Why hospital physicians attend work while ill? The spiralling effect of positive and negative factors

Illness presenteeism among physicians and trainees: Study protocol of a scoping review

BACKGROUND

Illness presenteeism (IP) is the phenomenon where individuals continue to work despite illness. While it has been a prevalent and longstanding issue in medicine, the recent onset of the COVID-19 pandemic and the growing movement to improve physician wellness brings renewed interest in this topic. However, there have been no comprehensive reviews on the state of literature of this topic.

PURPOSE

The main aim of this scoping review is to explore what is known about presenteeism in physicians, residents, and medical students in order to map and summarize the literature, identify research gaps and inform future research. More specifically: How has illness presenteeism been defined, problematized or perceived? What methods and approaches have been used to study the phenomenon? Has the literature changed since the pandemic?

METHOD

Using the Arksey and O'Malley framework several databases will be searched by an experienced librarian. Through an iterative process, inclusion and exclusion criteria will be developed and a data extraction form refined. Data will be analyzed using quantitative and qualitative content analyses.

POTENTIAL IMPLICATIONS OF RESULTS

By summarizing the literature on IP, this study will provide a better understanding of the IP phenomena to inform future research and potentially have implications for physician wellness and public health.

Understanding peer support: a qualitative interview study of doctors one year after seeking support

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.

Sickness absenteeism among primary health care workers in Qatar before and during the COVID-19 pandemic

OBJECTIVES

To explore the patterns, trends, nature, and extent of changes in sickness absence among health care workers (HCWs) at the Primary Health Care Corporation (PHCC) in Qatar-during the COVID-19 pandemic compared to previous years and uncover the main associated factors.

METHODS

We conducted a retrospective analysis of all sick leaves' records of PHCC HCWs regardless of their profession from January 2019 till August 2021.

RESULTS

A total of 41,132 sick leaves were taken during the studied period. The majority of HCWs who availed sick leaves were between 30-39 years (45.9%), females (65.1%), and expatriates (65.1%). Compared with pre-COVID-19 (Jan 2019-Feb 2020), Wave 1 of COVID-19 had significantly less incidence of sick leaves per day per 1000 HCWs. While wave 2 had significantly higher incidence of sick leaves compared to both pre-COVID-19 and wave 1. The number of sick leaves per person among female HCWs was significantly higher than that of male HCWs. Moreover, the number of sick leaves per person among locals were about two times the number among expatriate HCWs. Physicians and nurses had significantly lower number of sick leave per person compared to other professions. The rates of sick leaves due to suspected or confirmed COVID-19 infection, back/neck pain and gastroenteritis were significantly higher in the second wave compared to the first wave of COVID-19.

CONCLUSION

Overall and cause specific sick leave rates among HCWs varied significantly across different periods of the COVID-19 pandemic. COVID-19 related sick leave rate was higher during the second wave compared to first one. By addressing the root causes of sick leaves, it is possible to reduce the burden on HCWs and ensure their continued ability to provide essential care to those in need.

Factors underpinning an improved menopausal experience in the workplace for doctors: a UK-based qualitative study

OBJECTIVES

A recent British Medical Association survey revealed that very few National Health Service (NHS) doctors felt comfortable discussing symptoms with their managers, and many feel unable to make changes to their working lives to accommodate their menopause. An improved menopausal experience (IME) in the workplace has been associated with increased job satisfaction, increased economic participation and reduced absenteeism. Currently, existing literature fails to explore menopausal doctors' experiences and none factors in non-menopausal colleagues' perspectives. This qualitative study aims to determine the factors underpinning an IME for UK doctors.

DESIGN

Qualitative study using semistructured interviews and thematic analysis.

PARTICIPANTS

Menopausal doctors (n=21) and non-menopausal (n=20) doctors including men.

SETTING

General practices and hospitals in the UK.

