Sleep and Military Leaders: Examining the Values, Beliefs, and Quality of Sleep and the Impact on Occupational Performance

INTRODUCTION

Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance.

MATERIALS AND METHODS

This observational, mixed-methods study design recruited a convenience sample of 109 Army active duty medical service members currently serving in a leadership role. Participants completed an electronic survey to include general demographic information and three self-report measures: the Pittsburgh Quality of Sleep Index, the Dysfunctional Beliefs about Sleep, and the Functional Outcomes of Sleep Questionnaire. Eleven participants completed the semi-structured qualitative interview focusing on sleep values and the impacts on performance. Univariate and multivariate regressions were performed for statistical analysis of the quantitative survey data, whereas thematic analysis was used to analyze the qualitative interview data. This study was approved by the U.S. Army Medical Center of Excellence Institutional Review Board.

RESULTS

Multivariate regression analysis demonstrated small-to-medium effect sizes (R2 = 0.355-0.559) for relationships between sleep quality, sleep beliefs, functional performance, and demographic variables. More specifically, military grade, position, use of alcohol, time in service, and gender were all found to contribute significantly to scores on the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep Scale-16, and the Functional Outcomes of Sleep Questionnaire-10 (P < .05). Qualitative data resulted in three primary themes: (1) Poor sleep degrades performance, (2) sleep is a top priority, and (3) leaders have a responsibility for subordinates' sleep health.

CONCLUSIONS

This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.

Green human resource management, competitive advantages, and green ambidexterity: using partial least squares structural equation modeling and necessary condition analysis

This study investigates the effect of green human resource management practices on green competitive advantage and the mediating role of competitive advantage between the green human resource management practices and green ambidexterity. This study also examined the effect of green competitive advantage on green ambidexterity and the moderating effect of firm size on green competitive advantage and ambidexterity. The results reveal that green recruitment and green training and involvement are not sufficient, but they are necessary for any outcome level of green competitive advantage. The other three constructs (green performance management and compensation, green intellectual capital, and green transformational leadership) are sufficient and necessary; however, green performance management and compensation is necessary only at an outcome level of more than or equal to 60%. The findings revealed that the mediating effect of green competitive advantage is significant only between three constructs (green performance management and compensation, green intellectual capital, and green transformational leadership) and green ambidexterity. The results also indicate that a green competitive advantage has a significant positive effect on green ambidexterity. Exploring the necessary and sufficient factors using a combination of partial least squares structural equation modeling and necessary condition analysis provides valuable guidance for practitioners to optimize firm outcomes.

A narrative review of the impact of work hours and insufficient rest on job performance

OBJECTIVE

This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management.

STUDY DESIGN

Narrative review.

METHODS

Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar.

RESULTS

Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine.

CONCLUSION

Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur.

CLINICAL SIGNIFICANCE (OR IMPACT)

A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

The Relationship Between Nurses' Quality of Work-Life on Organizational Loyalty and Job Performance in Saudi Arabian Hospitals: A Cross-Sectional Study

Purpose

The purpose of this study is to analyze the relationship between quality of work-life on the organizational loyalty and job performance in Saudi Arabia.

Methods

This study used a cross-sectional design for collecting the data related to the nurses' quality of work-life, organizational loyalty, and job performance from nursing staff in Saudi Arabian hospitals. Three questionnaires were used in this study, which includes Quality of Work Life Scale (QWLS), Organizational Commitment Questionnaire (OCQ), and Individual Work Performance Questionnaire (IWPQ). An online version of the survey questionnaire was generated using the Google survey, to which a link is generated for collecting data. At the end of the survey, 243 responses were received. After removing the incomplete responses, 209 responses were considered for the data analysis. The statistical techniques including t-tests and Pearson's correlation were used in the data analysis.

Results

Nurse managers reflected good quality of life, and high loyalty toward their employers, and also reflected good job performance levels. However, staff nurses reflected poor quality of work-life, organizational loyalty, and job performance. Training and development had strong positive correlation with continuance commitment (r = 0.628, p < 0.01). Job satisfaction and job security held strong positive correlation with task performance (r = 0.601, p < 0.01) and contextual performance (r = 0.601, p < 0.01).

Conclusion

Quality of work-life, organization loyalty, and job performance are positively correlated, and poor quality of work-life can negatively impact job performance and organizational loyalty of nurses.

Impacts of heavy smoking and alcohol consumption on workplace presenteeism: A cross-sectional study

Presenteeism refers to the practice of going to work despite poor health, resulting in subpar performance. This study aimed to explore the impacts of smoking and alcohol consumption on workplace presenteeism based on demographic, health-related, and employment variables.The study adopted a cross sectional design with 60,051 wage workers from the database of the second and third Korean Working Conditions Surveys in 2010 and 2011, respectively. A total of 41,404 workers aged 19 years and older, who had worked for at least 1 hour in the previous week, answered the survey questions. Chi-square test as well as univariate and multiple logistic regression analyses were conducted using SPSS, version 18.0, to determine the impacts of smoking and alcohol consumption on workplace presenteeism.Of the 41,404 Korean workers, 8512 (20.6%) had experienced presenteeism in the past 12 months. There were significant differences among gender, age, educational status, income, health problems, absenteeism, shift work, night shift, weekly working hours, exposure to secondhand smoke at work, and satisfaction with the workplace environment. Based on the results of multiple regression analysis, heavy smoking (adjusted odds ratio = 1.38, 95% confidence intervals [1.11, 1.72]) and high-risk drinking (adjusted odds ratio = 1.19, 95% confidence intervals [1.08, 1.31]) were significantly related to presenteeism among workers.The results of our study confirmed that smoking and alcohol drinking were related to presenteeism even after controlling other variables (demographic, health-related, and employment variables) that affect presenteeism. Smoking and alcohol drinking are associated with and potentially influence presenteeism; in particular, heavy smoking and high-risk drinking contributed to presenteeism. Companies that encourage employees to receive treatments for reduction of smoking or alcohol consumption may benefit from greater productivity. Hence, we should consider the impact of smoking and alcohol consumption in the workplace and build appropriate strategies and programs to help reduce these behaviors.

Personalized digital extension services and agricultural performance: Evidence from smallholder farmers in India

Productivity growth in smallholder agriculture is an important driver of rural economic development and poverty reduction. However, smallholder farmers often have limited access to information, which can be a serious constraint for increasing productivity. One potential mechanism to reduce information constraints is the public agricultural extension service, but its effectiveness has often been low in the past. Digital technologies could enhance the effectiveness of extension by reducing outreach costs and helping to better tailor the information to farmers’ individual needs and conditions. Using primary data from India, this study analyses the association between digital extension services and smallholder agricultural performance. The digital extension services that some of the farmers use provide personalized information on the types of crops to grow, the types and quantities of inputs to use, and other methods of cultivation. Problems of selection bias in the impact evaluation are reduced through propensity score matching (PSM) combined with estimates of farmers’ willingness to pay for digital extension. Results show that use of personalized digital extension services is positively and significantly associated with input intensity, production diversity, crop productivity, and crop income.

Using Consistently Low Performance to Identify Low-Quality Physician Groups

Importance

There has been a growth in the use of performance-based payment models in the past decade, but inherently noisy and stochastic quality measures complicate the assessment of the quality of physician groups. Examining consistently low performance across multiple measures or multiple years could potentially identify a subset of low-quality physician groups.

