Sickness presenteeism: measurement and management challenges

Since work can be restorative to health, attending work when unwell should not be viewed as an inherently negative phenomenon. However, the functional benefits are likely to depend on the health condition, and the psychosocial quality of the work provided. The current study used a workforce survey to explore differences in the pattern of presenteeism and absenteeism by health condition, the association of psychosocial work factors with presenteeism compared to absenteeism, and their interaction to predict health. Findings indicate that instead of substituting absenteeism for presenteeism, the two tend to coincide, but the balance differs by health condition. Presenteeism is more likely to occur in poorer psychosocial environments, reinforcing the importance of ensuring work is designed and managed in ways that are beneficial rather than detrimental to health. The findings also highlight the methodological importance of differentiating between the act and impact of presenteeism in future research and practice

A stage of change approach to reducing musculoskeletal disorders (MSD) in the workplace

With a view to improving the efficacy of MSDs interventions, this work examined the applicability of the stage of change approach to occupational health interventions. An initial study explored the current practices of ergonomics consultants in tackling MSDs, and revealed that consultants' recommendations generally focused on physical aspects of the work environment, and did not take explicit account of employees' knowledge or attitudes. A second study evaluated leaflets aimed at helping employers and/or employees tackle MSDs, and revealed that leaflets generally overlooked the maintenance of risk reducing measures. Due to the importance of maintaining risk reducing measures on an ongoing basis, this may be a fundamental limitation to their effectiveness. Tools were developed to assess both managerial and worker stage of change, and were found to possess high levels of reliability. To evaluate these tools in practice, 24 interventions aimed at reducing MSDs were monitored within a variety of organisations. In half of these cases, approaches were tailored according to managers' and workers' stage of change. Significant reductions were found in self-reported musculoskeletal pain in the upper arm, elbow, forearm, wrist, hand, lower back, and legs. No significant differences in self-reported musculoskeletal pain were identified following standard interventions. To gain qualitative information regarding the intervention process, post-intervention interviews were also conducted with managers. Interviewees identified issues relating to knowledge, attitudes, perceptions, and behaviour change, in addition to structural factors, as the main barriers and facilitators in the process of implementing interventions to tackle MSDs. Both the quantitative and qualitative findings of this work are compatible with calls for the application of the stage of change approach to the workplace. The findings suggest that scope exists for improving the success of health and safety interventions by tailoring approaches according to stage change. By tackling the attitudes, beliefs, and behavioural intentions that underpin an individuals' current stage, tailored approaches can increase the uptake, implementation, and maintenance of risk-reducing measures

Understanding organizational learning in a healthcare organization during sudden and disruptive change

Purpose Complex and sudden change that healthcare organizations often have to respond to, such as during the recent pandemic, can create major disruptions and a prolonged state of alert. Although the impact of such crises can be predominantly negative, rapid adjustments during this time can also yield positive change that can support organizational response to crisis, if managed well. Using insights from organizational learning and organizational change theory, the aim of this study was to understand organizational learning during sudden change. Specifically, the authors aimed to understand the experiences and types of gains and losses in the processes of complex and disruptive change in one large healthcare organization in the UK. Design/methodology/approach Focus group data were used from 23 focus group discussions with 575 participants representing all functions and departments in one Healthcare Trust. Findings The participants revealed the rich gains, losses, and lessons experienced in response to sudden change that can promote organizational learning. Perceived losses are more likely to drive a desire to refreeze “back to normal” and perceived gains more likely to lead to an emphasis on embedding gains and changing to better. Therefore, on balance, the substantial, in number and variety, gains and learnings point to a learning organization. This is an essential attribute for responding to disruptive change successfully and facilitating organizational recovery in a post-pandemic world. Practical implications The findings highlight the importance of timely harnessing of the organizational learning emerging from crises and how this can inform a more resilient organization, as well as supporting sustainable organizational cross-learning. Originality/value By extending these insights on workers’ adaptation to sudden change, the findings can help to advance the science and practice of organizational learning and support organizational recovery, especially as they describe the new status in UK healthcare organizations.</p

Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video‐enhanced feedback and deliberate practice

AIMS: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations.METHODS: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness.RESULTS: There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention.CONCLUSION: Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.</p