|Implemented in this survey?|
The Spanish National Health Service (SNHS) has been decentralized into 17 regions in 2003. Still, human resource issues of civil servants in the health system have been regulated by national acts. The most recent develops, for the first time, a framework for professional development that recognizes personal skills and commitment. It tries to avoid a lineal model which is only based on seniority and consequently less motivational for professionals. It is now being implemented in many regions.
The main objective of this reform is to develop a professional career development among professionals working for the Spanish National Health Service (SNHS).
Characteristics and expected outcomes
The national act 55/2003 is to develop a professional career development among professionals working for the Spanish National Health Service (SNHS).
Professionals working inside the Spanish National Health Service (SNHS)
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
|Implemented in this survey?|
Before the current 55/2003 act for professionals inside the SNHS, human resources issues were regulated by pre-constitutional acts established during Franco's dictatorship (before 1978). These did not take into account any professional development except seniority, for any work category. Mainly because for years there had been a lack of professional incentives and regulations, in the late 90's some regions like Catalonia or Navarra launched pilot programs that started to carry out professional career development first for health professionals like physicians and nurses and then for the non-health professionals working inside the SNHS.
These pilot approaches definitely helped to further the implementation of the current act after the complete decentralization of health services into 17 regions had taken place in 2003. The Ministry of Health and regional governments on behalf of the central government were the main forces to develop this current act. They looked for a brand new policy, never seen before in any European country, that tries to reward good professionals and also allows them to leave an old-fashioned way of managment behind.
This new economic incentive scheme based on quality of care objectives for all workers and professional development has opened a new way of runnig business inside the public administration.
The 55/2003 act as an instrument gives a scenario and basic background for professional development. Every region then has to complete and define it with specific trade union consensus. This process is now taking place in many regions.
Central points in the act are:
Before this current law, human resources issues inside the SNHS were regulated by pre-constitutional acts established during Franco's dictatorship (before 1978). These acts did not take into account any professional development except seniority. For the first time, a national act provides a framework to develop professional career among SNHS professionals so it can be considered a brand new policy.
The approach of the idea is described as:
The Spanish government, particularly the Ministry of Health, has been the main promoter of the 55/2003 act and, consequently, the instigator of incentives and professional career development for workers of the SNHS. At the beginning, this policy was not well received by trade unions, but after consensus with the Ministry and regional governments, they strongly approve it. Health professionals also strongly agree with this policy as long as it allows them to improve their professional career. No main actors disagree with the act and its recent implementation in the regions.
|Spanish Ministry of Health||very supportive||strongly opposed|
|Regional governments||very supportive||strongly opposed|
|Public Providers||very supportive||strongly opposed|
|Patients||very supportive||strongly opposed|
|Trade Unions||very supportive||strongly opposed|
|Professionals of the SNHS||very supportive||strongly opposed|
The 55/2003 act gives an original framework to develop professional development and incentives for workers inside the SNHS. As a decentralized issue, specific degrees and career status should be discussed with trade unions at negotiating tables in every region. Due to these specific negotiations, professional incentives can be rather different among regions. In fact, some regional governments have applied an idea of progressing professional careers linearily following seniority, in contradiction with the new philosophy that aims to reward commitment and excellence among workers inside the organization.
|Spanish Ministry of Health||very strong||none|
|Regional governments||very strong||none|
|Public Providers||very strong||none|
|Trade Unions||very strong||none|
|Professionals of the SNHS||very strong||none|
Since decentralization in 2003, all the regions have implemented the 55/2003 act and therefore installed professional incentives for their workers. Professional careers may vary in every region due to local policies and trade union involvement at the negotiating tables. Workers inside the SNHS have improved their professional perspectives with this new act and trade unions have also participated in its implementation.
Some of the public health providers have already submitted a professional development career similar to the SNHS so it could be a good measure of success.
No main obstacles have been observed since the implementation of this new professional policy.
No major evaluations have been conducted since the new act has been submitted. Only the Catalan region has published a paper regarding the impact of economic incentives on the quality of professional life and end-user satisfaction in primary care and among health professionals (Gené-Badia et al 2007).
The study performed by the Catalan region shows that the quality of professional life (QPL) after this policy implementation, has improved in terms of the dimension "perception of support from the management structure" among physicians (4,9 versus 5,2) as well as nurses (5,2 versus 5,6). Further, physicians perceived an increase in the dimension "demands made upon them" (6.1 versus 6.3), differently from the group of nurses (5,8 versus 5,9). Overall, user satisfaction did not vary significantly although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses and a negative relationship between "demands upon them" and user satisfaction in the case of physicians. As a conclusion, this study reveals that incentives related to annual targets for quality of care may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase.
To sum up, the log-term professional development submitted in the 55/2003 act has been well approved by professionals and trade unions inside the SNHS. Also, some SNHS providers have introduced a professional development career among their professionals quite similar to this one so this could be a good measure of policy success. Regarding direct effects on quality, access and equity further studies will be needed in order to know the real impact of this policy.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Patricia Fernandez-Vandellos and Lluis Fornies-Vilagrasa