Job satisfaction of primary care team members and quality of care

Does Organizational Commitment to Mental Health Affect Team Processes? A Longitudinal Study

Purpose

Team processes, such as reflexivity and participation, are critical for organizational sustainability, especially in high-reliability professions such as healthcare. However, little is known about health-related predictors of team processes. Basing our hypotheses on the Input-Process-Output (IPO) model, this study investigates the influence of perceived organizational commitment to mental health (OCMH) on healthcare workers' team reflexivity and participation via mental health-specific leadership (MHsL) and team autonomy.

Patients and Methods

The study involved 82 participants (ie, physicians, nurses, healthcare assistants, healthcare technicians, and physiotherapists) working in the Medicine, Emergency, and Neurological Departments at a large public healthcare organization in Italy. Data was gathered at 2-time points, 14 months apart.

Results

The results suggest that healthcare workers' perception of their organization's support for mental health at T1 significantly impacts team participation at T2 through MHsL and team autonomy. Likewise, the indirect effect of OCMH through MHsL and team autonomy was also significant in the model predicting team reflexivity. However, in both models, no direct relationship of OCMH on the dependent variables was found.

Conclusion

The findings highlight the importance of a mental health-supportive environment and leadership to foster team autonomy and, subsequentially, team processes, which are fundamental for performance and patient care.

A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations

BACKGROUND

Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited.

PURPOSE

We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers' job satisfaction.

METHODOLOGY

We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual's job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual's network). We examined this relationship for both instrumental and expressive ties.

RESULTS

Individuals who were more central in the expressive network were less satisfied in their job, b = -0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05.

CONCLUSION

Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers' risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers' access to full information, supporting competence and confidence.

PRACTICE IMPLICATIONS

Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers' sense of well-being.

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Background

Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task.

Methods

Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis.

Results

Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program.

Conclusions

Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.

Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study

Background

Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven.

Objective

The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use.

Methods

We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders’ perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results.

Results

Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes.

Conclusions

Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients’ resistance toward using innovative technology and compensate for patients’ limited access to technology and care facilities.

Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation

Several psychosocial factors have been suggested as facilitators of change among inpatients treated for substance use disorder (SUD). Research suggests that staff members are also influenced by the practice in which they are involved, and by contextual psychosocial factors at their treatment facilities. This cross-sectional questionnaire survey study was conducted to investigate the role of recovery-orientated interventions in describing work-related satisfaction among clinicians at inpatient SUD treatment facilities. The respondents (n = 407) rated items indicating work-related satisfaction and the degree of recovery orientation at their treatment facilities. The main findings of two block regression analyses indicated that clinicians’ work-related satisfaction was positively influenced by inpatients’ opportunities to pursue their goals and choices, and negatively influenced by inpatient involvement. The change in clinicians’ work-related satisfaction could not be described by the degree of individually tailored and varied interventions at the treatment facility. Clinicians should be supported and involved in the process of implementing measures to increase inpatient involvement in the treatment programmes, and treatment measures that enable inpatients to pursue their goals and choices should be enhanced. The findings of this and previous studies indicate that a recovery-oriented framework promotes clinicians’ work-related satisfaction and has an enabling influence on both inpatients and clinicians.

Evaluation of team effectiveness and personal empathy for associations with professional quality of life and job satisfaction in companion animal practice personnel

OBJECTIVE

To examine variables of veterinary team effectiveness and personal empathy for associations with professional quality of life (ie, compassion satisfaction, burnout, and secondary traumatic stress) and job satisfaction in companion animal practice personnel.

DESIGN

Cross-sectional survey.

SAMPLE

Data from 232 surveys completed by personnel from 10 companion animal veterinary practices in 2 regions of the United States between April 7 and December 20, 2016.

PROCEDURES

Online surveys were used to collect practice-level data (eg, practice type, setting, and staffing) and individual-level data (eg, demographics, job position, and years in the position and profession). Instruments used in developing the surveys included the Team Effectiveness Instrument, Davis Interpersonal Reactivity Index, Professional Quality of Life Scale, and a measure for job satisfaction. Data were evaluated for associations with professional quality of life and job satisfaction.

