Healthcare professionals' perspectives on working conditions, leadership, and safety climate: a cross-sectional study

The influence of hospital leadership support on burnout, psychological safety, and safety climate for US infection preventionists during the coronavirus disease 2019 (COVID-19) pandemic

OBJECTIVE

To explore infection preventionists' perceptions of hospital leadership support for infection prevention and control programs during the coronavirus disease 2019 (COVID-19) pandemic and relationships with individual perceptions of burnout, psychological safety, and safety climate.

DESIGN

Cross-sectional survey, administered April through December 2021.

SETTING

Random sample of non-federal acute-care hospitals in the United States.

PARTICIPANTS

Lead infection preventionists.

RESULTS

We received responses from 415 of 881 infection preventionists, representing a response rate of 47%. Among respondents, 64% reported very good to excellent hospital leadership support for their infection prevention and control program. However, 49% reported feeling burned out from their work. Also, ∼30% responded positively for all 7 psychological safety questions and were deemed to have "high psychological safety," and 76% responded positively to the 2 safety climate questions and were deemed to have a "high safety climate." Our results indicate an association between strong hospital leadership support and lower burnout (IRR, 0.61; 95% CI, 0.50-0.74), higher perceptions of psychological safety (IRR, 3.20; 95% CI, 2.00-5.10), and a corresponding 1.2 increase in safety climate on an ascending Likert scale from 1 to 10 (β, 1.21; 95% CI, 0.93-1.49).

CONCLUSIONS

Our national survey provides evidence that hospital leadership support may have helped infection preventionists avoid burnout and increase perceptions of psychological safety and safety climate during the COVID-19 pandemic. These findings aid in identifying factors that promote the well-being of infection preventionists and enhance the quality and safety of patient care.

Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network

BACKGROUND

Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research.

METHODS

In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations.

RESULTS

Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic.

CONCLUSIONS

Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.

The Impact of Transformational Leadership in the Nursing Work Environment and Patients' Outcomes: A Systematic Review

BACKGROUND

With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective leadership; particularly, transformational leadership (TFL) is shown to scientifically be the most successfully recognized leadership style in healthcare, focusing on relationship building while putting followers in power and emphasizing values and vision.

AIM

To examine how transformational leadership affects nurses' job environment and nursing care provided to the patients and patients' outcomes.

DESIGN

A systematic literature review was conducted. From 71 reviewed, 23 studies were included (studies included questionnaire surveys and one interview, extracting barriers and facilitators, and analyzing using qualitative synthesis).

RESULT

TFL indirectly and directly positively affects nurses' work environment through mediators, including structural empowerment, organizational commitment, and job satisfaction. Nurses perceived that managers' TFL behavior did not attain excellence in any of the included organizations, highlighting the necessity for additional leadership training to enhance the patient safety culture related to the non-reporting of errors and to mitigate the blame culture within the nursing environment.

CONCLUSION

Bringing more focus to leadership education in nursing can make future nursing leaders more effective, which will cultivate efficient teamwork, a quality nursing work environment, and, ultimately, safe and efficient patient outcomes. This study was not registered.

Violence Prevention Climate and Health-Oriented Leadership in German Emergency Departments

Emergency departments (EDs) are high-risk environments for workplace violence. Research into techniques to prevent violence has less frequently explored the influence of leadership. This study aims to analyze the association of leadership with the prevention of violence using the concepts of health-oriented leadership (HoL) and the violence prevention climate (VPC). This quantitative cross-sectional study was conducted through online surveys between November 2021 and March 2022 across Germany. A sample of 370 doctors and nurses working in German EDs were recruited. Perceptions towards VPC and HoL were compared between groups divided according to profession and position using independent t-tests or Mann-Whitney U tests. Separate multiple linear regression models for supervisors and employees analyzed the association between different profiles of HoL with VPC. Supervisors and employees showed significant differences in supervisor staff-care and VPC. Regression analysis demonstrated that supervisors' self-care and employees' assessment of supervisor's staff-care positively predicted all dimensions of VPC. This empirical study provides insights into the variable perceptions of different groups and the association of leadership profiles with the perceptivity of VPC. The results of this study can be used to emphasize the importance of HoL training for both employees and supervisors to improve communication and health-promoting behavior.

General health and working conditions of Flemish primary care professionals

BACKGROUND

The Quintuple aim explicitly includes 'health and wellbeing of the care team' as requirement for the care of patients. Therefore, we examined working conditions, work engagement and health status of professionals active in primary care in Belgium (Flanders), and how these are interrelated.

METHODS

Data of the cross-sectional 'Health professionals survey of the Flemish Primary care academy' of 2020 were examined. We performed logistic regression analyses to study the relationship between working conditions and self-reported dichotomized health of primary care professionals (sample size = 1033).

RESULTS

The majority of respondents (90%) reported having a good to very good general health and has a strong work engagement. Quality of employment was high, in particular regarding job security and supportive relations with colleagues, while less in terms of proper rewards and job career opportunities. Working as self-employee (vs. as salaried employee), and in a multidisciplinary group practice (vs. other organizational settings) were positively related to health. Work engagement and all dimensions of employment quality were related to general health, but work family balance, proper rewards, and perceived employability were independently positively related to self-reported health.

CONCLUSION

Nine out of 10 Flemish primary care professionals working in diverse conditions, employment arrangements and organizational settings report good health. Work family balance, proper rewards, and perceived employability were important for primary care professionals' health, and could provide opportunities to further strengthen the job quality and health of primary care professionals.

Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being

BACKGROUND

Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey.

METHODS

The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics.

RESULTS

Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics.

CONCLUSION

Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.

A Brief Assessment of Patient Safety Culture in Anesthesia and Intensive Care Departments

Due to the nature of their activity, anesthesia and critical care have generally well-developed patient safety cultures, which are linked to a greater level of incident awareness and reporting during clinical activity. In order to determine the status quo and identify and adopt, where appropriate, techniques and instruments for further improving patient safety, it is necessary to evaluate the culture and barriers in these departments. The main objective of our study was to assess patient safety culture in Romanian anesthesia and intensive care departments (AICDs), to pinpoint the areas that may need improvement, and to examine the correlation between the prevalence of adverse event reporting, as well as the level of self-reported patient safety culture. To determine how anesthesia and intensive care department staff perceived patient safety, the Hospital Survey on Patient Safety Culture (HSOPSC) was used in a translated Romanian version. In total, 1200 employees from 36 anesthesiology and intensive care departments across 32 hospitals in Romania received the questionnaire, representing 42.66% of all anesthesia and intensive care departments in the country. In 7 of the 12 examined dimensions, significant differences between tertiary and secondary hospitals were observed. Among all dimensions, the highest positive score was for "organizational learning and continuous development". In general, our study revealed a positive view on patient safety in anesthesia and intensive care departments. Further studies are required to determine a threshold of the level of culture development.

