Tackling Childcare: The Business Case for Employer-Supported Childcare CASE STUDY Schön Klinik Healthcare, Germany ABOUT IFC IFC, a member of the World Bank Group, is the largest global development institution focused on the private sector in emerging markets. Working with more than 2,000 businesses worldwide, we use our capital, expertise, and influence to create markets and opportunities in the toughest areas of the world. In FY17, we delivered a record $19.3 billion in long-term financing for developing countries, leveraging the power of the private sector to help end poverty and boost shared prosperity. For more information, visit www.ifc.org COPYRIGHT AND DISCLAIMER NOTICE © International Finance Corporation 2017. All rights reserved. 2121 Pennsylvania Avenue, N.W. Washington, D.C. 20433 Internet: www.ifc.org The material in this work is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. 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International Finance Corporation is an international organization established by Articles of Agreement among its member countries, and a member of the World Bank Group. All names, logos and trademarks are the property of IFC and you may not use any of such materials for any purpose without the express written consent of IFC. Additionally, “International Finance Corporation” and “IFC” are registered trademarks of IFC and are protected under international law. September 2017 Policy Overview Germany Leave policies Paid maternity leave Yes 98 days No Paid paternity leave Parental leave is available to men Paid parental leave Yes 360 Economy name: Germany Main business city: Legal obligation for employers Berlin* to support childcare 0-2 years 3-5 years Region: Obligation for employers to support childcare? No No OECD high income Based on the number of female employees? N/A N/A Based on the number of employees regardless Income level: of gender? N/A N/A High income Special legislation on employer-provided Population: childcare? No No 80,889,505 Female population: Government incentives to 41,167,323 employers to support childcare Tax benefits to employers to support childcare? No No Non-tax benefits to employers to support Yes, Yes, Labor force childcare? (monetary and/or nonmonetary benefits) (subsidy to (subsidy to participation (15+): cover the cost cover the cost of daycare of daycare 55% female center center 66% male construction construciton and operation) and operation) Compulsory primary education Quality of private childcare services enrollment age: 6 years License or registration required? Yes Yes Zoning requirements? Yes Yes Pupil-teacher ratio required? Yes Yes Pentalties for noncompliance with laws? Yes Yes *The Women, Business and the Law data are based on domestic laws and regulations that apply to the main business city of the economy. For more information on the methodology including the maternity/paternity/parental leave calculation methodology, visit wbl.worldbank.org 3 SchÖn Klinik Healthcare, GERMANY Schön Klinik's Employee Profile in 2016: • 75% of its 9,500 employees nationally, and 75% of its 999 employees in Neustadt are women PARENTS, WORK, AND CHILDCARE • Women are 42% of nursing care IN GERMANY staff, 11% of doctors, and 13% of In the last decade, the work-family landscape has changed significantly in heads of departments and senior Germany. After decades of low investment in childcare and policies that management promoted a family model where mothers stayed at home to raise their children, Schön Klinik supports employees there has been a significant expansion of investments in public childcare, with children through: incentives for mothers to return to work sooner after childbirth, and for fathers • Free childcare centers during early to more equitably share in child rearing tasks (Blome, 2017). The lack of public and late shifts supports had led to record low fertility rates (Germany, with low birth rates of • On-site childcare in some locations 1.44, is the only country in the world with several decades of fertility rates well • Subsidized summer camps below the replacement rate of 2.1 (Bujard, 2015)) and costly losses in terms of • 20 days emergency back-up care human capital for German employers as skilled female workers had long periods per year (in some locations) of absence from the labor market. • National hotline to provide advice The reforms introduced by the German government to encourage both increased on childcare and caregiving issues and help find care solutions female labor force participation and increased birth rates have had a strong impact. These reforms include reducing the costs of having children and making • Advisory service for finding nannies and babysitters it easier to be a working parent (Bauernschuster, Hener, and Rainer, 2013) and implementing the European Commission’s 2002 Barcelona objectives for • Part-time work options in all positions and a variety of different increasing the availability of high-quality, affordable childcare (European working time options Commission, 2013). Between 2006 and 2014, the labor force participation of mothers of young children increased dramatically, from just 9 percent to 42 Main business impacts of providing percent for mothers of two-year-olds, and from 13 percent to 55 percent for childcare supports: mothers of three-year-olds (European Commission, 2015). During the same • Employer of choice in competitive period, women’s labor force participation rate increased by 11 percentage points labor market to 69.3 percent, albeit still substantially below the rate for men of 77.8 percent • Staffing for 24/7 operations (Bundesagentur für Arbeit, 2016). The reforms included updated parental leave rights and a substantial investment in childcare. Parents are entitled to three years of job-protected leave per child. Since 2007, 14 months of this leave is partially paid (at approximately two-thirds of prior salary) as long as each parent takes at least two months leave (BMFSFJ, 2016). As an incentive for mothers to return to work earlier, and to make leave more attractive to fathers, paid parental leave can be extended and combined with part-time work (BMFSFJ, 2016). 4 Case Study: GERMANY SchÖn Klinik As part of efforts to increase the supply of childcare and improve the reconciliation of work-family life, the federal government has supported several initiatives. These include the support of knowledge-sharing networks for employers, the publication of company good practice examples, a free consulting service for companies interested in providing PHOTO: COURTESY OF SCHÖN KLINIK childcare, and financial subsidies for companies that invest in childcare supports (BMFSFJ, 2016). This case study discusses how Schön Klinik, a private hospital group in Germany, supports its employees with children through subsidized workplace childcare, summer camps, flexible working, and other supports that make it possible for them to stay at work and be productive. Childcare supports SCHÖN KLINIK NEUSTADT STAFF WITH THEIR CHILDREN. contribute to making Schön Klinik an employer of choice in a highly competitive labor market and help the company staff its 24/7 operations. The study is focused on Schön Klinik Neustadt Investment in early and preschool education was substantially in Holstein (Neustadt) in the north of Germany.1 expanded, and, from 2013 onward, all children age one and older have been entitled to at least four hours of publicly provided childcare per day (European Commission, 2015). COMPANY BACKGROUND Although elementary schools still typically operate for only half Schön Klinik is a private hospital group in Germany focused of the workday, 60 percent of secondary schools now offer on orthopedics, neurology, surgery, and internal medicine. full-day options (European Commission, 2015). Yet, demand The group has 9,500 employees across 17 locations and serves for childcare still substantially exceeds supply, particularly for approximately 100,000 patients annually. Schön Klinik is children ages one to three, and for noncore times (early in family-owned and was founded in 1985. The group follows a the morning, later afternoon, and evenings). The demand for patient-focused quality-oriented strategy that was recognized childcare for older children is better met (BMFSFJ, 2017). Only in an international study as providing “striking improvements about half of all childcare provision for preschool children is in outcomes and efficiency, and growth in market share” full time (largely corresponding to parents’ wishes), and only (Porter and Lee, 2013) and has won several awards for its 17 percent of elementary school children are in all-day care quality management in healthcare. In 2016, Schön Klinik had (BMFSJ, 2017). revenues of 796.8 million euros ($893 million) (Schön Klinik, 2017). 5 Case Study: GERMANY SchÖn Klinik BUSINESS CONTEXT FOR SUPPORTING CHILDCARE “There is a lot of competition in Three quarters of Schön Klinik’s employees are women, the hospital sector. Most of our including half of its medical staff, and almost nine in 10 of its staff could walk into a new job nursing care staff. As a hospital, Schön Klinik provides services tomorrow if they wanted. We around the clock and throughout the year. Although Schön Klinik’s main focus is on orthopedics, rehabilitation, and have to differentiate ourselves psychosomatic care, specializations where services can be as a good employer if we want to more easily scheduled than in some other medical disciplines, retain a good workforce.” the Neustadt hospital also provides accident and emergency care to patients. Neustadt is a tourist resort in the north of Michaela Preis, Human Resources Specialist, Germany and demand for such services swells during the Schön Klinik Group summer months, when the city’s population doubles from 100,000 to 200,000. Supporting its staff so they are able to provide quality service when it is needed is a key business anyone with the required qualifications. The demand for objective for Schön Klinik. skilled staff is very high.” Although Neustadt itself is not a big The labor market for doctors and skilled nursing care staff city, several other cities are within easy commute. is highly competitive and expected to remain so into the Terms and conditions in some of the hospitals in the Schön foreseeable future in response to the aging population and Klinik Group are set by collective agreements, but even the retirement of the baby boomer generation of skilled workers Schön Klinik hospitals that are formally outside of these (Blum and Löffert, 2010; Bundesministerium für Gesundheit, agreements tend to stick to the collective rates for most 2016). The majority of the new generation of doctors is female: staffing categories. As a result, the Schön Klinik hospitals 60 percent of medical students are women, and many expect only have limited options in terms of offering higher salaries a working environment that allows them to combine work to improve recruitment and retention. Given considerable and family (Bundesärztekammer, 2016). Schön Klinik Group overcapacity in the German hospital sector and financial and Human Resources Specialist Michaela Preis explained, “There structural reforms that tightly control reimbursement rates for is a lot of competition in the hospital sector. Most of our staff medical procedures, hospitals also operate with tight margins. could walk into a new job tomorrow if they wanted. We have In response to these pressures, Schön Klinik differentiates to differentiate ourselves as a good employer if we want to itself through its emphasis on quality management, both as a retain a good workforce.” The hospital is also competing for provider of medical services and as an employer. Recognizing nursing care staff with the growing eldercare sector. Thomas and supporting employees’ responsibilities as family caregivers Brachmann, Director of Personnel at Schön Klinik Neustadt, is an important component of Schön Klinik’s philosophy. explained, “The eldercare facilities around here will take 6 Case Study: GERMANY SchÖn Klinik HOW SCHÖN KLINIK SUPPORTS EMPLOYEES WITH CHILDCARE NEEDS Schön Klinik Group offers a large variety of childcare supports to its employees, including guaranteed spaces in a local childcare center, free childcare for workers in the early morning and late afternoon/evening hours, subsidized PHOTO: COURTESY OF SCHÖN KLINIK summer camps, back-up care, and free membership to a service that provides help with finding childcare or eldercare services. Schön Klinik also offers extensive options for working part-time and/or alternative shift patterns. The management of each of its 17 locations decides which of these childcare benefits to implement. At each location, any childcare benefit offered is open to all employees, irrespective of their gender or professional status. DIETER SCHÖN, CEO AND CHAIRMAN OF THE BOARD OF SCHÖN KLINIK, FACES QUESTIONS FROM THE PRESS AT THE OPENING OF THE NEW CHILDCARE CENTER FOR UNDER-THREES IN NEUSTADT. At Schön Klinik Neustadt, employees benefit from on-site daycare for children younger than three years old (U3 in German parlance), extended opening hours, subsidized Private-public partnership for an on-site summer camps, and a consulting service to help workers find childcare center solutions to childcare and other care needs. The impetus for In February 2014, Schön Klinik Neustadt opened the doors offering extended daycare and investing in childcare for under to a new childcare center with 20 spaces for children ages threes came when Dieter Schön, CEO and Chairman of the 2 months (the earliest a mother is allowed to return to Board of Schön Klinik, attended the opening of a new hospital work after giving birth under German law) to three years. wing in Neustadt in 2009. He was approached informally The 360-square meter U3 facility is on the hospital grounds by several employees who told him of their difficulties with and is the result of a private-public partnership (PPP) with finding childcare, especially during early morning and evening the local city government. Schön Klinik provided the land, hours and for children younger than three years old. He paid for two-thirds of the facility’s construction costs, and is committed then and there to the mayor of the city that Schön responsible for its maintenance. Building the facility took just Klinik would work with the city to find solutions to the area’s seven months. The city has leased the building for 25 years and lack of childcare. employs and pays for the staff. Barbara Hamann, Director of the crèche, explained that operating the crèche as a PPP has a lot of advantages for the company. In her words, “Running the crèche as a private-public partnership is much easier: if Schön Klinik had decided to run the facility itself, it would have been very complicated given all the regulations of childcare centers.” 7 Case Study: GERMANY SchÖn Klinik The manager of nursing care services at the hospital and father of a three-year-old who was in the crèche and is now “Running the crèche as a transferring to the childcare center for older kids, explained, private-public partnership is “The crèche was the reason that my partner, who manages much easier: if Schön Klinik nursing care services for one of the wards, came back to work had decided to run the facility just nine months after she gave birth to our son. We drop him off at 5:45 a.m. in the morning for a 6 a.m. start, and then she itself, it would have been very picks him up at 14:30 [2:30 p.m.].” Although there are core complicated given all the hours when parents cannot drop off or pick up, so as not to regulation of childcare centers.” disrupt the children’s routines, parents have some flexibility in the drop-off and pick-up times. Barbara Hamann, Director of crèche at Schön Klinik Neustadt Extended operating hours Since 2011, all publicly run childcare centers in the city, including the on-site early care center, offer extended hours, starting at 5:45 a.m. and potentially staying open until 8:30 p.m. Schön Klinik pays the city for the costs of extended care in Ten of the 20 crèche spaces are reserved for the children of all the city’s facilities; the use of the extended hours service is hospital employees; the other 10 are open to all Neustadt free for employees. In 2016, 35 employees, approximately half residents (but currently include another three children of of them mothers, made use of the extended opening hours for hospital staff). The center is operated by the city as a satellite their children. of a larger childcare center that caters to children ages three to six (when primary school starts), with joint spaces for 100 The on-site early care center is open from 5:45 a.m. until 5:00 children. Once children in the early care center reach age p.m. Initially, the center also offered extended evening hours three, they transfer to other public childcare centers in the until 8:30 p.m., but this was discontinued due to insufficient city. However, Schön Klinik has no reserved spaces for its staff demand. According to Hamann, “Most queries about the at this and other centers for older kids in the city; allocation availability of extended evening care come from parents is prioritized for local residents. This transition period can be before a child is born. But once the child is in the crèche, so difficult for employees. far no one has wanted to use the extended evening option. Parents are covering those hours in other ways, through The fees for care are set by the city and paid by parents grandparents or by working alternative shifts so that one directly to the childcare facility. For infants and children parent can drop off, and another pick up. So we no longer younger than three, the fee for full-day care, from 7:30 a.m. offer it.” to 4:00 p.m., is 390 euros ($435) per month. For children aged three to six, full-day care is 194 euros ($217) per month. There are also several part-day options for parents who work part- time, or who prefer part-time care for their children. 8 Case Study: GERMANY SchÖn Klinik Emergency and back-up care “Most queries about the Schön Klinik Group has contracted with a national service availability of extended evening provider that can help employees find childcare and eldercare solutions, whether on a long-term basis or just in a crisis care come from parents before a situation. The service can be accessed through a national child is born. But once the child hotline. The service is anonymous and Schön Klinik is only is in the crèche, so far no one provided with a count of different types of inquiries, but has wanted to use the extended no personal details. The service also acts like an agency, connecting families to care providers willing to provide in- evening option. Parents are home childcare or babysitting services. For routine daycare covering those hours in other services, Schön Klinik carries the costs of using the service ways, through grandparents or and the employee pays the costs of the actual care. In two of by working alternative shifts so its locations, Hamburg and Munich, both large metropolitan areas, Schön Klinik offers its employees 20 days of fully paid that one parent can drop off, and in-home emergency back-up care per year. So far, however, it another pick up. So we no longer has not been possible to offer this service to employees of the offer it” Neustadt Klinik because of a lack of babysitters or caregivers available to offer such services at short notice. Barbara Hamann, Director of crèche at Schön Klinik Neustadt Since the end of 2015, employees at Schön Klinik’s administrative headquarters in Prien, at Lake Chiemsee in Bavaria, can use a “child and parent” room that is equipped with a PC, mats, and toys for children. The space is available Although all Schön Klinik Neustadt employees can use one of to workers in a childcare emergency, for example, when their the 10 reserved places in the crèche, services in the childcare usual childcare arrangement falls through or when the child centers in the city are prioritized for residents. Nonresidents is mildly ill. Parents must stay with their children at all times. can only use the public service if there is no waiting list from Such an arrangement, however, is not possible in Schön local residents. They also need their local government to agree Klinik’s hospital locations because children cannot accompany to pay for the costs of the childcare place beyond the fees paid parents while they perform their work with patients in the by the parent. medical wards. 9 Case Study: GERMANY SchÖn Klinik Summer camps however, single mothers or fathers in lower-paid positions can apply to Schön Klinik for a 50 percent reduction of the fee. Schön Klinik Neustadt offers subsidized summer camps for Lunch, snacks, and all costs for trips and activities are included. children ages three to 12 years. Although public childcare Parents sign disclaimers, acknowledging that they carry any centers often are open during school vacations in the spring or risk of injury while their child is at the camp. fall, typically they are closed during the six-week summer vacation period. Parents of school-age children typically have Maternity, parental, and other paid leave enough paid leave to cover shorter school holidays. Under German law, employees are entitled to a minimum of 20 days Mothers and fathers at Schön Klinik are entitled to Germany’s of paid vacation, and many have 25 or 30 days based on statutory parental leave. Birth mothers receive 14 weeks of full-time work, prorated for part-time workers. However, paid maternity leave (of which eight weeks must be taken school vacations during the summer can present a real after the birth). The leave is paid at 100 percent of previous challenge for many working parents. The availability of salary, largely paid by the employer with some contribution commercial summer camps is limited outside the former East from the employee’s healthcare insurance (Blum, Erler, and German region, where it was—and still is—more common for Riemer, 2016). Each parent is entitled to up to three years mothers to work full time, supported by an extensive offering of job-protected leave, of which 24 months can be taken of childcare, including in the summer. In former West until the child is eight years old. Parents can receive up to 14 Germany, finding care can be more difficult. A female doctor months of parental leave per child, as long as each parent explained, “Between my husband and I, we can cover the fall, takes at least two months; the remainder can be freely shared winter, and spring school holidays of the kids through our between parents. Payment is approximately two-thirds of normal paid leave, but the six-week summer period would be prior salary (depending on the earnings level) and is paid by a real challenge. During the last six years my kids have used the federal government (BMFSFJ, 2016). the summer camp. This keeps me working at Schön Klinik.” In Parents of children born since 2015 can alternatively use 2016, 24 employee parents (12 female and 12 male) from Schön Parental Leave Pay Plus, which allows them to extend the Klinik Neustadt used the summer camp for their children. period of paid leave to 24 months (28 months if both parents The Schön Klinik Group started the “SCHÖNe Ferien” summer take leave) at half of their pay and combine it with up to 30 camp program on a pilot basis in one of the hospital locations hours of part-time work per week. Since 2001, both mothers in 2010, and now offers the program at all of its locations. and fathers have had the right to shift to part-time work, with Children can attend full time or part-time for a fee of 2 euros ($2.25) per hour, reduced to 1.70 euros ($1.90) for siblings. The “My kids have used the summer fee represents one-third of the costs, and Schön Klinik carries the other two-thirds, paid directly to the provider. The fee is camp for the last six years. This the same for all parents, irrespective of their earnings; keeps me working at Schön Klinik.” Doctor, mother of four children, working part-time 10 Case Study: GERMANY SchÖn Klinik Fathers are less likely to take parental leave, and the Parental Leave at Schön Klinik in 2016 overwhelming majority of employees (98 percent across Schön Klinik and 95 percent in Neustadt) who take parental leave are women. Still, the number of fathers taking parental leave is 514 women were on parental leave in Schön growing. In 2016, across the Schön Klinik Group, nine fathers Klinik (7% of all female employees), were on parental leave (0.4 percent of all male employees), including 53 in Neustadt. including three fathers in Neustadt. 9 men were on parental leave in Schön Klinik Under German law, employees are entitled to 10 days of paid (0.4% of all male employees), including leave to care for a sick child (capped at 20 days for parents of three in Neustadt. four children or more). These leave days are remunerated at 67 percent of salary, paid by the employee’s healthcare insurance. Schön Klinik recognizes that often when a child is sick parents may prefer to provide care themselves. Yet, given the costs of absenteeism, Schön Klinik is exploring ways of providing emergency back-up options to parents, as described earlier. a right to return to full-time work once their child is three years old. Working time flexibility In 2016, 7 percent of women employed by Schön Klinik (514 Schön Klinik Neustadt offers an array of alternative work women across its locations, including 53 in Neustadt) were on arrangements. The majority of its employees—66 percent of maternity/parental leave. Most mothers in nursing care jobs its female and 18 percent of its male workforce—work take a full year of leave and return to work on a part-time part-time. Part-time work is common across different types of basis once the period of paid leave is over. Among doctors it is work in the hospital, including among doctors. Male part-time more common to return after six months of leave, but working workers are most common in nursing care jobs. One mother part-time following leave is not uncommon. Typically, mothers explained that when she returned from maternity leave, she no longer breastfeed once they return to work, and Schön Klinik Neustadt does not have a dedicated breastfeeding location. “Some of our nursing care staff with kids work only nights, some work three days per week. We and they are keen to stay connected after childbirth. We have good scheduling software and can be very flexible.” Thomas Brachmann, Director of Personnel, Schön Klinik Neustadt 11 Case Study: GERMANY SchÖn Klinik sat down with her clinical director and discussed the working hours that would fit best for her and her team. Some wards “Thirty years ago, when the field and specialties are easier than others in terms of customizing working hours; she works in orthopedic rehabilitation, where of orthopedics and rehabilitation there is high level of part-time work. started to take off, hospitals could pick the doctors they Thomas Brachmann, Director of Personnel at Schön Klinik Neustadt, explains that given scheduling software, dealing wanted. Now it is the reverse, with varying shifts and working time preferences is not too and doctors can pick the hospital time intensive. However, he stressed that working time they want.” flexibility has to be give and take, respecting both the needs to provide 24/7 service and the work-family needs of employees. Dr. Peter Sand, Clinical Director for All employees will at some stage be expected to work less Rehabilitation and Director of Quality popular night or weekend shifts, he explained. To avoid Assurance, Schön Klinik Neustadt backlash, working less popular shifts cannot soley be the task of employees with fewer care needs. from parents or from other sources. The costs for Schön Klinik BUSINESS IMPACT OF SCHÖN were approximately 90,000 euros ($105,000) in 2016. Schön KLINIK’S CHILDCARE BENEFITS Klinik Neustadt is also responsible for maintenance and repairs on the building; these services are provided by Schön Klinik Childcare supports are an essential part of Schön Klinik’s Neustadt’s general maintenance staff. The crèche staff are efforts to recruit and retain medical staff in a tight labor directly employed and paid by the city. market. They are also integral to running 24/7 services and to realizing the company’s quality-focused business strategy. Schön Klinik Neustadt also pays the costs for the extended opening hours in the crèche and the preschool centers for Cost of providing childcare older children, as well as the costs for the summer camp. Under the agreement with the City of Neustadt, Schön Klinik Together these costs were approximately 90,000 euros Neustadt contributed two-thirds, or 870,000 euros ($105,000) in the last financial year, or 10,000 to 20,000 euros ($975,000), to the cost of building the crèche on the grounds per location per year were specifically for the summer camp. of the hospital, and the city contributed 380,000 euros ($425,000) (Schön Klinik, 2014). The building is the property of Schön Klinik and has been leased to the city for 25 years. These costs were carried centrally by the Schön Klinik Group. Under the agreement, the city and Schön Klinik each agreed to pay for half of any operational costs not covered by fees collected 12 Case Study: GERMANY SchÖn Klinik Childcare supports is one of several benefits offered by Schön Klinik Neustadt to set itself apart as an attractive employer. “Many young families are Other benefits include a focus on employee engagement attracted to Neustadt because it and involvement, starting with a structured induction period is a family-friendly small town. for employees, a staffing ratio that is perceived as allowing Yet, the first question we will enough time for patient care, a proactive approach to meet employees’ working time preferences, and access to its private typically get from potential healthcare services for all employees, irrespective of their applicants is, ‘Will I have a space individual insurance coverage. in a childcare center?’” Benefits for retention Thomas Brachmann, Personnel Director, Childcare supports also help Schön Klinik Neustadt retain Schön Klinik Neustadt experienced staff. The impact is particularly strong for new parents, but having a childcare center also reduces the likelihood that an employee will leave for another job. Benefits for recruitment Staff turnover is approximately 10 percent at Schön Klinik Neustadt, lower than in the hospital sector overall, according Childcare supports are an essential component of Schön Klinik to Brachmann. The 10 percent turnover rate partly reflects Neustadt’s recruitment package. After experiencing a the inevitable movement of junior doctors to expand their considerable surplus of doctors and other medical staff in the experience and medical expertise; turnover for nursing care 1990s, hospitals now face shortages, which are expected to staff is lower. last into the foreseeable future. The number of female doctors is increasing rapidly, and female, as well as male, doctors Having childcare on-site makes a critical contribution to expect good work-life balance, including supports for working improving maternity return rates, and to encouraging a parents. Dr. Peter Sand, Clinical Director for Rehabilitation, return that is before the end of a parent’s full leave allocation. Director of Quality Assurance, and a specialist in rehabilitation, Crèche staff help new parents transition to their new status explained that, unlike in the past, doctors can pick where they of being both a parent and an employee. “The crèche makes want to work. The labor market for nursing care staff is a big contribution by helping new parents to transition back similarly tight, and is expected to remain so well into the to work. New parents are often very nervous whether they foreseeable future. Thomas Brachmann, Director of Personnel will be able to manage both work and care, whether it is good at Schön Klinik Neustadt, explained that the hospital benefits for their child if they come back to work. The crèche provides from its idyllic location in a family-friendly small town by the good care, and it links them to other parents in similar sea, which makes it attractive to young families. Yet, one of situations,” said Brachmann. the first questions asked by many applicants is whether they will be able to get a space in a childcare center. 