Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care

Revisiting organizational culture in healthcare: Heterogeneity as a resource

Aligning culture to be similar across work units is a common organizational tactic, but its appropriateness for the multidisciplinary context of healthcare is far from certain. Variation in perceptions of culture across large health systems may serve a functional purpose in delivering high quality care and ameliorating job stress; however, past research in healthcare has focused on culture as the average set of values and norms (i.e., cultural content) rather than on (dis)agreement about values and norms among organizational members (i.e., cultural structure). This survey-based study examines both cultural content (averages among individuals) and structure (distances between individuals) in departments of a large U.S. healthcare organization (total sample = 26,314 workers, response rate = 84%). We used linear models to associate four commonly used culture measures with outcome measures (perceived care quality, intent to stay, and manageable job stress). We found substantial heterogeneity in perceptions for multiple culture types. We found curvilinear relationships between heterogeneity for all culture types and outcomes, suggesting that heterogeneity promotes positive outcomes up to a certain point after which the positive effect declines. For research, our findings point to the importance of studying culture in healthcare with greater focus on heterogeneity; for practice, this study highlights how culturally-focused efforts to improve care quality and worker experience in healthcare should be more precise about balancing cultural alignment and heterogeneity.

Strategies of Well-being Training and Resilience

As cardiothoracic surgeons, we face frequent challenges to our well-being and our ability to function as our best selves. Building personal resilience is an important way to help us manage these challenges. Here, the authors outline the scope of the problem, the consequences of burnout, and offer 4 strategies to train ourselves to be more resilient: (1) Pursuit of fulfillment, (2) Cultivation of community and belonging, (3) Mitigation of microstresses and avoiding feelings of overwhelm, and (4) Building a "resilience bank account."

Trauma-informed climate scale-10 and attitudes related to trauma-informed care-10: An examination of scale psychometrics using data from disability service providers

BACKGROUND

Assessment is fundamental to the implementation of trauma-informed care. As trauma-informed care advances among organizations supporting people with intellectual and developmental disabilities (IDD), it is critical that they have access to validated assessment tools.

OBJECTIVE

This is the first study to examine the psychometric properties of two brief measures associated with trauma-informed care, Trauma-Informed Climate Scale (TICS-10) and Attitudes Related to Trauma-Informed Care (ARTIC-10), using data from the IDD service industry.

METHODS

We employed structural equation modeling to examine the factor structure, reliability of TICS-10 and ARTIC-10, and construct validity with the ProQOL using secondary data from 374 service providers.

RESULTS

We confirmed the factorial validity of TICS-10 and ARTIC-10 with single factor solutions; however, modifications were necessary to achieve adequate model fit.

CONCLUSIONS

The current study provides initial evidence of the validity and reliability of TICS-10 and ARTIC-10 when used within organizations supporting people with IDD. Recommendations for subsequent improvements and future research of the scales are provided.

Predictive modeling of burnout based on organizational culture perceptions among health systems employees: a comparative study using correlation, decision tree, and Bayesian analyses

Burnout is a significant concern, particularly within the healthcare field, affecting both nurses and physicians. It is a common issue in health systems, which encompass a range of healthcare facilities, such as hospitals, physician practices, ambulatory sites, and administrative offices like finance. Despite this, there has not been an extensive exploration of burnout in employees working directly with patients versus those in non-patient-facing roles within these health systems. It is important to note that organizational culture plays a crucial role in influencing various aspects of employees' work-life balance and their experiences of burnout. This study adopts a cross-sectional design, involving the distribution of a 57-question Likert scale survey to employees in health systems. These employees serve in various roles, both patient-facing and non-patient-facing, within jointly owned healthcare organizations, which encompass hospitals, ambulatory sites, and administrative offices. The survey was disseminated through trade organizations and employees at the managerial level and above within these health systems. Data was collected between October 2022 and January 2023, resulting in a total of 67 responses. The study employs correlation analysis to explore the connection between organizational culture and burnout. Furthermore, a decision tree model is constructed to predict burnout scores based on survey responses, specifically the question regarding the perceived positivity of the organizational culture. The decision tree models indicate that perceiving organizational culture as positive, safety-oriented, and supportive predicts various outcomes for individuals, including job retention, positive experiences with patients, increased callousness, and stimulation while working with colleagues. Bayesian analysis, considering the small sample size, reinforces these findings and provides a different perspective, incorporating prior knowledge and credible intervals. An association test suggests a strong link between a positive organizational culture and burnout symptoms, while another test supports a connection with engagement signs. Similar to nurses and physicians, administrative health systems' personnel are susceptible to burnout. Organizational culture can affect burnout. Therefore, health systems' leaders should cultivate an organizational culture that protects against burnout.

The role of organizational culture and communication skills in predicting the quality of nursing care

AIMS

This study aims to identify the level of nursing care quality and examine its predictors considering nurses' demographic data, organizational culture, and communication skills.

BACKGROUND

Quality of care is a determinant of the sustainability of any healthcare organization. Therefore, it is imperative to understand how factors may contribute to the quality of nursing care. Limited research is available on the interaction between the concepts of quality of nursing care, communication skills, and organizational culture.

METHODS

A cross-sectional multi-site correlational design was used in this study. A convenience sample of 200 nurses from four Jordanian hospitals was recruited. Data was collected using self-reported questionnaires. Descriptive statistics, Pearson correlations, and multiple regression were performed to achieve the study's aims.

