Implications For Health Care Organizations Research Articles

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study.

To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure. A cross-sectional study. An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure. Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure. Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion. Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure. This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses. We have followed the STROBE checklist in reporting this study. No Patient or public contribution.

Perceived work stressors and the transition to burnout among nurses in response to the pandemic: implications for healthcare organizations.

This study aimed to assess the associations of pre-pandemic perceived work stressors and work satisfaction among nurses, including nurse assistants, with burnout profiles and their transitions in response to the pandemic. Three hundred and thirty-seven nurses working in an Italian University hospital participated in a longitudinal study including a survey in August 2019 investigating perceived work stressors (assessed using the HSE Indicator Tool), work satisfaction (Work Satisfaction Scale), and burnout (Maslach Burnout Inventory), and a second survey in December 2020 assessing burnout. Using latent transition analysis, we identified burnout profiles and then estimated the associations between work stressors and satisfaction on profiles and transitions. We identified three pre-pandemic profiles, namely engaged (67%), ineffective (15%), and burnout (18%); and three pandemic profiles, namely engaged (37%), exhausted (51%), and severe burnout (12%). The severe burnout profile consisted of 70% nurses classified in the burnout profile before the pandemic. Overall, work stressors and satisfaction were associated with both pre-pandemic and pandemic burnout profiles. Among nurses not in the burnout profile prior to COVID-19, pre-pandemic hostile relationships increased [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05-1.34] and work satisfaction decreased (OR 0.82, 95% CI 0.68-0.98) the probability to transition to exhausted. Moreover, work satisfaction (OR 0.54, 95% CI 0.32-0.91) and participation in work organization (OR 0.69, 95% CI 0.51-0.93) protected from transitioning to severe burnout. The association between peer support and the transition to exhausted needs further investigation. Pre-pandemic work stressors and satisfaction were associated with pandemic burnout and burnout transitions. To enhance preparedness for future crises, healthcare managers should carefully assess and tackle work-related constraints affecting nurses.

Associations of health care staff burnout with negative health and organizational outcomes in the U.S. military health system

RationaleBurnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level. ObjectiveThis assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout. MethodsAnonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. Burnout was measured using the Copenhagen Burnout Inventory and the Mini-Z. ResultsResults showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. Burnout was associated with increases in adverse physical and behavioral health (BH) outcomes. ConclusionsResults indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.

Organizational attributes that contribute to the learning & improvement capabilities of healthcare organizations: a scoping review

BackgroundThis study aims to explore and identify the organizational attributes that contribute to learning and improvement capabilities (L&IC) in healthcare organizations. The authors define learning as a structured update of system properties based on new information, and improvement as a closer correspondence between actual and desired standards. They highlight the importance of learning and improvement capabilities in maintaining high-quality care, and emphasize the need for empirical research on organizational attributes that contribute to these capabilities. The study has implications for healthcare organizations, professionals, and regulators in understanding how to assess and enhance learning and improvement capabilities.MethodsA systematic search of peer-reviewed articles published between January 2010 and April 2020 was carried out in the PubMed, Embase, CINAHL, and APA PsycINFO databases. Two reviewers independently screened the titles and abstracts and conducted a full-text review of potentially relevant articles, eventually adding five more studies identified through reference scanning. Finally, a total of 32 articles were included in this review. We extracted the data about organizational attributes that contribute to learning and improvement, categorized them and grouped the findings step-by-step into higher, more general-level categories using an interpretive approach until categories emerged that were sufficiently different from each other while also being internally consistent. This synthesis has been discussed by the authors.ResultsWe identified five attributes that contribute to the L&IC of healthcare organizations: perceived leadership commitment, open culture, room for team development, initiating and monitoring change, and strategic client focus, each consisting of multiple facilitating aspects. We also found some hindering aspects.ConclusionsWe have identified five attributes that contribute to L&IC, mainly related to organizational software elements. Only a few are identified as organizational hardware elements. The use of qualitative methods seems most appropriate to understand or assess these organizational attributes. We feel it is also important for healthcare organisations to look more closely at how clients can be involved in L&IC.Trial registrationNot applicable.

Harnessing Innovation and Collaboration to Improve Unit-Based Huddle Communication

This article details the effectiveness of utilizing smart board technology and multidisciplinary collaboration to ensure huddle presentation is visually appealing, consistent, timely, and relevant, and encourages staff engagement. To improve huddles in the emergency department of a busy level 1 trauma center, the leadership team implemented smart board technology and multidisciplinary participation to promote effective formal transmission of information. Staff surveys showed significant improvement in the areas of satisfaction, timeliness, and feeling that they received a formal huddle report. Implications for health care organizations include leveraging technology and standardized processes to improve communication, staff satisfaction, patient safety, and operational efficiency.