Hospital Work Conditions and the Mediation Role of Burnout: Residents and Practicing Physicians Reporting Adverse Events

Background

"Patient Safety" in everyday practices is a target of healthcare leaders, and adverse events reported by healthcare providers directly reflect patient safety in the health system. Recognising how residents and practising physicians rate adverse events concerning their work conditions and burnout must be explored.

Objective

This study aims to explore the mediation effect of burnout dimensions (emotional exhaustion and burnout-interpersonal disengagement) between the effects of work conditions on perceived patient safety by exploring the adverse events that residents and practising physicians reported.

Methods

A quantitative and cross-sectional study collected data from 249 residents and practising physicians in a huge teaching hospital and primary health care centre (PHC) in the Eastern Province of Saudi Arabia. Hayes Macro regression analysis was employed to evaluate the multiple mediation effect of burnout dimensions, with 5000 bootstrapping and a confidence interval (CI) of 95% for statistical inference and p≤0.05 for the significance level.

Results

Leadership support (B= 0.39, t= 6.24, p<0.001) and physician engagement (B=0.43, t=6.50, p<0.001) were associated with a decreased rate of adverse events to patient safety, whereas workload (B=-0.23, t=-3.73, p<0.001) was negatively associated with an increased rate of adverse events. Burnout was shown to mediate the relationship between the effects of physician's leadership support (R²=0.26, F=27.50, p<0.001), work engagement (R²=0.25, F=27.07, p<0.001) and workload (R²=0.23, F=24.23, p<0.001) on the rate of adverse events.

Conclusion

This study provides insights into burnout dimensions and their consequences on patient safety indicators (ie, adverse events). Work conditions (ie, leadership support, physician engagement, and workload) directly affect the rate of adverse events and indirectly through mediators like burnout-emotional exhaustion and burnout-interpersonal disengagement.

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey

In our study, we investigated possible differences across occupational groups regarding employees’ perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees’ attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

Intervention hesitancy among healthcare personnel: conceptualizing beyond vaccine hesitancy

We propose an emerging conceptualization of "intervention hesitancy" to address a broad spectrum of hesitancy to disease prevention interventions among healthcare personnel (HCP) beyond vaccine hesitancy. To demonstrate this concept and its analytical benefits, we used a qualitative case-study methodology, identifying a "spectrum" of disease prevention interventions based on (1) the intervention's effectiveness, (2) how the intervention is regulated among HCP in the Israeli healthcare system, and (3) uptake among HCP in the Israeli healthcare system. Our cases ultimately contribute to a more nuanced conceptualization of hesitancy that HCP express towards disease prevention interventions. Our case interventions included the seasonal influenza vaccine, the Mantoux test, and the hepatitis B (HBV) vaccine. Influenza and HBV are vaccine-preventable diseases, though their respective vaccines vary significantly in effectiveness and uptake among HCP. The Mantoux test is a tuberculin skin test which provides a prevention benchmark for tuberculosis (TB), a non-vaccine preventable disease. We conducted semi-structured interviews with relevant stakeholders and analyzed them within Israeli and international policy context between 2016 and 2019, a period just prior to the COVID-19 pandemic. We propose the conceptualization of "intervention hesitancy"-beyond "vaccine hesitancy"-as "hesitancy towards a wide range of public health interventions, including but not limited to vaccines". Results suggested that intervention hesitancy among HCP is rooted in weak trust in their employer, poor employment conditions, as well as mixed institutional guidelines and culture. Conceptualizing intervention hesitancy expands the ability of healthcare systems to understand the root of hesitancy and foster a supportive institutional culture and trust, cognizant of diverse disease prevention interventions beyond vaccination.

Assessing the psychosocial work environment of migrant and non-migrant workers in inpatient mental health centres: A feasibility study

The number of migrant workers in Germany has increased over the last decades and will probably further increase in the context of a growing cultural diversity of the population and shortage of skilled professionals. Since migrant workers face different challenges, they may experience poorer psychosocial work environments than non-migrants. A negative psychosocial work environment can increase burnout and depression symptoms. To this date no study has investigated differences in the perceived psychosocial work environment in the mental health field. The aim of this study is to evaluate the feasibility of a cross sectional study comparing the perceived psychosocial work environment of migrants and non-migrant workers in inpatient mental health centres in Germany. The study was conducted in four inpatient mental health centres in Germany using the Copenhagen Psychosocial Questionnaire. All staff members (N = 659) categorized in seven professional groups were invited to participate in the study. The feasibility of the study was determined by four criteria (1) Implementation of the study in inpatient mental health centres (2) Representativity of the sample (3) Reliability and usability of the questionnaire and (4) Variability of collected data. Three of four feasibility criteria were achieved. The study was successfully implemented in four mental health centres, the usability of the used questionnaire was confirmed as well as the variability of the data. The targeted response rate was partially met, and the total number of migrant workers could not be provided, which limits the representativity of the sample. In conclusion, a main study is feasible, but an effort must be put in an effective recruitment strategy to obtain valid results.

Burnout and work-privacy conflict - are there differences between full-time and part-time physicians?

Background

Changes in everyday work with regard to working time models have reached the medical profession. The number of physicians working part-time is steadily increasing. At the same time, however, the population's need for care is also rising. This can reinforce the impending shortage of doctors in the future. The aim was to investigate differences in work-privacy conflict and burnout among physicians working full-time or part-time.

Method

The present study includes data from a baseline survey of the long-term study of physicians with different medical backgrounds. The analysis focused on a sub-sample of 598 physicians (not self-employed). The two main outcomes under investigation—burnout and work-privacy conflict—were measured using the Copenhagen Burnout Inventory adapted for health care professionals, as well as the associated subscale of the Copenhagen Psychosocial Questionnaire (COPSOQ). Data analyses included descriptive statistics followed by regression models.

Results

Descriptive analyses show, that 31.8% of physicians are working part-time, whereas 68.2% are working full-time. The part-time subsample is significantly older, and female physicians are more likely to work part-time. With regard to workload and work-privacy conflict, significant differences between part-time and full-time physicians were only observed in terms of work-privacy-conflict. However, regression analysis underline the importance of possible confounding variables (such as medical setting) within the relationship between job size and job-related well-being.

Discussion

Differences in working hour arrangements (full-time or part-time work) are only accompanied by less work-privacy conflict. No differences with regard to burnout (patient-related, work-related or personal) could be obtained. Rather, the data suggests that other job-related variables may play a role and should be further investigated.

FACTORS AFFECTING NURSES' ATTITUDES TOWARDS RISKS IN THE WORK ENVIRONMENT: A CROSS-SECTIONAL STUDY

AIM

This study aimed to examine the factors affecting nurses' attitudes towards risks in the work environment.

BACKGROUND

Nurses' attitudes towards work environment-associated risks affect both risk management and employee health.

METHODS

This descriptive study was conducted with 338 nurses working in a public hospital, university hospital, and private hospital. Data were collected using the Personal Information Form and the Nurses' Attitudes Towards Work Environment Risks Scale.

