A Estratégia Saúde da Família (ESF), fundada nos referenciais da Atenção Primária à Saúde (APS) e sustentada pela Política Nacional de Atenção Básica orgânica e sistemicamente endossada pelos princípios do Sistema Único de Saúde (SUS) , se apresenta como modelo estruturante das Redes de Atenção à Saúde no Brasil. Qualificar a Atenção Básica em Saúde (ABS) e, por conseguinte, a ESF, neste contexto de grande complexidade, é propósito do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), concebido pelo Ministério da Saúde, enquanto proposta de avaliação e indução de mudanças na gestão, gestão do cuidado e cuidado nos quais se encontram envolvidas Equipes de Saúde da Família (EQSFs) e gestão da ESF. Pouco estudos, focados em análises de experiências de implantação e/ou avaliação de resultados do PMAQ, retratando realidades municipais, têm sido relatados na literatura do campo; contudo, tendo em vista a inexistência de trabalhos publicados, esta pesquisa teve como objetivo analisar avaliações e percepções de trabalhadores de EQSFs e gestores da ESF em relação à concepção, implantação e operacionalização do PMAQ, com seus possíveis impactos, tomadas a partir do referencial de experiências dos sujeitos, no contexto de trabalho. Neste sentido, realizou-se pesquisa de abordagem mista, delineada por estudo de levantamento e grupo focal, com vistas a explorar, descrever e compreender o cenário experienciado por equipes e gestores, no contexto do PMAQ-AB, em municípios da região norte do Estado de São Paulo - Brasil. Referida pesquisa apontou para um perfil de profissionais atuantes em faixa etária significantemente jovem, com diminuto tempo de formado e de experiência na ESF, com baixa vinculação à equipe, num contexto de gestão ainda fragilizado pelas significativas instabilidades na composição das EQSFs, além da rotatividade de profissionais e precariedade de vínculos particularmente em relação aos médicos. Observou-se, em geral, elevado grau de aceitação dos sujeitos para com as propostas de avaliação do PMAQ-AB, embora tenha sido evidenciado significativo contingente de profissionais que desconheciam as diretrizes gerais e indicadores do programa, particularmente os médicos. Evidenciou-se significativo percentual de demandas relacionadas à qualificação sobretudo de enfermeiros , com razoável grau de discordância, por parte dos gestores da ESF, quanto à priorização de determinadas demandas, quando confrontadas com as indicadas pelos profissionais das EQSFs. Também, observaram-se inconsistências no processo de incorporação/implantação de ferramentas e programas estratégicos em diversas áreas de domínio da ESF e em relação ao PMAQ-AB , com variados e significativos graus de discordâncias, em relação aos mesmos, entre profissionais e estes e gestores. Neste contexto foram apontadas, em elevado grau, fragilidades relacionadas ao fazer cotidiano das EQSFs que, ordinariamente, comprometem o processo de trabalho. Em que pesem as observações empíricas reveladas, trabalhadores das EQSFs e das gerências da ESF, contraditoriamente, se autoavaliaram de forma razoavelmente satisfatória, em relação ao acesso e cuidado ofertados pelas equipes. A experiência com o PMAQ foi considerada satisfatória pelos trabalhadores das EQSFs, a despeito das críticas e restrições quanto a concepção, implantação, operacionalização e avaliações efetivadas pelo programa, em aspectos que se mostravam dependentes da instância federal e/ou da gestão municipal. Reiteram-se os desafios colocados para a gestão do trabalho e da educação na saúde, em relação aos trabalhadores atuantes na ESF, e reconhecem-se o momento oportuno, o potencial técnico e o caráter complexo e multidimensional que cercam o PMAQ, em sua necessária abrangência nacional; contudo, julga-se premente promover realinhamentos em sua concepção e operacionalização, de modo que seus componentes de indução e avaliação possam contemplar as demandas postas na cotidianidade da APS/ABS no Brasil, a fim de qualificar o acesso e o cuidado na ESF. / The Family Health Strategy (FHS), founded in the system of reference of the Primary Health Care (PHC) and supported by the Brazilian Primary Care Policy organic and systemically endorsed by the principles of the National Unified Health System (SUS) is presented as the model that structures the network of Brazilian Healthcare. Qualification of PHC, and as consequence, of FHS, in this context of great complexity, is the purpose of the National Program for Improving Access and Quality of Primary Care (PMAQ), ideated by the Ministry of Health as an evaluation proposal and induction of changes to improvement the administrative and care management, as well as of the quality of healthcare, provided by the Family Health Teams (FHT) and FHS managers. Few studies, focused on implementation experiences and/or evaluations of PMAQs initial results, have been reported in the literature, most portraying local realities. Given the scarcity of publications, this research aimed to analyse the evaluations and perceptions of FHTs workers and FHS managers about the design, implementation and execution of PMAQ, and its possible impact on the qualification of the local labor process, in the perspective of the subjects, on work environment. In this sense, it was proposed a mixed approach of research, outlined by survey studies and focus group to explore, describe and comprehend the scenario experienced by teams and managers, in the context of PMAQ, in municipalities in the north region of state of São Paulo - Brazil. The research pointed to a professional profile significantly young, with short time of graduation and work experience in the FHS. Many professionals have demonstrated low attachment to the FHT, in a context influenced by significant instability, high turnover among professionals and precariousness of the labor contract, mainly for the physicians. In general, there was high degree of acceptance to PMAQ\'s proposals, although a significant number of professionals did not know the general guidelines and the basic indicators of the program, particularly doctors. There was a high degree of demands related to professional qualification, particularly by the nurses, with a reasonable degree of disagreement of the managers in relation to such demands, when compared to the indicated by family health teams professionals. Also, observed it inconsistencies in the process of incorporation and deployment of tools and strategic programs, in various areas of the field of FHS and domains evaluation of the PMAQ, with variable degrees of significant discrepancies in assessments of this process by professionals and managers. In this context, weaknesses related to the real practices were identified in high degree by professionals, which may compromise the work process . Notwithstanding the empirical observations pointed out, FHTs workers and FHS\'s managers, contradictorily, considered, in a self-assessment, the access and care offered by the teams as reasonably satisfactory. The experience with PMAQ was considered satisfactory by FHT members, despite criticism and restrictions on the design, implementation, operation and evaluation models provided by the program. Emphasis is put on some challenges to be faced to the adequate management of labor force and of education of health profession in the FHS, although it is also recognized that PMAQ experience provide a unique opportunity to evaluate the complex and multidimensional nature of PHC in studied region and nationwide. However, it is deemed urgent promote realignments in the PMAQ\'s design and operation, so that their induction and assessment components can contemplate the daily life of PHC workers demands in Brazil, in order to qualify the access and care in the FHS.