RESULTS

Individual engagement was positively associated with job satisfaction, negatively associated with secondary traumatic stress, and moderated by levels of personal distress for compassion satisfaction and burnout. Toxic team environment was positively associated with burnout and negatively associated with job satisfaction. Empathetic concern and personal distress were both positively associated with secondary traumatic stress. Empathetic concern was moderated by team engagement for compassion satisfaction.

CONCLUSIONS AND CLINCAL RELEVANCE

Results indicated that variables influencing professional quality of life and job satisfaction were multimodal and included aspects of team effectiveness and empathy; therefore, workplace strategies that enhance individual and team engagement and mitigate toxic team environments could potentially improve professional quality of life and job satisfaction in veterinary personnel.

Development and Validation of the Work-Related Well-Being Index: Analysis of the Federal Employee Viewpoint Survey

OBJECTIVE

To describe development and validation of the work-related well-being (WRWB) index.

METHODS

Principal components analysis was performed using Federal Employee Viewpoint Survey (FEVS) data (N = 392,752) to extract variables representing worker well-being constructs. Confirmatory factor analysis was performed to verify factor structure. To validate the WRWB index, we used multiple regression analysis to examine relationships with burnout associated outcomes.

RESULTS

Principal Components Analysis identified three positive psychology constructs: "Work Positivity", "Co-worker Relationships", and "Work Mastery". An 11 item index explaining 63.5% of variance was achieved. The structural equation model provided a very good fit to the data. Higher WRWB scores were positively associated with all three employee experience measures examined in regression models.

CONCLUSIONS

The new WRWB index shows promise as a valid and widely accessible instrument to assess worker well-being.

Variables associated with job satisfaction among mental health professionals

Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.

Associated and Mediating Variables Related to Job Satisfaction among Professionals from Mental Health Teams

Using a structural analysis, this study examines the relationship between job satisfaction among 315 mental health professionals from the province of Quebec (Canada) and a wide range of variables related to provider characteristics, team characteristics, processes, and emergent states, and organizational culture. We used the Job Satisfaction Survey to assess job satisfaction. Our conceptual framework integrated numerous independent variables adapted from the input-mediator-output-input (IMOI) model and the Integrated Team Effectiveness Model (ITEM). The structural equation model predicted 47% of the variance of job satisfaction. Job satisfaction was associated with eight variables: strong team support, participation in the decision-making process, closer collaboration, fewer conflicts among team members, modest knowledge production (team processes), firm affective commitment, multifocal identification (emergent states) and belonging to the nursing profession (provider characteristics). Team climate had an impact on six job satisfaction variables (team support, knowledge production, conflicts, affective commitment, collaboration, and multifocal identification). Results show that team processes and emergent states were mediators between job satisfaction and team climate. To increase job satisfaction among professionals, health managers need to pursue strategies that foster a positive climate within mental health teams.

Factors associated with internal medicine physician job attitudes in the Veterans Health Administration

Background

US healthcare organizations increasingly use physician satisfaction and attitudes as a key performance indicator. Further, many health care organizations also have an academically oriented mission. Physician involvement in research and teaching may lead to more positive workplace attitudes, with subsequent decreases in turnover and beneficial impact on patient care. This article aimed to understand the influence of time spent on academic activities and perceived quality of care in relation to job attitudes among internal medicine physicians in the Veterans Health Administration (VHA).

Methods

A cross-sectional survey was conducted with inpatient attending physicians from 36 Veterans Affairs Medical Centers. Participants were surveyed regarding demographics, practice settings, workplace staffing, perceived quality of care, and job attitudes. Job attitudes consisted of three measures: overall job satisfaction, intent to leave the organization, and burnout. Analysis used a two-level hierarchical model to account for the nesting of physicians within medical centers. The regression models included organizational-level characteristics: inpatient bed size, urban or rural location, hospital teaching affiliation, and performance-based compensation.

