Vol. 30. Num. 3. - 2014. Pages?=$articulo_paginas?> 105-112
Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity
[La superación de las exigencias laborales para ofrecer una elevada calidad asistencial en el ámbito hospitalario en Europa: papel del trabajo en equipo y la positividad]
Patrícia L. Costa1 , Ana M. Passos1 , Sílvia A. Silva1 , Ema Sacadura-Leite2 , Susana M. Tavares1 , Florina Spanu3 , Elitsa Dimitrova4 , Vera Basarovska5 , Milan Milosevic6 , Meral Turk7 , Efharis Panagopoulou8 , Anthony Montgomery9
1Inst. Univ. Lisboa, Portugal ,2Hosp. Santa Maria, Lisboa, Portugal ,3Babes-Bolyai Univ., Dep. Psychology, Cluj-Napoca, Rumanía ,4Bulgarian Academy of Sciences, Inst. Population and Human Studies, Bulgaria ,5Inst. Occupational Health of RM, Neuropsychiatric Dep., Skopje, Macedonia ,6Univ. Zagreb, School of Medicine, Croacia ,7Ege Univ., Dep. Public Health, Turquía ,8Aristotle Univ., Medical School, Thessaloniki, Grecia ,9Univ. Macedonia, Dep. Education and Social Policy, Thessaloniki, Grecia
Abstract
Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demands have a negative impact on the quality of care delivered by health professionals. Backup behaviors had a mediating effect between job demands and quality of care. Also, the positivity ratio of professionals (ratio of positive and negative emotions experienced) was also found as a significant mediator between most job demands and quality of care dimensions. Finally, we found a double mediation between most job demands and quality of care, where backup behaviors influenced the positivity ratio. Quality of care in hospitals is closely related to job demands. Hospital managers should consider the importance of cooperation within health care professionals’ teams and ought to find ways to develop teamwork in order to promote patients’ safety.
Resumen
Los profesionales de la salud tratan a diario con múltiples exigencias laborales -emocionales, cognitivas, organizacionales y físicas. También deben garantizar la máxima calidad de atención a sus pacientes. El objetivo de este estudio es analizar el impacto de las demandas laborales en la calidad de los cuidados y de investigar los procesos de equipo (backup behaviors) e individuales (positivity ratio) que ayudan a proteger al trabajador de ese impacto. Se recogieron datos de 2.890 médicos y enfermeros en 9 países europeos a través de cuestionarios. Las demandas laborales tienen un impacto negativo en la calidad de los cuidados proporcionados por profesionales de la salud. Los procesos de equipo (backup behaviors) tuvieron un efecto de mediación entre las demandas del trabajo y la calidad de los cuidados. Además, la ratio de positividad de los profesionales (proporción de emociones positivas y negativas) también se encontró como un mediador importante entre la mayoría de demandas de trabajo y la calidad del cuidado. Por último, se encontró una doble mediación entre la mayoría de las demandas de trabajo y calidad de la atención, donde los procesos de equipo influyeron en la ratio de positividad. La calidad de los cuidados proporcionados en los hospitales está muy relacionada con las exigencias del trabajo. Los directores de hospitales deben considerar la importancia de la cooperación entre equipos de profesionales de salud y encontrar formas de desarrollar el trabajo en equipo con el fin de promover la seguridad de los pacientes.
Aiken et al., 2012, Arocena and Garcia Prado, 2007, Ashkanasy, 2003, Bakker and Demerouti, 2007, Bakker et al., 2003, Bakker et al., 2004, Barnes et al., 2008, Bartlett et al., 2008, Bolte et al., 2003, Campbell et al., 2000, Caplan, 1994, Carayon and Gurses, 2005, Chambers et al., 1996, Demerouti et al., 2001, Donabedian, 1980, Eckleberry-Hunt et al., 2009, European Comission, 2008, Fahrenkopf et al., 2008, Firth-Cozens, 1995, Fredrickson, 2001, Fredrickson and Joiner, 2002, Fredrickson and Losada, 2005, Fredrickson et al., 2003, Ghodse and Galea, 2006, Hakannen et al., 2006, Hayes, 2012, Institute of Medicine, 1999, Isen et al., 1987, Isikhan et al., 2004, Kazmi et al., 2008, Krokos et al., 2009, Linzer et al., 2000, McGowan et al., 2011, McIntyre and Salas, 1995, Porter et al., 2003, Preacher and Hayes, 2008, Richter and Hacker, 1998, Rousseau et al., 2006, Salas et al., 2008, Salas et al., 2009, Salas et al., 2005, Seligman and Csikszentmihalyi, 2000, Shanafelt et al., 2002, Silva et al., 2013, Sofaer and Firminger, 2005, Soler et al., 2008, Sweetman and Luthans, 2010, Teng et al., 2012, Thompson, 2007, Toral-Villanueva et al., 2009, Watson et al., 1988, Weinberg and Creed, 2000, West et al., 2006, Winstanley and Whittington, 2004 and Xanthopoulou et al., 2007.
References
Aiken et al., 2012
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., … Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal, 344 , e1717. doi:10.1136/bmj.e1717.
Arocena and Garcia Prado, 2007
Arocena, P., & Garcia Prado, A. 2007. Accounting for Quality in the Measurement of Hospital Performance: Evidence from Costa Rica. Health Economics 16 , 667-685. doi: 10.1002/hec.1204.