RESULTS

Four overarching themes underpinning an IME were identified: menopausal knowledge and awareness, openness to discussion, organisational culture, and supported personal autonomy. The levels of knowledge held by menopausal participants themselves, their colleagues and their superiors were identified as crucial in determining menopausal experiences. Likewise, the ability to openly discuss menopause was also identified as an important factor. The NHS culture, gender dynamics and an adopted superhero mentality-where doctors feel compelled to prioritise work over personal well-being-further impacted under the umbrella of Organisational culture. Personal autonomy at work was considered important in improving menopausal experiences at work for doctors. The superhero mentality, lack of organisational support and a lack of open discussion were identified as novel themes not found in current literature, particularly in the healthcare context.

CONCLUSIONS

This study highlights that doctors' factors underpinning an IME in the workplace are comparable to other sectors. The potential benefits of an IME for doctors in the NHS are considerable. NHS leaders can address these challenges by using pre-existing training materials and resources for their employees if menopausal doctors are to feel supported and retained.

The role of unsustainable HR practices as illegitimate tasks in escalating the sense of workplace ostracism

Unsustainable HR practices impose illegitimate tasks on employees due to a shortage of resources. These illegitimate tasks bring counterproductive work behavior in terms of workplace incivility that creates a sense of ostracism in employees. To address these issues, the study examined the relationship among unsustainable HR practices in terms of illegitimate tasks and workplace ostracism. Whereas workplace incivility is defined as an underlying reason through which this association exists. Adopting a theoretical framework from earlier research, the study used cross-sectional data and subsequently a method of quantitative research, and the sample comprised permanent faculty members of private universities in Pakistan working in different departments with different role titles. Smart PLS was applied to run multiple statistics analyzed on the obtained data. The results from the study supported the hypothesis by depicting a positive and significant association between illegitimate tasks and workplace ostracism. Further, workplace incivility was playing the mediating role between illegitimate tasks and workplace ostracism. The results from the study carry significant implications for managers and researchers. Recommendations and future research directions are also discussed in the paper.

Sickness presenteeism explained by balancing perceived positive and negative effects

Within the ever-growing body of research on sickness presenteeism, studies of perceived consequences are scarce and equally rare are joint considerations of beneficial and harmful effects. This study examined how experienced and expected consequences of the behavior are related to presenteeism. Positive and negative effects were considered simultaneously and comprehensively. This approach allowed us to capture the trade-off process of individuals in deciding to work or call in sick when ill. In a cross-sectional online survey, 591 working adults in Germany rated a thoroughly developed pool of specific experienced or potential consequences of working while sick and gave an overall judgment of effects. The results show that perceptions of effects are consistent with behavior. Individuals who exhibit presenteeism do so primarily because of work-related effects such as the completion of one’s work tasks and the meeting of deadlines. Few specific effects stand out and can largely explain attendance behavior and the overall assessment of effects. The findings are consistent with the assumptions of the health belief model and the expectancy value theory of work motivation and they relate to the health-performance framework. They demonstrated that benefits and costs of the behavior are simultaneously weighed in the decision to engage in presenteeism or not.

Contributing Factors of Presenteeism among Portuguese and Swiss Nurses: A Qualitative Study Using Focus Groups

Evidence of nurse presenteeism has mainly focused on quantifying its prevalence and consequences on productivity, quality of care, and patient safety. Few data exist on nurses’ perceptions of their presenteeism and its related causes. We explored concepts of presenteeism and its contributing factors with frontline nurses and nurse managers in different healthcare settings in Portugal and Switzerland. Our qualitative study design involved 8 online focus groups involving 55 participants. The transcribed data was explored using thematic analysis. Three main reasons for presenteeism were identified: unfamiliar terminology; the paradoxical effect of `being present’ but absent; and presenteeism as a survival strategy. Six contributing factors were also recognized: (a) institutional disinterest toward employees; (b) paradigm shift: the tension between person-centered and task-centered care; (c) sudden changes in care practices due to the COVID-19 pandemic; (d) a lack of shared work perspectives with hierarchical superiors; (e) the financial burden of being absent from work; and (f) misfit of human responses. This study generates valuable, in-depth knowledge about the concepts and causes of presenteeism, and significant suggestions for the broader audience of nurse managers and leaders seeking to improve the quality of care.

