Sources of burnout among healthcare employees as perceived by managers

Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites

OBJECTIVE

Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave.

DESIGN

Cohort study.

SETTING AND INTERVENTION

Five Danish hospitals.

PARTICIPANTS

A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study.

INTERVENTION

From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group.

OUTCOME MEASURES

Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention).

RESULTS

Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group.

CONCLUSION

The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.

Perception Differences in Burnout: A Study of Swiss-German Managers and Subordinates

OBJECTIVE

Burnout differences between management and subordinates can affect preventative interventions chosen by management. Our study investigated if these differences in experiences of burnout (1) are dimension specific (2) correspond to differences in perceptions of the effectiveness of burnout prevention methods.

METHODS

Two hundred thirty nine managers and 217 subordinates completed an online survey that categorized their self-reported experiences into the three dimensions of burnout and investigated their perceptions of the effectiveness of burnout prevention techniques.

RESULTS

Contrary to the literature, Swiss-German managers experienced greater exhaustion than subordinates. Despite this experiential difference, their perceived effectiveness of burnout prevention methods did not differ.

CONCLUSIONS

Contextual differences explain dimension-specific differences in self-reported experiences of burnout at different hierarchal levels; however, these did not contribute to leader distance or perception gap either due to foundational or context-specific factors.

What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand

Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal.

Retaining experienced hospital administrators: a neglected topic in healthcare

The sharp increase in the present need for healthcare services has been attributed to the expanding population of older adults (those above the age of 65 years) and the increasing number of aging healthcare professionals seeking retirement without enough qualified replacements. In this regard, retaining experienced healthcare professionals, especially hospital administrators, may be the key to managing this growing demand for healthcare services at present and for the future. Veteran hospital administrators have many years of experience and can offer a wide array of skills and competencies to their organization. As such, organizations should make every effort to retain these individuals and implement efforts for their continued contribution to the healthcare industry. Given the nature of their work and the various changes accompanying aging, experienced hospital administrators may have specific personal and professional challenges that may be compelling them to consider retirement options. The authors' primary focus was to identify the unique issues associated with retaining experienced hospital administrators and to propose certain accommodations and recommendations to promote their continued and valued contributions to the healthcare industry.

What happens to health professionals when the ill patient is the health care system? Understanding the experience of practising medicine in the Romanian socio-cultural context

OBJECTIVES

Our aims were to investigate the sources of work strain and stress, and the way in which they are experienced by Romanian health professionals in a work context shaped by the ongoing 20 years long reform of the national health care system.

DESIGN

An exploratory, qualitative design was used to investigate medical professionals' perceptions of stress and work strain.

METHODS

Twenty eight interviews and two focus groups were conducted with 38 physicians, residents and nurses, between the age of 26 and 53. A semi-structured interview guide was used for data gathering and the major themes were identified using thematic analysis of the transcripts.

RESULTS

Three themes emerged in the analysis: governance and health system management, scarcity of resources, and health system reputation. Health professionals described the image of a suffering health system, exhausted by an inconsistent management plan, underfunded and understaffed; a system that is a constant source of discontent, bitterness and doubts for them and their patients.

CONCLUSIONS

Romanian health professionals' experiences reveal a health care system which after 20 years of reform managed to shape a learned helplessness culture within the medical community and drive a large proportion of its workforce across the borders.

Oral health -- not a priority issue a grounded theory analysis of barriers for young patients with disabilities to receive oral health care on the same premise as others

Oral health problems are reported more frequently in children with disabilities, but the reasons for this are not fully known. The present study was conducted to illuminate and to gain a deeper understanding of the possible barriers preventing children with disabilities from receiving oral health care on the same premise as others. Transcribed in-depth interviews with 65 informants (14 parents, 18 dental health-care professionals, 17 medical health-care professionals, and 16 individuals with disabilities) were analysed in open, axial, and selective coding processes according to Grounded Theory. The results showed that no-one seems to take an overriding responsibility for the oral health of young patients with disabilities. This was described in a formal theory showing that defective knowledge about importance of oral health, limited ability to focus on oral health, and uncertainty in treating the unknown in patients, family, and dental and medical health-care professionals result in a situation in which oral health is left out in young patients with disabilities; it is not a priority issue.

