Application of an Impact of Restructuring Scale to the Healthcare Sphere

Job loss and job insecurity are frequently associated with today's widespread restructuring and downsizing of the workplace. The authors have developed an Impact of Restructuring Scale that quantifies the effects of restructuring in the healthcare sphere. The scale documents the effects of the resulting cutbacks, hospital mergers and hospital closings on two areas: quality of healthcare services and effects on staff. The study described in this article applies the scale to the healthcare sphere as reported in a sample of 1,363 nurses employed in hospitals that were being restructured. The nurses returned a self-report questionnaire in which they reported their reactions on a variety of measures designed to assess extent of restructuring initiatives, stressors, hospital support, job satisfaction and distress. Results showed that predictors of the impact of restructuring on nurses include restructuring initiatives undertaken by the hospital, deterioration of hospital facilities and services, work stressors (e.g., workload, bumping, use of generic workers) and social support. Hospital restructuring was also associated with lower job security, diminished job satisfaction and increase in depression, anxiety and somatization.     

工作场所暴力对商丘市医务人员工作能力、工作满意度和转岗打算影响的通径分析

目的以职业紧张理论为模式探讨工作场所暴力对医务人员工作能力、工作满意度、转岗打算的影响,为科学评价工作场所暴力的作用过程和不良后果提供理论依据。方法采用分层整群随机抽样的方法抽取河南省商丘市5家市级医院483名医务人员作为研究对象,运用自制调查表对其遭受工作场所暴力、暴力恐惧、暴力应对资源、工作能力、工作满意度、转岗打算等情况进行调查。采用有序结果变量回归和通径分析探讨各变量的关系。结果通径分析显示:(1)工作场所暴力既可直接影响工作能力和工作满意度,又可间接通过暴力恐惧影响工作能力和工作满意度。(2)工作场所暴力通过暴力恐惧、工作满意度间接影响转岗打算。结论遭受工作场所暴力可以通过直接或间接作用影响医务人员的工作能力、工作满意度、转岗打算。应采取措施,控制工作场所暴力的发生以降低其不良影响。     

Occupational stress in health service employees.

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.     

Hospital restructuring,workload, and nursing staff satisfaction and work experiences

This study examined changes in patient-nurse ratios resulting from hospital restructuring and the relationship of such changes to nursing staff satisfaction, psychological health, and perceptions of hospital functioning. Data were obtained from 744 hospital-based nursing survivors using questionnaires. Fifty-three percent of staff nurses indicated an increased patient-nurse ratio. Nursing staff indicating increased ratios generally reported less job satisfaction, poorer psychological (but not physical) health, and less effective hospital functioning.     

Staff views of a hospital at home model implemented in a Scottish care setting

PurposeDemographic and financial challenges mean prioritising a shift in healthcare provision from acute to community settings. One well-evidenced model encapsulating this is ‘hospital at home’, however limited research has examined staffs'' views on its implementation, which may inform service development and increase job satisfaction. The aim within was to explore the staff perspective of implementing a ‘hospital at home’ model in a Scottish care setting which can inform service provision and ultimately increase job satisfaction.MethodsThe ‘Acute Care @ Home’ (AC@H) service had a multi-disciplinary team. Referrals were predominantly received from a geriatric hospital ward. Inclusion criteria were older adults with geriatric syndromes and who required care input for a duration between one to seven days. In-depth staff interviews (N = 13) were conducted and analysed thematically to understand barriers and facilitators to implementation. These were supplemented with questionnaires assessing constructs of interest including training, communication and overall satisfaction.ResultsSeveral themes urged from our study: inter-team and intra-team collaboration, service development and operation, and scaling considerations. High job satisfaction was reported (mean score 73%), particularly due to a perceived non-hierarchical team structure and inclusive management style. Staff attributed positive outcomes through better identifying patients'' needs at home compared to in hospital. Continuity of care facilitated rapport building. Recruitment challenges restricted the acuity and volume of patients the team were able to care for.ConclusionsThis qualitative methodology could be useful for future implementation of intermediate care resources for the future health and care system building. Patient assessments at home, as opposed to in hospital, in conjunction with care continuity by staff, may mitigate against hospital risks and better facilitate reablement. Where recruitment challenges are present, agile models of care delivery should be considered.     