RESULTS

The majority of the nurses in this study were females with bachelor's degrees. Age ranged between 22 and 53 years whereas experience ranged from 1 to 30 years. Communication skills significantly predicted the quality of nursing care; however, organizational culture was not a significant predictor of the quality of nursing care. Nevertheless, Pearson r correlation results revealed a significant correlation between organizational culture and communication skills (r = 0.57, p < 0.05).

CONCLUSION

Nurses and organizational managers can increase the level of quality of nursing care by investing in programs that target improving nurses' communication skills. Providing a good environment in the hospital can increase communication skills between staff members, ultimately increasing the quality of nursing care. Further studies are recommended to elaborate and further uncover concerns related to the current research.

Description of organizational and clinician characteristics of primary dementia care in Canada: a multi-method study

Background

Organizational and clinician characteristics are important considerations for the implementation of evidence-based recommendations into primary care practice. The introduction of Canadian dementia practice guidelines and Alzheimer strategies offers a unique context to study which of the organizational and clinician characteristics align with good quality care in primary care practices.

Methods

To evaluate the quality of dementia care, we carried out a retrospective chart review in randomly selected patients with a diagnosis of dementia and who had a visit during a 9-month period in 33 primary care practices. We collected data on indicators that were based on existing Canadian evidence-based recommendations to measure a quality of dementia care score. In addition, four questionnaires were administered: two questionnaires to evaluate the organizational characteristics of the practices (dementia-specific and general organization) and two to evaluate the clinician characteristics (one for family physicians and one for nurses). Primary care practices were stratified into tertiles based on their average quality of dementia care score (low, moderate, high). The differences between the groups organizational and clinician questionnaires scores were analyzed descriptively and visually.

Results

The mean overall scores for each questionnaire were higher in the high quality of dementia care group. When looking at the breakdown of the overall score into each characteristic, the high-quality group had a higher average score for the dementia-specific organizational characteristics of “access to and coordination with home and community services”, “financial support”, “training”, “coordination and continuity within the practice”, and “caregiver support and involvement”. The characteristic “Leadership” showed a higher average score for the moderate and high-quality groups than the low-quality group. In both clinician questionnaires, the high group scored better in “attitudes towards the Alzheimer’s plan” than the other two groups.

Conclusions

These results suggest that investing in organizational characteristics specifically aimed at dementia care is a promising avenue to improve quality of dementia care in primary care. These results may be useful to enhance the implementation of evidence-based practices and improve the quality of dementia care.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions

BACKGROUND

Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

METHODS

A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically.

RESULTS

Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support.

CONCLUSIONS

A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Prevalence, features and workplace factors associated with burnout among intensivists in Australia and New Zealand

Objectives: To investigate the prevalence and features of self-reported burnout among intensivists working in Australia and New Zealand, and evaluate potentially modifiable workplace stressors associated with increased risk of self-reported burnout. Methods: We performed an electronic survey among registered intensivists in Australia and New Zealand. Burnout and professional quality of life were measured using the Professional Quality of Life Scale version 5 (ProQOL-5). Socio-organisational factors were defined a priori and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors. Results: 261 of 921 estimated intensivists responded (response rate, 28.3%). Overall, few participants (0.8%) demonstrated high scores (> 75th centile) for burnout, and 70.9% of participants scored in the average range for burnout. Of note, 98.1% of participants scored in the average to high range for compassion satisfaction. No association was found between sex, age, or years of practice with the level of burnout or compassion satisfaction. Seven themes emerged regarding intensivists' most stressful aspects of work: interpersonal interactions and workplace relationships (25.5%), workload and its impact (24.9%), resources and capacity (22.6%), health systems leadership and bureaucracy (16.1%), end-of-life issues and moral distress (8.4%), clinical management (4.9%), and job security and future uncertainty (1.3%). Conclusion: Fewer Australian and New Zealand intensivists experienced burnout than previously reported. Many self-reported work stressors do not relate to clinical work and are due to interpersonal interactions with other colleges and hospital administrators. Such factors are potentially modifiable and could be the focus of future interventions.

A conceptual model of the relationship between organisational intelligence traits and digital government service quality: the role of occupational stress

Purpose

This paper presents a conceptual model that links digital government service quality with organisational intelligence (OI) traits and occupational stress among the service providers in the public sector.

Design/methodology/approach

This is a conceptual paper that carries out a systematic review of the key literature from 1978 to 2021, concerning the evolution of models, scales and dimensions attributing to digital government service quality, OI traits and occupational stress. Following this, a new conceptual model is proposed to reflect the need of today's public service delivery from a broader perspective.

Findings

Based on the reviews of the existing models, there is no convincing evidence of the existence of a conceptual model that incorporates digital government service quality, OI traits and occupational stress from the public service providers' viewpoint. Therefore, a conceptual model, with occupational stress acting as a mediator between various OI traits and digital government service quality, is presented as a comprehensive framework to heighten the quality of the public service delivery.

Originality/value

This paper explores the gap in the current service quality studies and proposes a conceptual model that is more reflective of today's public service delivery. Firstly, it helps better understand digital government service quality from a much less focused area, the supply side (service providers) standpoint as opposed to the demand side (citizen) viewpoint (citizen). Secondly, it extends the understanding of performance and evaluation of public service delivery from perspectives such as knowledge utilisation, strategic alignment and participatory decision-making. Thirdly, it extends the literature on digital service quality from a non-technological perspective, as to how it is influenced by employees' psychological well-being factors.

Understanding the Link Between Burnout and Sub-Optimal Care: Why Should Healthcare Education Be Interested in Employee Silence?

