Sickness absence and 'working through' illness: a comparison of two professional groups

Relationships between transformational leadership, perceived social support, occupational coping self-efficacy and presenteeism among Chinese ICU nurses: a cross-sectional study

OBJECTIVE

This study aimed to investigate the relationship between transformational leadership and presenteeism among intensive care unit (ICU) nurses in tertiary hospitals and further investigate the chain-mediated role of perceived social support and occupational coping self-efficacy.

DESIGN

This is a cross-sectional survey study.

SETTING

Six tertiary hospitals in Sichuan Province, China.

PARTICIPANTS

590 ICU nurses were recruited from six tertiary hospitals in China for the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Presenteeism of ICU nurses was the primary outcome indicator. Transformational leadership, perceived social support and occupational coping self-efficacy were secondary outcome indicators. The transformational leadership scale, perceived social support, occupational coping self-efficacy and Stanford presenteeism scale were used to investigate ICU nurses through convenience sampling.

RESULTS

The presenteeism score of ICU nurses was 15.46±4.45 (mean±SD), in which the incidence of high presenteeism was 53.90%. Correlation analysis showed that presenteeism was negatively correlated with transformational leadership, perceived social support and occupational coping self-efficacy (r=-0.412 to -0.486; p<0.05). Perceived social support partially mediated the relationship between transformational leadership and presenteeism, with an effect value of 0.055 (95%CI: -0.102 to -0.012; p<0.001); occupational coping self-efficacy partially mediated the relationship between transformational leadership and presenteeism, with an effect value of 0.042 (95% CI: -0.074 to -0.017; p<0.001); perceived social support and occupational coping self-efficacy chain-mediated between transformational leadership and presenteeism, with an effect value of 0.029 (95% CI: -0.046 to -0.016; p<0.001).

CONCLUSION

ICU nurses' perceived social support and occupational coping self-efficacy are chain-mediated between transformational leadership and presenteeism. Therefore, to reduce nurses' presenteeism, nursing managers should adopt targeted interventions based on the factors influencing them to improve transformational leadership and enhance their perceived social support and occupational coping self-efficacy.

Navigating the Boundaries of Health and Identity: Medical Students' Perspectives

BACKGROUND

Medical professionals do not always manage their own health in an optimal way. Research conducted on medical students' response to illness is limited; however, some studies suggest they choose to self-manage and seek advice outside of the traditional pathways of care. This study aims to understand how medical students perceive and manage their health as they transition through medical school.

METHODS

Individual semistructured interviews with 10 medical students from one institution in England were conducted. Interviews explored students' experiences of managing their own physical and mental health and the health of family and friends, and how they could be better supported at medical school. Thematic analysis was conducted.

RESULTS

Four themes were described reflecting: the different sources of learning that students used to construct their notion of health and how these changed during their training; how these notions of health influenced the practices that students used for good and bad self-care; how they held multiple identities of a lay person and somebody with medical status that could result in conflicts and tensions; finally, students suggested supportive practices including creating a safe space for reflection and the discussion of conflict.

DISCUSSION

Becoming a doctor can result in many tensions as students develop increasingly medicalised notions of health that may lead to poor self-care. Creating spaces within the curriculum to discuss the privileges and tensions that arise from training to be a doctor may yield future benefits for the medical profession and patient care.

'Do I cry or just carry on?' A story completion study of healthcare professionals' anticipated responses to experiencing chest pain

Healthcare professionals may experience barriers to seeking healthcare that differ from the general population. We explored healthcare professionals' anticipated responses to experiencing chest pain following a period of stress using qualitative story completion method with healthcare professionals (n = 44). Data were analysed using reflexive thematic analysis, which identified three themes: '"Do I cry or just carry on?": A Culture of Suffering in Silence' identified worries that expressing health concerns would be perceived as weakness, with potential impact on career opportunities. Participants also described self-diagnosis and self-medication rather than help-seeking. '"Me? Have a panic attack?": Psychosomatic Shame' suggested mental health issues may be ignored due to stigma. '"We definitely don't take care of ourselves": Prioritising Pressures of Multiple Responsibilities over Self-care' identified real or perceived pressures to de-prioritise their health. Future research should explore the design of confidential, time efficient support for healthcare professionals that tackle cultural norms and barriers to self-care.

Why do physicians go to work when they are sick? Presenteeism at different career stages

INTRODUCTION AND OBJECTIVE

Physicians find it difficult to take on the role of the patient and they show unusual behaviors when ill. One of these behaviors is presenteeism, which is working while sick. The objective of this research is to analyze the factors that contribute to the phenomenon of presenteeism in Spanish physicians.

MATERIAL AND METHODS

Mixed methodology study: one national survey through the General Council of Medical Associations website (quantitative part), 22 semistructured interviews with sick residents and practicing physicians, and three focus groups involving professionals from the occupational health services (qualitative). A bivariate analysis using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). Qualitative analysis using the comparative-constant method until saturation of information.

RESULTS

Presenteeism is reported by 89.4% of doctors who responded to the survey, and it is more common among women. Contributing factors include fear of overburdening colleagues (the main reason and more common among women 58.14% vs 48.35%), self-perception of doing one's duty (the second reason and more common among men, 44.63% vs 33.14%) and economic impact and difficulty in accepting the role of a sick person. This behavior has an impact on patient safety, and is part of the hidden curriculum that also affects the training of medical professionals.

CONCLUSIONS

Presenteeism is a widespread and accepted practice among medical professionals. Although normalized, and even appreciated as a way to avoid overburdening colleagues, presenteeism has important implications for clinical ethics and patient safety.

Latent profile analysis and influence factors study of presenteeism among ICU nurses in China

Background

Presenteeism is a significant global public health problem, and nurses are a high-prevalence group of presenteeism, affecting not only nurses' physical and mental health, work efficiency, and quality of work but even poses a serious threat to patient safety.

Objective

The categorization of presenteeism among ICU nurses is unclear. Our research aims to explore the subtypes of presenteeism among ICU nurses based on latent profile analysis, analyze the influencing factors of different subtypes, and provide a reference basis for developing targeted interventions to reduce the presenteeism rate.

Methods

From January to February 2023, 509 ICU nurses in Sichuan Province, China, were selected as respondents and surveyed using the general information questionnaire, the presenteeism scale, and the perceived social support scale. Potential categories of presenteeism among ICU nurses were explored using potential profile analysis, and factors influencing the potential types of presenteeism among ICU nurses were investigated using the chi-square test and multivariate logistic regression analysis.

Results

The best model was suggested to consist of three profiles: low presenteeism-normal coping group (18.3%), moderate presenteeism group (47.9%), and high presenteeism-work limitation group (33.8%). Multiple logistic regression results showed that secondary hospitals (OR = 0.116, p = 0.015), good physical health (OR = 0.084, p = 0.023), general physical health (OR = 0.016, p = 0.037), ICU human resource allocation = 1:2.5 to 3 (OR = 0.315, p = 0.007), and higher social support scores (OR = 0.975, p = 0.047) were more likely to be grouped into low presenteeism-normal coping group; married with no children (OR = 24.554, p = 0.005) were more likely to be grouped into moderate presenteeism group; and having experienced workplace violence in the past year (OR = 1.182, p = 0.049) were more likely to be grouped into high presenteeism-work limitation group.