RESULTS

Nurses were found to have a positive attitude towards risk in the work environment. Regression analysis showed that nurses' attitudes towards risk was affected by institution, gender, access to unit-specific risk management training, past experiences of sharp penetrating tool injuries, acceptance of risks due to the belief that risks are unavoidable, exposure to violence from colleagues, exposure to biological hazards, and neglect to take risk precautions.

CONCLUSIONS

This study's results show that nurses' attitudes towards risk in the work environment is affected by both individual and organizational factors.

IMPLICATIONS FOR NURSING MANAGEMENT

This study's results can help institutions and nurse managers understand the factors affecting nurses' attitudes towards work-related risks, thereby allowing them to determine the primary strategies that may be used to address these factors.

Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China

Purpose

Understanding the antecedents of patient safety culture among medical staff is essential if hospital managers are to promote explicit patient safety policies and strategies. The factors that influence patient safety culture have received little attention. The authors aim to investigate the antecedents of patient safety culture (safety climate) in relation to medical staff to develop a comprehensive approach to improve patient safety and the quality of medical care in China.

Design/methodology/approach

The Chinese version of the Safety Attitudes Questionnaire (CSAQ) was used to examine the attitudes toward patient safety among physicians and nurses. This medical staff was asked to submit the intra-organizational online survey via email. A total of 1780 questionnaires were issued. The final useable questionnaires were 256, yielding a response rate of 14.38%. One-way analysis of variance (ANOVA) was employed to test if different sex, supervisor/manager, age, working experience, and education result in different perceptions. Confirmatory factor analysis (CFA) was used to verify the structure of the data. Then linear regression with forward selection was performed to obtain the essential dimension(s) that affect the safety culture (safety climate).

Findings

The CFA results showed that 26 CSAQ items measured 6 safety-related dimensions. The linear regression results indicated that working conditions, teamwork climate, and job satisfaction had significant positive effects on safety culture (safety climate).

Practical implications

Hospital managers should put increased effort into essential elements of patient-oriented safety culture, such as working conditions, teamwork climate, and job satisfaction to develop appropriate avenues to improve the quality of delivered medical services as well as the safety of patients.

Originality/value

This study focused on the contribution that the antecedents of patient safety culture (safety climate) make with reference to the perspective of medical staff in a tertiary hospital in China.

Hospital patient safety at the emergency department - a systematic review

Abstract Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses’ perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses’ perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses’ perception on patient safety culture in emergency services, contributes to improving the quality of care provided.

Fostering a culture of nursing excellence during the COVID-19 crisis

Medical center uses Pathway to Excellence® framework to sustain a positive practice environment.

Hospital patient safety at the emergency department - a systematic review

Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses' perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses' perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses' perception on patient safety culture in emergency services, contributes to improving the quality of care provided.

Safety climate in hospitals: A cross-sectional study on the perspectives of nurses and midwives

Aims

To explore nurses' and midwives' perspectives of safety climate in Austrian hospitals as measurable elements of safety culture and to identify areas of quality improvement.

Background

Due to close contact with patients, nurses and midwives play a vital role in ensuring patient safety.

Method

An online survey among 713 nurses and midwives was conducted, using the 19‐item Safety Climate Survey (SCS). To answer the survey, a 5‐point Likert scale was provided with higher ratings indicating a more positive safety climate.

Results

Results demonstrate a positive safety culture (MD 4.09, SD 0.53). Significant group differences in overall safety climate score could be found regarding nurses and midwives in managerial positions, between gender and participants age with low effect size. High item missing rates focus aspects on management/leadership, institutional concerns, leadership by physicians, and handling of adverse events. In addition, these items present the lowest ratings in safety climate.

Conclusion

Results indicate potentials for optimization in the areas of leadership communication and feedback, the handling of safety concerns, and visibility or improvement of patient safety strategies.

Implications for Nursing Management

A regular, standardized safety climate measurement can be a valuable tool for nurse managers and (political) decision‐makers to manage patient safety initiatives.

Nurses and physicians attitudes towards factors related to hospitalized patient safety

INTRODUCTION

The attitudes of healthcare staff towards patients' safety, including awareness of the risk for adverse events, are significant elements of an organization's safety culture.

AIM OF RESEARCH

To evaluate nurses and physicians' attitudes towards factors influencing hospitalized patient safety.

MATERIALS AND METHODS

The research included 606 nurses and 527 physicians employed in surgical and medical wards in 21 Polish hospitals around the country. The Polish adaptation of the Safety Attitudes Questionnaire (SAQ) was used to evaluate the factors influencing attitudes towards patient safety.

RESULTS

Both nurses and physicians scored highest in stress recognition (SR) (71.6 and 80.86), while they evaluated working conditions (WC) the lowest (45.82 and 52,09). Nurses achieved statistically significantly lower scores compared to physicians in every aspect of the safety attitudes evaluation (p<0.05). The staff working in surgical wards obtained higher scores within stress recognition (SR) compared to the staff working in medical wards (78.12 vs. 73.72; p = 0.001). Overall, positive working conditions and effective teamwork can contribute to improving employees' attitudes towards patient safety.

CONCLUSIONS

The results help identify unit level vulnerabilities associated with staff attitudes toward patient safety. They underscore the importance of management strategies that account for staff coping with occupational stressors to improve patient safety.

Reflection on leadership behavior: potentials and limits in the implementation of stress-preventive leadership of middle management in hospitals - a qualitative evaluation of a participatory developed intervention

Background

Mental health and stress prevention aspects related to workplace in hospitals are gaining increasingly more attention in research. The workplace hospital is characterized by high work intensity, high emotional demands, and high levels of stress. These conditions can be a risk for the development of mental disorders. Leadership styles can hinder or foster work-related stress and influence the well-being of employees. Through leadership interventions, leaders may be encouraged to develop a stress-preventive leadership style that addresses both, the well-being of the leaders and of the subordinates. A comprehensive qualitative description of leaders’ experiences with interventions on the topic of stress-preventive leadership is yet missing in the literature. Therefore, we address leaders of middle management regarding the development of stress-preventive leadership styles through supporting interventions. The research questions are: How do leaders of middle management perceive their leadership role in terms of effectiveness in stress prevention? Which potentials and limits in the implementation of stress-preventive leadership are experienced?

Methods

The study follows a qualitative research design and content analysis. We conducted individual interviews with leaders of middle management (n = 30) of a tertiary hospital in Germany for the participatory development of an intervention. This intervention, consisting of five consecutive modules, addressed leaders of middle management in all work areas within one hospital. After participation in the intervention, the leaders were asked to reflect on and evaluate the implementation of the contents learned within focus group discussions. Overall 10 focus group discussions with leaders (n = 60) were conducted.

Results

The results demonstrate that leaders of middle management perceived potentials for a stress-preventive leadership style (e.g., reflection on leadership role and leadership behavior, awareness/mindfulness, and conveying appreciation). However, limits were also mentioned. These can be differentiated into self-referential, subordinate-related, and above all organizational barriers for the implementation of stress-preventive leadership.