Evidence on the association of burnout with objective indicators of performance is scarce in healthcare. In parallel, healthcare professionals ameliorate the short-term impact of burnout by prioritizing some tasks over others. The phenomenon of employee silence can help us understand the evolution of how culture is molded toward the prioritization of some tasks over others, and how this contributes to burnout. Silence in healthcare has been associated with concealing errors, reduced patient safety, and covering up errors made by others. Conversely, there is evidence that in organizations where employees are encouraged to speak up about concerns, and where concerns are responded to appropriately, better patient outcomes such as improved patient safety and patient experience occur. Interventions to promote "speaking-up" in healthcare have not been successful and are rooted in a professional culture that does not promote speaking out. In this paper, we review the evidence that exists within healthcare to argue why healthcare education should be interested in employee silence, and how silence is a key factor in understanding how burnout develops and impacts quality of care. The following key questions have been addressed; how employee silence evolves during medical education, how is silence maintained after graduation, and how can leadership style contribute to silence in healthcare. The impact of withholding information on healthcare professional burnout, patient safety and quality of care is significant. The paper concludes with a suggested future research agenda and additional recommendations.

Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework

BACKGROUND

This study examined non-financial aspects of the organizational performance of public hospitals from the perspective of hospital physicians; the obtained results were analyzed to identify the necessary improvements in organizational performance.

METHODS

This was a cross-sectional study of multidisciplinary public hospitals on a group of 249 randomly selected physicians from 22 in-patient departments or clinics operating in the Warsaw region. The study data was collected using the structured World Health Organization questionnaires (to be filled out by respondents) assessing the hospital's organizational performance variables qualified according to the McKinsey 7-S Framework. Epidata software version 3.1 was used for data entry, and the analysis was carried out in the SPSS software, version 19. The results of the organization evaluation are presented in the McKinsey 7-S Framework diagram. Key elements of the performance factors were grouped into 'stens', and the sten values were expressed as arithmetic means. Normal distribution of the stens was validated with the Kolmogorov-Smirnov test. 95% confidence intervals were calculated. The significance of differences between the analyzed stens was compared with the paired Student t-test. The interdependence of the variables was determined using the Pearson's correlation coefficient.

RESULTS

The results revealed a significant difference (p <0.05) in the respondents' assessment of social (a mean score of 2.58) and technical (a mean score of 2.80) organizational aspects of the hospital operation. Scores for all variables were low. The social elements of an organization with the lowest score included 'staff', and in it the aspect - 'efforts are made to inspire employees at the lowest levels of the organization', 'skills' involving the learning style followed by the management/managerial staff, and 'management style' (average scores of 2.38, 2.56, 2.61, respectively).

CONCLUSION

Consistently with the existing literature, social factors were shown to play a more significant role in the management and they therefore deserve careful attention and more recognition when identifying and improving the key aspects affecting the organizational performance of public hospitals. Technical elements (strategy, structure, system) are important, but were demonstrated to have limited effect on the organizational operations geared towards ensuring effective functioning of a public hospital.

The Distance Between Us: the COVID-19 Pandemic's Effects on Burnout Among Resident Physicians

Entering the second year of the COVID-19 pandemic, we reflect on how this public health crisis has amplified burnout in the medical profession. In particular, the pandemic has had a significant impact on medical residents. Recognizing trainee burnout as a side effect of the pandemic is crucial and highlights the need for programmatic change to support medical trainees. We reviewed the literature and propose multiple interventions to improve trainee well-being, targeting individual, peer-to-peer, and system levels. The pandemic has highlighted the importance of institutional support for medical trainees to prevent burnout and protect the pipeline of future physicians.

Reality Meets Belief: A Mixed Methods Study on Character Strengths and Well-Being of Hospital Physicians

Positive psychology deals with factors that make life most worth living and focuses on enhancing individual potentials. Particularly, character strengths can positively contribute to well-being and work-related health, bearing a promising potential for professions, such as physicians, who are at risk for burnout or mental illnesses. This study aims to identify beneficial character strengths by examining the quantitative and qualitative data. In a cross-sectional multi-method study, 218 hospital physicians completed an online survey assessing their character strengths and their general and work-related well-being, comprising thriving, work engagement, and burnout dimensions (outcome variables). Quantitative data were analyzed for the total sample and by tertiary split. Additionally, interview-gathered opinions of four resident physicians and four medical specialist educators were collected to expand the perspective on which character strengths might be beneficial for the well-being of the resident physicians. The highest significant correlations between character strengths and outcome variables were found for hope and thriving (r = 0.67), zest, and work engagement (r = 0.67) as well as emotional exhaustion (r = -0.47), perseverance/leadership and depersonalization (r = -0.27), bravery, and reduced personal accomplishment (r = -0.39). Tertiary splits revealed that some correlations were not consistent across the entire scale continuum, for example, creativity was only significantly correlated with comparatively high levels of thriving (r = 0.28) or forgiveness with comparatively high levels of depersonalization (r = -0.34). Humility, social intelligence, and teamwork showed predominantly low correlations with all outcome variables (r = -0.17 - 0.34), although humility was stated by all interviewed medical specialist educators to be the most relevant for the well-being at work, and the latter two by three resident physicians, respectively. Different perspectives resulting from quantitative and qualitative data in terms of beneficial character strengths for work-related well-being may be driven by different work experiences, professional understandings, generational beliefs, or social expectations. Some significant correlations between character strengths and well-being outcomes varied depending on low, medium, or high outcomes. This raises questions about suitable work-related well-being interventions, as simple single intervention approaches (one intervention fits all) may not work for the respective outcome levels. These new findings warrant further research on how to foster the well-being of resident physicians at work.