'They don't really know why they're here' mental health professionals' perspectives of consumer representatives.

There are several barriers to meaningful, non-tokenistic consumer representation in mental health, including stigma and negative attitudes towards consumers. The aim of this study was to examine mental health professionals' perspectives about collaborating with consumer representatives. Semi-structured interviews were conducted with 11 mental health professionals across Australia. Informed by the social identity framework, the findings are discussed in relation to the themes of (1) the need for greater clarity about the roles of consumer representatives, (2) perceptions about whether consumer representatives are held to equal professional standards, (3) understandings of consumers' place in organizational hierarchies, (4) facilitating more meaningful collaboration between consumer representatives and non-consumer health professionals and (5) the blurring of these identities when mental health professionals have lived experience. Findings suggest that the social identities of mental health consumer representatives (along with their organizational roles) are often unclear and need development within healthcare organizations. Leaders can provide guidance on group boundaries to enable effective collaboration. The implications for healthcare organizations and policy include the provision of clear frameworks for collaborative mental healthcare and clear roles, terminology and responsibilities for mental health consumer representatives.

The effect of service excellence training: Examining providers' patient experience scores

Previous research and applied work has shown that communication-based training has the potential to impact important outcomes for healthcare organizations. Our institution developed and deployed Service Excellence, a communications-focused training, in our large academic cancer-focused healthcare system. In this study, we investigated whether patient experience improved for those with care providers who completed Service Excellence, as measured by Press Ganey Provider Experience surveys, and whether the effect of Service Excellence training depends on employee engagement. Results indicated that participating in Service Excellence training positively impacts perceptions of patient experience, and that the impact of the training is stronger for providers with low engagement as compared to providers with high engagement. Findings suggest that communications-based training can be an effective mitigation strategy to assist even those low engaged physicians with displaying the expected behaviors for positive patient interactions. Implications for healthcare organizations are discussed, including the rationale for motivating providers to attend such training. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Engaging Tomorrow\u2019s Doctors in Clinical Ethics: Implications for Healthcare Organisations

Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. We designed a programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not (yet) exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice.

Online contraceptive discussion forums: a qualitative study to explore information provision

BackgroundWomen in the UK spend up to 30 years avoiding pregnancy, and effective use of contraception requires detailed information and support. Online forums offer opportunities to discuss contraception with few...

Health Professionals' Engagement With Email-Enabler or Disrupter?

The use of email is an internationally recognized and accepted method to communicate information in an asynchronous manner. Yet, despite its ubiquitous use, there is evidence that there are differences in the degree of engagement with and perceived value of email as legitimate work within the healthcare setting. A lack of engagement with email could have consequences on the care of patients if email communication is not read or responded to by the intended recipient. The purpose of this study was to understand the email practices of health professionals within a hospital setting, including their interactions, experiences, and thoughts and ideas for sharing information in the future. Four focus groups (total number of participants, 30) were conducted in 2015 and 2016 using an Appreciative Inquiry model to focus on the use of email. Data were thematically analyzed, with three overarching themes identified: professional practice, workforce self-care, and shaping the future using technology. Overall, email was perceived as a less important function within a health professional's everyday clinical practice; however, this differed depending on their role. The health professionals' use of email ranged from very little engagement to what could be judged as over-engagement, all of which have implications for healthcare organizations who view email as a legitimate work task and a key way to communicate.

Senior registered nurses working with new graduate nurses in the intensive care unit: a narrative inquiry

