Relationships between healthcare employees and managers as a resource for well-being at work

This paper is a report of a study to investigate healthcare managers' perspectives on factors contributing to the increase of healthcare employees on sick leave for burnout symptoms. Current turbulent healthcare reorganization has resulted in structural instability, role conflicts and vague responsibility commitments, all of which contribute to increasing numbers of sick days caused by burnout symptoms. Managers' perceptions of burnout sources are important as these perceptions guide the actions taken to prevent burnout. Interviews were carried out with 30 healthcare managers, with different occupational backgrounds and from different units. The data were collected in Sweden in 2003 and analysed using thematic qualitative content analysis. According to the healthcare managers, continuous reorganization and downsizing of healthcare services has reduced resources and increased demands and responsibilities. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth as well as making them feel less confirmed and less valued as people. The main finding indicates that healthcare employees are thrown into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness. To understand and influence people's actions, one has to understand their perceptions and thoughts - their explanatory models. This study shows the complexity and interconnection between sources of burnout as perceived by healthcare managers, and highlights the encouragement of realism without the destruction of enthusiasm as an important factor in management and healthcare practice.

Background Sickness absence is high among healthcare employees in many European countries, including Sweden. In addition to physical workload, the importance of psychosocial work factors for this is emphasized. To promote a good psychosocial work environment, provisions on organisational and social work environment, mandatory to all work sectors, was launched in 2016 in Sweden. We compared sickness absence (SA) due to mental diagnoses two years before and two years after these provisions were introduced, among healthcare employees, employed by the municipality, the region, or private organisations. Methods Register microdata were used for analyses of all employees in the healthcare sector in Sweden in 2014 (N = 260,709) and in 2018 (N = 277,901). The odds ratios (OR) with 95% confidence intervals (CI) of new SA (in SA spells >14 days) and of long-term SA (>90 days) with a mental diagnosis in 2018 compared to 2014 were calculated, using logistic regression. Results The ORs of new SA and long-term SA with mental diagnoses among healthcare employees were somewhat higher in 2018 than in 2014 (OR = 1.14; 95% CI 1.11-1.17), (OR = 1.12; 1.07-1.17). The OR for the private sector for a new SA spell was 1.11; 1.02-1.19, and for the regional sector, OR 1.05; 1.01-1.08. The highest probability of long-term SA with mental diagnoses in 2018 compared to 2014 was found among employees in the municipal sector, OR 1.33, CI; 1.11-1.61, and in the private sector, OR 1.15, CI; 1.03-1.29. Discussion The mandatory provisions aim to promote good work environment and prevent risks of ill health due to organisational and social conditions at work. We observed a somewhat higher probability of SA with mental diagnoses two years after the provisions were introduced. SA due to mental diagnoses is influenced by many factors of which psychosocial work environment is only one part and maybe longer follow-ups are needed. Key messages • Sickness absence due to mental diagnoses among healthcare employees was somewhat higher two years after the introduction of an organisational and social work environment provision. • Many factors influence sickness absence with mental diagnoses; other factors and longer follow-ups are needed to gain knowledge on possible effects of the work environment provision.

Purpose This study aims to evaluate the effects of perceived leader–-member exchange and working conditions on turnover intention among healthcare employees. Design/methodology/approach The study population consisted of healthcare employees working in a medical faculty hospital in Türkiye. A stratified sampling method was used in sample selection. The data were obtained by the questionnaire method, and voluntary participation was taken as a basis. The questionnaire included sociodemographic information, a leader–-member exchange (LMX) scale and a turnover intention scale. The research was conducted between April and May 2022 and completed with 400 participants. Descriptive statistics, correlation analysis and multiple linear stepwise regression analyses were chosen for data analysis. Findings The findings showed that the participants had a medium-level perception of leader–-member exchange and a medium-level turnover intention. Multiple linear stepwise regression analysis revealed that especially “affect and professional respect” sub-dimensions of LMX had a statistically significant and negative effect on turnover intention scores. In addition, weekly working hours had a statistically significant and positive effect on turnover intention (p < 0.05). Finally, it was determined that the variance in turnover intention score was explained by the “affect and professional respect” sub-dimensions of LMX and weekly working hours (R2 = 0.241). Originality/value This study provides evidence on the impact of the “affect” and “professional respect” sub-dimensions of leader–member exchange as well as work environment factors on the turnover intentions of healthcare employees. The results are expected to guide healthcare organization leaders and managers on how to create a collaborative work environment that leads to employee retention.

