2014-02-19

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Gender Equality at the District Health Care Centre

How can gender equality be secured at a district health care centre? Is it possible without applying for major funding? What are the difficulties and what is there to learn? What is a gender equal health care centre?

The district health care centre in Hässelby in the western part of Stockholm has 72 employees who handle 24 000 patients a year. Five years ago, the head of the centre, Erik Lucht, attended Stockholm County Council’s gender equality course for management staff, led by Ann-Katrine Roth. To date, 800 managers at Stockholm County Council have completed the course.

‘I was new to the position and had many opportunities. A newly hired administrator at the centre was also interested in gender equality issues and decided to join me.’

Hard Facts

They initiated a process based on the recommendations from the course. They generated a bunch of numbers, which served as hard facts in discussions at work and management meetings. But the initiative met resistance, especially from the doctors.

‘We were already gender equal, they said. Both genders were represented at the centre. When we looked at the numbers, the initial reaction was that the statistics were wrong,’ says Lucht.

‘When we looked at the numbers, the initial reaction was that the statistics were wrong’

But the more we analysed them, the more the resistance disappeared. The gendered statistics showed that the most common reasons for female patients to contact the centre were incontinence and urinary tract infections as well as depression. There was no way to deny the bars in the diagram. Without the gendered statistics, this information would have remained unknown.

Now people had become less defensive. This was brand-new knowledge.

‘The mid-wives had already pointed to the tendency and problems, but nobody had paid attention.’

Serious Weaknesses

The centre lacked a gynaecology room despite the fact that the mid-wives had said that they had a spare room. The doctors were not knowledgeable enough to meet the great demand, and equipment was lacking or of poor quality.

‘This was a serious weakness. These diagnoses had not been prioritised and the patients couldn’t really be examined properly. The whole issue of women’s incontinence was surrounded by insecurity and the available resources simply didn’t correspond to the number of visits.’

Two-thirds of the doctors at the centre were men. However, only one of the secretaries was a man, and there were no men at all among the nurses. The male doctors had a higher average salary than the female ditto.

‘The overall sick leave statistics for the centre looked alright,’ says Lucht. ‘But when we separated them between men and women, it became obvious that the female doctors had a much higher level of absenteeism. Two female doctors were on long-term sick leave for burnout.’

Unequal workload

‘When we started discussing the reasons for the large difference in sick leave between the 15 male and eight female doctors, we found several factors. For example, the workload for female doctors who had dropped down from full time to part time had not been reduced. Instead of working 100 per cent they were working 75-90 per cent, but they were still seeing the same number of patients!’

‘For example, the workload for female doctors who had dropped down from full time to part time had not been reduced.’

They found many ergonomic factors as well, such as old-fashioned equipment made for stereotypically masculine bodies and hand-pumped examination tables. To spread out the costs, the tables were replaced one at a time. Today an external ergonomics consultant evaluates the centre once a year.

Due to the different work situation for male and female doctors, patients had not been able to see the same doctor at return visits. Thus, the lack of gender equality had affected the quality of service negatively.

Evening out the Differences

‘Today nobody at the centre thinks there’s something wrong with the numbers. Instead they will tell you that gender equality doesn’t come easy. Some costs are down, for example for sick leave and prescriptions of antibiotics. The salary differences are getting smaller.’

The patient surveys show that women have become more satisfied. The differences in satisfaction between male and female patients have been evened out.

A lot to Learn

Lucht feels that a lot can be learned from the work so far.

‘One key is to be concrete. Get the statistics. Make sure to always include the gender perspective when things are measured. And use the competence of your own staff.’

‘Gender equality does not come automatically. Everybody has to keep reminding each other.’

‘The yearly gender equality plans mean a lot. Gender equality must be made a permanent point on all meeting agendas. It’s important to make it sustainable, to secure the process. The managers must ensure that the gender equality plan is followed and updated yearly. It’s also important to consider gender equality a useful qualification when hiring new personnel.’

‘Gender equality does not come automatically. Everybody has to keep reminding each other.’

Success Factors According to Erik Lucht,

  1. Be concrete. Get the statistics, ensure that gender equality is always included in assessments.
  2. Gender equality must be made a permanent point on all meeting agendas. Use the competence of the staff.
  3. Gender equality does not come automatically. Everybody has to keep reminding each other.
Lisa Gålmark
Edited: 25 Oct 2016
Published: 19 Feb 2014
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