Introduction: The experiences and perceptions of new graduate nurses (NGNs) as they transition into professional practice and intensive care units (ICUs) abounds in the literature. However, there is a dearth of literature exploring the experiences of senior registered nurses (SRNs) who work with NGNs in ICUs. Aims: The aim of this inquiry was to contribute to nursing knowledge by examining SRNs’ stories of experience around the complexity of enabling development of NGNs whilst working in clinical or team leading roles in ICU. Thus, allowing the SRNs’ voice to be heard in the literature. Methods: Narrative Inquiry methodology, underpinned by Dewey’s theory of experience, was used to examine the experiences of five SRNs in one Level 6 ICU. This was achieved by engaging SRNs in individual conversations then co-composing the final individual narrative accounts with participants, whilst remaining immersed in the three-dimensional space of temporality, sociality and place. Thematic analysis methods actively identified two overarching threads that resonated across all five narrative accounts. Results: The first thread, ‘Reverberations’, contained five minor threads: ‘We Carry Them’, ‘It’s Dangerous Here’, ‘Patrolling Like a Surf Lifesaver’, ‘Enjoyable Moments’ and ‘Survival Mode’. The second thread, ‘Caring’, contained three minor threads: ‘I’ve Been There’, ‘They Must Ask Questions’ and ‘Not In My Backyard’. Analysis identified SRNs’ workload and level of patient surveillance increased when working with NGNs in the ICU, leading to perceptions of feeling stressed, pressured and overwhelmed. Yet an obligation prevailed to support and care for NGNs, perceived by participant SRNs as not yet possessing the clinical skills to independently care for critically ill patients in the dangerous ICU environment Conclusion: There are significant implications for health care organisations to increase resources to alleviate SRNs’ substantial workload and recognise their essential role in supporting NGNs while simultaneously sustaining quality ICU patient care.

Reducing Workplace Absenteeism Caused by Work Stress in a Health Maintenance Organization Department of Psychiatry

It is well established that work stress is a major economic burden not only in lost work productivity but also in increased health care utilization and costs. However, there is little research into effective treatment models for work stress. To retrospectively examine the effectiveness of a psychiatric pilot quality improvement program in improving the return-to-work rate in patients in a health maintenance organization who had work stress and took medical leave from work. A health maintenance organization's Department of Psychiatry developed a pilot quality improvement program that reviewed a new program of group psychotherapy and specialty mental health treatment targeting patients who self-identified as having work stress and who requested medical leave from work. The retrospective data were collected from the electronic medical record. Of the 166 patients who participated in the Work Recovery Group program, 141 (85%) returned to work and did not have any days off after the Work Recovery Group within the 11-month analysis. Involvement in the group also was associated with improvement in self-reported symptom severity, with a 4.5-point decrease in the average score on the Adult Outcomes Questionnaire about depression and anxiety. This is the first known treatment program from a health maintenance organization to provide data on return-to-work outcomes. By providing specialty mental health treatment and getting patients back to work more quickly, this program has potential to reduce mental health service utilization. These results show promise for program expansion and have broader implications for health care organizations and employers.

Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients

Since its beginning in the 1990s, enthusiasm for evidence-based medicine (EBM) has flourished. As its methodology becomes more sophisticated and its breadth expands, EBM increasingly is referred to in patient care, insurance coverage decisions, technology assessments, medical education, and health care policymaking. Despite this growth, the intersection of EBM and bioethics often is not explored. This article discusses the deontologic and utilitarian aspects of EBM and assesses EBM according to 4 bioethical principles: Respect for autonomy, beneficence, nonmaleficence, and justice. Strong ethical arguments support EBM as the best approach to patient care. However, practitioners and health care organizations must be aware that each principle involves complex issues that challenge EBM’s ethical values.

Mentoring up: A grounded theory of nurse-to-nurse mentoring.

To generate a theoretical explanation of nurse-to-nurse mentoring in the clinical setting. Despite an abundance of mentoring literature, the processes involved between nurses in mentoring relationships have yet to be studied. Nursing literature has focused on mentor attributes and relationship outcomes rather than focusing on theoretical discovery. Classical grounded theory (CGT). CGT procedures (constant comparative method, coding and memoing) were used to analyse interview data exploring fifteen nurse protégés' experiences of mentoring. Confidencing, the protégés' need to become confident in the professional role, emerged as the main concern of study participants. Three dimensions are threaded throughout nurse-to-nurse mentoring: earnest intentions, filial bond and trust-worthiness. Earnest intentions are the sincere attitude that protégés and mentors demonstrate regarding their mentoring relationship. An exclusive, familial-type connection, filial bond, attends to the affective needs of protégés and mentors. Trust-worthiness, the explicit feeling of trust between protégés and mentors, strengthens as each demonstrates being worthy of the other's trust. Mentoring Up theory explains five phases of mentoring: seeding, opening, laddering, equalising and reframing. The initial phases are periods of relationship discovery (seeding) and testing (opening). Laddering is an intense period of reciprocal interactions between mentors and protégés. Equalising begins as protégés perceive themselves to be equal to their mentors in terms of their professional capability. Protégés reflect on the meaning of the relationship in the reframing phase. Mentoring Up is a dense theory that reveals insights, explanations and predictions for initiating, developing and engaging in mentoring relationships. Mentoring Up fills a gap in the existing literature and provides a framework for future mentoring research. The theory has implications for healthcare organisations, nursing education and individual nurses. Mentoring Up expounds on the interpersonal connections and reciprocal interactions vital for successful nurse-to-nurse mentoring.

