Job morale: a scoping review of how the concept developed and is used in healthcare research

Indicators associated with job morale of physicians in low- and middle-income countries during the COVID- 19 pandemic: a systematic review and meta-analysis

BACKGROUND

The COVID- 19 pandemic has placed immense strain on healthcare systems around the globe, with low- and middle-income countries facing unique challenges due to limited resources and fragile healthcare infrastructures. This systematic review and meta-analysis aims to define the levels of four indicators of job morale (job motivation, job satisfaction, burnout, and depression symptoms) among physicians working in public healthcare settings in low- and middle-income countries.

METHODS

A comprehensive search of Scopus, PubMed, Embase, Web of Science, the Cochrane Library, and grey literature was performed. Studies were eligible if at least one job morale indicator (job motivation, job satisfaction, burnout, or depression symptoms) was assessed using quantitative methods, and at least 50% of the sample were qualified physicians working in low- and middle-income countries during the COVID- 19 pandemic. Random effects meta-analyses, planned sub-group analyses, and meta-regression were performed.

RESULTS

Overall, 82 studies involving 65,431 participants across 26 middle-income countries met the inclusion criteria for the review. The pooled random effect estimates of the prevalence of burnout suggest that 49% of physicians working in middle-income countries during the COVID- 19 pandemic suffered from professional burnout. The overall estimate of the mean was 24.64, which also indicated a high level of burnout. The pooled random effect estimates of the prevalence of depression symptoms varied from 41 to 58%, depending on the adopted scale. Sufficient data were not available for meta-analyses of job motivation and job satisfaction.

CONCLUSIONS

The findings suggest that job morale among physicians working in middle-income countries was generally low during the COVID- 19 pandemic. However, due to substantial variation and limited methodological quality among the studies included, any conclusions offered should be approached with caution. Future research should focus on assessing job morale in low-income regions and identifying effective resilience strategies to support interventions aimed at improving job morale.

A mixed method exploration of job morale of physicians working in public healthcare settings in Kazakhstan during the COVID-19 pandemic

BACKGROUND

Physicians faced increased workloads during the COVID-19 pandemic, which exposed them to considerable physical and psychological stress. Gaining insight into shapers of job morale of physicians can help healthcare administrators assess the effectiveness of current work conditions and support systems, enabling them to develop policies that improve work environments and prepare healthcare systems for future resurgences of COVID-19 and other future unknown challenges. Therefore, the present study aimed to improve the understanding of physicians' experiences of job morale in Kazakhstan during the COVID-19 pandemic.

METHODS

This was an explanatory sequential mixed method study that adopted an online structured questionnaire and semi-structured individual interviews as tools for data collection. The Warr-Cook-Wall scale, Maslach Burnout Inventory Human Services Survey for Medical Personnel, and Beck Depression Inventory were used to measure job morale indicators. The interview topic guide, in turn, covered two key areas: general views on physicians' job morale during the COVID-19 pandemic and specific experiences which worsened or improved job morale during the COVID-19 pandemic. Descriptive statistics and regression models were utilised to analyse the quantitative data, while thematic analysis was employed for the qualitative data.

RESULTS

A total of 2086 survey responses and 30 interviews were analysed. Although job motivation was moderate, physicians were rather satisfied with their jobs. The prevalence of burnout was 30.97%, and signs of severe depression symptoms were detected among 3.69% of participants. Four themes emerged from the thematic analysis: (1) fear of uncertainty; (2) media scrutiny; (3) resurgence in appreciation; and (4) heightened sense of duty.

CONCLUSIONS

Despite the significant challenges posed by the COVID-19 pandemic, physicians in Kazakhstan's public healthcare sector maintained generally positive job morale. This was mainly due to their strong sense of calling and a renewed appreciation for their role. Future research should rigorously examine longitudinal changes in job morale and the relationship between physicians' job morale and patient experiences.

Resilience and coping during protracted conflict: a comparative analysis of general and evacuees populations

BACKGROUND

On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel's southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation.

METHODS

Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14-21, 2024 (N = 1,360), and the evacuees' data from March 1-9, 2024 (N = 372; 133 from the north, 239 from the south).

RESULTS

Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples.

CONCLUSIONS

The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges.

