Performance-based contracting in home-care work in The Netherlands: professionalism under pressure?

Abstract

Our aim was to improve the understanding of the relationships between performance-based contracting, management supportiveness and professionalism in home care. Using path analysis, this article explores the relationships between home-care workers' perceptions of management support, implementation of performance-based contracting (i.e. use of strict time registration rules and cost-efficiency measures) and autonomy and intrinsic job satisfaction. We hypothesised that: use of strict time registration rules and cost-efficiency measures relates to lower levels of autonomy and intrinsic job satisfaction (H1); there is an indirect relationship between use of strict time registration rules and use of cost-efficiency measures and intrinsic job satisfaction via autonomy (H2); higher levels of management support relate to the use of looser time registration rules and less use of cost-efficiency measures (H3); and higher levels of management support relate to higher levels of autonomy and intrinsic job satisfaction (H4). We used data from a cross-sectional survey conducted in 2010 of a sample of Dutch home-care workers (N = 156, response rate = 34%). Overall, our study suggests that the consequences of performance-based contracting for professionalism are ambiguous. More specifically, using strict time registration rules is related to lower levels of autonomy, whereas using cost-efficiency measures does not seem to affect autonomy (H1). Performance-based contracting has no consequences for the level of fulfilment home-care workers find in their job, as neither of the two contracting dimensions measured was directly or indirectly related to intrinsic job satisfaction (H1, H2). The role of managers must be taken into account when studying performance-based contracting, because perceived higher management support is related to managers' less frequent use of both strict time registration rules and of cost-efficiency measures (H3). The insight we gained into the importance of supportive managers for both autonomy and job satisfaction (H4) can help home-care organisations improve the attractiveness of home-care work.

Care workers under pressure – A comparison of the work situation in Swedish home care 2005 and 2015

“…The decrease in household work between 2005 and 2015 could be interpreted in the light of tightened public funding of eldercare services, which has somewhat squeezed out tasks such as cleaning and shopping from home care, and shifted these tasks to the family and/or the private market (Ulmanen & Szebehely, ). In line with previous research (Glendinning, ; Oomkens et al, ), it seems likely that the increased use of measuring performance and various monitoring and documentation systems, due to NPM, has contributed to the increase in the proportion of workers undertaking administrative tasks.…”

“…The decreased job autonomy and feelings of reduced trust from manager between the years could partly be understood in the context of taylorisation of home care and the influence of NPM, confirming the picture delineated in previous research. Several studies on working conditions in eldercare have identified potential tensions between market‐inspired practices and discretion at work (Glendinning, ; Kamp, Klemsdal, & Gonäs, ; Oomkens et al, ). As the share of private for‐profit providers has grown in Swedish home care, in line with the predictions of regulatory theory (Braithwaite, Makkai, & Braithwaite, ), public authorities have found it necessary to establish more detailed oversight and monitoring of both publicly and privately provided care.…”

“…Both international and Swedish scholars point out how NPM has had implications for eldercare services. These reforms have not only resulted in standardisation and fragmentation of work (often called ‘taylorisation’) (Dahl, ; England & Dyck, ; Szebehely & Trydegård, ), they have also undermined home‐care work by limiting job discretion and workers’ capacity to meet the clients’ needs (Stranz & Szebehely, ; Vabø, ), increasing workloads and decreasing levels of job satisfaction (Denton et al, ; Oomkens, Hoogenboom, & Knijn, ).…”

Institutional context: What elements shape how community occupational therapists think about their clients’ care?

“…Considering current efforts to optimise healthcare and associated measurement and accountability requirements in Québec (Ministère de la Santé et des Services sociaux, ; LSSSS , s. 182.1 ff.) and elsewhere (Gray, Berta, Deber, & Lum, ; Oomkens, Hoogenboom, & Knijin, ; Rostgaard, ; Vabø, ), professional regulatory colleges/associations should be aware of potential threats to the public interest and the quality of professional services, and also consider how best to support therapists in their everyday work.…”

Strategies Used by Home Health Care Professionals Working With Older Adults to Navigate the Institutional Context: An Integrative Review

“…12,[58][59][60] Thus, turning to strategies could reduce the discomfort of HHC professionals regarding the institutional context, especially those related to time pressures and performance indicators. 40,58,[61][62][63][64][65][66][67] Performance indicators are measures of practice performance. 68,69 In HHC, performance indicators often revolve around the number of visits made by professionals.…”