Conclusions

Some of the organizational barriers can be addressed by mid-level leadership interventions (e.g., lack of peer-exchange) or possibly by adapted leadership interventions for top management (e.g., lack of stress-preventive leadership styles in top level management). Other organizational limits are working conditions (e.g., staff shortage) that can only be influenced by health policy decisions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00339-7.

Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review

Background

Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses.

Objectives

The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany.

Methods

A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies’ references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting.

Results

A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected.

Conclusion

The state of research on setting-specific differences of nurses’ health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses’ health and prevention of violence, as well as dealing with violence experiences of nurses.

Impact of the Work Environment on Patients' Safety as Perceived by Nurses in Poland-A Cross-Sectional Study

Numerous studies have found that organizational features connected with the work environment of nurses have a significant influence on patients' safety. The aim of this research was to capture nurses' opinions about patients' safety and discern relationships with work environment characteristics. This cross-sectional study surveyed 1825 nurses. The research used questionnaire consisting of four parts: (1) covered The Practice Environment Scale of the Nursing Work Index (PES-NWI); (2) assessed the quality of nursing care and care safety; (3) contained information on the most recent duty served by the nurses and (4) captured social and demographic data of participants. The research identified strong association between patient safety assessment and work environment of nurses in the aspect of employment adequacy, cooperation between nurses and doctors, support for nurses from the managing staff, the possibility to participate in the management as well as professional promotion of nurses employed in the hospital (p < 0.001). Nurses rated patient safety higher when responsible for a smaller number of patients. Work environment factors such as proper staffing, good cooperation with doctors, support from the management, as well as professional independence are significantly related to nurses' assessment of patients' safety.

Nursing workplace and its relation to occupational health outcomes and physical activity

BACKGROUND

Working in hospitals entails several risks to nurses. A better nursing workplace can help in improving physical activity and reducing adverse occupational health outcomes among nurses.

AIM

This study aimed to investigate the relationships of the nursing workplace with occupational health outcomes and physical activity.

METHODS

A cross-sectional correlation study was conducted with 623 nurses. Data were collected through report self-administered questionnaires that included employment and occupational conditions, hospital workplace environment, and adverse occupational health outcomes as well as physical activity pattern.

RESULTS

The current study showed that the nursing workplace environment and conditions had a negative effect on occupational health outcomes and physical activity among nurses in the study units. Nurses in this study reported a high prevalence of low back pain (82.7%), burnout (78.3%), and occupational injuries (70.5%). They also reported insufficient physical activities (90.6%). High prevalence of burnout and low back pain were associated with low levels of physical activities among nurses.

CONCLUSION

A fair working environment and conditions have been implicated as a causative factor of negative occupational health outcomes and limitations of physical activity among nurses. Adverse occupational health outcomes also affect the nurses engaging in physical activity.

Critical Care Nurse Burnout in Veterans Health Administration: Relation to Clinician and Patient Outcomes

BACKGROUND

Critical care nurses have a burnout rate among the highest of any nursing field. Nurse burnout may impact care quality. Few studies have considered how temporal patterns may influence outcomes.

OBJECTIVE

To test a longitudinal model of burnout clusters and associations with patient and clinician outcomes.

METHODS

An observational study analyzed data from annual employee surveys and administrative data on patient outcomes at 111 Veterans Health Administration intensive care units from 2013 through 2017. Site-level burnout rates among critical care nurses were calculated from survey responses about emotional exhaustion and depersonalization. Latent trajectory analysis was applied to identify clusters of facilities with similar burnout patterns over 5 years. Regression analysis was used to analyze patient and employee outcomes by burnout cluster and organizational context measures. Outcomes of interest included patient outcomes (30-day standardized mortality rate and observed minus expected length of stay) for 2016 and 2017 and clinician outcomes (intention to leave and employee satisfaction) from 2013 through 2017.

RESULTS

Longitudinal analysis revealed 3 burnout clusters among the 111 sites: low (n = 37), medium (n = 68), and high (n = 6) burnout. Compared with sites in the low-burnout cluster, those in the high-burnout cluster had longer patient stays, higher employee turnover intention, and lower employee satisfaction in bivariate models but not in multivariate models.

CONCLUSIONS

In this multiyear, multisite study, critical care nurse burnout was associated with key clinician and patient outcomes. Efforts to address burnout among nurses may improve patient and employee outcomes.

Evaluating Polish nurses' working conditions and patient safety during the COVID-19 pandemic

Aim

To study the relationship between Polish nurses' working conditions and their attitudes towards patient safety during the COVID‐19 pandemic.

Background

Facing the COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, healthcare worldwide has been reorganised. How these changes affected patient safety for hospitalised persons is not well understood.

Introduction

Difficult working conditions related to the outbreak of the COVID‐19 pandemic may affect the provision of safe and effective care by healthcare staff.

Methods

This observational research was performed on the group of 577 nurses working during the COVID‐19 pandemic in isolation infection wards (n = 201) and non‐infectious diseases wards (n = 376) in Polish hospitals. The evaluation of working conditions was performed with an author's questionnaire, while the evaluation of factors influencing attitudes towards safety of the hospitalised patients was performed using Safety Attitudes Questionnaire. The STROBE checklist was used to report this study.

Results

The procedures developed by management in advance for COVID‐19 patient treatment had a statistically significant influence on nurses' ‘evaluation of teamwork climate, safety climate, job satisfaction, perception of management and work conditions’. Providing management with the ability to perform a swab polymerase chain reaction SARS‐CoV‐2 test for hospital staff in the workplace, and psychological support from professionals and employers were statistically significant for higher ratings of ‘teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions’ by the Polish nurses. Hospital workload during the COVID‐19 pandemic was significantly correlated with lower evaluation of work conditions.

Discussion

Our study reinforces the existing literature on many fronts and demonstrates how even when operating under the COVID‐19 pandemic conditions, some factors remain critical for fostering a culture of patient safety. Reinforcing patient safety practices is a imperative under these conditions.

Conclusions and implications for nursing

Working conditions influence nurses' attitudes towards safety of the hospitalised patients. These are largely modifiable factors related to the workplace and include prior preparation of procedures, restrictions to extending daily work hours and psychological counselling for the staff.

Measuring the safety climate in an Australian emergency department

BACKGROUND

There are numerous intricate human, system and cultural factors that can impact upon the safe and effective implementation of patient safety systems (e.g. rapid response systems). Safety climate is one of these factors and is a measure of frontline healthcare workers' shared perceptions, behaviours, beliefs and attitudes towards the organisation's culture of safety. Safety climate scores are also associated with the frequency of errors and adverse events in the healthcare setting. However, there is little evidence regarding the relationships between attitudes to patient safety and staff characteristics such as emergency care expertise and experience. The aims of this study were to measure perceptions of the safety climate in an Australian metropolitan Emergency Department and examine relationships between safety climate perceptions and staff characteristics.

