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

A job rating scale for use in psychiatric rehabilitation.

Work has been a highly valued feature of psychiatric rehabilitation programmes. The performance of patients has often been the object of scrutiny and ...
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