PurposeThe Health Insurance Portability and Accountability Act (HIPAA) is US legislation aimed at protecting patient information privacy, but it imposes a significant burden on healthcare employees, especially since the privacy provisions are still evolving and healthcare organizations are still struggling to meet compliance criteria. This study seeks to illuminate characteristics of both the environment (organization) and the individual (healthcare professional) and their relevant influence on compliance intentions by leveraging theories from the domains of social psychology, management, and information systems.Design/methodology/approachA study of 208 healthcare professionals located at healthcare facilities throughout the USA were surveyed as to their perceptions regarding HIPAA compliance and the underlying organizational and individual factors that influence said compliance.FindingsThe findings indicate that perceptions of organizational support and self‐efficacy (SE) leading to HIPAA compliance vary based on organizational and occupational characteristics. Furthermore, these perceptions of organizational support and SE explain some of the differences in their intent to comply with this legislation.Research limitations/implicationsFor healthcare managers, the findings of this research may serve to validate HIPAA compliance initiatives. Through increased attention and resources dedicated to providing a supportive environment for HIPAA compliance, healthcare managers can increase the likelihood of compliance success by improving employee SE.Originality/valueThis paper represents the first empirical study to account for environmental factors and their influence on individual intentions to comply with HIPAA.

Healthcare organizations have been facing employee retention challenges since before the Covid-19 pandemic. This latter has solely accelerated turnover rates. Healthcare managers and leaders need to take action to keep their talent while still delivering quality care. The purpose of this paper is to provide a literature review on the subject to examine the role of healthcare managers in employee retention. Understanding how managers influence staff retention is essential to monitoring turnover rates and designing effective strategies for retaining skilled and talented healthcare employees. The findings of this review indicated that healthcare employees who were satisfied with the behavior of their managers were committed to their organization and more likely to remain employed for a long period. Communication, autonomy, respect and recognition, and training and development were significant predictors of job satisfaction, organizational commitment, and staff retention. Improving staff retention strategies is critical to improving the quality of care, reducing healthcare costs, and achieving growth and success. The review concluded that healthcare managers play a crucial role in employee retention. Further exploration of the employee retention challenge is required to better understand this multifaceted area of human resource management.

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery.

Interpersonal conflict between physicians and their coworkers hinders health care organizations today on an unprecedented scale. Most research on physician conflict has been restricted to 2 occupational groups, nurses and administrators. Yet as health care delivery becomes more complex and interdependent, physician interpersonal conflict impacts all occupational groups. Thus, we seek to provide health care managers with specific guidance about how they might eliminate negative effects of physician-related interpersonal conflict for each occupation. We examined antecedents and outcomes of physician conflict across 4 occupational groups (office clerical and support staff, professional and technical, nursing, and managerial) in a survey of 1451 US health care employees. Using Multigroup Structural Equations Modeling (MSEM) analysis we estimated each relationship in our model across the 4 occupational groups. We found that workload, perceived HR climate and patient-related incentives predicted physician conflict, and that physician conflict related to burnout, intention to turn over and psychological safety. Most notably, these antecedents and outcomes varied meaningfully across occupational groups. These observed differential effects in our results suggest that managers should carefully consider the needs of different occupational groups separately when designing and implementing interventions to prevent and ameliorate physician conflict. In short, the antecedents and outcomes of physician conflict are different for office/clerical, nurses, professional/technical employees, and management groups and therefore require different solutions. In short, it behooves health care organizations to avoid a one size fits all approach to improving workplace relationships.

