Managerialism in the Neoliberal Hospital

In October 2024, Hult et al. published the article ‘Decent and Precarious Work Among Nursing and Care Workers: A Mixed-Method Systematic Review’ in Journal of Advanced Nursing. The article critically examines the impact of decent and precarious work on nursing outcomes. We acknowledge the value of their contributions and appreciate the authors' efforts in broadening our understanding of employment quality in healthcare. However, we believe that recent studies on related themes offer additional perspectives that may enhance the discourse initiated by Hult et al. Here, we draw on three of our previously published studies to extend their findings. Our study, titled ‘Decent Work and Ethical Ideologies of Nurses: A Multicenter Cross-Sectional Study’, highlighted how decent work influences nurses' ethical ideologies, such as idealism and relativism (Zoromba et al. 2024). Similar to Hult et al.'s findings, we found that decent work fosters favourable workplace behaviours, particularly adherence to ethical standards. However, our study emphasises that key components such as organisational values and interpersonal safety are not only essential for well-being but also promote ethical ideologies. This underscores that fostering decent work conditions benefits both the emotional and ethical dimensions of healthcare work. Our second study, ‘How Decent Work Influences Internal Whistleblowing Intentions: The Mediating Roles of Felt Obligation and Organizational Identification’, examined how decent work promotes proactive behaviours like whistleblowing (El-Gazar and Zoromba 2024). While Hult et al. primarily focus on employee retention and well-being, our research suggests that decent work can also catalyse moral actions by strengthening organisational identification. Specifically, our findings demonstrate that felt obligation and identification mediate the relationship between decent work and whistleblowing intentions, providing a framework to explore other ethical behaviours cultivated by decent work conditions. In ‘The Role of Psychological Ownership in Linking Decent Work to Nurses' Vigor at Work: A Two-Wave Study’, we explored how psychological ownership mediates the effect of decent work on vigour (El-Gazar et al. 2024). While Hult et al. emphasise the mental health benefits of decent work, we propose that vigour offers a complementary lens for understanding employee engagement. Our findings suggest that decent work not only reduces stress but also fosters an environment where nurses feel ownership of their roles, leading to sustained energy and job satisfaction. The nuanced inclusion of psychological ownership deepens the understanding of how decent work translates into high job performance (International Labour Organization, 2019). While Hult et al.'s systematic review provides a comprehensive overview, highlighting the significance of sustainable employment policies in mitigating precarious work conditions, our findings highlight the need to explore additional dimensions, such as ethical ideologies, whistleblowing and psychological ownership, within the context of decent work. Our research suggests that the concept of decent work extends beyond job satisfaction to encompass critical moral and behavioural outcomes. This recent approach of nursing research stressing investing in leadership programs to foster organisational identification and ethical behaviours, including whistleblowing, encouraging psychological ownership through strategies that enhance nurses' autonomy and engagement. To further enrich this discourse, we recommend that future studies adopt longitudinal approaches, as employed in our two-wave design, to capture temporal changes in work conditions and behaviours. Additionally, interventions aimed at enhancing organisational values and psychological ownership could amplify the benefits of decent work. Conclusion: We commend Hult et al. for their valuable contribution to nursing research. Our studies complement their findings by offering insights into the behavioural and psychological outcomes associated with decent work. We hope that our discussion encourages further research and informs practical interventions aimed at enhancing working conditions in healthcare. M.A.Z. and H.E.E. planned the letter and made substantial contributions to conception and design. M.A.Z., S.A.A. and H.E.E. were major contributors in writing and drafting the manuscript. H.E.E. and M.A.Z. were major contributors in writing the letter. All authors given final approval of the version to be published and Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article, as no new data were created or analyzed in this study.

To identify and describe evidence from original studies on the contextual factors, dimensions, and outcomes of decent and precarious work among nursing and care workers. This is a mixed-methods systematic review. The Scopus, Web of Science, PubMed, CINAHL, PsycINFO and SocINDEX databases were searched on January 11, 2024. Two reviewers independently applied eligibility criteria, selected studies, and conducted quality appraisals. We employed data-based convergent synthesis as the data synthesis method. The dimensions of decent and precarious work were analysed deductively using the Employment Quality Framework. Five studies on decent work and 13 studies on precarious work were included. Five contextual factors were common, though opposite, in both decent and precarious work studies: employment contract, position, financial situation, age, and work experience. Three outcomes were also common. Decent work increased, and precarious work decreased, physical and mental health and empowerment, whereas turnover was decreased by decent work and increased by precarious work. Challenges can be converted into positive outcomes for the future, moving towards meaningful work, fair jobs, sustainable employment policies, and attractive career prospects. To achieve this, more knowledge is needed about employment quality in nursing and care work. Young nurses and care workers should be provided opportunities to fully engage in their work and organisations. Training is also crucial for managers, as it decreases authoritarian and controlling management practices. This review is the first to synthesise research evidence on decent and precarious work in nursing and care work, confirming that they are opposite concepts of employment quality. The results benefit nurses and care workers, organisations, and decision-makers. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. No Patient or Public Contribution.

