"To be, or not be… satisfied in NPOs": a serial multiple mediation and clustering analysis of paid staff and volunteers' profiles

Introduction

Non-profit organizations (NPOs) are a complex working context whose main characteristic resides in the dichotomy between paid staff and volunteers. Despite its benefits for goal achievement, this circumstance can be also a challenge, for both groups' interaction, for their comprehension of their own role and to HR management. The aim of this study was to explore factors that may contribute to promote job satisfaction among NPOs' members.

Methods

Combining two different data analyses, serial multiple mediation analyses and cluster analyses, first we analyze whether there are differences between paid staff and volunteers in perceived intrapersonal conflict and performance and its effect on job satisfaction, and second, we analyze whether there is an additional profiles distribution that reflects more adequately the reality of NPOs, despite the formal roles that coexist in these organizations (paid staff and volunteers).

Results

Results confirm that paid staff and volunteers differ on their perceived job satisfaction level, with volunteers being more satisfied. This relationship is serially mediated by role conflict, role ambiguity, and performance. Another characteristic of the NPOs is that the dichotomy between paid staff and volunteers does not capture well the reality of the labor relations between members of both groups and the organization. To explore this phenomenon, we perform a cluster analysis based on paid staff and volunteers' perceptions. Cluster analyses demonstrate the existence of three rather homogenous profiles.

Discussion

Additionally, practical implications for HR management in NPOs and future research lines to understand this organizational context dynamics are also discussed.

Reintegration of crisis services employees: a systematic literature review

Purpose

Crisis services personnel are frequently deployed around the globe under highly demanding conditions. This raises the need to better understand the deployment process and more especially, sustainable reintegration after deployment. Despite recent research efforts, the study of the post-deployment stage, more specifically the reintegration process, remains fragmented and limited. To address these limitations, this review aims at (1) describing how reintegration is conceptualised and measured in the existing literature, (2) identifying what dimensions are associated with the reintegration process and (3) identifying what we know about the process of reintegration in terms of timing and phases.

Design/methodology/approach

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, the authors identified 5,859 documents across several scientific databases published between 1995 and 2021. Based on predefined eligibility criteria, 104 documents were yielded.

Findings

Research has primarily focused on descriptive studies of negative individual and interpersonal outcomes after deployment. However, this review indicates that reintegration is dynamic, multi-sector, multidimensional and dual. Each of its phases and dimensions is associated with distinct challenges.

Originality/value

To the authors’ knowledge, this is the first research that investigates reintegration among different crisis services and provides an integrative social-ecological framework that identifies the different dimensions and challenges of this process.

A Matter of Feelings: Mediators' Perceptions of Emotion in Hierarchical Workplace Conflicts

Emotions play a central role in the process of conflict and resolution. For a mediator, it is important to recognize emotions correctly and act upon them. Whether interventions are appropriate depends to a large extent on the ability of mediators to accurately perceive the emotions of conflict parties. Particularly in hierarchical labor conflicts, this can be challenging, since subordinates tend to hide emotions while supervisors tend to express them. In this study, we investigated if subordinates and supervisors differ in their emotional experience during mediation and whether mediators perceive these emotions accurately. To this end, we compared the extent to which disputants experienced certain emotions with the extent to which mediators perceived these emotions. Data were collected through surveys of mediation clients and mediators in hierarchical labor conflicts in the Netherlands. As expected, subordinates experienced a higher level of negative emotions during the mediation than supervisors did. Positive emotions, however, were experienced to a similar extent by both supervisors and subordinates in mediation. Mediators perceived supervisors' emotions more accurately than they did subordinates' emotions. While supervisors' emotions were positively related with mediators' perceptions, this was not the case for subordinates' emotions. Furthermore, mediators were more accurately perceiving supervisors' negative emotions than their positive emotions. Implications for mediation theory and practice are discussed.