Results

A total of 373 physicians provided useable survey responses. The majority (72%) of respondents reported some level of teaching involvement. Almost half (46%) of the sample reported some level of research involvement. Degree of research involvement was a significant predictor of favorable ratings on physician job satisfaction and intent to leave. Teaching involvement did not have a significant impact on outcomes. Perceived quality of care was the strongest predictor of physician job satisfaction and intent to leave. Perceived levels of adequate physician staffing was a significant contributor to all three job attitude measures.

Conclusions

Expanding opportunities for physician involvement with research may lead to more positive work experiences, which could potentially reduce turnover and improve system performance.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3015-z) contains supplementary material, which is available to authorized users.

Women's Health Outpatient Care Teams: Focus on Advanced Practice Providers

Team-based care in the outpatient women's health setting has the potential to help alleviate the demand for women's health care providers and to deliver improved quality of care to the growing population of US women. Although teamwork is necessary in the current health care system, most of the current obstetrics and gynecology and advanced practice provider (APP) workforce were not trained for collaborative practice. Core competencies for building an effective outpatient women's health care team are explained and current evidence regarding the specific role of APPs in women's health care is reviewed.

Job satisfaction among mental healthcare professionals: The respective contributions of professional characteristics, team attributes, team processes, and team emergent states

Objectives

The aim of this study was to determine the respective contribution of professional characteristics, team attributes, team processes, and team emergent states on the job satisfaction of 315 mental health professionals from Quebec (Canada).

Methods

Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were organized into four categories according to a conceptual framework inspired from the Input-Mediator-Outcomes-Input Model. The contribution of each category of variables was assessed using hierarchical regression analysis.

Results

Variations in job satisfaction were mostly explained by team processes, with minimal contribution from the other three categories. Among the six variables significantly associated with job satisfaction in the final model, four were team processes: stronger team support, less team conflict, deeper involvement in the decision-making process, and more team collaboration. Job satisfaction was also associated with nursing and, marginally, male gender (professional characteristics) as well as with a stronger affective commitment toward the team (team emergent states).

Discussion and Conclusion

Results confirm the importance for health managers of offering adequate support to mental health professionals, and creating an environment favorable to collaboration and decision-sharing, and likely to reduce conflicts between team members.

A comparative study of job satisfaction among nurses, psychologists/psychotherapists and social workers working in Quebec mental health teams

Background

This study identified multiple socio-professional and team effectiveness variables, based on the Input-Mediator-Output-Input (IMOI) model, and tested their associations with job satisfaction for three categories of mental health professionals (nurses, psychologists/psychotherapists, and social workers).

Methods

Job satisfaction was assessed with the Job Satisfaction Survey. Independent variables were classified into four categories: 1) Socio-professional Characteristics; 2) Team Attributes; 3) Team Processes; and 4) Team Emergent States. Variables were entered successively, by category, into a hierarchical regression model.

Results

Team Processes contributed the greatest number of variables to job satisfaction among all professional groups, including team support which was the only significant variable common to all three types of professionals. Greater involvement in the decision-making process, and lower levels of team conflict (Team Processes) were associated with job satisfaction among nurses and social workers. Lower seniority on team (Socio-professional Characteristics), and team collaboration (Team Processes) were associated with job satisfaction among nurses, as was belief in the advantages of interdisciplinary collaboration (Team Emergent States) among psychologists. Knowledge sharing (Team Processes) and affective commitment to the team (Team Emergent States) were associated with job satisfaction among social workers.

Conclusions

Results suggest the need for mental health decision-makers and team managers to offer adequate support to mental health professionals, to involve nurses and social workers in the decision-making process, and implement procedures and mechanisms favourable to the prevention or resolution of team conflict with a view toward increasing job satisfaction among mental health professionals.

