Work-related support, community and trust - Dentistry in Sweden and Denmark

Abstract: Work as a dentist provides great opportunities for human contacts with patients as well as with co-workers. The context for provision of health care is changing, implicating that the roles of health professionals - including dentists - are challenged. This thesis deals with positive work relations among dentists. The overall aims were: 1) to improve understanding of what characterizes Good Work for general dental practitioners and 2) to analyse associations between factors in the work environment and social support, community, and trust among dentists in Sweden and Denmark. The thesis is based on both qualitative and quantitative methods, comprising results from three studies, presented in four papers. The study populations include general dental practitioners from Sweden and Denmark working in the private and in the public sector. In Paper I, dentists’ perceptions of Good Work regarding positive and rewarding aspects were explored through phenomenological analysis of interviews with Danish and Swedish general dental practitioners. The main result was that the core of Good Work emanates from the clinical encounter; from the relation with the patient and from the opportunity to carry out high quality odontological handicraft. Social relations at the workplace, as well as organizational values and conditions, were perceived as influencing the opportunities to achieve rewarding aspects from the clinical encounter. The aim of Paper II was to study to what extent Danish general dental practitioners perceived support from colleagues and to relate this support to demographic and work-related background factors. The analysis was based on answers from 222 dentists included in a cross-sectional survey of randomly selected general dental practitioners from Denmark. Most respondents perceived that they had a colleague with whom they would choose to discuss a potential complaint proceeding, even though it was more common to discuss difficult treatments than problems concerning dissatisfied patients with colleagues. Dentists who were female, young, from group practices, often in contact with colleagues outside the practice, and who reported that they were supported in practical matters, perceived on average a higher degree of Emotional Support. Dentists who were married/cohabitant, coming from a group practice, often in contact with colleagues outside the practice and who were emotionally supported perceived a higher degree of Practical Support. The study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry. Data from a cross-sectional comparative survey were used in papers III and IV. A questionnaire was sent to randomly selected general dental practitioners working in Sweden or Denmark in the private or the public sectors. The net response was 68%. In paper III, two scales were developed; the one measuring Community with Trust (the sense of being part of a community characterized by trust and humour at work) and the other Collegial Support (perceived social support from colleagues in relation to the work with patients) were developed. The psychometric properties of the scales were evaluated. Explorative factor analysis was used to investigate dimensionality; internal consistency was assessed by Cronbach’s coefficient alpha. Differential item functioning and convergent validity were assessed. The reliability and validity of the two new scales were satisfactory. The aim of paper IV was to analyse variables associated with the scales for Collegial Support and Community with Trust. Two models were built using multiple hierarchical linear regression analysis. Demographic background factors, work factors, managerial factors and factors relating to objectives and values characterizing the climate of the practice were introduced as blocks in the models. The main results were that having common breaks and decision authority, as well as working in a practice climate characterized by professional values were positively associated with the scale for Community with Trust. Dentists who were female, married/cohabitant, who had frequent contacts with colleagues outside the practice, and worked at a practice with frequent common breaks, where the leader had formalized managerial education, and the climate was characterized by professional values, were positively associated with the scale for Collegial Support. In contrast, being managerially responsible and having worked many years as a dentist were negatively associated with Collegial Support. Thus, a different pattern was documented for Collegial Support than for Community with Trust, indicating different underlying mechanisms. A professionally oriented practice climate and common breaks at work were strongly associated with both outcome variables. Differences in average for dentists’ Collegial Support and Community with Trust were found among different organizational settings. The final regression analyses pointed to organizational differences such as size of practices, influence on work, frequency of common breaks, managerial education and practice climate as well as, for example, gender distributions, contributed to possible explanations. Thereby, new knowledge has been achieved about a number of work environment factors which are of relevance for positive social relations in dentistry. In conclusion, the work with patients constitutes the core of work in dentistry, while relations among peers, staff, and management are important frameworks. This thesis points to the importance of collegiality and work-related community with freedom in work with patients. Therefore, it is relevant to address the professional and relational character of the work when organizing and managing dentistry.