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Sandvik MK, Nesvåg R, Jorem J, Lien L. Which factors affect job satisfaction of doctors in psychiatry? Nord J Psychiatry 2024; 78:198-204. [PMID: 38247281 DOI: 10.1080/08039488.2024.2303314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Recent reports have described challenges in retaining and recruiting psychiatrists in public mental health care. To improve the work situation for doctors, the Norwegian Psychiatric Association (NPA) conducted surveys to explore job satisfaction among its members. The purpose of this study is to explore how doctors in mental health services perceive their work, and factors affecting their job satisfaction. MATERIAL AND METHODS A Questback survey was sent to all employed members of NPA in June 2020 and in December 2021. In the first survey, 670 members (37%) responded and 903 (43%) in the second. Job satisfaction was measured on a Likert scale from one to five. Linear regression was used to examine associations between work-related factors and job satisfaction. RESULTS In 2021, more than half of the respondents (56%) were satisfied, 16% were dissatisfied and 27% were neutral. The oldest and youngest doctors were most satisfied (p < 0.001). Partial treatment responsibility was related to reduced job satisfaction (β = -0.23, p < 0.001) as well as access to an experienced colleague (β = 0.39, p < 0.001), time for direct patient contact (β = 0.17, p < 0.001) and ability to treat patients in a satisfactory manner (β = 0.52, p < 0.001). Job satisfaction decreased from 2020 to 2021. CONCLUSIONS Psychiatrists seem to be torn between treating their own patients and having medically responsible for other therapists' patients. Time for patient contact and discussions with colleagues are crucial for psychiatrists' well-being at work.
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Affiliation(s)
| | | | - Jacob Jorem
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Lars Lien
- Norwegian Psychiatric Association, Inland Norway University of Applied Sciences, and Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Disorders, Oslo, Norway
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Voltmer E, Rosta J, Köslich-Strumann S, Goetz K. Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study. PLoS One 2024; 19:e0296703. [PMID: 38181025 PMCID: PMC10769063 DOI: 10.1371/journal.pone.0296703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Physicians' health and wellbeing are important albeit often neglected quality indicators of health care systems. The aims of the study were to compare job satisfaction and work stress among doctors in Germany and Norway, and to identify predictors for job satisfaction. METHODS All active physicians in Schleswig-Holstein, Germany (N = 13,304) and a nationwide sample of Norwegian physicians (N = 2,316) were surveyed in a cross-sectional design in 2021. Response rates of German and Norwegian physicians were n = 4,385 (33%) and n = 1,639 (70.8%), respectively. In addition to age, sex, and work-hours, the main outcome measures were the validated Job Satisfaction Scale (JSS) and the short form of the Effort-Reward Imbalance Questionnaire (ERI). RESULTS There were significant differences between Norwegian and German physicians in job satisfaction but with small effect sizes. All effort scores of German physicians were significantly higher and four of seven reward scores significantly lower than for their Norwegian colleagues. The proportion of German physicians in the state of a gratification crisis was significantly higher (67%) than in their Norwegian colleagues (53%). In both countries, physicians with a gratification crisis scored significantly lower on all items of job satisfaction. There were only minor gender differences in job satisfaction and effort-reward balance. Age, effort, and reward accounted for 46% of the explained variance of job satisfaction. CONCLUSIONS Lower job satisfaction and reward in some areas and higher perceived effort of physicians in Germany than in Norway are still in favor of Norwegian working conditions, but the differences seem to diminish. The high proportions of gratification crises in both countries warrants appropriate measures for prevention and health promotion.
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Affiliation(s)
- Edgar Voltmer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | | | - Katja Goetz
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Lübeck, Germany
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Elzahhar R, Aylott J, Indrasena BSH, Wrazen R, Othman A. Exploring the motivation of surgeons to lead juniors and the impact of their leadership on junior doctors motivation and leadership preference. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37971782 DOI: 10.1108/lhs-05-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. DESIGN/METHODOLOGY/APPROACH In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. FINDINGS The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. RESEARCH LIMITATIONS/IMPLICATIONS The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. PRACTICAL IMPLICATIONS The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt.
