Brit. J. Ps,chiat. (1976), 128, 462-6
A Job Rating Scale for Use in Psychiatric Rehabilitation By ALISTAIR
Summary. programmes.
E. PHILIP
and JOHN
W. MOORE
Work has been a highly valued feature of psychiatric rehabilitation The performance
of patients
has often been the object
of scrutiny
and assessment, but the jobs performed by these patients have not been so assessed. This paper describes the development and use of a job rating scale which parallels the use of patient assessment instruments.
INTRODUCTION
and the other of job difficulty.
Rehabilitation oflong-stay psychiatric patients has been a feature of mental hospital activity over the past ten to fifteen years. While the concept of work as a part of psychiatric treat ment and care is long established (Bangour Village
Hospital,
for example,
was built in 1906
to a plan which aimed to make it a self-contained community with work places, dwelling places and so forth, hence the term ‘¿Village')the development of Industrial Therapy Units de signed to train people to work to everyday standards is a phenomenon of the 19605. The formation of such units usually led to a reduc tion of the number of patients employed in hospital
utility
departments,
many
Assessments
of
the former are frequently carriedout,usually in a structured fashion similar to that described by Cheadle ci al (1967), but the grading of jobs does not appear to have been tadded in the same structured way. This paper reports the outcome of applying formal rating scales to the jobs available in one hospital. METHOD
Bangour Village Hospital, cated,
was designed
to cater
as previously indi for patients
who
were seen to require long-term care. At 31.7.74 the hospital had 733 in-patients. One hundred and fivepatientswere in acute admissionor rehabilitation wards, 221 patients were in designated psychogeriatric accommodation, while the remainder, 407 in all, were long-stay patients. Most of these were fairly quiescent schizophrenics, with a sprinkling of depressed,
of the jobs in
these departments becoming incorporated into a rehabilitation work programme. In such a programme there is usually some incentive pay ment scheme in operation, patients being paid sums which vary according to how well they have been seen to work. Incentive payment schemes attempt to simulate some of the features of outside employment. Patients are paid accord ing to the quantity and quality of their work, their timekeeping and the like. Conceptually these incentive schemes are closely related to the notion that hospital rehabilitation must be geared to discharging patients to the outside world and outside work. The amount of money which can be dis bursed to any individual as an incentive pay ment is, of course, very small, and for any such scheme to function properly two assessments must be made, one of the worker's performance
epileptic
or mentally
handicapped
individuals.
A total of fifty jobs within the hospital were seen to be rehabilitative, the individuals em ployed in them being eligible for incentive payments. Twenty-five of the jobs were in service
departments
of the hospital,
the others
were various activities supervised by the OT Department One hundred and eighty-three patients were engaged in these fifty activities. A Job Rating Scale was devised in which each of eleven aspects of work were rated on a three-point scale (see Appendix ‘¿A'). The aspects of work covered by the scale derive from distillations of ratings of work performance factors made by supervisors, and from other 462
BY A. E. PHILIP AND J. W. MOORE
463
TAaiil Details of jobs assessed on the Job Rating Scale
of'Jobnumber JobNumber Job titleDepartment
i
Storeman
2
Typist/Duplicator
Op.
patientsrating
Stores
4
17
O.T.
I
57
O.T. Tailors Library Laundry O.T. Gardens Gardens Hosp. Shop O.T. Gardens Nurses Home
9 2
57 17 i8
i 1 i I I 3
19 ‘¿9 19 19 19
3 4 5 6 7 8 9 10 ii
Woodwork Grade ‘¿A' Tailor's Assistant Librarian Hand Ironing Gardening Assistant Groundsman Paperboy Greenhouse man Domestic Assistant
52
Assistant
53 14 15 i6
Clerk/Clerkess Cosy Corner—Serving C.S.S.D. Canteen Worker
O.T. Patients' Cafe Industrial Unit Industrial Unit
Gardener
Gardens
‘¿9
5 2 10
20 20 21 2!
17
Domestic
O.T.
i
i8 59
Mop Assembly Storeman
Industrial Unit O.T.
2 i
2! 21
20
Steamair Finishing
Laundry
2!
Dishwasher
Patients'
22 23 24
Ward Kitchen Hand General Garden Lab. Garden Labourer
Wards O.T. Gardens O.T. Gardens
25
Cashier
Patients'
26
Domestic Assistant
Domestic
I
27
Transport
Transport
i
25
28
Woodwork Grade ‘¿B'
O.T.