The relationship between presenteeism, quality of life and social support in higher education professionals: A cross-sectional path analysis

Presenteeism is the practice of being present at workplace, but not being able to carry out all the tasks due to health problems. Social support globally associated with health and wellbeing might positively influence presenteeism and consequently, the quality of life of these professionals. With this in mind, the aim of this study was to investigate the relationships between presenteeism, quality of life and social support in the work of non-teaching and non-research professionals within the context of higher education. A cross-sectional study was conducted, in which sociodemographic data were collected and the Portuguese versions of the Stanford Presenteeism Scale (SPS-6) (which includes the dimensions work-completed and distraction avoided) and Quality of Life Index (EUROSHIS-QOL-8) and the subscales of Supervisor’s Social Support and Peers’ Social Support of the Copenhagen Psychosocial Questionnaire (COPSOQ) were used. The questionnaire was applied online, and 322 professionals from a public university higher education institution in Northern Portugal participated in the study. Presenteeism was reported by 97 (30.1%) professionals. The peers’ social support was positively associated with quality of life. The supervisor’s social support was positively associated with distraction avoided and work completed and positively indirectly associated with quality of life, and the association was mediated by distraction avoided. We conclude that implementing strategies that can promote social support in the work context, namely strengthening networks between colleagues and competent and well-trained supervisors may prevent or reduce presenteeism in higher education professionals, as well as, provide a better quality of life.

Complications of Adenoviral Keratoconjunctivitis in Ophthalmologists and Orthoptists: Epidemiology and Risk Factor, A Retrospective Questionnaire Analysis

PURPOSE

The purpose of this study was to assess the medical history of adenoviral keratoconjunctivitis (AK) and subepithelial infiltrates (SEIs) among French ophthalmologists and orthoptists and the frequency of unreported occupational diseases. We also described short-term and long-term consequences of AK and evaluated associated factors.

METHODS

The REDCap questionnaire was diffused online several times over 7 consecutive months, from October 2019 to May 2020, through mailing lists (French Society of Ophthalmology, residents, and hospital departments), social networks, and by word of mouth.

RESULTS

Seven hundred ten participants were included with a response rate of 6.2% for ophthalmologists, 3.8% for orthoptists, and 28.3% for ophthalmology residents. The medical history of AK was found in 24.1% (95% confidence interval 21%-27.2%) of respondents and SEI in 43.9% (36.5%-51.3%) of the AK population. In total, 87.1% (82.1%-92.1%) of AK occupational diseases were not declared. In total, 57.7% of respondents took 9.4 ± 6.2 days of sick leave, mostly unofficial, and 95.7% stopped surgeries for 13.0 ± 6.6 days. Among the AK population, 39.8% had current sequelae, with 17.5% having persistent SEIs, 19.9% using current therapy, and 16.4% experiencing continuing discomfort. SEIs were associated with wearing contact lenses (odds ratio 3.31, 95% confidence interval 1.19-9.21) and smoking (4.07, 1.30-12.8). Corticosteroid therapy was associated with a greater number of sequelae (3.84, 1.51-9.75).

CONCLUSIONS

AK and SEI affect a large proportion of ophthalmologists and orthoptists, possibly for years, with high morbidity leading to occupational discomfort. Few practitioners asked for either to be recognized as an occupational disease. Associated factors would require a dedicated study.

Coronavirus disease 2019 (COVID-19) screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and coworkers

OBJECTIVE

To investigate the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center, which comprised of symptom-screening, self-referrals to the Occupational Health Services team, and/or a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test.

DESIGN

We conducted a retrospective cohort study of all employee attestations and SARS-CoV-2 tests performed between March and June 2020.

SETTING

A large multi-institutional academic medical center, including both inpatient and ambulatory settings.

PARTICIPANTS

All employees who worked at the study site.

METHODS

Data were combined from the attestation system (COVIDPass), the employee database, and the electronic health records and were analyzed using descriptive statistics including χ2, Wilcoxon, and Kruskal-Wallis tests. We investigated whether an association existed between symptomatic attestations by the employees and the employee testing positive for SARS-CoV-2.

