The rapidly changing world of healthcare is faced with many challenges, not the least of which is a diminishing workforce. Healthcare organizations must develop multiple strategies, not only to attract and retain employees, but also to ensure that workers are prepared for continuous change in the workplace, are working at their full scope of practice and are committed to, and accountable for, the provision of high-quality care. There is evidence that by creating a healthier workplace, improved patient care will follow. Aligning Healthy Workplace Initiatives with an organization's strategic goals, corporate culture and vision reinforces their importance within the organization. In this paper, we describe an innovative pilot to assess a career development program, one of multiple Healthy Workplace Initiatives taking place at Providence Care in Kingston, Ontario in support of our three strategic goals. The results of the pilot were very encouraging; subsequent success in obtaining funding from HealthForceOntario has allowed the implementation of a sustainable program of career development within the organization. More work is required to evaluate its long-term effectiveness.
The purpose of this paper is to examine anger associated with types of negative work events experienced by health administrators and to examine the impact of anger on intent to leave.
Textual data analysis is used to measure anger in open-ended survey responses from administrative staff of a Canadian hospital. Multivariate regression is applied to predict anger from event type, on the one hand, and turnover intentions from anger, on the other.
Person-related negative events contributed to administrator anger more than policy-related events. Anger from events predicted turnover intentions after adjusting for numerous potential confounds.
Future studies using larger samples across multiple sites are needed to test the generalizability of results.
Results provide useful information for retention strategies through codifying respect and fairness in interactions and policies. Health organizations stand to gain efficiencies by helping administrators handle anger effectively, leading to more stable staffing levels and more pleasurable, productive work environments.
This paper addresses gaps in knowledge about determinants of turnover in this population by examining the impact of administrator anger on intent to leave and the work events which give rise to anger. Given the strategic importance of health administration work and the high costs to health organizations when administrators leave, results hold particular promise for health human resources.
Compliance-enhancing organizations such as the military and police are characterized by guiding and controlling employees, and they increasingly tend to control and restrict employees' behavior when exposed to external uncertainty. Restrictions on employees' behavior are intended to increase efficiency, safety, and combat readiness through reducing misunderstandings and conflicts. However, many writers have argued that the most natural reaction to external unpredictability and uncertainty is internal flexibility and utilizing the entire range of employees' qualifications. The question raised in this study is whether restrictions imply that employees feel they are subject to incompatible work conditions and are deprived of resources and opportunities to execute their everyday responsibilities and thereby experience role conflict. Hierarchical regression analyses performed on data from 71 police and 71 army officers showed that rules and routines that were perceived as restrictive or coercive better explained role conflict among employees than either leadership loyalty, commitment, and rules or routines that were perceived as enabling.
To investigate the association between organizational climate and work commitment, and sickness absence in a general population of workers and consecutively selected employed sick-listed.
Questionnaire data used in this cross-sectional study consisted of two cohorts: (1) randomly selected individuals in a general working population cohort (2763) and (2) consecutively selected employed sick-listed cohort (3044) for more than 14 days over 2 months.
Poor organizational climate was associated with increased odds of belonging to the employed sick-listed cohort among both women and men, while high work commitments were associated with increased odds only among women. The increased adjusted odds ratio for the combinations of poor organizational climate and high work commitment was 1.80 (confidence interval 1.36 to 2.37) among women and 2.74 (confidence interval 1.84 to 4.08) among men.
These results support the magnitude of combining organizational climate and work commitment.
The present study examined whether job control moderated the association between stress indicators (distress and sleeping problems) and intentions to change profession among 2,650 Finnish physicians. Ordinal logistic regression analysis was applied. The authors found that high levels of distress and sleeping problems were associated with higher levels of intentions to change profession, whereas high job control was associated with lower levels of intentions to change profession even after adjusting for the effects of gender, age, and employment sector. In addition, high job control was able to mitigate the positive association that distress and sleeping problems had with intentions to change profession. Our findings highlight the importance of offering more job control to physicians to prevent unnecessary physician turnover.
Recruiting and retaining health professions remains a high priority for health system planners. Different employment sectors may vary in their appeal to providers. We used the concepts of inflow and stickiness to assess the relative attractiveness of sectors for physical therapists (PTs) in Ontario, Canada. Inflow was defined as the percentage of PTs working in a sector who were not there the previous year. Stickiness was defined as the transition probability that a physical therapist will remain in a given employment sector year-to-year.
A longitudinal dataset of registered PTs in Ontario (1999-2007) was created, and primary employment sector was categorized as 'hospital', 'community', 'long term care' (LTC) or 'other.' Inflow and stickiness values were then calculated for each sector, and trends were analyzed.
There were 5003 PTs in 1999, which grew to 6064 by 2007, representing a 21.2% absolute growth. Inflow grew across all sectors, but the LTC sector had the highest inflow of 32.0%. PTs practicing in hospitals had the highest stickiness, with 87.4% of those who worked in this sector remaining year-to-year. The community and other employment sectors had stickiness values of 78.2% and 86.8% respectively, while the LTC sector had the lowest stickiness of 73.4%.
Among all employment sectors, LTC had highest inflow but lowest stickiness. Given expected increases in demand for services, understanding provider transitional probabilities and employment preferences may provide a useful policy and planning tool in developing a sustainable health human resource base across all employment sectors.
Cites: Arch Phys Med Rehabil. 2004 Feb;85(2):210-714966704
Cites: Can J Public Health. 2011 Nov-Dec;102(6):427-3122164552
The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process.
The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden.
This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care.
Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement.
The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.
This study investigates the relationship between hospital quality improvement (QI) team success and changes in empowerment, 'organizational commitment, organizational citizenship behaviour' (OCB) and job behaviour related to QI. Data were collected from administrative staff, healthcare professionals and support staff from four community hospitals. The study involved a field investigation with two data collection points. Structured questionnaires and interviews with hospital management were used to collect data on the study variables. High scores were observed for organizational commitment, OCB and job behaviour related to QI when individuals identified with teams that were successful. Low scores were observed when individuals identified with teams that were unsuccessful. Empowerment was positively related to job behaviour associated with QI. It is concluded that participation on QI teams can lead to organizational learning, resulting in the inculcation of positive 'extra-role' and 'in-role' job behaviour.
From 1978 to 1983, researchers at the University of North Carolina conducted a National Evaluation of Rural Primary Care Programs. Thirty years later, many of the programs they studied have closed, but the challenges of providing rural health care have persisted. I explored the histories of 4 surviving rural primary care programs and identified factors that contributed to their sustainability. These included physician advocates, innovative practices, organizational flexibility, and community integration. As rural health programs look ahead, identifying future generations of physician advocates is a crucial next step in developing the rural primary care workforce. It is also important for these programs to find ways to cope with high rates of staff turnover.
Cites: Med J Aust. 2005 Nov 21;183(10 Suppl):S77-8016296958
Cites: J Am Board Fam Pract. 1997 Jul-Aug;10(4):272-99228622
Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this.
The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project.
Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility.
Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.