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Affiliation(s)
- Ramy Elzahhar
- Department of Orthopaedics and Traumatology, Benedictus Krankenhaus Tutzing, Tutzing, Germany
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Remig Wrazen
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
| | - Ahmed Othman
- Department of Orthopaedic Surgery, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
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Dennis AA, Colton L, Tewari P, Slavin S. Promoting Well-Being in Graduate Medical Education: Embracing Principles Rather Than "Recipe". ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01827-0. [PMID: 37552402 DOI: 10.1007/s40596-023-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | - Lara Colton
- Houston Methodist Medical Center, Houston, TX, USA
| | - Priti Tewari
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stuart Slavin
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
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Rosta J, Rø KI. Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys. BMJ Open 2023; 13:e069331. [PMID: 37349097 PMCID: PMC10314479 DOI: 10.1136/bmjopen-2022-069331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/01/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway. DESIGN Repeated postal surveys in 2016 and 2019. SETTING Norway. PARTICIPANTS Representative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019. MAIN OUTCOME MEASURES Self-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care. ANALYSES Linear mixed models with estimated marginal means and proportions. RESULTS From 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%). CONCLUSIONS Working hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.
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Affiliation(s)
- Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
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Horne IMT, Veggeland F, Bååthe F, Drewes C, Rø KI. Understanding peer support: a qualitative interview study of doctors one year after seeking support. BMC Health Serv Res 2023; 23:324. [PMID: 37004074 PMCID: PMC10066008 DOI: 10.1186/s12913-023-09312-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Doctors' health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs. MATERIALS AND METHODS Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein. RESULTS The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised. CONCLUSIONS Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors' needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.
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Affiliation(s)
- Ingrid Marie Taxt Horne
- Research Institute Modum Bad, Postbox 33, Vikersund, 3371, Norway.
- Institute for Studies of the Medical Profession, Oslo, Norway.
| | - Frode Veggeland
- Department of Organisation, Leadership and Management, Inland Norway University of Applied Sciences (HINN), Lillehammer, Norway
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, Oslo, Norway
| | - Christina Drewes
- Health Department, County Governor of Trøndelag, Trondheim, Norway
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Herttuala N, Konu A, Kokkinen L. Working as a nurse manager and being in the middle of one’s career is connected to lower work well-being. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2023. [DOI: 10.1080/20479700.2023.2173831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Niina Herttuala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - A. Konu
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - L. Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Bogerd R, Debets MPM, Keuken DG, Hassink RJ, Henriques JPS, Lombarts KMJMH. The relationship between physicians' self-kindness and professional fulfillment and the mediating role of personal resilience and work-home interference: A cross-sectional study. PLoS One 2023; 18:e0284507. [PMID: 37093877 PMCID: PMC10124859 DOI: 10.1371/journal.pone.0284507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Professional fulfillment is crucial for physicians' well-being and optimal patient care. Highly demanding work environments, perfectionism and self-critical attitudes jeopardize physicians' professional fulfillment. OBJECTIVE To explore to what extent a kinder attitude towards the self, i.e. self-kindness, was associated with physicians' professional fulfillment and whether this relationship was mediated by personal resilience and work-home interference. METHODS In 2020, cardiologists (n = 374) in the Netherlands participated in a web-based survey. Self-kindness was measured by the self-kindness subscale of the Self-Compassion Scale, personal resilience by the Brief Resilience Scale, work-home interference by the negative Work-Home Interference subscale of the Survey Work-Home Interaction-Nijmegen, and professional fulfillment by the corresponding subscale of the Professional Fulfillment Index. Using Hayes' SPSS macro PROCESS v3.5, the authors tested the parallel mediation model. RESULTS Self-kindness was not directly associated with professional fulfillment (direct effect = .042, p = .36, 95% CI: -0.048, 0.132). Self-kindness was indirectly related to professional fulfillment through individual resilience (indirect effect = .049, 95% CI: .020, 0.086) and work-home interference (indirect effect = .057, 95% CI: .023, 096). CONCLUSIONS This study suggests that improving physicians' self-kindness may enhance professional fulfillment through personal resilience and work-home interference. Our findings may stimulate and remind physicians to be kind towards themselves as it may benefit them and their patients.
