Effects of a randomized intervention to improve workplace social capital in community health centers in China

The study protocol for the randomized controlled trial of the effects of a theory-based intervention on resilience, social capital, psychological wellbeing, and health-promoting lifestyle in healthcare workers

BACKGROUND

The workplace has been identified as a key determinant of health status. There is evidence of innumerable health problems among employees, particularly healthcare workers. Against this background, a holistic-systemic approach together with a good theoretical framework is required to reflect on this issue, and to support the design of effective interventions to promote the health and wellbeing of the given population. The present study aims to evaluate the effectiveness of an educational intervention in improving resilience, social capital, psychological wellbeing, and health-promoting lifestyle in healthcare workers, utilizing the Social Cognitive Theory integrated into the PRECEDE-PROCEED model.

METHODS

This randomized controlled trial will be performed on a large sample of the employees working in two healthcare centers in the city of Shiraz, Iran. The study will proceed with the healthcare workers of one city being given the educational intervention and the healthcare workers of the other city serving as a control group. Using a census method, all healthcare workers in the two cities will be informed of the trial and its purpose, and then invitations to join the study will be issued. The minimum sample size required has been calculated as 66 individuals in each healthcare centers. Recruitment to the trial will by systematic random sampling of eligible employees who submit an expression of interest in joining the trial, and subsequently give informed consent. Data will be collected through a self-administered survey instrument at three stages: at baseline, and both immediately and three months after the intervention. The experimental group members should participate in at least eight of the ten weekly educational sessions of the intervention and complete the surveys in the three stages. There is no educational intervention for the control group, and they simply experience some routine programs, and complete the surveys at the same three timepoints.

DISCUSSION

The findings will provide evidence for the possible effectiveness of a theory-based educational intervention to improve resilience, social capital, psychological wellbeing, and health-promoting lifestyle among healthcare workers. If the educational intervention is found to be effective, then its protocol will be exploited in other organizations to boost resilience. Trial registration IRCT20220509054790N1.

Positive association between social capital and the quality of health care service: A cross-sectional study

BACKGROUND

Social capital is an acknowledged theoretical concept in work environment research focusing on collective resources that arise from social networks between employees in the workplace. Social capital is divided into bonding (in the work unit), bridging (between work units), and linking social capital (between the work units and management). However, only a few studies have investigated the relationship between social capital and the quality of health care, which is the key outcome of hospital services.

OBJECTIVE

We investigated the associations between bonding, bridging and two types of linking social capital with the self-reported quality of health care services among Danish hospital employees. Next, we directly compared how social capital, workload and work pace each affected the quality of health care.

DESIGN

A cross-sectional study at Regional Hospital West Jutland, Denmark.

DATA

Questionnaire data were collected from 1589 Danish hospital employees. We used validated scales for social capital, workload, and work pace and self-developed scales for clinical quality, quality of patient involvement, and overall professional quality.

METHODS

Binary logistic regression analyses were conducted.

RESULTS

The analyses showed significant, positive associations of bonding and bridging social capital with all types of quality and negative associations between workload and all types of quality. The work pace was negatively associated with clinical quality. When covariates were included in the model, the associations remained statistically significant and showed no decrease in odds ratios. The marginal effects showed that when bonding and bridging social capital were increased by a single scale point, the predicted probability for a high clinical quality increased by an average of 0.5 percentage points. This increase corresponds to a change in the predicted probability of self-reported high clinical quality from 10% for the lowest reported bridging social capital to 54% for the highest reported bridging social capital. For workload and work pace, the effects were -0.2 and -0.3 percentage points, respectively.

DISCUSSION & CONCLUSIONS

This study adds to the literature on positive work environment factors by focusing on social capital and the importance of well-functioning relationships within and especially between hospital units for high-quality health care. Hence, bridging and bonding social capital should be included in theoretical frameworks, as well as in hospital strategies and work environment guidelines to potentially improve the quality of health care services. However, further studies are needed to develop and test the effects of specific social capital interventions on the quality of health care services.