Conclusion

There is group heterogeneity in the presenteeism of ICU nurses, and nursing managers should develop targeted interventions to reduce the presenteeism rate of ICU nurses according to the characteristics and influencing factors of each type of presenteeism of ICU nurses.

The role of effort-reward imbalance and depressive symptoms in the relationship between long working hours and presenteeism among Chinese village doctors: a moderated mediation model

BACKGROUND

Long working hours and effort-reward imbalance (ERI) among medical workers may contribute to poor mental health and reduced productivity. However, the potential mechanisms among them are not well understood. This study aimed to explore the role of depressive symptoms and ERI in the relationship between long working hours and presenteeism among village doctors.

METHODS

We conducted a cross-sectional study in Jiangsu Province, eastern China. 705 village doctors were assessed for working hours, ERI (the Effort-Reward Imbalance Questionnaire, ERI questionnaire), presenteeism (6-item Stanford Presenteeism Scale, SPS-6 Scale), and depressive symptoms (12-item General Health Questionnaire, GHQ-12). A moderated mediation model was used to test the role of depressive symptoms (M), and ERI (W) in the relationship between long working hours (X) and presenteeism (Y).

RESULTS

45.11% of the village doctors worked more than 55 h per week, and 55.89% were exposed to ERI. The prevalence of depressive symptoms among Chinese village doctors was 40.85%. Long working hours (≥ 55 h per week) were significantly associated with presenteeism behaviors (β = 2.17, P < 0.001). Mediation analysis demonstrated that depressive symptoms (GHQ score > 3) could partly mediate the relationship between long working hours and presenteeism (indirect effect β = 0.64, P < 0.001). Moderated mediation further indicated that the interaction of long working hours and ERI was significantly and positively associated with depressive symptoms, which in turn predicted elevated presenteeism behaviors.

CONCLUSIONS

Depressive symptoms had a mediating role in the association of long working hours with presenteeism behaviors among Chinese village doctors and ERI augment their negative effects.

Sick Leave Determinants in the Healthcare Sector (Part III): A Review of Individual-Level Factors

Background

The objective of this review is to describe individual-level factors that influence and contribute to sick leave in healthcare, and especially hospital, settings. In doing so, to utilize relevant publications from the period 2004 - 2022 in order to provide a comprehensive and evidence-based resource for readers interested in effective human resource management and healthcare or hospital workforce planning. The review referred to studies on the determinants of absenteeism in the healthcare setting.

Methods

To ensure that pertinent papers (2004 - 2022) were identified, a systematic literature review was performed searching Google Scholar, Econ Lit, PubMed, ResearchGate, ScienceDirect, Emerald Insight, Scopus, Medline, PsychInfo, and Web of Science. All abstracts were screened to identify papers that empirically investigated factors at individual level that are relevant to sickness absence in a healthcare population. A total of 494 papers were initially identified. These were reduced to 123 papers using pre-determined inclusion and exclusion criteria.

Results

Individual-level factors such as age, gender, health, marital status, personality, tenure and job satisfaction have moderately strong associations with absence. There is a negative relationship between ageing, health status and absenteeism.

Conclusions

The review concludes that consideration by administrators of the impact of ageing and life phases will assist greatly in strategic workforce planning in the healthcare sector. There are marked differences in rates of absenteeism by gender, specifically by life phase that should be considered in staffing decisions.

The Impact of the Workload and Traumatic Stress on the Presenteeism of Midwives: The Mediating Effect of Psychological Detachment

Objectives

Midwives are at high risk of presenteeism, which may impact the quality of midwifery and maternal and infant health outcomes. However, no research has been conducted to investigate the relationship between workload, traumatic stress, psychological detachment, and presenteeism among midwives. This study, therefore, aimed at exploring the mediating effects of psychological detachment on workload, traumatic stress, and presenteeism among midwives.

Method

A multicenter cross-sectional study was conducted among 547 midwives in Jiangsu Province. Participants completed the National Aeronautics and Space Administration task load index, traumatic stress impact subscale for midwives, psychological detachment scale, and Stanford presenteeism scale and provided sociodemographic information. The mediating effects of psychological detachment were assessed using Mplus.

Results

The mean score of midwives' presenteeism was 17.09±3.56. Presenteeism was positively associated with both workload and traumatic stress (both P < 0.01) and negatively associated with psychological detachment (P < 0.01) among midwives. Psychological detachment partially mediated the relationships between (a) workload and presenteeism (β = 0.005, P < 0.05) and (b) traumatic stress and presenteeism (β = 0.006, P < 0.05), with mediating effects of 11.90% and 10.00%, respectively.

Conclusions

Presenteeism among midwives is at moderately high levels and requires attention from nursing managers. Psychological detachment is a mediating variable of the relationship between workload, traumatic stress, and presenteeism among midwives. Implications for Nursing Management. This study has implications for decreasing midwives' presenteeism in practical terms. Specifically, it is crucial that care managers attempt to adjust midwives' work patterns, reduce their workload, and provide organizational support for work-related traumatic stress. Moreover, our findings also indicate that psychological detachment is probably an essential element that is worthy of attention.

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

OBJECTIVES

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

DESIGN

Qualitative study using semistructured interviews and thematic analysis.

PARTICIPANTS

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

SETTING

General practices and hospitals in the UK.

RESULTS

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

CONCLUSIONS

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

The Effects of Job Demand-control-support Profiles on Presenteeism: Evidence from the Sixth Korean Working Condition Survey

Background

Presenteeism is closely related to work performance, work quality and quantity, and productivity at work. According to the job demand-control-support model, job demand, job control, and support play important roles in presenteeism. The present study investigated job characteristics profiles based on the job demand-control-support model and identify the association between job characteristics profiles and presenteeism.

Methods

This secondary data analysis used the Sixth Korean Working Condition Survey, a nationwide cross-sectional dataset. The study included 25,361 Korean wage workers employed in the workplace with two or more workers. Participants were classified into four job characteristics profiles based on the job demand-control-support model, using latent profile analysis, and logistic regression was performed to examine the association between study variables.

Results

Overall, 11.0 % of study participants reported experience of presenteeism in the past 12 months. Age, sex, location, monthly income, shift work, work hours, health problems, and sleep disturbances were significantly associated with presenteeism. The rate of presenteeism was the highest in the passive isolate group. The passive collective, active collective, and low-stain collective groups had a 23.0%, 21.0%, and 29.0% lower likelihood of experiencing presenteeism, respectively, than the passive isolate group.

Conclusions

The job demand-control-support profiles and the risk of presenteeism were significantly associated. The most significant group that lowered the experience of presenteeism was the low-strain collective group, which had a low level of demand and high levels of control and support. Therefore, we need a policy to reduce job demand and increase job control and support at the organizational and national levels.