Objective

To identify low-performing physician groups based on consistently low performance after adjusting for patient characteristics across multiple measures or multiple years for 10 commonly used quality measures for diabetes and cardiovascular disease (CVD).

Design, Setting, and Participants

This cross-sectional study used medical and pharmacy claims and laboratory data for enrollees ages 18 to 65 years with diabetes or CVD in an Aetna health insurance plan between 2016 and 2019. Each physician group's risk-adjusted performance for a given year was estimated using mixed-effects linear probability regression models. Performance was correlated across measures and time, and the proportion of physician groups that performed in the bottom quartile was examined across multiple measures or multiple years. Data analysis was conducted between September 2020 and May 2021.

Exposures

Primary care physician groups.

Main Outcomes and Measures

Performance scores of 6 quality measures for diabetes and 4 for CVD, including hemoglobin A1c (HbA1c) testing, low-density lipoprotein testing, statin use, HbA1c control, low-density lipoprotein control, and hospital-based utilization.

Results

A total of 786 641 unique enrollees treated by 890 physician groups were included; 414 655 (52.7%) of the enrollees were men and the mean (SD) age was 53 (9.5) years. After adjusting for age, sex, and clinical and social risk variables, correlations among individual measures were weak (eg, performance-adjusted correlation between any statin use and LDL testing for patients with diabetes, r = -0.10) to moderate (correlation between LDL testing for diabetes and LDL testing for CVD, r = .43), but year-to-year correlations for all measures were moderate to strong. One percent or fewer of physician groups performed in the bottom quartile for all 6 diabetes measures or all 4 cardiovascular disease measures in any given year, while 14 (4.0%) to 39 groups (11.1%) were in the bottom quartile in all 4 years for any given measure other than hospital-based utilization for CVD (1.1%).

Conclusions and Relevance

A subset of physician groups that was consistently low performing could be identified by considering performance measures across multiple years. Considering the consistency of group performance could contribute a novel method to identify physician groups most likely to benefit from limited resources.

Physiotherapist' job performance, impression management and organizational citizenship behaviors: An analysis of hierarchical linear modeling

Studies on physiotherapists are generally focused on clinical professionalism, with very few examining job performance from a management standpoint. To address this gap, this study sought to investigate the relationship between impression management and organizational citizenship behavior and job performance. This study targeted medical institutions offering rehabilitation and physiotherapy services and conducted a questionnaire survey based on scales developed by domestic and foreign scholars. A total of 600 questionnaires were distributed and 523 valid ones collected. The data was tested and verified using regression analysis and hierarchical linear modeling (HLM). In the survey, the Impression Management Scale, Organizational Citizenship Behavior Scale, and Job Performance Scale indicated that at the individual level, the impression management of physiotherapists is significantly related to their organizational citizenship behaviors and job performance. The organizational citizenship behaviors were also found to have a mediating effect between impression management and job performance. At the group level, impression management had a conditioning effect on organizational citizenship behaviors and job performance. In terms of statistical methods, group-level variables act as moderators, which affects the power of individual-level explanatory variables on outcome variables, i.e., the influence of the slope. The job behaviors of physiotherapists entail direct service and their performance is closely related to organizational development. Impression management gives people certain purposes and behaviors while organizational citizenship behaviors are a type of non-self-seeking, selfless dedication behaviors. Therefore, the motivation of physiotherapists who demonstrate organizational citizenship behaviors should be further explored.

Relationship between mindfulness, stress, and performance in medical students in pediatric emergency simulations

Objectives: Pediatric teams of emergency departments work under extreme stress, which affects high-level cognitive functions, specifically attention and memory. Therefore, the methods of stress management are being sought. Mindfulness as a process of intentionally paying attention to each moment with acceptance of each experience without judgment can potentially contribute to improving the performance of medical teams. Medical simulation is a technique that creates a situation to allow persons to experience a representation of a real event for the purpose of education. It has been shown that emergency medicine simulation may create a high physiological fidelity environment similarly to what is observed in a real emergency room. The aim of our study was to determine whether the technical and non-technical skills of medical students in the course of pediatric high fidelity simulations are related to their mindfulness and stress. Participants and methods: A total of 166 standardized simulations were conducted among students of medicine in three simulation centers of medical universities, assessing: stress sensation (subjectively and heart rate/blood pressure), technical (checklists) and non-technical skills (Ottawa scale) and mindfulness (five facet mindfulness questionnaire): ClinicalTrials.gov ID: NCT03761355. Results: The perception of stress among students was lower and more motivating if they were more mindful. Mindfulness of students correlated positively with avoiding fixation error. In the consecutive simulations the leaders' non-technical skills improved, although no change was noted in their technical skills. Conclusion: The results of our research indicate that mindfulness influence the non-technical skills and the perception of stress of medical students during pediatric emergency simulations. Further research is needed to show whether mindfulness training leads to improvement in this field.

Personal Protective Equipment in COVID-19: Impacts on Health Performance, Work-Related Injuries, and Measures for Prevention

OBJECTIVE

To assess impact of personal protective equipment (PPE) on healthcare providers (HCPs) in caring for COVID-19 patients.

METHODS

A cross-sectional survey was conducted over 50 hospitals in China. Descriptive analyses and Chi-square tests were performed on the collected data.

RESULTS

All 104 frontline HCPs report negative impacts of PPE on their clinical performance, 97% of them experienced discomfort and injuries caused by wearing PPE for long hours. Frontline HCPs provided suggestions to alleviate the negative impacts and to enhance communication between healthcare staff and patients. Two hundred eighty two non-frontline HCPs also revealed similar problems; however, we recorded a few discrepancies between answers given by frontline and non-frontline HCPs.

CONCLUSIONS

Wearing PPE for long hours degrades health performance. Measures were suggested to improve the design of PPE for protecting HCPs and enhancing their services to COVID patients.

Two definitions of presenteeism: sickness presenteeism and impaired work function

BACKGROUND

Two major definitions exist for presenteeism: sickness presenteeism and impaired work function. The evidence for comparing previous studies on presenteeism is insufficient because of the different definitions of presenteeism used.

AIMS

To assess the relationship between the two major definitions of presenteeism.

METHODS

This cross-sectional study analysed secondary data on 5334 respondents to an employee survey administered in a construction company in Japan. Impaired work function was measured using the Work Functioning Impairment Scale (WFun). Multiple logistic regression was performed.

RESULTS

A strong linear association was observed between the number of days of sickness presenteeism and impaired work function (all P < 0.001). In contrast, the number of days of sickness absence was only partially positively associated with impaired work function. All choices for most frequent health problem were positively associated with impaired work function, beginning with mental problems (adjusted odds ratio [OR] = 20.45, 95% confidence interval [CI]: 14.94-28.01), followed by malaise (adjusted OR = 11.91, 95% CI: 9.08-15.62) and sleeping problems (adjusted OR = 8.62, 95% CI: 6.57-11.33).

CONCLUSIONS

A strong relationship was observed between the two major definitions of presenteeism, even after adjusting for a variety of chronic health conditions. Although a consensus on the definition of presenteeism is yet to be reached, this study provides insight on comparing existing studies on presenteeism.

