New Challenges for Public
Services Social Dialogue
Integrating Service User and Workforce
Involvement in the Netherlands
End of project conference – Brussels
January 30, 2015
Eva Knies, Peter Leisink, Mijke van de Noort
with the contribution of Jan Dijkstra
With financial support from
the European Union
Integrating service user & workforce
involvement in the Netherlands
• User involvement and its relationship with social dialogue in
the hospital and school sectors in the Netherlands
• Our analysis is based on:
– Interviews with representatives of the stakeholders at national
level: government ministries, employer associations, trade
unions, and user organizations
– Interviews with representatives of the stakeholders in one
hospital and one school for secondary education
– Documents of the organizations that took part in this study,
policy reports, earlier studies and relevant scientific literature
Drivers of user involvement
• ‘User’: narrow and broad understanding
– Narrow: patient (health), student and parent (education)
– Broad: citizens in general (accessible and high-quality services)
• Interest in user involvement has increased since 1990s;
NPM: focus on quality of service, performance and customer
approach
• Health
– Cost reduction, increasing number of chronically ill patients
– Government: user involvement to promote co-production of
effective services and to stimulate a critical counterforce
• Education
– Need for good governance
– Incidents (financial mismanagement)
Forms of user involvement
• User involvement is highly institutionalised
• National level
– Health: patient organisations very influential actor
– Education: national action committee of students (LAKS)
influential position
• Organisational level
– User involvement is regulated through laws strengthening the
position of individual users (e.g. right to file complaint)
– Health: client council mandatory; Arnstein: informing and
consultation (resulting in advice)
– Education: parents and students represented in school
councils; Arnstein: informing and consultation, and partnership
through rights of approval
Social dialogue & user involvement
• Social dialogue and user involvement are separate domains
and employee issues and user issues are disconnected
– Unions: employment interests
– Patient and student organisations: quality of care/education
• Even when there is a joint table, stakeholders focus on their
own interests and respect the others’ legitimate domain
• Conflict is rare
• In theory both stakeholders recognize that employee
participation and user involvement might strengthen each
other
• In practice coalitions are rare and are engaged only in a
pragmatic way
A new challenge for public
services dialogue?
No … from the prevalent union perspective which
concentrates on employment interests
Yes … seen from the perspective of improving the
accessibility and quality of public services
Overview
320,000 patients/year; 2,500 employees
•Active client council: representing the
client perspective
–8 members, appointed by board of
directors
–Different backgrounds
•Works council: 15 members, no doctors
•Openness & transparency, only 3
management levels, informal culture
•Involvement is the norm; management:
added value of participation
Client Council
•Client council mandatory (citizens,
patients, family members):
representative of clients of the hospital
•Right to information, consultation,
advice on:
–Changes in the mission or goals,
mergers, relocations, changes in
organizational structure, budget
–Improvement of quality of care
–Quality of food, safety and recreation
–Appointment members of Board of
Directors
•Power and influence of client council
varies considerably
Work together
Patient satisfaction
–Yearly patient satisfaction survey
–Panel discussions
–Meetings management and client
council (formal and informal)
Client council and works council
–Common ground: patient satisfaction
& quality of care
–Issues that affect both:
•E-health
•Office hours
&
“SMALL QUALITY” matters