PurposeThe purpose of this paper is to identify lessons and implications on the theme of decent work in social care. This has long been highlighted as integral to improving social care for the elderly. The COVID-19 pandemic experience reveals lessons and implications about the systemic absence of decent work in one place, Scotland, in care homes. The main lesson and implication is a need for change beyond the focus on levels of pay and systemic advocacy of decent work as it is conventionally understood.Design/methodology/approachData was collected using qualitative, semi-structured interviews with 20 care workers in care homes.[AQ4] A range of care system institutional stakeholders was also interviewed. A range of care system institutional stakeholders was also interviewed.FindingsDecent work in social care may only be progressed to the extent that a culture change is achieved, transcending the institutional stasis about who owns and engages with progressing decent work.Research limitations/implicationsThis is a study in one place, Scotland, with a small sample of frontline care workers in care homes and representatives from a range of institutions.Practical implicationsEffective culture change for decent work in care homes needs to be a higher research priority. More explicit culture policies can be a mechanism by which overall decent work and system change may be catalysed and sustainably secured together. Explicit culture change is here set out with respect to operational, institutional and national domains.Social implicationsThere needs to be social policy and political support for situating decent work to be part of a broader culture change around care work with the elderly. A culture-oriented change plan as well as new resourcing and structures can together ensure that the nadir of the pandemic experience was a historical turning point towards transformation rather than being just another low point in a recurring cycle.Originality/valueThe situating of systemic decent work progress within a broader culture change, and modelling that culture change, are original contributions.

Call for papers for the 2021 Emerging Discourse Incubator: Managing Working Conditions in Supply Chains: Towards Decent Work

Background:With the increasing emphasis on sustainability in health care, it is essential to clarify how work conditions and professional identity influence sustainable behavior in nurses. Decent work environments may contribute to professionalism, which is known to foster sustainable practices.Purpose:This study was designed to investigate the relationship between decent work practices and self-reported sustainable behavior in nurses, with a focus on the mediating role of professionalism.Methods:This cross-sectional study was conducted on a sample of 206 clinical nurses. Data were collected using validated Arabic versions of the Decent Work Scale, Nurses’ Professionalism Inventory, and Self-Reported Sustainable Behavior Scale. Statistical analyses included Pearson correlation, t-tests, analysis of variance (ANOVA), and mediation analysis.Results:The results revealed significantly positive associations between all of the study variables. Decent work practices were shown to correlate strongly with both professionalism (r=.870) and sustainable behavior (r=.897). Also, professionalism was found to correlate positively with sustainable behavior (r=.823). The results of the mediation analysis confirmed professionalism to significantly mediate the relationship between decent work and sustainable behavior (indirect effect β=0.332, 95% CI [0.194, 0.447]).Conclusions/Implications for Practice:Decent work conditions enhance professionalism and, as a result, promote sustainable behavior in nurses. These findings underscore the importance of fostering supportive work environments and professionalism to achieve sustainable health care practices. Interventions that enhance decent work and professionalism may play a critical role in advancing sustainability in health care.

A review on the gendered impact of COVID-19 pandemic towards achieving sustainable development goals in Bangladesh: Ecofeminist perspectives on the response to COVID-19 pandemic

BackgroundSimilar to the general public, mental health professionals sometimes also have negative attitudes towards individuals with mental illness; which could ultimately affect the quality of care received by the patients. This study aims to explore attitudes to mental illness among mental health professionals in Singapore; make comparisons with the general population; and investigate the significant correlates.MethodsA cross-sectional design was used. Eligible participants were recruited from the Institute of Mental Health, Singapore. Attitudes to mental illness among the mental health professionals were measured using an adapted 26-item Attitudes to Mental Illness questionnaire (AMI). An earlier study amongst the general population in Singapore had used the same tool; however, factor analysis suggested a 20-item, 4-factor structure (AMI-SG) was the best fit. This 4-factor structure was applied among the current sample of mental health professionals to allow comparisons between the professionals and the general population.Data were collected through an online survey tool ‘Questionpro’ from February to April 2016, and 379 participants were included in the current analysis. Attitudes to mental illness among these professionals were compared to those of the general population, which were captured as part of a national study conducted from March 2014 to April 2015.ResultsThe 20-item, 4-factor structure AMI-SG derived from the general population was applicable among the mental health professionals in Singapore. Compared to the general population, mental health professionals had significantly more positive attitudes to mental illness; however their scores on ‘social distancing’ did not differ from the general population. Indian ethnicity was negatively associated with ‘social distancing’ and ‘social restrictiveness’ among the professionals; while higher education was negatively related to ‘prejudice and misconception’. Compared to nurses, doctors showed significantly more positive attitudes on ‘social restrictiveness’ and ‘prejudice and misconception’. Having family or close friends diagnosed with mental illness was negatively associated with ‘social distancing’ among the professionals.ConclusionThe AMI-SG is an effective tool to measure attitudes to mental illness among mental health professionals in Singapore. Although the professionals had significantly more positive attitudes to mental illness than the general public in Singapore, their attitudes on ‘social distancing’ resembled closely that of the general public. Professionals tended to have more negative attitudes if they were nurses, less educated, and of Chinese ethnicity. More studies are needed to explore the underlying reasons for the differences and to generalize these findings among mental health professionals elsewhere.