The Association between Shift Work and Health-Related Productivity Loss due to Either Sickness Absence or Reduced Performance at Work: A Cross-Sectional Study of Korea

Background: The purpose of the present study was to investigate the association between shift work and health-related productivity loss (HRPL) due to either sickness absence or reduced performance at work. Methods: From January 2020 to February 2020, data were collected using the web-based questionnaire. Workers in Korea (n = 4197) were selected with the convenience sampling method. To evaluate HRPL, the Korean version of the “Work Productivity and Activity Impairment Questionnaire” was used. The nonparametric association between shift work and HRPL was determined. To estimate productivity loss by shift work, generalised linear models were used, and the productivity loss of workers who did not do shift work was used as the reference. Contrasts between the reference (non-shift work) and shift work, including the shift work subtype, were demonstrated. In the adjusted model, age, gender, and occupation were included as covariates. To test whether there were differences in this association by gender, a gender-stratified analysis was conducted. Results: Shift work significantly reduced productivity (2.5% points; 95% CI: 0.2–4.6). The fixed night shift had the largest productivity loss (7.7% points; 95% CI: 1.8–13.7), and the relationship between HRPL and shift work was more prominent among female workers. Conclusions: Shift work is related to an increase in HRPL, and there are gender differences in this association. Our study further indicated that a fixed night shift is most detrimental to workers’ health and productivity.

How critical activities within COVID-19 intensive care units increase nurses' daily occupational calling

During normal and predictable circumstances, employees' occupational calling (i.e., a transcendent passion to use their talent and competencies toward positive societal impact and a sense of meaningfulness derived from working in a chosen occupational domain) is observed to be relatively stable. However, with the onset of the COVID-19 pandemic, circumstances have become anything but normal and predictable, thus putting employees' sense of occupational calling to the test. In this study, we investigate the possibility that occupational calling fluctuates across days during situations of crisis, and we identify antecedents and consequence of such fluctuations. To test our model, we conducted a daily diary study of 66 nurses working in intensive care units over 5 consecutive work days in a specialized Wuhan hospital that only admitted confirmed COVID-19 patients during the peak of the pandemic in China. We found that the daily number of code blue events (i.e., cardiopulmonary resuscitation efforts with the primary goal of patient revival) was positively related to daily occupational calling for nurses. Moreover, individual differences in prosocial motivation predicted the average level and variability of occupational calling over the 5 days, which subsequently related to the nurses' job performance. Our study sheds light on how occupational calling enables people with the needed occupational knowledge and skills to function effectively in crisis situations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Are blue-collar workers more physically active than white-collar at work?

This study evaluates the physical activity level at work and leisure time of white-collar and two groups of blue-collar workers from the latex glove industry and the association of physical activity level and musculoskeletal complains and work ability. The workers' sociodemographic and behavioral health characteristics, work ability index, musculoskeletal complains, total step count and caloric expenditure for three consecutive days, were assessed. The blue-collar workers that move most from the workstation (longD) were more physically active at work compared to white-collar and blue-collar that moved close the workstation (shortD). But in leisure-time the result is reversed, white-collar and blue-collar groups were significantly more active. There was no association between physical activity level and musculoskeletal pain intensity and work ability. All the groups of workers exhibited satisfactory physical activity levels, but only blue-collar (longD) were more physically active (10,000 steps per day).

Disentangling the Relationship between Physician and Organizational Performance: A Signal Detection Approach

Background. In previous research, we employed a signal detection approach to measure the performance of general practitioners (GPs) when deciding about urgent referral for suspected lung cancer. We also explored associations between provider and organizational performance. We found that GPs from practices with higher referral positive predictive value (PPV; chance of referrals identifying cancer) were more reluctant to refer than those from practices with lower PPV. Here, we test the generalizability of our findings to a different cancer. Methods. A total of 252 GPs responded to 48 vignettes describing patients with possible colorectal cancer. For each vignette, respondents decided whether urgent referral to a specialist was needed. They then completed the 8-item Stress from Uncertainty scale. We measured GPs' discrimination (d') and response bias (criterion; c) and their associations with organizational performance and GP demographics. We also measured correlations of d' and c between the 2 studies for the 165 GPs who participated in both. Results. As in the lung study, organizational PPV was associated with response bias: in practices with higher PPV, GPs had higher criterion (b = 0.05 [0.03 to 0.07]; P < 0.001), that is, they were less inclined to refer. As in the lung study, female GPs were more inclined to refer than males (b = -0.17 [-0.30 to -0.105]; P = 0.005). In a mediation model, stress from uncertainty did not explain the gender difference. Only response bias correlated between the 2 studies (r = 0.39, P < 0.001). Conclusions. This study confirms our previous findings regarding the relationship between provider and organizational performance and strengthens the finding of gender differences in referral decision making. It also provides evidence that response bias is a relatively stable feature of GP referral decision making.

Evaluating healthcare workers' hand hygiene performance using first-person view video observation in a standardized patient-care scenario

BACKGROUND

Monitoring healthcare workers' (HCWs) hand hygiene (HH) performance is recommended for improving compliance. Observer biases challenge data validity, thus supplemental approaches such as video observation are needed to complement monitoring.

METHODS

We investigate first-person view (FPV) video observation during simulated standardized patient care handling a catheter in a study with 71 HCWs. HH performance was evaluated for (1) all HH opportunities and (2) a subset of opportunities required in an ideal work sequence, hereafter core opportunities. HCWs' acceptance of FPV video observation and usability judgments were assessed.

RESULTS

Compliance level for core HH opportunities (M = 43.5%) was significantly higher than compliance considering all opportunities (M = 30.4%, t(70) = 8.493, P < .001). Reducing HH opportunities to core opportunities would significantly increase compliance levels from the observed average of 30.4% to 44.9% (t(70) = 12.822, P < .001). Overall, both usability ratings and acceptance of the body camera were promising.

DISCUSSION

FPV video observation in simulated standardized patient care provides new instruments to evaluate HH performance beyond mere compliance rates. Our results emphasize the role of optimizing workflow in order to improve HCW's HH compliance.

CONCLUSIONS

FPV video observation in a standardized patient care simulation is feasible and offers information for HH interventions that target actual deficiencies.

The Buffering Effect of Relationships on Combat Exposure, Military Performance, and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs

This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.

Impact of an electronic-based assessment on student pharmacist performance in a required therapeutics course

INTRODUCTION

The use of technology in the classroom has continued to grow, and with the advancement of classroom management systems and online exam software, there are opportunities to administer exams electronically. This study assessed the impact of electronic-based assessments on examination scores in a required therapeutics course.

METHODS

This was a retrospective, single-centered, observational study including second professional year pharmacy students enrolled in a required, one semester therapeutics course. Four assessments were administered each semester. Lecture content and exam format, a mixture of multiple-choice questions and free response written cases, did not differ significantly between years. Assessments administered during the first two years were printed on paper, while assessments administered during the third and fourth year of the study were all electronic, submitted through a classroom management system. Following institutional review board approval, the change in mean overall examination scores between paper and electronic-based assessments were analyzed.

RESULTS

Of the 948 students enrolled in this study, there was no difference in overall mean scores between paper and electronic-based assessments (74.8% vs. 73.8%). In addition, there was no difference in mean examination scores between overall individual paper and electronic Exam 1 through 4 or overall multiple-choice or free response scores between paper and electronic-based assessments.

CONCLUSIONS

Scores did not differ between paper and electronic-based assessments. From this study, test method does not appear to impact exam results.

