8 minute read
About the size of it
Andrew Chick | Senior Communications Advisor
When you’re up against entrenched staffing shortages and battling to keep your head above water, job-sizing can be a useful way of matching staffing levels to service requirements.
“Between MECA negotiations, job sizing is one of the most important things we do. It is a great organising opportunity and can give members a renewed sense of control over their work,” says ASMS Senior Industrial Officer Henry Stubbs. Clause 13 of the DHB MECA is the job sizing clause. It states any employee’s hours of work and job size “shall objectively reflect the requirements of the service and the time reasonably required for the employee to complete their agreed duties and responsibilities, as set out in their job description”. It is a provision that has been there since the first DHB MECA was negotiated in 2003.
Importantly, the clause also says that a job size must be “mutually agreed” between employer and employees – neither can unilaterally change it. And the words “objectively” and “reasonably” mean the conclusion of any job sizing can be evaluated by a third party – it is not just a negotiation. “A mechanism that gives that kind of shared control over work and workloads is unusual for collective agreements in this country, let alone what most working people on an individual employment agreement experience,” says New Zealand Council of Trade Unions Legal Advisor Gayaal Iddamalgoda.
“Despite any ups and downs in actually doing job sizing, ASMS members should recognise the strength this job sizing process gives them and the level of high-engagement it encourages.” There is at least one job sizing review going on in most of our DHBs at any given time. Henry Stubbs says requests for job sizing have come up from groups of members when services feel they are under particular pressure. “As we see more and more pressure on DHBs, we have seen increasing demand for job sizing. But job sizing should be under regular review in all services for all DHB members.”
Valuable process
Job sizing can take several months to complete. ASMS Senior Industrial Officer Lloyd Woods says firstly all members of the team need to get together for the initial exercise, then review what they come up with, before finally presenting it to management. Management then has time to respond. “It is the best tool we have to increase staffing levels, but it can be a very slow process. Sometimes it can be fast but not often,” Lloyd says.
Henry agrees that despite the time commitment, job sizing is incredibly valuable.
“To have an accepted process to objectively define how much work is required to do your job – agreeing on that is a massive step in tackling the endemic problems of excessive workload.”
That said, a job-sizing exercise does not always result in a recommendation for more SMOs.
“It can be more registrars, more nurse specialists or more administration,” says Lloyd. “And, even where it is more SMOs, it can be impossible to recruit. Then it can become a very challenging question of the size of the service being delivered and having to reduce that.”
What does job sizing involve?
The process of job sizing starts at the service or team level. It produces an average total weekly number of clinical hours to deliver the full range of clinical duties required in that service. From there it can be converted into a full-time equivalent number of employees required to provide that service. With the addition of time allocated for non-clinical tasks and leave within the service, the number of SMO hours required to provide that service may be arrived at.
There are slightly different approaches to establishing routine duties and measuring after-hours call work.
Both are done collectively with your colleagues. For routine work, all your colleagues in the service gather round a whiteboard or a computer spreadsheet and start by listing all the clinical activities that are required in your service. Then you agree among yourselves how much time, based on reasonable averages, each of those activities requires.
It can take some time to remember and capture all the various aspects of your service’s clinical work – not everyone performs every task. But you want to capture all tasks. Also, it can also be easy to just assume how long a task can take based on how long it is usually scheduled to take, but it is important to recognise how many hours are reasonably required and should be allowed for that activity.
“Members sometimes ask why we only calculate clinical hours or how in fact you define clinical hours,” says Lloyd. “The fact is, when a service is understaffed, the first thing that is lost is non-clinical time. Trying to measure how much non-clinical work is happening is pointless.” ‘Clinical’ is defined as any activity directly relating to the diagnosis, treatment and/ or management of a named patient, and clinical activities are clearly spelt out in Clause 48.2c of the MECA.