Facing the Post-Pandemic Challenges: The Role of Leadership Effectiveness in Shaping the Affective Well-Being of Healthcare Providers Working in a Hybrid Work Mode

The COVID-19 pandemic has brought new challenges to the medical industry, including hybrid work, in which specialists can perform some of their duties remotely, in addition to physical contact with patients and their teams. Hybrid work provides opportunities, but also generates difficulties (e.g., accurate long-distance diagnosis); therefore, there is a need to ensure the well-being of healthcare workers, especially in the context of leadership strategies. As there is little research on leadership practices in remote and hybrid medical worker management, this study analyses the relationship between certain behavioural strategies and competencies of leaders and the affective well-being of hybrid employees. The research was conducted among a group of employees (N = 135) from seven countries who provide healthcare in a hybrid model. The correlations between the variables showed the statistical significance of all leadership strategies introduced into the model and focused on building involvement (employee empowerment and team orientation), creating a shared vision, defining clear goals and strategies, promoting adaptability (change management, promotion of organisational learning and patient focus), managing consistency through shared values, agreement and effective coordination, as well as competencies such as communicativeness, credibility, self-development and digital readiness. Despite the significance of all the relationships, the linear regression showed that the variability of affective well-being was explained mainly by the adaptability leadership strategy. The results of the study expand the knowledge on the competencies of healthcare leaders, and shed new light on the management of medical employees performing remote and hybrid work. Because such research into well-being has not been published to date, the analysis begins an important discussion on redefining leadership in the healthcare sector, taking into account the digital transformation.

Reliability and Validity of the Chinese General Social Capital Scale and Its Effect on Physical Disease and Psychological Distress among Chinese Medical Professionals

The study was designed with two objectives. The first was to assess the factor structure, internal consistency reliability, and preliminary psychometric properties of the Chinese version of the Chinese-translated General Social Capital Scale (GSCS) in a sample of Chinese medical professionals. The second was to investigate the association between general social capital, physical disease, and psychological distress using the same Chinese sample. The English version of the GSCS was translated into Chinese, and its factor structure, estimates of internal consistency reliability, and psychometric properties were examined in a representative sample of medical professionals. In particular, a total of 3367 participants in Shandong Province, China were identified using the multi-stage stratified sampling method. In addition to the GSCS, preliminary data were collected using self-report instruments that included questionnaires on physical diseases, psychological distress, and general sociodemographic information. Results include internal consistency reliability estimates at 0.933 and acceptable values of the Guttman split-half coefficients for the GSCS and its subscales. The Kaiser–Meyer–Olkin value for the Chinese GSCS was 0.933, and the p-value of Bartlett’s test was less than 0.001. Exploratory factor analysis supported nine components of the scale with an acceptable cumulative rate (66.63%). The study further found a negative relationship between physical diseases, psychological distress, and social capital. The Chinese version of the GSCS has a satisfactory factor structure, reliability estimates, and satisfactory evidence of concurrent validity estimates for medical professionals from various demographic backgrounds. The current scale holds promise for wide use in future investigations on Chinese populations.

Enhancing the social capital in industrial work teams: results from a participatory intervention

We investigated the effects of an intervention aiming at enhancing four types of team-level social capital (bonding, bridging and two types of linking social capital) in six dairy plants with a total of 60 teams. Social capital and work engagement was assessed in baseline and follow-up surveys. The follow-up period was approximately 20 months, comprising an intervention period of 12 months. Intervention effects were assessed by comparing changes in team-level mean-scores for teams that had developed action plans with teams that had not. Results show that teams that had developed action plans generally showed a larger increase in social capital and work engagement than other teams. Differences were statistically significant for linking social capital towards the workplace as a whole and work engagement. However, effect sizes indicate an effect of the action plans despite the lack of statistical significance. Moreover, the self-reported level of implementation of the action plans was associated with the size and direction of the observed change.

Can a participatory organizational intervention improve social capital and organizational readiness to change? Cluster randomized controlled trial at five Danish hospitals

AIM

This study investigates the effect of a participatory organizational intervention on social capital and organizational readiness for change.

DESIGN

Cluster randomized controlled trial.

METHODS

In 2016, 27 departments from five hospitals in Denmark were randomly allocated at the department level to 1 year of participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The participatory intervention consisted of 2 × 2 hr workshops, where managers, 2-5 healthcare workers from each department, and the hospital's health and safety staff, developed action plans for implementing solutions for improving the use of assistive devices at the department throughout the 1-year intervention period. Workplace social capital: (a) within teams (bonding); (b) between teams and nearest leaders (linking A); and (c) between teams and distant leaders (linking B) and organizational readiness for change were measured using questionnaires at baseline, 6, and 12 months.