Functional interactivity in social media: an examination of Chinese health care organizations' microblog profiles.

Social media hold enormous potentials as a communication tool for health care due to its interactive nature. However, prior research mainly focused on contingency interactivity of social media, by examining messages sent from health care organizations to audiences, while little is known about functional interactivity, which refers to social media's presence of functions for facilitating communication between users and its interface. That is, how health care organizations use interactive features on social media to communicate with the public. Thus, with a general basis of the functional interactivity framework proposed by Waters et al. (Engaging stakeholders through social networking: how nonprofit organizations are using Facebook. Pub Relat Rev 2009;35:102-106), the current study investigated three aspects of functional interactivity in microblogging, and its subsequent effects. Specifically, this study analyzed 500 Chinese hospitals' profiles on Sina Weibo, the most popular microblogging platform in China. The results showed that the most common functional interactivity feature was organization disclosure, followed by information dissemination, and audience involvement. These interactive features all positively predicted the number of followers. Also, Chinese private hospitals scored significantly higher than public hospitals to use interactive features offered by social media. The findings of this study provide important implications for health care organizations to understand new communicative functions available on social media, incorporate more functions into their profiles and thus provide audiences with greater opportunity to interact with them via social media.

A new approach to simplifying care models

The work being carried out in ‘vanguard’ sites has implications for healthcare organisations. Vanguards have been tasked with making health services more accessible and effective by dismantling NHS care pathways that no longer work well and by taking a fresh approach to service design. NHS England envisages that the new care models will be blueprints for the future NHS.

Implications of Dsm-5 for Health Care Organizations and Mental Health Policy

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called “dimensional”) approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM-5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

Cross-Validation of the Work Organization Assessment Questionnaire Across Genders: A Study in the Australian Health Care Sector.

The main aim of this study was to examine the measurement invariance of the Work Organization Assessment Questionnaire (WOAQ) across genders in a group of health care employees, using bifactor modeling. There is a very limited research that uses invariance testing of bifactor models, despite their usefulness. Establishing validity of the WOAQ in this way is important for demonstrating its relevance for both men and women. A bifactor modeling procedure was used here to examine the validity of the WOAQ with a sample of 946 paramedics employed in a large Australian organization in the health care sector. The results of this study show that the WOAQ has good psychometric properties across genders in health care settings. In addition, there were significant mean differences between men and women in their perceptions of "quality of relationships with colleagues," and "reward and recognition." There were no differences between men and women in the remaining factors: "quality of relationships with the management," "quality of relationships with colleagues," and "quality of the physical environment." The use of bifactor modeling to establish the cross-validity of the WOAQ across male and female paramedics adds to evidence for the measure's good psychometric properties. The findings confirm those of previous research that has used higher order confirmatory factor analysis. Moreover, mean differences between men and women were found to be significant in two of the five WOAQ subscales. These findings have practical implications for health care organizations, in terms of assessing work characteristics and developing activities to support the health and well-being of their employees.

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay

We conduct an empirical investigation of the impact of queue management on patients’ average wait time and length of stay (LOS). Using an emergency department’s (ED) patient-level data from 2007 to 2010, we find that patients’ average wait time and LOS are longer when physicians are assigned patients under a pooled queuing system with a fairness constraint compared to a dedicated queuing system with the same fairness constraint. Using a difference-in-differences approach, we find the dedicated queuing system is associated with a 17% decrease in average LOS and a 9% decrease in average wait time relative to the control group—a 39-minute reduction in LOS and a four-minute reduction in wait time for an average patient of medium severity in this ED. Interviews and observations of physicians suggest that the improved performance stems from the physicians’ increased ownership over patients and resources that is afforded by a dedicated queuing system, which enables physicians to more actively manage the flow of patients into and out of ED beds. Our findings suggest that the benefits from improved flow management in a dedicated queuing system can be large enough to overcome the longer wait time predicted to arise from nonpooled queues. We conduct additional analyses to rule out alternate explanations for the reduced average wait time and LOS in the dedicated system, such as stinting and decreased quality of care. Our paper has implications for healthcare organizations and others seeking to reduce patient wait time and LOS without increasing costs. This paper was accepted by Serguei Netessine, operations management.

Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting

Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients.