The organisation scheme in the long-stay institutions is usually
very simple one. In Demir Kapija, the structure of organisation (organigram)
divides the institution into general service (administrative and technical) and
residential services, these are then divided into the wards. The ‘ward organisation’
coincides with spatial organisation (each service is ‘housed’ in a special
building or in a part of it). In Topansko Pole and Banja Bansko the services
are divided into the general (administration), residential[1]
and educational (occupational) services[2]
– the residential in Banja Bansko being divided according to age groups of
residents (dept. for nursing and care of up to 6 years old, 7–14, 15–26 and
above 26 years).
In Topansko Pole, the activities of their units are coordinated by a
series of managing bodies. Professional
collegium, consisting of director, deputy director, secretary, dept.
leaders, social worker, psychologist, doctor and others meets weekly (every
Monday) and deals with current affairs. Professional
council consists of deputy director (chairs), special educators, educators,
instructors and members of professional team (doctor, psychologist, social
worker) and they manage professional issues. Professional team consists of deputy director, doctor, social
worker and psychologist. The task of the team is observation and new
admissions, suggestions on users; it also undertakes field visits to assess the
situations of applicants. The managing
committee is the main organ of the institution that is overseeing the
management; accept the annual reports and programmes. In Demir Kapija, such
organs and meetings do not seem to be functioning, probably due to recent
frequent changes in management and atmosphere of demotivation of the leading
workers.
The majority of managers tends to be from the ranks of professional
workers (special educators, social workers, psychologists), sometimes the managers
are imported from political ranks or are recruited from the institution’s
administrative staff (jurists, economists). In the case of professional workers
as managers, they lack knowledge and training in management and organisation
(use of such profiles can sometimes be seen as a waste of professional knowledge
and skills, which are badly needed on the ground); while in case of managers
from the outside they lack the knowledge of disabilities issues and the social
care system. One of the best solutions seems to be embodied in the present
director of Demir Kapija, who has been employed in the administration of the
institution, finished the degree of management (in tourism, albeit), so she has
a good knowledge of the institution and also about management. The directors of
the institutions were and have been in most cases exposed to the ideas of
deinstitutionalisation, but have never had a systematic training on this topic,
especially from the point of managing the change and transformation. Neither
have they received support on these issues.
In addition to the issue of management skills issues and the problem
of coordination, we have observed two major problems in management of the
institutions. One is lack of stability of management due to political
recruiting of directors; another is the lack of authority and autonomy in
management. In the case of Demir Kapija, we have only in four months witnessed
four different managers, which is probably an extreme case. However, some of
the change can be attributed to the political changes.
Directors of care institutions feel and actually are constrained in
their decisions and resources management. Actually, they are more like
administrators of public resources and ministerial decisions rather than managers of public institutions. They
seem to be compelled to consult with the responsible civil servants and seek
their permission in the ministry regarding the financial decisions, handling
the resources, minor maintenance works and deals with firms performing them,
speaking to the press etc. The perception on the side of the ministry sometimes
seems to be that the directors lack initiative and are asking them permissions
in the matters that they have full authority to act.
Intervention of foreign and domestic external agencies and experts
(like us) make the lack of autonomy and authority of management even worse.
Dependence on donation, power delegated to the ‘intruders’ and absence of
vision and strategy make managers an easy prey and subvert their autonomous position.
Due to lack of training, organisational culture both in the
institutions as well as in Macedonia at large, the level and quality
of management and management support is low. The recruitment practices are
subject to political and clan affiliations, clear job descriptions are in
deficit as well as clear assessment procedures of staff (staff performance
plans), promotion prospects and training of staff are neglected
(especially with the staff with lower qualification, which often have led to
the demotivation and poor performance of the staff.
Professional groups or specialist activities are seldom formed as
formally distinct services, or any kind of formal units (e.g. psychosocial
service, health or medical service – sometimes some units are called
educational or rehabilitation units). However, the division of labour along the
professional lines is very strong and there is, in some institutions little
collaboration across the specialities. In Demir Kapija, which is probably an
extreme case, the division is rigid. The special educators undertake
‘defectology treatment’, nurses distribute medicines and take care of health
issues, while the care staff feeds, dresses, washes residents and keeps them
warm. The social worker is seen more as a part of administration – due to
location in the administrative building, but also because a major bulk of her
work is concerned with sorting administrative matters and relationships with
relatives and external authorities. Even when there is a group distribution of
tasks, they are distributed by the type of work and not shared by all
professions. A care worker said: “I never saw a defectologist change a diaper.”
Claimer: This blog is intended as a part of Situation Analysis
and Assessment/ Evaluation Report of Implementation of National Strategy on
Deinstitutionalisation 2008–2018, which will be soon presented to the
public within the EU framework project Technical assistance support for the
deinstitutionalization process in social sector. For this blog, Vlado Krstovski
and Andreja Rafaelič are considered to be co-authors.
[1] In Banja Bansko named ‘Service for rehabilitation and
socialisation’, in Topansko Pole ' Department for health with accommodation
(internat) and kitchen'.
[2] In Banja Bansko named ‘Education service', in Topansko Pole
'Department of education, work training and training for production work and
day centre for adults’. In the latter case, deputy director is the leader of
educational unit.
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