Good Work for dentists - a qualitative analysis

Leadership, work environment and caries prevention - what is good for the staff, is also good for the patients

OBJECTIVES

Dental caries is a health problem that can be prevented. The aim of this study is to analyse if the quality of leadership, in Swedish Public Dental Health clinics, influences the extent to which patients with caries receive preventive care, and if any such effect is mediated through a collaborative work climate, clear role expectations and a low average level of burnout among staff.

METHODS

The multilevel cross-sectional design includes work environment data from surveys of 75 general public dental clinics, register-based data on preventive measures provided to 5398 patients who received a dental filling due to a caries diagnosis, and patient demographics. Using a multilevel path analysis with logistic regression, we tested a model with one direct and three indirect pathways, controlling for the potential confounding effect of patient demographic factors.

RESULTS

Leadership quality, as assessed by the staff at the clinic, was associated with increased odds of patients with caries receiving prevention, controlling for patient demographic factors. Leadership quality was also positively related to a collaborative work climate, clear role expectations and a low average level of burnout among staff. Against expectations, however, no indirect effect from leadership quality on prevention through the other work environment factors was found.

CONCLUSIONS

In conclusion, the quality of leadership in Swedish Public Dental Health clinics was positively related to a good work environment for staff and to delivery of preventive care to patients experiencing caries.

The Role of Staff-Assessed Care Quality in the Relationship between Job Demands and Stress in Human Service Work: The Example of Dentistry

The aim of this study was to investigate staff-assessed care quality at the clinic as a predictor of stress and as a moderator between job demands (quantitative demands and role conflict) and stress among dental professionals as an example of human service workers. Cross-sectional questionnaire data from 1012 dental professionals (i.e., dentists, dental hygienists and dental nurses) working at 99 clinics were analysed by confirmatory factor analysis and a two-level hierarchical linear model. Stress, quantitative demands and role conflict were measured by the Swedish standard version of COPSOQ III and care quality was measured by three proprietary items. The results showed that staff-assessed care quality at the clinic was of importance for the individual workers' experiences of stress. Furthermore, the staff's joint assessment of the care quality at the clinic mitigated the negative effect of role conflict on stress among dental nurses. These results indicate that a high level of staff-assessed care quality at the clinic can contribute to reduced stress in dental professionals.

Does workplace social capital predict care quality through job satisfaction and stress at the clinic? A prospective study

Background

Welfare societies like Sweden face challenges in balancing the budget while meeting the demand for good quality healthcare. The aim of this study was to analyse whether care quality, operationalized as survival of dental fillings, is predicted by workplace social capital and if this effect is direct or indirect (through stress and/or job satisfaction among staff at the clinic), controlling for patient demographics.

Methods

The prospective design includes A) work environment data from surveys of 75 general public dental clinics (aggregated data based on 872 individual ratings), and B) register-based survival of 9381dental fillings performed during a 3-month period around the time of the survey, and C) patient demographics (age, gender, income level and birth place). Using a multi-level discrete-time proportional hazard model, we tested whether clinic-level social capital, stress, and job satisfaction could predict tooth-level filling failure, controlling for patient demographics. One direct and two indirect pathways, moderated by filling tooth, location, and filling type, were tested.

Results

High workplace social capital reduced the risk of early failure of fillings in molar teeth, mediated by group-perceived job satisfaction (indirect path: OR = 0.93, p < .05, direct path from job satisfaction: OR = 0.89, p < .05). Contrary to expectations, we found no support for a direct effect from social capital on care quality or for the indirect pathway via stress at the clinic level.

Conclusions

Workplace social capital boosted the quality of dental fillings through increased levels of job satisfaction. In addition, staff at clinics with higher social capital reported less stress and higher levels of job satisfaction. These results indicate that promotion of social capital may improve both occupational health and care quality.

Does staff-assessed care quality predict early failure of dental fillings? A prospective study

OBJECTIVES

The aim of this study was to evaluate staff-assessed care quality as an indicator of register-based measures of care quality at dental clinics, more specifically register-based measures of survival of dental fillings and initiation of preventive treatments for caries patients.