RESULTS

After data linkage and cleaning, there were 2,117,298 attestations submitted by 65,422 employees between March and June 2020. Most attestations were asymptomatic (99.9%). The most commonly reported symptoms were sore throat (n = 910), runny nose (n = 637), and cough (n = 570). Among the 2,026 employees who ever attested that they were symptomatic, 905 employees were tested within 14 days of a symptomatic attestation, and 114 (13%) of these tests were positive. The most common symptoms associated with a positive SARS-CoV-2 test were anosmia (23% vs 4%) and fever (46% vs 19%).

CONCLUSIONS

Daily symptom attestations among healthcare workers identified a handful of employees with COVID-19. Although the number of positive tests was low, attestations may help keep unwell employees off campus to prevent transmissions.

Estimated Cost Effectiveness of Influenza Vaccination for Emergency Medical Services Professionals

INTRODUCTION

Because of their frequent contact with compromised patients, vaccination against influenza is recommended for all healthcare workers. Recent studies suggest that vaccination decreases influenza transmission to patients and reduces worker illness and absenteeism. However, few emergency medical services (EMS) agencies provide annual vaccination, and the vaccination rate among EMS personnel remains low. Reticence among EMS agencies to provide influenza vaccination to their employees may be due in part to the unknown fiscal consequences of implementing a vaccination program. In this study, we sought to estimate the cost effectiveness of an employer-provided influenza vaccination program for EMS personnel.

METHODS

Using data from published reports on influenza vaccination, we developed a cost-effectiveness model of vaccination for a hypothesized EMS system of 100 employees. Model inputs included vaccination costs, vaccination rate, infection rate, costs associated with absenteeism, lost productivity due to working while ill (presenteeism), and medical care for treating illness. To assess the robustness of the model we performed a series of sensitivity analyses on the input variables.

RESULTS

The proportion of employees contracting influenza or influenza-like illness (ILI) was estimated at 19% among vaccinated employees compared to 26% among non-vaccinated employees. The costs of the vaccine, consumables, and employee time for vaccination totaled $44.19 per vaccinated employee, with a total system cost of $4,419. Compared to no vaccination, a mandatory vaccination program would save $20,745 in lost productivity and medical costs, or $16,325 in net savings after accounting for vaccination costs. The savings were 3.7 times the cost of the vaccination program and were derived from avoided absenteeism ($7,988), avoided presenteeism productivity losses ($10,303), and avoided medical costs of treating employees with influenza/ILI ($2,454). Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. The net monetary benefits were positive across all ranges of input assumptions, but cost savings were most sensitive to the vaccination uptake rate, ILI rate, and presenteeism productivity losses.

CONCLUSION

This cost-effectiveness analysis suggests that an employer-provided influenza vaccination program is a financially favorable strategy for reducing costs associated with influenza/ILI employee absenteeism, presenteeism, and medical care.

Why do doctors seek peer support? A qualitative interview study

OBJECTIVES

To understand how doctors reflect on when and why they seek help from an organised peer-support service.

DESIGN

Data were collected through audiotaped, qualitative, semi-structured interviews. The interviews were analysed with systematic text condensation.

SETTING

A peer-support service accessible to all doctors in Norway.

PARTICIPANTS

Thirteen doctors were interviewed after attending a counselling service in fall 2018. They were selected to represent variation in gender, demographics, and medical specialty. Doctors were excluded if the interview could not be held within 10 days after they had accessed peer support.

RESULTS

The doctors' perspectives and experiences of when and why they seek support and their expectations of the help they would receive are presented, and barriers to and facilitators of seeking support are discussed. Three categories of help-seeking behaviour were identified: (1) 'Concerned-looking for advice' describing help seeking in a strenuous situation with need for guidance; (2) 'Fear of not coping any longer' describing help seeking when struggling due to unreasonable stress and/or conflict in their lives; and (3) 'Looking for a way back or out' describing help seeking when out of work. Expectations to the help they would receive varied widely. Motivations for seeking help had more to do with factors enabling or restricting help-seeking than with the severity of symptoms.

