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Is organizational justice climate at the workplace associated with individual-level quality of care and organizational affective commitment? A multi-level, cross-sectional study on dentistry in Sweden. Int Arch Occup Environ Health 2017; 91:237-245. [PMID: 29124319 PMCID: PMC5797211 DOI: 10.1007/s00420-017-1275-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
Purpose The aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members’ perceptions of care quality and affective commitment to the workplace. Methods The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confounding by group size, gender, age, and occupation. Results The results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p < 0.001). Conclusions Organizational justice climate at work unit level explained all variation in affective commitment among dental clinics and was associated with both the individual staff members’ affective commitment and perceived quality of care. These findings suggest a potential for that addressing organizational justice climate may be a way to promote quality of care and enhancing affective commitment. However, longitudinal studies are needed to support causality in the examined relationships. Intervention research is also recommended to probe the effectiveness of actions increasing unit-level organizational justice climate and test their impact on quality of care and affective commitment.
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Vu-Eickmann P, Loerbroks A. [Psychosocial working conditions of physician assistants: results from a qualitative study on occupational stress, resources, possible approaches to prevention and intervention needs]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 126:43-51. [PMID: 28716704 DOI: 10.1016/j.zefq.2017.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/17/2017] [Accepted: 06/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Numerous studies have documented adverse psychosocial working conditions among health care staff. Working conditions may not only impair the health outcomes of this professional group, but can also affect the quality of care they deliver to patients. Previous work stress research has mainly focused on physicians and nurses. Comparable evidence remains limited, however, for physician assistants (Medizinische Fachangestellte, MFAs), who represent the largest professional group in German primary care. This study aimed to gain insights into work stressors and resources experienced by MFAs and to explore both possible approaches to prevention and intervention needs. METHODS Participants were recruited from a criterion-based sample of medical practices in and around the city of Düsseldorf (Germany) and with assistance provided by the Medical Staff Association (VMF e. V.). In total, 26 qualitative in-depth interviews were conducted (11/2015-02/2016), transcribed and content analyzed using MaxQDA. RESULTS MFAs reported a high workload and unforeseeable incidents as salient occupational stressors. Additional stressors included interpersonal relationship problems with superiors and a lack of social support from colleagues. At the same time though, support from superiors and colleagues can provide a key resource for coping with work stressors. Furthermore, social interactions with patients and diversified tasks were perceived as supportive professional resources. Possible approaches to prevention were exclusively seen to operate at the organizational level. The perceived need for intervention primarily concerned adequate wages and appreciation from superiors and society. CONCLUSIONS Physician assistants described their working conditions as being characterized by high demands, low job control and low rewards. We suggest basic approaches for employers to improve the working experience of MFAs, which may represent the starting point for further research efforts to develop preventive measures.
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Affiliation(s)
- Patricia Vu-Eickmann
- Institut für Arbeits-, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Adrian Loerbroks
- Institut für Arbeits-, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Vargas Bustamante A, Martinez A, Chen X, Rodriguez HP. Clinic Workload, the Quality of Staff Relationships and Diabetes Management in Community Health Centers Catering to Latino and Chinese Patients. J Community Health 2016; 42:481-488. [PMID: 27752860 DOI: 10.1007/s10900-016-0280-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examine whether workplace climate-quality of staff relationships (QSR) and manageable clinic workload (MCW) are related to better patient care experiences and diabetes care in community health centers (CHCs) catering to Latino and Chinese patients. Patient experience surveys of adult patients with type 2 diabetes and workplace climate surveys of clinicians and staff from CHCs were included in an analytic sample. Comparisons of means analyses examine patient and provider characteristics. The associations of QSR, MCW and the diabetes care management were examined using regression analyses. Diabetes care process were more consistently provided in CHCs with high quality staff relations and more manageable clinic workload, but HbA1c, LDL cholesterol, and blood pressure outcomes were no different between clinics with high vs. low QSR and MCW. Focusing efforts on improvements in practice climate may lead to more consistent provision of important processes of diabetes care for these patients.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA.
| | - Ana Martinez
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, USA
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Loerbroks A, Weigl M, Li J, Angerer P. Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health 2016; 16:342. [PMID: 27090211 PMCID: PMC4835931 DOI: 10.1186/s12889-016-3016-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
Background Work stress may impair physicians’ ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians’ poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care. Methods We used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians’ perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians’ mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses. Results Both an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians’ depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care. Conclusions Our study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians’ depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Jian Li
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Psychobiological Pathways from Work Stress to Reduced Health: Naturalistic and Experimental Studies on the ERI Model. ALIGNING PERSPECTIVES ON HEALTH, SAFETY AND WELL-BEING 2016. [DOI: 10.1007/978-3-319-32937-6_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Benzer JK, Mohr DC, Evans L, Young G, Meterko MM, Moore SC, Nealon Seibert M, Osatuke K, Stolzmann KL, White B, Charns MP. Team Process Variation Across Diabetes Quality of Care Trajectories. Med Care Res Rev 2015; 73:565-89. [PMID: 26670549 DOI: 10.1177/1077558715617380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
Conceptual frameworks in health care do not address mechanisms whereby teamwork processes affect quality of care. We seek to fill this gap by applying a framework of teamwork processes to compare different patterns of primary care performance over time. We thematically analyzed 114 primary care staff interviews across 17 primary care clinics. We purposefully selected clinics using diabetes quality of care over 3 years using four categories: consistently high, improving, worsening, and consistently low. Analyses compared participant responses within and between performance categories. Differences were observed among performance categories for action processes (monitoring progress and coordination), transition processes (goal specification and strategy formulation), and interpersonal processes (conflict management and affect management). Analyses also revealed emergent concepts related to psychological and organizational context that were reported to affect team processes. This study is a first step toward a comprehensive model of how teamwork processes might affect quality of care.