Healthcare employees are experiencing poor wellbeing at an increasing rate. The healthcare workforce is exposed to challenging tasks and a high work pace, a situation that worsened during and after the COVID-19 pandemic. In turn, exposure to these high demands contributes to poor health, increased turnover, reduced job satisfaction, reduced efficacy, and reduced patient satisfaction and safety. Therefore, it is imperative that we identify measures to mitigate this crisis. One piece of this puzzle is how to implement sustainable tools and processes to improve the work environment of healthcare organizations. In this paper, we present the study protocol for the outlining and piloting of a joint training for pairs of healthcare line managers and their associated health and safety representatives in a Swedish healthcare organization. The objective of the training is to aid and advance the implementation of interventions to improve the work environment at the unit level. Following recommendations in the literature, the training is based on a stepwise approach that considers the specific context and focuses on the involvement of employees in creating interventions based on their needs. A central component of the training is the development of the pairs' collaboration in prioritizing, developing, implementing, and evaluating the interventions. The training is based on an on-the-job train-the-trainer approach in which participants are progressively trained during four workshops in the steps of a participatory intervention process. Between these workshops, the pairs follow the same progressive steps together with their employees to develop and implement interventions at their unit. The pilot will involve four pairs (i.e., eight participants) representing different parts and functions of the organization and will be conducted over a period of three months. We will use a mixed method design to evaluate preconditions, the process, and proximal transfer and implementation outcome factors of the training. The overall aim of the pilot is to appraise its feasibility and be able to adjust the training before a potential scale-up.

Agile leadership is an important managerial function in which responsiveness and innovation appear to be essential elements for the long-term development and success of any business. The world has become increasingly volatile, uncertain, complex, and ambiguous (VUCA) during and post COVID-19. Managers are required to possess agile leadership to facilitate their employees’ successful careers. Therefore, this study aims to find out the relationship between agile leadership and career success by examining the mediation of job embeddedness in healthcare organizations. The descriptive research design and survey method were employed in this study. The data were collected by using three scales from healthcare employees in healthcare organizations in Turkey. Hypotheses were tested using structural equation modelling (SEM). The data were analysed by using SPSS and AMOS programs. The findings of this study showed that agile leadership behaviours enhance career success. Moreover, the relationship between agile leadership and career success is mediated by job embeddedness. The role of agile leadership in promoting employees’ career success has rarely been studied in the literature. This is one of the first studies to examine the effect of agile leadership on career success along with the mediating role of job embeddedness. Healthcare managers have faced many critical challenges at their workplace during the COVID-19 pandemic. Through the lens of managing efficient healthcare organizations in many contexts, this research sheds some important light on the association between agile leadership, career success, and job embeddedness. Managers with high agility levels used strategies such as group decision making, problem solving, effective internal and external communication, and adaptation to uncertain environment in order to increase their career success.

In an era when healthcare organizations are beset by intense competition, lawsuits, and increased administrative costs, it is essential that employees perform their jobs efficiently and without distraction. Deviant workplace behavior among healthcare employees is especially threatening to organizational effectiveness, and healthcare managers must understand the antecedents of such behavior to minimize its prevalence. Deviant employee behavior has been categorized into two major types, individual and organizational, according to the intended target of the behavior. Behavior directed at the individual includes such acts as harassment and aggression, whereas behavior directed at the organization includes such acts as theft, sabotage, and voluntary absenteeism, to name a few (Robinson and Bennett 1995). Drawing on theory from organizational behavior, we examined two important features of supportive leadership, leader-member exchange (LMX) and perceived organizational support (POS), and two important features of job design, intrinsic motivation and depersonalization, as predictors of subsequent deviant behavior in a sample of over 1,900 employees within a large US healthcare organization. Employees who reported weaker perceptions of LMX and greater perceptions of depersonalization were more likely to engage in deviant behavior directed at the individual, whereas employees who reported weaker perceptions of POS and intrinsic motivation were more likely to engage in deviant behavior directed at the organization. These findings give rise to specific prescriptions for healthcare managers to prevent or minimize the frequency of deviant behavior in the workplace.