医护人员工作综合满意度影响因素的通径分析

目的 通过对医护人员的工作综合满意度现状进行调查研究,摸清医护人员工作综合满意度的影响因素,探讨各因素之间的内在关系,为提高医护人员的综合满意度提供依据.方法 采用自行设计的〈医护人员工作满意度影响因素研究调查问卷〉,问卷内容主要包括领导状况、医院综合状况、工作状况、工作回报及公平性、人际关系、职业发展、工作综合满意度等纬度.在4家医院随机抽取总计300例医护人员进行调查,其中医生125例,护士175例.应用多元线性回归、相关及通径分析等方法,对工作综合满意度的影响因素进行分析,揭示因素间的内在关系.结果 本研究的剩余通径系数U为0.305,U2为0.093,其值较小,说明工作综合满意度的大部分都可以通过已纳入的纬度指标来解释,其不能解释的部分仅为9.3%.医护人员的综合满意度的直接影响因素有职业发展、医院综合状况、工作状况,其通径系数分别为0.470、0.326、0.214;而领导状况、工作回报及公平性、人际关系是间接影响工作满意度.结论 初步确定了影响医护人员工作综合满意度的直接因素为职业发展、医院综合状况、工作状况,而间接因素为领导状况、工作回报及公平性、人际关系;通过本次研究,希望能为今后提高医护人员工作综合满意度的政策研究及决策提供依据.     

Impact of Restructuring Scale: An Instrument to Measure Effects of Hospital Restructuring

As restructuring and downsizing occur throughout the workplace, many individuals are either losing their jobs or experiencing job insecurity. The study of downsizing is particularly important within the healthcare system where hospital mergers and closings, and severe cutbacks, have dramatically reduced healthcare services. Since nurses are the largest group employed by hospitals, they are the most likely to be affected by recent cutbacks. All this leads to the conclusion that a measure of the impact of restructuring is needed. This study reports on the Impact of Restructuring Scale — a new scale containing acceptable psychometric properties — that quantifies the effects of restructuring on organizations and individuals. The scale was applied to a sample of 1,363 nurses employed in hospitals undergoing restructuring and downsizing. The nurses returned a self-report questionnaire in which they reported their reactions to hospital restructuring and to specific job stressors.     

The progress of reforms: job satisfaction in a typical hospital in Estonia.

OBJECTIVE: To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction. DESIGN: Questionnaire survey. SETTING: P?rnu County Hospital in Estonia. STUDY PARTICIPANTS: All staff members of the P?rnu County Hospital (n = 673), except 56 staff members who were away from work during the study. RESULTS: Respondents (n = 473) indicated an average job satisfaction level of 3.86 +/- 0.81 on a 5-point scale. The efficiency of hospital management as measured by planning, relationships with supervisors, knowledge and communication regarding hospital goals, plans, quality of services, budgetary situation, and staffing problems was positively correlated with job satisfaction. Stress and unrealistic expectations were negatively correlated with job satisfaction. The feeling of being part of the organization was also correlated with job satisfaction. Recognition from supervisors and discussions with colleagues were found to be weakly correlated with job satisfaction. There were differences between occupational categories. CONCLUSION: The management of P?rnu County Hospital has been able to create good supervisory relationships with staff by providing sufficient information about the goals of the hospital, the quality of services, the budgetary situation, and staffing problems that arise. Stress levels reported are not excessive and staff are loyal to their hospital.     

Workplace violence and its effect on burnout and turnover attempt among Chinese medical staff

The present study was to evaluate workplace violence and examine its effect on job burnout and turnover attempt among medical staff in China. A total of 2,020 medical employees were selected from Fujian province by using stratified cluster sampling method. The Chinese version of the Workplace Violence Scale and the Maslach Burnout Inventory–General Survey were used to measure the workplace violence and job burnout, respectively. Other potential influencing factors for job burnout and turnover attempt were collected using a structured questionnaire. The incidence of workplace violence among medical staff was 48.0%. Workplace violence had a positive correlation with emotional exhaustion and cynicism and a negative correlation with professional efficacy. Workplace violence, marital status, employment type, working time (≥ 10 h/day), performance recognition, and life satisfaction were significant predictors for turnover attempt among Chinese medical staff.     