El denominado proceso de "globalización" ha propiciado nuevos patrones de desarrollo en las relaciones económicas a nivel mundial, que no sólo se han traducido en una nueva organización del trabajo y cambios generales en la producción sino que, a su vez, han modificado las relaciones de poder entre el capital y el trabajo. Como consecuencia de esta profunda reorganización social y económica, la denominada "flexibilización" laboral se ha convertido en una de las características dominantes del mercado laboral que ha tenido diversos efectos negativos para los trabajadores en cuanto a su estabilidad, seguridad laboral, y pérdida de poder. En este contexto, surge la precariedad laboral que ha comportado profundos cambios en el empleo, transformando las relaciones de reproducción social y de las relaciones en el ámbito de la producción, acrecentando la vulnerabilidad de los trabajadores. Al mismo tiempo, la emergencia de la precariedad laboral ha coincidido históricamente con el aumento de los flujos migratorios de carácter principalmente económico.La precariedad laboral no afecta de la misma manera al conjunto de la fuerza de trabajo sino que perjudica especialmente a ciertos grupos vulnerables, entre los que se encuentran los inmigrantes. Así, la precariedad está estrechamente relacionada con los ejes de la desigualdad, que permiten explicar cómo las desigualdades sociales se traducen en distintos niveles de salud. No obstante, existe escasa evidencia que permita entender, con la profundidad suficiente, la relación entre los factores estructurales que configuran la precariedad laboral y su relación con la salud de los trabajadores. Aún menor es la evidencia disponible que analice específicamente la situación de los trabajadores inmigrantes. Esta tesis se propone conocer las características y dimensiones de la precariedad laboral específicas de los trabajadores inmigrantes y analizar su relación con la salud y bienestar de los mismos. Para conseguirlo, propone una metodología cualitativa, con dos orientaciones en el análisis. En una primera parte, el método de análisis utilizado fue la inducción analítica, a partir del marco teórico desarrollado por Amable (2006) sobre la precariedad laboral en asalariados españoles.La segunda parte del análisis es descriptiva e interpretativa siguiendo el método de la teoría fundamentada, utilizado para describir la relación de la precariedad con la salud y bienestar percibidos por los informantes. Los trabajadores inmigrantes caracterizan la precariedad laboral describiendo la elevada inestabilidad del empleo, escaso poder para negociar las condiciones de empleo, indefensión y una intensificación de la carga de trabajo. Perciben también, que sus ingresos son insuficientes para cubrir sus necesidades y que poseen escasos beneficios sociales que limitan su capacidad de ejercer derechos. Los trabajadores en situación irregular, comparten las características descritas de la precariedad, aunque perciben mayor indefensión y peores condiciones laborales. En la relación de la precariedad laboral con la salud, los informantes describieron no sólo problemas sobre su salud general (musculoesqueléticos, problemas alimentación, etc.) sino también problemas como la insatisfacción laboral, estrés, factores psicosociales, malas condiciones de vida y también hábitos poco saludables, como consumo de alcohol y medicamentos.A partir de este estudio hemos observado que la principal diferencia entre el colectivo de trabajadores españoles y el de inmigrantes reside en la extensión de la precariedad laboral. Entre los inmigrantes, la precariedad se presenta en niveles muy altos o incluso extremos, que exceden el ámbito laboral e incluyen aspectos de precariedad social, relacionados a sus condiciones de vida, marginación y exclusión. En el caso de los trabajadores en situación irregular necesariamente entran en la precariedad lo que los ubica como un colectivo muy vulnerable.Finalmente, si se considera que el trabajo es uno de los principales mecanismos de inserción en la sociedad, los inmigrantes que se hallan en situación de precariedad laboral podrían quedar expuestos a una inserción social igualmente precaria. Desde la perspectiva de Salud Pública es necesario considerar que aún y cuando la situación de la inmigración represente un impacto pequeño sobre la salud de los trabajadores, la magnitud de la inmigración a nivel mundial es muy elevada, por lo que el potencial impacto que ésta podría tener sobre la salud global de la población podría ser enorme.

