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Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital.

ABSTRACT: BACKGROUND:Workload and demands on hospital staff have been growing over recent years. To ensure patient and occupational safety, hospitals increasingly survey staff about perceived working conditions and safety culture. At the same time, routine data are used to manage resources and performance. This study aims to understand the relation between survey-derived measures of how staff perceive their work-related stress and strain and patient safety on the one hand, and routine data measures of workload and quality of care (patient safety) on the other. METHODS:We administered a written questionnaire to all physicians and nurses in the inpatient units at a German university hospital. The questionnaire was an amalgam of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Copenhagen Burnout Inventory (CBI) scale to assess patient-related burnout of and portions of the Hospital Survey on Patient Safety Culture (HSPSC). Indicators from administrative data used to assess workload and patient-related work-strain were: amount of overtime worked, work intensity recording of nurses, cost weight, occupancy rate and DRG-related length of stay. Quality of care was assessed using readmission rates and disease-related length of stay. Univariate associations were tested with Pearson correlations. RESULTS:Response rate were 37% (224) for physicians and 39% (351) for nurses. Physicians' overtime correlated strongly with perceived quantitative demands (.706, 95% CI: 0.634 to 0.766), emotional demands (.765; 95% CI: 0.705 to 0.814), and perceived role conflicts (.655, 95% CI: 0.573 to 0.724). Nurses' work-intensity measures were associated with decreasing physician job satisfaction and with less favorable perceptions of the appropriateness of staffing (-.527, 95% CI:-0.856 to 0.107). Both professional groups showed medium to strong associations between the morbidity measure (cost weight) and role conflicts; between occupancy rates and role clarity (-.482, 95% CI: -0.782 to -0.02) and predictability of work (-.62, 95% CI: -0.848 to -0.199); and between length of stay and internal team functioning (-.555, 95% CI: -0.818 to -0.101). Higher readmission rates were associated with lower perceived patient safety (-.476, 95% CI: -0.779 to 0.006), inadequate staffing (-.702, 95% CI: -0.884 to -0.334), and worse team functioning (-.520, 95% CI: -0.801 to -0.052). Shorter disease-related length of stay was associated with better teamwork within units (-.555, 95% CI: -0.818 to -0.101) and a lower risk of physician burnout (-.588, 95% CI: -0.846 to -0.108). CONCLUSION:Perceptions of hospital personnel regarding sub-optimal workplace safety and teamwork issues correlated with worse patient outcome measures. Furthermore, objective measures of overtime work as well as objective measures of workload correlated clearly with subjective work-related stress and strain. This suggests that objective workload measures (such as overtime worked) could be used to indirectly monitor job-related psychosocial strain on employees and, thus, improve not only staff wellbeing but also patient outcomes. On the other hand, listening to their personnel could help hospitals to improve patient (and employee) safety.

SUBMITTER: Sturm H

PROVIDER: S-EPMC6319813 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital.

Sturm Heidrun H Rieger Monika A MA Martus Peter P Ueding Esther E Wagner Anke A Holderried Martin M Maschmann Jens J

PloS one 20190104 1

<h4>Background</h4>Workload and demands on hospital staff have been growing over recent years. To ensure patient and occupational safety, hospitals increasingly survey staff about perceived working conditions and safety culture. At the same time, routine data are used to manage resources and performance. This study aims to understand the relation between survey-derived measures of how staff perceive their work-related stress and strain and patient safety on the one hand, and routine data measure ...[more]