CONCLUSIONS

Many different situations lead doctors to seek peer support, and they have various expectations of the service as well as diverse needs, motivations and constraints to seeking peer support. Further research is warranted to investigate the impact of peer support and how to tailor the service to best suit doctors' specific needs.

Revisiting presenteeism to broaden its conceptualization: A qualitative study

BACKGROUND

Presenteeism is generally viewed as a symptom of organizational or individual dysfunction and is rarely considered as a behavioral response to positive triggering factors. Our study examines this issue in small enterprises (SEs), which are an unexplored environment in terms of presenteeism.

OBJECTIVE

Through in-depth analysis, this study aims to understand the positive and negative factors that impact presenteeism in the context of small and medium enterprises (SMEs), with a particular focus on SEs.

METHODS

We adopt a qualitative methodological approach in which we conducted 17 semi-structured interviews with employees and owner-managers of SEs with between 20 and 49 employees.

RESULTS

Our thematic analysis shows that presenteeism can be explained by factors related to pressure to attend work, by individuals' constraints and commitment, by organizational and individual characteristics and by a congenial work environment. Presenteeism can also be a type of "therapy" which helps individuals to avoid focusing on being sick and enables them to stay active and avoid social isolation.

CONCLUSIONS

Our study differs from earlier research by providing a more in-depth analysis of the positive and negative factors that trigger presenteeism. This article will help to expand the current theoretical knowledge about presenteeism and encourage a more holistic interpretation of the phenomenon.

Understanding the Decision-Making Process Between Presenteeism and Absenteeism

Due to their impact on various stakeholder groups, research on the global phenomena of sickness presenteeism (working despite illness) and sickness absenteeism (absence due to illness) is constantly growing. Most studies focus on identifying factors associated with the attendance behaviors. In contrast, there have been few theoretical approaches to explain the individual decision-making process for or against working while ill. Moreover, their empirical verification is still pending. In the present study, we refer to expectancy theory to theoretically explain how the decision is made. To empirically test the model predictions we applied experimental vignette methodology in an online survey with working adults. The hypotheses were confirmed in that the calculated and predicted decisions significantly matched the intentionally chosen decisions. The results contribute to a better theoretical understanding of the decision-making process and provide starting points for interventions to manage attendance behavior in organizations.

Exploring Hong Kong nurses' decision-making processes around presenteeism

BACKGROUND

Presenteeism among nurses is the common behaviour of being physically present at work when one should not be due to personal health and well-being, a stressful work environment, lack of work-life balance, or a sense of professional identity or obligation.

AIMS

To explore nurses' decision-making process related to presenteeism in a large Hong Kong public hospital.

METHODS

As part of a larger study on nurse presenteeism in Hong Kong, we conducted focus groups with nurses to understand their considerations related to working sick.

RESULTS

Eleven major themes emerged from the focus groups, which we grouped into three organizational domains reflecting nurses' decision-making process around presenteeism: consideration for colleagues, organizational factors and professional identity.

CONCLUSIONS

Presenteeism was a familiar behaviour among Hong Kong nurses in our study. We found both overlap and divergence with prior presenteeism research in the domains and themes identified. Loyalty to colleagues, written and unwritten rules and professional identity as nurses all seemed to encourage presenteeism among Hong Kong nurses. Organizations seeking to discourage presenteeism should evaluate policies such as sick leave certificates, ensure appropriate coverage for all nurse ranks and address subcultural norms encouraging presenteeism.

Nurses' illness perceptions during presenteeism and absenteeism

BACKGROUND

Presenteeism has been linked with lost productivity, impaired health and absence. Whilst much research has focused on types of diseases associated with presenteeism and absenteeism, there has been little investigation into the role of individuals' illness perceptions in these episodes.

AIMS

To assess how illness perceptions vary between presenteeism and absenteeism episodes.

