Doctors’ perceived working conditions and the quality of patient care: A systematic review

Numerous reports advocate improving doctors’ working conditions as an important part of initiatives to enhance the quality of patient care. However, the research literature is not clear on this underlying relationship. This systematic review examines the evidence on the relationship between the working conditions perceived by doctors and the quality of patient care. Seven electronic databases were searched, with 21 studies from six countries included in the review. The findings highlight the questions how quality of care is constructed and measured as the presence of these relationships varied by the outcome measure used. A greater number of significant relationships were observed for clinical excellence and patient safety than patient experience. The reviewed literature reflects a lack of theoretical underpinning and consideration of the mechanisms underlying pathways between doctors’ perceived working conditions and quality of care. It also does not capture the complexities within the healthcare sector, nor the wider theoretical and empirical developments in the field. Therefore, a definitive relationship between doctors’ perceived working conditions and the quality of patient care should be considered with caution. Future research should account for the observed methodological and theoretical limitations to better understand the nuances within this complex, but important relationship

A theoretical perspective on the mediating role of mental clarity in the relationship between health and cognitive processing

Background. Previous research has linked health to cognitive processing. Cognitive processing is an important predictor of performance in the workplace and, thus, plays a role in the productivity of organisations and for the well-being of individuals. However, the processes involved in the link between health and cognitive performance outcomes are unclear. Two possible underlying influences linking health and cognitive function are described in the literature on (a) sickness behaviour and in the literature on (b) executive function. Sickness behaviour is a term used to describe bodily and psychological responses to illness. The physical process here involves the body responding to threats by releasing pro-inflammatory proteins called cytokines. The effects of increased cytokine levels include, among other effects, a suppression in one’s ability to concentrate and a depression of mood. Executive function is a term used to describe the underlying cognitive processes that guide behaviour, particularly in non-routine cognitive tasks. Given that sickness behaviour has been related to cognitive performance; by implication, sickness behaviour is likely to be related to executive function. However, the process by which sickness behaviour and executive function relate to outcome cognitive performance is unclear. A possible common linkage between health and cognitive performance could be explained by an emerging research stream on mental clarity, defined as a “clouding of mental operations” (Leavitt & Katz, 2011, p. 445). Study Aim. Based on the extant literature, we present a theoretical model of how mental clarity possibly relates to both health and cognitive processing. Our suggestion is that mental clarity plays a mediating role in the relationship between health and cognitive functioning. Specifically, we hypothesize that symptoms of illness invoke a sickness behaviour-related response within the individual, which depresses mental clarity. We propose that this reduction in mental clarity, in turn, reduces an individual’s capacity to process cognitively demanding stimuli. Method. We review the literature on mental clarity, sickness behaviour, and cognitive processing and present a theoretical mediating model. The aim is to test this model empirically using latent modeling techniques. Results. Data collection is currently ongoing. Discussion. The model proposed here will be considered in light of the available literature from a multi-disciplinary perspective. Implications for future research and workplace practices will be proposed. References Leavitt, F., & Katz, R. S. (2011). Development of the mental clutter scale. Psychological Reports, 109, 445-452. doi: 10.2466/02.07.14.22.PR0.109.5.445-45

Missed opportunity for tuberculosis case detection in household contacts in a high burden setting

Contact investigation remains an essential component of tuberculosis (TB) control, yet missed opportunities to trace, medically examine, and treat close contacts of newly diagnosed index TB cases persist. We report a new case of active TB in a 21 year-old woman who was a household contact of a known TB index case in Kampala, Uganda. She was identified during a house-to-house TB case finding survey using chronic cough (≥2 weeks). This case study re-emphasizes two important public health issues in relation to TB control in developing countries; the need to promote active contact investigations by National TB programs and the potential complementary role of active case finding in minimizing delays in TB detection especially in high burden settings like Uganda.Pan African Medical Journal 2012; 12:

Estimating the economic burden posed by work-related violence to society: a systematic review of cost-of-illness studies

Estimates of the economic burden on society posed by work-related violence are important and often highly cited sources of evidence; typically used to substantiate arguments for prevention. However, such sources of information are generally poorly understood and seldom critiqued outside the disciplines of health economics and public health. The objective of this systematic review is to collate, review and synthesize evidence-based economic estimations of the burden on society of work-related violence. A research protocol was developed and peer-reviewed a priori, examining both the academic and grey literatures. Ten cost-of-illness studies met the inclusion criteria and were reviewed. All studies used a bottom-up (person-based) approach to derive their economic estimates, with only two national-contexts examined. In general, a limited number of indirect (productivity-related) and intangible cost components were accounted for in the cost-of-illness studies. The reviewed studies were notably dated, with only two published post-2010. The derived economic estimates ranged from $2.36 million to$ 55.86 billion (figures inflated to 2016 US dollars). We conclude that much of the available evidence provides an informative, but possibly dated estimate, of the cost of incidents of work-related violence at the ‘sharp-end’ of exposure. Possibly such estimates are gross under-valuations, under-representing the true burden to society. This first systematic review in the area identifies key limitations in the operationalization and measurement of the construct of work-related violence within cost-of-illness studies. We argue such critiques should frame and deepen our understanding of economic estimates in this domain. Future directions are discussed