Variables associated with work performance in multidisciplinary mental health teams

OBJECTIVES

This study investigates work performance among 79 mental health teams in Quebec (Canada). We hypothesized that work performance was positively associated with the use of standardized clinical tools and clinical approaches, integration strategies, "clan culture," and mental health funding per capita.

METHODS

Work performance was measured using an adapted version of the Work Role Questionnaire. Variables were organized into four key areas: (1) team attributes, (2) organizational culture, (3) inter-organizational interactions, and (4) external environment.

RESULTS

Work performance was associated with two types of organizational culture (clan and hierarchy) and with two team attributes (use of standardized clinical tools and approaches).

DISCUSSION AND CONCLUSION

This study was innovative in identifying associations between work performance and best practices, justifying their implementation. Recommendations are provided to develop organizational cultures promoting a greater focus on the external environment and integration strategies that strengthen external focus, service effectiveness, and innovation.

Work motivation, task delegation and job satisfaction of general practice staff: a cross-sectional study

BACKGROUND

Recent research has shown that a high degree of task delegation is associated with the practise staff's overall job satisfaction, and this association is important to explore since job satisfaction is related to medical as well as patient-perceived quality of care.

OBJECTIVES

This study aimed: (1) to investigate associations between degrees of task delegation in the management of chronic disease in general practice, with chronic obstructive pulmonary disease (COPD) as a case and the staff's work motivation, (2) to investigate associations between the work motivation of the staff and their job satisfaction.

METHODS

The study was based on a questionnaire to which 621 members of the practice staff responded. The questionnaire consisted of a part concerning degree of task delegation in the management of COPD in their respective practice and another part being about their job satisfaction and motivation to work.

RESULTS

In the first analysis, we found that 'maximal degree' of task delegation was significantly associated with the staff perceiving themselves to have a large degree of variation in tasks, odds ratio (OR) = 4.26, confidence interval (CI) = 1.09, 16.62. In the second analysis, we found that this perceived large degree of variation in tasks was significantly associated with their overall job satisfaction, OR = 2.81, confidence interval = 1.71, 4.61.

CONCLUSION

The results suggest that general practitioners could delegate highly complex tasks in the management of COPD to their staff without influencing the staff's work motivation, and thereby their job satisfaction, negatively, as long as they ensure sufficient variation in the tasks.

Development and validation of an instrument to assess job satisfaction in eye-care personnel

PURPOSE

The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India.

METHODS

A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance.

RESULTS

Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction.

CONCLUSIONS

The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction.

A Systematic Review of the Impact of Physicians' Occupational Well-Being on the Quality of Patient Care

Background

It is widely held that the occupational well-being of physicians may affect the quality of their patient care. Yet, there is still no comprehensive synthesis of the evidence on this connection.

Purpose

This systematic review studied the effect of physicians’ occupational well-being on the quality of patient care.

Methods

We systematically searched PubMed, Embase, and PsychINFO from inception until August 2014. Two authors independently reviewed the studies. Empirical studies that explored the association between physicians’ occupational well-being and patient care quality were considered eligible. Data were systematically extracted on study design, participants, measurements, and findings. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.

Results

Ultimately, 18 studies were included. Most studies employed an observational design and were of average quality. Most studies reported positive associations of occupational well-being with patient satisfaction, patient adherence to treatment, and interpersonal aspects of patient care. Studies reported conflicting findings for occupational well-being in relation to technical aspects of patient care. One study found no association between occupational well-being and patient health outcomes.

Conclusions

The association between physicians’ occupational well-being and health care’s ultimate goal—improved patient health—remains understudied. Nonetheless, research up till date indicated that physicians’ occupational well-being can contribute to better patient satisfaction and interpersonal aspects of care. These insights may help in shaping the policies on physicians’ well-being and quality of care.

Electronic supplementary material

The online version of this article (doi:10.1007/s12529-015-9473-3) contains supplementary material, which is available to authorized users.