Resilience interventions in physicians: A systematic review and meta-analysis

The aim of this review was to evaluate the effectiveness of interventions in promoting resilience among physicians. Previous reviews concerning resilience did not assess effectiveness in a systematic way using meta-analytic methods. PubMed, PsycINFO, and Cochrane Register of Controlled Trials were searched from inception to January 31, 2020. Randomized clinical trials, non-randomized clinical trials, and repeated-measures studies of intervention designs targeting at resilience in physicians were included. Eleven studies were included in the review (n = 580 physicians). Research findings suggest that interventions for resilience in physicians were associated with small but significant benefits. Subgroup analyses suggested small but significantly improved effects for emotional-supportive-coping interventions (Hedges's g = 0.242; 95% CI, 0.082-0.402, p = .003) compared with mindfulness-meditation-relaxation interventions (Hedges's g = 0.208; 95% CI, 0.131-0.285, p = .000). Interventions that were delivered for more than a week indicated higher effect (Hedges's g = 0.262; 95% CI, 0.169-0.355, p = .000) compared with interventions delivered for up to a week (Hedges's g = 0.172; 95% CI, -0.010 to 0.355, p = .064). Results were not influenced by the risk of bias ratings. Findings suggest that physicians can benefit in their personal levels of resilience from attending an intervention specifically designed for that reason for more than a week. Moreover, policy-makers should view current results as a significant source of redesigning healthcare systems and promoting attendance of resilience interventions by physicians. Future research should address the need for more higher-quality studies and improved study designs.

Assessment of burnout among urology residents in KSA: A cross-sectional study

OBJECTIVES

There is a shortage of urology residents in the KSA, and patients may have to wait for nearly three months to seek medical consultation with qualified urologists. According to the literature, urology residents face work-related burnout, which may affect the quality of health services provided to Saudi patients. This study aims to investigate the prevalence of work-related burnout among urology residents in KSA.

METHODS

A cross-sectional survey was carried out among Saudi urology residents using the Copenhagen Burnout Inventory (CBI), which includes personal, work, and patient-related burnouts. The survey was electronically sent to urology residents registered with the Saudi Commission for Health Specialties (SCFHS). Data were analysed using the SPSS program.

RESULTS

Of the 247 selected residents, 215 (87.04%) completed the questionnaire. Concerning personal burnout, 12.6% reported 'always feeling tired', 13% 'always physically exhausted', and 19.1% reported being 'always emotionally exhausted'. In addition, approximately 14% described the work as emotionally exhausting to a very high degree, while 18.6% added that they felt burnt out because of the work to a very high degree. According to the CBI, the mean personal burnout was 57.92, while the mean work-related burnout was 55.26.

CONCLUSIONS

Urology residents in KSA suffer from a high degree of burnout, and urgent interventions are essential to make their work-life balance less exhausting.

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees - A Narrative Literature Review

BACKGROUND

Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual's ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training.

METHODS

A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words 'burnout' and 'educational environment' or 'clinical learning environment' or 'postgraduate medical education' or 'learning environment'.

RESULTS

A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

Effects of horizontal violence among nurses on patient safety: Mediation of organisational communication satisfaction and moderated mediation of organisational silence

AIMS

This study aimed to investigate the effect of nurses' horizontal violence on patient safety as mediated by organisational communication satisfaction and to examine the moderated mediation effect of organisational silence.

BACKGROUND

Patient safety is a worldwide concern in health care, but patients still experience adverse events. Among factors affecting patient safety, organisational silence must be examined in relation to organisational communication satisfaction and horizontal violence.

METHOD

A total of 301 nurses working at four general hospitals with over 500 beds in Gyeonggi-do were recruited from October to November 2018. Data were collected through questionnaires and analysed using SPSS 25.0 and SPSS PROCESS macro.

RESULTS

Horizontal violence directly affected patient safety and indirectly affected patient safety via mediation by organisational communication satisfaction. Organisational communication satisfaction had a partial mediation effect, and organisational silence had a significant moderated mediation effect in the path from horizontal violence to organisational communication.

CONCLUSION

To enhance patient safety, educational programmes and strategies that improve organisational silence and organisational communication satisfaction should be developed at an organisational level.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators should be aware of the pivotal impact of organisational silence among nurses on patient safety.

New Ways of Working and Public Healthcare Professionals’ Well-Being: The Response to Face the COVID-19 Pandemic

This research proposes analyzing the influence of new ways of working (NWW) on healthcare professional’s well-being and how these may affect work performance and public service motivation. These variables and relationships were important before COVID-19 pandemic, and everything points to the fact that during and after the pandemic their importance will be higher. To buffer the potential negative effects of implementing the NWW, both organizations and employees must identify personal (psychological capital) and job resources (inter-role conflict, psychological empowerment, meaning of work) capable of acting as effective moderators to promote employee well-being and avoid negative experiences at work. This paper aims to shed light on new ways of coping and adapting to uncertain job requirements such as those that have arisen during COVID-19. Moreover, it highlights the great changes that public healthcare needs to face to improve the quality of the service offered to society. It is urgent that public administrators and human resources managers design effective strategies and make effective decisions in which employee well-being and service quality are main priorities.

Assessment of Burnout: A Pilot Study of International Women Physicians

INTRODUCTION

Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions.

METHODS

Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions.

RESULTS

Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evaluated using a 1-way ANOVA, with no statistically significant differences between other regions.

DISCUSSION

The data suggests that there may be regional differences in the prevalence of burnout in women physicians. Various factors could play a role in explaining the higher burnout scores in female physicians in Africa, including younger average age, establishing practice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.

