Front-line staff perspectives on a caring culture in Chinese hospitals: Validation of a Chinese version of the Culture of Care Barometer

The interplay between organizational culture and burnout among ICU professionals: A cross-sectional multicenter study

PURPOSE

Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.

MATERIALS AND METHODS

Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.

RESULTS

696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.

CONCLUSIONS

Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.

Implementation of a value-based approach for older people who have suffered an acute myocardial infarction: study protocol

Introduction

Due to the rapid aging of the global population, new approaches are required to improve the quality of life of older people and to reduce healthcare system expenditures. One of the approaches that can be used is value-based healthcare. This article describes a value-based solution for older people who have suffered a myocardial infarction.

Methods

This solution combines the work of healthcare professionals and informal caregivers and the use of modern and user-friendly technologies to support the achievement of patients' values. Patients older than 65 years who have suffered a myocardial infarction will be divided into control and intervention groups within a pre-post-controlled design research study. Members of the intervention group will be provided with a personalized plan developed by healthcare professionals and based on the results from the baseline questionnaire.

Discussion

Two ValueCare digital solution components will be developed: a mobile application for the participants and a web platform for the professionals, researchers, and informal caregivers. Together with smartwatches, which will track important health aspects, and applications, this approach would enable older people to improve their health through correct lifestyle choices and their professional and informal caregivers to track their progress. With the use of the described technology and the multidisciplinary approach, the unmet needs and values of participants could be achieved. Using this approach, it could be possible to reduce overall healthcare expenses through the active involvement of both older people and their informal caregivers through a shared decision-making process with healthcare professionals.

Clinical trial registration

The ISRCTN registry number is 25089186. The date of trial registration is 16/11/2021.

Systematic RADaR analysis of responses to the open-ended question in the Culture of Care Barometer survey of a Dutch hospital

OBJECTIVES

Systematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to the one open-ended question posed in the Dutch version of the Culture of Care Barometer (CoCB-NL) to examine (1) if the responses offered new insights into healthcare employees' perceptions of their work environment and (2) if the original CoCB had any themes missing.

DESIGN

Retrospective text analysis using Rigorous and Accelerated Data Reduction technique.

SETTING

University hospital in the Netherlands using the CoCB-NL as part of the annual employee survey.

PARTICIPANTS

All hospital employees were invited to participate in the study (N=14 671). In total, 2287 employees responded to the open-ended question.

RESULTS

2287 comments were analysed. Comments that contained more than one topic were split according to topic, adding to the total (n=2915). Of this total, 372 comments were excluded because they lacked content or respondents indicated they had nothing to add. Subsequently, 2543 comments were allocated to 33 themes. Most comments (n=2113) addressed the 24 themes related to the close-ended questions in the CoCB-NL. The themes most commented on concerned questions on 'organisational support'. The remaining 430 comments covered nine additional themes that addressed concerns about work environment factors (team connectedness, team effectiveness, corporate vision, administrative burden and performance pressure) and themes (diversity and inclusion, legal frameworks and collective bargaining, resilience and work-life balance, and personal matters).

CONCLUSIONS

Analysing responses to the open-ended question in the CoCB-NL led to new insights into relevant elements of the work environment and missing themes in the COCB-NL. Moreover, the analysis revealed important themes that not only require attention from healthcare organisations to ensure adequate improvements in their employees' work environment but should also be considered to further develop the CoCB-NL.

Measuring the work environment among healthcare professionals: Validation of the Dutch version of the Culture of Care Barometer

OBJECTIVES

A positive work environment (WE) is paramount for healthcare employees to provide good quality care. To stimulate a positive work environment, employees' perceptions of the work environment need to be assessed. This study aimed to assess the reliability and validity of the Dutch version of the Culture of Care Barometer (CoCB-NL) survey in hospitals.

METHODS

This longitudinal validation study explored content validity, structural validity, internal consistency, hypothesis testing for construct validity, and responsiveness. The study was conducted at seven departments in two Dutch university hospitals. The departments were included based on their managers' motivation to better understand their employees' perception of their WE. All employees of participating departments were invited to complete the survey (n = 1,730).

RESULTS

The response rate was 63.2%. The content of the CoCB-NL was considered relevant and accessible by the respondents. Two factor models were found. First, confirmative factor analysis of the original four-factor structure showed an acceptable fit (X2 2006.49; df 399; p = <0.001; comparative fit index [CFI] 0.82; Tucker-Lewis index [TLI] 0.80; root mean square error of approximation [RMSEA] 0.09). Second, explanatory factor analysis revealed a five-factor model including 'organizational support', 'leadership', 'collegiality and teamwork', 'relationship with manager', and 'employee influence and development'. This model was confirmed and showed a better fit (X2 1552.93; df 395; p = < 0.00; CFI 0.87; TLI 0.86; RMSEA 0.07). Twelve out of eighteen hypotheses were confirmed. Responsiveness was assumed between the measurements.

CONCLUSIONS

The CoCB-NL is a valid and reliable instrument for identifying areas needing improvement in the WE. Furthermore, the CoCB-NL appears to be responsive and therefore useful for longitudinal evaluations of healthcare employees' work environments.