13 Case Study: GERMANY SchÖn Klinik Replacing experienced nursing care staff is costly and difficult. Supporting 24/7 operations Much of the knowhow of Schön Klinik’s staff is firm-specific, As a hospital, Schön Klinik Neustadt is open 24 hours each making it difficult to hire someone who can step straight day and needs to have care staff on-site to provide services. into a full task load. The director of nursing care services Childcare supports make this possible. Providing childcare estimates that it takes about three months for an experienced supports for parents during early morning hours ensures that qualified nurse to be a fully productive team member. It takes staff are available to provide services during the morning shift. considerably longer for a newly hired, newly qualified nurse Ensuring that parents are supported through summer camps to become fully productive. During the first three months during summer vacations, when usual childcare arrangements the new nurse mainly observes other members of the team; are often not available but when demand for services tends to during the following three months he or she is expected to be particularly high at the hospital, improves staffing during perform about 30 to 40 percent of a full task load, with about this critical period. The cost of the summer camp subsidy another 10 percent each of the following months until the provided by Schön Klinik is easily covered by the benefits of employee is fully productive. In specialist positions, such as greater staffing availability and reduced need for temporary intensive care or surgical nursing care, it takes up to two years. staff during summer months. It also takes a new junior doctor about six months to be able to carry a full load because during the initial months, he or she will primarily shadow an experienced doctor. The costs resulting from lower productivity are additional to any costs “Even if we do not offer crèches directly related to recruitment and selection or to the costs for temporary replacement of staff who have left. everywhere, all our locations offer some supports for The monthly salary for a relatively junior nurse is 3,000 euros2 ($3,360). Conservatively estimating a cost of approximately employees with kids. But we need four months’ salary to hire and train a new staff member to communicate more about the (there are no well-established estimates for the replacement different options. Employees are costs of healthcare staff (Jones and Gates, 2007)), the savings not aware of how much support from preventing one staff member from leaving because of lack of childcare are 12,000 euros, and 120,000 euros for we offer and how much we the 10 infant care places reserved for Schön Klinik staff in invest.” the childcare center. These retention-related costs alone Michaela Preis, Human Resources Specialist, cover Schön Klinik’s annual costs for childcare. In addition, the prospects of a crèche are also likely to motivate workers Schön Klinik Group with more long-term plans of having a family, and thus are multiplied beyond those who directly benefit in any given year. 14 Case Study: GERMANY SchÖn Klinik Quality management Working with partners Schön Klinik Neustadt has won several quality awards. For Schön Klinik Neustadt draws on the services and cooperation a private hospital that largely provides elective surgery and of a variety of childcare specialists to offer childcare services nonacute care, where patients have time, and information, in a cost-effective manner. This includes partnering with the to choose between providers, excellent quality ratings are City of Neustadt for its crèche provision and contracting with a critical competitive advantage. All staff are trained in private providers on the summer camps and on providing essential team processes to ensure quality; predictability access to childcare and care-specific consulting and referral and reliability of staffing are essential elements for delivering services. quality services. As Sand explained, “As long as there is predictability, everything is fine.” Childcare supports contribute Systematic needs analysis to predictability by improving attendance and retention of To assess demand, every five to seven years, hospitals conduct staff trained in the quality processes and procedures used in dedicated staffing surveys on the need for childcare and other the hospital. care supports. Importantly, as Preis explained, such surveys are only conducted if a hospital is willing to invest in childcare LESSONS LEARNED solutions as any such survey will raise expectations. Survey data can help to identify needs and target scarce childcare Given the German hospital sector’s tight labor market and resources. One recent survey found that there was a lower its largely female workforce, offering childcare benefits is than expected