Burnout Syndrome and Work-Related Stress in Physical and Occupational Therapists Working in Different Types of Hospitals: Which Group Is the Most Vulnerable?

Because of the nature of their work, physical and occupational therapists are at high risk of burnout, which is associated with decreased job satisfaction, medical errors, and mental wellbeing in healthcare professionals. To well manage and minimize potential impact of burnout, risk factors should be determined. This study examined burnout and job stress in physical and occupational therapists in various Korean hospital settings. Physical and occupational therapists from several rehabilitation facilities in South Korea completed a survey between March-May 2019. A set of questionnaires, including the Maslach Burnout Inventory and Job Content Questionnaire, were distributed to all participants. In total, 325 professionals (131 men and 194 women) were recruited. Burnout and work-related stress differed significantly according to several factors. Hospital size, gender, and age were the main contributory factors affecting at least two dimensions of the questionnaires. The more vulnerable group consisted of female therapists in their 20s at small- or medium-sized hospitals with low scores for quality of life. High levels of job stress and burnout were observed in female therapists in their 20s at small- or medium-sized hospitals. Hospitals and society should create suitable environments and understand the nature of therapists' work to improve healthcare.

The Moderating Effect of Organization Culture on Competition Intensity and Hospital Quality

This study empirically tests the relationship between hospital competition intensity and its quality, and the moderating impact of hospital culture on this relationship. An emailed questionnaire collected data from 239 American hospital CEO's to validate the measures and test the hypothesized relationships. The results corroborated the importance of competition intensity as determinant of hospital quality and the positive moderating impact of hospital organization culture as measured here. Future research should expand this model to include other potential determinants of hospital quality such as economic conditions and hospital size. Also, future research should explore other potential moderators and mediators for inclusion in a more elaborate model. While hospitals administrators cannot control the intensity of their competition, and are forced to do everything they can to improve hospital quality (including establishing a helpful organization culture), understanding how to measure these constructs and manage their relationships should be very useful.

Development of Cynicism in Medical Students: Exploring the Role of Signature Character Strengths and Well-Being

Reports of medical students experiencing burnout-related symptoms (e.g., cynicism) have increased in recent years. Little is known about the developmental process of this phenomenon and its relations with signature character strengths and well-being. The aim of this longitudinal analysis was to explore changes in the level of cynicism of medical students while in preclinical education. We further examined how the applicability of signature character strengths and well-being are related to this developmental process. Medical students (N = 99) participated in three online surveys over 3 years during medical school. Latent growth modeling, latent class growth modeling, general mixed modeling was conducted, and post hoc mixed ANOVA, Friedman test and Welch test analyses were examined. The results showed an increase in cynicism among medical students from first to last measurement. Two groups with distinct developmental trajectory patterns of cynicism were identified. Students with high levels of cynicism (high-level group) and students with changing levels of cynicism (increasing group) perceived higher applicability of signature character strengths in private life compared to the study context. Moreover, the high-level group experienced significantly lower psychological well-being (in particular mastery, optimism, and relationship) in their first year of medical education. This explorative study offers a comprehensive understanding of cynicism development in medical students during medical school and its relations to the applicability of signature character strengths and well-being. Prospective replication studies are needed to replicate the results obtained in this study.

Severe burnout among critical care workers in Turkey

Objectives:

To determine the prevalence and risk factors for burnout in the intensive care units (ICU) staff in Turkey. Burnout is prevelant in physicians and nurses in the ICU worldwide. Most ICU workers with burnout plan to leave their professions. Frequent replacement of ICU staff increases cost and decreases the quality of care. Prevalence and risk factors of burnout in ICU staff in Turkey are largely unknown.

Methods:

This is a cross-sectional study. Data were gathered using the Maslach Burnout Inventory (MBI) which was distributed during August 2018, among all 1161 ICU workers in Turkey.

Results:

Burnout was detected in at least one subscale in 99% of participants and in all 3 subscales in 15% of the participants. Risk factors for emotional exhaustion included female gender (odds ratio [OR]=1.87 [95% CI: 1.26-2.78]; p<0.01), alternate-day shift (OR=3.93 [95% CI: 1.66-9.30]; p<0.01), and incidence of end of life care (OR=1.01 [95% CI: 1.00-1.03]; p<0.01). For depersonalization it included alternate-day shift (OR=2.22 [95% CI: 1.15-4.26]; p<0.05), incidence of end of life care (OR=1.02 [95% CI: 1.01-1.03]; p<0.01), and for reduced personal accomplishment it included incidence of end of life care (OR=0.97 [95% CI: 0.96-0.98]; p<0.01).

Conclusion:

The results indicated that ICU staff in Turkey had a high rate of burnout.

Advanced Practice Provider Perspectives on Organizational Strategies for Work Stress Reduction

Unresolved work stress contributes to burnout, compassion fatigue, disengagement, and other work-contextualized factors. The impact of occupational stressors extends to the organization in a negative fashion as well. In 2017, advanced practice providers (APPs) from four health systems, including nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, and physician assistants, participated in a quantitative online cross-sectional survey; 754 participants responded to a free-text question related to work stress and work–family balance. Suggested organizational strategies were ordered into 29 codes, 10 subthemes, and four main themes: “reduce job stressors,” “improve leadership and operations,” “promote APP well-being,” and “maintain the status quo.” Findings are consistent with other research related to occupational stress with many of the reported strategies considered as evidence-based. Targeted interventions for reducing job stress will need to include improved autonomy for APPs, role delineation, support for work–family balance, and better communication as part of management practices.