53
25
29
Packing
Laundry
30
Packing and Checking Sainsbury Stencils Stage 2 Dismantling Waitress Label Assembly Mary Qpant Dolls Table Tennis Balls Stage i Dismantling
Industrial Unit Industrial Unit O.T. Phones Contract Hosp. Shop Industrial Unit Industrial Unit Industrial Unit O.T. Phones Contract
32 33 35 37
Portering
Cafe
i
2!
3
22
5 4 4
22 24 24
Cafe
25
2
25
6 4 23 i 8 so 8 5
25 25 25 26 26 26 26 26
Leather Punching
Industrial
i
26
39
Packing Relays
O.T. Phones Contract
2
26
40
Press
Laundry
4
27
4!
Sewing Roli Callender+Folding Tables Paintshop Activities OddJob Man ‘¿A'
Sewing Room Laundry Nursing O.T. Gardens
2 4 5 ,
27 27 27 28
45
Garden Labourer
Gardens
i
28
46 47 48 49
Break-OIls Porter Cleaner Darts
Industrial Unit Hoep. Porters Transport Industrial Unit
io
28 28 28 29
50
OddJobMan'B'
Gardens
43
Room
Unit
24
2
29
A JOB RATING SCALE FOR USE IN PSYCHIATRIC REHABILITATION
464
assessment forms used by these supervisors in industrial rehabilitation units (Moore, 1973). A team of three raters, psychologist, occupation therapist and Nursing Officer, discussed every job with the appropriate supervisor before agreeing on a team rating for each of the eleven aspects of work being rated. The score for any particular job was obtained by adding the ratings for each item in the scale. The theoretical range of scores is from i i (denoting a very demanding job) to 33 (denoting a very un demanding job). For comparative purposes a fairly low level production line job, packing potato crisps in a local factory, was rated using the above procedure. RESULTS
Table I lists the jobs ranked according to their score
on the rating
scale.
The
department
in
which the job was based and the number of patients employed on such jobs are also listed. The most demanding jobs have a score of 17,
the least demanding
that of 29. The median
job ratmg is 24@5, and the distribution
of scores
is such that it is possible to group the fifty jobs into four grades, each having approximately the same number of jobs. Table
II shows
the grades
and
number
Rating
Scale.
Considering work places by grades, it is found that most work places are in Grades C and D. Table III showsthe number of work places by grade for utility departments and rehabilitation departments. Two thirds of the available work places in this hospital are in Grades C and D. Once again, utility departments differ from
T@ii II Number ofjobs in each grade
jobsn
Dept jobs
Rehabilitation
jobsAll
GradeUtility
%A
%
B..
[email protected] 4O@
[email protected] ..8
n
32@O 20'O i6@o 12-0II22@O25 32@O 5
ioo@o
4 8 10 3
%n-
i6.o 32@052
5324@O
ioo@o50ioo@oTABlE 25
IIIWork gradeGradeUtility
places available at each
Dept places placesn %n%A
B C D..
%
.. .. ..54
52
5 15 17'546
of
jobs in each for utility and rehabilitation areas respectively. Jobs in utility departments tend to be either very demanding or very easy. Reha bilitative work tends to fall mainly in Grades B or C. While there are fifty different jobs, there are 183 work places. Fig I shows the number of work places available at each point on the Job
Rehabilitation placesAll n
30.4
12
26@I
28
20'4
8@8
IO@9
8o
58-4
32@6
57
I2@426
I0O'O
537
ioo@o183ioo@o
40
2I@9
85
46@4
32I4@2
BY A. E. PHILIP AND J. W. MOORE
465
produce different results, but there is no doubt that a comparative assessment of jobs available as well as an assessment of patients is necessary to any rehabilitation programme. Hospital populations change, some patients leave, some remain and grow old, for others the revolving
*5
*0
door spins merrily. As the population changes so also do ideas about rehabilitation. Token economies and resocialization programmes can make use of incentive money and can claim to be effective in reducing institutionalism and dependence. Work is not the only form of rehabilitation available, and the introdssction of choice between kinds of rehabilitation necessitates an evaluation of what is offered by the competing programmes. Job assessment can
3,
130
25
120
15
help 10
5
@
@D
@Y
@V
if
@L 222
303
2@
IASIPS
@)
differentiate
departments
which
are truly
SCOU
Fio i .—Number of patientsat eachjob ratinglevel. rehabilitative
those jobs
rehabilitative from those which are diver sional. It can help to clarify thinking about the function of jobs which may have outlived their usefulness, and finally, in conjunction with some form of worker assessment it can help in placing the right patient in the right job.
in grade distribution;
utility work placements tend to be very easy or very difficult while one half of all rehabilitative work places fall in Grade C. The factory job rated for comparative pur poses (crisp packing) was given a score of 21, which places it among the Grade B jobs. If it were included in Table I it would have a rank of i8, showing quite clearly that most hospital work activities are much less demanding than this typical unskilled factory job.