METHODS

The Victorian Managed Insurance Authority Safety Climate Survey was administered to all doctors (n = 44) and nurses (n = 119) at an Australian emergency department.

RESULTS

Completed surveys were received from 127 (78%) respondents, 25 (52%) doctors and 100 (84%) nurses. Reliability analysis showed very good internal consistency of all 43-items of the survey (α = 0.94). With the exception of stress recognition, nurses rated the organisation's commitment to patient safety higher than doctors in all remaining attitudinal domains (p < 0.05). Both groups acknowledge that fatigue, increased workload and stress recognition negatively impacts upon patient safety. There was a significant trend for declining safety climate ratings related to participants' clinical competence level and experience across all domains except stress recognition (p < 0.05).

CONCLUSIONS

The Safety Climate Survey appears to be a reliable measure of patient safety climate for use in Emergency Departments. Emergency doctors and nurses did not perceive there to be a strong organisational commitment to patient safety in an Australian Emergency Department. Emergency Departments can provide a safer environment through genuine commitment to safety culture improvement which capitalises on the insights, intrinsic strengths and behaviours characteristic of the ED team's expertise and experience. This kind of commitment can positively influence the effectiveness of actions taken to minimise risk to patient safety and improve ED staff job satisfaction and effectiveness.

Perspectives of policymakers and health care managers on the retention of health workers in rural and remote settings in Nigeria

BACKGROUND

Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention.

METHODS

We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria.

RESULTS

Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building.

CONCLUSION

The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations.

Interdisciplinary differences in patient safety culture within a teaching hospital in Southeast Asia

BACKGROUND

Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital.

METHOD

A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff.

RESULTS

Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range = 31.1 to 84.7%), with job satisfaction (72.3% ± 21.9%) and stress recognition (58.3 ± 25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction and working conditions compared to nurses.

CONCLUSIONS

The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.

Safety Performance of Healthcare Professionals: Validation and Use of the Adapted Workplace Health and Safety Instrument

Improving patient safety and reducing occupational accidents are two of the main challenges in healthcare. Instruments to measure safety performance and occupational safety are rare. This study aimed to prepare and validate a German version of the adapted workplace health and safety instrument to assess the safety performance of healthcare professionals. Overall, 168 healthcare professionals participated in this explorative cross-sectional study. The instrument consists of 16 items related to safety performance in four dimensions. We calculated mean values and standard deviations for each individual item and those of the four dimensions of the instrument. We evaluated internal consistency and construct validity, explored the dimensionality of the instrument through exploratory factor analysis, and tested how our data fit with the original model with confirmatory factor analysis. Among the participants, 73.8% were nurses and nurses in training, with the majority of the sample being female (71.9%) and younger than 30 (52.5%). Cronbach's alpha for all four dimensions was >0.7. All items were loaded on factors according to the original theoretical model. Confirmatory factor analysis showed good model fit (normed χ²/df = 1.43 (≤2.5), root mean square error of approximation = 0.06 (≤0.07), goodness of fit index = 0.90 (>0.90), comparative fit index = 0.95 (≥0.90), and Tucker-Lewis index = 0.93 (>0.90). The German version of the instrument demonstrated acceptable properties and was a good fit to the original theoretical model, allowing measurement of healthcare professionals' safety knowledge, motivation, compliance, and participation.

Healthcare Worker Serious Safety Events: Applying Concepts from Patient Safety to Improve Healthcare Worker Safety

Introduction:

Patient safety has improved pediatric healthcare by defining when patient safety events meet criteria as serious safety events (SSEs). Similar concepts apply to healthcare worker (HCW) safety. We describe the newly designed process for HCW injury reporting, the process for evaluating HCW SSEs, and early experience with the new systems.

Methods:

The work to redesign our approach to HCW safety included 2 parts: (1) process flow mapping and redesigning the work for HCW injury reporting; and (2) creating a process to categorize HCW injuries and determine when such injuries rise to a HCW SSE level. We evaluated the mean time per month from HCW injury to reporting and compared those values during the postimplementation time. We also evaluated the team’s experience with the first 4 potential HCW SSEs.

Results:

By improving the process flow, the mean time to reporting decreased significantly from 28 days implementation time-period (September–October 2019) to 9 days during the postimplementation time-period (November 2019–May 2020) (P = 0.0002). Of the first 4 HCW events identified and reviewed as possible HCW SSE events, there were 2 defined as HCW SSE level 4, one defined as a precursor event, and one defined as a nonsafety event.

Conclusion:

Adapting infrastructure and definitions used previously to improve patient safety can improve HCW safety.

Burnout, satisfaction and happiness among German general practitioners (GPs): A cross-sectional survey on health resources and stressors

Well-being is a major issue among health care professionals, especially physicians. Less job satisfaction and impaired health can have an impact on health care quality. Our aim was to examine the association of stressors (illegitimate tasks) and health related resources (work-related sense of coherence; recovery experience) with life satisfaction, happiness, job satisfaction and burnout among German general practitioners (GPs). We conducted a cross-sectional survey among general medical practices in Germany. Main outcome measures were life satisfaction, happiness (Subjective Happiness Scale), job satisfaction (Work Satisfaction Scale) and burnout (Copenhagen Burnout Inventory). 548 GPs from across Germany participated (53.6% males, 45.6% females; mostly representative of German GPs). One third (35.2%) of the participants reported a high prevalence of personal, and one quarter (26.5%) indicated a high prevalence of work-related burnout symptoms. Illegitimate tasks are negatively associated with life and job satisfaction and are positively associated with personal, work-related and patient-related burnout among GPs. Work-SoC and recovery experience are positively associated with life satisfaction, happiness, and job satisfaction and are negatively associated with personal, work-related and patient-related burnout. Female physicians have a higher job satisfaction than male physicians. Being female and working as an employed physician is associated with a higher prevalence of personal burnout symptoms. GPs working in a group practice are happier and more satisfied with their job than GPs in single practices. Personal, work-related and patient-related burnout symptoms are stronger in GPs working in a single practice than in GPs in group practices. Our results highlight that Work-SoC, recovery experience and illegitimate tasks are important for creating work-related well-being among GPs. Introducing health promotion activities which aim to strengthen recovery experience and Work-SoC, as well as interventions to restructure tasks, may increase life satisfaction, happiness, and job satisfaction and reduce burnout symptoms in this health care profession.