上海市杨浦区某社区卫生服务中心职工工作满意度及离职意愿调查

目的了解社区卫生服务中心的职工流动性和工作满意度的现状,以便更有效地提高社区卫生的管理水平。方法采用自填式的工作满意度问卷调查,对数据进行统计描述和Logistic回归分析。结果社区卫生服务中心职工工作满意度属于"一般"水平,婚姻、年龄、学历、工作年限、目前职位和人事关系因素对部分的工作满意度维度有影响;工作满意度与离职意愿呈负相关。结论需重视社区卫生服务中心职工工作满意度测量,针对重点人群对于工作满意度较低的维度进行干预,从而进一步提高职工满意度。     

郑州市综合医院医务场所暴力与医务人员工作倦怠的关系

目的:探讨郑州市综合医院医务场所暴力与医务人员工作倦怠的关系。方法:整群抽取郑州市6所综合医院,随机抽取医务人员1265名,采用自制暴力问卷和工作倦怠量表通用版(MBI-GS)进行暴力经历和工作倦怠调查。结果:暴力发生率为46.1%;遭受过暴力(包括不同形式暴力)的医务人员在工作倦怠的情绪衰竭和去人格化两个维度得分差异有统计学意义(P<0.05);不同暴力来源医务人员的去人格化维度得分差异有统计学意义(P<0.05);采取不同应对方式的医务人员在去人格化和个人成就感维度的得分差异有统计学意义(P<0.05)。结论:医务场所暴力可以引起医务人员工作倦怠,导致工作满意度降低、情绪衰竭、消极怠慢等。     

公立医院医务人员工作满意度影响因素与治理机制

针对当前医务人员工作满意度偏低、医患矛盾突出的社会现状,现有医务人员工作满意度研究缺失考察患者对医务人员的理性尊重、认可、信任,现行社会医疗体制、公共舆论环境等内容及条目设计,也缺乏将医务人员满意度测评与多元利益相关主体协同治理体系结合起来等理论与现实问题,本文在大量文献研究基础上,界定了治理视角下公立医院医务人员工作满意度概念;提出了"工作本身、组织管理、工作条件、工作回报、人际关系"五要素测评的内在维度;厘清了政府—医患—社会层面参与公立医院治理的主要利益相关主体以及各自职能、权利与社会医疗责任,探寻了影响医务人员工作满意度的外在治理因素;构建了医务人员工作满意度概念及多元协同治理结构逻辑模型,分析了各主体之间及其对医务人员工作满意度的作用机制;针对性提出了治理机制框架及思考,供学界争鸣与讨论。     

Job Satisfaction Among Hospital Nurses: Facility Size and Location Comparisons

Despite recent declines in turnover and vacancy rates, maintaining a stable nursing staff continues to be critical to the effective operation of American hospitals. Job satisfaction is a pivotal element in nurse retention, and organizational theory suggests that some of the factors that influence job satisfaction vary by facility size. This is a study of job satisfaction among a sample of 731 nurses providing direct patient care in 22 hospitals. The sample includes approximately equal numbers of nurses employed in very small rural hospitals (1-49 beds), medium sized facilities located in small towns (50-99 beds), and larger metropolitan institutions (> 100 beds). Differences by hospital size were observed in overall job satisfaction and in five sub-dimensions of that concept (i.e., professional status, task requirements, pay, organizational policies, and autonomy). With the exception of pay, the results indicated that nurses employed in the very small rural hospitals were more satisfied with their jobs. Differences by hospital size were also observed in the personal characteristics of the nurses, several specific aspects of their job, and in their perceptions of job mobility. A set of four hierarchically nested ordinary least squares regression models indicated that job-specific characteristics were the most powerful predictors of job satisfaction.     

Association of work-related factors with psychosocial job stressors and psychosomatic symptoms among Japanese pediatricians

A cross-sectional study was conducted to explore what work-related factors were associated with job stress among pediatricians in Japan, as determined by the demand-control-support model and psychosomatic symptoms. We sent an anonymous questionnaire to a random sample of 3,000 members selected from the nationwide register of the Japan Pediatric Society and received 850 responses (response rate, 28%). Data from the 590 respondents who worked more than 35 h per week as a pediatrician and had no missing responses in the questionnaire were analyzed. We measured workload-related variables (e.g. working hours, work schedule) and recovery-related variables (e.g. workdays with no overtime, days off with no work in the past month) as exposure variables, and psychosocial job stressors (the Brief Job Stress Questionnaire) and psychosomatic symptoms as outcome variables. Longer working hours per week was significantly associated with greater job demand, lower job control and more psychosomatic symptoms (p<0.05). After adjusting for working hours, more workdays with no overtime was significantly associated with lower job demand, greater job control and fewer psychosomatic symptoms (p<0.05). Our findings suggest that long working hours is a risk factor for job stressors and psychosomatic symptoms, and that workdays with no overtime is a protective factor which may facilitate recovery. Controlling working hours and encouraging non-overtime workdays may be important for reducing job stressors and psychosomatic symptoms among pediatricians in Japan.     

Hospital board effectiveness: relationships between governing board composition and hospital financial viability.