Assessment of the organizational factors in incident management practices in healthcare: A tree augmented Naive Bayes model

Despite the exponential transformation occurring in the healthcare industry, operational failures pose significant challenges in the delivery of safe and efficient care. Incident management plays a crucial role in mitigating these challenges; however, it encounters limitations due to organizational factors within complex and dynamic healthcare systems. Further, there are limited studies examining the interdependencies and relative importance of these factors in the context of incident management practices. To address this gap, this study utilized aggregate-level hospital data to explore the influence of organizational factors on incident management practices. Employing a Bayesian Belief Network (BBN) structural learning algorithm, Tree Augmented Naive (TAN), this study assessed the probabilistic relationships, represented graphically, between organizational factors and incident management. Significantly, the model highlighted the critical roles of morale and staff engagement in influencing incident management practices within organizations. This study enhances our understanding of the importance of organizational factors in incident management, providing valuable insights for healthcare managers to effectively prioritize and allocate resources for continuous quality improvement efforts.

Job Burnout and Job Satisfaction among Healthcare Service Providers in a Daycare Center for Individuals with Autism Spectrum Disorders in Low-Resource Settings

Job satisfaction and burnout are components of job morale. In general, and among healthcare provider personnel, these are psychological factors of the job and under the influence of different conditions and the organizational management of the healthcare systems. Both job burnout and job satisfaction among healthcare service providers have received scant attention in the literature, particularly in the healthcare systems of the Kurdistan Region of Iraq (KRI) as one low- or middle-income country (LMIC). The burnout rate and job satisfaction in a daycare center for children with autism spectrum disorders were reviewed and measured using a sample consisting of 34 employees from three different sections. The Maslach Burnout Inventory-Third Edition (MBI-3) and the Job Descriptive Index (JDI) were used. The relationships between the two scales and their consisting factors were examined using Pearson Correlation and Chi-square test to understand the correlation and levels of significant difference between the expected and the observed frequencies. There was a significant negative correlation between job burnout and satisfaction with the job and some significant correlations between the factors of the scales. Lower levels of emotional exhaustion and depersonalization factors of the burnout scale were statistically correlated. It was shown that the personnel were mainly satisfied with their jobs through their choices in the four parts of the job satisfaction scale. Further investigations are needed to understand different contributing factors to job satisfaction and burnout among healthcare providers in KRI. The current study might highlight the importance of understanding the healthcare providers' perspectives on their careers.

Job morale of physicians and dentists in Kazakhstan: a qualitative study

BACKGROUND

Job morale is thought to be particularly low in Kazakhstan, adversely affecting job motivation, job satisfaction and burnout rates. Previous research suggests that high job morale has a better effect on patient outcomes and care quality. We, therefore, conducted a qualitative study to explore experiences underpinning positive and negative job morale, and to generate potential strategies for improving job morale of physicians and dentists working in public healthcare settings in Kazakhstan prior to the COVID-19 pandemic.

METHODS

Three focus groups containing 23 participants and 30 individual interviews were conducted, evidencing respondents' explanations of what affects job morale, and possible strategies to improve it. Data was synthesised using a thematic analysis.

RESULTS

The themes about what influences job morale were: being unfairly rewarded for work; feeling vulnerable and undervalued; poor working styles and practices; and high internal value-based motivation. Various strategies were identified by participants to improve job morale, and these included: ensuring adequate and equitable financial income; improving the current malpractice system; eliminating poor working styles and practices; and creating a shared responsibility for health.

CONCLUSIONS

The current study has found that despite prevailing threats, job morale amongst physicians and dentists working in public healthcare settings in Astana have been prevented from becoming negative by their strong sense of calling to medicine and the satisfaction of helping patients recover. Emphasising this rather traditional understanding of the role of physicians and dentists may be a way to improve job morale throughout training and practice.

Allied health front-line manager perceptions of factors impacting workplace morale and burnout risk

PURPOSE

This exploratory case study investigated the factors impacting employee morale and burnout risk among allied health professionals operating within a large Australian public hospital. The study aimed to understand what factors may positively influence group morale and reduce burnout risk.

DESIGN/METHODOLOGY/APPROACH

Qualitative data was collected using semi-structured interviews and focus groups with 30 Allied Health Managers. A manual thematic analysis and confirmatory content analysis (viz., Leximancer) identified several prominent themes impacting morale and potential burnout risk.