Variations in Workplace Safety Climate Perceptions and Outcomes Across Healthcare Provider Positions

EXECUTIVE SUMMARY

Injury rates reported among healthcare practitioners tend to vary depending on position. Nurses and healthcare aides report different rates of injury, which suggests that position and job duties may be key injury antecedents. The outcomes related to workplace safety climate perceptions (e.g., injury rates, job satisfaction, turnover) require reflection to identify antecedents of safety perception. The purpose of this study was to examine workplace safety perceptions and well-being (e.g., stress, job satisfaction) of healthcare practitioners by position. A cross-sectional survey of care teams (e.g., nurses, healthcare aides, allied health professionals) was conducted across three inpatient units. Data (N = 144) were analyzed using hierarchical linear regression and binomial logistic regression to examine the relationship between safety climate and self-reported injuries and ANOVA to determine variations in safety climate perceptions by position. Results indicated that nurses, healthcare aides, and allied health professionals report differing levels of workplace safety climate perceptions. Nurses reported the poorest safety perceptions, lowest job satisfaction, and highest stress, while allied health professionals reported the highest safety perceptions and job satisfaction and the lowest stress. Safety climate perceptions were found to be significantly related to care practitioner reported stress, turnover intent, and job satisfaction. Considering the importance of safety climate perceptions for the well-being of care practitioners, healthcare organizations need to prioritize workplace safety to optimize practitioners' perceptions. This study makes a unique contribution to the safety climate literature by identifying the variation in safety climate perceptions by care practitioner position. Practical implications are offered for enhancing workplace safety perceptions.

Job Satisfaction and Associated Factors Among Health Care Professionals Working in Public Health Facilities in Ethiopia: A Systematic Review

BACKGROUND

Job satisfaction is a feeling that measure cognitive and behavioral aspects of workers' towards their job. According to the World Health Organization report, it predicts that 40% of health care professionals' (nurses, midwives, and doctors) will leave their job as a result of job dissatisfaction.

METHODS

Studies were searched systematically using International databases from PubMed, Google Scholar, Cochrane Library, Embase, and CINAHL. The quality of searched articles assessed using the New Castle Ottawa scale for a cross-sectional study design. Statistical analysis was performed by using STATA version 14 software for window and systemic review carried out using a random effect method. The Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline was followed for reporting results.

RESULTS

From the total 1120 records screened, 8 studies with 4092 participants who fulfilled the inclusion criteria were included in this systematic review. The estimated pooled prevalence of job satisfaction of health care professionals in Ethiopia was 41.17%.

CONCLUSION

About one in three health care professionals were satisfied. Therefore, the government and health institution should focus on strategies to promote health care professionals' of job satisfaction.

A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic

The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.

Factors associated with work-private life conflict and leadership qualities among line managers of health professionals in Swiss acute and rehabilitation hospitals - a cross-sectional study

Background

The workforce shortage of health professionals is a matter of global concern. Among possible causative factors in this shortage are the incompatibility of health professionals’ work with their private life, which may lead to increased stress and burnout symptoms, job dissatisfaction and a higher intention to leave the profession prematurely. Also, poor leadership qualities among direct line managers (e.g. clinic directors, leading physicians, ward managers, team leaders) have been associated with health professionals’ job dissatisfaction and intention to leave in previous studies. This study therefore aimed to identify key factors associated with health professionals’ work-private life conflicts and their managers’ leadership quality.

Methods

The study is based on a cross-sectional survey in 26 Swiss acute and rehabilitation hospitals, consisting of 3398 health professionals from various disciplines. For data analysis, multilevel models (with hospitals as the second level variable) were performed for ‘work-private life conflict’ and ‘quality of leadership’, considering significant main effects (using AIC) and significant interactions (using BIC) of potential explanatory variables.

Results

The main findings reveal that the compatibility of health professionals’ work and private life is associated with how much they can influence shift planning (possibility of exchanging shifts, B = -2.87, p < 0.01), the extent to which their individual preferences are considered (e.g. working on one specific shift only, B = 6.31, p < 0.01), number of work shifts per weekend (B = 1.38, p < 0.01) and working hours per week (B = 0.13, p < 0.01). In addition, the factors high quantitative demands (B = 0.25, p < 0.01), being required to hide their emotions (B = 0.16, p < 0.01) and poor social community support at work (B = -0.12, p < 0.01) were related to severe work-private life conflicts among health professionals. Regarding managerial leadership, health professionals perceived the leadership qualities of their direct line manager as being better if they received more social support (B = 0.61, p < 0.01) and rewards (B = 0.41, p < 0.01) at work.

Conclusions

The results show key components of improving the compatibility of work and private life for health professionals as well as managerial leadership qualities, and may help leaders working in acute or rehabilitation hospitals to develop appropriate interventions.

Precarious working conditions and psychosocial work stress act as a risk factor for symptoms of postpartum depression during maternity leave: results from a longitudinal cohort study

BACKGROUND

The majority of Western women work during their reproductive years, but past research has often neglected the influence of work-related factors on postpartum mental health. Especially postpartum depression (PPD) is an enormous psychological burden for mothers. Therefore, this study aims to investigate the prospective impact of precarious working conditions and psychosocial work stress during pregnancy (such as work-privacy conflict and effort-reward imbalance at the job) on symptoms of maternal PPD.

METHODS

In the prospective-longitudinal cohort study DREAM (DResdner Studie zu Elternschaft, Arbeit und Mentaler Gesundheit), N = 587 employed women were questioned about their work during pregnancy and their mental health 8 weeks after delivery.

RESULTS

Multiple regression analyses revealed that work-privacy conflict, low reward at work, and precarious working conditions significantly predicted symptoms of PPD, even when controlling for lifetime depression, anxiety, education, parity, and age.

CONCLUSION

Our results indicate that psychosocial work stress and precarious working conditions have important implications for maternal peripartum mental health. They might act as prospective risk factors for PPD during the period of maternal leave. Hence, future research should focus on preventative measures targeting work life.

Practice assistants´ perceived mental workload: A cross-sectional study with 550 German participants addressing work content, stressors, resources, and organizational structure

Introduction

Practice assistants represent a highly relevant occupational group in Germany and one of the most popular training professions in Germany. Despite this, most research in the health care sector has focused on secondary care settings, but has not addressed practice assistants in primary care. Knowledge about practice assistants’ workplace-related stressors and resources is particularly scarce. This cross-sectional study addresses the mental workload of practice assistants working in primary care practices.

Methods

Practice assistants from a network of 185 German primary care practices were invited to participate in this cross-sectional study. The standardized `Short Questionnaire for Workplace Analysis’ (German: Kurzfragebogen zur Arbeitsanalyse) was used to assess practice assistants´ mental workload. It addresses eleven workplace factors in 26 items: versatility, completeness of task, scope of action, social support, cooperation, qualitative work demands, quantitative work demands, work disruptions, workplace environment, information and participation, and benefits. Sociodemographic and work characteristics were also obtained. A descriptive analysis was performed for sociodemographic data and “Short Questionnaire for Workplace Analysis” factors. The one-sided t-test and Cohen´s d were calculated for a comparison with data from 23 professional groups (n = 8,121).

Results

A total of 550 practice assistants from 130 practices participated. The majority of practice assistants was female (99.3%) and worked full-time (66.5%) in group practices (50.6%). Compared to the other professional groups, practice assistants reported higher values for the factor social support (4.0 versus 3.7 [d 0.44; p<0.001]), information and participation (3.6 versus 3.3 [d 0.38; p<0.001] as well as work disruptions (2.7 vs. 2.4 [d 0.42; p<0.001]), while practice assistants showed lower values regarding scope of action (3.4 versus 3.8 [d 0.43; p<0.001]).