The ill physician who self-discloses: What do patients think?

BACKGROUND

Physicians with a serious illness face difficult decisions about revealing this sensitive information to patients. Self-disclosure of illness is a largely unexplored topic, particularly from the patient's perspective.

OBJECTIVES

To learn about patients' emotions and reactions to their family physician's sharing with them about having a major illness.

METHODS

The study was carried out in a family practice office in a suburb of Jerusalem, beginning the day that a family physician returned to work after a prolonged illness. A questionnaire study was performed with nine closed and four open questions relating to patients' reactions to learning about the illness. The questionnaire was distributed to 200 consecutive patients ages 18 years or older. Data extraction, compilation, and content analysis were performed to elicit and categorise major themes and issues that arose.

RESULTS

A total of 82% of the patients were pleased that the physician shared the information with them and none were displeased. Patients expressed a wide range of reactions to being told of the illness by the physician himself, among them: empathy, surprise, appreciation, pride, criticism, comfort/discomfort, and closeness. The value of sharing personal experience and the unique connection with the family physician were emphasised.

CONCLUSION

Physician self-disclosure of major illnesses to patients can reveal the physician's humanity, encourage empathy on the part of patients and strengthen the physician-patient relationship. This report adds to current knowledge about when to share this powerful information with patients and highlights the topic's importance in the education of future doctors.

Vorschlag eines umfassenden Modells zur Vorhersage von Präsentismus

Zusammenfassung. Das Phänomen „Präsentismus“ definiert als das Verhalten von Berufstätigen, trotz Vorliegen von Krankheitssymptomen der Arbeitstätigkeit nachzugehen. Studien haben gezeigt, dass verschiedene Faktoren Präsentismus beeinflussen. In der vorliegenden Untersuchung soll ein umfassendes Modell, das die Vorhersagequalität personenbedingter, organisationaler und arbeitsbezogener Faktoren hinsichtlich Präsentismus zeigt, entwickelt werden und damit bestehende Forschungsbefunde erweitern, um somit zu einem besseren Verständnis von Präsentismus beizutragen. Um die Fehlervarianz zu minimieren wurden über 800 Probanden eines einzigen Unternehmens befragt. Es zeigten sich Zusammenhänge von Präsentismus vor allem mit organisationalen und arbeitsbezogenen Faktoren, i.e. „Arbeitsplatzsicherheit“, „empfundene Gerechtigkeit“, „Unterstützung des Vorgesetzten“, „Funktion“ sowie „Vertretung im Krankheitsfall“, während nur „Gesundheitszustand“ als einziger personenbedingter Aspekt einen Prädiktionswert hatte.

Job Crafting and Nurses' Presenteeism: The Effects of Job Embeddedness and Job Irreplaceability

Background

Presenteeism is defined as the behavior of people who insist on attending work despite complaints of ill health that should prompt rest and absence from work. Due to the heavy workloads and irreplaceable duties of the nursing service, nurses are a typical representative group suffering from presenteeism. Although more scholars have recently begun focusing on presenteeism, an abundant number of studies have tended to focus on presenteeism's external objective factors. There is, thus, a lack of studies based on variables related to the intra-individual initiative. This study aimed to address this gap by exploring the relationship between job crafting and nurses' presenteeism from the perspective of the individual internal initiative. Furthermore, this study also aimed to examine job embeddedness' mediating effect and job irreplaceability's moderating effect on presenteeism.

Methods

A total of 900 nurses from a 3A-graded hospital in Henan Province were invited to participate in the online study in October, November, and December 2021, respectively. Participants were asked to complete Self-report scales on job crafting, job embeddedness, job irreplaceability, and presenteeism at three time points above. Job crafting was measured at Time 1, job embeddedness and job irreplaceability were measured at Time 2, and presenteeism was measured at Time 3.

Results

Presenteeism was significantly associated with differences in participants' age and tenure. Job crafting was significantly positively associated with job embeddedness, and job embeddedness was significantly negatively correlated with presenteeism. Job embeddedness mediated the relationship between job crafting and presenteeism. Job irreplaceability moderated the relationship between job embeddedness and presenteeism.

Conclusions

This study explored job crafting's influence mechanism on nurses' presenteeism, which is beneficial to providing effective suggestions for managing and preventing the incidence of nurses' presenteeism. Future research should consider expanding the sampling area and enriching the occupational fields of included participants to conduct a more in-depth discussion on the relationship between job crafting and nurses' presenteeism.

Returning to clinical work and doctors' personal, social and organisational needs: a systematic review

OBJECTIVE

This systematic review aims to synthesise existing evidence on doctors' personal, social and organisational needs when returning to clinical work after an absence.

DESIGN

Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO and PubMed were searched up to 4 June 2020. Non-database searches included references and citations of identified articles and pages 1-10 of Google and Google Scholar.

ELIGIBILITY CRITERIA

Included studies presented quantitative or qualitative data collected from doctors returning to work, with findings relating to personal, social or organisational needs.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a piloted template. Risk of bias assessment used the Medical Education Research Study Quality Instrument or Critical Appraisal Skills Programme Qualitative Checklist. Data were not suitable for meta-analyses and underwent narrative synthesis due to varied study designs and mixed methods.

RESULTS

Twenty-four included studies (14 quantitative, 10 qualitative) presented data from 92 692 doctors in the UK (n=13), US (n=4), Norway (n=3), Japan (n=2), Spain (n=1), Canada (n=1). All studies identified personal needs, categorised as work-life balance, emotional regulation, self-perception and identity, and engagement with return process. Seventeen studies highlighted social needs relating to professional culture, personal and professional relationships, and illness stigma. Organisational needs found in 22 studies were flexibility and job control, work design, Occupational Health services and organisational culture. Emerging resources and recommendations were highlighted. Variable quality and high risk of biases in data collection and analysis suggest cautious interpretation.

CONCLUSIONS

This review posits a foundational framework of returning doctors' needs, requiring further developed through methodologically robust studies that assess the impact of length and reason for absence, before developing and evaluating tailored interventions. Organisations, training programmes and professional bodies should refine support for returning doctors based on evidence.

Impact of COVID-19 vaccine-associated side effects on health care worker absenteeism and future booster vaccination

BACKGROUND

Short-term side effects related to mRNA vaccines against SARS-CoV-2 are frequent and bothersome, with the potential to disrupt work duties and impact future vaccine decision-making.

OBJECTIVE

To identify factors more likely to lead to vaccine-associated work disruption, employee absenteeism, and future vaccine reluctance among healthcare workers (HCWs).

HYPOTHESIS

Side effects related to COVID vaccination: 1- frequently disrupt HCW duties, 2- result in a significant proportion of HCW absenteeism, 3- contribute to uncertainty about future booster vaccination, 4- vary based on certain demographic, socioeconomic, occupational, and vaccine-related factors.

