Good work for dentists : ideal and reality for female unpromoted general practice dentists in a region of Sweden

Kvinnliga obefordrade allmäntandläkare i Folktandvården utgör cirka en fjärdedel av alla yrkesverksamma tandläkare i Sverige. Enligt många rapporter har denna grupp en besvärlig psykosocial arbetssituation. Målet med denna avhandling var att: - Beskriva den självuppfattade hälsan för dessa allmäntandläkare i jämförelse med andra med likartad arbetssituation. - Analysera deras uppfattning om stöd i jämförelse med andra grupper. - Beskriva hur de uppfattade det "goda arbetet", dvs ett arbete som är både hälsosamt och socialt ansvarstagande, samt beskriva om det fanns en skillnad mellan deras ideal och deras verklighet gällande ett gott arbete. - Analysera mönster i två faktorer av det goda arbetet för tandläkare, nämligen en moralfaktor och en karriärfaktor. Postenkäter skickades 2000 till alla kvinnliga obefordrade allmäntandläkare i Folktandvården i en svensk region. Svarsfrekvensen var 94%. Resultaten visade att: - Tandläkarna mådde dåligt, sämre än övriga jämförda grupper. - De fick lite stöd från ledningen. - Det förekom få interkollegiala kontakter. - Det fanns inga tvärsnittssamband mellan kollegiala nätverk och stöd, men den kvalitativa undersökningen visade att kollegiala nätverk uppfattades positivt. - Det fanns en stor skillnad mellan det som tandläkarna uppfattade som ett idealiskt gott arbete och den verklighet de befann sig i. Den största skillnaden mellan ideal och verklighet fanns i bristen på inflytande. - Tre faktorer av det goda arbetet kunde konstateras, nämligen moral-, karriär- och arbetsmiljöfaktorerna. Tandläkarna upplevde att den moraliska aspekten av arbetet var allra viktigast. Detta bekräftar att tandläkarna upplevde sitt yrke som först och främst ett människovårdande yrke. Sammanfattningsvis fanns det allvarliga arbetsmiljöproblem bland tandläkarna. Tandläkarna mådde dåligt och upplevde stor brist på inflytande över viktiga frågor. Det förekom få interkollegiala kontakter, men kollegiala nätverk uppfattades positivt. De fick lite stöd från ledningen, vilket pekade på en svaghet i relationen mellan arbetsgivarna och de kvinnliga obefordrade allmäntandläkarna. Tre komponenter av det goda arbetet kunde konstateras, varav den moraliska komponenten både var den viktigaste och uppvisade den största skillnaden mellan ideal och verklighet. Sålunda värderade tandläkarna den moraliska delen av arbetet högst, vilket bekräftar att tandvård primärt är ett människovårdande yrke och inte ett industriellt yrke. De tandläkare med högst engagemang upplevde de största skillnaderna. Organisationen har följaktligen misslyckats med att övertyga eller engagera de tandläkare som den borde engagera, dvs de med det största engagemanget. Vägen till att förbättra de kvinnliga allmäntandläkarnas arbetssituation bör vara genom ökat inflytande och ökat stöd för att på så sätt överbrygga skillnaden mellan ideal och verklighet.Female unpromoted general practice dentists (GPDs) in the Public Dental Health Service (PDHS) constitute about one fourth of all working dentists in Sweden. Unpromoted means that the position is without managerial functions. According to many reports, they have a problematic psychosocial work situation. This thesis aimed to: - Describe the perceived health for these GPDs, in comparison with others with a similar work situation. - Analyse their sense of support in comparison with others. - Describe how they perceived "good work", i.e. both the healthy and socially responsible work, and whether there was a difference between their ideal and their reality. - Analyse patterns in two aspects - the moral and the career aspects - of "good work" for dentists. In 2000, questionnaires were sent to all female unpromoted GPDs in the PDHS in a region of Sweden. The response rate was 94%. Results: - The dentists felt unwell, worse than other compared groups. - There was little support from the management. - There was little inter-colleague contact. - There was no cross-sectional association between collegial networks and support, but the qualitative investigation showed that collegial networks were perceived as positive. - There was a great difference between ideal and reality concerning good work. The dentists felt a lack of influence, and this was the greatest difference of all. - Three components of good work - "moral values and skill discretion", "career development" and "work environment" - were found. The dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work. In conclusion: There were serious work environmental problems among these dentists. The dentists felt unwell and felt a great lack of influence on important decisions. There was little inter-colleague contact, but collegial networks were perceived as positive. There was little support from the management, indicating a clear weakness in the relations between employers and female unpromoted GPDs in the PDHS. Three components of good work were found, where the moral component was the most important but it also showed the greatest difference between ideal and reality. Thus, the dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work and not industrial work. The dentists with the highest level of commitment perceived the largest differences. The PDHS organization has therefore failed to convince or engage those whom it ought to engage, i.e. those with the greatest commitment. The way to improve the female unpromoted GPDs' work situation would be through increased influence and support, bridging the gap between ideal and reality