RESULTS

No group-by-time interaction occurred for any of the outcome measures. However, explorative post hoc analysis showed within-group improvements in bonding and linking B social capital and organizational readiness for change following the participatory intervention.

CONCLUSION

Participatory organizational interventions may improve social capital within teams and between teams and distant leaders and organizational readiness for change.

IMPACT

Implementing participatory interventions at the workplace may be a cost-effective strategy as they provide additional benefits, e.g., increased social capital and improved organizational readiness for change, that exceed the primary outcome of the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02708550) March 2016.

Quality of supervisor behaviour, workplace social capital and psychological well-being

Background

Employees with a higher level of workplace social capital (i.e. relationships, trust and reciprocity at work) have a lower risk of mental health problems. Supervisor behaviour may be a predictor of workplace social capital.

Aims

To examine the associations between supervisor behaviour, workplace social capital and psychological well-being.

Methods

We conducted a secondary analysis of the sixth European Working Conditions Survey. The study sample included 28 900 employees in 35 European countries with an immediate line manager. Depression was assessed with the WHO-5 Well-Being Index. Supervisor behaviour quality and workplace social capital were each measured with a 6-item question. Association between quality of supervisor behaviour and workplace social capital was analysed using a hierarchical linear modelling. A mediation analysis was conducted by using hierarchical logistic models of depression with and without workplace social capital index.

Results

A higher supervisor behaviour quality index was associated with an increased workplace social capital index (β, 0.55; 95% confidence interval [CI], 0.51–0.59). A higher workplace social capital index was associated with lower odds of depression (odds ratio [OR], 0.89; 95% CI, 0.87–0.90). A higher supervisor behaviour quality index was associated with lower odds of depression (OR, 0.90; 95% CI, 0.89–0.92); 58% of the effect was mediated by workplace social capital.

Conclusions

Our findings support the hypothesis that better supervisor behaviour quality increases workplace social capital and contributes to psychological well-being of employees. This may be useful for planning organizational interventions to enhance mental health of workers.

Disease causing poverty: adapting the Onyx and Bullen social capital measurement tool for China

Background

Disease-causing poverty is a serious problem in rural China, where social capital can mediate the disease—poverty relationship. However, there is no generally accepted reliable, robust and viable measure of social capital for China’s unique socio-cultural context. This study adapts for China the widely used Onyx and Bullen social capital measurement scale and tests the validity and reliability of a modified Chinese Onyx-Bullen general scale, the Chinese Onyx-Bullen health scale, for a disease-causing-poverty subpopulation in rural China.

Methods

We conducted the forward and backward translation procedure and cross-cultural adaptation process to derive the 34 item Chinese Onyx-Bullen general scale. Next we collected through face-to face interviews a sample of disease-causing poverty population in rural Shandong province in China to test a 29 item modified Chinese Onyx-Bullen general scale for a health subpopulation. Most of the rural respondents had no formal work, so 5 work-related items in the Onyx-Bullen general scale were deleted in the Chinese Onyx-Bullen health scale. Exploratory factor analysis was conducted to evaluate the structure, validity, internal consistency and reliability of the Chinese Onyx-Bullen health scale. SPSS21.0 software was used for data analysis.

Results

A total of 467 people completed the scale. For the 29-item scale, a better simple structure was found when the number of factors was limited to 8. The absolute values of inter-factor correlations were in the range of 0.004 to 0.213 and the Kaiser-Meyer-Olkin value was 0.834. All the eight factors explain a total of 59.51% of the variance. The total scale had a Cronbach’s alpha = 0.868, in which seven of the eight factors had Cronbach’s α greater than 0.5.

Conclusion

The Chinese health version of the Onyx-Bullen general social capital scale showed an adequate reliability and validity in a rural disease-causing poverty subpopulation in Shandong province, providing the first general, robust, consistent and reliable measure of social capital in China. The Chinese Onyx-Bullen general social capital scale provides a scale for testing social capital in China or for modification along the lines of the Chinese Onyx-Bullen health scale.