METHODS

This prospective study includes data from cross-sectional workplace psychosocial risk assessment surveys at dental clinics and register data on survival of dental fillings, and initiation of preventive treatment for caries patients obtained from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa) Demographic background data on the age, gender, income level and place of birth of patients was obtained from Statistics Sweden (SCB). The data were analysed using discrete-time multilevel survival analysis and multiple linear regression analysis.

RESULTS

The results showed that staff-assessed care quality rated by the total staff or by dental nurses at the clinic predicted the risk of replacement of dental fillings made due to a caries diagnosis during the 3-year follow-up period, controlling for potential confounding due to patient demographic characteristics (age, sex, income and country of birth). In contrast, the better the staff-assessed care quality at the clinic, the smaller the proportion of the patients received preventive care in addition to operative caries therapy when controlling for potential confounding due to patient demographics. Care quality assessed by dentists at the clinic did not predict either of these outcome measures.

CONCLUSIONS

Premature failure of dental fillings is costly for both patients and society, which leads to a need for relevant measures for following dental care quality. Our findings indicate that staff-assessed care quality - a cheap and easy measure to collect and follow continuously in dental practice - can be used to monitor aspects of quality in real time in order to facilitate continuous improvement and quickly amend quality problems. Also, it can be used for integrating quality improvement in systematic work environment risk management.

No Job Demand Is an Island - Interaction Effects Between Emotional Demands and Other Types of Job Demands

Emotional demands are an inevitable feature of human services, and suggested to be a defining antecedent for workers’ stress and ill health. However, previous research indicate that emotional demands can have a favorably association to certain facets of human service workers’ motivation and well-being. Furthermore, recent research report that the effect of emotional demands on workers’ health and well-being seem to be contingent on the parallel level of other job demands. Still, initial investigations of interaction effects between emotional demands and other types of job demands have primarily focused on negative outcomes in terms of stress-related concerns and absenteeism. The present study investigated interaction effects between emotional demands and other types of job demands in relation to positive outcomes. In a larger sample of human service workers (social workers, n = 725), interaction effects were investigated between emotional demands and other job demands (quantitative demands, work pressure, and role conflict) for meaning in work and quality of work. Hypotheses stated that other job demands would moderate the relationship between emotional demands and positive outcomes, so that emotional demands would have a positive relation (i.e., act as a challenge) when the level of other demands is lower, but have a negative relation (i.e., act as a hindrance) when the level of other demands is high. Overall, the results provided support for the idea that emotional demands may act as a challenge. We found small but significant interaction effects between emotional demands and work pressure – in relation to meaning of work, as well as between emotional demands and quantitative demands, work pressure, and role-conflict, respectively – in relation to quality of work. Yet, the results did not support the assumption that emotional demands act as a hindrance when the level of other types of job demands is high. In sum, the results contribute by showing that emotional demands may promote human-service workers’ job attitudes when the level of parallel job demands is lower. We discuss the contribution of the study and the potential practical implications of the results, and give some suggestions for future research.

Can a poor psychosocial work environment and insufficient organizational resources explain the higher risk of ill-health and sickness absence in human service occupations? Evidence from a Swedish national cohort

AIM

The aim of this study was to investigate differences in burnout, self-rated health (SRH) and sickness absence between human service occupations (HSOs) and other occupations, and whether they can be attributed to differences in psychosocial work environment and organizational resources.

METHODS

Data were derived from the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population ( n = 4408). Employment in HSOs, psychosocial work environment and organizational resources in 2012 predicted relative risks of sickness absence, burnout and suboptimal SRH in 2014 using modified Poisson regressions. The psychosocial work factors' and organizational resource variables' relative importance were estimated by adding them to the models one by one, and with population attributable fractions (PAFs).

RESULTS

Employment in HSOs was associated with a higher risk of sickness absence and the risk was explained by psychosocial and organizational factors, particularly high emotional demands, low work-time control and exposure to workplace violence. Employment in HSOs was not associated with burnout after sociodemographic factors were adjusted for, and furthermore not with SRH. A lower risk of suboptimal SRH was found in HSOs than in other occupations with equivalent psychosocial work environment and organizational resources. PAFs indicated that psychosocial work environment and organizational resource improvements could lead to morbidity reductions for all outcomes; emotional demands were more important in HSOs.