Sustainable Work Performance: The Roles of Workplace Violence and Occupational Stress

The purpose of this study is to analyze the relationships between workplace violence, occupational stress, and sustainable work performance. Multiple dimensions of workplace violence (harassment, mobbing, ostracism, and stalking) were used in this study. A questionnaire survey was used, composed of 48 items with a 5-point Likert scale (1, strongly disagree, to 5, strongly agree). Data were collected from 15 hospitals in the vicinity of Karachi, Lahore, and Islamabad, Pakistan. The target population of this study consisted of doctors, nurses, and paramedical staff. We distributed 500 questionnaires among the target population. In total, 345 usable questionnaires were returned, resulting in a response rate of 69%. Partial least squares structural equation modeling was used to test the direct and indirect effects. The results of this study highlight that in both direct and indirect relationships, workplace violence negatively influences sustainable work performance. The findings of this study are as follows: First, harassment reduces employee morale, which consistently lessens employees' work performance. Second, mobbing at the workplace reduces productivity, increases levels of stress, anxiety, depression, and irritability, and increases low work engagement, work absences, and work destruction. Third, ostracism at the workplace reduces motivation among workers and organizations, which reduces work efficiency. Work performance is undermined due to stalking at the workplace because it creates a bad image and brings toxicity among colleagues and peers. Fourth, occupational stress is considered a stigma among employees who are facing stress at the workplace. We can conclude that if employees are happy and healthy, they can be their most productive. So, organizations need to construct a culture where employees can be at their best and shine.

The effectiveness of workplace nutrition and physical activity interventions in improving productivity, work performance and workability: a systematic review

BACKGROUND

Healthy lifestyles play an important role in the prevention of premature death, chronic diseases, productivity loss and other social and economic concerns. However, workplace interventions to address issues of fitness and nutrition which include work-related outcomes are complex and thus challenging to implement and appropriately measure the effectiveness of. This systematic review investigated the impact of workplace nutrition and physical activity interventions, which include components aimed at workplace's physical environment and organizational structure, on employees' productivity, work performance and workability.

METHODS

A systematic review that included randomized controlled trials and or non-randomized controlled studies was conducted. Medline, EMBASE.com, Cochrane Library and Scopus were searched until September 2016. Productivity, absenteeism, presenteeism, work performance and workability were the primary outcomes of our interest, while sedentary behavior and changes in other health-related behaviors were considered as secondary outcomes. Two reviewers independently screened abstracts and full-texts for study eligibility, extracted the data and performed a quality assessment using the Cochrane Collaboration Risk-of-Bias Tool for randomized trials and the Risk-of-Bias in non-randomized studies of interventions. Findings were narratively synthesized.

RESULTS

Thirty-nine randomized control trials and non-randomized controlled studies were included. Nearly 28% of the included studies were of high quality, while 56% were of medium quality. The studies covered a broad range of multi-level and environmental-level interventions. Fourteen workplace nutrition and physical activity intervention studies yielded statistically significant changes on absenteeism (n = 7), work performance (n = 2), workability (n = 3), productivity (n = 1) and on both workability and productivity (n = 1). Two studies showed effects on absenteeism only between subgroups.

CONCLUSIONS

The scientific evidence shows that it is possible to influence work-related outcomes, especially absenteeism, positively through health promotion efforts that include components aimed at the workplace's physical work environment and organizational structure. In order to draw further conclusions regarding work-related outcomes in controlled high-quality studies, long-term follow-up using objective outcomes and/or quality assured questionnaires are required.

TRIAL REGISTRATION

Registration number: PROSPERO CRD42017081837.

Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes

BACKGROUND

Healthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied.

METHODS

This study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing.

RESULTS

We found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process.

CONCLUSIONS

Our study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.

Are high-performing therapists both effective and consistent? A test of therapist expertise

OBJECTIVE

Therapist effectiveness has primarily been defined as being the aggregate of the client therapy outcomes within a therapist's caseload. It may seem intuitive that the most skilled therapists are both effective (in the way defined above) and consistent in facilitating positive outcomes across their clients; however, this premise has not been fully tested. The present study sought to empirically examine this question in a large, multisite, geographically diverse sample. We first computed a consistency variable and an aggregate outcome variable for each therapist among a subset of each individual therapist's caseload (the first 30 clients per therapist within our data set). We then utilized this consistency score and aggregate outcome score to predict the therapy outcomes of their remaining clients. Clients' pretreatment severity scores were also included as a moderator of the association between therapist consistency, therapist aggregate outcome, and client outcomes.

METHOD

The sample included 27,778 clients who were treated by 275 therapists. At the start of each session, clients completed the Behavioral Health Measure-20 as a measure of psychological functioning.

RESULTS

Polynomial regression and response surface analysis indicated a discrepant effect, such that subsequent clients' outcomes were highest when therapists' aggregate outcome with their first 30 clients was high and the consistency in the outcomes of their first 30 clients was also high. This relationship was not moderated by clients' pretreatment severity.

CONCLUSION

Therapists' expertise consists of both high performance and consistency. Therapists who achieved better outcomes consistently were top performers with their subsequent clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The complexity of human performance variability on watch standing task

The primary objective of this study was to examine the complexity of human temporal variability of topside roving watch task in naval operations concerning the reported times of ship status and to explore the potential presence of chaotic behavior and fractal properties of the reported log times. Topside rover reporting time intervals recorded in the deck logs of the USS Jason Dunham over the 2013-2015 period were analyzed to understand the underlying complexity of the watch standing task that is critical to the success of naval operations. The results on the 0-1 test, analysis of the largest Lyapunov exponents, as well the exploration of the fractal dimension and 1/f spectral analyses, showed that the fluctuation of standing watch time reports data exhibits chaotic and fractal system properties. The critical implications of the study findings for the human-centered design of complex systems were also discussed.

The Ottawa Paramedic Physical Ability Test: test-retest reliability and analysis of sex-based performance differences

The Ottawa Paramedic Physical Ability Test (OPPAT) is a physical employment standard (PES) that candidates must pass as a pre-hire requirement and that incumbents may have to pass prior to returning to work after absence, to demonstrate their physical capabilities as required to safely meet the demands of paramedic work. Consistent with best practice guidelines for PES development, it is important to establish reliability and to investigate sex-based performance differences. Active duty paramedics completed the OPPAT twice while candidates completed the OPPAT six times. Across all participants, a median improvement of 76.0 s was observed in OPPAT performance (922.0-846.0 s) between trial 1 and trial 2. Among candidates, OPPAT performance stabilised by the fourth trial confirming reliability. Sex-based analyses revealed median differences in OPPAT performance time of 39.0 and 63.0 s between males and females during the first and second trials respectively. Practitioner summary: Active duty paramedics and candidates performed the Ottawa Paramedic Physical Ability Test (OPPAT) faster following familiarisation. Among candidates, performance time stabilised by the fourth trial. Performance time was slower among females, but this had less impact on females' ability to meet the OPPAT standard.

Association between alcohol consumption and impaired work performance (presenteeism): a systematic review

OBJECTIVES

The aim of this review was to explore the notion of alcohol-related presenteeism; that is, whether evidence in the research literature supports an association between employee alcohol consumption and impaired work performance.

DESIGN

Systematic review of observational studies.

DATA SOURCES

MEDLINE, Web of Science, PsycINFO, CINAHL, AMED, Embase and Swemed+ were searched through October 2018. Reference lists in included studies were hand searched for potential relevant studies.