METHODS

Using an anonymous, voluntary electronic survey, we obtained responses from a large, heterogeneous sample of COVID-19-vaccinated HCWs in two healthcare systems in Southern California. Descriptive statistics and regression models were utilized to evaluate the research questions.

RESULTS

Among 2,103 vaccinated HCWs, 579 (27.5%) reported that vaccine-related symptoms disrupted their professional responsibilities, and 380 (18.1%) missed work as a result. Independent predictors for absenteeism included experiencing generalized and work-disruptive symptoms, and receiving the Moderna vaccine [OR = 1.77 (95% CI = 1.33 - 2.36), p < 0.001]. Physicians were less likely to miss work due to side effects (6.7% vs 21.2% for all other HCWs, p < 0.001). Independent predictors of reluctance toward future booster vaccination included lower education level, younger age, having received the Moderna vaccine, and missing work due to vaccine-related symptoms.

CONCLUSION

Symptoms related to mRNA vaccinations against SARS-CoV-2 may frequently disrupt work duties, lead to absenteeism, and impact future vaccine decision-making. This may be more common in Moderna recipients and less likely among physicians. Accordingly, health employers should schedule future booster vaccination cycles to minimize loss of work productivity.

Workplace influenza vaccination in private hospital setting: a cost-benefit analysis

Background

Influenza illness causes several disruptions to the workforce. The absenteeism that often ensues has economic implications for employers. This study aimed to estimate the cost-benefit of influenza vaccination in a healthcare setting from the employer’s perspective.

Methods

A cross-sectional questionnaire survey was conducted in a private hospital in 2018–2019 comparing voluntary vaccinated with non-vaccinated employees with influenza vaccine. The analyses were made based on self-reporting on absenteeism and presenteeism from Influenza-like illnesses (ILIs). The costs incurred, both direct and indirect costs, were included in the study. A cost-benefit analysis was performed by measuring the cost of the vaccination program. The costs of absenteeism and reduced productivity were calculated using 3 hypothesised levels of effectiveness in the following percentage of productivity of 30%, 50%, and 70%. The costs were also calculated based on four scenarios: with and without operating income and with and without replacement. The benefits of the influenza vaccination from the employer’s perspective were analysed. The benefit to cost ratio was determined.

Results

A total of four hundred and twenty-one respondents participated. The influenza vaccination rate was 63.0%. The rate of ILI of 38.1% was significantly lower among vaccinated. The ILI-related absenteeism reported was also significantly lower amongst vaccinated employees at 30% compared to 70% non-vaccinated. Employers could save up to USD 18.95 per vaccinated employee when only labour cost was included or 54.0% of cost savings. The cost-saving rose to USD 155.56 when the operating income per employee was also included. The benefit to cost ratio confirmed that the net cost-benefit gained from the vaccination was more than the net cost of vaccination.

Conclusions

Influenza vaccination for working adults was cost-saving and cost-beneficial when translated into financial investments for the employer. A workplace vaccination demonstrates a significant cost-benefit strategy to be applied in any institutional setting.

Why do doctors seek peer support? A qualitative interview study

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany

Background

General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team?

Methods

Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach.

Results

GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors.

Conclusion

We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00336-w.

The Effect of Emotional Labor on Presenteeism of Chinese Nurses in Tertiary-Level Hospitals: The Mediating Role of Job Burnout

Background: Employees who are physically present but work insufficiently because of illness are deemed as having presenteeism. In the health care setting, the issue has taken on greater importance because of the impairment of the physical and mental health of nurses and the nursing safety of the patients. According to the Job Demand-Resource Model, burnout may link emotional labor with presenteeism. Thus, this study analyzed the role of burnout as a mediating factor between the three types of emotional labor strategies and presenteeism among nurses in tertiary-level hospitals. Methods: A cross-sectional study of 1,038 nurses from six Chinese hospitals was conducted. The questionnaires, including the 14-item emotional labor strategies scale, 22-item Maslach Burnout Inventory scale, 6-item Stanford Presenteeism Scale, and items about demographic characteristics and work-related factors, were used to collect data. A multivariable linear regression was used to predict work-related factors and investigate the correlation of emotional labor, burnout, and presenteeism. The structural equation model was implemented to test the mediating effects of job burnout. Results: The results of the study showed that the average presenteeism score of the participants was 14.18 (4.33), which is higher than in Spanish, Portuguese, and Brazilian nurses. Presenteeism was explained by 22.8% of the variance in the final model in multivariable linear regression (P < 0.01). Presenteeism was found to be positively correlated with surface acting, emotionally expressed demands, deep acting, emotional exhaustion, depersonalization, and low personal accomplishment (P < 0.01). Notably, presenteeism was negatively correlated with deep acting (P < 0.01). In addition, burnout partially mediated the correlation between emotionally expressed demands, deep acting, and presenteeism with a mediatory effect of 24 and 63.31% of the total effect. Burnout completely mediated the association between surface acting and presenteeism, a mediating effect of 86.44% of the total effect. Conclusions: The results of this study suggested that different emotional labor strategies affect presenteeism, either directly or indirectly. Nursing managers should intervene to reduce presenteeism by improving the ability of the nurses to manage emotions, thereby alleviating burnout.

Balance Versus Integration: Work-Life Considerations

The term work-life balance may cause physicians to feel inadequate in pursuing a reality in which work and life each have equal importance. Furthermore, the term implies competition between these 2 realms. Instead, work-life integration is a more constructive and realistic term. Achieving harmonious integration requires self-reflection on the current state, goals, and resources and strategies needed to achieve and maintain such a state. Prioritizing aspects of both, and aligning them with individual requirements, while incorporating consistent and intentional investment of time and efforts in both professional and personal arenas is crucial to cultivate and sustain longitudinal well-being.

Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial

BACKGROUND

Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP.

METHODS

The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction.

RESULTS

Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001).

CONCLUSIONS

In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.

Reasons for presenteeism in different occupational branches in Sweden: a population based cross-sectional study

Objective

To compare the prevalence and reasons for presenteeism in occupations in three branches defined as employees handling people, handling things or handling symbols.

Method

A cross-sectional population-based cohort study was conducted. The study group was drawn from a representative sample (n = 6230) aged 16–64, who had been interviewed in 2015 or in 2017 for the Swedish Work Environment Surveys (SWES). The odds ratios (ORs) stratified by occupational category for reasons of presenteeism, with 95% confidence intervals (CI), were estimated using binomial multiple logistic regression analysis.

Results

The study showed that presenteeism was more common among employees handling people (74%), when compared to employees handling things (65%) or handling symbols (70%). The most common reason for presenteeism among employees handling people was “I do not want to burden my colleagues”, while “Because nobody else can carry out my responsibilities” was most common in the other two categories. After control for socio-demography, work environments and health, the differences in reasons mostly remained significant between the three occupational categories.

Conclusion

The differences between occupational categories are important for prevalence and reasons for presenteeism. As presenteeism affects the future health of employees and the productivity of the work unit, attempts to reduce presenteeism may be important. Because the reasons vary between occupations, customized preventive measures should be applied in different occupational settings. Among employees handling people, covering up for absence in work team is relevant, while among employees handling symbols and handling things the corresponding focus could be on shared responsibilities for specific tasks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01701-2.