OBJECTIVE. Two theories--agency and managerialism--are compared with respect to their usefulness in explaining the role of insiders on the hospital board: whether their participation enhances or impairs board financial decision making. DATA SOURCES/STUDY SETTING. The study used 1985 hospital financial and governing board data for a representative sample of acute care California hospitals. STUDY DESIGN. Relationships were examined cross-sectionally between the presence or absence of insiders on the board and measures of hospital financial viability while controlling for the organizational factors of system affiliation, ownership, size, region, and corporate restructuring. PRINCIPAL FINDINGS. Multiple regression analysis found significant relationships between insider (CEO, medical staff) participation and hospital viability. CONCLUSIONS. These results support the managerial theory of governance by suggesting that the CEO and medical staff provide informational advantages to the hospital governing board. However, the cross-sectional design points to the need for future longitudinal studies in order to sequence these relationships between insider participation and improved hospital viability.     

军队医院聘用专业技术人员工作满意度量表的编制研究

目的编制适用于军队医院聘用专业技术人员的工作满意度评定量表。方法采用理论分析、深度访谈、问卷调查、探索性因素分析等方法编制工作满意度量表。结果工作满意度量表包括一般满意、内在满意和外在满意3个构面,具有良好的信度和效度。结论该量表可以作为军队医院聘用专业技术人员工作满意度的评定工具。     

Hospital design and staff perceptions: an exploratory analysis

The movement in the health care design field to focus on "patient-centered care" and "healing environments" is often reflected in the health care facilities' incorporation of features meant to mitigate the stressful nature of serious illness. These features may range from a resource center (to allow patients and families to properly educate themselves about their illness) to providing space in rooms so family members can remain with patients, to more ambient features such as soft lighting, water features, or healing gardens. Research has shown that such features can in fact have positive effects for patients and may reduce stress and speed physical healing. What is not as well understood is how (if at all) the medical staff uses these types of features. Good health care cannot be administered without health care professionals, but factors such as job stress and burnout can impair both the physical and psychological health of the staff. A supportive organizational environment is imperative, but this article will set out to show that a supportive physical environment can be just as necessary in influencing how the staff views their workplace as well as how they might fare with regard to their own health. This article will examine a subset of results from a recent employee satisfaction survey given at a medical center. Exploratory analysis and interpretation will begin to shed light on whether or not building design can have an impact (positive or negative) on staff satisfaction. This can potentially act as a springboard to guide future empirical research in the area of health care design and its impact on staff satisfaction and well-being. By analyzing findings from a recent employee satisfaction survey, we can begin to understand how the hospital staff perceives the design of their building and begin to determine if these perceptions might impact health outcomes among the employees.     

Effects of changing hospital units during organizational restructuring

This study examined the effects on work experience, satisfaction, and psychological well-being when hospital-based nursing staff change nursing units during a period of major health care system and hospital restructuring. Data were collected from 1,362 staff nurses using anonymous questionnaires. Fourteen percent (n = 194) had changed units in the preceding year. Although the effects of changing units were small, staff nurses who had changed units generally reported higher levels of work stressors, less satisfaction, and more negative emotional well-being.     

Selection from fixed term to permanent employment: prospective study on health,job satisfaction,and behavioural risks

STUDY OBJECTIVE: To examine health, job satisfaction, and behavioural risks as antecedents of selection from fixed term to permanent employment. DESIGN: Prospective cohort study of change in employment contract during a two year period. Self reported health, recorded sickness absence, job satisfaction, behavioural risks, demographics, and occupational characteristics were assessed at baseline. SETTING: Hospital staff in two Finnish hospital districts. PARTICIPANTS: A cohort of 526 hospital employees (54 men, 472 women) aged 20 to 58 years with a fixed term job contract at baseline. Main results: During the follow up period, 137 became permanently employed. Men, employees in higher positions, full time workers, and those with five to eight years in the employ of the hospital were more likely to become permanently employed. After adjusting for these factors, obtaining a permanent job contract was predicted by self rated good health (odds ratio (OR) 3.90; 95% confidence intervals (CI) 1.34 to 11.36), non-caseness of psychological distress (OR 1.80; 95% CI 1.01 to 3.20), high job satisfaction (OR 1.86; CI 1.17 to 2.94), and non-sedentary life style (OR 2.64; CI 1.29 to 5.41), compared with the rest of the cohort. CONCLUSIONS: Investigation of fixed term employees yields new information about selective mechanisms in employment mobility. Good health seems to promote the chances for a fixed term employee to reach a better labour market status. These results correspond to earlier research on selective mechanisms in other forms of employment mobility and provide a partial explanation for the socioeconomic gradient of health.