ELIGIBILITY CRITERIA

We included observational studies, published 1990 or later as full-text empirical articles in peer-reviewed journals in English or a Scandinavian language, containing one or more statistical tests regarding a relationship between a measure of alcohol consumption and a measure of work performance.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data. Tested associations between alcohol consumption and work performance within the included studies were quality assessed and analysed with frequency tables, cross-tabulations and χ² tests of independence.

RESULTS

Twenty-six studies were included, containing 132 tested associations. The vast majority of associations (77%) indicated that higher levels of alcohol consumption were associated with higher levels of impaired work performance, and these positive associations were considerably more likely than negative associations to be statistically significant (OR=14.00, phi=0.37, p<0.001). Alcohol exposure measured by hangover episodes and composite instruments were over-represented among significant positive associations of moderate and high quality (15 of 17 associations). Overall, 61% of the associations were characterised by low quality.

CONCLUSIONS

Evidence does provide some support for the notion of alcohol-related presenteeism. However, due to low research quality and lack of longitudinal designs, evidence should be characterised as somewhat inconclusive. More robust and less heterogeneous research is warranted. This review, however, does provide support for targeting alcohol consumption within the frame of workplace interventions aimed at improving employee health and productivity.

PROSPERO REGISTRATION NUMBER

CRD42017059620.

High-Performance Work System, Work Well-Being, and Employee Creativity: Cross-Level Moderating Role of Transformational Leadership

Under the new normal, the economic development mode and growth momentum of China has brought about fundamental changes, which means that the development of enterprises has gradually shifted from being factor-and investment-driven to being innovation-and talent-driven. As the foundation of corporate innovation, employee creativity plays an important role in this process. In the field of strategic human resource management, high-performance work system is the embodiment of its core competence. Although some research has begun to try to explore the impact of high-performance work system on employee creativity, the underlying mechanism and the boundary condition is not yet fully understood. According to the Job demands-resources (JD-R) model, this study theorized and examined whether and when high-performance work system stimulate employee creativity. Using a sample of large and medium-sized enterprises in China, we collected data, which are time-lagged and multilevel, from 266 employees in 61 departments. Results of the hierarchical linear model found that (1) High-performance work system is positively related to employee creativity; (2) High-performance work system positively affects employee work well-being; (3) Work well-being positively affects employee creativity; (4) Employee work well-being partially mediates the relationship between high-performance work system and creativity; (5) Transformational leadership, which represents an important contextual variable in the workplace, moderates the relationship between work well-being and employee creativity; (6) Moreover, we have also revealed that transformational leadership can moderate the indirect effect of high-performance work system on employee creativity. We discussed the theoretical and practical implications of these findings.

Daily eudaimonic well-being as a predictor of daily performance: A dynamic lens

Sustaining employees' well-being and high performance at work is a challenge for organizations in today's highly competitive environment. This study examines the dynamic reciprocal relationship between the variability in office workers' eudaimonic well-being (i.e., activity worthwhileness) and their extra-role performance. Eighty-three white-collar employees filled in a diary questionnaire twice a day, once in the morning and once in the afternoon, on four consecutive working days. The results show that eudaimonic well-being displays clear variability in a short time frame. In addition, Bayesian Multilevel Structural Equation Models (MSEMs) reveal a significant positive relationship between the levels of state eudaimonic well-being in the afternoon and the increase in the levels of state extra-role performance from that afternoon to the next morning. Moreover, the overall levels of self-reported state eudaimonic well-being across the diary measurements are significantly and positively related to the overall levels of extra-role performance assessed by the supervisor during the diary measurement. Finally, there is a significant negative relationship between the amount of intra-individual variability in state eudaimonic well-being during the week and the overall levels of self-rated state extra-role performance during the same week. These findings shed light on the dynamic nature of both the eudaimonic component of well-being and performance, highlighting the importance of eudaimonic well-being for extra-role performance and expanding the happy-productive worker thesis. The results suggest that the daily eudaimonic experience of meaning at work should complement the experience of hedonic well-being because it is an important factor in achieving better and more sustainable employee performance on a daily basis.

When Do Service Employees Suffer More from Job Insecurity? The Moderating Role of Coworker and Customer Incivility

The present study examines the effect of service employees’ job insecurity on job performance through emotional exhaustion. We identified workplace incivility (i.e., coworker and customer incivility) as a boundary condition that strengthens the positive relationship between job insecurity and emotional exhaustion. To test this moderating effect, we collected online panel surveys from 264 Korean service employees at two time points three months apart. As predicted, the positive relationship between job insecurity and job performance was partially mediated by emotional exhaustion. Of the two forms of workplace incivility, only coworker incivility exerted a significant moderating effect on the job insecurity–emotional exhaustion relationship, such that this relationship was more pronounced when service employees experienced a high level of coworker incivility than when coworker incivility was low. Coworker incivility further moderated the indirect effect of job insecurity on job performance through emotional exhaustion. These findings have theoretical implications for job insecurity research and managerial implications for practitioners.

Work Functioning Among Firefighters: A Comparison Between Self-Reported Limitations and Functional Task Performance

Purpose Performance-based and disease indicators have been widely studied in firefighters; self-reported work role limitations have not. The aim of this study was to describe the distributions and correlations of a generic self-reported Work Limitations Questionnaire (WLQ-26) and firefighting-specific task performance-based tests. Methods Active firefighters from the City of Hamilton Fire Services (n = 293) were recruited. Participants completed the WLQ-26 to quantify on-the-job difficulties over five work domains: work scheduling (4 items), output demands (7 items), physical demands (8 items), mental demands (4 items), and social demands (3 items). A subset of participants (n = 149) were also assessed on hose drag and stair climb with a high-rise pack performance-based tests. Descriptive statistics and correlations were used to compare item/subscale performance; and to describe the inter-relationships between tests. Results The mean WLQ-26 item scores (/5) ranged from 4.1 to 4.4 (median = 5 for all items); most firefighters (54.5-80.5%) selected "difficult none of the time" response option on all items. A substantial ceiling effect was observed across all five WLQ-26 subscales as 44.0-55.6% were in the highest category. Subscale means ranged from 61.8 (social demands) to 78.7 (output demands and physical demands). Internal consistency exceeded 0.90 on all subscales. For the hose drag task, the mean time-to-completion was 48.0 s (SD = 14.5; range 20.4-95.0). For the stair climb task, the mean time-to-completion was 76.7 s (SD = 37.2; range 21.0-218.0). There were no significant correlations between self-report work limitations and performance of firefighting tasks. Conclusions The WLQ-26 measured five domains, but had ceiling effects in firefighters. Performance-based testing showed wider score range, lacked ceiling effects and did not correlate to the WLQ-26. A firefighter-specific, self-report role functioning scale may be needed to identify compromised work role capabilities in firefighters.

Evaluating non-technical skills and mission essential competencies of pilots in military aviation environments

To develop and validate a classification of non-technical skills (NTS) in military aviation, a study was conducted, using data from real operations of F16 aircraft formations. Phase 1 developed a NTS classification based on the literature review (e.g. NOTECHS) and a workshop with pilots. The Non-TEChnical-MILitary-Skills (NOTEMILS) scheme was tested in Phase 2 in a series of Principal Component Analysis with data from After-Action-Review sessions (i.e. 900 records from a wide range of operations). The NTS were found to make a good prediction of Mission Essential Components (R² > 0.80) above the effect of experience. Phase 3 undertook a reliability analysis where three raters assessed the NOTEMILS scheme with good results (i.e. all r_wg > 0.80). To look into the consistency of classifications, another test indicated that, at least, two out of three raters were in agreement in over 70% of the assessed flight segments. Practitioner Summary: A classification scheme of Non-Technical Skills (NTS) was developed and tested for reliability in military aviation operations. The NTS scheme is a valuable tool for assessing individual and team skills of F-16 pilots in combat. It is noteworthy that the tool had a good capability of predicting Mission Essential Competencies.