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Affiliation(s)
- Rosa Bogerd
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten P M Debets
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Debby G Keuken
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - José P S Henriques
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Bååthe F, von Knorring M, Isaksson-Rø K. How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:261-274. [PMID: 36573612 PMCID: PMC10427974 DOI: 10.1108/lhs-02-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals' engagement. DESIGN/METHODOLOGY/APPROACH Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. FINDINGS The top managers had the intention to balance between quality of patient care, economy and professionals' engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. PRACTICAL IMPLICATIONS For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals' engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals' engagement. However, this study builds on a limited number of participants. More research is needed. ORIGINALITY/VALUE Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals' engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.
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Affiliation(s)
- Fredrik Bååthe
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway; Institute of Stress Medicine at Region Västra Götaland, Gothenburg, Sweden and Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mia von Knorring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Karin Isaksson-Rø
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway and Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway
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Deilkås ET, Rosta J, Baathe F, Søfteland E, Lexberg ÅS, Røise O, Rø KI. Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey. BMC PRIMARY CARE 2022; 23:267. [PMID: 36284296 PMCID: PMC9594954 DOI: 10.1186/s12875-022-01878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice. METHODS A cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019. RESULTS The response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians' interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated. CONCLUSIONS This study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.
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Affiliation(s)
- Ellen Tveter Deilkås
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Judith Rosta
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway
| | - Fredrik Baathe
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway ,The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Eirik Søfteland
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Åse Stavland Lexberg
- grid.459157.b0000 0004 0389 7802Quality Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Olav Røise
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.18883.3a0000 0001 2299 9255Faculty of Health Sciences, SHARE – Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Karin Isaksson Rø
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway
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Greenberg AL, Boscardin C, Lebares CC. Flourishing as a guide to intervention: a national multicenter study of general surgery residents. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:12. [PMID: 38624947 PMCID: PMC8968303 DOI: 10.1007/s44186-022-00014-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 04/17/2024]
Abstract
Purpose Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact. Methods In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed. Results Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect. Conclusions Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00014-3.
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Affiliation(s)
- Anya L. Greenberg
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Christy Boscardin
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Carter C. Lebares
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
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Lebares CC, Greenberg AL, Gonzales PA, Boscardin CK. Validity evidence for flourishing as a measure of global wellbeing: a national multicenter study of academic general surgery residents. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:1. [PMID: 38624941 PMCID: PMC8832420 DOI: 10.1007/s44186-022-00008-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 10/28/2022]
Abstract
Purpose Physician wellbeing is critical to high-quality sustainable healthcare and optimal patient experience. Few objective measures exist to assay wellbeing (as opposed to just pathology) in surgery, or to evaluate the efficacy of wellbeing interventions. Flourishing (as measured by the Mental Health Continuum, MHC) has been suggested as a concise measure of global wellbeing in surgeons. We aimed to establish validity evidence for flourishing in a large national sample of surgical trainees, explore differences by gender and race, and confirm support for the underlying constructs. Methods This cross-sectional study of all General Surgery residents at 16 ACGME-accredited academic programs included an online survey of published measures distributed in February 2021. The Mental Health Continuum (MHC), a three-factor model, assesses emotional, social, and psychological wellbeing and is an established metric of psychosocial thriving in non-physicians. A global score cut-off exists for flourishing which represents high wellbeing. Correlation between flourishing and established measures of risk and resilience in surgery were assessed for validity evidence. Differences by gender and race were explored. A confirmatory factor analysis (CFA) was performed to confirm the three-factor structure in surgical trainees. Results 300 residents (60% non-male, 41% non-white) responded to the survey. For the overall group, flourishing was significantly positively correlated with all wellbeing resilience factors and negatively correlated with all risk factors. This held true for race and gender subgroups based on interaction analyses. CFA and sensitivity analysis results supported the three-factor structure. Conclusions Our findings offer validity evidence for flourishing as a measure of global wellbeing and confirm the three-factor structure of emotional, social, and psychological wellbeing in surgical trainees. Thus, the MHC may be a concise tool for assaying wellbeing, within and across subgroups, and for assessing wellbeing intervention effectiveness within the surgery.