METHODS

A cross-sectional questionnaire was distributed to ward-based nurses working with older adults. Data on illness perceptions during presenteeism and absenteeism episodes were collected. Data were analysed via the Paired-Samples t-test, Wilcoxon test and McNemar test.

RESULTS

Two hundred and seventy cases were analysed (88% response rate). Compared with presenteeism, illnesses during absenteeism were thought to affect lives more (P < 0.001), to have more serious symptoms (P < 0.001), to be more concerning (P = 0.003), more likely to be treated (P = 0.009), more infectious (P < 0.001) and perceived as more legitimate reasons for absenteeism (P < 0.001). Treatment was considered more effective during absenteeism (P < 0.001), whilst workability was better during presenteeism (P < 0.001). Presenteeism was perceived as harmful and absenteeism beneficial for illness. Individuals attended work when presenteeism was expected to be less harmful (P < 0.001) and avoided work when absenteeism was expected to be more beneficial for illness (P < 0.001).

CONCLUSIONS

Illness perceptions varied significantly between presenteeism and absenteeism episodes and should be included in models of illness behaviour. Findings also highlight that policy may influence illness behaviour and that nurses may attend work despite concerning levels of illness.

Working While Ill Is Not Always Bad-Positive Effects of Presenteeism

Presenteeism-going to work while ill-is a widespread phenomenon worldwide. Previous research has concentrated mainly on its negative effects. This study investigates the positive consequences of presenteeism derived from a comprehensive content model of presenteeism that was developed on the basis of negative effects. In a quantitative online-survey employees (N = 181) rated the degree of experienced or potential positive effects depending on whether they had worked while ill (75%) or not (25%) during the previous year. Results revealed that all postulated positive effects described in the content model were relevant. Most positive effects were rated significantly higher by participants who had shown presenteeism in comparison to those who had not. The positive effects significantly predicted presenteeism propensity (adjusted R ² = 0.20) for participants having shown presenteeism. In addition, an overall rating of positive effects was significantly related to presenteeism, however, to a lesser degree. Overall, the results demonstrate the applicability of the content model to positive effects of presenteeism. They point to the need for further investigation of them and their consideration for the management of presenteeism.

Presenteeism, Overcommitment, Workplace Bullying, and Job Satisfaction: A Moderated Mediation Relationship

Presenteeism is a hazardous behaviour that may have personal and organizational consequences. The main objective of this research was to investigate the relationship between presenteeism and job satisfaction and evaluate the role of overcommitment as a mediator and the role of work-related and personal bullying as moderators in these relationships. Results from 377 subjects showed that presenteeism and overcommitment are positively related to job satisfaction, with overcommitment being a mediator in the relationships. These relationships are moderated by work-related bullying but not by personal bullying. The findings are discussed, and implications, future research pathways, and limitations are noted.

Predictors of Presenteeism Among Hospital Employees-A Cross-Sectional Questionnaire-Based Study in Switzerland

OBJECTIVE

The aim of this cross-sectional study was to examine work- and person-related predictors of the largely "invisible" behavior and phenomenon of presenteeism among employees in a health-care setting in German-speaking Switzerland.

METHODS

Self-reported survey data from 1840 employees of four hospitals and two rehabilitation clinics collected in 2015 and 2016 were utilized and analyzed.

RESULTS

All studied work-related factors such as patient contact, job satisfaction, high work load, forced overtime, fear of job-loss, and particularly mental strain turned out to be significant and relevant predictors of presenteeism. Younger employees, female workers, and employees with a chronic disease also were more likely to show presenteeism.

CONCLUSION

Work stress, work without patients, job dissatisfaction, a chronic disease, and/or a younger age or rather less work experience seem to increase the chances of presenteeism among health-care workers.

Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China

Background

This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China.

Methods

A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis.

Results

The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences.

Conclusion

In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors’ presenteeism warrant further investigation.

Reported variability in healthcare facility policies regarding healthcare personnel working while experiencing influenza-like illnesses: An emerging infections network survey

BACKGROUND

Presenteeism, or working while ill, by healthcare personnel (HCP) experiencing influenza-like illness (ILI) puts patients and coworkers at risk. However, hospital policies and practices may not consistently facilitate HCP staying home when ill.