Inside "Pandora's Box" of Solidarity: Conflicts Between Paid Staff and Volunteers in the Non-profit Sector

Non-profit organizations (NPOs) are quite complex in terms of organizational structure, diversity at the workplace, as well as motivational mechanisms and value rationality. Nevertheless, from the perspective of organizational psychology, the systematic analysis of this context is scarce in the literature, particularly regarding conflicts. This qualitative study analyzes types, prevalence, and consequences of conflicts in a large NPO considering as theoretical framework several consolidated organizational psychology theories: conflict theory, social comparison theory, and equity theory. Conflicts were analyzed taking into account volunteers’ perspective, who have been the consistent protagonist in NPO research, but also considering paid staff’s perspective as one of the main stakeholders in these organizations, whose relative power has increased in the past decade due to the professionalization of the NPO’s sector. Results confirmed the existence of four types of conflicts: task, process, status, and relationship conflicts. Relationship conflict is the least reported type, revealing the protection factor that values and engagement with a social aim have on this organizational context. The most relevant finding is the strong difference between paid staff and volunteers in conflict perceptions, showing paid staff, overall, higher levels of conflicts than volunteers. Findings also show stronger negative consequences for paid staff compared to volunteers. Theoretical and practical implications are discussed.

Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals

OBJECTIVES

To investigate the relationships between patient safety culture (PSC) dimensions and PSC self-reported outcomes across different cultures and to gain insights in cultural differences regarding PSC.

DESIGN

Observational, cross-sectional study.

SETTING

Ninety Belgian hospitals and 13 Palestinian hospitals.

PARTICIPANTS

A total of 2836 healthcare professionals matched for profession, tenure and working hours.

PRIMARY AND SECONDARY OUTCOME MEASURES

The validated versions of the Belgian and Palestinian Hospital Survey on Patient Safety Culture were used. An exploratory factor analysis was conducted. Reliability was tested using Cronbach's alpha (α). In this study, we examined the specific predictive value of the PSC dimensions and its self-reported outcome measures across different cultures and countries. Hierarchical regression and bivariate analyses were performed.

RESULTS

Eight PSC dimensions and four PSC self-reported outcomes were distinguished in both countries. Cronbach's α was α≥0.60. Significant correlations were found between PSC dimensions and its self-reported outcome (p value range <0.05 to <0.001). Hierarchical regression analyses showed overall perception of safety was highly predicted by hospital management support in Palestine (β=0.16, p<0.001) and staffing in Belgium (β=0.24, p<0.001). The frequency of events was largely predicted by feedback and communication in both countries (Palestine: β=0.24, p<0.001; Belgium: β=0.35, p<0.001). Overall grade for patient safety was predicted by organisational learning in Palestine (β=0.19, p<0.001) and staffing in Belgium (β=0.19, p<0.001). Number of events reported was predicted by staffing in Palestine (β=-0.20, p<0.001) and feedback and communication in Belgium (β=0.11, p<0.01).

CONCLUSION

To promote patient safety in Palestine and Belgium, staffing and communication regarding errors should be improved in both countries. Initiatives to improve hospital management support and establish constructive learning systems would be especially beneficial for patient safety in Palestine. Future research should address the association between safety culture and hard patient safety measures such as patient outcomes.

Improving patient safety in Palestinian hospitals: a cross-sectional and retrospective chart review study

BACKGROUND

Patient safety is the central component of health-care quality. There is a lack of patient safety data in the occupied Palestinian territory. The aim of this study was to assess patient safety and explore relationships between patient safety culture and the prevalence of adverse events at the department level.

METHODS

Between May 25, 2009, and June 1, 2010, the Arabic validated Hospital Survey on Patient Safety Culture was used to measure the norms and perceptions of health professionals regarding safety. The survey was used in eight medical departments in two hospitals (Al Makassed hospital and Al Ahli hospital in the West Bank; four departments per hospital). During the same period, a retrospective review of medical records was done to identify adverse events using the validated Palestinian version of the Global Trigger Tool. Descriptive statistics and Spearman's rho coefficient were used. Ethical approval was obtained from the participating hospital boards and the Palestinian health authorities, and written consent was obtained from participants.

FINDINGS

640 randomly selected records (320 records per hospital) were reviewed, and 428 health-care workers participated in the safety culture assessment (response rate 74%). 213 (50%) participants were nurses, 163 (38%) were doctors, and 52 (12%) were other health-care professionals. Patients had a mean age of 44·2 years (SD 19·6; range 18-95) and a mean length of stay of 4·8 days (SD 5·6; range 1-70). 91 (14%) records included an adverse event. Adverse events were negatively associated with the aggregate safety culture (r=-0·905; p=0·0009), hospital management support (r=-0·881; p=0·0017), non-punitive response to errors (r=-0·731; p=0·019), communication and feedback on errors (r=-0·905; p=0·0009), teamwork (r=-0·886; p=0·0021), organisational learning (r=-0·778; p=0·011), and supervisor actions promoting patient safety (r=-0·857; p=0·0029), indicating that departments with a more positive patient safety culture had lower rates of adverse events.