Community Health and Employee Work Performance in the American Manufacturing Environment

Although better community health has long been assumed to be good for local businesses, evidence demonstrating the relationship between community health and employee performance is quite limited. Drawing on human resources data on 6103 employees from four large US manufacturing plants, we found that employees living in counties with poor community health outcomes had considerably higher rates of absenteeism and tardiness (ABT). For example, in one company, employees living in communities with high rates of children on free or reduced lunch had higher rates of ABT compared to other employees [adjusted odds ratio (OR) 2.76, 95% confidence interval (CI) 2.52-3.04], and employees living in communities with high rates of drug overdose deaths had higher rates of ABT (OR 1.51, 95% CI 1.29-1.77). In one plant, the annual value of lost wages due to ABT was over $1.3 million per year. Employees reported that poor community health (e.g., poverty, caregiving burdens, family dysfunction, drug use) resulted in "mental stress" leading to distraction, poor job performance, and more rarely, lapses in safety. These findings bolster the case for greater private sector investment in community health.

How leaders perceive employee deviance: Blaming victims while excusing favorites

Drawing from theories of attribution and perception, we posit that employees who are victims of rudeness are themselves (inappropriately) evaluated by leaders as being interpersonally deviant. We further theorize that employees who are themselves rude to others at work are evaluated negatively, but not when they have high-quality relationships with leaders or are seen as high performers. We tested our predictions across 4 studies. Our first study included 372 leader-follower pairs. Our second study extended to dyadic interactions among employees by using an employee roster method, resulting in paired data from 149 employees (2,184 dyads) across 5 restaurant locations. Our third and fourth studies utilized a policy-capturing design in which individuals provided performance evaluations for fictitious employees. We find that victims of rudeness are viewed by leaders as deviant, and that leaders are less likely to perceive rude employees as deviant when these perpetrators are seen as having high levels of leader-member exchange (LMX) or performance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A New Multisource Feedback Tool for Evaluating the Performance of Specialty-Specific Physician Groups: Validity of the Group Monitor Instrument

INTRODUCTION

Since clinical practice is a group-oriented process, it is crucial to evaluate performance on the group level. The Group Monitor (GM) is a multisource feedback tool that evaluates the performance of specialty-specific physician groups in hospital settings, as perceived by four different rater classes. In this study, we explored the validity of this tool.

METHODS

We explored three sources of validity evidence: (1) content, (2) response process, and (3) internal structure. Participants were 254 physicians, 407 staff, 621 peers, and 282 managers of 57 physician groups (in total 479 physicians) from 11 hospitals.

RESULTS

Content was supported by the fact that the items were based on a review of an existing instrument. Pilot rounds resulted in reformulation and reduction of items. Four subscales were identified for all rater classes: Medical practice, Organizational involvement, Professionalism, and Coordination. Physicians and staff had an extra subscale, Communication. However, the results of the generalizability analyses showed that variance in GM scores could mainly be explained by the specific hospital context and the physician group specialty. Optimization studies showed that for reliable GM scores, 3 to 15 evaluations were needed, depending on rater class, hospital context, and specialty.

DISCUSSION

The GM provides valid and reliable feedback on the performance of specialty-specific physician groups. When interpreting feedback, physician groups should be aware that rater classes' perceptions of their group performance are colored by the hospitals' professional culture and/or the specialty.

Burnout is Associated With Emotional Intelligence but not Traditional Job Performance Measurements in Surgical Residents

OBJECTIVE

To evaluate whether burnout was associated with emotional intelligence and job performance in surgical residents.

DESIGN

General surgery residents at a single institution were surveyed using the Maslach Burnout Inventory (MBI) and trait EI questionnaire (TEIQ-SF). Burnout was defined as scoring in 2 of the 3 following domains; Emotional Exhaustion (high), Depersonalization (high), and Personal Accomplishment (low). Job performance was evaluated using faculty evaluations of clinical competency-based surgical milestones and standardized test scores including the American Board of Surgery In-Training Exam (ABSITE) and the United States Medical Licensing Examination (USMLE) Step 3. USMLE Step 1 and USMLE Step 2, which were taken prior to residency training, were included to examine possible associations of burnout with USMLE examinations. Statistical comparison was made using Pearson correlation and simple linear regression adjusting for PGY level.

SETTING

This study was conducted at the University of Alabama at Birmingham (UAB) general surgery residency program.

PARTICIPANTS

All current and incoming general surgery residents at UAB were invited to participate in this study.

RESULTS

Forty residents participated in the survey (response rate 77%). Ten residents, evenly distributed from incoming residents to PGY-4, had burnout (25%). Mean global EI was lower in residents with burnout versus those without burnout (3.71 vs 3.9, p = 0.02). Of the 4 facets of EI, mean self-control values were lower in residents with burnout versus those without burnout (3.3 vs 4.06, p < 0.01). Each component of burnout was associated with global EI, with the strongest correlation being with personal accomplishment (r = 0.64; p < 0.01). Residents with burnout did not have significantly different mean scores for USMLE Step 1 (229 vs 237, p = 0.12), Step 2 (248 vs 251, p = 0.56), Step 3 (223 vs 222, p = 0.97), or ABSITE percentile (44.6 vs 58, p = 0.33) compared to residents without burnout. Personal accomplishment was associated with ABSITE percentile scores (r = 0.35; p = 0.049). None of the 16 surgical milestone scores were significantly associated with burnout.

CONCLUSIONS

Burnout is present in surgery residents and associated with emotional intelligence. There was no association of burnout with USMLE scores, ABSITE percentile, or surgical milestones. Traditional methods of assessing resident performance may not be capturing burnout and strategies to reduce burnout should consider targeting emotional intelligence.

Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation

BACKGROUND

Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals.

METHODS

A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly.

RESULTS

Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported.

CONCLUSION

Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation.

Patient centred medical home (PCMH) and patient-practitioner orientation: Is there a relationship?

BACKGROUND

The patient-centred medical home (PCMH) and utilisation of a patient-centred care approach have been promoted as opportunities to improve healthcare quality while controlling expenditures.

OBJECTIVES

To determine the penetration of PCMH within physician practices, and to evaluate physician attitudes towards patient-practitioner orientation. The ultimate objective was to explore relationships between the patient-practitioner orientation of respondents and the presence of PCMH elements within their practice.

METHODS

A survey instrument was developed following a comprehensive literature review. Lead physicians practicing in four states were surveyed.

RESULTS

The adjusted response rate was 26.7%. Responses indicated increased utilisation of PCMH elements (electronic medical records, e-mail and telephone consultations, and physician performance monitoring and feedback) compared with previous research. Within a logistic regression model, medical school graduation year (1990 or later >prior to 1990), practice size (group >solo), and percentage of time allocated to patient care (less >more) were significant predictors of working in a high PCMH alignment setting. Physician and practice characteristics did not predict the level of patient-practitioner orientation, though rural physicians were more patient-centred than urban physicians. A non-linear correlation between patient-practitioner orientation and the likelihood of practicing in a low or high PCMH-aligned practice was observed.