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Affiliation(s)
- Carter C. Lebares
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Anya L. Greenberg
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Paul A. Gonzales
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Christy K. Boscardin
- Departments of Medicine and Anesthesia, Univeristy of Carlifornia San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - and the General Surgery Research Collaborative on Resident Wellbeing
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
- Departments of Medicine and Anesthesia, Univeristy of Carlifornia San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
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Lebares CC, Greenberg AL, Ascher NL, Delucchi KL, Reilly LM, van der Schaaf M, Baathe F, O’Sullivan P, Isaksson Rø K. Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program: A Mixed-Methods Study. JAMA Netw Open 2021; 4:e2032676. [PMID: 33404621 PMCID: PMC7788470 DOI: 10.1001/jamanetworkopen.2020.32676] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Physician well-being is a critical component of sustainable health care. There are few data on the effects of multilevel well-being programs nor a clear understanding of where and how to target resources. OBJECTIVE To inform the design of future well-being interventions by exploring individual and workplace factors associated with surgical trainees' well-being, differences by gender identity, and end-user perceptions of these initiatives. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods study among surgical trainees within a single US academic surgical department included a questionnaire in January 2019 (98 participants, including general surgery residents and clinical fellows) and a focus group (9 participants, all clinical residents who recently completed their third postgraduate year [PGY 3]) in July 2019. Participants self-reported gender (man, woman, nonbinary). EXPOSURES Individual and organizational-level initiatives, including mindfulness-based affective regulation training (via Enhanced Stress Resilience Training), advanced scheduling of time off, wellness half-days, and the creation of a resident-driven well-being committee. MAIN OUTCOMES AND MEASURES Well-being was explored using validated measures of psychosocial risk (emotional exhaustion, depersonalization, perceived stress, depressive symptoms, alcohol use, languishing, anxiety, high psychological demand) and resilience (mindfulness, social support, flourishing) factors. End-user perceptions were assessed through open-ended responses and a formal focus group. RESULTS Of 98 participants surveyed, 64 responded (response rate, 65%), of whom 35 (55%) were women. Women vs men trainees were significantly more likely to report high depersonalization (odds ratio [OR], 5.50; 95% CI, 1.38-21.85) and less likely to report high mindfulness tendencies (OR, 0.17; 95% CI, 0.05-0.53). Open-ended responses highlighted time and priorities as the greatest barriers to using well-being resources. Focus group findings reflected Job Demand-Resource theory tenets, revealing the value of individual-level interventions to provide coping skills, the benefit of advance scheduling of time off for maintaining personal support resources, the importance of work quality rather than quantity, and the demoralizing effect of inefficient or nonresponsive systems. CONCLUSIONS AND RELEVANCE In this study, surgical trainees indicated that multilevel well-being programs would benefit them, but tailoring these initiatives to individual needs and specific workplace elements is critical to maximizing intervention effects.