Exploring burnout and job stressors among advanced practice providers

BACKGROUND

Minimal research exists on how engagement, burnout, work-family balance, and job stressors impact advanced practice nurses and physician assistants, collectively referred to advanced practice providers (APPs).

PURPOSE

To investigate the interrelationships among burnout, job stressors, work-family balance, and engagement with APPs.

METHODS

An online questionnaire was distributed to APPs working in four healthcare systems. A total of 1,216 APPs completed the survey. A hypothesized model was tested using structural equation modeling.

FINDINGS

There was a high correlation of job stressors with development of burnout. A significant negative effect between job stress and work engagement was supported; however, indirect effects of stress through job burnout had a stronger impact on work engagement. Higher levels of work-family balance contributed to a lower level of stress experienced by providers.

DISCUSSION

Organizational leaders desiring to improve employee engagement and reduce burnout need to focus on the significance of work-family balance to job stressors.

The Mediating Role of Burnout in the Relationship between Perceived Patient-safe, Friendly Working Environment and Perceived Unsafe Performance in an Obstetric Unit

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.'s Safety Attitudes Questionnaire - Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers' roles in ensuring optimal clinical working environment for health care employees.

Views of institutional leaders on maintaining humanism in today's practice

OBJECTIVE

To explore leadership perspectives on how to maintain high quality efficient care that is also person-centered and humanistic.

METHODS

The authors interviewed and collected narrative transcripts from a convenience sample of 32 institutional healthcare leaders at seven U.S. medical schools. The institutional leaders were asked to identify factors that either promoted or inhibited humanistic practice. A subset of authors used the constant comparative method to perform qualitative analysis of the interview transcripts. They reached thematic saturation by consensus on the major themes and illustrative examples after six conference calls.

RESULTS

Institutional healthcare leaders supported vision statements, policies, organized educational and faculty development programs, role modeling including their own, and recognition of informal acts of kindness to promote and maintain humanistic patient-care. These measures were described individually rather than as components of a coordinated plan. Few healthcare leaders mentioned plans for organizational or systems changes to promote humanistic clinician-patient relationships.

CONCLUSIONS

Institutional leaders assisted clinicians in dealing with stressful practices in beneficial ways but fell short of envisaging systems approaches that improve practice organization to encourage humanistic care.

PRACTICE IMPLICATIONS

To preserve humanistic care requires system changes as well as programs to enhance skills and foster humanistic values and attitudes.

A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare

OBJECTIVES

Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare.

SETTING AND PARTICIPANTS

Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia.

PRIMARY AND SECONDARY OUTCOME MEASURES

Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress.

DESIGN

A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures.

RESULTS

The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression.

CONCLUSIONS

The findings highlight that staff's perception of their workplace and organisational culture can have implications for staff well-being.

The role of emotional exhaustion among public healthcare professionals

Purpose

The nature of public healthcare highlights not only the need of understanding the role of emotional exhaustion in the relationship between employees’ job demands and desirable employees’ job attitudes, but also to adequate the combination of certain job resources and other organisational variables to moderate the employees’ feelings of emotional exhaustion. The paper aims to discuss this issue.

Design/methodology/approach

This viewpoint designs the theoretical approach that aims to understand the mediating role of emotional exhaustion among healthcare professionals and the capacity of certain variables to moderate it. The nature of the variables considered and the design of the theoretical model proposed highlights structural equation modelling as an optimal methodology to be used among a sample of European healthcare professionals.

Findings

Managers should be able to design strategies to mitigate, eliminate and prevent the causes of emotional exhaustion in public healthcare with the objective to improve the health and quality of life of healthcare professionals, and consequently the quality of the service provided to patients and their families.

Originality/value

This viewpoint highlights the importance of analysing the influence of employees’ emotional exhaustion on their attitudes in public healthcare. Direct relationships between emotional exhaustion and certain antecedents or consequences have been studied previously; however, studies analysing the mediating role of emotional exhaustion are very scarce and show mixed results. There are also few studies analysing the moderating role of certain job resources and other organisational variables in the relationships between employees’ job demands, employees’ emotional exhaustion and employees’ job attitudes.

Organizational Culture and Job Demands and Resources: Their Impact on Employees' Wellbeing in a Multivariate Multilevel Model

(1) The present study aims to explore the impact of job demands and resources (JDR), personal resources, and the organizational culture on workers' wellbeing and health. (2) A cross-sectional survey of Spanish workers in small and medium-sized enterprises (SMEs) was conducted with a sample of 1599 workers from 154 SMEs. A multivariate multilevel analysis was performed to analyze the different relationships. (3) In light of the results obtained, we observed that job demands were negatively associated with workers' health, while job resources were positively correlated to workers' health and wellbeing. Secondly, the different types of identification at work are positively related to job satisfaction and organizational citizenship behaviors (OCBs), but the intensity of this association differs with the form of identification. Finally, at the organization level, the dimensions of organizational culture are related differently to employees' job satisfaction, OCBs, and health; (4) these results confirm the role of organizational culture and its association with desirable outcomes, allowing us to expand the JDR model.

Burnout in Chest Physicians after Health Care Reforms: A Cross-Sectional Study in Turkey

OBJECTIVES

The health reform has recently been one of the most important items on the agenda worldwide. The aim of this study is to investigate burnout syndrome in chest physicians and exhibit its connection with reform processes.

MATERIALS AND METHODS

In this survey, the "Socio-demographic Data Form" and "Maslach Burnout Inventory" were used. Between September and November 2016, chest physicians were reached with permissions by expertise associations via e-mail groups. A sample size of 352 physicians was included in the study out of 2,349 chest physicians in Turkey.