Organizational ergonomics : reflections and guidelines

Abstract of oral presentation.Background: Studies on the physical and psychosocial work situation for dentists constitute the background for ongoing studies about positive, healthy and rewarding aspects in dentists’ work life, to find ways of achieving a sustainable work life. We investigate organizational differences in public and private dentistry in Sweden and Denmark. Organizational ergonomics combines elements of both the physical and the psychosocial work situation and focuses on a good work situation with high efficiency. A condition for achieving this is that the dentists feel well. My research earlier has focused on the reality and the ideals for Swedish female unpromoted general practice dentists (GPDs) (material 1), working in the Public Dental Health Service (PDHS). In Sweden, more than half of all dentists are employed in the PDHS, where the female GPDs without a managerial function constitute the largest group. These dentists had serious work-environmental problems. The difference was marked between their ideal work situation and reality. They felt a lack of influence, with the greatest difference between ideals and reality of all measured indicators. When comparing these dentists with other human service groups, including oral and maxillofacial surgeons (mostly men, material 2), we have shown that the female dentists felt worse than the others. The strongest component in the dentists’ work was “moral values and skill discretion”, which confirms Hasenfeld’s theory of Human Service Organizations. Materials: Four materials were used. 1. A questionnaire about psychosocial work environment and healthy work to all female unpromoted GPDs in a region of Sweden. Response rate 94 %. (Hjalmers K. Diss. 2006) 2. A questionnaire concerning psychosocial work environment to all personnel at oral and maxillofacial surgery clinics in Sweden. Response rate 86 %. (Pilgård G. Diss. 2009) 3. Nine semi-structured, in-depth interviews with a phenomenological approach about overall job satisfaction with GPDs from Sweden and Denmark. (Berthelsen H, Hjalmers K. 2008) 4. A questionnaire about the multidimensional concept of overall job satisfaction to 1835 GPDs, randomly sampled from the Swedish/Danish dental associations. Response rate 68 %. (Söderfeldt B, Hjalmers K, Berthelsen H, Bergström K, Ordell S. 2008) Results and Conclusions: There were several differences for dentists working in public/private/Swedish /Danish dentistry, e.g. as to the perception of overall job satisfaction, professional autonomy, and how the job affected their health. The dentists’ emphasis on moral values confirms the character of dentistry as primarily human service work and not industrial work, and should be considered when organizing dentists’ work. The overall job satisfaction emanates from the patient relation, and from the possibility to perform high quality handicraft, thus involving both moral values and skill discretion. Support from colleagues is important. About 50 % of the Swedish public, 60 % of the Swedish private and 75 % of both the public and private Danish dentists, thought they would continue working until the normal age of retirement. To achieve a sustainable, complete working life, it is really important that dentists have decision authority over their work situation and feel overall job satisfaction

Ideal kontra verklighet : kvinnliga tandläkares yrkesliv har kartlagts

Kvinnliga obefordrade allmäntandläkare i folktandvården utgör cirka en fjärdedel av alla yrkesverksamma tandläkare i Sverige. Enligt tidigare rapporter har gruppen en besvärlig arbetssituation. Fokus för denna avhandling var att studera deras psykosociala arbetssituation. Avhandlingen utgår från teorier om människovårdande organisationer (Human service organizations) men innehåller också element om krav/kontroll, effort/reward samt teorier om det goda arbetet. Syftet med avhandlingen var att undersöka hur obefordrade kvinnliga allmäntandläkare uppfattar ett "gott arbete", det vill säga ett hälsosamt och socialt ansvarstagande arbete - ett arbete som är bra för både tandläkare och patienter, samt att identifiera positiva aspekter på tandläkaryrket som kan bidra till att tandläkare mår bra och som gör att de vill och kan stanna i arbetet ett helt yrkesliv

Moral values and career : Factors shaping the image of healthy work for female dentists

Objective. Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how ‘‘good work’’ for the dentists could be obtained. Material and Methods. In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. Results. In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. Conclusions. The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists’ emphasis on moral values confirms the character of dentistry as primarily a human service work

Perceived social support in relation to work among Danish general dental practitioners in private practices

Social support is an important phenomenon in the psychosocial work environment. The aim of this study was to assess the extent to which Danish general dental practitioners perceived support from colleagues and to relate perceived support to demographic and work related background factors. A questionnaire was sent to a random sample of 300 Danish dentists. The response rate was 80% after one reminder. Factor analyses and multiple regression analyses were carried out. The results showed that clinic size was the overall most important variable explaining perceived support among dentists. Gender differences were found in perceived emotional and practical support, and women perceived more emotional support (e.g. discussing problematic patients with peers) than their male colleagues. A similar gender difference was not found for the perception of practical support, such as helping each other in the event of falling behind schedule. Dentists from small and large practices did not differ in the extent of peer contact outside the clinical environment. This study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry

Good work : the relations between social capital, influence at work and perceived quality of work