Attitudes Toward Collaboration Among Practitioners in Newly Established Medical Homes: A Survey of Nurses, General Practitioners, and Specialists

The objective was to evaluate the attitudes toward collaboration of nurses, general practitioners (GPs), and specialists practicing in newly established Medical Homes (MHs) in Parma Local Health Authority (LHA), Emilia-Romagna region, Italy. The 15-item Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered electronically to 172 physicians (66 GPs, 106 specialists) and 113 nurses practicing in 12 MHs. In all, 191 surveys (45 GPs, 59 specialists, 87 nurses) were completed (67% response rate). The mean total score among nurses (51.5, standard deviation [SD] = 3.7) reflected a significantly (P < .01) more positive attitude toward collaboration compared with GPs (47.8, SD = 4.6) and specialists (45.3, SD = 7.7). Discrepancies in attitudes are concerning because conflicting perceptions of professional roles may impede a successful transition to integrated care within MHs in Parma LHA. Internationally, further research into understanding interprofessional relationships within MHs is needed to inform policy and build a necessary culture of team-based care.

Evaluation of job satisfaction and working atmosphere of dental nurses in Germany

OBJECTIVES

The purpose of the study was to assess the level of job satisfaction of dental nurses in ambulatory care and to explore the impact of aspects of working atmosphere on and their association with job satisfaction.

METHODS

This cross-sectional study was based on a job satisfaction survey. Data were collected from 612 dental nurses working in 106 dental care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Working atmosphere was measured with five items. Linear regression analyses were performed in which each item of the job satisfaction scale was handled as dependent variables. A stepwise linear regression analysis was performed with overall job satisfaction and the five items of working atmosphere, job satisfaction, and individual characteristics.

RESULTS

The response rate was 88.3%. Dental nurses were satisfied with 'colleagues' and least satisfied with 'income.' Different aspects of job satisfaction were mostly associated with the following working atmosphere issues: 'responsibilities within the practice team are clear,' 'suggestions for improvement are taken seriously,' 'working atmosphere in the practice team is good,' and 'made easier to admit own mistakes.' Within the stepwise linear regression analysis, the aspect 'physical working condition' (β = 0.304) showed the highest association with overall job satisfaction. The total explained variance of the 14 associated variables was 0.722 with overall job satisfaction.

CONCLUSIONS

Working atmosphere within this discrete sample of dental care practice seemed to be an important influence on reported working condition and job satisfaction for dental nurses. Because of the high association of job satisfaction with physical working condition, the importance of paying more attention to an ergonomic working position for dental nurses to ensure optimal quality of care is highlighted.

The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics

OBJECTIVE

To determine the role of veterinary team effectiveness regarding job satisfaction and burnout in companion animal veterinary practice.

DESIGN

Cross-sectional observational study.

SAMPLE

48 companion animal veterinary health-care teams.

PROCEDURES

274 team members participated in an online survey. Overall job satisfaction was evaluated with a 1-item measure, and the 3 dimensions of burnout (exhaustion, cynicism, and professional efficacy) were measured with the Maslach Burnout Inventory-General Survey. Team effectiveness was assessed with a survey developed for this study. Demographic and team effectiveness factors (coordinated team environment, toxic team environment, team engagement, and individual engagement) associated with job satisfaction and burnout were evaluated.

RESULTS

Overall mean job satisfaction score was 5.46 of 7 (median, 6.00); veterinary technicians and kennel attendants had the lowest scores. According to the Maslach survey results, 22.4% of participants were in the high-risk category for exhaustion, 23.2% were in the high-risk category for cynicism, and 9.3% were in the high-risk category for professional efficacy. A coordinated team environment was associated with increased professional efficacy and decreased cynicism. A toxic team environment was negatively associated with job satisfaction and positively associated with exhaustion and cynicism. Individual engagement was positively associated with job satisfaction and professional efficacy and negatively associated with exhaustion and cynicism.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested the effectiveness of a veterinary team can significantly influence individual team members' job satisfaction and burnout. Practices should pay specific attention to the effectiveness with which their veterinary team operates.