PMID: 30608945

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Project description:BackgroundSocial firms are companies on the general labour market which provide employment to people with severe disabilities. In this setting different job resources are offered for its employees, including social support or flexibility in terms of working hours, tasks or pace of work. However, to date, only limited evidence exists on the work and health situation of supervisors in social firms. Therefore, the study aims to explore job demands and resources of supervisors in social firms to increase knowledge in a little researched field and to develop recommendations for action on workplace health promotion.MethodsSixteen semi-structured telephone interviews were conducted with supervisors of social firms in the North of Germany within July and November 2020. Different sectors such as gastronomy or cleaning services as well as employment opportunities for people with different types of disabilities were included. The interviews were recorded, transcribed verbatim and analysed following the qualitative content analysis according to Mayring (deductive-inductive approach).ResultsOverall, a heterogeneous composition was aimed for in terms of age and gender distribution (68.75% were male and between 32 and 60 years old). Supervisors reported various job demands in social firms, including for instance emotional demands, conflicts between social and economic objectives, conflict management, exposure to heat, heavy lifting or constant standing. In contrast, a high meaning of work, possibilities in shaping the structure of the social firm, social support of colleagues or the management and the provision of an ergonomic work environment were highlighted as job resources. Further person-related demands (e.g. own expectations) and resources (e.g. patience) were underlined as well.ConclusionFirst exploratory insights were provided with reference to job demands and resources for supervisors in social firms. The overview on working conditions underlines the significance of a supportive work environment taking structural and behavioural-related implications into account to reduce demands and strengthen resources. Further interventional research is needed regarding the development, testing and evaluation of workplace health promotion interventions in social firms.

Project description:IntroductionPractice assistants represent a highly relevant occupational group in Germany and one of the most popular training professions in Germany. Despite this, most research in the health care sector has focused on secondary care settings, but has not addressed practice assistants in primary care. Knowledge about practice assistants' workplace-related stressors and resources is particularly scarce. This cross-sectional study addresses the mental workload of practice assistants working in primary care practices.MethodsPractice assistants from a network of 185 German primary care practices were invited to participate in this cross-sectional study. The standardized `Short Questionnaire for Workplace Analysis' (German: Kurzfragebogen zur Arbeitsanalyse) was used to assess practice assistants´ mental workload. It addresses eleven workplace factors in 26 items: versatility, completeness of task, scope of action, social support, cooperation, qualitative work demands, quantitative work demands, work disruptions, workplace environment, information and participation, and benefits. Sociodemographic and work characteristics were also obtained. A descriptive analysis was performed for sociodemographic data and "Short Questionnaire for Workplace Analysis" factors. The one-sided t-test and Cohen´s d were calculated for a comparison with data from 23 professional groups (n = 8,121).ResultsA total of 550 practice assistants from 130 practices participated. The majority of practice assistants was female (99.3%) and worked full-time (66.5%) in group practices (50.6%). Compared to the other professional groups, practice assistants reported higher values for the factor social support (4.0 versus 3.7 [d 0.44; p<0.001]), information and participation (3.6 versus 3.3 [d 0.38; p<0.001] as well as work disruptions (2.7 vs. 2.4 [d 0.42; p<0.001]), while practice assistants showed lower values regarding scope of action (3.4 versus 3.8 [d 0.43; p<0.001]).ConclusionsOur study identified social support and participation within primary care practices as protective factors for mental workload, while work disruptions and scope of action were perceived as stressors.

Project description:ObjectiveTo establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses.Materials and methodsRepeated measures mixed-methods study in a surgical intensive care unit. Wearable and environmental sensors captured work process data. Nurses rated their mental (ME) and physical exertion (PE) for each four-hour block, and recorded patient and staffing-level workload factors. Shift was the grouping variable in multilevel modeling where sensor-based measures were used to predict nursing perceptions of exertion.ResultsThere were 356 work hours from 89 four-hour shift segments across 35 bedside nursing shifts. In final models, sensor-based data accounted for 73% of between-shift, and 5% of within-shift variance in ME; and 55% of between-shift, and 55% of within-shift variance in PE. Significant predictors of ME were patient room noise (ß = 0.30, p < .01), the interaction between time spent and activity levels outside main work areas (ß = 2.24, p < .01), and the interaction between the number of patients on an insulin drip and the burstiness of speaking (ß = 0.19, p < .05). Significant predictors of PE were environmental service area noise (ß = 0.18, p < .05), and interactions between: entropy and burstiness of physical transitions (ß = 0.22, p < .01), time speaking outside main work areas and time at nursing stations (ß = 0.37, p < .001), service area noise and time walking in patient rooms (ß = -0.19, p < .05), and average patient load and nursing station speaking volume (ß = 0.30, p < .05).DiscussionAnalysis yielded highly predictive models of critical care nursing workload that generated insights into workflow and work design. Future work should focus on tighter connections to psychometric test development methods and expansion to a broader variety of settings and professional roles.ConclusionsSensor-based measures are predictive of perceived exertion, and are viable complements to traditional task demand measures of workload.

Dataset Information

Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital.

Publications

Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital.

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