"We All Held Our Own": Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study

"The magic triangle between bed, office, couch": a qualitative exploration of job demands, resources, coping, and the role of leadership in remote work during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has necessitated many employees to work from home with immediate effect for several months, regardless of their workplace preference or situation at home. Against this backdrop, this study explores perceived job demands and resources as well as the role of leadership and coping strategies of employees and managers with little or no prior experience with working from home in the altered work environment.

METHODS

Based on the job demands-resources model, we developed an interview guide and conducted thirty-four semi-structured interviews. The interviews were transcribed and analyzed deductively-inductively using qualitative content analysis.

RESULTS

Experienced job demands include, e.g., challenging, insufficient digital communication, and lack of social exchange, while greater flexibility and work-life balance were identified as valuable resources. Regarding the role of leadership, signaling trust, keeping regular contact, and supporting employees are important. To cope with the unforeseen yet persistent work situation, participants applied creative strategies by setting up offices at home with what they had at disposal. Differences were observed between employee and managerial perceptions as well as over time during the pandemic.

CONCLUSIONS

The results expand our knowledge about healthy remote work by adding specific demands, resources, and coping strategies employees and managers experienced during the extreme situation of the COVID-19 pandemic to the picture as well as specifying the role of leadership. Moreover, our findings provide a foundation for guidelines for healthy remote work design and collaboration in times of abrupt change and crises.

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

BACKGROUND

Employee Occupational Health ('occupational health') clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could combat historical limitations of healthcare personnel mental health programmes, which have been isolated and underused.

OBJECTIVE

We aimed to document innovation and opportunities for supporting healthcare personnel mental health through occupational health clinicians. This work was part of a national qualitative needs assessment of employee occupational health clinicians during COVID-19 who were very much at the centre of organisational responses.

DESIGN

This qualitative needs assessment included key informant interviews obtained using snowball sampling methods.

PARTICIPANTS

We interviewed 43 US Veterans Health Administration occupational health clinicians from 29 facilities.

APPROACH

This analysis focused on personnel mental health needs and opportunities, using consensus coding of interview transcripts and modified member checking.

KEY RESULTS

Three major opportunities to support mental health through occupational health involved: (1) expanded mental health needs of healthcare personnel, including opportunities to support work-related concerns (eg, traumatic deployments), home-based concerns and bereavement (eg, working with chaplains); (2) leveraging expanded roles and protocols to address healthcare personnel mental health concerns, including opportunities in expanding occupational health roles, cross-disciplinary partnerships (eg, with employee assistance programmes (EAP)) and process/protocol (eg, acute suicidal ideation pathways) and (3) need for supporting occupational health clinicians' own mental health, including opportunities to address overwork/burn-out with adequate staffing/resources.

CONCLUSIONS

Occupational health can enact strategies to support personnel mental health: to structurally sustain attention, use social cognition tools (eg, suicidality protocols or expanded job descriptions); to leverage distributed attention, enhance interdisciplinary collaboration (eg, chaplains for bereavement support or EAP) and to equip systems with resources and allow for flexibility during crises, including increased staffing.

Analysis of influencing factors of job demands of healthcare workers working in mobile cabin hospitals in China

AIM

To explore the job demands of healthcare workers (HCWs) working in mobile cabin hospitals in Shanghai and identify the influencing factors.

DESIGN

The study had a cross-sectional design.

METHODS

Using the convenience sampling method, we selected 1223 HCWs (medical team members) working in these mobile cabin hospitals during April-May 2022. The findings of the general information questionnaire and the hierarchy scale of job demands of HCWs working in mobile cabin hospitals were used for the investigation.

RESULTS

The total score of job demands of the included HCWs was 132.26 ± 9.53; the average score of the items was 4.73 ± 0.34. Multivariate linear regression analyses showed that the following HCWs had significantly higher job demands: female HCWs and HCWs who received psychological training or intervention during the COVID-19 pandemic, were satisfied with the doctor/nurse-patient relationship, received support from family members/friends/colleagues, believed that the risk of working in mobile cabin hospitals was high, had adapted to the working environment of mobile cabin hospitals and had college/undergraduate level of education. They would benefit from increased social support and better training in terms of psychological coping mechanisms(both theoretical knowledge and applicable skills) and COVID-19 prevention,control and treatment abilities.

