| Abstract | Ovaj se doktorski rad bavi temom iseljavanja zdravstvenih radnika/ca iz Hrvatske u novije vrijeme. Glavni je cilj rada utvrđivanje i razumijevanje ključnih, ali i svih ostalih relevantnih čimbenika koji sudjeluju u procesu donošenja odluke zdravstvenih radnika/ca o iseljenju, kao i različitih kontekstualnih varijabli koje na taj proces mogu utjecati. U tu je svrhu provedeno kvalitativno istraživanje, a kao metoda istraživanja odabrana je metoda polustrukturiranog intervjua. Ciljane su populacije iseljenih, ali i neiseljenih zdravstvenih radnika/ca, kako onih koji su razmišljali (ili razmišljaju) o iseljenju tako i onih koji tu opciju ne razmatraju. Intervjuirano je ukupno 45 zdravstvenih radnika/ca, a svi intervjui su, i to zbog konteksta pandemije bolesti COVID-19 tijekom koje se istraživanje odvijalo, realizirani na daljinu putem internetskih komunikacijskih platformi. Materijal dobiven istraživanjem analiziran je i obrađen metodom tematske analize po pristupu analize obrazaca. Ovom analizom identificirano je pet tema koje grupiraju čimbenike relevantne za iseljavanje zdravstvenih radnika/ca iz Hrvatske: organizacijski kontekst hrvatskog zdravstvenog sustava, društveno-politički kontekst suvremenog hrvatskog društva, profesionalne aspiracije zdravstvenih radnika/ca, kvaliteta života te sistemsko nasilje. Od toga su kao ključne za tumačenje fenomena iseljavanja zdravstvenih radnika/ca prepoznate teme organizacijskog konteksta zdravstvenog sustava te društveno-političkog konteksta, a kao integrativna, odnosno transverzalna tema u odnosu na prethodne dvije, tema sistemskog nasilja unutar zdravstvenog sustava. Ključni čimbenici iseljavanja bili su sljedeći: neuređenost te visoki stupanj politizacije zdravstvenog sustava, percepcija visoke razine korupcije i nepotizma u zdravstvenom sustavu i društvu, izostanak meritokratskih principa u sustavu i u širem društvu, opća klima apatije i beznađa, kako u sustavu tako i u širem društvu. |
| Abstract (english) | This doctoral thesis deals with the topic of recent emigration of healthcare workers from Croatia. The phenomenon of emigration of Croatian healthcare workers to more developed countries and the consequent change in the structure of the health sector have been noticeable for several years, especially since Croatia’s accession to full membership in the European Union in 2013. Compared to other professions, the probability of further emigration of doctors and other healthcare workers from Croatia is particularly high, as well as the risk of the consequences of such emigration in terms of shortages on the labor market. So far, research into this phenomenon has been almost exclusively carried out within the framework of quantitative methodology, and also mostly by healthcare workers themselves, which significantly contributed to the initial insights into the motives of emigration of healthcare workers from Croatia and their mapping. However, we noticed that this phenomenon is insufficiently researched from the perspective of social sciences, with their specific theoretical and methodological approaches, and we considered in-depth research of this phenomenon to be particularly fruitful in terms of gaining a better insight into the perspective of the healthcare workers themselves. Therefore, we have chosen qualitative methodology for our research, which offers the possibility of gaining deeper insight into the perspective of the actors of the phenomenon itself. The main goal of the thesis is to determine and understand key factors, but also all other relevant factors that take part in the decision-making process of healthcare workers on emigration, as well as various contextual variables that can influence this process. For this purpose, qualitative research was conducted, and the semi-structured interview was chosen as the research method. The target population were healthcare workers in emigration, as well as healthcare workers still living and working in Croatia and considering emigration, and those who are not considering that option. A total of 45 healthcare workers were interviewed, and due to the context of the COVID19 pandemic during which research took place, all interviews were conducted remotely via online communication platforms. Because of the triangulation that we used as a methodological approach, whereby we were given the opportunity to compare the perspective of emigrant healthcare workers with the perspective of non-emigrants who are not thinking about emigration, and non-emigrants who are considering emigration, we gained insight that can explain the differences between these groups. These differences can point us to some explanations of the phenomenon itself, which would not be possible if we conducted research including only one of these populations. The material obtained from the research was analyzed and processed using the method of thematic analysis based on the pattern analysis approach. This analysis identified five themes that group factors relevant to the emigration of healthcare workers from Croatia: organizational context of the Croatian healthcare system, socio-political context of contemporary Croatian society, professional aspirations of healthcare workers, quality of life and systemic violence. Of all these, the themes of the organizational context of the healthcare system and the sociopolitical context were recognized as key for the interpretation of the phenomenon of emigration of healthcare workers. In the area of the organizational context of the Croatian healthcare system, we single out the following as key factors of emigration: the absence of meritocratic principles, bad interpersonal relations and mobbing, a high degree of politicization of the profession and the healthcare system, as well as the perception of a high degree of corruption and nepotism. These emigration factors related to the organizational context of the healthcare system are actually a reflection of the broader context of Croatian society, and a clear link between these two groups of factors can be seen in this sense. The key emigration factors of healthcare workers related to the socio-political context of Croatian society are the following: the perception of a high level of corruption and nepotism, the general social climate of apathy and hopelessness, the absence of meritocratic principles, that is, the feeling of the absence of the rule of principles of justice and honesty in society. We also highlight the topic of systemic violence, which, through a different and new lens, covers the issue of the work experience of workers in the healthcare system. Although this topic overlaps with other topics to some extent, since it has transversal characteristics, it is important to emphasize it through the phrase “systemic violence”, because this phrase has a completely different meaning and implications in public discourse than the phrase “organizational context”. The phrase “systemic violence” refers to the severity of the conditions of work and functioning in the system in which such a phenomenon is present, for all its stakeholders, both workers and patients, as well as the urgent need to act in terms of public policies. Given that this topic is relatively under-researched in Croatian sociology, the thesis certainly represents a significant scientific contribution to the study of the topic and the understanding of this phenomenon, from the perspective of the broader field of social sciences and humanities. The scientific contribution manifests itself, on the one hand, in the theoretical contribution of the work for the analysis and deeper understanding of the factors of emigration of healthcare workers from Croatia, and through empirical contribution and innovation on the other, because it represents the first systematic and comprehensive qualitative study of the emigration of healthcare workers. The additional scientific value of the thesis manifests itself in the potential application, since research results can eventually help in (co-)creating public policies and measures in Croatia that relate to the target population of workers in the Croatian healthcare system, i.e. that affect the position and perspectives of health of workers in Croatia, their aspirations for emigration by staying or returning. |
