Workplace culture and patient outcomes: What's the connection?

The Experiences of LGBTQ Healthcare Professionals within Military Medical Culture

BACKGROUND

Creating a positive workplace culture affects patient outcomes and force readiness. An inclusive workplace culture is especially important for lesbian, gay, bisexual, transgender, and queer (LGBTQ) military healthcare professionals, who have historically faced discrimination within the United States military. While research has examined LGBTQ service members' experiences in the military as a whole, there is a gap in the professional literature regarding LGBTQ healthcare workers' experiences within military medicine.

METHODS

This qualitative phenomenological study explored the experiences of ten LGBTQ military healthcare professionals. We interviewed each participant for one hour. Our research team then coded each interview and came to a consensus on how to organize these codes into emerging themes. We used reflexivity and member checking to increase the credibility of our results.

RESULTS

Four themes emerged from our data analysis: (1) implicit bias; (2) explicit bias; (3) response to discrimination; and (4) recommendations for improving workplace culture. The participants described both the underlying and outright discrimination they faced at work. They made recommendations for reducing this discrimination through education, training, and increased leadership representation.

CONCLUSIONS

Our results revealed that LGBTQ healthcare professionals continue to face discrimination in the workplace. This discrimination must be addressed to create an inclusive workplace environment within military medicine, which will enhance force readiness.

Does Manual Abdominal Pressure During Colonoscopy Put Endoscopy Staff and Patients at Risk? Experiences of Endoscopy Nurses and Technicians

Endoscopy staff suffer work-related musculoskeletal disorders at a rate greater than or comparable to nurses and technicians in other subspecialities, which may be attributable to the widespread use of manual pressure and repositioning during colonoscopy. In addition to negatively impacting staff health and job performance, colonoscopy-related musculoskeletal disorder injuries may also signal potential risks to patient safety. To assess the prevalence of staff injury and perceived patient harm relating to the use of manual pressure and repositioning techniques during colonoscopy, 185 attendees of a recent national meeting of the Society of Gastroenterology Nurses and Associates were asked to recall experiencing injuries to themselves or observing injuries to other staff or patients during colonoscopy. A majority of respondents (84.9%, n = 157) reported either experiencing or observing staff injury, whereas 25.9% ( n = 48) reported observing patient complications. Among respondents who perform manual repositioning and apply manual pressure during colonoscopy (57.3%, n = 106), 85.8% ( n = 91) reported experiencing musculoskeletal disorders from performing these tasks; 81.1% ( n = 150) reported no awareness of colonoscopy-specific ergonomics policies at their facility. Results highlight the relationship between the physical job requirements of endoscopy nurses and technicians, staff musculoskeletal disorders, and patient complications, and suggest that implementation of staff safety protocols may benefit patients as well as endoscopy staff.

'Us versus them': A social identity perspective of internal medicine trainees

INTRODUCTION

Silos and group boundaries in the clinical workplace can result in interprofessional conflict which can be a source of anxiety for doctors in training. The social identity perspective (SIP) incorporates theories of social identity and self-categorisation, and may provide a useful lens to understand the socialisation and identity development of doctors. This study aimed to determine if and how the SIP may provide insight into intergroup relations as experienced by internal medicine (IM) trainees in Scotland.

METHODS

Interprofessional communication workshops hosted as part of an IM boot camp between August 2020 and March 2021 were audio recorded and transcribed verbatim. Subsequent individual interviews with consenting trainees further explored social identity and intergroup relations. Data analysis employed template analysis and deductive independent coding with the SIP informing the initial coding template and new codes added inductively.

RESULTS

Seventeen workshops, involving 100 trainees, and ten subsequent individual interviews were included. Trainees related to the social identity of an IM doctor and to stereotypes within the workplace. They described intergroup tensions resulting from a perception of differing priorities. They experienced outgroup derogation and the impact of role modelling those in their social group during their identity development.

DISCUSSION

The SIP provides a useful lens to understand the social phenomena at play for IM trainees. It confirms the expectation of conflict between specialties and negative perceptions of outgroups. There is a need to consider the hidden curriculum of socialisation in the workplace during training and the influence of the learning environment on identity development.

Development of management structures for future nursing services in the Republic of Kazakhstan requires change of organizational culture

Aim

This study's aim was to describe the development of new management structures for nursing services in pilot public healthcare organizations in the Republic of Kazakhstan by focusing on cultural change from the former Soviet system to the modern nursing management system.

Background

Because organizational culture plays an essential role in developing nursing management processes, the challenge in Kazakhstan is to change the deep‐rooted Soviet administration practices, such as top‐down management and the absence of a career structure in nursing, to meet the new public management system's requirements.

Method

Participatory method was used to generate organizational culture change in 31 pilot organizations.

Results

The organizational structures were reorganized with new nursing positions. Changes concerning nurses' job descriptions and educational requirements were introduced to the legislation. Workforce planning and work division between the healthcare professionals were suggested, allowing new operational functions for nurses. The implemented changes facilitate the culture change in the healthcare and nursing service system.

