keyword within the Healthcare sector for centuries. The sector can be characterised by an almost unlimited demand for services of a high quality level and with relatively fixed public budgets to fulfil the demand. Most governments, social partners and professional bodies are working towards improving education and training for healthcare workers. This work can be seen as a balance between Quantity and Quality Theory and Practice Medical staff and Non-medical staff Work-based training and School-based education Qualifications supply and Competence demand Domestic workforce and Migration Recruitment and Replacement demand Hospital-based care and Community-based care Investment in training is a critical factor in the development of high-quality health services, especially since healthcare workers need many years of training before they are fully qualified. The development of training usually goes hand in hand with the development of job classification and qualifications systems. These specify the tasks and responsibilities of each job as well as the skills needed to fulfill them. It is not clear what the right balance between theoretical and practical training should be, but it has been recognised that practical, on-the-job training and involvement of mentors is a very important part of the curriculum. A number of aspects within quality assurance development in the Healthcare sector can and will be interesting to discuss and to develop further. We have selected the following four themes for this seminar: Models for the training and for quality assurance and development in the enterprises, institutions, local and regional authorities. 3
The trainers in the enterprises/institutions. Documentation of quality. Managing labour market needs and skills supply All actors make decisions in relation to these four themes. These decisions influence the quality of the vocational education and training both directly and indirectly. We expect that the presentations and discussions at the seminar will contribute to the identification of emerging issues, trends and key messages. The participants will have the opportunity to exchange information and share experience of good practices during the seminar. Theme 1: Models for the training and for quality assurance and development in the enterprises, institutions, local and regional authorities. Training and quality assurance development are organised in a number of different ways both across the European Member States, countries, regions as well as across national healthcare educational institutions and organisations. A number of questions can be raised in order to find and reflect on these differences and similarities: What local and regional administrative practices for quality assurance exist? How can school-based and enterprise-based models be integrated? How can we bring education and training standards closer to occupational standards and make them more responsive to employer priorities in the healthcare? How can we develop an education system which can respond quickly to continuously changing requirements? What are the main drivers of change and how do they influence scenarios on health care education and training in Europe? What are the characteristics of a national education system that provides and promotes appropriate career pathways and a future oriented approach to skill needs in health care? Which partnerships are or should be established to gain benefits from research, innovation and education? 4
Theme 2: The trainers in enterprises/institutions Trainers are often recognised as the most important single factor in the students evaluations of who and what contributes to the quality of the education. A number of questions can be raised: What kind of training is needed for the trainers? What motivates trainers? How can the training be organised? How can the on-the-job training and the theoretical educational aspect complement each other? Shall the learning plans be broad and wide or specialised? What kind of training and training materials is needed for the trainers? Theme 3: Documentation of quality All actors within healthcare aim for high quality, but the definition and documentation methods of quality vary between educational institutions, healthcare institutions, political and administrative organisations both at a national level and across Europe. A number of questions can be raised: How is quality defined at the different levels and by the different actors? What aspects of quality are measured in documentation and what is the effect? Which tools for evaluation of students are used? How is the documentation collected presented and used? Theme 4: Managing labour market needs and skills supply The link between supply and demand can be considered as the most important overarching quality criterion. A number of questions can be raised: How do we plan how many healthcare workers/staff to educate and employ? How can we improve recruitment, retention and return? What are the consequences for education and training of migration? Which incentives are effective in motivating healthcare staff? How can we determine and deploy the most effective skill mix of the healthcare staff? How can we improve the productivity of healthcare workers? 5
How can we maintain workload with reasonable limits, for individuals and for teams of healthcare workers? How can new healthcare workers be recruited? Drop out when, how, why and what to do about it? The aim of the seminar is to identify and raise awareness about the key trends with respect to quality assurance in the vocational education and training of the European healthcare sector. The seminar attempts to enhance evidence based development and policy-making at the national and European level. Sources and suggestions for further reading - http://www.cedefop.europa.eu/etv/upload/projects_networks/skillsnet/flashes/skillsnetsf_healthca re.pdf - Recommendation of the European Parliament and Council on the establishment of a European Quality Assurance Reference Framework For more information on the EQAVET Framework and its quality cycle, please visit are our interactive EQAVET Quality Cycle software tool where you can find extended information on EQAVET indicative descriptors and indicators and how they can be used and implemented to develop and build VET quality assurance systems at www.eqavet.eu. 6