Preferences and barriers to the utilization of primary health care by sick physicians: a nationwide survey

BACKGROUND

Physicians are often dissatisfied with their own medical care. Self-prescribing is common despite established guidelines that discourage this practice. From a pilot study, we know primary care physicians' (PCP) preferences, but we lack information regarding other specialties and work places.

OBJECTIVES

The goal of this study was to examine whether physicians are satisfied with their personal primary care and how this could be improved.

METHODS

We distributed an electronic survey to all physicians registered with the Israeli Medical Association. The questionnaire examined satisfaction with medical care, preferences for using formal care versus informal care, self-prescribing and barriers to using formal care.

RESULTS

Two thousand three hundred and five out of 24 360 invited physicians responded. Fifty-six per cent of the respondents were satisfied with their personal primary care. Fifty-two per cent reported initiating self-treatment with a medication during the last year. Five and four per cent initiated treatment with a benzodiazepine and an antidepressant, respectively, during the last year. This was despite the fact that most physicians did not feel competent to treat themselves. Having a personal PCP was correlated with both a desire to use formal care and self-referral to formal care in practice. Regression analysis showed that the highest odds ratio (OR) for experiencing a large gap between desired and actual care were for physicians who had no personal PCP (OR = 1.92).

CONCLUSIONS

Physicians frequently engage in self-treatment and in informal medical care. Whether the root cause is the health care system structure that does not meet their needs or the convenience of self-treatment is not known.

COVID-Well: Evaluation of the Implementation of Supported Wellbeing Centres for Hospital Employees during the COVID-19 Pandemic

Supported Wellbeing Centres have been set up in UK hospital trusts in an effort to mitigate the psychological impact of COVID-19 on healthcare workers, although the extent to which these are utilised and the barriers and facilitators to access are not known. The aim of the study was to determine facility usage and gather insight into employee wellbeing and the views of employees towards this provision. The study included (i) 17-week service use monitoring, (ii) employee online survey with measures of wellbeing, job stressfulness, presenteeism, turnover intentions, job satisfaction, and work engagement, as well as barriers and facilitators to accessing the Wellbeing Centres. Over 17 weeks, 14,934 facility visits were recorded across two sites (peak attendance in single week n = 2605). Facilities were highly valued, but the service model was resource intensive with 134 wellbeing buddies supporting the centres in pairs. 819 hospital employees completed an online survey (88% female; 37.7% working in COVID-19 high risk areas; 52.4% frontline workers; 55.2% had accessed a wellbeing centre). There was moderate-to-high job stress (62.9%), low wellbeing (26.1%), presenteeism (68%), and intentions to leave (31.6%). Wellbeing was higher in those that accessed a wellbeing centre. Work engagement and job satisfaction were high. Healthcare organisations are urged to mobilise access to high-quality rest spaces and psychological first aid, but this should be localised and diversified. Strategies to address presenteeism and staff retention should be prioritised, and the high dedication of healthcare workers should be recognised.

Working while sick in context of regional unemployment: a Europe-wide cross-sectional study

BACKGROUND

Research suggests that areas with high unemployment have lower rates of sickness absence, but the underlying mechanisms remain unclear. One assumption is that when unemployment is high people are more likely to work while being sick (discipline hypothesis). Against this background, we investigate the association between regional unemployment and sickness presenteeism. Second, we study interactions with factors of occupational disadvantage.

METHODS

We combined survey data of 20 974 employees collected 2015 in 232 regions from 35 European countries with data on regional unemployment rates obtained from Eurostat. Presenteeism was assessed by the fraction of days worked while ill among all days with illness (presenteeism propensity). To investigate if unemployment was related to presenteeism, we estimated multi-level models (individuals nested in regions) that were adjusted for socio-demographic and occupational covariates to account for compositional differences of the regions.

RESULTS

The mean presenteeism propensity was 34.8 (SD 40.4), indicating that workers chose presenteeism in 1 out of 3 days with sickness. We found that a change in unemployment by +10 percentage points was associated with a change in presenteeism by +5 percentage points (95% CI 1.2 to 8.6). This relationship was more pronounced among workers with low salary, low skill-level, and industrial and healthcare workers.

CONCLUSION

Our results support the assumption that high unemployment elevates presenteeism, and that people in disadvantaged occupations are particularly affected. Policies managing presenteeism should consider the labour market context, particularly during the aftermath of the COVID-19 pandemic.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys

OBJECTIVES

To explore and discuss the changes in the levels of work stress for Norwegian doctors in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia) from 2010 to 2019.

DESIGN

Repeated questionnaire surveys in 2010, 2016 and 2019, where samples were partly overlapping.

SETTING

Norway.

PARTICIPANTS

A representative sample of 1500-2200 doctors in different job positions. Response rates were 66.7% (1014/1520) in 2010, 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.

MAIN OUTCOME MEASURE

Validated 9-item short form of the 'Effort-Reward Imbalance' questionnaire. A risky level of work stress was defined as an effort/reward ratio above 1.0.

ANALYSES

Linear mixed models with estimated marginal means of job positions controlled for gender and age. Proportions with 95% CIs.

RESULTS

From 2010 to 2016 and further to 2019, GPs reported a significant increase in levels on the effort scale (ES: 2.96, 3.25, 3.51) and significant decrease in levels on the reward scale (RS: 4.27, 4.05, 3.67). No significant changes were reported by hospital doctors (ES: 3.13, 3.10, 3.14; RS: 4.09, 3.98, 4.04), private practice specialists (ES: 2.58, 2.61, 2.59; RS: 4.32, 4.32, 4.30) and doctors in academia (ES: 2.63, 2.51, 2.52; RS: 4.09, 4.11, 4.14). The proportion of doctors with risky levels of work stress increased significantly for GPs (10.3%, 27.7%, 40.1%), but did not significantly change for hospital doctors (23.0%, 27.3%, 26.9%), private practice specialists (8.2%, 12.7%, 9.4%) and doctors in academia (11.9%, 19.0%, 16.4%).

CONCLUSION

During a 9-year period, the proportion of risky levels of work stress increased significantly for GPs but did not significantly change for other job positions. This may be partly due to changes in expectations of younger GPs and several healthcare reforms and regulations.

Nurses' Job Insecurity and Emotional Exhaustion: The Mediating Effect of Presenteeism and the Moderating Effect of Supervisor Support

Presenteeism refers to attending work when one is ill, which not only leads to a decline in the physical and mental health of employees but also negatively impacts organizational productivity and increases an organization's extra costs. Therefore, to explore the antecedents and outcomes of nurses' presenteeism behavior and the acting mechanism among the variables, a sample of 330 nurses from China were investigated with the Sickness Presenteeism Questionnaire, Job Insecurity Scale, Perceived Supervisor Support Scale, and Emotional Exhaustion Scale. The results indicated that (1) job insecurity had a significantly predictive effect on nurses' presenteeism behavior; (2) nurses' presenteeism partially mediated the relationship between job insecurity and emotional exhaustion; and (3) supervisor support moderated the relationship between nurses' presenteeism behavior and emotional exhaustion; i.e., the higher the level of supervisor support, the weaker the positive relationship between nurses' presenteeism behavior and emotional exhaustion. The findings provide theoretical guidance and an empirical basis for prevention and intervention strategies concerning nurses' presenteeism behavior.