While non-clinical time is not initially considered, it is still important. MECA clause 11.7 defines non-clinical duties. The MECA also recommends a recognised standard of 30% non-clinical time, and job sizing must reflect this. After-hours duties are done slightly differently and are measured by keeping diaries. Over the appropriate roster-cycle period, members tick boxes daily about the types of after-hours call work they are required to do. That information is then collated and analysed at the end of the period. The overriding message is do not wait until you and your colleagues are feeling tired, cannot take your leave or do not get decent non-clinical time – or worse, suffer burnout. Contact your ASMS industrial officer and talk about it.
Working updates
Safe work
Aspecific focus for our industrial team is enforcing current MECA clauses and supporting various services to negotiate additional payments for the extra duties caused by the Covid surge and short staffing.
No SMO should be put in an ongoing position of being expected to supply additional hours or duties without additional remuneration. The MECA provides that “alternative arrangements and/or compensation” must be put in place where vacancies and gaps arise and where no locum arrangements are in place. Having written agreements, rather than informal arrangements, provide certainty for you and your colleagues about hours of work, and ensures that any adjustments to your workload will be remunerated. Formal service-level agreements also ensure the employer records the ongoing cost of staffing gaps. This is really important. When staff are pressured to cover ongoing vacancies and gaps as part of “business as usual” the true cost of providing healthcare in your service remains hidden. It means that SMOs (and other clinicians) are subsidising the cost of maintaining care. Recently there has been some pleasing progress on these issues. Auckland metro DHBs are now implementing some minimum additional payments which will apply during the surge. This should mean a fairer and more transparent remuneration landscape across the Auckland region which ASMS will continue to monitor.
A significantly improved shift agreement has been negotiated at Taira -whiti DHB’s emergency department which has been struggling with significant vacancies. The new agreement means SMOs who are currently employed will be more fairly paid for the work they do, and the improved local terms and conditions are one less barrier to recruitment.
A surge agreement has also been negotiated with the Auckland Regional Public Health Service. Covid has placed major burdens on our largest public health service. Now there are written provisions to support a fairer distribution of extra work, along with recovery and remuneration arrangements. Because it is a formal arrangement it both enforceable and reviewable.
Work is underway to put similar arrangements in place with several mental health services. This will help stop unreasonable workplace demands being placed on SMOs, and solidify existing MECA arrangements around recovery time, extra duties and work done after hours.
The pathway to genuine SMO wellbeing is to ensure that services are fully staffed, job sizing occurs regularly, increases in demand and workload are funded, and individual SMOs can access a balanced clinical and non-clinical load. Organising with your colleagues to enforce your MECA is a way forward. Contact your industrial officer if you would like advice or help.
Slow but determined battle on gender pay
Dr Charlotte Chambers | Director of Policy & Research
It’s been slow going, but some progress is being made as ASMS works to close the gender pay gap in the specialist workforce. A bit of history
In 2019, ASMS-commissioned research on the gender pay gap in the specialist workforce found female specialists were paid 12.5% less per hour than their male colleagues. It also found that gap widened for female specialists with children. The issue was taken to the National JCC where it was agreed between ASMS and the DHBs to develop and test a mechanism to address the existing pay gap. However, attitudes to privacy and a general reluctance to share data by the DHBs and TAS meant this initially promising project slowly ground to a halt, and the pilot was never completed. In the meantime, ASMS continued to pick up individual cases with a mixture of success and challenge. A handful of DHBs have required ‘confidential settlements’ as the only mechanism they are prepared to use to adjust individual SMO remuneration, with no public acknowledgment of the problem. ASMS believes this is no way to fix the issue and is now pursuing a more direct approach.
Steps being taken
ASMS has written to every DHB, requesting detailed payroll information so that we can run our own data analysis of the national picture. This data includes the salary step and anniversary date for every member. This will mean we can progress the work nationally, without recourse to TAS or the DHBs. Once we have this data, we can match it with the vocational registration status and medical college information from the Medical Council database. This will give us a sound basis for identifying the root causes of the gender pay gap, from which we can then initiate action or intervention.