Enhancing the social capital in industrial workplaces: Developing workplace interventions using intervention mapping

Social capital in the workplace has been found to be associated with employee wellbeing and work engagement. Yet, evidence of effects of interventions to enhance the social capital are lacking. The intervention mapping method has been described as a useful tool for developing workplace interventions but it is very resource consuming. We aimed to develop an adapted version of the intervention mapping method which is more practically feasible to apply. To get insight into strengths and weaknesses of the adapted method, we applied it and conducted interviews with staff at six companies. The interviews revealed that the action plans developed using the adapted intervention mapping method were generally perceived as relevant and that the action plans had a positive effect on the social capital. However, the implementation of the action plans had been a challenge. In conclusion, the adapted intervention mapping method appears to be suitable for developing interventions to enhance the social capital in the workplace. However, more attention to the implementation of the action plans needs to be incorporated into the method. Suggestions to enhance the implementation included the involvement of the management in the implementation and monitoring of the implementation of the action plans as well as integrating the action plans into existing procedures in the workplace.

Investigation into the metric properties of the workplace social capital questionnaire and its association with self-rated health and psychological distress amongst Greek-Cypriot registered nurses: cross-sectional descriptive study

Background

Social capital can been described as an individual or a collective attribute, with structural and cognitive components, and a bonding, bridging and linking typology. While extensively studied in the community, studies in occupational settings are sparse by comparison. Furthermore, there is no uniformity in its measurement. This study investigated the construct validity of a Workplace Social Capital questionnaire (WSC), originally developed in the Finnish Public Sector occupational cohort, in a different socio-cultural setting (Cyprus), language (Greek) and occupational group (Registered Nurses). It also explored its criterion concurrent validity according to observed association with self-rated health and psychological distress.

Methods

Participants were 10% of all registered nurses (N = 362) who responded to the 8-item WSC scale during a nationwide educational programme. A unidimensional model was compared with the postulated two-factor (structural vs cognitive) and three-factor model (bonding, bridging, linking) in Confirmatory Factor Analyses. The association with self-rated health (0–100 Visual Analogue Scale) and mental distress (GHQ-12 ≥ 4) was assessed in linear and logistic regression models.

Results

A bonding (Cronbach’s a = 0.76), bridging (a = 0.78) and linking (a = 0.89) structure explained 77.6% of the variance and was a better fit as indicated by goodness of fit indices. Elevated odds of mental distress and poorer self-rated health were observed among participants with the lowest levels of perceived workplace social capital. In adjusted models, associations appeared stronger with bonding social capital (adjOR of mental distress = 2.71 95% CI = 1.08, 6.79) while those with the highest scores rated their health higher by 8.0 points on average (95% CI = 2.1, 13.8). Low linking social capital was also associated with poorer health but no consistent associations were observed with bridging.

Conclusion

While associations appeared stronger with bonding and linking, this may reflect a weakness of the measure to fully capture bridging social capital. Even though, this aspect might need strengthening, the WSC showed good metric properties in a different setting, language and occupational group. Cross-national and cognitive validation studies are needed.

Associations between psychosocial work environments and social capital: a multilevel analysis study in a Chinese context

BACKGROUND

Understanding the determinants of social capital is the prerequisite to building social capital. However there was few studies to explore factors related to workplace social capital. We aim to examine associations between psychosocial work environments and social capital in a Chinese context through a cross-sectional study.

METHODS

A cross-sectional study was conducted in Shanghai, China from December 2016 through March 2017. In total, 2380 workers from 32 workplaces were randomly sampled by a two-stage sampling procedure. Workplace social capital (WSC), psychosocial work environments (PWEs), and workplace Chinese Confucian values (CCVs), were assessed using validated and psychometrically tested measures. Multilevel ordinal regression models were used to examine the associations of WSC with individual- and workplace-level PWEs and workplace CCVs after controlling for individual socioeconomic characteristics.

RESULTS

After controlling for individual socioeconomic characteristics, all individual-level PWEs (unstandardized coefficients [B] ranging from 0.280 to 2.467) were positively associated with WSC. Individual-level workplace CCVs had mixed associations with WSC-high individual levels of respect for authorities (B: 0.325; 95%CI: 0.134, 0.516) and altruism (B: 0.347; 95%CI: 0.155, 0.539) were associated with high WSC, while high individual levels of acceptance of authorities (B: - 0.214; 95%CI: - 0.381, - 0.046) and the mianzi rule (B: - 0.258; 95%CI: - 0.435, - 0.080) were associatecd with low WSC. No workplace-level variable was associated with WSC.

CONCLUSION

These findings suggest that workplace social capital associates with multiple factors. Psychosocial work environments and cultural context are important in understanding variations in workplace social capital between individuals.