Hidden and Understaffed: Exploring Canadian Medical Laboratory Technologists' Pandemic Stressors and Lessons Learned

(1) Background: The COVID-19 pandemic has highlighted the critical role of medical laboratory technologists (MLTs) in the healthcare system. Little is known about the challenges MLTs faced in keeping up with the unprecedented demands posed by the pandemic, which contributed to the notable staff shortage in the profession. This study aims to identify and understand the stressors of MLTs in Canada and the lessons learned through their lived experiences during the pandemic. (2) Methods: In this descriptive qualitative study, we conducted five semi-structured focus groups with MLTs working during the pandemic. The focus group sessions were audio-recorded and then transcribed verbatim. Thematic analysis was used to inductively code data and identify themes. (3) Results: A total of 27 MLTs across Canada participated in the study. Findings highlighted four key themes: (i) unexpected challenges navigating through the uncertainties of an ever-evolving pandemic; (ii) implications of staff shortage for the well-being of MLTs and quality of patient care; (iii) revealing the realities of the hidden, yet indispensable role of MLTs in predominantly non-patient-facing roles; and (iv) leveraging insights from the COVID-19 pandemic to enhance healthcare practices and preparedness. (4) Conclusion: The study provides in-depth insight into the experiences of MLTs across Canada during the pandemic. Based on our findings, we provide recommendations to enhance the sustainability of the laboratory workforce and ensure preparedness and resiliency among MLTs for future public health emergencies, as well as considerations as to combating the critical staff shortage.

What helps hospital staff in times of crisis: qualitative results of a survey on psychosocial resources and stressors in German hospitals during the COVID-19 pandemic

Background

Even before the COVID-19 pandemic, hospital workers faced a tremendous workload. The pandemic led to different and additional strain that negatively affected the well-being of employees. This study aims to explore psychosocial resources and strategies that were used by hospital staff.

Methods

In the context of an intervention study, employees of three German hospitals were questioned in writing in summer and fall 2020. Five open-ended questions about the pandemic were asked to capture corresponding effects on daily work routine. Answers of 303 participants were evaluated using structuring qualitative content analysis.

Results

Significant stressors and resources were identified in the areas of work content and task, social relations at work, organization of work, work environment and individual aspects. Stressors included, for example, emotional demands, conflicts, an increased workload, time and performance pressure. Important resources mentioned were, among others, the exchange with colleagues and mutual support. Sound information exchange, clear processes and guidelines and a positive work atmosphere were also important. In addition, the private environment and a positive mindset were perceived as helpful.

Conclusion

This study contributes to a differentiated understanding of existing psychosocial resources of hospital staff in times of crisis. Identifying and strengthening these resources could reduce stress and improve well-being, making hospital staff better prepared for both normal operations and further crisis situations.

Under pressure - The working situation of Swedish healthcare managers during the first wave of COVID-19

Introduction

The aim of this study is to provide insight into the psychosocial work situation of hospital managers during the first wave of the COVID-19 pandemic.

Methods

Mixed-effect modelling was used on survey data on job demands, job resources, job motivation, and work-life balance among over 500 managers working in 55 departments of a large Swedish university hospital in 2019 and 2020. Responses from 6011 employees were then used to stratify the analysis for COVID-19 exposure. Inductive content analysis was applied to open-ended questions on the managers' views on organisational prerequisites during the onset of the pandemic.

Results

The proportion of managers reporting difficulties with role clarity, quantitative demands, decision-making authority, and emotional support, time for recovery at work, motivation deficits, or problems with work-life balance clearly increased during the first wave of the pandemic. The proportion of managers reporting negative responses was higher in departments with high COVID-19 exposure. The qualitative analysis shows that overall governance in terms of clear, fair, and well-communicated routines, resource allocation, and division of responsibilities constituted an important framework for managerial during the crisis. First-line managers also require a mandate to re-organize their roles and their teams to successfully adapt to the situation. Organisational and social support was also important resources.