Conclusions

Our study identified social support and participation within primary care practices as protective factors for mental workload, while work disruptions and scope of action were perceived as stressors.

Assessing Patient Safety Culture: Application of the Safety Attitudes Questionnaire in a Kenyan Setting

Background:

Patient safety has recently been declared a global health priority. Achievement and sustenance of a culture of patient safety require a regular and timely assessment of the organization. The Safety Attitudes Questionnaire is a patient safety culture assessment tool whose usefulness has been established in countries, but a few studies have been published from Africa, more so, in Kenyan settings.

Objective:

To evaluate the reliability of the Safety Attitudes Questionnaire in assessing the patient safety culture in a Kenyan setting and to assess healthcare workers' perceptions of patient safety culture.

Methods:

A descriptive quantitative approach was utilized whereby the Safety Attitudes Questionnaire was administered to 241 healthcare workers in two public hospitals. The Cronbach’s α was calculated to determine the internal consistency of the SAQ. Descriptive and inferential statistics were used to analyze and describe the data on patient safety culture.

Results:

The total scale Cronbach’s alpha of the SAQ was 0.86, while that of the six dimensions was 0.65 to 0.90. The overall mean score of the total SAQ was 65.8 (9.9). Participants had the highest positive perception for Job Satisfaction with a mean score of 78.3 (16.1) while the lowest was evaluated for Stress Recognition with a mean score of 53.8 (28.6).

Conclusion:

The SAQ demonstrated satisfactory internal consistency and is suitable for use in the Kenyan context. The perception of patient safety culture in the Kenyan hospital is below international recommendations. There is a need for implementation of strategies for the improvement of the organization culture in Kenyan hospitals.

Determinants of Occupational Safety Culture in Hospitals and other Workplaces-Results from an Integrative Literature Review

Background: The aim of the present study was to obtain an overview of occupational safety culture by assessing and mapping determinants in different workplaces (hospital workplaces and workplaces in construction, manufacturing, and other industry sectors) using an already established theoretical framework with seven clusters developed by Cornelissen and colleagues. We further derived implications for further research on determinants of occupational safety culture for the hospital workplace by comparing the hospital workplace with other workplaces. Methods: We conducted an integrative literature review and searched systematically for studies in four research databases (PubMed, Web of Science, CINAHL, and PsycINFO). The search was undertaken in 2019, and updated in April 2020. Results of the included studies were analyzed and mapped to the seven clusters proposed by Cornelissen and colleagues. Results: After screening 5566 hits, 44 studies were included. Among these, 17 studies were conducted in hospital workplaces and 27 were performed in other workplaces. We identified various determinants of an occupational safety culture. Most studies in hospital and other workplaces included determinants referring to management and colleagues, to workplace characteristics and circumstances, and to employee characteristics. Only few determinants in the studies referred to other factors such as socio-economic factors or to content relating to climate and culture. Conclusions: The theoretical framework used was helpful in classifying various determinants from studies at different workplaces. By comparing and contrasting results of studies investigating determinants at the hospital workplace with those addressing other workplaces, it was possible to derive implications for further research, especially for the hospital sector. To date, many determinants for occupational safety culture known from workplaces outside of the healthcare system have not been addressed in studies covering hospital workplaces. For further studies in the hospital workplace, it may be promising to address determinants that have been less studied so far to gain a more comprehensive picture of important determinants of an occupational safety culture in the hospital sector.

Comparing perceived psychosocial working conditions of nurses and physicians in two university hospitals in Germany with other German professionals - feasibility of scale conversion between two versions of the German Copenhagen Psychosocial Questionnaire (COPSOQ)

Background

In 2015, the WorkSafeMed study assessed, amongst others, perceived psychosocial working conditions in nurses (n = 567) and physicians (n = 381) from two German university hospitals using scales from the German standard version of the COPSOQ (Copenhagen Psychosocial Questionnaire). This standard version is based on the international COPSOQ I and II. Since 2017, a further developed version of the German COPSOQ (G-COPSOQ III) has been available and data from this version are stored in the German COPSOQ database. The aim of the present study was to compare scales depicting perceived psychosocial workloads and strain in hospital staff from the WorkSafeMed study with reference data (hospital care nurses, general hospital physicians, reference values across all occupations) from the German COPSOQ database (2012-2017). As preliminary work, we explored whether a conversion of COPSOQ scales based on data from the WorkSafeMed study to the G-COPSOQ III scales was possible.

Methods

We applied a multistep approach for conversion. First, we compared 17 COPSOQ scales used in the WorkSafeMed study with the corresponding scales from the G-COPSOQ III according to content and then decided if a conversion was appropriate. If possible, we converted WorkSafeMed scales - the converted scales comprised the same content and number of items as in G-COPSOQ III. An explorative statistical analysis for each original and converted WorkSafeMed scale followed detecting possible statistical and relevant differences between the scales. We then compared converted WorkSafeMed scales with reference data from the German COPSOQ database.

Results

Based on the comparison undertaken according to content, a conversion was possible for 16 scales. Using the data from the WorkSafeMed study, the statistical analysis showed only differences between original and converted COPSOQ scales "control over working time" (mean 40.2 vs. 51.8, d_Cohen = 0.56) and "social relations" (mean 55.6 vs. 41.8, d_Cohen = - 0.55). Comparing converted WorkSafeMed scales with reference data revealed higher values for "quantitative demands", "work-privacy-conflict", and "job satisfaction" in the WorkSafeMed sample.

Conclusions

The conversion of WorkSafeMed scales was appropriate, allowed a comparison with three reference values in the German COPSOQ database and revealed some implications for improving psychosocial working conditions of nurses and physicians in university hospitals in Germany.

IMPROVEjob - Participatory intervention to improve job satisfaction of general practice teams: a model for structural and behavioural prevention in small and medium-sized enterprises - a study protocol of a cluster-randomised controlled trial

Background

Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel.

Methods

In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes.

Discussion

It is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises.

Trial registration

German Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.

Clinical perspectives on hospitals' role in the opioid epidemic

BACKGROUND

Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic.

METHODS

We conducted individual semi-structured interviews with 23 clinicians from 6 different acute care hospitals that are part of a single healthcare system in the Midwestern United States. Our participants were hospitalists (N = 12), inpatient registered nurses (N = 9), and inpatient adult nurse practitioners (N = 2). In the interviews, we asked clinicians whether hospitals play a role in the opioid epidemic, and if so, how hospitals may contribute to the epidemic. We used a qualitative thematic analysis approach to analyze coded text for patterns and themes and examined potential differences in themes by respondent type using Dedoose software.