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Affiliation(s)
| | | | - Nancy L. Ascher
- Department of Surgery, University of California, San Francisco
| | | | - Linda M. Reilly
- Department of Surgery, University of California, San Francisco
| | - Marieke van der Schaaf
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fredrik Baathe
- Institute of Care and Health Services, University of Gothenburg, Gothenburg, Sweden
- Institute of Stress Medicine, Gothenburg, Sweden
- Institute for the Studies of the Medical Profession, University of Oslo, Oslo, Norway
| | | | - Karin Isaksson Rø
- Institute for the Studies of the Medical Profession, University of Oslo, Oslo, Norway
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Lynn Dobkin P, Velez C. Physicians' Views on a Wellbeing Course Gifted to Them: A Qualitative Study. Perm J 2020; 24:1-8. [PMID: 33482957 PMCID: PMC7849267 DOI: 10.7812/tpp/19.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Given concerns about staff burnout and distress, the Chief of the Department of Medicine sponsored the Physician Wellbeing program making it cost-free for doctors at a large academic medical setting. Ninety doctors registered within the 1-year pilot project time frame. Following a Mind-Body Medicine online and Mindful Medical Practice workshop a qualitative study was conducted to identify physicians' views about the initiative. Physicians who agreed to take part following the workshops were the participants in the study. METHODS Focus groups and individual interviews were conducted following 4 workshops. Participants (N = 15) were queried about helpful and unhelpful aspects of the program. Thematic framework analysis was employed for data analysis. RESULTS Four themes regarding participants' views on the well-being course were identified. These were: 1) online curriculum (from engaging to disengaging); 2) intimate sharing amongst physicians in the workshop; 3) reflecting on and practicing wellness; and 4) a valuable "gift" from the Department of Medicine. Workshops were highly valued as they provided an opportunity to practice what was learned online as well as engage in fruitful exchanges amongst colleagues. CONCLUSIONS Physicians supported the integration of wellness programs into medical settings where stress is an inherent aspect of the work environment. They were grateful for the "gift" of being valued and supported by the administration.
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Rosta J, Bååthe F, Aasland OG, Isaksson Rø K. Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys. BMJ Open 2020; 10:e037474. [PMID: 33082185 PMCID: PMC7577039 DOI: 10.1136/bmjopen-2020-037474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To explore and discuss the changes in the levels of work stress for Norwegian doctors in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia) from 2010 to 2019. DESIGN Repeated questionnaire surveys in 2010, 2016 and 2019, where samples were partly overlapping. SETTING Norway. PARTICIPANTS A representative sample of 1500-2200 doctors in different job positions. Response rates were 66.7% (1014/1520) in 2010, 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019. MAIN OUTCOME MEASURE Validated 9-item short form of the 'Effort-Reward Imbalance' questionnaire. A risky level of work stress was defined as an effort/reward ratio above 1.0. ANALYSES Linear mixed models with estimated marginal means of job positions controlled for gender and age. Proportions with 95% CIs. RESULTS From 2010 to 2016 and further to 2019, GPs reported a significant increase in levels on the effort scale (ES: 2.96, 3.25, 3.51) and significant decrease in levels on the reward scale (RS: 4.27, 4.05, 3.67). No significant changes were reported by hospital doctors (ES: 3.13, 3.10, 3.14; RS: 4.09, 3.98, 4.04), private practice specialists (ES: 2.58, 2.61, 2.59; RS: 4.32, 4.32, 4.30) and doctors in academia (ES: 2.63, 2.51, 2.52; RS: 4.09, 4.11, 4.14). The proportion of doctors with risky levels of work stress increased significantly for GPs (10.3%, 27.7%, 40.1%), but did not significantly change for hospital doctors (23.0%, 27.3%, 26.9%), private practice specialists (8.2%, 12.7%, 9.4%) and doctors in academia (11.9%, 19.0%, 16.4%). CONCLUSION During a 9-year period, the proportion of risky levels of work stress increased significantly for GPs but did not significantly change for other job positions. This may be partly due to changes in expectations of younger GPs and several healthcare reforms and regulations.
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Affiliation(s)
- Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, Oslo, Norway
- Institute of Stress Medicine, Gothenburg, Sweden
| | - Olaf G Aasland
- Institute for Studies of the Medical Profession, Oslo, Norway
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Pervaz Iqbal M, Manias E, Mimmo L, Mears S, Jack B, Hay L, Harrison R. Clinicians' experience of providing care: a rapid review. BMC Health Serv Res 2020; 20:952. [PMID: 33059673 PMCID: PMC7559170 DOI: 10.1186/s12913-020-05812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/09/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. METHODS A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. RESULTS Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools. CONCLUSION Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.
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Affiliation(s)
- Maha Pervaz Iqbal
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Laurel Mimmo
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
- Sydney Children’s Hospitals, Network, Sydney, NSW Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, NSW 2350 Australia
| | - Briony Jack
- Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Liz Hay
- Economics and Analysis, Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
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