RESULTS

Among 352 physicians, 238 (67.60%) were women, and the mean age was 38.93 (±9.97). Higher burnout scores were determined in young physicians (aged ≤35), residents, those with low income, and those with ≥55 weekly working hours. The performance-based salary system was regarded as a problem by 84.7%, and 83.5% stated that they had not enough leisure time for themselves and their families. More than a half (55.7%) indicated that they would not choose the same specialty if they ever had a chance to choose again.

CONCLUSION

We observed that most of chest physicians in Turkey experience burnout syndrome, which might be influenced by reforms in the health care system. The health system and working conditions should be dealt with immediately by health authorities and reformed in accordance with human dignity and rights to life.

Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice

BACKGROUND

Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction.

OBJECTIVE

To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians.

DESIGN

From January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations.

PARTICIPANTS

Sixty eight of the 92 (74%) study participants who received the survey provided written responses. All subjects who were sent the survey had participated in a year-long small-group faculty development program to enhance humanistic practice and teaching. As humanistic leaders, subjects should have insights into motivating and inhibiting factors.

APPROACH

Participants' responses were analyzed using the constant comparative method.

KEY RESULTS

Motivators included an organizational culture that enhances humanism, which we judged to be the overarching theme. Related themes included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities that promote humanism, and practice structures that facilitate humanism. Impediments included top down organizational culture that inhibits humanism, along with related themes of non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures.

CONCLUSIONS

While healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus.

Impact of Burnout on Organizational Outcomes, the Influence of Legal Demands: The Case of Ecuadorian Physicians

Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of efficacy dimension had more positive influence on turnover in group that believed that the Criminal Code does not affect their practice. The study is unique because incorporated new legal demands to traditional relation burnout and organizational outcomes in physicians.

Resident burnout: evaluating the role of the learning environment

BACKGROUND

Although burnout is viewed as a syndrome rooted in the working environment and organizational culture, the role of the learning environment in the development of resident burnout remains unclear. We aimed to evaluate the association between burnout and the learning environment in a cohort of Belgian residents.

METHODS

We conducted a cross-sectional online survey among residents in a large university hospital in Belgium. We used the Dutch version of the Maslach Burnout Inventory (UBOS-C) to assess burnout and the Dutch Residency Educational Climate Test (D-RECT) to assess the learning environment.

RESULTS

A total of 236 residents (29 specialties) completed the survey (response rate 34.6%), of which 98 (41.5%) met standard criteria for burnout. After multivariate regression analysis adjusting for hours worked per week, quality of life and satisfaction with work-life balance, we found an inverse association between D-RECT scores and the risk of burnout (adjusted odds ratio; 0.47 for each point increase in D-RECT score; 95% CI, 0.23 - 0.95; p = 0.01).

CONCLUSIONS

Resident burnout is highly prevalent in our cohort of Belgian residents. Our results suggest that the learning environment plays an important role in reducing the risk of burnout among residents.

The work-related stressors and coping strategies of group-employed rural health care practitioners: A qualitative study

BACKGROUND

Escalating demands on practitioners, stagnating/dwindling resources, and diminishing autonomy have heightened patient-care work-related stress. Using qualitative content/thematic analysis of responses to open-ended survey questions, plus spontaneous comments, we sought to identify rural clinicians' subjective perceptions of their workplace stressors and typical adaptive/coping strategies.

METHODS

Within a hybrid inductive-deductive approach, we framed empirical themes (derived by consensus, corroborated with text segments, and extant literature) into theory-based coding templates by which we analyzed the data.

RESULTS

Of 308 (65.1% of) recipients completing questionnaires, 290 (94%) answered open-ended questions and/or provided comments. Categorizing stressors by socio-ecology, they cited four themes: Organizational, practitioner/staff-related, patient-related, and third party-induced stressors. Organizational stressors were referenced most conspicuously. How respondents described their coping fitted the Stress, Appraisal and Coping. [Lazarus and Folkman (1984): New York, NY: Springer Publishing Company, Inc] model. Emotion-focused were referenced more than problem-focused approaches. Themes scarcely differed by demographics, except for marital status.

CONCLUSIONS

Findings highlight needs for resilience coaching, rekindling work meaningfulness, mentorship in work-home balance/limit-setting, supportive peer networks, and deeper teamwork.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC)

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC).

MATERIAL AND METHODS

A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession.

RESULTS

Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors.

CONCLUSIONS

This small-scale study of staff's attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

The relationship between leadership and physician well-being: a scoping review

To date, research has established the individual and organizational factors that impair well-being. Thus, we are aware of the organizational “cogs and wheels” that drive well-being, and there is a sense that we can potentially utilize effective leadership to push and pull these in the appropriate directions. However, reviews of leadership in health care point to the lack of academic rigor and difficulty in reaching solid conclusions. Conversely, there is an accepted belief that the most important determinant of the development and maintenance of cultures is current – and future – leadership. Thus, leadership is assumed to be an important element of organizational functioning without the requisite evidence base. Medicine is a unique organizational environment in which the health of physicians may be a significant risk factor for inadequate patient safety and suboptimal care. Globally, physicians are reporting increasing levels of job burnout, especially among younger physicians in training. Not surprisingly, higher levels of physician burnout are associated with suboptimal care for patients and medical error, as well as maladaptive coping strategies among physicians that serve to exacerbate the former. This review is a scoping analysis of the existing literature to address the central question: is there a relationship between organizational leadership and physician well-being? The objectives of the review are as follows: 1) identify the degree to which physician health is under threat; 2) evaluate the evidence linking leadership with physician well-being; 3) identify alternative ways to approach the problem; and 4) outline avenues for future research. Finally, enhancing progress in the field is discussed in the contexts of theory, methodology, and impact.

