Health care in transition : threat or opportunity? Psychosocial work quality and health for staff and organization

Abstract: Impact of the psychosocial work environment on the health and well-being of health care personnel should be studied with a global view, including individual and organizational resources to cope with work conditions. Work quality of health care workers has to be considered in an overall evaluation of quality of care. This work is based on a stress theory, and includes large studies of health care workers. A partly general questionnaire was used and continuously developed. The thesis identified predictors of healthy work and tried to identify supporting individual and organizational coping resources modifying the interaction between work environment, and health and well-being of staff. The thesis has pointed out the importance of individual and professional as well as organisatonal factors to understand the work-worker-health interaction among health care employees. Paper I more generally studied the work environment and health of a national sample Swedish registered nurses but also more specificly the importance of gender and medical specialty for perceived work environment, health and work relations. Paper II emphasized the importance of job satisfaction and job influence as key factors for perceived work environment. health and work relations of Swedish registered nurses. As criteria for work quality, predictors of job satisfaction were identified and used. Anxiety and depression, intellectual discretion, job demand, job control and general health were shown to be of relevance for work quality. Paper III. This paper studied preferences for important psychosocial workplace improvements, based on responses to an open-ended question from registered nurses and physicians. Work climate, organization, workload, and competence and development seemed to be the most important areas for improvements. Paper IV was methodological and concerned development of an health care instrument using overall factor analysis. Variable structures for areas of work quality, health and well-being, and supporting resources as possible modifiers of the work-worker-health interaction were replicated in three large studies. A further modified stress model was tested and social climate confirmed as a significant modifier of the work quality-health interaction. Paper V. In this paper, health care workers exposed to different health care work environments were studied, using the measures developed in paper IV. Importance of gender, age, profession and organization was emphasized as well as time trends in measures during 1992-1995. An increase in exhaustion was found over time, explained by a deterioration in social climate and perceived work quality Paper Vl. There is a lack of interventions evaluating effects on staff health and well-being. Measures developed in paper IV were used to evaluate effects of an intervention program at a regional hospital on staff perceived work quality, health and well-being, and supporting resources. Intervention programs might have some preventive effects on staff in times of health care transitions.