Role conflict, role ambiguity, and job satisfaction in nurse executives

This article reports the results of a cross-sectional correlational survey design of nurse executives' (NEs') views on role conflict, role ambiguity, job satisfaction, and depression. A total of 380 surveys were returned from 1000 randomly selected participants. Four instruments were utilized, 1 for demographic data and 3 established instruments. Results indicated that the respondents had low to moderate amounts of role ambiguity, high levels of job satisfaction, low levels of depression, a negative relationship between role conflict and role ambiguity and job satisfaction, and a positive relationship between role conflict and depression. Furthermore, although levels of role conflict are decreasing, levels of role ambiguity are increasing. Neither educational level nor age was related to the dependent variables. Role conflict and role ambiguity are both forms of role stress. This study indicates that stress levels are not overwhelming to the NE and may be encouraging development of required skills. Healthcare organizations will continue to evolve and increase in complexity putting pressure on NEs in their many roles. Although this study did not consider strategies for coping with stress, this important avenue needs to be considered as NEs move forward with more extensive roles in the leadership of our healthcare system.

Nurses’ ethical reflections on caring for people with malodorous exuding ulcers

The aim of this study was to illuminate nurses’ reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants’ reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to ‘do good’ and ‘be good’. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to ‘do good’ for patients and ‘be good’ nurses.

Burnout in health-care professionals during reorganizations and downsizing. A cohort study in nurses

BACKGROUND

Burnout is a psychological reaction triggered by interaction between personal characteristics and stress factors. Reorganizations and downsizing with increased workload imply stress for health-care professionals. This is a study of burnout in nurses during a period with two comprehensive reorganizations.

METHODS

In this quasi-experimental retrospective cohort study, burnout was assessed in nurses with long work experience in three surveys during a 30 months' period with two comprehensive reorganizations and downsizing of a hospital unit with mostly seriously ill patients with cancer. Burnout was measured with Bergen Burnout Indicator (BBI) at each survey, and "Sense of Coherence" (SOC) with Antonovsky's questionnaire at the last survey.

RESULTS

One man and 45 women aged 30 to 65 years were invited to the surveys. There was a significant increase in burnout during the study period, the mean increase in BBI-score was 12.5 pr year (p < 0.001). The proportion of satisfied nurses at the first and last survey were 84% and 35% respectively, and the proportions with burnout were 0% and 29% respectively (p < 0.001). Except for auxiliary nurses with experience from the medical department, all subgroups experienced a significant increase in BBI. Burnout was associated with low SOC (p < 0.001, r square 0.33).

CONCLUSIONS

There was a significant development of burnout in a group of nurses during a period with two reorganizations and downsizing. Burnout was associated with low SOC. Working with seriously ill patients with cancer has probably made the nurses exceptionally vulnerable to the stress and workload related to the reorganizations.

Being closely connected to health care providers experiencing burnout: putting one's life on hold to help

Being closely connected to a person experiencing illness may be a trying experience.This study aimed to illuminate meanings of being closely connected to health care providers experiencing burnout. Ten interviews were conducted with five people closely connected (i.e., family members or supportive friends) to health care providers recovering from burnout. The interviews were tape-recorded and transcribed verbatim, and the resulting text was interpreted using a phenomenological-hermeneutic method. One consequence of being closely connected to health care providers experiencing burnout is putting one's life on hold to help. In facing an almost unmanageable burden, those closely connected revealed their own suffering, emphasizing their need for support. Health care professionals need to be aware that those who are closely connected to a person experiencing burnout may lack knowledge about burnout and its related challenges. It is to be hoped such knowledge would allow significant others to better support the person experiencing burnout and promote their own health.