With financial support from the EU
New Challenges for Public Services Social Dialogue: Integrating
Service User and Workforce Involvement in Slovakia
Marta Kahancová and Mária Sedláková, Central European Labour Studies Institute
European Commission project, coordinated by Professor Stephen Bach, King’s College,
London: ‘Industrial Relations and Social Dialogue’ VP/2013/0362, January 2015
Executive Summary
Background
This report examines service user involvement in the health and secondary education
sectors, focusing especially on hospitals and schools. It is based on data collected from a one
year comparative European Commission project that considers the connections and
consequences of user involvement for employment relations and social dialogue. It involved
data collection in Denmark, Italy, the Netherlands, Slovakia and the UK (England) with
differing traditions of social dialogue and service user involvement, facilitating comparative
analysis.
The analysis in each report builds on four underlying research questions:
a) How is the pressure of service user involvement altering which actors are represented
directly & indirectly within systems of social dialogue?
b) To what extent has an emphasis on service user engagement encouraged new forms of
direct user involvement & what are the implications for traditional representative voice?
c) How is the scope of social dialogue changing? In what ways has the agenda of social
dialogue changed & are the concerns of service users compatible with the interests of the
social partners?
d) What are the consequences for the social partners & workplace practice of these new
challenges?
Introduction
This report reviews the trends in user involvement for improving the quality in public
education and healthcare and the interaction with social dialogue. Evidence is based on a
variety of written sources and 25 semi-structured interviews conducted in 2014 with
representatives of organized service users (patients’ organizations and various
councils/boards in the education sector), trade unions, employer associations, government
representatives and independent experts. The analytical framework and methods derive
from the common framework of the international comparative project, of which this
national report is part.
Drivers of user involvement
User involvement is defined as a subgroup of civic participation in relation to public
decisions, or decisions with involvement of the public, with consequences for the public, and
concerning public funds. User involvement resembles the involvement of one group of the
public (users of public services) in decisions that relate to the financing of public issues
(transparency and efficiency), the services provided from public funds (character of
services), and with consequences for the public (service quality). End users in healthcare
(hospitals) refer to patients and their organizations, while end users in education (secondary
schools) refer to parents and students.
The key drivers of user involvement in Slovakia include the transition to democracy and a
market economy, public services reform in line with new public management over the past
decade, and pressures from NGOs to increase the efficiency and transparency of public
services.
Forms of user involvement: institutionalization
User involvement in both healthcare and education is rather indirect than direct, with no
“obvious” actors representing users at the national level. While education inherited a user
involvement structure from state socialism, more significant user involvement processes
started only in late 2000s with the establishment of school self-governance. In healthcare, a
user involvement structure is gradually developing along the challenge of overcoming the
direct state rule in hospital functioning prior to the regime change in 1989.
In both sectors different user organizations represent different types of users. Such
structural fragmentation motivates competition among user interests rather than their
sector-wide cooperation; and leaves a formalized and functioning system of user
involvement through collective interest representation underdeveloped. Some user
involvement platforms in education directly bring together representatives of end users and
social partners, whereas a similar trend does not exist in healthcare where user involvement
and social dialogue remain distinct. The underdeveloped system of formal user involvement
in healthcare can be partly explained by the establishment of the nation-wide Healthcare
Surveillance Authority, which serves as a unique facilitator of individual patients’
involvement in shaping the quality of healthcare services.
In the context of interest fragmentation on the side of users, and the existence of a central
authority that exhausts other forms of user involvement, we find the most significant user
pressure to derive from the initiative of third actors. In particular, there are NGOs aiming to
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increase user pressure through accessible comparative analyses of service quality through
the collection of individual user responses. This initiative increases user pressure on the
quality of public services without organized user involvement.
Social dialogue and user involvement
User involvement pressure through organized user interests has a marginal impact on social
dialogue processes and agendas at the sector level. At the establishment level, where user
involvement is less formalized and structured, indirect influences on social dialogue can be
observed because of closer direct or indirect interaction between the users with school and
hospital representatives. Such interaction varies from modest formalization (the quality
system through user feedback survey in the case study hospital) to limited formalization
(direct interaction of users with teachers in the case study school).
The above-mentioned NGO initiatives to motivate user involvement without user
participation yield currently indirect and limited effects on social dialogue. However, such
external initiatives motivate public debate on the quality of schools and hospitals. It
facilitates users gaining a better understanding of the connection between service quality
and the quality of working conditions in schools and hospitals. Moreover, the relevance for
social dialogue is that such efforts motivate users to seize opportunities from their voice,
feedback and other channels of influence to discuss themes of relevance to social dialogue.
This concerns working time and work organization in schools and hospitals. There is also an
indirect link between user involvement and wage negotiations, especially in education,
through which users are motivated to understand that improvements in service quality
develop hand in hand with improvements in wages and working conditions of service
providers.
Consequences for the social partners and the workplace practice
Social partners view user organizations neither as allies nor as competitors. Their channels of
influence largely remain separate despite several relevant cases of indirect mutual
influences. In general terms, trade unions would welcome more support from user
organizations. This also holds for user organizations welcoming support from trade unions,
albeit their direct interaction remains marginal. Employers engage in closer interaction with
users (individually or through user organizations), but their interests do not clearly align with
the interests of users.
The impact of service user pressures on working conditions remains indirect, but more
relevant than the impact on social dialogue processes. This is because user feedback often
addresses themes of work organization, which are directly perceived by users in each sector.
Case studies report cases when work organization has been adjusted upon user pressures
and employer interest to undertake such adjustments.
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