Social capital in a regional inter-hospital network among trauma centers (trauma network): results of a qualitative study in Germany

Background

As inter-hospital alliances have become increasingly popular in the healthcare sector, it is important to understand the challenges and benefits that the interaction between representatives of different hospitals entail. A prominent example of inter-hospital alliances are certified ‘trauma networks’, which consist of 5-30 trauma departments in a given region. Trauma networks are designed to improve trauma care by providing a coordinated response to injury, and have developed across the USA and multiple European countries since the 1960s. Their members need to interact regularly, e.g. develop joint protocols for patient transfer, or discuss patient safety. Social capital is a concept focusing on the development and benefits of relations and interactions within a network. The aim of our study was to explore how social capital is generated and used in a regional German trauma network.

Methods

In this qualitative study, we performed semi-standardized face-to-face interviews with 23 senior trauma surgeons (2013-14). They were the official representatives of 23 out of 26 member hospitals of the Trauma Network Eastern Bavaria. The interviews covered the structure and functioning of the network, climate and reciprocity within the network, the development of social identity, and different resources and benefits derived from the network (e.g. facilitation of interactions, advocacy, work satisfaction). Transcripts were coded using thematic content analysis.

Results

According to the interviews, the studied trauma network became a group of surgeons with substantial bonding social capital. The surgeons perceived that the network’s culture of interaction was flat, and they identified with the network due to a climate of mutual respect. They felt that the inclusive leadership helped establish a norm of reciprocity. Among the interviewed surgeons, the gain of technical information was seen as less important than the exchange of information on political aspects. The perceived resources derived from this social capital were smoother interactions, a higher medical credibility, and joint advocacy securing certain privileges.

Conclusion

Apart from addressing quality of care, a trauma network may, by way of strengthening social capital among its members, serve as a valuable resource for the participating surgeons. Some member hospitals could exploit the social capital for strategic benefits.

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review

Background

Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and “burnout” at work than staff in other sectors. There is a growing call for the ‘triple aim’ of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom’s (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff.

Objectives

This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing.

Methods

A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours.

Results

Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours.

Conclusions

This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff.

Occupational well-being and leadership in a school community

Purpose

The purpose of this paper is to present well-being, leadership, and the development of each from a communal perspective in a Finnish primary school in the years 2000-2009.

Design/methodology/approach

The study included five sets of data. The quantitative research data were collected from the school staff using the Well-Being at Your Work index questionnaire in 2004 (n=36), 2005 (n=41), and in 2009 (n=34). In 2006, two group interviews were carried out with the school personnel (n=21), and in 2011, retrospective interview data were collected from an expert classroom teacher (n=1). Quantitative data were analysed statistically using descriptive statistics. The qualitative group interview data were analysed by an inductive content analysis, while the expert interview was analysed according to the methods of factual analysis.

Findings

During this period, several communal interventions were developed in the school to promote occupational well-being. Over the course of the study, staff members’ satisfaction with the actions and the support provided by the principal has improved, and leadership-related problems have decreased.

Research limitations/implications

The results cover research findings from one school and therefore cannot be generalised to other Finnish school communities.

Originality/value

Schools’ work communities must be active in developing interventions to improve their own occupational well-being. Furthermore, leaders must be actively involved in the development of occupational well-being.

Confirmation of Maslow's Hypothesis of Synergy: Developing an Acceptance of Selfishness at the Workplace Scale

This study aimed to develop a new Acceptance of Selfishness at the Workplace Scale (ASWS) and to confirm Maslow's hypothesis of synergy: if both a sense of contribution and acceptance of selfishness at the workplace are high, workers are psychologically healthy. In a cross-sectional study with employees of three Japanese companies, 656 workers answered a self-administered questionnaire on paper completely (response rate = 66.8%). Each questionnaire was submitted to us in a sealed envelope and analyzed. The ASWS indicated high internal consistency (Cronbach's alpha = 0.86). Significant (p < 0.001) positive moderate correlations between ASWS scores and job control scores support the ASWS's convergent and discriminant validity. Significant (p < 0.001) associations of ASWS scores with psychological distress and work engagement supported the ASWS's criterion validity. In short, ASWS was a psychometrically satisfactory measure. Significant (p < 0.05) interactions between a sense of contribution and acceptance of selfishness at the workplace in linear regression models showed that when those two factors are low, psychological distress becomes high. However, when a sense of contribution and acceptance of selfishness are high, work engagement also becomes high. Thus, Maslow's hypothesis of synergy was confirmed.