INTERPRETATIONS

Safety must be improved for Palestinian patients. To promote patient safety, managers and policy makers should acknowledge and allocate resources for enhancing overall safety culture, hospital management support, non-punitive response, communication on errors, teamwork, organisational learning, and supervisor actions.

FUNDING

Research and development, KU Leuven, Leuven, Belgium.

You can't always get what you want? Leadership expectations of intrapreneurs

Purpose

The purpose of this paper is to examine the leadership expectations of young employees in intrapreneurial jobs.

Design/methodology/approach

Group interviews were conducted with 42 young intrapreneurs and 13 leaders of a Dutch ICT consultancy firm. Data were coded and analyzed using qualitative data analysis software.

Findings

The authors find ten different expectations on leadership. Young intrapreneurs expect to have a personal connection, sufficient feedback, ample freedom, and trust, clear directions when asked and a leader who is a role model.

Research limitations/implications

This qualitative study was conducted in one organization. It however sheds a first light on expectations of employees with intrapreneurial job requirements.

Practical implications

In order to motivate and guide young intrapreneurs, direct supervisors should aim not to breach expectations. By getting to know their employees on a personal basis, taking the time to coach them in their career goals, showing intrapreneurship themselves, focusing on an open relationship, and providing a challenging and dynamic environment, direct supervisors build a strong and cooperative relationship.

Originality/value

This paper is one of the first to look at the relationship between direct supervisors and intrapreneurial employees. Doing so, it also expands the current knowledge of Implicit Leadership Theory by exploring expectations of young intrapreneurs and adds to the full-range leadership theory by showing the importance of investigating its subdimensions.

Psychological impact and recovery after involvement in a patient safety incident: a repeated measures analysis

OBJECTIVE

To examine individual, situational and organisational aspects that influence psychological impact and recovery of a patient safety incident on physicians, nurses and midwives.

DESIGN

Cross-sectional, retrospective surveys of physicians, midwives and nurses.

SETTING

33 Belgian hospitals.

PARTICIPANTS

913 clinicians (186 physicians, 682 nurses, 45 midwives) involved in a patient safety incident.

MAIN OUTCOME MEASURES

The Impact of Event Scale was used to retrospectively measure psychological impact of the safety incident at the time of the event and compare it with psychological impact at the time of the survey.

RESULTS

Individual, situational as well as organisational aspects influenced psychological impact and recovery of a patient safety incident. Psychological impact is higher when the degree of harm for the patient is more severe, when healthcare professionals feel responsible for the incident and among female healthcare professionals. Impact of degree of harm differed across clinicians. Psychological impact is lower among more optimistic professionals. Overall, impact decreased significantly over time. This effect was more pronounced for women and for those who feel responsible for the incident. The longer ago the incident took place, the stronger impact had decreased. Also, higher psychological impact is related with the use of a more active coping and planning coping strategy, and is unrelated to support seeking coping strategies. Rendered support and a support culture reduce psychological impact, whereas a blame culture increases psychological impact. No associations were found with job experience and resilience of the health professional, the presence of a second victim support team or guideline and working in a learning culture.

CONCLUSIONS

Healthcare organisations should anticipate on providing their staff appropriate and timely support structures that are tailored to the healthcare professional involved in the incident and to the specific situation of the incident.

Computer-Mediated Negotiation of an Escalated Conflict

This study analyzed style of handling an escalated conflict in a computer-mediated negotiation context. Literature focusing on negotiation and media evidenced two contradictory perspectives. One of them asserted that negotiators are less integrative when interacting in a computer-mediated context. The other perspective affirmed that a barrier in the communication enhances integrativeness. These contrary perspectives motivated the present study. In a computer-mediated negotiation setting a confederate escalated the conflict with the participants in a standardized way. Interactions were recorded and two groups of coders assessed the use of avoiding, compromising, problem solving, accommodating, and forcing. Results showed a higher use of avoiding and a decrease in forcing behavior along the computer-mediated interaction. Results from revised literature regarding face-to-face context show a different pattern consisting of an increase in forcing behavior and compromising along the encounter. Practical implications of results are discussed.

Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study

OBJECTIVES

When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called "second victim" of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim.

MATERIALS AND METHODS

Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident.

RESULTS

The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects.

CONCLUSION

These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial.

The Relation Between Supervisors' Big Five Personality Traits and Employees' Experiences of Abusive Supervision

The present study investigates the relation between supervisors' personality traits and employees' experiences of supervisory abuse, an area that - to date - remained largely unexplored in previous research. Field data collected from 103 supervisor-subordinate dyads showed that contrary to our expectations supervisors' agreeableness and neuroticism were not significantly related to abusive supervision, nor were supervisors' extraversion or openness to experience. Interestingly, however, our findings revealed a positive relation between supervisors' conscientiousness and abusive supervision. That is, supervisors high in conscientiousness were more likely to be perceived as an abusive supervisor by their employees. Overall, our findings do suggest that supervisors' Big Five personality traits explain only a limited amount of the variability in employees' experiences of abusive supervision.

Transformational Leadership and Stakeholder Management in Library Change

This article aims to analyse the role of library managers as change agent when implementing Library 2.0, using transformational leadership and stakeholder management approaches. To do so, a case study in a Latin American academic library was performed. The experiences acquired for a period of six years were analysed, during which three library managers were involved in managing change. Qualitative data from documents, interviews, and observations were collected, and qualitative analysis methods were used to obtain in-depth understanding of the change process. Results show that lack of transformational leadership and stakeholder management contribute to delayed implementation and limited adoption of innovations. Although library managers recognized the importance of different stakeholders to implement changes, they did not apply systematic and proactive strategies to define and manage them. All in all, library managers should be trained as change agents, with emphasis on transformational leadership and stakeholder management skills.

Involvement of health-care professionals in an adverse event: the role of management in supporting their workforce

INTRODUCTION

 After an adverse event, not only patients and family members but also health-care professionals involved in the event become victims. More than 50% of all health-care professionals suffer emotionally and professionally after being involved in an adverse event. Support is needed for these "second victims" to prevent a further negative impact on patient care.

OBJECTIVES

 The aim of the study was to evaluate the prevalence and content of organizational‑level support systems for health-care professionals involved in an adverse event.

METHODS

 A survey was sent to 109 Belgian hospitals regarding 2 aspects: first, the availability of a protocol for supporting second victims; and, second, the presence of a contact person in the organization to provide support. A total of 59 hospitals participated in the study. Hospitals were asked to submit their protocols for providing support to second victims. A content analysis based on an Institute for Healthcare Improvement's white paper and the Scott Model was performed to evaluate the protocols.

RESULTS

 Thirty organizations had a systematic plan to support second victims. Twelve percent could not identify a contact person. The chief nursing officer was seen as one of the main contact people when something went wrong. In terms of the quality of the protocols, only a minority followed part of the international resources.

CONCLUSIONS

 A minority of hospitals are somewhat prepared to provide support for health-care professionals. Management should take a leadership role in establishing support protocols for their health-care professionals in the aftermath of an adverse event.

The Arabic version of the hospital survey on patient safety culture: a psychometric evaluation in a Palestinian sample

BACKGROUND

A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals.

METHODS

The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument.

RESULTS

With respect to face and content validity, the CVI analysis showed excellent results for the Arab context (CVI = 0.96). As to construct validity, the 12 original dimensions could not be applied to the Palestinian data. Furthermore, three of the 12 original dimensions were not reliable (α <0.6). The split-half technique resulted in an optimal 11-factor model.

CONCLUSIONS

Our study is the first study in the Arab world to provide an evaluation of the HSOPSC using Arabic data from Palestine. The Arabic translation of the HSOPSC comprises an 11-factor structure showing good validity and acceptable reliability. Despite the similarity between the Arab factor structure of the HSOPSC and that of the original one, and taking into account that our version may be applied in Arabic hospitals, there is a need for caution in comparing HSOPSC data between countries.