RESULTS

The majority of clinicians believed hospitals contribute to the opioid epidemic. Multiple clinicians cited Center for Medicare and Medicaid Services' (CMS) reimbursement policy and the Joint Commission's report as drivers of inappropriate opioid prescribing in hospitals. Furthermore, numerous clinicians stated that opioids are inappropriately administered in the emergency department (ED), potentially as a mechanism to facilitate discharge and prevent re-admission. Many clinicians also described how overreliance on pre-populated pain care orders for surgical (orthopedic) patients, may be contributing to inappropriate opioid use in the hospital. Finally, clinicians suggested the following initiatives for hospitals to help address the crisis: 1) educating patients about negative consequences of using opioids long-term and setting realistic pain expectations; 2) educating medical staff about appropriate opioid prescribing practices, particularly for patients with complex chronic conditions (chronic pain; opioid use disorder (OUD)); and 3) strengthening the hospital leadership efforts to decrease inappropriate opioid use.

CONCLUSIONS

Our findings can inform efforts at decreasing inappropriate opioid use in hospitals.

Relationship of patient safety culture with factors influencing working environment such as working hours, the number of night shifts, and the number of days off among healthcare workers in Japan: a cross-sectional study

Background

Patient safety culture is defined as a product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Factors influencing healthcare workers’ working environment such as working hours, the number of night shifts, and the number of days off may be associated with patient safety culture, and the association pattern may differ by profession. This study aimed to examine the relationship between patient safety culture and working environment.

Methods

Questionnaire surveys were conducted in 2015 and 2016. The first survey was conducted in hospitals in Japan to investigate their patient safety management system and activities and intention to participate in the second survey. The second survey was conducted in 40 hospitals; 100 healthcare workers from each hospital answered a questionnaire that was the Japanese version of the Hospital Survey on Patient Safety Culture for measuring patient safety culture. The relationship of patient safety culture with working hours in a week, the number of night shifts in a month, and the number of days off in a month was analyzed.

Results

Response rates for the first and second surveys were 22.4% (731/3270) and 94.2% (3768/4000), respectively. Long working hours, numerous night shifts, and few days off were associated with low patient safety culture. Despite adjusting the working hours, the number of event reports increased with an increase in the number of night shifts. Physicians worked longer and had fewer days off than nurses. However, physicians had fewer composites of patient safety culture score related to working hours, the number of night shifts, and the number of days off than nurses.

Conclusions

This study suggested a possibility of improving the patient safety culture by managing the working environment of healthcare workers. High number of night shifts may lead to high number of event reports. Working hours, the number of night shifts, and the number of days off may differently influence patient safety culture in physicians and nurses.

Malay Validation of Copenhagen Psychosocial Work Environment Questionnaire in Context of Second Generation Statistical Techniques

Psychosocial hazards present in workplaces are being actively investigated by researchers from multiple domains. More research and resources are required to investigate the debilitating consequences of these hazards in the developing and underdeveloped countries where this issue remains one of grave concern. This study aims at investigating the psychometric properties of Malaysian version of Copenhagen Psychosocial Questionnaire for reliability and validity purpose. The Malaysian version of COPSOQ is a multidimensional questionnaire; it comprises of 7 major formative constructs and 28 variables with an additional inclusion of two variables which are organizational loyalty and physiological health biomarkers (blood pressure and body mass index) that explicate a reflective construct which has 93 items all catering to assess psychosocial determinants present in workplace environments. Each formative second-order construct is further categorized into different reflective first-order constructs. The focus of this study was only on first-order reflective constructs. Probability sampling was used for data collection from 300 respondents working in industries with a response rate of 100%; structural equation modeling technique was applied for data analysis. All psychometric analysis performed on reflective constructs gave reliable results which demonstrate the validity of Bahasa Melayu (BM-COPSOQ) and its comprehensiveness of including relevant dimensions particularly in context to Asian region. The BM-COPSOQ will fill up the knowledge gap and provide a bridge between researchers, work professionals and practitioners, and many other workplaces for the best understanding of psychosocial work environment.

Correction to: Healthcare professionals' perspectives on working conditions, leadership, and safety climate: a cross-sectional study

In the original publication of this article [1], the authors missed that reverse coding was necessary for the item "Do you work separate from your colleagues?" before calculating the scale 'social relations'. So they corrected the analysis accordingly. The results with the revised scale show that there are no longer any significant differences between nurses and physicians with regard to this scale.

Integrating Safety Attitudes and Safety Stressors into Safety Climate and Safety Behavior Relations: The Case of Healthcare Professionals in Abu Dhabi

Objectives

How safety climates, safety attitudes, and safety behaviors are related remains unexplored in the literature, with no study so far investigating the moderating path of safety stressors between these variables. We sought to understand the path through which safety climates may affect safety-behavior-related outcomes, such as safety compliance and participation, through the integration of safety attitudes. Since this study is related to the safety-related perception-intention-behavior relationship, safety stressors are proposed as a moderator of this relationship.

Methods

A total of 770 healthcare professionals working in public hospitals across Abu Dhabi were randomly selected for this study. We used questionnaires covering demographic details, safety behaviors, safety climates, safety attitudes, and safety stressors to obtain the data.

Results

The results revealed the partial mediating role of safety attitudes in the relationship between safety climate and safety behavior. Additionally, safety stressors did not moderate the relationship between safety climates, safety attitudes, and safety behaviors, which has some interesting implications for healthcare professionals.

Conclusions

The study suggests that safety attitudes may also regulate the impact of perceptions of management values regarding safety, policies, and procedures. It is highly likely that healthcare professionals who experience a positive workplace safety climate will form positive safety attitudes that encourage safety behavior. In addition, the homogeneous characteristics of healthcare professionals' in the UAE may also offer the positive coping strategy that caused the insignificant moderating effect of safety stressors on the relationship between safety climates, safety attitudes, and safety behaviors.

Assessing the quality of medication documentation: development and feasibility of the MediDocQ instrument for retrospective chart review in the hospital setting

OBJECTIVE

The medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records.

DESIGN

Cross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ).

SETTING

Two German university hospitals.

PARTICIPANTS

Records from 1361 patients admitted between April and July 2015 were evaluated.

METHODS

The MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items.

RESULTS

Overall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration.

CONCLUSIONS

MediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.

An observational study on the rate of reporting of adverse event on healthcare staff in a mental health setting: An application of Poisson expectation maximisation analysis on nurse staffing data

Evidence highlights the intrinsic link between nurse staffing and expertise, and outcomes for service users of healthcare, and that workforce retention is linked to the clinical and organisational experiences of employees. However, this understanding is less well established in mental health. This study comprises a retrospective observational study carried out on routinely collected data from a large mental healthcare provider. Two databases comprising nurse staffing levels and adverse events were modelled using latent variable methods to account for the presence of multiple underlying behaviours. The analysis reveals a strong dependence of the rate of adverse events on the location and perceived clinical demand of the wards, and a reduction in adverse events where registered nurses exceed ‘clinically required levels’. In the first study of its kind, these findings present significant implications for nursing workforce policy and present an opportunity to not only improve safety but potentially impact nurse retention.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

OBJECTIVE

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Literature review and an analysis framework to review studies.

SETTING

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

DATA SOURCES

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

RESULTS

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

CONCLUSIONS

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.