Organisationer behöver kvalificerad personal för att fungera effektivt och därmed blir rekrytering en viktig aktivitet. Det är också angeläget att ny personal anpassar sig väl till arbetsförhållandena. Syftet med denna avhandling var att tydliggöra möjligheterna att genom urval bidra till en långsiktigt hållbar rekrytering för organisation, individ och samhälle. Avhandlingen omfattar tre delstudier och baseras på data från rekrytering av nya poliser i Sverige. En kohort har följts från urvalet av de sökande till polisutbildningen våren 2008 (N = 1 344) över tre uppföljningstillfällen (N = 717–729), nämligen vid slutet av två års polisutbildning, vid slutet av sex månaders aspirantutbildning och vid slutet av det första anställningsåret. Studie I syftade till att undersöka möjligheterna att välja ut de sökande som är mest lämpade att bli poliser genom att kombinera information från flera urvalsmetoder. Vanligtvis används intervjuer för att i slutet av urvalsprocessen välja ut de mest lämpade kandidaterna. Analyser med flera kriterier på framgångsrik rekrytering (prestation, tillfredsställelse med utbildning respektive arbete, vilja att stanna i yrket och hälsa) vid de tre uppföljningstillfällen, visade att ett alternativt förfarande – att kombinera information från urvalsmetoder som i tidigare steg använts för att sålla bort olämpliga sökande – hade högre prognosförmåga. Det handlade om information från begåvningstest, personlighetstest och konditionstest. Ett sådant förfarande kan också vara mer tillförlitligt och resurseffektivt. Vid urval av poliser bör intervjuer däremot främst ses som ett verktyg för att sålla bort olämpliga kandidater. Studie II syftade till att öka förståelsen för hur resultat från begåvningstest ska tolkas och användas vid urval. För de flesta yrken, inklusive polisyrket, har begåvningstest visats vara en av de urvalsmetoder som bäst predicerar prestation. Det har förklarats med effekter av generell begåvning. Resultaten från Studie II visade dock att utöver generell begåvning kan också en verbal och kunskapsladdad komponent antas viktig för att predicera prestation. Samtidigt gav studien stöd för att vid urval använda en samlad totalpoäng från begåvningstest. Studie III syftade till att undersöka den relativa betydelsen av urvalsfaktorer som personlighet och begåvning respektive den psykosociala arbetsmiljön för nya polisers arbetsrelaterade attityder och hälsa efter det första anställningsåret. Studien visade att arbetsmiljöfaktorer, såsom möjligheter till utveckling och återkoppling i arbetet samt rimlig arbets­belastning, var betydligt viktigare än urvalsfaktorer för nya polisers anpassning till arbetsförhållandena i yrket. Sammanfattningsvis visar föreliggande avhandling att det är meningsfullt att över tid beakta flera kriterier på framgångsrik rekrytering. Den visar också att information från flera urvalsmetoder bör kombineras för att välja ut de mest lämpade kandidaterna. Vidare visar avhandlingen på värdet av att använda verbalt laddade begåvningstest vid urval. Förmågan att predicera framgång i polisyrket med olika urvalsmetoder är dock måttlig. Avhandlingen visar däremot att arbetsförhållandena för ny personal kan ha avgörande betydelse. Det betyder att organisationer som strävar efter hållbar rekrytering bör prioritera både urval och sunda arbetsförhållanden för ny personal. Det gäller inte minst polisorganisationer där kostnaderna för rekrytering är höga. / Organizations need qualified personnel to work effectively. Accordingly recruitment is an important organizational activity. Moreover, to attain sustainability for organizations, individuals, and the society, it is assumed important that new personnel adjust well to their working conditions. The aim of this thesis was to investigate the role of selection for long-term sustainable recruitment. The thesis includes three studies based on data from the recruitment of new police officers in Sweden. A cohort of new police officers was followed from the end of the admittance process to the basic police training program in spring 2008 (N = 1,344) and then at three consecutive follow-ups (N = 717-729), 1) at the end of two years of academy training, 2) at the end of six months of field training, and 3) at the end of the first working year. Study I aimed to further the understanding of how to select suitable police applicants by using combinations of common selection methods. Analyses of several criteria (performance, satisfaction, occupational retention, and health) at the three follow-ups suggest that combining information from cognitive, personality, and physical fitness tests, that in earlier hurdles have been used to screen out unsuitable applicants, would be useful in identifying the most suitable candidates, while interviews may primarily be considered as a tool for screening out any unsuitable ones. Study II focused on how to interpret and make use of results from cognitive tests in applied settings such as selection. In most occupations, including the police, cognitive tests are among the most valid predictors of performance. This has been explained by the influence of general intelligence. However, the results from Study II showed that beyond general intelligence, a verbal and knowledge loaded component can be important in predicting performance. Also, the study supported the use of total scores in selection. Study III aimed to examine the relative importance of selection factors (e.g., personality and general intelligence) and psychosocial working conditions for new police officers’ work-related attitudes and health. The study showed that psychosocial working conditions, such as opportunities for development and feedback as well as a balanced workload, were far more important than selection factors for the new police officers’ adjustment to their occupation. Taken together, the thesis shows the value of considering several time points and several criteria of successful recruitment. Also, it demonstrates the usefulness of combining information from several selection methods to select the most suitable candidates, along with the value of using verbally loaded cognitive tests in selection. Still, the ability to predict success among police officers by using selection methods remains modest. Additionally, the thesis shows that the working conditions for new personnel can be considered crucial if recruitment is seen as a long-term process that also includes the introduction phase. Accordingly, organizations striving for sustainable recruitment need to focus on developing sound selection processes and providing sound working conditions for their new personnel. This is of particular importance for organizations such as the police, where the costs of recruitment are high. / <p>At the time of the doctoral defense, the following papers was unpublished and had a status as follows: Paper 3: Manuscript.</p>