CONCLUSIONS

There is a non-linear correlation between patient-practitioner orientation and the likelihood of a physician practicing in a low or high PCMH-aligned practice. The ability of a physician to work in a PCMH setting or practicing patient-centred care can go beyond a physician's aspirations to work and practice in that manner.

The IPE performance report: A tool for preceptor development

INTRODUCTION

In order to promote interprofessional education (IPE) within the advanced experiential curriculum, the Office of Experiential Affairs (OEA) at Western New England University (WNE) created a process by which information regarding IPE at the practice sites is collected, verified, quantified, and used for preceptor development.

METHODS

An interprofessional education preceptor survey (IPEPS), consisting of 43 standardized questions designed to assess IPE opportunities available at practice sites, was administered to 55 preceptors in spring 2016 using Qualtrics^TM. Throughout the 2016-2017 academic year, students were required to document two interprofessional interactions that occurred during each of their four required APPE rotations. Results from the IPEPS were used to determine a perceived level of IPE occurring at each site and compared to student field encounter logs, then used to inform preceptor development through a customized IPE Performance Report.

RESULTS AND DISCUSSION

Response rates for both the IPEPS and student field encounter logs were 100%. Data relating to preceptors' perception of IPE opportunities afforded by their sites were collected and compared to data logged by students regarding IPE encounters at the sites. The data were compiled through a customized IPE Performance Report and communicated to preceptors as a form of professional development around IPE.

The effect of low ventilation rate with elevated bioeffluent concentration on work performance, perceived indoor air quality, and health symptoms

The aim of this laboratory experiment was to study the effects of ventilation rate, and related changes in air quality, predominantly bioeffluents, on work performance, perceived indoor air quality, and health symptoms in a typical conditions of modern open-plan office with low material and equipment emissions. In Condition A, outdoor air flow rate of 28.2 l/s person (CO₂ level 540 ppm) was applied and in Condition B, outdoor air flow rate was 2.3 l/s person (CO₂ level 2260 ppm). CO₂ concentration level was used as an indicator of bioeffluents. Performance was measured with seven different tasks which measure different cognitive processes. Thirty-six subjects participated in the experiment. The exposure time was 4 hours. Condition B had a weak negative effect on performance only in the information retrieval tasks. Condition B increased slightly subjective workload and perceived fatigue. No effects on health symptoms were found. The intensity of symptoms was low in both conditions. The experimental condition had an effect on perceived air quality and observed odor intensity only in the beginning of the session. Although the room temperature was controlled in both conditions, the heat was perceived to impair the performance more in Condition B.

Height premium for job performance

This study assessed the relationship of height with wages, using the 1998 and 2012 Korean Labor and Income Panel Study data. The key independent variable was height measured in centimeters, which was included as a series of dummy indicators of height per 5cm span (<155cm, 155-160cm, 160-165cm, and ≥165cm for women; <165cm, 165-170cm, 170-175cm, 175-180cm, and ≥180cm for men). We controlled for household- and individual-level random effects. We used a random-effect quantile regression model for monthly wages to assess the heterogeneity in the height-wage relationship, across the conditional distribution of monthly wages. We found a non-linear relationship of height with monthly wages. For men, the magnitude of the height wage premium was overall larger at the upper quantile of the conditional distribution of log monthly wages than at the median to low quantile, particularly in professional and semi-professional occupations. The height-wage premium was also larger at the 90th quantile for self-employed women and salaried men. Our findings add a global dimension to the existing evidence on height-wage premium, demonstrating non-linearity in the association between height and wages and heterogeneous changes in the dispersion and direction of the association between height and wages, by wage level.

Determinants of Work Performance in Workers with Depression and Anxiety: A Cross-Sectional Study

Depression and anxiety are highly prevalent disorders with an impact on existential aspects of person’s life, including employment i.e., work performance (WP). In order to develop appropriate strategies, it is essential to identify determinants of WP. The objective of this study was to identify the built, social, attitudinal and health system-related environmental determinants of WP in workers with anxiety or depression in total (N = 1211) and regarding the level of disability. Hierarchical binary logistic regression was performed on data obtained from implementation of the WHO Model Disability Survey (MDS) in Chile in 2015. Hindering aspects of means of transportation and workplace, and the use of personal assistance were determinants of WP for all workers with anxiety or depression. Results differed with level of disability. Hindering aspects of means of transportation and workplace, and discrimination were determinants of WP for persons with mild to moderate disability, while hindering aspects of the workplace and dwelling, and the use of personal assistance were determinants of WP for persons with severe disability. Our results emphasize the need for a broader understanding of determinants of WP and the requirement for an integrative approach in developing both universal and specific strategies that go beyond workplace settings.

Patient-reported Outcomes in a French Nationwide Survey of Inflammatory Bowel Disease Patients

BACKGROUND

Patient reported-outcomes [PROs] are a major therapeutic goal in inflammatory bowel disease [IBD].

METHODS

Between January and June 2014, patients affiliated with the French national IBD association filled out six self-questionnaires: quality of life 9QoL, according to the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and the Short-Form-36 Questionnaire [SF-36] v2); fatigue (the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]); work productivity (the Work Productivity and Activity Impairment [WPAI] questionnaire); disability [the I nflammatory Bowel Disease Disability Index]; and anxiety/depression (the Hospital Anxiety and Depression scale [HADS]). Associated factors were identified by univariate and multivariate logistic regression analyses.

RESULTS

Datasets were obtained from 1185 IBD patients. Around half of patients reported poor QoL [SIBDQ <45: 53.3%], severe fatigue [FACIT-F <30: 47.4%] and/or depression [HAD-D >7: 49.4%]. One-third of the patients reported anxiety [HAD-A >7: 30.3%] and/or moderate [22.4%] or severe [11.9%] disability. About half of them reported presenteeism and moderate-to-severe loss of work productivity and loss of activity. Poor QoL, severe fatigue, severe disease-related disability, and/or high WPAI were all associated with female gender, unemployment, and disease activity. Poor QoL, severe fatigue, and high WPAI were also associated with the use of tumour necrosis factor antagonists. A history of surgery was associated with poor QoL, whereas age was associated with severe fatigue. Severe depression was associated with female gender and disease activity.

CONCLUSIONS

The disease burden is very high in IBD, with poor QoL, fatigue, work impairment, and depression in half of patients. Marked disability and anxiety were reported by one-third of patients.

Development of Evaluation Indicators for Hospice and Palliative Care Professionals Training Programs in Korea

INTRODUCTION

The importance of training for Hospice and Palliative Care (HPC) professionals has been increasing with the systemization of HPC in Korea. Hence, the need and importance of training quality for HPC professionals are growing. This study evaluated the construct validity and reliability of the Evaluation Indicators for standard Hospice and Palliative Care Training (EIHPCT) program.

METHODS

As a framework to develop evaluation indicators, an invented theoretical model combining Stufflebeam's CIPP (Context-Input-Process-Product) evaluation model with PRECEDE-PROCEED model was used. To verify the construct validity of the EIHPCT program, a structured survey was performed with 169 professionals who were the HPC training program administrators, trainers, and trainees. To examine the validity of the areas of the EIHPCT program, exploratory factor analysis and confirmatory factor analysis were conducted.

