Physicians as clinical directors: working conditions, psychosocial resources and self-rated health

Social networks of professionals in health care organizations: a review

In this article, we provide an overview of social network research in health care, with a focus on social interactions between professionals in organizations. We begin by introducing key concepts defining the social network approach, including network density, centrality, and brokerage. We then review past and current research on the antecedents of health care professionals' social networks-including demographic attributes, professional groups, and organizational arrangements-and their consequences-including satisfaction at work, leadership, behaviors, knowledge transfer, diffusion of innovation, and performance. Finally, we examine future directions for social network research in health care, focusing on micro-macro linkages and network dynamics.

Moderating Role of Interior Amenities on Hospital Medical Directors' Patient-Related Work Stresses

Objective:

Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health.

Background:

Previous studies have revealed that hospital medical directors—senior physicians in the management positions with high-demand jobs in clinical practices and management—had a lower self-rated health.

Methods:

This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed.

Results:

Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints ( p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects ( p < 0.05).

Conclusions:

Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses.

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

BACKGROUND

While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered.

OBJECTIVE

To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety.

METHODS

The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009.

RESULTS

A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals.

CONCLUSIONS

Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care.

Physicians' working conditions and job satisfaction: does hospital ownership in Germany make a difference?

Background

A growing number of German hospitals have been privatized with the intention of increasing cost effectiveness and improving the quality of health care. Numerous studies investigated what possible qualitative and economic consequences these changes issues might have on patient care.

However, little is known about how this privatization trend relates to physicians' working conditions and job satisfaction. It was anticipated that different working conditions would be associated with different types of hospital ownership. To that end, this study's purpose is to compare how physicians, working for both public and privatized hospitals, rate their respective psychosocial working conditions and job satisfaction.

Methods

The study was designed as a cross-sectional comparison using questionnaire data from 203 physicians working at German hospitals of different ownership types (private for-profit, public and private nonprofit).

Results

The present study shows that several aspects of physicians' perceived working conditions differ significantly depending on hospital ownership. However, results also indicated that physicians' job satisfaction does not vary between different types of hospital ownership. Finally, it was demonstrated that job demands and resources are associated with job satisfaction, while type of ownership is not.

Conclusion

This study represents one of a few studies that investigate the effect of hospital ownership on physicians work situation and demonstrated that the type of ownership is a potential factor accounting for differences in working conditions. The findings provide an informative basis to find solutions improving physicians' work at German hospitals.

[Social support and physicians' health]

OBJECTIVES

Over the last decades, social support (SU) has proved to be an important psychological health resource in the prevention of mental and physical illness as well as for the promotion and restoration of general health. This study evaluates the relevance of social support for the health and well-being of physicians.

METHOD

This is a systematic literature review using PubMed from 1970 to 2007 with the keywords "social support", "physicians", "physician's role", and respectively "medical staff, hospital" from medical subheadings (MeSH). From the retrieved articles the additionally relevant keywords "marriage", "spouse", "friends", and "self-help groups" (MeSH) were identified and researched.

RESULTS

Social support with distinct effects on physician's health could be shown in the areas of colleagues and professional network (30 sources), marriage/spouse (47), friends (3), and support groups (13). Female physicians appeared to seek and profit more from SU than did male physicians. Informal friendships have yet to be evaluated thoroughly.

CONCLUSION

In the light of a physician's daily stress, SU appears to be a jeopardized resource that could significantly contribute to the prevention of burnout or other profession-related symptoms or illnesses.

Working conditions, psychosocial resources and work stress in nurses and physicians in chief managers' positions

The study investigated whether psychosocial work conditions, professional network, job support, social network and support, sick leave and salary were associated with work stress in nurses in chief manager' positions above ward level and physicians in clinical director positions. A sample consisting of 205 nurses and 274 physicians in chief managers' positions at higher structural level answered a questionnaire. Odds ratios were used for estimating the bivariate association between work stress and psychosocial resources. The result showed that both nurse managers (OR 6.8; 95% CI: 3.5-13.5) and clinical directors (OR 6.7; 95% CI: 3.6-12.5) exposed to high job demands had a significantly higher probability of high level of work stress. The results also indicated that the available psychosocial resources taken together inside and outside work did not balance the experienced work stress in nurse managers and the clinical directors who were exposed to high work demands. No relation was found between work stress and sick leave and salary.