COVID-19 Pandemic: What Has Work Got to Do With It?

Covid-19 - Call Centre Workers and Health-Safety, Union Challenges and Organisation

PurposeThe study aims to investigate the impact of “decent work” dimensions on faculty members’ work engagement levels in the higher education institutions in India.Design/methodology/approachData were obtained from 293 faculty members working in higher education institutes in India. The proposed study hypotheses were tested by deploying the statistical technique of multiple regression analysis using statistical package for social sciences Version-24.FindingsResults demonstrated that of the five dimensions of “decent work,” only “access to health care” and “complementary values” were significant predictors of work engagement. “Adequate compensation,” “free time and rest” and “safe interpersonal working conditions” as dimensions of “decent work” were not found to be significantly related to work engagement.Research limitations/implicationsFindings encourage education policymakers to implement a “decent work” policy for faculty members with greater emphasis on ensuring workplace-fit and provision of adequate health-care facilities to keep the workforce engaged.Originality/valueIt is one of the few studies conducted in the South-Asian context that highlight “decent work” as a crucial job resource, useful in enhancing the work engagement of faculty members in higher education institutions.

Ageing population is global phenomenon. As it causes deficit workforce and family structural change, more care job opportunities are provided. Nevertheless, global care workers are experiencing poor working conditions involving low wage, less social security and hard work. The purpose of this study is to investigate the causes of indecent work among paid domestic care workers in Thailand, with the aim to give voice and enhance visibility of them. Research methodology includes decent work related regulations and a set of care policies review and eight in-depth interviews of paid domestic care workers. Results are that (i) Thai regulations is inadequate to reward more decent work and unfriendly for representation of care workers. Care policies recognize the role of unpaid volunteer care work. (ii) All paid domestic care workers in this study experienced indecent working conditions and perceive care work as indecent work. Significant finding is that paid domestic care worker are trapped within indecent care work because of three factors, which are invisibility, structural inequality and cultural norms. Apart from changing legal framework, three interventions approaches are recommended: (i) making care work more visible; (ii) tackling inequality within care policies for all workers; and (iii) development of people's decent work definition.

Traditional theories within vocational psychology have often prompted people to contemplate what types of jobs fit their personality and then attempt to secure such positions. The Psychology of Working Theory (PWT) theorizes that securing decent work is positively linked with satisfying survival needs, social connection needs, and self-determination needs. Intrinsic motivation is an internal inclination toward exploration and mastery that is ignited by genuine personal interest and enjoyment. Beyond benefits to individual employees, the widespread attainment of decent work has the potential to broadly impact communities and organizations. The adequate compensation and health care that is provided by decent work, for instance, can help to alleviate the negative effects of poverty and unemployment on the well-being of entire communities. The burden of pursuing decent work must not fall solely on individuals, especially when considering the presented macro-level concerns. Scientists and politicians must help to advocate for socially just policies and laws for restricting access to decent work among minority groups.

Decent work in Brazil: Context, conceptualization, and assessment

Safely Returning America to Work Part II: Industry-Specific Guidance.

This study seeks to highlight the necessity of paid domestic care workers in the context of ageing populations in Asia, particularly in the Asia-Pacific region and its subregions. Asia is going through the demographic transition and it is becoming old. The working population must provide support not only to their dependent children but also to elderly individuals. Consequently, both men and women are compelled to participate in the labour market. Previously, care work was predominantly the responsibility of women within households; however, they are now increasingly entering the workforce to earn a livelihood. In this context they need to depend upon outside labour force for looking their old parents. This automatically increased the demand for paid domestic care workers. This paper provides an overview of the situation of both by the employer and employee in the new global scenario. Earlier this care work for elders is provided by the family members themselves but due to the changing labour market scenario members in upper- and middle-class family began to depend on paid domestic care workers. This paper is analysed within the framework of ILO’s Asia Pacific Employment Outlook 2024.The ILO calculations based on UN DESA Population Projections also used for the study. From this study it is clear that there is an increasing demand for paid domestic care workers and the present study emphasise the need for providing decent work the care workers for a dignified life of old people. This paper demonstrates that safeguarding the dignity of both the elderly population and workers can only be achieved through the provision of decent work. This paper aims to propose measures for enhancing the decent working conditions of this marginalized group. This study concentrates in Asia and Pacific region because the population aged 65 and above rising faster in these regions compared to the rest of the world.