Sick leave accessibility in junior doctors at an Australian health service

Background

Doctors commonly continue to work when they are unwell. This norm is increasingly problematic during the COVID-19 (SARS-CoV-2) pandemic when effective infection control measures are of paramount importance. This study investigates the barriers existing before COVID-19 that prevent junior doctors with an acute respiratory illness working in Canberra, Australia, from taking sick leave, and offers suggestions about how to make sick leave more accessible for junior doctors.

Methods

Anonymous online survey study.

Results

192 junior doctors were invited to participate in the study. Fifty-four responded, and only those who had worked whilst unwell with an acute respiratory illness were included, providing a total number of fifty responses. Of these, 72% believed they were infectious at the time they worked whilst unwell. 86% of respondents did not feel supported by the workplace to take sick leave when they were unwell, and 96% identified concerns about burdening colleagues with extra workload and lack of available cover as the main deterrents to accessing sick leave.

Conclusion

Junior doctors at our health service, pre-COVID-19, do not widely feel empowered to take sick leave when they have an acute respiratory illness. Junior doctors are primarily concerned about burdening their colleagues with extra workloads in an environment where they perceive there to be a lack of available cover. Having more available cover, leadership from seniors, and clearer guidelines around the impact of sick leave on registration may contribute to a culture where junior doctors feel supported to access sick leave.

•

Results capture junior doctors' sick leave behaviours before COVID-19.

•

86% of junior doctor respondents did not feel supported to take sick leave.

•

72% of the doctors who reported working whilst unwell believed they were infectious.

•

Doctors were concerned about inadequate cover and burdening colleagues with work.

•

Cultural and practical changes may improve sick leave accessibility for junior doctors.

Association between employment status and sickness presenteeism among Korean employees: a cross-sectional study

Background

Sickness presenteeism (SP) indicates “going to work while being ill.” The importance of SP has only recently been investigated, and the association between SP and employment status has been inconsistent across studies. Therefore, we conducted this study to explore the association between SP and employment status by using presenteeism propensity (PP), which can reflect the individual decision-making process.

Methods

The study population included employees participating in the 5th Korean Working Condition Survey. We analyzed data of only employees with at least one health event, which was calculated as the sum of SP and sickness absenteeism days. Employment status was grouped into 3 categories: stable employment, unstable employment (contract period ≥ 1 year), and unstable employment (contract period < 1 year). Survey-weighted logistic regression analysis was conducted to assess the association between employment status and PP (dichotomized as “≤ 0.5” and “> 0.5”).

Results

Unstable employees (contract period ≥ 1 year) had higher odds of PP than stable employees (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.03–1.47), whereas unstable employees (contract period < 1 year) had lower odds of PP than stable employees (OR: 0.82, 95% CI: 0.71–0.96).

Conclusions

Employment status was associated with SP. Given the negative health impact of SP, social efforts, such as paid sick leave, are required to reduce SP and enhance the health status of unstable workers.

Severe and moderate seasonal influenza epidemics among Italian healthcare workers: A comparison of the excess of absenteeism

Background

This study aims to quantify the excess of sickness absenteeism among healthcare workers (HCWs), to estimate the impact of a severe versus moderate influenza season and to determine whether the vaccination rates are associated with reduced sickness absence.

Methods

We investigated the excess absenteeism that occurred in a large Italian hospital, 5300 HCWs, during the severe influenza season of 2017/2018 and compared it with three moderate flu seasons (2010/2013). Data on influenza vaccinations and absenteeism were obtained from the hospital's databases. The data were split into two periods: the epidemic, from 42 to 17 weeks, and non‐epidemic, defined as 18 to 41 weeks, which was used as the baseline. We stratified the absenteeism among HCWs in multiple variables.

Results

Our study showed an increased absenteeism among HCWs during the epidemic period of severe season in comparison with non‐epidemic periods, the absolute increase correlated with a relative increase of 70% (from 4.05 to 6.68 days/person). Vaccinated HCWs had less excess of absenteeism in comparison with non‐vaccinated HCWs (1.74 vs 2.71 days/person). The comparison with the moderate seasons showed a stronger impact on HCW sick absenteeism in the severe season (+0.747days/person, P = .03), especially among nurses and HCWs in contact with patients (+1.53 P < .01; +1.19 P < .01).

Conclusions

In conclusion, a severe influenza epidemic has greater impacts on the absenteeism among HCWs than a moderate one. Although at a low rate, a positive effect of vaccination on absenteeism is present, it may support healthcare facilities to recommend vaccinations for their workers.

Factors associated with work impairment and productivity among Lebanese community pharmacists

Background Community pharmacists provide an essential service by promoting, maintaining and improving the health of the community. However, factors affecting community pharmacists' work productivity remain poorly studied. Objective Our study aimed to assess, on a national level, work productivity components and its correlates among Lebanese community pharmacists. Methods: The study was carried out between March and July 2018, using a representative sample of community pharmacies from all districts of Lebanon. Main outcome measure: The work productivity components were assessed using the Work Productivity and Activity Impairment questionnaire. Results The study included 435 community pharmacists, the prevalence of sickness presenteeism and sickness absenteeism reached 91% and 45%, respectively. Presenteeism was positively associated with reporting higher depression score (β = 0.26) and insomnia (β = 0.20) whereas better mental (β = - 0.35) and physical health (β = - 0.38) were negatively associated with presenteeism. Absenteeism was positively associated with male gender (adjusted OR 2.05, 95% CI 1.14-3.70), reporting higher depression score (adjusted OR = 1.07, 95% CI 1.02-1.11) and negatively associated with better mental and physical health (adjusted OR = 0.93, 95% CI 0.90-0.96 and adjusted OR = 0.96, 95% CI 0.93-0.99; respectively). Activity impairment was positively associated with depression (β = 0.16) and insomnia (β = 0.12) and negatively associated with better mental (β = - 0.22) and physical health (β = - 0.015). Conclusion This is the first study assessing work productivity and activity impairment among Lebanese community pharmacists. Further research is needed to predict sickness absenteeism and presenteeism and this information will be useful to ensure quality of care is delivered.

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

Background

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

Methods

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

Results

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

Conclusion

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

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Background

The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.

Objectives

Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.

Design

Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.

Data sources

Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.

Review methods

We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.

Results

A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.

Limitations

Variable quality of included literature; limited UK-based studies.

Future work

Use this evidence synthesis to refine, implement and evaluate interventions.