Conclusion

The shift of healthcare organizations towards a modern nursing management system has started in Kazakhstan.

Implications for Nursing Management

Good understanding and competence of cultural issues related to the change processes are critical in countries that are undergoing fundamental reforms in their healthcare systems.

The workplace culture in addiction psychiatry in Finland as described by healthcare personnel

Purpose

The purpose of this study is to describe the workplace culture and factors associated with it from the viewpoint of the personnel providing care to patients with dual diagnosis.

Design/methodology/approach

Data were collected from six organizations using an electronic survey in 2019. The respondents (n = 75) worked in addiction psychiatry in specialized health care and provided care to patients. The data were statistically analyzed.

Findings

Workplace culture was evaluated as positive. Stress was experienced occasionally (Md = 2.58, Q1 = 1.96, Q3 = 3.03), job satisfaction levels were moderate (Md = 4.83, Q1 = 4.28, Q3 = 5.44) and the practice environment was evaluated as neutral (Md = 4.46, Q1 = 4.00, Q3 = 5.04). Gender, age in years, employment relationship, work time, staffing, number of patients and the participants’ experience in health care and experience in their current workplace had statistically significant associations with workplace culture.

Originality/value

In Finland, there have been attempts to reform service structures that also influence mental health and substance addiction services. Workplace culture is one approach to promote service development. Yet, there has been no research on workplace culture in the context of the care of patients with dual diagnosis. The results of this study bring knowledge about how health-care personnel perceives stress, job satisfaction and their practice environment in addiction psychiatry, which can be used to further develop services and workplace culture.

The correlation between work environment and patient safety in a general hospital in Indonesia

Patient safety is an important for health care services in the hospital setting. The most difficult obstacle in ensuring patient safety is creating a safety. The objective of this study was to determine the correlation between the hospital work environment, nurses' characteristics, and patient safety. The method was a descriptive correlative study with a cross-sectional approach. The data were obtained from 123 ward nurses through using valid and reliable questionnaires. The results showed a significant relationship between hospital work environment and nurses' characteristics (education level, length of service, and training concerning patient safety) (p<.05). In contrast, nurses' age and marital status were not related to patient safety in the hospital (p>.05). Findings indicate that the hospital work environment and nurses' characteristics are related to patient safety. The study recommended to build a model of patient's safety culture that includes all aspects that influence patients' safety culture.

Understanding team dynamics to promote team building in a radiotherapy department

Background:

Teamwork is a central framework in healthcare delivery. Team dynamics can impact the team as a whole and has been identified within the literature as a contributory factor to quality and safety, patient satisfaction, staff satisfaction and overall performance. Within radiation therapy (RT), teamwork is essential in the delivery of high-quality care, yet team building and team development is under-reported.

Aim:

The focus of this research is to form a better understanding of what plays an impact on teams in a large urban RT cancer centre and how to better engage staff to work together, improve team dynamics and promote team building.

Materials and Methods:

An electronic search of the literature was conducted to better inform debate and aid in the development of team-building sessions in a busy radiotherapy department. Abstracts were screened and relevant articles selected if they met the search criteria that included relevancy related to team building, contributory factors on team dynamics, team-based learning, team performance and implication of civility.

Results:

A total of 45 articles were included in the final analysis. The majority were from the disciplines of medicine (45%), business (22%) and nursing (18%). Only 3 of the 45 articles (7%) focused on the profession of RT. Most articles discussed more than 1 theme with team dynamics and team building being the most common themes discussed in 16 articles each (36%). Other common themes included teamwork (31%), respect and civility (20%), leadership and hierarchy (11%), medical errors (11%) and team training (11%). Only 3 of the 45 articles (7%) focused on RT.

Conclusion:

There is a lack of longitudinal evidence to support the impact of team building sessions to improve team dynamics and promote a positive, cohesive team environment. Specifically within RT, the impact team building has on team dynamics has been under investigation.

Highlights:

High-quality patient care can be linked to team collaboration and cohesiveness. Changing the culture within a team and engaging in civility and respect in everyday practice has the potential to improve team dynamics, patient safety, staff and patient satisfaction.

Do Health Promotion Behaviors Affect Levels of Job Satisfaction and Job Stress for Nurses in an Acute Care Hospital?

OBJECTIVE

The aim of this study was to explore the relationships between nurse-reported health-promoting behaviors (HPBs), job stress, and job satisfaction in a hospital setting.

BACKGROUND

Job stress and satisfaction are key components of the nursing work environment; however, evidence of the relationship between HPB and job stress and satisfaction is lacking.

METHODS

A cross-sectional, 144-item survey was administered to nurses working in an acute care, community hospital in the southeastern United States.

RESULTS

Higher levels of HPB were associated with lower job stress and higher job satisfaction. Total HPB was associated with the competence subscale of job stress. Lower job stress was significantly associated with HPB subscales: spiritual growth, interpersonal relations, and stress management.

CONCLUSIONS

Nursing organizations can implement interventions that support HPB for nurses to reduce job stress and improve satisfaction.