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Affiliation(s)
- Justin K Benzer
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA VISN 17 Center of Excellence for Research on Returning War Veterans, TX, USA
| | - David C Mohr
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
| | - Leigh Evans
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
| | - Gary Young
- Northeastern University Center for Health Policy and Healthcare Research, Boston, MA, USA
| | - Mark M Meterko
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
| | - Scott C Moore
- National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA
| | - Marjorie Nealon Seibert
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Katerine Osatuke
- National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA
| | - Kelly L Stolzmann
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Bert White
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Martin P Charns
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
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Tyler TR, Goff PA, MacCoun RJ. The Impact of Psychological Science on Policing in the United States. Psychol Sci Public Interest 2015; 16:75-109. [DOI: 10.1177/1529100615617791] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The May 2015 release of the report of the President’s Task Force on 21st Century Policing highlighted a fundamental change in the issues dominating discussions about policing in America. That change has moved discussions away from a focus on what is legal or effective in crime control and toward a concern for how the actions of the police influence public trust and confidence in the police. This shift in discourse has been motivated by two factors—first, the recognition by public officials that increases in the professionalism of the police and dramatic declines in the rate of crime have not led to increases in police legitimacy, and second, greater awareness of the limits of the dominant coercive model of policing and of the benefits of an alternative and more consensual model based on public trust and confidence in the police and legal system. Psychological research has played an important role in legitimating this change in the way policymakers think about policing by demonstrating that perceived legitimacy shapes a set of law-related behaviors as well as or better than concerns about the risk of punishment. Those behaviors include compliance with the law and cooperation with legal authorities. These findings demonstrate that legal authorities gain by a focus on legitimacy. Psychological research has further contributed by articulating and demonstrating empirical support for a central role of procedural justice in shaping legitimacy, providing legal authorities with a clear road map of strategies for creating and maintaining public trust. Given evidence of the benefits of legitimacy and a set of guidelines concerning its antecedents, policymakers have increasingly focused on the question of public trust when considering issues in policing. The acceptance of a legitimacy-based consensual model of police authority building on theories and research studies originating within psychology illustrates how psychology can contribute to the development of evidence-based policies in the field of criminal law.
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Affiliation(s)
- Tom R. Tyler
- Yale Law School, Yale University
- Department of Psychology, Yale University
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Pérez-Arechaederra D, Briones E, Lind A, García-Ortiz L. Perceived Organizational Justice in Care Services: Creation and multi-sample validation of a measure. Soc Sci Med 2014; 102:26-32. [DOI: 10.1016/j.socscimed.2013.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
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Koponen A, Vahtera J, Pitkäniemi J, Virtanen M, Pentti J, Simonsen-Rehn N, Kivimäki M, Suominen S. Job strain and supervisor support in primary care health centres and glycaemic control among patients with type 2 diabetes: a cross-sectional study. BMJ Open 2013; 3:e002297. [PMID: 23645912 PMCID: PMC3646170 DOI: 10.1136/bmjopen-2012-002297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study investigates associations between healthcare personnel's perceived job strain, supervisor support and the outcome of care in terms of glycaemic control among patients with type 2 diabetes. DESIGN A cross-sectional study from 2006. SETTING 18 primary care health centres (HCs) from five municipalities in Finland. PARTICIPANTS Aggregated survey data on perceived job strain and supervisor support from healthcare personnel (doctors, n=122, mean age 45.5 years, nurses, n=300, mean age 47.1 years) were combined with registered data (Electronic Medical Records) from 8975 patients (51% men, mean age 67 years) with type 2 diabetes. OUTCOME MEASURE Poor glycaemic control (glycated haemoglobin (HbA1c) ≥7%). RESULTS The mean HbA1c level among patients with type 2 diabetes was 7.1 (SD 1.2, range 4.5-19.1), and 43% had poor glycaemic control (HbA1c ≥7%). Multilevel logistic regression analyses, adjusted for patient's age and sex, and HC and HC service area-level characteristics, showed that patients' HbA1c-levels were less optimal in high-strain HCs than in low-strain HCs (OR 1.44, 95% CI 1.12 to 1.86). Supervisor support in HCs was not associated with the outcome of care. CONCLUSIONS The level of job strain among healthcare personnel may play a role in achieving good glycaemic control among patients with type 2 diabetes.
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Affiliation(s)
- Anne Koponen
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- Department of Public Health, Folkhälsan Research Center, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
- Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Janne Pitkäniemi
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Marianna Virtanen
- Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Nina Simonsen-Rehn
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- Department of Public Health, Folkhälsan Research Center, Helsinki, Finland
| | - Mika Kivimäki
- Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Psychology, Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, Folkhälsan Research Center, Helsinki, Finland
- Department of Public Health, University of Turku, Turku, Finland
- Department of Public Health, Nordic School of Public Health, Göteborg, Sweden
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Modeling Organizational Justice Improvements in a Pediatric Health Service. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:45-59. [DOI: 10.1007/s40271-013-0002-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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