Understanding the cost of mental health at work: an integrative framework

Book synopsis: The SAGE Handbook of Organizational Wellbeing is a comprehensive and cutting-edge work providing the latest insights into a range of perspectives on organizational wellbeing, as well as highlighting global wellbeing issues and exploring new contexts. Topics covered include: digital working and social media, LGBTQIA+ identifications and work, suicide at work, refugee workers, and mental health. A multi- and inter-disciplinary work, this handbook embraces ideas and empirical work from a range of fields including psychology, business and management, economics, and science. This handbook draws together current knowledge whilst also outlining emerging issues and directions, making this an invaluable resource for students and researchers spanning a wide array of disciplines

Psychosocial work characteristics, burnout, psychological morbidity symptoms and early retirement intentions: a cross-sectional study of NHS consultants in the UK

Objectives: The objectives of this study are twofold. First, to examine the direct effect of psychosocial work characteristics (as measured by job autonomy and work-related pressure) in relation to self-reported psychological morbidity symptoms and early retirement intentions among a sample of hospital consultants in the National Health Service (NHS). Second, to investigate burnout as mediating variable (ie, indirect effect) of these postulated associations. Design: A cross-sectional observational study. Participants: 593 NHS consultants (male=63.1%) from hospitals in England, Scotland and Wales. Measures: Self-reported online questionnaires on work-related pressure and job autonomy (Job Demands-Resources Questionnaire); emotional exhaustion and depersonalisation (Maslach Burnout Inventory); depressive and anxiety symptoms (State Trait Personality Inventory) and a single-item on early retirement intention. Results: This study observed high prevalence rates across all adverse health measures: emotional exhaustion (38.7%), depersonalisation (20.7%), anxiety symptoms (43.1%) and depressive symptoms (36.1%). Multiple linear regressions examined the postulated direct and indirect effects. Job autonomy had significant negative direct effects on the frequency of NHS consultants’ anxiety and depressive symptoms, and their intention to retire early. Both emotional exhaustion and depersonalisation mediated the relationships that work-related pressure (full mediation) and job autonomy (partial mediation) had with self-reported symptoms of psychological morbidities. Only emotional exhaustion mediated the relationships where early retirement intention was the outcome. In terms of sociodemographic factors, age and years’ experience predicted both burnout dimensions and psychological morbidity. Conclusions: This is the first study to observe job autonomy to be associated with the number of self-reported psychological morbidity symptoms and early retirement intentions in a sample of NHS consultants. Burnout dimensions mediated these relationships, indicating that interventions need to focus on enhancing working conditions and addressing burnout among NHS consultants before more severe symptoms of psychological morbidity are reported. This study has implications for NHS policy makers and senior leadership

Burnout among surgeons in the United Kingdom during the COVID-19 pandemic: A cohort study

Background: Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic. Methods: This cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the United Kingdom of all specialities and grades. Participants completed of the Maslach Burnout Inventory and bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Results: 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains burnout prevalence was exceptionally high in the Core Trainee 1-2 and Specialty Trainee 1-2 grades. Conclusions: These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons

A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

BackgroundTo explore how a vocational rehabilitation (VR) intervention can be integrated within existing healthcare services for people with multiple sclerosis (MS) in the United Kingdom (UK) National Health Service (NHS).MethodsData from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research and an intervention logic model.ResultsFour themes were identified relating to the structure of current NHS services, how to improve access to and awareness of VR services, the collaboration between internal and external networks, and the benefits of integrating VR within the NHS services. Participants identified several implementation barriers such as poor links with external organisations, staffing issues, and lack of funding. To overcome these barriers, participants suggested enablers such as technology (such as apps or online assessments) and collaboration with third-sector organisations to reduce the pressure on the NHS.ConclusionSignificant organisational changes are required to ensure a successful implementation of a VR intervention within current NHS services. Despite this, the NHS was seen as a trustworthy organisation to offer support that can optimise the health and professional lives of people with MS

Using intervention mapping to develop evidence-based toolkits that provide mental wellbeing support to workers and their managers whilst on long-term sick leave and following return-to-work

Background Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. Purpose To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experience for workers on long-term sick leave. Methods This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits – one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. Results Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. Conclusion Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial

Managing risks to drivers in road transport

This report presents a number of case studies in managing risks to road transport drivers. The cases feature a variety of initiatives and interventions to protect drivers.In the road transport sector, as with any other, it is important to pay attention to working conditions in order to ensure a skilled and motivated workforce. Certain characteristics of the sector make it more difficult to practice risk management than in other sectors. But by taking account of how the sector operates in practice, and the characteristics of drivers themselves and the way they work, risks can be successfully manage