Discussion

This is the first study investigating healthcare managers' work situation during the first wave of the COVID-19 pandemic in a Swedish context. As expected, it indicates an increasingly strained work situation during the crisis, but it also provides findings on organisational prerequisites that allow healthcare managers to cope with stressful situations. In line with previous research on organisational resilience, the study provides suggestions for how higher-level managers can act in order to provide front-line managers with the organisational prerequisites they need to adapt, learn and develop successfully during times of unpredictability, insecurity, and rapid change in order to offer the best possible support to health care workers.

Exploring Managerial Job Demands and Resources in Transition to Distance Management: A Qualitative Danish Case Study

Organizations worldwide have shifted to working from home, requiring managers to engage in distance management using information and communication technologies (ICT). Studies show that managers experience high job demands and inadequate guidance during COVID-19; therefore, the transition to distance management raises questions about the increase in managerial job demands and the impact on managers' well-being. This study aims to explore first-line managers' perceptions of job demands and available resources during the first year of the pandemic and understand the implications for first-line managers' well-being. First-line managers face complex and conflicting demands, making them more challenged in their management task than other management levels. We used the job demands-resources model in this qualitative, longitudinal empirical study. The study draws on 49 semi-structured interviews with seven first-line managers from a large pharmaceutical company in Denmark, whom we followed throughout the first year of the COVID-19 pandemic, from May 2020 to May 2021. Our findings suggest that the first-line managers perceived increased emotional and practical demands. While the managers appreciated the initial guidance provided by the organization, they perceived the organizational support as outdated and superficial. As a result, to cope with the uncertainty caused by the pandemic and the shift to distance management, the managers relied on work engagement enablers such as social support. Even though the COVID-19 pandemic portrays unique circumstances in transitioning to distance management that require further exploration outside the COVID-19 context, the insights from this study can assist organizations in developing awareness about transitions to better support first-line management to embrace changes in the future.

Within- and between-person changes in work practice and experiences due to COVID-19: Lessons learned from employees working from home, hybrid working, and working at the office

Introduction

In response to the requirement of keeping social distance during the COVID-19 outbreak a lot of employees needed to change from a regular office to a home-office at short notice. The aim of the present study is to explore these employees' experiences and evaluate changes in their work situation during the pandemic.

Method

A mixed-method design was used with panel data collected twice in an insurance company in Norway. The first dataset was collected in December 2020 (Time 1; N = 558), with a follow up in March 2021 (Time 2; N = 601).

Results

Our study indicated that employees' main reasons for working from home were to keep social distance, avoid contagion and protect their loved ones. Flexibility, timesaving and more time with family and friends were also motivators. Most employees reported that they had the necessary technical equipment to work from home and wanted more opportunity to use their home office in the future. General Linear Models (GLM) indicated that work-family balance and workload were the same across age, gender, and worksites. Women and employees working from home reported more fear of being infected by COVID-19 at work. Younger employees reported experiencing less social contact with colleagues than normal during the pandemic, compared to the older employees. Overall, employees working at home were more positive toward digital solutions and digital meetings than those at the office. Repeated measures MANOVA showed that the work motivation and digital competence decreased over time for all worksites. Productivity increased for home-office employees but decreased for the hybrid and work-office employees.

Discussion

This paper contributes to knowledge of employees' experiences with different worksite solutions, which will be useful for anticipating employees experience in the future with more hybrid work.

Burnout among Health Care Professionals during COVID-19

The present study examined organizational, situational (i.e., COVID-19-related), and psychological factors associated with burnout during the COVID-19 pandemic among 268 health care professionals in Norway. A total burnout score based on the Burnout Assessment Tool (BAT), the four core BAT subscales (i.e., Exhaustion, Mental Distance, Cognitive Impairment, and Emotional Impairment), and the COVID-19 Burnout Scale served as the dependent variable. Among the results, organizational factors such as work-home conflict, workload, and role conflict were positively related to burnout. Although autonomy and colleague support were negatively related to burnout, support from leaders was positively related to it, which might suggest a suppressive effect. Organizational factors explained most of the variance in general burnout (i.e., BAT Total), whereas situational (i.e., COVID-19-related) factors (e.g., involvement with COVID-19, fear of COVID-19, and COVID-19-induced stress) seemed to better explain COVID-19 burnout. COVID-19-oriented actions were related only to Mental Distance. Psychological factors such as meaning were negatively related to BAT Total, Exhaustion, and Mental Distance, whereas a breach of the psychological contract was related to all subscales. Such results suggest that organizational and situational factors contribute differently to general and COVID-19 burnout and that administering pandemic-specific assessment tools can clarify how the pandemic has affected mental health.

