Working conditions and the possibility of providing good care.

Abstract

Background An open and tolerant climate characterized by joy in work where the personnel can mature as people and develop their professional competence was postulated as essential to working conditions under which good care can be provided in line with a care policy accepted for healthcare in a northern Swedish county. This study aimed to examine working conditions before and 3 years after the implementation of the care policy. All personnel working on four hospital wards in the county described their experiences in questionnaires in a baseline measure in 1995 (n = 119) and a follow-up measure in 1998 (n = 106). Lower ratings for working conditions were found in many respects in the follow-up measure. Fewer respondents from three wards expressed satisfaction with their current work situation. More respondents in one of these wards expressed, in addition, an inability to keep up with their work and fewer also evaluated their immediate superiors as good leaders. More of the respondents from one ward expressed the intention of looking for alternative employment and wanted to have another job. More respondents in two wards reached scores indicating burnout risk or burnout, and lower means were seen in two to 10 work climate dimensions per ward, out of 10 possible, in the follow-up measure compared with the baseline. The working conditions seen as requisite for the possibility of providing good care seem to have deteriorated in a number of respects on the wards studied over a three-year period and improvements are needed if the care offered is to be in line with the stated care policy. A concurrent study investigating patient satisfaction of the care quality in the same county showed a deterioration in their assessments between measurements carried through with a three-year interval, implying a relationship between the working conditions of the personnel and the patients' experiences of care.