OBJECTIVE AND METHODS

We conducted a mixed-methods survey in March 2018 of Emerging Infections Network infectious diseases physicians, describing institutional experiences with and policies for HCP working with ILI.

RESULTS

Of 715 physicians, 367 (51%) responded. Of 367, 135 (37%) were unaware of institutional policies. Of the remaining 232 respondents, 206 (89%) reported institutional policies regarding work restrictions for HCP with influenza or ILI, but only 145 (63%) said these were communicated at least annually. More than half of respondents (124, 53%) reported that adherence to work restrictions was not monitored or enforced. Work restrictions were most often not perceived to be enforced for physicians-in-training and attending physicians. Nearly all (223, 96%) reported that their facility tracked laboratory-confirmed influenza (LCI) in patients; 85 (37%) reported tracking ILI. For employees, 109 (47%) reported tracking of LCI and 53 (23%) reported tracking ILI. For independent physicians, not employed by the facility, 30 (13%) reported tracking LCI and 11 (5%) ILI.

CONCLUSION

More than one-third of respondents were unaware of whether their institutions had policies to prevent HCP with ILI from working; among those with knowledge of institutional policies, dissemination, monitoring, and enforcement of these policies was highly variable. Improving communication about work-restriction policies, as well as monitoring and enforcement, may help prevent the spread of infections from HCP to patients.

Physician Parents Attending Work Despite Own Sick Children: A Qualitative Study on Caregiver Presenteeism Among Norwegian Hospital Physicians

BACKGROUND

Studies have shown that physicians manifest a clear duty to work, even in the face of personal risk, and despite their own symptoms of ill health; this is termed presenteeism. We lack knowledge on their willingness to attend work when their children are sick or in times of concern for their unborn; this is termed caregiver presenteeism. To gain a comprehensive knowledge on the occurrence of presenteeism among physicians, it is important to include caregiver presenteeism.

OBJECTIVE

The aim of this study is to explore the perception and experience with caregiver presenteeism among hospital physicians who are parents or pregnant and to explore its foundations and its consequences.

METHODS

Secondary thematic analysis of semi-structured interviews of hospital physicians (N = 18).

RESULTS

Positive and negative dimensions associated with (1) situations with severe pregnancy symptoms or responsibility for sick children; (2) the perceived impact on their work commitments, personal health, and adequate care for own children; (3) accompanying moderators in the organisational structure and professional culture; and (4) proposed approaches to resolve caregiver and work responsibilities simultaneously contributing to caregiver presenteeism.

CONCLUSIONS

The study underlines the impact of factors in organisational structure, professional culture, and the personal sphere affecting caregiver presenteeism. It appears that targeting factors contributing to attendance pressure in physicians, including those who are pregnant, is particularly important. This includes changing attitudes towards caregiver responsibilities among physician colleagues, department leaders, and physicians themselves, as well as simple cost-efficient organisational interventions in staffing, routines of absence, and work adjustment.

The role of feedback in ameliorating burnout

PURPOSE OF REVIEW

Assessment of the current literature surrounding interventions directed toward the prevention of burnout in the field of medicine and particularly in anesthesiology.

RECENT FINDINGS

Recently, burnout has been noted to lead to medication errors and subsequently increased harm to our patients. On a personal level, burnout can lead to depression and even suicide amongst physicians. Strategies to prevent burnout amongst anesthesiologists that have been studied in the literature include multisource feedback, mentorship and early recognition.

SUMMARY

There remains no clear or definitive intervention to prevent burnout for physicians. However, changing our environment to embrace mentorship, the continual exchange of feedback and the fostering self-care could startlingly improve our work environment.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers

BACKGROUND

Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW.

METHODS

We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings.

RESULTS

Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness.

