Pride and confidence at work: potential predictors of occupational health in a hospital setting

BACKGROUND: This study focuses on determinants of a healthy work environment in two departments in a Swedish university hospital. The study is based on previously conducted longitudinal studies at the hospital (1994–2001), concerning working conditions and health outcomes among health care personnel in conjunction with downsizing processes. Overall, there was a general negative trend in relation to mental health, as well as long-term sick leave during the study period. The two departments chosen for the current study differed from the general hospital trend in that they showed stable health development. The aim of the study was to identify and analyse experiential determinants of healthy working conditions. METHODS: Thematic open-ended interviews were carried out with seventeen managers and key informants, representing different groups of co-workers in the two departments. The interviews were transcribed verbatim and an inductive content analysis was made. RESULTS: In the two studied departments the respondents perceived that it was advantageous to belong to a small department, and to work in cooperation-oriented care. The management approaches described by both managers and co-workers could be interpreted as transformational, due to a strain of visionary, delegating, motivating, confirmative, supportive attitudes and a strongly expressed solution-oriented attitude. The daily work included integrated learning activities. The existing organisational conditions, approaches and attitudes promoted tendencies towards a work climate characterised by trust, team spirit and professionalism. In the description of the themes organisational conditions, approaches and climate, two core determinants, work-pride and confidence, for healthy working conditions were interpreted. Our core determinants augment the well-established concepts: manageability, comprehensiveness and meaningfulness. These favourable conditions seem to function as a buffer against the general negative effects of downsizing observed elsewhere in the hospital, and in the literature. CONCLUSION: Research illuminating health-promoting aspects is rather unusual. This study could be seen as explorative. The themes and core dimensions we found could be used as a basis for further intervention studies in similar health-care settings. The result could also be used in future health promotion studies in larger populations. One of the first steps in such a strategy is to formulate relevant questions, and we consider that this study contributes to this

Gränser i omsorgsarbete : En studie om arbetets innehåll, villkor och kvalitet

Boundaries in home care work. A study of work content and its significance for working conditions and quality in care The aim of the study was to investigate work content and its significance for working conditions and quality in home care work. Work content refers to work tasks and client category. 341 home care workers in a Swedish municipality answered a questionnaire concerning work content, working conditions, client relations, quality in care and health (response rate 68 per cent). The workers were categorised according to the client group they worked with (mixed, elderly and demented) and according to work tasks (generalists vs. specialists). Differences between groups were tested using two way analyses of variance. The results reveal that those working with a mixed client group experienced more strain than those working with elderly or demented caretakers and task generalists expressed more problems in work compared to the specialists. Workers with a mixed client group reported lower level of decision latitude and greater qualitative and quantitative work load as well as a more problematic relationship with their clients. They also reported a higher degree of physical exhaustion. The task generalists more often felt they had to many caretakers to attend to and also reported a larger emotional and intellectual workload as well as work related stress. Task generalists who worked with a mixed client group had the most strainful working conditions. Different strategies for specialisation in home care are discussed with respect to quality in work and care.Studiens syfte var att undersöka arbetsinnehåll i äldre- och handikappomsorg och dess betydelse för upplevelse av arbetsvillkor och kvalitet. Med arbetsinnehåll avses dels vilka arbetsuppgifter som ingår i personalens ansvar och dels hur klientgruppen ser ut. En enkät skickades ut till samtliga vårdbiträden och undersköterskor i en svensk kommun. Svarsfrekvensen var 68 procent (n=341). Respondenterna kategoriserades utifrån klientgrupp (blandad, äldre och demenssjuka) samt utifrån arbetsuppgifter (generalister och avgränsade). Variansanalyser genomfördes med klientgrupp och uppgifter som oberoende variabler. Resultaten visar att arbetsvillkor upplevs som mer påfrestande dels av uppgiftsgeneralister jämfört med de uppgiftsavgränsade, dels av de som arbetar med en blandad klientgrupp jämfört med de som arbetar med äldre eller med demenssjuka. Resultaten pekar på den särskilt svåra kombinationen av att både vara generalist i uppgifter och att arbeta med en blandad klientgrupp. I studien diskuteras olika förändringsstrategier för en avgränsning av arbetsinnehållet. En uppgiftsavgränsning kan modifiera arbetsbelastningen men medför samtidigt negativa konsekvenser för omsorgskvaliteten. Medan uppgiftsavgränsning motverkar helhetssyn och kontinuitet innebär klientgruppspecialisering att vårdbiträdena får en möjlighet till fördjupade kunskaper om klientgruppens behov. Denna utveckling kan betraktas som en positiv professionalisering som rimmar väl med kvalitetsaspekter som helhetssyn och kontinuitet

Psychosocial stressors and well-being in health care workers. The impact of an intervention program

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.health professionals psychosocial work quality job control coping work stressors

Arbetsmiljökvalitet i skolan : Utvärdering av en arbetsmiljöintervention baserad på samverkan

Work Environment Quality at School : A Work Environment Intervention Based on Collaboration Development towards a Swedish school system with management by objectives and results has been in progress for some years. The ability of schools to cope with management by objectives and results has proved deficient, and internal control of the work environment can be viewed as a stipulation of management by objectives and results in the work environment context. Work environment intervention was tested at seven schools based on training material previously compiled for quality assurance of the work environment. The study also included fourteen reference schools. Pupils and staff at these schools were observed between 1996 and 1999, using quantitative and qualitative methods. Self-ratings indicated inferior work environment, reduced mental well-being and heightened stress among the participants. However, the intervention group rated more improvements and less deterioration than the comparison group, which shows that the work environment intervention succeeded in starting a process, which counteracted a negative development of work environment and health. Key words: Intervention, Systematic Work Environment Management, work organisation, Work Environment Act, working team, school, health, well-being, pupils, participation, evaluation.Utveckling mot en mål- och resultatstyrd skola har fortgått under ett antal år i Sverige. Skolornas förmåga att hantera mål- och resultatstyrning har befunnits bristfällig och systematiskt arbetsmiljöarbete kan ses som ett påbud att arbeta med mål- och resultatstyrning inom arbetsmiljöområdet. Vid sju skolor prövades en arbetsmiljöintervention med stöd av utbildningsmaterial för att kvalitetssäkra arbetsmiljön. Fjorton jämförelseskolor ingick i studien. Elever och personal på skolorna följdes under åren 1996-1999 med hjälp av kvantitativa och kvalitativa metoder. Självskattningar visar på försämring av arbetsmiljön, minskning av det mentala välbefinnandet och ökad stress under undersökningsperioden. Interventionsgruppen skattade dock fler förbättringar och färre försämringar än jämförelsegruppen vilket visar att arbetsmiljöinterventionen lyckades med att starta en process som motverkat en negativ utveckling av arbetsmiljö och hälsa