Unfashionable tales: narratives about what is (still) great in NHS general practice

BACKGROUND

There is clear evidence that general practice has become a less popular career choice and among GPs there are high levels of dissatisfaction and demotivation. Little empirical evidence has emerged to indicate which factors contribute intrinsic value to the working lives of GPs and sustain their ongoing commitment.

AIM

To understand which aspects of work continue to motivate and engage senior GPs by exploring their narrative accounts.

DESIGN AND SETTING

This was part of a qualitative study in which senior GPs and hospital specialists contributed narratives in which they reflected on their working lives.

METHOD

Individual, open interviews were conducted with eight GPs who had graduated in the early 1980s. Thematic analysis and situational analysis mapping were used to identify and connect related themes.

RESULTS

During interviews in which doctors drew on a wide range of encounters and experiences, they revealed which aspects of work were associated with greater intrinsic rewards and contributed to their continuing motivation. Having chosen careers that suited their preferred settings and working practices, they recounted adjustments made in response to new challenges and confirmed experiencing greater enjoyment when performing roles affirming their sense of providing valued health care.

CONCLUSION

This study's findings offer an alternative angle from which to consider the current unpopularity of general practice careers. The article proposes that long-term engagement of practitioners may be achieved through provision of adequate supportive resources to allow them to enact a sense of medical identity that matches with their acquired expectations of their role in the NHS.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

BACKGROUND & OBJECTIVE

Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.

DESIGN

Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed.

RESULTS

The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.

CONCLUSIONS

There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

Job demands, burnout, and engagement among nurses: A multi-level analysis of ORCAB data investigating the moderating effect of teamwork

According to the Job Demands-Resources (JD-R) model, burnout and engagement are psychological reactions that develop when individual characteristics interact with work characteristics. This study tests the JD-R model using multilevel analysis to test the main and moderating effects of teamwork effectiveness among 1156 nurses in 93 departments from seven European countries. Workload, emotional and organizational demands were positively associated with emotional exhaustion, depersonalization, and negatively with vigor. Emotional and organizational demands were negatively associated with dedication. Teamwork effectiveness was positively associated with engagement. We found no evidence for the moderating effect of teamwork effectiveness in reducing individual perceptions of demands.

Patients and health care professionals: partners in health care in Croatia?

OBJECTIVES

To explore quality in hospitals from the patients' and health care professionals' perspective in line with Act on the Protection of Patient Rights.

DESIGN

A qualitative study using a focus group design and semi-structured interviews.

METHODS

Three focus groups among health care professionals were conducted with 51 participants: 24 nurses and medical technicians, 15 physicians, 12 residents, followed by additional interviews (20 nurses and medical technicians, 10 physicians, and 2 residents). Twenty patients were interviewed at the time of their discharge from the hospital. Collected data were analysed using thematic analysis.

RESULTS

Patients identified waiting for medical treatments/procedures as the most concerning factor, followed by changes in administration procedures and admission in hospitals. From the physicians' and nurses' perspective, the main topics were inadequate resources to work with and inadequate working environment. Residents emphasized administration and lack of adequate equipment in contrast to other health care professionals. Both patients and health care professionals identified similar organizational and administrative issues impacting on service delivery.

CONCLUSIONS

Health care providers and patients equally recognize the factors that impact upon quality of care. This problem is beyond the health care professionals' possibility to solve, which is the main source of stress and burnout that influence the quality of care. These factors cannot be overcome, by either health care professionals or patient organizations working alone. Greater partnership between health providers and patient associations is needed.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Healthcare providers and patients have the same goal: good quality of care and safety. Croatia has undergone significant socio-economic and political changes, which have affected the organization of the health care system. The patient experience is positively associated with clinical effectiveness and patient safety. What does this study add? From the perspective of patients and health professionals the main concern regarding quality of care is the organization of work in hospitals. Croatian patients and health professionals show considerable agreement with regard to the administrative problems in hospitals. Solutions that include only efforts on the part of the health care worker will fail.

Application of WHO model for evaluating Patient Safety Friendly Hospital Initiatives (PSFHI) in an Eye hospital in Tehran, Iran

Background:

Patient safety is one of the major issues concerning the medical community and the World Health Organization (WHO) in most countries. This study aimed to evaluate the patient safety status in an Eye Hospital in Tehran, using the WHO model for Patient Safety Friendly Hospital Initiatives (PSFHI) in 2012.

Methods:

This Cross-Sectional study was done in an Eye Hospital in Tehran. Measurement tool was a checklist related to the PSFHI, including 140 standards in three groups of critical, core and developmental. It was covering five domains of: a) Leadership and management, b) Patient and public involvement, c) Safe evidence-based clinical practices, d) Safe environment, and e) Lifelong learning.

Results:

Compliance with critical, core and developmental standards were 77.78%, 75.29%, and 21.42% respectively. The Rates of Meeting Standards in the leadership and management, patient and public involvement, safe evidence-based clinical practices, secure environment and for lifelong learning were 66.89%, 42.85%, 75.68%, 73.68%, and 63.63% respectively.

Conclusions:

The PSFHI standards play important role in improving patient safety using leadership, safety practices and creating good working conditions and environment for the staff. So focus on these standards is essential in improving the patient safety in hospitals in Iran.