Les transformations économiques visant la création d’un marché mondial unique, le progrès technologique et la disponibilité d’une main-d’œuvre qualifiée dans les pays à bas salaire amènent les dirigeants des entreprises à réexaminer l’organisation et la localisation de leurs capacités productives de façon à en accroître la flexibilité qui est, selon plusieurs, seule garante de la pérennité de l’organisation (Atkinson, 1987; Patry, 1994; Purcell et Purcell, 1998; Kennedy 2002; Kallaberg, Reynolds, Marsden, 2003; Berger, 2006). Une stratégie déployée par les entreprises pour parvenir à cette fin est la délocalisation (Kennedy, 2002; Amiti et Wei, 2004; Barthélemy, 2004; Trudeau et Martin, 2006; Olsen, 2006). La technologie, l’ouverture des marchés et l’accès à des bassins nouveaux de main-d’œuvre qualifiée rendent possible une fragmentation de la chaîne de production bien plus grande qu’auparavant, et chaque maillon de cette chaîne fait l’objet d’un choix de localisation optimale (Hertveldt et al., 2005). Dans ces conditions, toutes les activités qui ne requièrent aucune interaction complexe ou physique entre collègues ou entre un employé et un client, sont sujettes à être transférées chez un sous-traitant, ici ou à l’étranger (Farrell, 2005). La plupart des recherches traitant de l’impartition et des délocalisations se concentrent essentiellement sur les motivations patronales d’y recourir (Lauzon-Duguay, 2005) ou encore sur les cas de réussites ou d’échecs des entreprises ayant implanté une stratégie de cette nature (Logan, Faught et Ganster, 2004). Toutefois, les impacts sur les employés de telles pratiques ont rarement été considérés systématiquement dans les recherches (Benson, 1998; Kessler, Coyle-Shapiro et Purcell, 1999; Logan et al., 2004). Les aspects humains doivent pourtant être considérés sérieusement, car ils sont à même d’être une cause d’échec ou de réussite de ces processus. La gestion des facteurs humains entourant le processus de délocalisation semble jouer un rôle dans l’impact de l’impartition sur les employés. Ainsi, selon Kessler et al. (1999), la façon dont les employés perçoivent la délocalisation serait influencée par trois facteurs : la manière dont ils étaient gérés par leur ancien employeur (context), ce que leur offre leur nouvel employeur (pull factor) et la façon dont ils sont traités suite au transfert (landing). La recherche vise à comprendre l’impact de la délocalisation d’activités d’une entreprise sur les employés ayant été transférés au fournisseur. De façon plus précise, nous souhaitons comprendre les effets que peut entraîner la délocalisation d’une entreprise « source » (celle qui cède les activités et les employés) à une entreprise « destination » (celle qui reprend les activités cédées et la main-d’œuvre) sur les employés transférés lors de ce processus au niveau de leur qualité de vie au travail et de leurs conditions de travail. Plusieurs questions se posent. Qu’est-ce qu’un transfert réussi du point de vue des employés? Les conditions de travail ou la qualité de vie au travail sont-elles affectées? À quel point les aspects humains influencent-t-ils les effets de la délocalisation sur les employés? Comment gérer un tel transfert de façon optimale du point de vue du nouvel employeur? Le modèle d’analyse est composé de quatre variables. La première variable dépendante (VD1) de notre modèle correspond à la qualité de vie au travail des employés transférés. La seconde variable dépendante (VD2) correspond aux conditions de travail des employés transférés. La troisième variable, la variable indépendante (VI) renvoie à la délocalisation d’activités qui comporte deux dimensions soit (1) la décision de délocalisation et (2) le processus d’implantation. La quatrième variable, la variable modératrice (VM) est les aspects humains qui sont examinés selon trois dimensions soit (1) le contexte dans l’entreprise « source » (Context), (2) l’attrait du nouvel employeur (pull factor) et (3) la réalité chez le nouvel employeur (landing). Trois hypothèses de recherche découlent de notre modèle d’analyse. Les deux premières sont à l’effet que la délocalisation entraîne une détérioration de la qualité de vie au travail (H1) et des conditions de travail (H2). La troisième hypothèse énonce que les aspects humains ont un effet modérateur sur l’impact de la délocalisation sur les employés transférés (H3). La recherche consiste en une étude de cas auprès d’une institution financière (entreprise « source ») qui a délocalisé ses activités technologiques à une firme experte en technologies de l’information (entreprise « destination »). Onze entrevues semi-dirigées ont été réalisées avec des acteurs-clés (employés transférés et gestionnaires des deux entreprises). Les résultats de la recherche indiquent que la délocalisation a de façon générale un impact négatif sur les employés transférés. Par contre, cette affirmation n’est pas généralisable à tous les indicateurs étudiés de la qualité de vie au travail et des conditions de travail. Les résultats mettent en évidence des conséquences négatives en ce qui a trait à la motivation intrinsèque au travail, à l’engagement organisationnel ainsi qu’à la satisfaction en lien avec l’aspect relationnel du travail. La délocalisation a également entraîné une détérioration des conditions de travail des employés transférés soit au niveau de la sécurité d’emploi, du contenu et de l’évaluation des tâches, de la santé et sécurité au travail et de la durée du travail. Mais, d’après les propos des personnes interviewées, les conséquences les plus importantes sont sans aucun doute au niveau du salaire et des avantages sociaux. Les conséquences de la délocalisation s’avèrent par contre positives lorsqu’il est question de l’accomplissement professionnel et de la satisfaction de l’aspect technique du travail. Au niveau de la confiance interpersonnelle au travail, l’organisation du travail, la formation professionnelle ainsi que les conditions physiques de l’emploi, les effets ne semblent pas significatifs d’après les propos recueillis lors des entrevues. Enfin, les résultats mettent en évidence l’effet modérateur significatif des aspects humains sur les conséquences de la délocalisation pour les employés transférés. L’entreprise « source » a tenté d’amoindrir l’impact de la délocalisation, mais ce ne fut pas suffisant. Comme les employés étaient fortement attachés à l’entreprise « source » et qu’ils ne désiraient pas la quitter pour une entreprise avec une culture d’entreprise différente qui leur paraissait peu attrayante, ces dimensions des aspects humains ont en fait contribué à amplifier les impacts négatifs de la délocalisation, particulièrement sur la qualité de vie au travail des employés transférés. Mots clés : (1) délocalisation, (2) impartition, (3) transfert d’employés, (4) qualité de vie au travail, (5) conditions de travail, (6) technologies de l’information, (7) entreprise, (8) gestion des ressources humaines. / Economic transformations aimed at creating a unique international market, technology innovations and the availability of a highly-skilled workforce in low-wage countries urge company managers to reassess their organization and the location of their production capacities. This, in turn, increases flexibility, the only guarantee to ensure the survival of the organization (Atkinson, 1987; Patry, 1994; Purcell et Purcell, 1998; Kennedy, 2002; Kallaberg, Reynolds, Marsden, 2003 and Berger, 2006). One strategy displayed by organizations in order to remain competitive is outsourcing (Kennedy, 2002; Amiti and Wei, 2004; Barthélemy, 2004; Trudeau and Martin, 2006; Olsen, 2006). Technology, globalization and access to a new pool of highly skilled worforce make production fragmentation easier than it had been in past years and each link of the chain production attracts great amounts of attention to an optimum localization option (Hertveldt et al., 2005). In these conditions, all activities requiring no complex physical interaction between colleagues or between an employee and a customer are prone to be transferred to a subcontractor, be it here or abroad (Farrell, 2005). Most researches about outsourcing essentially