Acx.?iowtanor.J.lEwn This study would
co-operation Village
without
the
Hospital.
Special
thanks
are
due
to Mrs
A.
Wallace and Mr L. McMahon who helped rate the jobs. REFERENCES
C!w.i@rn2,J.A., CUSHINO, D., Da@w, C. D. A. & Moao@,
R. (1967)The measurement of the work performance of psychiatricpatientL BritishJournalof P4ychiat!y, 113, 841—6.
MooRE,J. W. (ig73) An Applicationof the Reperto@y Grid. Unpublished thesis, Brunel University Library. APPENDIX
DISCUSSION
The Job Rating Scales provide a good comparative ordering of jobs available for rehabilitative activities. While it would have been desirable to have had more ratings of jobs outside hospital, the present results show that jobs with a rehabilitative function vary greatly in the demands they make upon patients. For Bangour Village Hospital it is clear that there are few jobs which bear comparison with outside work, and these jobs are found more frequently in the utility departments than in the rehabilitation units. Other hospitals may
not have been possible
of all the work supervisors at Bangour
‘¿A'
iTEMS OF THE JOB RATING SCALE
A Control over standard of product (i)
Consistently
high
level
of accurate
movements
or mental operations required. (2)
Concentration
required
to
keep
standard
product consistent. (@)Precision irrelevant, e.g. movements
of
guided
entirely by jigs or other apparatus.
B Speed of work and adaptation (i)
Requires
high-pace
adaptive
work
to
a fluc
tuating schedule or machine cycle. Low fre quency of pauses.
466 (2)
A JOB RATING SCALE FOR USE IN PSYCHIATRIC REHABILITATION Moderate
speed
of work
to a predictable
fixed
schedule or machine cycle. Low frequency of pauses. (3) Speed irrelevant; not schedule, machine cycle or production-line work. High frequency of pauses.
(@)Job does not generate any frustrations (e.g. equipment
malfunctions).
G Level of supervision (i)
Individual
required
(2) Intermittent
C Level of competence in use of machinery and job related apparatus (i)
Requires
competent
use
of
sophisticated
(2) Tools
rudimentary,
require
minimal
skill
D Complexity of learning (i)
Requires
learning
of complex
(2) Requires
learning
of simple
Requires
high some
speed
of learning.
constant
as job
pro
F Emotional demands of job (2)
High
level
Involves
of stress, minor
critical,
complete
reliability
(2) Some
absence
tolerable,
timekeeping
must
major
other departments and the public. (2) Requires
harmonious
and
co-operative
work
a group of people.
irritations,
solving.
(i)
Impeccable
i.e.
minor
solving. problem
cleanliness
required,
foodstufl@ (2) Work
must
be kept
clean.
(@)Cleanliness unimportant in job. K Hours
problem
(1)31
worked
each week
to 40 hours.
(2) 2! tO 30 hours.
(3) Up to 20 hours.
Alistair E. Philip, M.A., Ph.D., Dip.Clin.Psychol., Principal Clinical Psychologist, John W. Moore, Psychological Assistant, Department of P@ychology,Bangour Village Hospital, Broxburn, W. Lothian EH52 6LW (Received 4 March 1975)
be
good (3) Timekeeping not important, hours flexible.
3 Standard of cleanliness required
learning
(@)Low level initial learning; fairly automatic procedures.
(i)
work
(3) Independent of other workers.
E Speed of learning (2) Requires
from
(i) Requires stableinterpersonalrelationships with
only.
(3) Requires little learning, e.g. low-level assembly work.
(i)
Absence
required.
I Group behaviour and interpersonal demands
procedures. task
supervision.
H Timekeeping requirements
in
effective use. (,@)Jobdoes not require use of tools or apparatus.
initiative—little
(@)Constant supervision. (i)
machinery.
to exercise
supervision.
e.g.
handling
in