Study registration

This study is registered as PROSPERO CRD42017069870.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

Sickness Presence among Health Care Professionals: A Cross Sectional Study of Health Care Professionals in Slovenia

Background and objectives: Presenteeism is a relatively new phenomenon that people, despite complaints and ill health that should prompt them to rest and take sick leave, go to work in any case. The highest sickness presence is largely to be found in the care and welfare and educational sectors. The aim of the study is to investigate the relations between different factors and sickness presence among health care professionals. Materials and Methods: A cross-sectional study was conducted at the largest hospital in Slovenia involving 5865 health care professionals employed at the University Medical Centre Ljubljana in the period between 1 January 2010 and 31 December 2010. Logistic regression methods were used to assess the associations between risk factors and their interactions and sickness presence. Results: Besides high odds for sickness presence in multivariate modelling for acute (OR = 359.7; 95%CI = 89.1–1452.8) and chronic disease (OR = 722.5; 95%CI = 178.5–2924.5) the highest odds were calculated for poor self-related health (OR = 3.0; 95%CI = 1.9–4.8), no possibility of replacement (OR = 1.9; 95%CI = 1.5–2.3), sickness absence > two times a year (OR = 1.6; 95%CI = 1.2–2.1), disabled workers (OR = 1.6; 95%CI = 1.0–2.5), and lower salary when on sick leave (OR = 1.5; 95%CI = 120–1.9). Risk factors interactions were not found to be associated with sickness presence among health care workers. Conclusions: The pre-requisite for higher sickness presence is workers’ bad health. The results indicate that sickness presence was associated with psycho social risk factors at work and their economic consequences. Continued sickness presence might have negative rather than positive consequences on work and health care professionals’ health in the future. Sickness presence needs to be taken into account for health care organizers.

Direct, Absenteeism, and Disability Cost Burden of Obesity Among Privately Insured Employees: A Comparison of Healthcare Industry Versus Other Major Industries in the United States

OBJECTIVE

To compare obesity-related costs of employees of the healthcare industry versus other major US industries.

METHODS

Employees with obesity versus without were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Employees working in healthcare with obesity were compared with employees of other industries with obesity for absenteeism/disability and direct cost differences. Multivariate models estimated the association between industries and high costs compared with the healthcare industry.

RESULTS

Obesity-related absenteeism/disability and direct costs were higher in several US industries compared with the healthcare industry (adjusted cost differences of $-1220 to $5630). Employees of the government/education/religious services industry (GERS) with obesity (BMI of 30 or greater) had significantly higher odds of direct costs at the 80th percentile and above (odds ratio vs healthcare industry = 2.20; P < 0.05).

CONCLUSIONS

Relative to the healthcare industry, employees of other industries, especially GERS, incurred higher obesity-related costs.

Addressing Needs of Women Radiologists: Opportunities for Practice Leaders to Facilitate Change

Women are, and have always been, underrepresented in radiology. This gender disparity must be addressed. Women bring a different perspective to the workplace; and their collaborative, empathetic, and compassionate approach to patient care and education is an asset that the radiology community should embrace and leverage. Radiologic organizations should focus on removing barriers to the entry of women physicians into radiology as a specialty and to their career advancement. Organizations should address bias, promote physician well-being, and cultivate a safe and positive work environment. Radiology leaders committed to increasing gender diversity and fostering an inclusive workplace have the opportunity to strengthen their organizations. This article outlines the key steps that practice leaders can take to address the needs of women in radiology: (a) marketing radiology to talented women medical students, (b) addressing recruitment and bias, (c) understanding and accommodating the provisions of the Family and Medical Leave Act of 1993 and the Fair Labor Standards Act for both trainees and radiologists in practice, (d) preventing burnout and promoting well-being, (e) offering flexible work opportunities, (f) providing mentorship and career advancement opportunities, and (g) ensuring equity. ^©RSNA, 2018.

Exploring presenteeism among hospital physicians through the perspective of job crafting

Purpose

The purpose of this paper is to seek a deeper understanding of presenteeism by utilising the perspective of job crafting to explore how a selected group of physicians make sense of their decision to attend work while ill and of their experience of doing so. Job crafting implies that employees not only respond to their job description, but also proactively change tasks, relationships and perceptions in order to experience work in meaningful ways.

Design/methodology/approach

A narrative methodological framework involving interviews was adopted to explore the ways in which a selected group of 20 Norwegian hospital physicians engaged in job crafting during presenteeism. The resulting data were analysed using theory-led thematic analysis utilizing the theoretical perspective of job crafting.

Findings

It was evident that physicians were indecisive and insecure when evaluating their own illness, and that, via task, relational and cognitive crafting, they trivialised, endured and showcased their illness, and engaged in presenteeism in various ways. Furthermore, physicians to some extent found themselves caught in dysfunctional circles by contributing to the creation of a work environment where presenteeism was maintained and seen as expected.

Research limitations/implications

Future research should address a wider range of contexts, and use longitudinal methods to explore the multifaceted, context-specific and evolving nature of presenteeism and job crafting in more depth. Interventions aimed at countering the negative implications of presenteeism should address the issue from both a social and a systemic point of view.

Originality/value

The findings extend the current understanding of presenteeism by demonstrating the multifaceted and evolving nature of the ways in which personal illness and presenteeism are perceived and enacted over time.

Working while sick: validation of the multidimensional presenteeism exposures and productivity survey for nurses (MPEPS-N)

Background

Presenteeism is the employee behaviour of physically attending work with reduced performance due to illness or for other reasons. Nurses are four times more likely to exhibit presenteeism compared to other occupations, threatening patient safety through increased patient falls, medication errors and staff-to-patient disease transmission. There is a paucity of standardized instruments that quantify the association between presenteeism with its exposures and related productivity. This study aims to validate an instrument that comprehensively measures presenteeism workplace and personal exposures specifically for Asian nurses.

Methods

Questionnaire domain items were selected based on the JD-R framework and a previously conducted systematic review of pre-existing validated scales measuring work attendance exposures used in previous healthcare studies. The preliminary questionnaire consisted of two outcomes (presenteeism frequency, productivity) and five exposure domains: work resources, work demands, work stress, work engagement, personal traits and health.

Content validation and back translation (English-Cantonese Chinese-English) were carried out. Responses from full-time nurses working in two acute care hospitals (Preliminary questionnaire at Hospital 1: N = 295 and main round questionnaire at Hospital 2: N = 1146) were included in the validation study to ensure an adequate sample size of ten cases per indicator variable for CFA analysis. A random sample of 80 nurses from Hospital 1 were selected for test-retest reliability 4 weeks post the initial survey. Internal consistency, convergent and discriminant validity tests were also tested.

Results

Satisfactory internal consistency (Cronbach’s alpha > 0.7), test-retest reliability (ICC > 0.4); and construct validity - convergent and discriminant validity was achieved. Confirmatory factor analysis yielded satisfactory fitness indices (CFI and TLI > 0.95, RMSEA < 0.08). Presenteeism and productivity significantly associated with all work resources, work engagement and work stress constructs in Hospital 2.