CONCLUSIONS

HSOs had higher risks of sickness absence and burnout than other occupations. The most important work factors to address were high emotional demands, low work-time control, and exposure to workplace violence.

Copenhagen Psychosocial Questionnaire - A validation study using the Job Demand-Resources model

Aim

This study aims at investigating the nomological validity of the Copenhagen Psychosocial Questionnaire (COPSOQ II) by using an extension of the Job Demands-Resources (JD-R) model with aspects of work ability as outcome.

Material and methods

The study design is cross-sectional. All staff working at public dental organizations in four regions of Sweden were invited to complete an electronic questionnaire (75% response rate, n = 1345). The questionnaire was based on COPSOQ II scales, the Utrecht Work Engagement scale, and the one-item Work Ability Score in combination with a proprietary item. The data was analysed by Structural Equation Modelling.

Results

This study contributed to the literature by showing that: A) The scale characteristics were satisfactory and the construct validity of COPSOQ instrument could be integrated in the JD-R framework; B) Job resources arising from leadership may be a driver of the two processes included in the JD-R model; and C) Both the health impairment and motivational processes were associated with WA, and the results suggested that leadership may impact WA, in particularly by securing task resources.

Conclusion

In conclusion, the nomological validity of COPSOQ was supported as the JD-R model-can be operationalized by the instrument. This may be helpful for transferral of complex survey results and work life theories to practitioners in the field.

Is organizational justice climate at the workplace associated with individual-level quality of care and organizational affective commitment? A multi-level, cross-sectional study on dentistry in Sweden

Purpose

The aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members’ perceptions of care quality and affective commitment to the workplace.

Methods

The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confounding by group size, gender, age, and occupation.

Results

The results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p < 0.001).

Conclusions

Organizational justice climate at work unit level explained all variation in affective commitment among dental clinics and was associated with both the individual staff members’ affective commitment and perceived quality of care. These findings suggest a potential for that addressing organizational justice climate may be a way to promote quality of care and enhancing affective commitment. However, longitudinal studies are needed to support causality in the examined relationships. Intervention research is also recommended to probe the effectiveness of actions increasing unit-level organizational justice climate and test their impact on quality of care and affective commitment.

Dentists' opinions on using digital technologies in dental practice

OBJECTIVES

To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account.

METHODS

A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice.

RESULTS

The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses.

CONCLUSION

Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.

It is not just about occupation, but also about where you work

OBJECTIVES

Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level.

METHODS

All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses.

RESULTS

First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects.

CONCLUSION

In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.

Organization and overall job satisfaction among publicly employed, salaried dentists in Sweden and Denmark

BACKGROUND

In Sweden and Denmark, clinical dentistry is changing and public dentistry is in transition towards more market orientation. Dentists' overall job satisfaction is important for how public dentistry can fulfil the new expectations from patients, the public and politicians.

OBJECTIVES

The aim of this study was to investigate what organizational factors were important for publicly employed salaried dentists' overall job satisfaction.

METHODS

A random sample of active, general dental practitioners (private and publicly employed) was selected in Denmark and in Sweden, and they received a postal questionnaire. The number of questionnaires was 1835 and the response rate was 68% (n = 1226). This study analysed only the publicly employed dentists. The sampling frame for the Swedish dentists was 431, response rate 68.9% (n = 297) and for the Danish ones 194, response rate 81.9% (n = 159). Multivariate regression was used with overall job satisfaction as a dependent variable.

RESULTS

Common organizational variables were important. The used model explained between 32% (Sweden) and 39% (Denmark) of the variance in overall job satisfaction. The only significant individual factor was less job satisfaction for Swedish dentists born outside Sweden. An organizational climate characterized by a focus on professional values was associated with job satisfaction in both countries. Among the Swedish dentists, number of colleagues and degree of influence were also important and among the Danish ones sufficient time for patients.

CONCLUSIONS

Organizational factors had an impact on salaried publicly employed dentists' overall job satisfaction in both countries. The findings may have implications for other Human Service Organizations with employed professionals.