FINDINGS

Key factors impacting allied health morale and contributing to burnout risk were captured in three main themes. The first included processes and relationships between people that were contributing to the culture negatively. The second identified the general lack of management training and limited capability of supervisors and leaders in human resource skills. The third theme identified change, high workloads and ineffective systems that were not supporting managers to be effective in their roles. This was also considered to be stifling internal innovation.

RESEARCH LIMITATIONS/IMPLICATIONS

This case study took a top-down approach which may have provided a biased viewpoint from the managers perspective, rather than the perspective of all levels. The findings are within one context, hence there is a potential lack of generalisability. A final limitation is that this project collected and interpreted data through processes of social interaction and relied on the individual perception, skill and knowledge of the researchers, which may cause some uncertainty in the findings.

PRACTICAL IMPLICATIONS

These findings support prioritising the evidence-based development of leadership and management competencies that have a focus on human resource management in hospitals. The study findings support the adoption of the theoretical framework of a systems approach to leadership that encourages the concept of being a learning organisation that creates pod-synergy within teams to enhance healthy personal, organisational and clinical outcomes. Adopting an empathetic leadership style that seeks to understand and support staff could improve staff morale within public health organisations and prevent burnout risk. Training managers with the skills and abilities to support autonomy amongst employees will support employee motivation and satisfaction in the workplace.

SOCIAL IMPLICATIONS

The findings were discussed using a socio technical system thinking perspective. This involves understanding the people (both leaders and front-line workers) and the systems and how they interact to support positive workplace morale.

ORIGINALITY/VALUE

Limited research has empirically explored from a socio-technical systems perspective how the systems and structures in healthcare organisations support allied health managers and employees in their role. Furthermore, the results provide new insights that encourage a more empathetic systems approach to leadership, one that supports social relationships and encourages pod-synergy amongst employees. Together these findings delivered strategies that can buffer against low morale and burnout risk among allied health care workers. This is an area that arguably has not yet been adequately addressed in allied health.

Components of Unrealistic Optimism of College Students: The Case of the COVID-19 Pandemic

College students are among the most strongly affected populations by the coronavirus disease-2019 (COVID-19) pandemic because of uncertainty regarding academic success, future careers, and social life during their study period. Their mental health and behavior may dramatically be impacted. The study examined an unrealistic optimism of Israeli college students in assessing the health, security, and economic risks during the pandemic, and the contributions of these perceived risks to the prediction of psychological coping responses, such as well-being, and coping suppressing response of anxiety, expressed during this pandemic. Using social networks, a questionnaire was disseminated to students during the third lockdown that was implemented in Israel because of the pandemic. Depressive and anxiety symptoms, perceived threats, resilience, well-being, hope, and morale were measured using a structured quantitative questionnaire. First, we hypothesized that the three perceived risks would be inversely rated, so perceived health risk would be rated lowest, and perceived economic risk would be rated highest. The second and third hypotheses claimed that psychological coping responses articulated along this pandemic would be predicted by all these perceived risks, as well as the observance of pandemic precaution rules. The fourth hypothesis suggested that the three investigated perceived risks will positively and significantly correlate with each other. The results generally supported the hypotheses and indicated that the unrealistic optimism process was employed quite consistently by the participating students.

Morale and Perceived Threats as Predictors of Psychological Coping with Distress in Pandemic and Armed Conflict Times

The present study investigated predictors of psychological coping with adversity responses during the COVID-19 pandemic and an armed conflict. Two paired samples that represented the Israeli population that was exposed to both adversities were compared. Respondents rated five different psychological coping responses associated with the two adversities, such as anxiety or individual resilience. Perceived security, pandemic, economic, and political risks, as well as level of morale, were rated. Two major findings were disclosed by two path analyses. Morale improved the predictions of the varied coping responses in both the pandemic and conflict and was the best predictor of four out of five responses and the second-best predictor of the fifth response. Contrary to previous studies, our findings revealed that the concept of a single major predictor of coping responses under distress is an overgeneralization. In both cases, the coping responses were better explained by other perceived risks rather than by the risk of the investigated adversity. Rather than assume that a perceived security threat accounts for low levels of public moods, it is vital to study the antecedents of coping responses and to empirically examine additional potential predictors.

Unit work environment, psychological empowerment and support for patient activation among nurses

AIMS

To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation.

BACKGROUND

Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated.

METHODS

This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea.

RESULTS

Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important.

CONCLUSION

Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation.

IMPLICATIONS FOR NURSING MANAGEMENT

To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.