Healthy social dialogue for a healthy healthcare sector

Based on its research into working conditions during the COVID-19 pandemic, Eurofound identified 11 groups of workers who are essential to the functioning of critical services. Of these groups, health and care workers, who are predominantly women (76% of the group), had the poorest job quality overall. As the figure below shows, half of these workers were in what we call ‘strained jobs’ – jobs in which the job demands surpass the job resources, which puts the health and well-being of workers at risk. The job demands in question were a combination of high levels of physical risks (including handling or being in contact with infectious materials) and physical demands (such as lifting or moving people), high exposure to adverse social behaviour (verbal abuse, bullying, harassment and violence, and unwanted sexual attention) and high work intensity (including working at high speed and being exposed to emotionally disturbing situations).

Note: The numbers at the start and end of each bar indicate the total percentage of workers in strained and resourced jobs, respectively.

While health and care workers were more likely to report receiving the support of colleagues and to display high levels of engagement – indicative of their level of vigour, absorption and dedication to their work – the sustainability of their jobs is questionable: half of these workers reported that their health and safety were at risk because of work, and more than half reported exhaustion or being at risk of burnout. These workers experience a volatile combination of poor job quality and poor job sustainability, a situation that is reducing the attractiveness of jobs in the sector and contributing to rising staff shortages.

• Publication: Job quality of COVID-19 pandemic essential workers

Physical and psychosocial risks are important aspects of health and care workers’ working conditions that could be addressed by inclusive and effective social dialogue between workers and their representatives, on the one hand, and providers in the hospital sector and the wider health and care sector, on the other. The social partners do not typically venture into these areas – traditionally, collective bargaining tends to focus on pay and working time. During the pandemic, however, social dialogue moved onto less familiar ground. Research by Eurofound shows that in several Member States, social dialogue played a prominent role in addressing some of the challenges posed by the pandemic to the hospital sector. The social partners tackled issues such as the adaptation of work organisation and reallocation of staff in order to secure sufficient workforce capacity in hospitals. They also agreed measures to protect the health and safety of staff.

• Publication: Social dialogue and collective bargaining in the hospital sector during the COVID-19 pandemic

The countries where this happened were those with well-established social dialogue institutions and a long-standing tradition of cooperation between the social partners: Austria, Belgium, Denmark, Finland, Germany, Luxembourg, the Netherlands, Norway and Sweden. In these countries, negotiations between the social partners were vital for, among other things, the changes to work organisation required to tackle the health crisis and the successful allocation of additional funding and resources.

In some countries where social dialogue typically plays a background role – Bulgaria, Czechia, Cyprus, Estonia and Malta, for example – it also proved useful and efficient in helping to secure hospital workforce capacity.

The COVID-19 pandemic exacerbated existing staff shortages, and in its wake the problem is intensifying, with international competition for the recruitment of health workers on the rise. The social partners in the hospital sector are increasingly concerned about the impact of high levels of stress and heavy workloads on staff retention, as these are often reasons for workers leaving the sector and the growing difficulty recruiting new staff. In a context of population ageing and climate change, both of which will likely increase the demand for healthcare and emergency services, the capacity of the sector to continue to provide an essential and quality service in the future is open to question. The involvement of the social partners is crucial to developing measures to address these concerns.

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Eurofound research findings confirm that when the social partners engaged with the challenges faced by the hospital sector during the COVID-19 pandemic, the solutions were developed faster and were more effective. Our evidence suggests that the healthy functioning of social dialogue and collective bargaining is crucial for a strong and healthy hospital sector, and for the advancement of the health sector more broadly – foundations on which rest the EU’s preparedness for the challenges ahead.

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