With a little help from my assistant: buffering the negative effects of emotional dissonance on dentist performance

OBJECTIVE

In this study, we hypothesized that dentist' interpersonal resources (good cooperation with one's assistant) together with their personal resources (optimism) buffer the negative effects of emotional dissonance (a demand that occurs when there is a difference between felt and displayed emotions) on job performance (in-role and extra-role performance) over time.

METHOD

We carried out Hierarchical Regression Modeling on a sample of 1954 Finnish dentists who participated in a two-wave 4-year longitudinal study.

RESULTS

Results showed that good cooperation with dental assistants buffered the negative effects of emotional dissonance on both in-role and extra-role performance among the dentists in the long term. However, unexpectedly, dentists' high optimism did not buffer their in-role nor extra-role performance over time under conditions of experiencing high emotional dissonance.

CONCLUSIONS

We conclude that interpersonal job resources such as good cooperation with one's colleagues may buffer the negative effect of emotional dissonance on dentists' job performance even in the long term, whereas the role of personal resources (e.g., optimism) may be less important for maintaining high job performance under conditions of emotional dissonance. The study novelties include the test of the negative effects of emotional dissonance on long-term performance in dentistry and the identification of the job rather than personal resources as the buffers against the negative effects of emotional dissonance on long-term performance.

Collegial Support and Community with Trust in Swedish and Danish dentistry

OBJECTIVES

The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust).

METHODS

A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models.

RESULTS

A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust.

CONCLUSION

A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Measurement of social support, community and trust in dentistry

BACKGROUND AND AIM

Relationships among people at work have previously been found to contribute to the perception of having a good work. The aim of the present paper was to develop scales measuring aspects of social support, trust, and community among dentists, and to evaluate psychometric properties of the scales.

MATERIAL AND METHODS

In 2008, a questionnaire was sent to 1,835 general dental practitioners randomly selected from the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Principal Component Analysis was applied to 14 items and scales were established based on the resulting factors. Internal consistency was evaluated by Cronbach's alpha. Differential Item Functioning (DIF) with respect to gender, nationality and employment sector was analysed using ordinal logistic regression methods. Construct validity was assessed in relation to self-rated health and a range of work satisfaction outcomes.

RESULTS

The percentage of missing values on the items was low (range 0.7%-3.8%). Two scales (range 0-100) were established to measure 'Community with Trust'(nine items, mean = 79.2 [SD = 13.4], Cronbach's alpha = 0.89) and 'Collegial Support'(five items, mean = 70.4 [SD = 20.8], Cronbach's alpha = 0.89). DIF of only minor importance was found which supported cultural equivalence. The two scales were weakly positively correlated with each other. 'Community with Trust' was in general more strongly correlated with work satisfaction variables than 'Collegial Support' was.

CONCLUSIONS

Stability and internal consistency of the scales were considered as satisfactory. Content validity and construct validity were considered as good. Further validation in other populations is recommended.

Overall job satisfaction among dentists in Sweden and Denmark: A comparative study, measuring positive aspects of work

OBJECTIVE

Human service work differs from industrial work, which should be considered when organizing work. Previous research has shown organizational differences in the perceptions of work, often with a focus on negative aspects. The aim of this study was to analyse the overall job satisfaction among private- and public-practising dentists in Sweden and Denmark. This also implied a description of the questionnaire Swedish and Danish Dentists' Perceptions of Good Work about opportunities and positive and rewarding aspects of work.

MATERIAL AND METHODS

A questionnaire covering the multidimensional concept of good work was developed. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. A special non-response study was performed. Principal components analysis (PCA) was used to create a measure of overall job satisfaction, comparing four organizational subgroups.

RESULTS

The average net response rate was 68% (n = 1226). The special non-response study of the Danish private practitioners showed more males, managers and dentists with more working hours than the respondents. PCA of three satisfaction questions showed a stable one-factor solution. There were differences in job satisfaction, with Danish public dentists ranked highest in overall job satisfaction and Swedish public dentists lowest.

CONCLUSIONS

There were organizational differences in the perception of job satisfaction. Further analysis of how the human service is organized in the different groups is needed.