concentrate on managerial motives to resort to it (Lauzon-Duguay, 2005) or on organizations’ successes or failures when trying to establish a strategy of that nature (Logan, Faught and Ganster, 2004). Nonetheless, potential impacts of outsourcing employees have rarely been considered in previous researches (Benson, 1998; Kessler, Coyle-Shapiro and Purcell, 1999 and Logan et al., 2004). However, human aspects must also be considered seriously because it could be the cause of success or failure of such a process. The human aspects surrounding the outsourcing process seem to play a role in the impact of outsourcing on employees. Thus, according to Kessler et al. (1999), three general factors would influence how employees perceive outsourcing: the way employees feel they were treated by their former employer (context), the degree of attractiveness of their new employment (pull factor) and the reality of employee experiences following the change in employer (landing). This research aims at understanding the impact of an organization’s decision to contract out a number of its activities on the employees who are therefore transferred to the subcontractor. More precisely, we want to understand what consequences the outsourcing of an organization named “Source” (the one who gives the activities and the employees) to an organization named “Destination” (the one who takes over the given activities and the workforce) can be found on the transferred employees when looking at their quality of life at work and at their working conditions. Many questions arise at this level. What is a successful transfer from the employees’ point of view? Are quality of life at work and working conditions impacted? To what level do the human aspects have an influence on the impact of the outsourcing of employees? What would be the best possible way to manage that kind of relocation from the employer’s point of view? The analysis model is composed of four variables. The first dependent variable (DV1) of our model relates to the quality of life at work of transferred employees. The second dependent variable (DV2) refers to the working conditions of transferred employees. The third variable, the independent variable (IV) relates back to the outsourcing of activities which contains two dimensions: (1) the decision of outsourcing and (2) the implementation process. The fourth variable, the moderator variable (MV), is the management of the human aspects that are considered on a three-dimensional basis: (1) context, (2) pull factor and (3) landing. Three research hypotheses result from our analysis model. The first two relate to the fact that outsourcing leads to a deterioration in the quality of life at work (H1) and of the working conditions (H2). The third hypothesis states that the management of the human aspects moderates the impact of employees who are contracted out (H3). This research consists of a case study conducted on a financial institution (Source) which outsourced its technology activities to an expert in IT organization (Destination). Eleven open-ended interviews were conducted with the key-players (transferred employees and managers from both organizations). Results show that outsourcing generally has a negative impact on transferred employees. On the other hand, it is not possible to generalize this assertion on all indicators. Results highlight the negative consequences found in intrinsic job motivation, organizational commitment as well as job satisfaction linked to its relational aspect. Outsourcing has also led to deterioration in working conditions of transferred employees when it comes to the level of job security, tasks content and evaluation, health and safety at work as well as the duration of work. But, from the employees point of view, the most significant consequences are related to the salary and the fringe benefits. The consequences of contracting out are, however, positive when it comes to professional accomplishment and job satisfaction linked to its technical aspect. As for interpersonal trust at work, work coordination, professional training and work location, there seems to have no significant consequences, according to what employees said when interviewed. Finally, results highlight the significant moderator effect of the human factors on the impact of outsourcing on the transferred employees. The financial institution (Source) tried to decrease the impact of outsourcing, but it was not sufficient. Employees were strongly attached to their first employer and did not want to leave it for another organization holding a different company culture that did not appeal to them. That is why the management of the human aspects contributed to amplifying the negative impacts of outsourcing, especially the ones related to the quality of life at work of transferred employees. Key words: (1) outsourcing, (2) transferred employees, (3) quality of life at work, (4) working conditions, (5) Information technologies (IT), (6) organization, (7) human resources management.

Le Québec reçoit chaque année un nombre croissant de travailleurs agricoles temporaires, à travers deux programmes : le Programme des travailleurs agricoles saisonniers (principalement Mexicains) et le Programme des travailleurs peu qualifiés (pour l’instant Guatémaltèques). Une de leurs caractéristiques communes est le lien fixe à l’employeur imposé aux travailleurs. Cette recherche analyse la conformité de cette disposition avec l’article 46 de la Charte québécoise qui garantit le droit à des conditions de travail justes et raisonnables. Un examen des effets du lien fixe démontre que celui-ci établit une dépendance forte des travailleurs envers leur employeur, aux niveaux légal (du fait de la possibilité du rapatriement anticipé en cas de problèmes liés au travail ou au comportement), financier (dû à la nomination des travailleurs année après année et au dépôt de sécurité imposé aux travailleurs guatémaltèques) et psychologique (soumission, crainte). L’interprétation de l’article 46 à la lumière du droit international des droits de la personne met en évidence la non conformité du lien fixe avec cette disposition. Or si l’objectif de cette mesure est de retenir la main-d’oeuvre dans le secteur agricole, il serait plus juste et raisonnable d’améliorer les conditions de travail de cette main-d’oeuvre plutôt que de l’asservir. / Each year the province of Quebec receives an increasing number of temporary farm workers through two programs: the Seasonal Agricultural Workers Program (mainly Mexican workers) and the Low-Skill Temporary Workers Program (with Guatemalan workers). These programs share a common characteristic: the workers’ permits are tied to an employer. This research analyses the compliance of the bonded-work permit with article 46 of the Quebec Charter, which guarantees the right to just and reasonable working conditions. An analysis of the effects of the work-tied permit shows that it creates a huge dependence of the workers vis-à-vis their employers – legally (due to the possibility of anticipated repatriation for work or behaviour related problems), financially (among other things because of the naming practise) and mentally (submission, fear). The interpretation of article 46 in light of international human rights law shows that tied-work permits violate that provision. If the objective of the bonded characteristic of the work permit is to retain a labour force, it would be much more just and reasonable to improve working conditions rather than to enslave workers.