Conclusion

A reliable Multidimensional Presenteeism Exposures and Productivity Survey (MPEPS-N) has been validated in two distinct hospital environments. The instrument helps to identify and quantify organizational or individual exposures that significantly associate with presenteeism and its related productivity, thus allowing hospital managers to set evidence-based intervention targets for wellness programs and formulate human resource policies in reducing presenteeism-related productivity loss.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4373-x) contains supplementary material, which is available to authorized users.

A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress-Part 3 of 6: Physician Illness and Impairment

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.

The Effect of Presenteeism on Productivity Loss in Nurses: The Mediation of Health and the Moderation of General Self-Efficacy

Background: Seventy-four percent of Chinese employees have experienced working with illness, but limited number of researchers have paid attention on this phenomenon. Most of the previous research on presenteeism has almost exclusively focused on North America and Europe and have gone to the financial emphasis. The current researches have two shortages, which are laying in the consensus on the definition and measurement of presenteeism, as well as the mechanism of presenteeism and its outcomes have set barriers for scholars to generate deeper understanding of the behavior. The aim of the present study was to explore the current situation of presenteeism among Chinese nurses and the mediating effect of health and the moderating effect of general self-efficacy between presenteeism and productivity loss. Methods: Data were collected from a sample of 340 female nurses from a 3A-graded general hospital in Henan Province, China by using the Sickness Presenteeism Questionnaire (SPQ), the Stanford Presenteeism Scale (SPS-6), the 12-item General Health Questionnaire (GHQ-12), and the General Self-Efficacy Scale (GSES). Results: The results indicated that the mean of SPQ was 3.2 ± 0.7 in this sample, and there were significant differences in age and marital status in SPQ scores. Presenteeism was significantly associated with health and productivity loss, and health was significantly associated with productivity loss, and general self-efficacy was negatively associated with productivity loss. A bootstrap test showed that health fully mediated the relationship between presenteeism and productivity loss in nurses. Hierarchical regression analysis confirmed the moderating role of general self-efficacy between presenteeism and productivity loss. Conclusions: Presenteeism can significantly predict productivity loss in nurses, and hospital management can improve the physical and mental health of nurses and enhance their self-efficacy level to reduce the negative impact of presenteeism on productivity loss.

Stressors contributing to burnout amongst pediatric radiologists: results from a survey of the Society for Pediatric Radiology

BACKGROUND

A recent study showed a high prevalence of burnout in pediatric radiology.

OBJECTIVE

The purpose of this study is to evaluate potential stressors contributing to burnout in pediatric radiology.

MATERIALS AND METHODS

Society for Pediatric Radiology members received an invitation for an anonymous survey evaluating stressors contributing to burnout. Stressors evaluated included call burden, financial stress, work-life balance, health care evolution and job market changes, and radiology as a career choice. Additional questions regarding demographics were obtained.

RESULTS

The response rate was 460/1,453 (32%). The prevalence of emotional exhaustion was 66% (286/435), depersonalization was 61% (265/433) and perceived lack of personal accomplishment was 15% (67/436). In a backward selective logistic regression model, work-life imbalance and call burden were the only significant factors predicting higher emotional exhaustion (P<0.001). Using a similar model, work-life imbalance, call burden and decreased rate of reimbursement were significantly associated with higher probability of depersonalization (P=0.033, 0.0002 and 0.015, respectively). Emotional exhaustion and depersonalization were significantly associated with higher odds of a radiologist's wish to work in another medical specialty (P=0.011 and 0.002, respectively).

CONCLUSION

Key stressors contributing to burnout in pediatric radiology include work-life imbalance, pediatric call burden and a decreased rate of reimbursement. Burnout in pediatric radiology is a serious issue that needs to be addressed and prioritized on the individual and departmental/institutional levels and further investigated to develop effective interventions to mitigate it.

Sickness presenteeism at work: prevalence, costs and management

INTRODUCTION

Presenteeism is defined as continuing to attend work during illness. As a growing health concern, awareness of the factors that encourage presenteeism and the risks of this behaviour is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and Psycinfo, was conducted.

AREAS OF AGREEMENT

A range of contextual and individual factors is associated with presenteeism. Workers in some sectors, such as healthcare, appear to be at greater risk. Presenteeism may facilitate rehabilitation and recovery but it can exacerbate existing health problems and increase the risk of subsequent illness and absence as well as impair workability.

AREAS OF CONTROVERSY

The incidence of sickness presenteeism is rising, alongside reductions in absenteeism. The growing awareness of the costs of presenteeism, especially in safety-critical environments, suggests that it should be considered a risk-taking behaviour and carefully measured and managed.

GROWING POINTS AND AREAS FOR DEVELOPING RESEARCH

Measuring presenteeism as well as absenteeism will provide more accurate information about employee health. Raising awareness of the risks of working while sick and the economic, moral, cultural and social pressures on employees to do so appears crucial. Systemic interventions to manage presenteeism based on research evidence are required.

Presenteeism exposures and outcomes amongst hospital doctors and nurses: a systematic review

Background

Presenteeism is a behavior in which an employee is physically present at work with reduced performance due to illness or other reasons. Hospital doctors and nurses are more inclined to exhibit presenteeism than other professional groups, resulting in diminished staff health, reduced team productivity and potentially higher indirect presenteeism-related medical costs than absenteeism. Robust presenteeism intervention programs and productivity costing studies are available in the manufacturing and business sectors but not the healthcare sector.

This systematic review aims to 1) identify instruments measuring presenteeism and its exposures and outcomes; 2) appraise the related workplace theoretical frameworks; and 3) evaluate the association between presenteeism, its exposures and outcomes, and the financial costs of presenteeism as well as interventions designed to alleviate presenteeism amongst hospital doctors and nurses.

Methods

A systematic search was carried out in ten electronic databases from 1998 to 2017 and screened by two reviewers. Quality assessment was carried out using the Critical Appraisal Skills Program (CASP) tool. Publications meeting predefined assessment criteria were selected for data extraction.

Results

A total of 275 unique English publications were identified, 38 were selected for quality assessment, and 24 were retained for data extraction. Seventeen publications reported on presenteeism exposures and outcomes, four on financial costing, one on intervention program and two on economic evaluations. Eight (39%) utilized a theoretical framework, where the Job-Demands Resources (JD-R) framework was the most commonly used model. Most assessed work stressors and resources were positively and negatively associated with presenteeism respectively. Contradictory and limited comparability on findings across studies may be attributed to variability of selected scales for measuring both presenteeism and its exposures/outcomes constructs.

Conclusion

The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures, economic costs, or interventions amongst hospital healthcare workers. This review will aid researchers in developing a standardized multi-dimensional presenteeism exposures and productivity instrument to facilitate future cohort studies in search of potential cost-effective work-place intervention targets to reduce healthcare worker presenteeism and maintain a sustainable workforce.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3789-z) contains supplementary material, which is available to authorized users.