Nurses’ Work Environment during the COVID-19 Pandemic in a Person-Centred Practice—A Systematic Review

The work environment and especially the psychosocial work environment influence the mental and physical well-being of employees. The aim of this study was to identify and analyse the state of knowledge regarding nurses’ work situation, health, and person-centred work during the COVID-19 pandemic through a systematic review. Methods: Systematic Review, nine included articles. The theoretical swAge model was used as the framework in a deductive content analysis. Results: The result was presented in the nine determinate areas from the swAge model and showed that all nine determinate areas of the swAge model were of importance to both the nurses’ sustainable work situation during the COVID-19 pandemic and to person-centred care. The COVID-19 pandemic has had a negative effect on nurses’ health, both physically but especially psychologically, with high levels of depression, anxiety, and burnout. Nurses experienced a lack of control and support from organizations. They had to work with limited resources and sometimes care for patients beyond their expertise. Conclusion: There is a further need for more studies that address person-centredness from an organisational perspective with the intention to develop strategies and measure activities on how to make the nurses’ work situation more sustainable, and to increase their ability to give more person-centred care.

The Cost-Effectiveness Analysis of the Productivity Measurement and Enhancement System Intervention to Reduce Employee Work-Related Stress and Enhance Work Performance

Background: The study evaluates the cost-effectiveness of the Productivity Measurement and Enhancement System (ProMes) intervention to reduce employee work-related stress and enhance work performance. Methods: A prospective cohort study was used to undertake the evaluation from a business perspective. Objective workload data and stress were gathered repeatedly over a 17-month period (i.e., before and after intervention). Independent t-test and an interrupted time series (ITS) analysis were used in the analysis. The average cost-effectiveness ratio (ACER) was calculated as a ratio of the average cost of the intervention and the effect sizes of the different outcomes to reflect the average cost per clinician for each unit change in outcome. Results: Based on the results of the ITS analysis, an expenditure of EUR 41,487 was linked with no change in stress levels, according to the ACER for stress. In addition, the expenditures associated with each unit change were EUR 3319 for overall tasks per hour worked, EUR 2761 for visits per hour worked, EUR 2880 for administrative tasks, but EUR 9123 for answering phone calls. Conclusions: ProMes is not cost–effective in terms of work-related stress levels, but the intervention seemed to have increased efficiency in some objective work performance measures, albeit at a relatively high extra cost.

Return to Work during the COVID-19 Outbreak: A Study on the Role of Job Demands, Job Resources, and Personal Resources upon the Administrative Staff of Italian Public Universities

Background: Compared to healthcare workers and teleworkers, occupational wellbeing of employees who continued or suddenly returned to work during the COVID-19 pandemic have received less attention thus far. Using the Job Demand–Resource model as a framework, the present study aimed at evaluating the role of job demands and job and personal resources in affecting emotional exhaustion among university administrative staff. Methods: This cross-sectional study analyzed data collected through an online questionnaire completed by 364 administrative employees that continued working in presence (WP) and 1578 that continued working blended (WB), namely, partly remotely and partly in presence. Results: Among job demands, quantitative job demand overloads and perceived risk of being infected were positively associated with higher levels of emotional exhaustion. Among job resources, colleague support was significantly associated with lower emotional exhaustion for both WB and WP, whereas supervisor support and fatigue management were salient only for WB. Among personal resources, personal contribution in managing COVID-19-related risk at work emerged as a protective factor for emotional exhaustion. Conclusion: Insights for the development of targeted preventive measure for a more psychologically safe and productive return to work can be derived from these results.