Cette thèse doctorale poursuit l’objectif de mieux comprendre le rôle joué par la profession réglementée en tant que déterminant de la détresse psychologique de la population en emploi au Québec et au Canada. Ceci, dans un contexte où plusieurs ordres professionnels représentant des professions réglementées, s’inquiètent de la santé mentale de leurs membres et de la pression considérable exercée sur eux dans une économie caractérisée par des pénuries de main-d’oeuvre importantes. Cette thèse fut également inspirée par les nombreuses limites constatées à la suite d’une revue de la littérature sur la santé mentale au travail, alors que les risques différenciés auxquels seraient soumis ces professionnels, comparativement à l’ensemble de la population en emploi, demeurent largement à documenter. La profession réglementée s’associe-t-elle directement à l’expérience de détresse psychologique? Quelles sont les conditions de travail susceptibles de conduire au développement ou à l’aggravation de la détresse psychologique pour ces professions? Dans le but de mieux comprendre le rôle joué par la profession réglementée en matière de détresse psychologique, nous avons eu recours à un modèle théorique multidimensionnel qui postule que les contraintes et les ressources découlent d’un ensemble de structures sociales incluant la profession, le travail, la famille, le réseau social hors-travail et les caractéristiques personnelles. Ce modèle découle des théories micro et macro en sociologie (Alexander et al., 1987; Ritzer, 1996), de l’approche agent-structure(Archer, 1995; Giddens, 1987) ainsi que de la théorie du stress social (Pearlin,1999). Trois hypothèses sont soumises à l’étude à travers ce modèle. La première hypothèse, est à l’effet que la profession réglementée, les conditions de travail, la famille ainsi que le réseau social hors-travail et les caractéristiques individuelles, contribuent directement et conjointement à l’explication du niveau de détresse psychologique. La seconde hypothèse induite par le modèle proposé, pose que le milieu de travail médiatise la relation entre la profession réglementée et le niveau de détresse psychologique. La troisième et dernière hypothèse de recherche, postule enfin que la relation entre le milieu de travail et le niveau de détresse psychologique est modérée par les caractéristiques individuelles ainsi que par la famille et le réseau social hors-travail. Ces hypothèses de recherche furent testées à partir des données longitudinales de l’Enquête nationale sur la santé de la population (ENSP) (cycles 1 à 7). Les résultats obtenus sont présentés sous forme de 3 articles, soumis pour publication, lesquels constituent les chapitres 5 à 7 de cette thèse. Dans l’ensemble, le modèle théorique proposé obtient un soutien empirique important et tend à démontrer que la profession réglementée influence directement les chances de vivre de la détresse psychologique au fil du temps, ainsi que le niveau de détresse psychologique lui-même. Les résultats indiquent que les professions réglementées sont soumises à des risques différenciés en termes de conditions de travail susceptibles de susciter de la détresse psychologique. Notons également que la contribution du milieu de travail et de la profession réglementée s’exerce indépendamment des autres dimensions du modèle (famille, réseau social hors-travail, caractéristiques personnelles). Les résultats corroborent l’importance de considérer plusieurs dimensions de la vie d’un individu dans l’étude de la détresse psychologique et mettent à l’ordre du jour l’importance de développer de nouveaux modèles théoriques, mieux adaptés aux contextes de travail au sein desquels oeuvrent les travailleurs du savoir. Cette thèse conclue sur les implications de ces résultats pour la recherche, et sur les retombées qui en découlent pour le marché du travail ainsi que pour le développement futur du système professionnel québécois et canadien. / This doctoral thesis aims to understand the role played by the regulated occupations as a determinant of psychological distress of the working population in Quebec and Canada. This, in a context where several professional organizations, representing regulated occupations, are concerned about the mental health of their members and the pressure exerted on them in an economy characterized by important shortages of labor. This thesis was also inspired by the many limitations observed after a literature review on work and mental health, whereas the differentiated risks which would be subjected to these professionals, compared to the total working population, remains largely undocumented. Is there a direct link between the regulated occupation and the experience of psychological distress? What working conditions contribute to the development or accentuate psychological distress for these regulated occupations? In order to better understand the role played by the regulated occupations in psychological distress, this thesis proposes a multidimensional theoretical model which postulates that the constraints and resources are generated by a set of social structures including the regulated occupation, the working conditions, family, social network outside of work and personal characteristics. This model stems from the micro and macro theories in sociology (Alexander et al., 1987; Ritzer, 1996), the agent-structure approach (Archer, 1995; Giddens, 1987) as well as the social stress theory (Pearlin, 1999). Three hypotheses are subject to analysis through the model. The first hypothesis assumes that regulated occupations, work conditions, family, social network outside the workplace, and individual characteristics contribute directly and jointly to explaining the level of psychological distress. The second hypothesis induced by the proposed model postulates that the workplace mediates the relationship between regulated occupations and psychological distress levels. The third and final research hypothesis postulates that the relationship between the workplace and psychological distress levels is moderated by individual characteristics, as well as by family and the social network outside the workplace.These hypotheses have been validated using longitudinal data from the National population health survey (NPHS) (cycles 1 to 7). The results of these analyses are presented in three articles submitted for publication, which are the chapters 5-7 of this thesis. Overall, the theoretical model gets an important empirical support and suggests that the regulated occupations directly influence the chances of living psychological distress over time as well as the level of psychological distress itself. The results also suggest that the regulated occupations are exposed to differentiated risks in terms of working conditions likely to generate psychological distress. The contribution of the workplace and regulated occupations is exercised independently of other dimensions of the model (family, social network outside of work, personal characteristics). The results also corroborate the importance in considering many dimensions of the life of an individual in the psychological distress and to put on the agenda the importance of developing new theoretical models, better suited to the realities characterizing today’s working environments in which knowledge workers work. This thesis concludes on the implications of these findings for research, and the benefits it brings to the labor market and for the future development of the professional system in Quebec and Canada.