DISCUSSION

Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

BACKGROUND

It has been shown that a recently defined stressor, 'illegitimate tasks', has negative effects on employees' work motivation and health. Better understanding of the illegitimate tasks undertaken by physicians might contribute to a more resource-efficient division of labour within the health care system, with beneficial effects on organisational economics and employee performance. We aimed to investigate the prevalence of unreasonable illegitimate tasks, their associations with workplace variables and their impact on health, in particular sickness presenteeism.

METHODS

Cross-sectional data were collected in 2012. A sample of 545 Norwegian physicians answered an online questionnaire. The response rate was high (71.8%). The data were analysed using independent-samples t-tests, ANOVA and logistic regression.

RESULTS

About 50.2% of physicians in all clinical positions reported that at least 11% of their everyday tasks could have been done by other hospital personnel. Seven percent of the physicians reported that at least 31% of their daily workload consisted of unreasonable illegitimate tasks. There were no significant differences in unreasonable illegitimate tasks according to clinical position, age or gender. Administrative task load and role conflict were positively associated with unreasonable illegitimate tasks that physicians reported could be reallocated to non-medical professionals. Moreover, unreasonable illegitimate task was associated with a higher probability of sickness presenteeism after controlling for age, gender, role conflict, control over work pace, exhaustion and administrative tasks.

CONCLUSIONS

The results confirm that physicians' workload includes a high proportion of unreasonable illegitimate tasks and that this can contribute to sickness presenteeism. Investigation of work environmental factors can provide insight into the mechanisms behind unreasonable illegitimate tasks. Decreasing the amount of administrative tasks and role conflicts faced by physicians should be a priority. These findings could be used to make hospital task management more resource-efficient. Our results indicate that a substantial proportion of physicians' work capacity could be re-allocated to core tasks. Further research is needed into the specific type and content of unreasonable illegitimate tasks undertaken by physicians in order to determine to whom they should be allocated to ensure a healthy and motivated workforce and provision of high quality, resource-efficient health care services.

Sick at work: prevalence and determinants among healthcare workers, western Ethiopia: an institution based cross-sectional study

Background

Going to work despite feeling sick also known as sickness presenteeism is one of the emerging global occupational health challenges. Sickness presenteeism negatively affects both health of work forces and productivity of organizations in general. However, there is insufficient research exploring this situation in majority of the Sub-Saharan African countries, including Ethiopia. Thus this study intended to investigate the prevalence and determinant factors of sickness presenteeism among health care workers, Western Ethiopia.

Methods

This study used an institution based cross-sectional quantitative study design. The study period was from February to March, 2017. We employed simple random sampling method to select 360 study samples. Data collection was performed by pre-tested structured and self- administered questionnaire. We used SPSS version 20 to carry out binary logistic regression analysis. Odds ratio with 95% confidence intervals was calculated and significance of associations was determined at p-value < 0.05.

Results

A total of 344 respondents fully completed the survey questionnaire. Mean age with standard deviation was 30.28 ± 6.181. Prevalence of sickness Presenteeism was 52.6% [95%CI: (47.4, 57.8)] in the past 12 months. Educational status [AOR:2.1, 95%CI: (1.17,3.90)], financial problem [AOR:1.9,95%CI:(1.07,3.46)], sickness absenteeism [AOR:2.7,95% CI:(1.50,5.02)], lack of staff replacement [AOR:2.7,95%CI:(1.50,5.02)], absence of occupational health services [AOR:3.0,95%CI:(1.34,6.70)], and pressure from supervisor [AOR:1.8,95% CI:(1.01,3.31)] were significant predictors of the dependent variable.

Conclusion

Relatively higher proportions of workers indicated sickness presenteeism as compared to other studies. Risk factors like educational status, personal financial problem, sickness absenteeism, lack of staff replacement, absence of occupational health services, and pressure from supervisors considerably increased the likely occurrence of employees’ sick attendance. It is advisable for health care managers to hire adequate health care staffs, to implement basic occupational health services and to design strategies which reduce pressure from supervisors.

Self-care as a professional imperative: physician burnout, depression, and suicide

PURPOSE

Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic.

SOURCE

The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems.

PRINCIPAL FINDINGS

Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care.

CONCLUSION

The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.