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DOI :10.26650/JECS2019-0037   IUP :10.26650/JECS2019-0037    Full Text (PDF)

White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital

Sinan Acar

With the Health Transformation Program (HTP) in Turkey whose infrastructure was established in the 1980s and came into practice in 2003, a significant stage of the neo-liberal transformation process started in the field of public health services. With the transformation process in health, a transition was made into performance- based service production in healthcare services, and flexible forms of employment started to be seen in employment processes. This study mainly focuses on the perception and experience of the white- collar subcontracted employees in public health services of flexible and precarious employment in the neoliberal period. As a result, it was observed that most participants were young, single and graduates of higher education. It was found that the knowledge, skills and experience of the employees were not considered in decision-making processes, and accordingly, they had lower levels of feelings of organizational justice. It may be stated that, due to the production of services with flexible and performance based work, the workload of the employees has increased considerably and the work is carried out with a low number of employees. Having employees with the same job and similar educational levels under different forms of employment was found to reveal material and moral inequalities among the employees. Consequently, the neo-liberal transformation process in public health services also shows its effect on the employment processes in these fields and the existing structure is being transformed in a way to also involve white-collar occupations by taking contracts, flexibility and precarity as a basis.

Keywords: Flexibility, Precarity, Public Health Services, White-Collar Subcontracted Employees
DOI :10.26650/JECS2019-0037   IUP :10.26650/JECS2019-0037    Full Text (PDF)

Kamu Sağlık Sektöründe Beyaz Yakalı Taşeron Çalışanlar: Fırat Üniversitesi Hastanesi Örneği

Sinan Acar

Türkiye’de kamu sağlık hizmetleri alanında 1980’li yıllardan itibaren alt yapısı oluşturulan, 2003 yılında ise uygulamaya giren Sağlıkta Dönüşüm Programı (SDP) ile neo-liberal dönüşüm sürecinin önemli bir aşamasına geçilmiştir. Sağlıkta dönüşüm süreciyle birlikte sağlık hizmetlerinde performansa dayalı hizmet üretim sürecine geçilmiş ve istihdam süreçlerinde de esnekliğe dayalı istihdam biçimleri görülmeye başlanmıştır. Bu çalışma temelde neo-liberal dönemde istihdamda görülmeye başlanan esneklik ve güvencesizlik süreçlerinin kamu sağlık hizmetlerindeki beyaz yakalı taşeron çalışanlarca nasıl algılandığı ve deneyimlendiği konusu üzerinedir. Araştırma sonucunda çalışanların çoğunluğunun genç, bekâr ve yükseköğretim mezunu kişilerden oluştuğu görülmüştür. Çalışanların karar alma süreçlerinde bilgi, beceri ve deneyimlerinin dikkate alınmadığı ve bu noktada örgütsel adalet duygularının düşük olduğu görülmüştür. Esnek ve performansa dayalı hizmet üretimine bağlı olarak çalışanların iş yüklerinin büyük oranda arttığı ve işlerin düşük eleman sayılarıyla yürütülmeye çalışıldığı söylenebilir. Kurumda aynı işi yapan ve benzer eğitim düzeylerine sahip çalışanların farklı istihdam şekillerine dayalı çalıştırılmasının çalışanlar arasında maddi-manevi eşitsizlikleri ortaya çıkardığı görülmüştür. Sonuç olarak kamu sağlık hizmetlerinde yaşanan neo-liberal dönüşüm süreci bu alanlardaki istihdamda da etkisini göstermekte ve mevcut yapı sözleşmeliliği, esnekliği ve güvencesizliği esas alarak ve beyaz yakalı meslekleri de içerecek şekilde dönüşmektedir.

Keywords: Esneklik, Güvencesizlik, Kamu Sağlık Hizmetleri, Beyaz Yakalı Taşeron Çalışanlar