Proactive behaviors at work refer to behaviors that are self-starting, future focused, and change oriented. Proactive behaviors are generally thought of as positive and desired and can benefit both the employee (e.g., job promotion) and organization (e.g., innovation). These behaviors can, however, backfire (e.g., due to unintended consequences), reflecting the "initiative paradox." The aim of this study was to investigate, through the perspectives of health care executives, how employees can be more effective when engaging in proactive behaviors. We used the episodic narrative interview method. Health care executives narrated instances of perceived effective and ineffective proactive behaviors among employees. We then performed an inductive qualitative analysis of these episodes to identify emerging themes and dimensions. The effectiveness of proactive behaviors among health care employees is shaped by three dimensions: managerial expectation (in)congruence (e.g., knowledge of expectations, engagement with chain of command), organizational priority (in)congruence (e.g., degree of alignment between individual and organizational benefits), and boundaries of action and change (e.g., nonadherence to regulatory or financial conditions). Among the dimensions, managerial expectations may be the most challenging for employees to navigate. Engaging in proactive behaviors is not a straightforward process. Navigating multiple dimensions is necessary for health care employees to be effective. Employees should be equipped with knowledge on relevant expectations, priorities, and boundaries when engaging in proactive behaviors at work. Health care leaders and managers should aim to clarify and periodically reassess these dimensions to facilitate effective proactive behaviors and to generate benefits for employees and the organization.

ObjectivesSystematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to...

Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation.

To investigate whether the development of job involvement of primary healthcare (PHC) employees in Southern Municipality (SM), where PHC services were outsourced to an independent non-profit organisation, differed from that in the three comparison municipalities (M1, M2, M3) with municipal service providers. Also, the associations of job involvement with factors describing the psychosocial work environment were investigated. A panel mail survey 2000-02 in Finland (n=369, response rates 73% and 60%). The data were analysed by descriptive statistics and multivariate linear regression analysis. Despite the favourable development in the psychosocial work environment, job involvement decreased most in SM, which faced the biggest organisational changes. Job involvement decreased also in M3, where the psychosocial work environment deteriorated most. Job involvement in 2002 was best predicted by high baseline level of interactional justice and work control, positive change in interactional justice, and higher age. Also other factors, such as organisational stability, seemed to play a role; after controlling for the effect of the psychosocial work characteristics, job involvement was higher in M3 than in SM. Outsourcing of PHC services may decrease job involvement at least during the first years. A particular service provision model is better than the others only if it is superior in providing a favourable and stable psychosocial work environment.

Background: District Health Information Software 2 (DHIS2) is an open source, web-based, health management information system (HMIS) recognized as world's largest HMIS platform, customized for health information system of Bangladesh for decentralized data entry since 2011. Health care managers and employees should be well informed about the health information system for accurate, appropriate, precise, timely, valid information and also interpretation of information which are the basis for policy planning and decision-making at various levels of the organization. The study aimed at exploring the limitations of DHIS2 in decision making process for health service management among the Upazila (Sub district) level health managers of Bangladesh. Methods: The cross sectional study was conducted among the Upazila Health and Family Planning Officers (UH&amp;FPOs) of Bangladesh during the period of January to December 2018. All (482) UH&amp;FPOs of Bangladesh posted as regular, current charge or in-charge were included for the study. Data were collected by a pre-tested semi-structured email-based questionnaire. Results: Response rate was 88.8% (428 out of 482). The mean age of the respondents was 47.08 (±6.33 SD). Mean duration of job experiences as UH&amp;FPO was 1.9 years (±1.635 SD). Regarding limitation, the study revealed that 76.2% (of 424) UH&amp;FPOs think that lack of rrealizing the Importance of DHIS2 by Doctors, Nurses and other Staffs is the most important “Facility Centered Barriers” for using DHIS2 as a decision support tool of Upazila health service management. Beside this 71.2% UH&amp;FPOs think that lack of effective training of the staffs concerned with DHIS2 operation are the second most important barrier. The study also revealed that 59.7% (of 402) UH&amp;FPOs think that absence of the option for automatically displaying the summary reports of various datasets in the respective Upazila dashboard is the most important “Software Centered Barriers” for using DHIS2 as a decision support tool of Upazila health service management beside this 58.5% UH&amp;FPOs think difficulties in identifying the management related data elements from various data sets of DHIS2. Conclusion: So, this study recommends scaling up DHIS2 by redesigning training programs with more focus on the ways of its’ application in the decision making process, create awareness among all categories of health staffs, customization of its contents and more research on this ground. These initiatives will explore several innovative approaches to monitor health indicators by DHIS2, measure and plan health interventions to ensure quality health service and will lead towards achieving Sustainable Development Goal 3 (SDG-3). JOPSOM 2023; 42(2): 43-50