Chapter 2 Getting everyone on the same page

In designing, implementing, and evaluating organizational interventions, program logic plays a central role as it outlines the core components of the intervention and links them to both proximal and distal outcomes. Also, central in the design, implementation, and evaluation of organizational interventions is the engagement of stakeholders across the organization (employees, managers, and specialists). Concrete tools are lacking for stakeholders to be engaged in the design of interventions and in defining criteria that can guide evaluation. This chapter outlines a structured process – the cocreated program logic (COP) process – for how organizational stakeholders can be involved in defining intervention goals and activities and thus forming the program logic together with interventionists (researchers or consultants). The program logic can then be used to guide the evaluation of the organizational intervention. The authors present two cases illustrating how the COP process has been used in their reserach. The chapter ends with lessons learned

Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work

<p>Abstract</p> <p>Objective</p> <p>Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors.</p> <p>Methods</p> <p>The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors.</p> <p>Results</p> <p>We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process.</p> <p>Conclusions</p> <p>This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.</p

All by myself: How perceiving organizational constraints when others do not hampers work engagement

Organizational constraints (OCs) represent work conditions that interfere with employees’ performance. Although employees share the same work environment, perceptions of OCs may vary among team members. In this study, we examined employee–teammate perceptual congruence and incongruence regarding three types of OCs (i.e., social, structural, and infrastructure) and the associated consequences for employee work engagement among health care employees from two Spanish hospitals (N = 141). Multilevel polynomial regression with response surface analyses revealed that the perceptual congruence and incongruence effects depended on the type of OCs. Congruence in perceptions was linked with greater work engagement only for social OCs. Incongruence had an effect in cases of social and structural OCs, but not infrastructure OCs: work engagement was worse when an employee rated OCs as higher (i.e., more problematic) than their teammates did. Our findings suggest that the negative effects of OCs are additionally exacerbated by perceptual incongruence with teammates and indicate the need to include social contexts in the study of work environment perceptions

Beyond the individual: A systematic review of the effects of unit-level demands and resources on employee productivity, health, and well-being

Creating sustainable employment—that is, a condition in which employees remain productive but also enjoy good health and well-being—is a challenge for many organizations. Work environment factors are major contributors to these employee outcomes. The job demands–resources model categorizes work environment factors into demands versus resources, which are, respectively, detrimental versus beneficial to employee outcomes. Although conceptualized as workplace factors, these job characteristics have been studied mostly at an individual level. Therefore, their roles at the supraindividual level (i.e., any work-unit level above an individual, such as group or organization) for employee productivity, health, and well-being remains unclear. The aim of this systematic review is to synthesize evidence concerning job resources and job demands at the supraindividual level and their relationships to productivity, health, and work-related well-being. The review covers articles published through December 2018. In total, 202 papers met the inclusion criteria. We found stronger support for the beneficial roles of supraindividual job resources than for the detrimental roles of job demands for productivity and work-related well-being. Regarding health, most of the relationships were found to be nonsignificant. To conclude, this review demonstrates that, at the supraindividual level, the motivational path has received more support than the health impairment path. Based on these findings, we provide recommendations for further research and practice

Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: A longitudinal interventional cohort study

BACKGROUND Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. METHODS The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. RESULTS A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005). CONCLUSIONS Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.Åsa Muntlin Athlin, Ulrica von Thiele Schwarz and Nasim Farrohkni

Forms of participation – the development and application of a conceptual model of participation in work environment interventions

In the realm of work environment improvements, the Nordic countries have led the way in demonstrating that employee participation is a key requisite for achieving improvements. Despite this there is a lack of precision on what ‘participatory’ in a participatory work environment intervention means. In this study, we present a conceptual model for participation in work environment interventions and apply it to protocols and manuals from 8 participatory interventions to determine the form of participation used in each intervention. We suggest that the conceptual model can be applied in the design and assessment of participatory work environment interventions

Health and ill health in working women – balancing work and recovery

Work conditions within the public health care sector are physically and psychosocially demanding. This means that balancing work with recovery is essential for employees in order to avoid ill health and stay healthy. This thesis is based on four studies. Study I investigated the prevalence of upper extremity disorders (UED) in female dental personnel. Results showed that 81% reported UED. Consequently, interventions aimed at reducing these risks were called for. Study II investigated the health-related effects of two work-place interventions, physical exercise (PE) and reduced working hours (RWH). Health-improvements were more consistent in the PE group, suggesting that PE may be an appropriate intervention to reduce health-risks. However, there were no effects on recovery from work or fatigue, which may result from other factors, such as overcommitment (OC), that prolong or sustain stress-related activity. Study III showed that high OC was associated with poorer next-day recovery and increased fatigue. Also, OC was a more important predictor of lack of recovery and fatigue than were psychosocial work characteristics. This highlights the importance of considering perseverative cognitions in relation to recovery from work and fatigue, and has implications for interventions targeting work-related ill health. Study IV related lack of recovery and fatigue to cumulative biological risk, allostatic load (AL), and to individual biomarkers. Women with a profile characterized by fatigue, sleep difficulties and lack of short-term recovery had a 2.9 increased risk of AL. This was not shown in analyses of individual biomarkers. In sum, this thesis shows that recovery from work is an important factor in relation to women’s work-related health. Fatigue and recovery should be considered interrelated but distinct concepts and recovery should be assessed as an early risk factor for stress-related disease with early risk being investigated using AL rather than individual biomarkers

Alignment for achieving a healthy organization

Modern working life is characterized by change and competiveness. It is also characterized by a drift away from low-skilled work to more complex jobs and increased social interaction. This means that the human resources employees and their skills, competencies, engagement and motivation are the greatest asset of many organizations. This has implications for how an organization can be healthy, i.e. create an environment that will contribute to employee health, wellbeing and motivation as well as achieve business outcomes. In this chapter, we will draw on theories from work and organizational psychology and behavioral psychology, and our own research, to describe what we believe to be the fundament of a healthy organization. We will do this by introducing the concept of alignment, which will be used to illuminate the healthy organization. Alignment can be described as the lining up of different aspects of what is going on in an organization so that they create a common thread. This cuts across different layers and processes in the organization; thus vertical, horizontal and diagonal alignments will be described. In the second part, we will use the framework of alignment to illuminate why occupational health interventions need to be integrated with the organizations strategy and systems in order to create sustainable change. Implications of alignment for participatory approaches, intervention fit, program theories, the role of management and more will be discussed. In the third part, we will describe the implications of our view of an aligned, healthy organization for designing and evaluating interventions in organizations. This includes arguing for changing the roles and responsibilities of researchers and practitioners, and how this change can be beneficial to the organization as well as the quality of the research

Employee Self-rated Productivity and Objective Organizational Production Levels Effects of Worksite Health Interventions Involving Reduced Work Hours and Physical Exercise

Objective: To investigate how worksite health interventions involving a 2.5-hour reduction of weekly working hours with (PE) or without (RWH) mandatory physical exercise affects productivity. Methods: Six workplaces in dental health care were matched and randomized to three conditions (PE, RWH and referents). Employees' (N = 177) self-rated productivity and the workplaces' production levels (number of patients) were examined longitudinally. Results: Number of treated patients increased in all conditions during the intervention year. While RWH showed the largest increase in this measure, PE showed significant increases in self-rated productivity, that is, increased quantity of work and work-ability and decreased sickness absence. Conclusions: A reduction in work hours may be used for health promotion activities with sustained or improved production levels, suggesting an increased productivity since the same, or higher, production level can be achieved with lesser resources