Introduction A model for Good Work, understood as positive and rewarding aspects of work, has previously been developed based on interviews including dentists working under different organizational systems. An overall finding was that a positive work climate with trustful relations and professional freedom was found important for being able to carry out high quality work. The aim of this presentation is to assess whether the central part of this model can be corroborated empirically. Material and methods All staff employed at public dentistry in two counties in Sweden received an email with a personal login to an electronic questionnaire. After two reminders a response rate of 78% and 81% respectively was obtained including a total of 610 respondents. Data from non-managerial dental hygienists and dentists with direct patient contact in their work were included in the analyses (N=198). The analyses are preliminary as data from more organizations are in the process of being collected. A scale was developed for perceived quality of the work done at the clinic. This scale was used as the dependent variable in a multiple linear hierarchical regression model. Independent variables: county, a scale developed to measure social support in relation to patient-work in addition to scales from the Copenhagen Psychosocial Questionnaire on horizontal trust, community at the workplace and influence. The study has been approved by the Regional Ethics Board in Southern Sweden and is funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE). Results A significant difference in average for perceived quality of work was seen in relation to organization, but this difference disappeared in the final regression model. Being part of a work-related community, having trusted relations and a good support were all significantly associated with a positive assessment of the quality of work performed at the workplace, while influence did not contribute to further explanation. The final regression model explained 35% of the variance of the outcome. Conclusion The overall model for Good Work was corroborated concerning the relationship between social capital and valuation of quality of care

Psychosomatic symptoms among female unpromoted general prac-tice dentists

Unpromoted female general practice dentists have a working situation with hard work conditions. The aim of the present study was to describe the perceived health for unpromoted female general practice dentists in comparison with others laving a somewhat similar working situation. Questionnaires were sent to all unpromoted female general practice dentists (n=183) within the Public Dental Health Service in a region in Sweden. The response rate was 94%. Comparisons have been done with personnel in the Social Insurance Organization in Sweden and Children Clinics in the Public Health Care in a region in Sweden. The dentists in this study suffered from many physical and mental troubles and also linked them to the working situation. They reported high prevalences of tiredness (70%) and back, neck and shoulder pain (76%) and related these symptoms to the job situation in 83% and 95%, respectively. The study showed statistically significant differences (p < 0.0001) in the comparison between all the samples that were investigated. In conclusion, the results show problems concerning self-perceived health for the unpromoted female dentists. We have shown that they are feeling unhealthy, worse than other high-risk-groups in a human service working situation, and they suffer from a multitude of problems also connected to their working environment

Healthy work for female unpromoted general practice dentists

This study describes how female unpromoted general practice dentists (GPDs) in a region in Sweden perceived “healthy work”, i.e. their image of the dimensions that the dentistry profession should contain if it is to be really healthy work. The study also investigates whether there is a gulf between ideal and reality for this group. All unpromoted GPDs within the Public Dental Health Service’s general practice in a region in Sweden received a questionnaire, and 94% responded. The data were collected during July and August 2000 and the question about healthy work was taken from work environment studies. A principal components analysis was performed. Three factors explaining more than half the variance (53%), forming three well defined vector clusters: 1) a factor for moral values and possibilities for skill discretion, i.e. properties specific for human services, 2) a factor for career development and 3) a factor for work environment. We found that factor 1 alone explained a greater proportion of the variance (28%) for the respondents. The main results were that the female unpromoted GPDs emphasized free and intellectually stimulating work and that the gulf between the ideal and the reality was wide, especially concerning the dentist’s influence on important decisions. A salutogenetic approach built on good communication and democracy at work, and based on freedom and the employees’ influence, could bring ideal and reality closer

Collaboration among Danish dentists in private general practices

Perceived social support is a central concept in classical stress models and is known to be important to health. Aim The aim of this study was to investigate to what extent Danish general dental practitioners support each other, in relation to background factors. Methods The study was a cross-sectional survey with a postal questionnaire sent to 300 dentists who were randomly selected members of the Danish Dental Association. Response rate was 80% after one reminder. Factor analyses of items describing collaboration among colleagues were performed. The extracted support factors were used as outcome variables in multiple regression analyses with background factors like age, gender, and work characteristics as independent variables. Results Two factors were extracted describing perceived support and were interpreted as emotional and practical support. The regression analyses with support as dependent variables gave the following main results (Model 1: R2=0.34; F=13.53 8/184; p≤0.000; Model 2: R2=0.24; F=8.50 8/184; p≤0.000): • Dentists from solo practices perceived significantly less emotional and practical support than dentists working in bigger units (p=0.002; p= 0.001); • The more time dentists spent with colleagues outside the clinical sphere, the more emotional support was perceived (p≤0.000). A parallel relation, but weaker was found for practical support (p=0.041); • Male dentists reported significantly less emotional support than their female colleagues (p=0.004). A similar gender difference was not found for practical support (p=0.843). • Being single in private life was associated with less perception of practical support compared to married dentists (p=0.044). Conclusion The study underlines the importance of structural and cultural conditions in work environment for the perception of social support from colleagues. Acknowledgements The study was financially supported by Telia and PFA