A review on leadership of head nurses and patient safety and quality of care

PURPOSE

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

DESIGN/METHODOLOGY/APPROACH

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

FINDINGS

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

VALUE/ORIGINALITY

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Health care professionals as second victims after adverse events: a systematic review

Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

The European quality of care pathways (EQCP) study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes

Background

Although care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP) study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process.

Methods/design

An international post-test-only cluster Randomised Controlled Trial (cRCT), combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal. Teams caring for proximal femur fracture (PFF) patients and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease (COPD) will be randomised into an intervention and control group. The intervention group will implement a care pathway for PFF or COPD containing three active components: a formative evaluation of the actual teams’ performance, a set of evidence-based key interventions, and a training in care pathway-development. The control group will provide usual care. A set of team input, process and output indicators will be used as effect measures. The main outcome indicator will be relational coordination. Next to these, process measures during and after pathway development will be used to evaluate the implementation processes. In total, 132 teams have agreed to participate, of which 68 were randomly assigned to the intervention group and 64 to the control group. Based on power analysis, a sample of 475 team members per arm is required. To analyze results, multilevel analysis will be performed.

Discussion

Results from our study will enhance understanding on the active components of care pathways. Through this, preferred implementation strategies can be defined.

Trail registration

NCT01435538

Care pathways lead to better teamwork: results of a systematic review

Care pathways are often said to promote interprofessional teamwork. As no systematic review on pathway effectiveness has ever focused on how care pathways promote teamwork, the objective of this review was to study this relationship. We performed an extensive search of electronic databases and identified 26 relevant studies. In our analysis of these studies we identified 20 team indicators and found that care pathways positively affected 17 of these indicators. Most frequently positive effects were found on staff knowledge, interprofessional documentation, team communication and team relations. However, the level of evidence was rather low. We found Level II evidence for improved interprofessional documentation. We also found Level II evidence for increased workload; improved actual versus planned team size; and improved continuity of care. The studies most frequently mentioned the need for a multidisciplinary approach and educational training sessions in order for pathways to be successful. The systematic review revealed that care pathways have the potential to support interprofessional teams in enhancing teamwork. Necessary conditions are a context that supports teamwork and including appropriate active pathway components that can mediate an effect on team processes. To achieve this, each care pathway requires a clearly defined team approach customized to the individual teams' needs.

Indicators for Follow-Up of Multidisciplinary Teamwork in Care Processes

In order to study the impact of interventions on multidisciplinary teamwork in care processes, relevant indicators need to be defined. In the present study, the authors performed a Delphi survey of a purposively selected expert panel consisting of scientific researchers and hospital managers. Thirty-six experts from 13 countries participated. Each participant rated a list of team indicators on a scale of 1–6. Consensus was sought in two consecutive rounds. The content validity index (CVI) varied from 8% to 92%. A final list of 19 indicators was generated: 5 on team context/structure, 8 on team process, and 6 on team outcomes. Most relevant team indicators were as follows: “team relations,” “quality of team leadership,” “culture/climate for teamwork,” “team perceived coordination of the care process,” and “team vision.” Scientific researchers and hospital managers that want to study and improve multidisciplinary teamwork in care processes should primarily focus on these team indicators.

The impact of shiftwork on work--home conflict, job attitudes and health

The present study was designed to test the impact of rotation and timing of shifts on work--home conflict, job attitudes, health and absenteeism among the military police. A total of 3122 employees participated in the study. Discriminant analysis was used to examine the relationships between rotation and timing of shifts on the one hand, and the outcome measures on the other. Whether employees had fixed dayshifts, fixed non-day shifts including weekends, or rotating shifts with or without weekends, could be predicted on the basis of the experienced work--home conflict, job attitudes, health and absenteeism. Each of the two parameters of shiftwork differentially affected the experience of the outcome measures. Rotation was most clearly related to unfavourable job attitudes (namely job satisfaction, cynicism, turnover intentions and professional efficacy), whereas timing was most clearly related to increased work--home conflict. The results suggest that fixed non-day shifts including weekends (i.e., during highly valuable times) should be avoided in order to minimize the conflict between work and home and that rotation rosters should be designed with a high degree of individualization and flexibility. These seem to be the most promising ways to reduce the negative consequences of shiftwork for employees, their families and organizations.