Quality of language intervention provided to primary-grade students with language impairment

This study had two aims: (a) to describe the quality of language intervention provided by school-based speech-language pathologists (SLPs) to children with language impairment in the primary grades with respect to the quality of emotional support, instructional support, and proactive management during SLP-child interactions, and (b) to determine if key characteristics of the SLPs are predictors of variance in intervention quality. Participants were 174 children nested within 40 SLPs' caseloads from various districts in two Midwestern states involved in a larger study of speech-language therapy practices in the public schools. A total of 208 videotaped language intervention sessions were coded for emotional support, instructional support, and proactive management using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Hamre, 2008). The quality of language intervention varied widely and was generally mid-range to high with respect to emotional support and proactive management, and low to mid-range in terms of instructional support. The quality of interactions varied and a large percentage of the observed variance in quality was attributed to SLPs. Time pressure was a strong predictor of the quality of emotional support, instructional support, and proactive management, and job satisfaction was a significant predictor of instructional support and proactive management. This descriptive information about school-based language intervention highlights the impact of the individual SLP in terms of the quality of the interactions taking place and the potential need to ease job pressures and promote job satisfaction.

LEARNING OUTCOMES

Readers will be able to: (1) identify and define three aspects of SLP-child interaction quality during intervention as framed in this study using the CLASS observation tool (Pianta, La Paro, et al., 2008); (2) discuss the relevance of those three aspects of quality to children with LI; and (3) identify SLP-level factors that significantly predict SLP-student interaction quality during intervention for children with LI.

Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases

Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.

Chinese primary care physicians and work attitudes

China passed a landmark health care reform in 2009, aimed at improving health care for all citizens by strengthening the primary care system, largely through improvements to infrastructure. However, research has shown that the work attitudes of primary care physicians (PCPs) can greatly affect the stability of the overall workforce and the quality and delivery of health care. The purpose of this study is to investigate the relationship between reported work attitudes of PCPs and their personal, work, and educational characteristics. A multi-stage, complex sampling design was employed to select a sample of 434 PCPs practicing in urban and rural primary care settings, and a survey questionnaire was administered by researchers with sponsorship from the Ministry of Health. Four outcome measures describing work attitudes were used, as well as a number of personal-, work-, and practice-related factors. Findings showed that although most PCPs considered their work as important, a substantial number also reported large workloads, job pressure, and turnover intentions. Findings suggest that policymakers should focus on training and educational opportunities for PCPs and consider ways to ease workload pressures and improve salaries. These policy improvements must accompany reform efforts that are already underway before positive changes in reduced disparities and improved health outcomes can be realized in China.

[New strategies to improve accessibility to laboratory tests in cancer patients]

OBJECTIVE

To develop models to improve accessibility of performing laboratory tests on chronic oncology patients, as well as a more flexible choice of sample collection in both primary and specialized care.

MATERIAL AND METHODS

Circuit analysis of cancer patients. Patient survey to study access to laboratory tests. High Resolution Consultation Development Model (MCAR) and Patient Access Analytical Model (MAAP).

RESULTS

The percentage of cancer patients on treatment has increased by 8.76% in the past two years. There was a 32% increased in the use of the MAAP model in the two years of its implementation, and has been the choice of 74% due to greater accessibility, with 8% of the patients having used both models to suit their needs.

CONCLUSIONS

The implementation of optimized and preferred care systems has shown that both models improve accessibility and flexibility of the diagnostic testing laboratory in the patients studied.