Nurses constitute the largest professional group in South Africa's health care services. Factors contributing to South African nurses' emigration were studied qualitatively by analysing expatriate nurses' responses to open-ended questions, and quantitatively by analysing newly registered nurses' responses to structured questionnaires. These results were contextualised within Maslow's Hierarchy of Needs Theory, revealing that nurses' inability to meet their physiological needs, due to inadequate remuneration, was the major factor contributing to nurses' emigration potential. While improved salaries might enable more nurses to remain in South Africa, expatriate nurses would not return to South Africa unless certain esteem and self-actualisation needs could also be satisfied. Improving nurses' salaries is essential to address South African nurses' emigration potential. However, improved working conditions, enhanced workplace security, improved levels of job satisfaction and the appointment of nurses into currently frozen posts are also necessary, as is governmental and public recognition of the value of the profession. The South African nursing profession, health care services, Government and society should urgently address factors contributing to South African nurses' emigration potential; otherwise a serious shortage of nurses could cause the collapse of this country's health care services. / Health Studies / DLITT ET PHIL (HEALTH ST)

No description available.

Os serviços públicos de urgência e emergência têm se caracterizado pela superlotação, ritmo acelerado e sobrecarga de trabalho para os profissionais da saúde. O presente estudo se inscreve nesse âmbito, buscando compreender o trabalho na sua relação com a saúde das profissionais de enfermagem. Dessa forma, a relação saúde-trabalho é enfocada a partir da descrição do contexto organizacional do serviço, da compreensão da dinâmica de trabalho em urgência e emergência e das vivências da equipe de enfermagem nessa realidade. O Serviço de Atendimento Externo (SAE) do Hospital de Pronto Socorro de Porto Alegre foi o local utilizado para a investigação, que seguiu um modelo qualitativo de estudo de caso. A presente pesquisa teve sua proposta previamente aprovada pelo Comitê de Ética em Pesquisa da própria Instituição. A coleta dos dados compreendeu a análise de documentos da Instituição (escalas de trabalho, registro das queixas, dentre outros), a observação da dinâmica do serviço, ocorrida em 14 períodos de duas horas de duração, e a realização de entrevistas semi-estruturadas com 12 profissionais de enfermagem. Os dados foram submetidos à análise de conteúdo, elaborando-se um conjunto textual interpretativo a fim de responder aos objetivos do estudo. Três categorias emergiram do tratamento dos dados: O contexto organizacional do SAE, Aspectos envolvidos na dinâmica do trabalho da enfermagem em urgência e emergência, e O sentido do trabalho propiciando a saúde das trabalhadoras. A primeira categoria incluiu aspectos referentes às demandas que o serviço atende e sua organização quanto à estrutura física e recursos humanos disponíveis para o atendimento. A segunda categoria contemplou as conseqüências da intensificação do trabalho para o cotidiano da enfermagem, os desafios para a implantação da política de acolhimento no serviço, as condições e a divisão do trabalho, bem como as interações das profissionais com os usuários. Ainda, nessa categoria, foram abordadas as estratégias coletivas de defesa utilizadas pela enfermagem para conviver com o sofrimento gerado por muitas situações reveladas nesta pesquisa. Na terceira categoria, visualizou-se que a saúde das trabalhadoras preserva-se pelo sentido que elas atribuem para a atuação, o que foi explorado com base no orgulho manifesto pelas participantes e no reconhecimento constituinte da identidade no trabalho. Diante disso, foi possível compreender que a saúde das profissionais de enfermagem é constituída a partir de uma dinâmica de trabalho, por vezes danosa, resultante de um contexto organizacional que carrega marcas de um sistema público de saúde com muitas lacunas, mas que permite, de algumasmaneiras, que as trabalhadoras encontrem caminhos originais para dar conta das exigências do trabalho e das suas próprias necessidades, sem adoecerem. Ainda sobre a relação saúde-trabalho, pôde-se constatar que aspectos como a imprevisibilidade da demanda, a tecnologia e as manobras para salvar a vida, são fatores que favorecem a saúde no trabalho pelo reconhecimento provindo da ação de salvar vidas, uma vez que nessas situações as profissionais exercem suas habilidades especializadas, atuam intelectualmente diante do objeto de trabalho e acompanham o desfecho da produção (a vida ou a morte do paciente). Identificaram-se, como impróprias à saúde, as situações que deixam as trabalhadoras contrariadas pela sua incompletude, ou seja, situações nas quais o problema do paciente não é resolvido, e as trabalhadoras percebem os seus fazeres desprovidos de sentido. / The urgency and emergency state services have been characterized by overcrowd, accelerated rhythm and work overload for the health professionals. The current study is inserted within this range and searches for understanding the job in its relation with the health of the nursing professionals. So, the health-work relation is focused from the description of the service organizational context, from the understanding of the work dynamics in urgency and emergency and from the life experiences of the nursing team within this reality. The External Attendance Service (EAS) of Hospital de Pronto Socorro de Porto Alegre was the site utilized for the research that followed a qualitative model of case study. The Ethics Committee on Research of the institution itself previously approved the proposal for the current research. The collection of data comprised the analysis of documents from the Institution (work time schedules, registration of claims, among others), the observation of the work dynamics occurred in 14 periods of two hours each; and the performance of semi-structured interviews with 12 nursing professionals. The data were submitted to content analysis and an interpretative textual set has been elaborated in order to meet the objectives of the study. Three categories emerged from the data treatment: The organizational context of AES, Aspects involved in the dynamics of the nursing work in urgency and emergency, and The meaning of the work providing the workers´ health. The first category included aspects regarding the demands that the service meets and its organization as to the physical structure and the human resources for