demand for childcare spaces, not least because arguably no longer optional. Schön Klinik has recognized some of the female doctors reported that their husbands or the importance of offering family supports to its employees, partners were the primary carer or had jobs, such as in and now provides a comprehensive set of childcare- teaching, that gave them more flexibility for working around related benefits across its 17 locations. However, in light childcare schedules. of the different childcare and labor market environments that characterize its 17 locations, Schön Klinik follows a decentralized approach to the benefits it offers to employees with children. “All of our locations offer at least something, but what precisely varies and is up to local management. “If we want to have good doctors, Rural locations have different needs and options than urban we have to do even more on locations. Regulations, such as the ratio of staff to children, differ across regions; different locations have different work-family benefits. The recruitment and retention needs. Only summer camps are health sector has fallen behind offered in each of our locations,” explained Schön Klinik Group employers in other sectors.” Human Resources Specialist Michaela Preis. Michaela Preis, Human Resources Specialist, Schön Klinik Group 15 Case Study: GERMANY SchÖn Klinik early morning or late evening hours when such services are needed. A doctor and mother of four children recounted, “The “The babysitting service tried to babysitting service tried to help find someone to pick my son help find someone to pick up my up from the childcare center at 3 p.m. while I am still at work. son from the childcare center at 3 It is impossible around here.” Schön Klinik is exploring p.m. while I am still at work. It is alternative options with its corporate partner. impossible around here.” Such constraints on childcare availability in the later afternoon also reflect traditional beliefs about the responsibilities Doctor, mother of four children of mothers, still held by many in the communities around Neustadt. Parents reported that it is hard to find care in the afternoon, from 3 to 6 p.m., when many childcare centers are closed. One mother noted, “In our area, they do not even offer On-site childcare is currently only offered in four of Schön something like a school bus to take children home at 3 p.m. Klinik’s locations. In some locations, public investment in The assumption is that as mothers we should not be at work childcare is now covering most of the demand for standard in the afternoon, and should be able to pick up our children care. Yet, because of considerable commutes for many of its ourselves.” The director of nursing care explains that this lack staff (in more rural locations, commutes of 50 to 70 km are of full-day care is a problem for many of his staff. He estimates not uncommon), on-site childcare is not necessarily a solution that approximately half of them have young children. that is very attractive to employees. Some have parents or in-laws who can step in, but many, particularly among the medical staff, have no nearby family. Constraints on expanding childcare supports While Schön Klinik has taken steps to expand the supply of Similar to many German employers, particularly in the 24/7 such care, its ability to progress will at least partly depend on service sector, Schön Klinik continues to be impacted by the changes in gendered cultural expectations in the communities lack of childcare provision outside of normal childcare and in which it has locations. school hours. The small town or rural locations of most of its Schön Klinik has made considerable progress in retaining hospitals limit the ease with which some options can be parents and finding scheduling solutions that meet both the offered. For example, ideally Schön Klinik would offer parents’ and the hospitals’ needs. Given that the working time emergency back-up in-home care service at most locations. preferences of parents are often fairly identical, as a result of However, currently this benefit can only be offered in its two school and childcare hours, the company is exploring more large city locations where there is a ready supply of caregivers proactive ways of putting together teams and working groups interested in doing such work. In the smaller and more rural to cater to diverse working time preferences. locations, it has not been possible to find people available on a short-term casual basis and/or willing to work during the 16 Case Study: GERMANY SchÖn Klinik Endnotes 1 Interviews for this case study were conducted in person by IWPR 2 Estimate is based on rates for a nursing care worker with five staff in Neustadt in Holstein in January 2017 with a cross-section of years’ experience (PraktischArzt, 2017a). The starting salary of Schön Klinik staff, including the Group’s Human Resource Specialist a junior doctor is approximately 4,300 euros ($5,060), and of a for Work-Life Benefits; Schön Klinik Neustadt managers for specialist 5,560 euros ($6,540) (PraktischArzt, 2017b). human resources, benefits, quality control; three employees using childcare facilities; and the director of the childcare center. References Bauernschuster, Stefan, Timo Hener, and Helmut Rainer. 2013. 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