The Certified Asthma Educator (AE-C)

Introduction: The Centers for Disease Control and Prevention report that the number of individuals with asthma in the United States has increased by 4.3 million, or 12.3%, between 2001 and 2009, creating an increasing burden on our health care system. Effective patient education is a key component of asthma management. The National Asthma Educator Certification Board (NAECB) promotes “optimal asthma management and quality of life by advancing excellence in asthma education through the Certified Asthma Educator process.” Methods: Following completion of the asthma educator certification examination, applicants were invited to participate in a voluntary, anonymous Web-based survey. The survey was developed and approved by the Executive and Research Committees of the NAECB, with the objective of reviewing the experience of applicants seeking initial certification and of those seeking recertification. Results: Completed surveys were obtained from 988 applicants. Seventy-six percent of respondents were first-time test takers; the remaining respondents were repeat test takers. Eighty percent reported having passed the examination. Approximately 85% felt that the time allotted for the examination was “just right”; the level of difficulty was “ just right” for 65% of the respondents, and the clarity of the examination questions was rated as “good” or “excellent” by 72% of the respondents. Seventy-two percent responded that the examination reflected the role of the asthma educator and 88.1% would recommend the examination to others interested in asthma education. Open-ended responses highlighted benefits and barriers. Discussion: The asthma educator certification examination is reflective of the professional responsibilities of the asthma educator. Benefits and barriers are discussed in the context of published literature.

Evaluation of job satisfaction of practice staff and general practitioners: an exploratory study

Background

Primary care teams' job satisfaction is an important issue in quality of care. The purpose of our study was to evaluate the job satisfaction of general practitioners (GPs) and non-physician staff and to explore the elements that may impact on overall job satisfaction for GPs and non-physician staff separately.

Methods

The study was based on data from the European Practice Assessment and used an observational design. Job satisfaction was measured with the 10-items Warr-Cook-Wall questionnaire with 7-point-Likert scales. Job satisfaction of GPs and non-physician staff was compared and impact on overall job satisfaction was analysed with stepwise linear regression analyses for both samples separately.

Results

The study population consisted of 2878 non-physician staff (mean age: 38 years) and 676 GPs (mean age: 50 years). The actual mean working time per week of GPs was 50.0 hours and of practice staff 26.0 hours. Both were satisfied with colleagues and fellow workers (mean = 5.99 and mean = 6.18 respectively) and mostly dissatisfied with their income (mean = 4.40 and mean = 4.79 respectively). For GPs the opportunity to use their abilities (β = 0.638) and for non-physician staff recognition for their work (β = 0.691) showed the highest scores of explained variance (R² = 0.406 and R² = 0.477 respectively) regarding overall job satisfaction.

Conclusions

Non-physician staff evaluate their job satisfaction higher than GPs except recognition for work. Job satisfaction of members of primary care teams is important because poor satisfaction is associated with suboptimal healthcare delivery, poor clinical outcomes and higher turnover of staff.

Practice guidelines need to address the 'how' and the 'what' of implementation

AIM

The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk.

BACKGROUND

The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice.

METHODS

Qualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes.

FINDINGS

Four themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health team and impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the 'how' and the 'what' of evidence implementation.

Job characteristics and job satisfaction among physicians involved with research in the veterans health administration

PURPOSE

Research conducted by physicians generates knowledge and has led to important advances and changes in the health care system. Physician retention is a concern facing many health care systems, and job satisfaction and attitudes play a role in retention. This study examined whether physicians who are involved with research have greater job satisfaction and more positive job characteristics perceptions.

METHOD

Cross-sectional analysis examined this research question using a sample of 7,734 physicians across 135 medical centers in the Department of Veterans Affairs (VA) in 2008. Using existing survey results, ratings on job characteristics (job autonomy, skill development opportunities, work and family balance, and performance feedback) and job satisfaction were regressed on research involvement in a multilevel hierarchical generalized linear model. The model controlled for physician-level characteristics and organization-level characteristics related to research activities.

RESULTS

Analyses revealed that physicians who spent part of their time involved with research activities were more likely to report favorable job characteristics ratings. Physicians involved with research were also more likely to be satisfied with their job. Physicians who worked in medical centers with greater levels of research funding were more likely to report favorable ratings for job characteristics and job satisfaction.

CONCLUSIONS

Involvement with research was associated with more favorable job characteristics and job satisfaction perceptions among physicians in VA. Although there is a time and opportunity cost involved with research, medical centers that provide physicians with the opportunity to conduct research may have a more satisfied workforce.