the performance of the attendances. The second category contemplated the consequences of work intensification in the nursing daily routine, the challenges for the implantation of the welcoming policy in the work, the labor conditions and division as well as the interactions of the professionals with the users. Yet, within this category, an approach has been made as to the collective defense strategies utilized by nursing in order to live along with the suffering generated by the many situations revealed in this research. The third category visualized that the health of the workers is preserved by the meaning that they assign to their performance, what has been explored based on the pride expressed by the participants and the recognition that constitutes the identity in the work. In view of the above, it was possible to understand that the health of the nursing professionals is constituted from aworking dynamics which is sometimes harmful because it results from an organizational context that carries marks of a state health system with many blanks but which allows, somehow, that the workers find original ways of taking over the work requirements and their own needs without getting sick. Yet, regarding the health-work relation, it was possible to find out that aspects like the unforeseeable character of the demand, the technology and the maneuvers to save life are factors that favor health in the work due to the recognition deriving from the action of saving lives since in these situations the professionals perform their specialized abilities, act intellectually before the work object and follow-up the result of the production (life or death of the patient). It has been identified as inappropriate for health the situations that upset the workers because they do not get finished, i.e, situations where the problem of the patient is not solved and the workers perceive their actions as deprived from sense. / Los servicios públicos de urgencia y emergencia se han caracterizado por la súper ocupación, por el ritmo acelerado y sobrecarga de trabajo para los profesionales de salud. El presente estudio se inscribe en ese ámbito, buscando comprender el trabajo en su relación con la salud de los profesionales de enfermería. De esa forma, la relación salud-trabajo es enfocada a partir de la descripción del contexto organizacional del servicio, de la comprensión de la dinámica de trabajo en urgencia y emergencia y de las vivencias del equipo de enfermería en esa realidad. El Servicio de Atención Externa (SAE) del Hospital de Pronto Socorro de Porto Alegre fue el local escogido para la investigación, que siguió un modelo cualitativo de estudio de caso. La presente investigación tuvo su propuesta previamente aprobada por el Comité de Ética en Investigación de la propia Institución. La recolección de los datos comprendió el análisis de documentos de la institución (escalas de trabajo, registro de quejas, entre otros), la observación de la dinámica del servicio, ocurrida en 14 períodos de dos horas de duración, y la realización de entrevistas semiestructuradas con 12 profesionales de enfermería. Los datos fueron sometidos al análisis de contenido elaborándose un conjunto textual interpretativo a fin de responder en los objetivos del estudio. Tres categorías emergieron del tratamiento de los datos: El contexto organizacional del SAE; Aspectos envueltos en la dinámica del trabajo de enfermería en urgencia y emergencia y El sentido del trabajo que propicia la salud de las trabajadoras. La primera categoría incluyó aspectos referentes a las demandas que el servicio atiende y su organización en cuanto a la estructura física y a los recursos humanos disponibles para la atención. La segunda categoría contempló las consecuencias de la intensificación del trabajo para el cotidiano de la enfermería, los desafíos para la implantación de la política de acogida en el servicio, las condiciones y la división del trabajo, bien como las interacciones de las profesionales con los usuarios. Aún, en esa categoría fueran abordadas las estrategias colectivas de defensa utilizadas por la enfermería para convivir con el sufrimiento generado por muchas situaciones reveladas en esa investigación. La tercera categoría visualizó que la salud de las trabajadoras se preserva por el sentido que ellas atribuyen a su actuación, lo que fue explorado con base en el orgullo manifestado por las participantes y en el reconocimiento constituyente de la identidad en el trabajo. Delante de eso, fue posible comprender que la salud de las profesionales de enfermeríase constituye a partir de una dinámica de trabajo a veces dañosa, resultante de un contexto organizacional que lleva marcas de un sistema público de salud con muchos vacíos pero que permite, de algunas maneras, que las trabajadoras encuentren caminos originales para hacer cargo de las exigencias del trabajo e de sus propias necesidades sin quedarse enfermas. Aún, acerca de la relación salud-trabajo, se pudo constatar que aspectos como el carácter imprevisible de la demanda, la tecnología y las maniobras para salvar la vida son factores que favorecen la salud en el trabajo por el reconocimiento provenido de la acción de salvar vidas una vez que, en esas situaciones, las profesionales ejercen sus habilidades especializadas, actúan intelectualmente delante del objeto de trabajo y acompañan el término de la producción (vida o muerte del paciente). Se identificaron, como impropias, a la salud, las situaciones que dejan las trabajadoras contrariadas a causa de que no se completan, o sea, situaciones en las cuales el problema del paciente no es resuelto y las trabajadoras perciben sus acciones vacías de sentido.

The aim of this study was to identify the health needs and problems of black employees within the Germiston City Health Department in order to indicate a possible relationship between such needs and problems and a high rate of absenteeism. Although the findings could relate to all employees, this study was limited to black employees only. Data was collected by means of observation, perusal of health records and personal interviews with personnel as well as with the selected sample. The results of the study highlighted the specific health needs and problems of employees as well as factors which could influence their health status and which could contribute to the problem of absenteeism. The main factors identified included interalia poor working conditions and unsatisfactory methods of solving employees problems. Relevant recommendations were made ;· to address the problem of absenteeism in the Germiston City Health Department / Health Studies / M.A. (Nursing Science)