EXTENDED ABSTRACT


The organization and functioning of the health system has been an important field in the development of the social structure in every period of history. It may also be argued that healthcare professionals have always been an important component of the system in the organization and functioning of healthcare services. Considering the organization processes of healthcare systems in the period where the Fordist accumulation regime was strong (1914-1970), there was a structure where healthcare professionals were seen as a basic component of the system, and they were employed as permanent staff throughout their lives. In the post-Fordist period that emerged by 1970s where the Fordist regime of accumulation started to weaken, work processes started to be built on flexibility and insecurity. In addition, life-long and secured employment had started to be replaced by forms of employment based on flexibility and precarity. At this point, the transformation in employment processes started to affect firstly peripheral employees who performed support services and then, white-collar employees who performed basic jobs and were known as core employees. With the Health Transformation Program (HTP) in Turkey whose infra-structure was established since 1980s and came into practice in 2003, a significant stage of the neo-liberal transformation process started in the field of public health services. With the transformation process in health, a transition was made into performance- based service production in healthcare services, and flexible forms of employment started to be seen in employment processes. Flexible and precarious employment in the field of health services, which was first seen in support services, has started to be seen in the white collar groups that carry out the essential works in following periods. This study mainly focuses on the perception and experience of the white collar subcontracted employees in public health services of flexible and precarious employment in the neoliberal period. The study was conducted in Fırat University Medical Faculty in Fırat Medical Hospital between June and July 2017. While the study mainly followed a quantitative research method, it also used qualitative research techniques. As part of the study, questionnaires were conducted with 120 white-collar healthcare professionals who were employed in positions with flexibility and precarity, and in-depth interviews were carried out with 17 of these employees. As a result, it was observed that most participants were young, single and graduates of higher education. Likewise, it was seen that the clientelist relations were effective in the process of the recruitment of these employees. It was found that the knowledge, skills and experience of the employees were not considered in decision-making processes, and accordingly, they had lower levels of feelings of organizational justice. It may be stated that, due to the production of services with flexible and performance based work, the workload of the employees has increased considerably and the work is carried out with a low number of employees. It was observed that processing increased workloads with low numbers of employees had a reducing effect on the performance and motivation of the employees, and additionally, this also had the potential to affect the patients negatively. Moreover, it was determined that the performance-based service production process weakened the structure among the healthcare professionals based on teamwork and settled a structure that was based on competition. Having employees with the same job and similar educational levels under different forms of employment was found to reveal material and moral inequalities among the employees. Accordingly, it can be said that employees are always made to feel directly or indirectly that they are in a flexible and precarious position. In addition to this, it was observed that an oppression-based control process was dominant on the employees, and they produced services in which they were always in fear of being fired. In addition to this, it was observed that a oppression-based control process was dominant on the employees, and they produced services in which they were always in fear of being fired. It was determined that the employees had a tendency to have additional jobs due to the inadequacy of their wages. Due to their current status in the organization it was observed that employees do not have a sense of belonging to their workplaces and that their sense of professional belonging is very low. Consequently, the neo-liberal transformation process in public health services also shows its effect on the employment processes in these fields, and the existing structure is being transformed in a way to also involve white-collar occupations by taking contracts, flexibility and precarity as a basis.


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APA

Acar, S. (2020). White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital. Journal of Economy Culture and Society, 0(61), 207-228. https://doi.org/10.26650/JECS2019-0037


AMA

Acar S. White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital. Journal of Economy Culture and Society. 2020;0(61):207-228. https://doi.org/10.26650/JECS2019-0037


ABNT

Acar, S. White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital. Journal of Economy Culture and Society, [Publisher Location], v. 0, n. 61, p. 207-228, 2020.


Chicago: Author-Date Style

Acar, Sinan,. 2020. “White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital.” Journal of Economy Culture and Society 0, no. 61: 207-228. https://doi.org/10.26650/JECS2019-0037


Chicago: Humanities Style

Acar, Sinan,. “White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital.” Journal of Economy Culture and Society 0, no. 61 (Nov. 2024): 207-228. https://doi.org/10.26650/JECS2019-0037


Harvard: Australian Style

Acar, S 2020, 'White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital', Journal of Economy Culture and Society, vol. 0, no. 61, pp. 207-228, viewed 23 Nov. 2024, https://doi.org/10.26650/JECS2019-0037


Harvard: Author-Date Style

Acar, S. (2020) ‘White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital’, Journal of Economy Culture and Society, 0(61), pp. 207-228. https://doi.org/10.26650/JECS2019-0037 (23 Nov. 2024).


MLA

Acar, Sinan,. “White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital.” Journal of Economy Culture and Society, vol. 0, no. 61, 2020, pp. 207-228. [Database Container], https://doi.org/10.26650/JECS2019-0037


Vancouver

Acar S. White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital. Journal of Economy Culture and Society [Internet]. 23 Nov. 2024 [cited 23 Nov. 2024];0(61):207-228. Available from: https://doi.org/10.26650/JECS2019-0037 doi: 10.26650/JECS2019-0037


ISNAD

Acar, Sinan. “White Collar Subcontracted Employees in the Public Health Sector: The Case of Fırat University Hospital”. Journal of Economy Culture and Society 0/61 (Nov. 2024): 207-228. https://doi.org/10.26650/JECS2019-0037



TIMELINE


Submitted25.11.2019
Accepted13.01.2020
Published Online30.06.2020

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