RESULTS

First, in the exploratory factor analysis, the indicators with factor loadings above 0.4 were chosen as desirable items, and some cross-loaded items that loaded at 0.4 or higher on two or more factors were adjusted as the higher factor. Second, the model fit of the modified EIHPCT program was quite good in the confirmatory factor analysis (Goodness-of-Fit Index > 0.70, Comparative Fit Index > 0.80, Normed Fit Index > 0.80, Root Mean square of Residuals < 0.05). The modified model of the EIHPCT comprised 4 areas, 13 subdomains, and 61 indicators.

DISCUSSION

The evaluation indicators of the modified model will be valuable references for improving the HPC professional training program.

Understanding the role of sleep quality and sleep duration in commercial driving safety

INTRODUCTION

Long-haul truck drivers in the United States suffer disproportionately high injury rates. Sleep is a critical factor in these outcomes, contributing to fatigue and degrading multiple aspects of safety-relevant performance. Both sleep duration and sleep quality are often compromised among truck drivers; however, much of the efforts to combat fatigue focus on sleep duration rather than sleep quality. Thus, the current study has two objectives: (1) to determine the degree to which sleep impacts safety-relevant performance among long-haul truck drivers; and (2) to evaluate workday and non-workday sleep quality and duration as predictors of drivers' safety-relevant performance.

MATERIALS AND METHODS

A non-experimental, descriptive, cross-sectional design was employed to collect survey and biometric data from 260 long-haul truck drivers. The Trucker Sleep Disorders Survey was developed to assess sleep duration and quality, the impact of sleep on job performance and accident risk, and other relevant work organization characteristics. Descriptive statistics assessed work organization variables, sleep duration and quality, and frequency of engaging in safety-relevant performance while sleepy. Linear regression analyses were conducted to evaluate relationships between sleep duration, sleep quality, and work organization variables with safety composite variables.

RESULTS

Drivers reported long work hours, with over 70% of drivers working more than 11h daily. Drivers also reported a large number of miles driven per week, with an average of 2,812.61 miles per week, and frequent violations of hours-of-service rules, with 43.8% of drivers "sometimes to always" violating the "14-h rule." Sleep duration was longer, and sleep quality was better, on non-workdays compared on workdays. Drivers frequently operated motor vehicles while sleepy, and sleepiness impacted several aspects of safety-relevant performance. Sleep quality was better associated with driving while sleepy and with job performance and concentration than sleep duration. Sleep duration was better associated with accidents and accident risk than sleep quality.

DISCUSSION

Sleep quality appears to be better associated with safety-relevant performance among long-haul truck drivers than sleep duration. Comprehensive and multilevel efforts are needed to meaningfully address sleep quality among drivers.

Naturalistic field study of the restart break in US commercial motor vehicle drivers: Truck driving, sleep, and fatigue

Commercial motor vehicle (CMV) drivers in the US may start a new duty cycle after taking a 34-h restart break. A restart break provides an opportunity for sleep recuperation to help prevent the build-up of fatigue across duty cycles. However, the effectiveness of a restart break may depend on its timing, and on how many nighttime opportunities for sleep it contains. For daytime drivers, a 34-h restart break automatically includes two nighttime periods. For nighttime drivers, who are arguably at increased risk of fatigue, a 34-h restart break contains only one nighttime period. To what extent this is relevant for fatigue depends in part on whether nighttime drivers revert back to a nighttime-oriented sleep schedule during the restart break. We conducted a naturalistic field study with 106 CMV drivers working their normal schedules and performing their normal duties. These drivers were studied during two duty cycles and during the intervening restart break. They provided a total of 1260days of data and drove a total of 414,937 miles during the study. Their duty logs were used to identify the periods when they were on duty and when they were driving and to determine their duty cycles and restart breaks. Sleep/wake patterns were measured continuously by means of wrist actigraphy. Fatigue was assessed three times per day by means of a brief psychomotor vigilance test (PVT-B) and a subjective sleepiness scale. Data from a truck-based lane tracking and data acquisition system were used to compute lane deviation (variability in lateral lane position). Statistical analyses focused on 24-h patterns of duty, driving, sleep, PVT-B performance, subjective sleepiness, and lane deviation. Duty cycles preceded by a restart break containing only one nighttime period (defined as 01:00-05:00) were compared with duty cycles preceded by a restart break containing more than one nighttime period. During duty cycles preceded by a restart break with only one nighttime period, drivers showed more nighttime-oriented duty and driving patterns and more daytime-oriented sleep patterns than during duty cycles preceded by a restart break with more than one nighttime period. During duty cycles preceded by a restart break with only one nighttime period, drivers also experienced more lapses of attention on the PVT-B and increased lane deviation at night, and they reported greater subjective sleepiness. Importantly, drivers exhibited a predominantly nighttime-oriented sleep schedule during the restart break, regardless of whether the restart break contained only one or more than one nighttime period. Consistent with findings in laboratory-based studies of the restart break, the results of this naturalistic field study indicate that having at least two nighttime periods in the restart break provides greater opportunity for sleep recuperation and helps to mitigate fatigue.

The influence of daily sleep patterns of commercial truck drivers on driving performance

Fatigued and drowsy driving has been found to be a major cause of truck crashes. Lack of sleep is the number one cause of fatigue and drowsiness. However, there are limited data on the sleep patterns (sleep duration, sleep percentage in the duration of non-work period, and the time when sleep occurred) of truck drivers in non-work periods and the impact on driving performance. This paper examined sleep patterns of 96 commercial truck drivers during non-work periods and evaluated the influence these sleep patterns had on truck driving performance. Data were from the Naturalistic Truck Driving Study. Each driver participated in the study for approximately four weeks. A shift was defined as a non-work period followed by a work period. A total of 1397 shifts were identified. Four distinct sleep patterns were identified based on sleep duration, sleep start/end point in a non-work period, and the percentage of sleep with reference to the duration of non-work period. Driving performance was measured by safety-critical events, which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Negative binomial regression was used to evaluate the association between the sleep patterns and driving performance, adjusted for driver demographic information. The results showed that the sleep pattern with the highest safety-critical event rate was associated with shorter sleep, sleep in the early stage of a non-work period, and less sleep between 1 a.m. and 5 a.m. This study also found that male drivers, with fewer years of commercial vehicle driving experience and higher body mass index, were associated with deteriorated driving performance and increased driving risk. The results of this study could inform hours-of-service policy-making and benefit safety management in the trucking industry.

The effect of slightly warm temperature on work performance and comfort in open-plan offices - a laboratory study

The aim of the study was to determine the effect of a temperature of 29°C on performance in tasks involving different cognitive demands and to assess the effect on perceived performance, subjective workload, thermal comfort, perceived working conditions, cognitive fatigue, and somatic symptoms in a laboratory with realistic office environment. A comparison was made with a temperature of 23°C. Performance was measured on the basis of six different tasks that reflect different stages of cognitive performance. Thirty-three students participated in the experiment. The exposure time was 3.5 h in both thermal conditions. Performance was negatively affected by slightly warm temperature in the N-back working memory task. Temperature had no effect on performance in other tasks focusing on psychomotor, working memory, attention, or long-term memory capabilities. Temperature had no effect on perceived performance. However, slightly warm temperature caused concentration difficulties. Throat symptoms were found to increase over time at 29°C, but no temporal change was seen at 23°C. No effect of temperature on other symptoms was found. As expected, the differences in thermal comfort were significant. Women perceived a temperature of 23°C colder than men.