Ashkanasy, 2003
Ashkanasy, N.M. (2003). Emotions in organizations: A multilevel perspective. In F. Dansereau & F. J. Yammarino (Eds.), Research in multi-level issues, vol. 2: Multi-level issues in organizational behavior and strategy (pp. 9-54). Oxford, UK: Elsevier Science.
Bakker and Demerouti, 2007
Bakker, A.B., & Demerouti, E. (2007). The Job Demands-Resources model: State of the art. Journal of Managerial Psychology, 22 , 309-328. doi: 10.1108/02683940710733115.
Bakker et al., 2003
Bakker, A.B., Demerouti, E., & Schaufeli, W.B. (2003). Dual processes at work in a call centre: An application of the Job Demands a Resources model. European Journal of Work and Organizational Psychology , 12, 393-417. doi: 10.1080/13594320344000165.
Bakker et al., 2004
Bakker, A.B., Demerouti, E., & Verbeke, W. (2004). Using the Job Demands Resources model to predict burnout and performance. Human Resource Management, 43 , 83-104. doi: 10.1002/hrm.20004.
Barnes et al., 2008
Barnes, C.M., Hollenbeck, J.R., Wagner, D.T., DeRue, D.S., Nahrgang, J.D., & Schwing, K.M. (2008). Harmful help: The costs of backing up behavior in teams. Journal of Applied Psychology, 93, 529-539.
Bartlett et al., 2008
Bartlett, G., Blais, R., Tamblyn, R.M., Clermont, R., & MacGibbon, B. (2008). The impact of patient communication problems on the risk of suffering preventable adverse events in acute care settings. Canadian Medical Association Journal, 178 , 1555-1562.
Bolte et al., 2003
Bolte, A., Goschkey, T., & Kuhl, J. (2003). Emotion and intuition: Effects of positive and negative mood on implicit judgments of semantic coherence. Psychological Science, 14 , 416-421. doi: 10.1111/1467-9280.01456.
Campbell et al., 2000
Campbell, S.M., Roland, M.O., & Buetow, S.A. (2000). Defining quality of care. Social Science & Medicine, 51, 1611-1625.
Caplan, 1994
Caplan, R.P. (1994). Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. British Medical Journal, 309 , 1261-1263. doi: 10.1136/bmj.309.6964.1261.
Carayon and Gurses, 2005
Carayon, P., & Gurses, A. (2005). Nursing workload and patient safety in intensive care units: A human factors engineering evaluation of the literature. Intensive and Critical Care Nursing, 21 , 284-301. doi: 10.1.1.182.7072.
Chambers et al., 1996
Chambers, R., Wall, D., & Campbell, I. (1996). Stresses, coping mechanisms and job satisfaction in general practitioner registrars. British Journal of General Practice, 46 , 343-348.
Demerouti et al., 2001
Demerouti E., Bakker, A.B., Nachreiner, F., & Schaufeli, W.B. (2001). The Job Demands - Resources model of burnout. Journal of Applied Psychology, 86 , 499-512. Doi: l0. i037//002i-90l0.86.3.499.
Donabedian, 1980
Donabedian, A. (1980). The definition of quality: A conceptual exploration. Explorations in Quality Assessment and Monitoring , 1, 3-31.
Eckleberry-Hunt et al., 2009
Eckleberry-Hunt, J., Lick, D., Boura, J., Hunt, R., Balasubramaniam, M., Mulhem, E., & Fisher, C. (2009). An exploratory study of resident burnout and wellness. Academy of Medicine, 84, 269-277. doi: 10.1097/ACM.0b013e3181938a45.
European Comission, 2008
European Comission (2008). Communication and Recommendation on Patient Safety, including the Prevention and Control of Healthcare-Associated Infections – Summary of the Impact Assessment. European Commission, Brussels.
Fahrenkopf et al., 2008
Fahrenkopf, A.M., Sectish, T.C., Barger, L.K., Sharek, P.J., Lewin, D., Chiang, V.W., … Landrigan, C.P. (2008). Rates of medication errors among depressed and burnt out residents: prospective cohort study. British Medical Journal. 336 , 488-491. doi: org/10.1136/bmj.39469.763218.
Firth-Cozens, 1995
Firth-Cozens, J. (1995). Stress in doctors: a longitudinal study . Leeds: University of Leeds.
Fredrickson, 2001
Fredrickson, B.L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist , 56, 218-226. doi: 10.1037//0003-066X.56.3.218.
Fredrickson and Joiner, 2002
Fredrickson, B., & Joiner, T. (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science, 13 , 172-175. doi: 10.1111/1467-9280.00431.
Fredrickson and Losada, 2005
Fredrickson, B.L., & Losada, M. (2005). Positive affect and the complex dynamics of human flourishing. American Psychologist, 60 , 678-686. doi: 10.1037/0003-066X.60.7.678.
Fredrickson et al., 2003
Fredrickson, B.L., Tugade, M.M., Waugh, C.E., & Larkin, G.R. (2003). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality & Social Psychology, 84, 365-376.
Ghodse and Galea, 2006
Ghodse, H., & Galea, S. Misuse of drugs and alcohol (2006). In J. Cox, J. King, A. Hutchinson, & P. McAvoy (Eds.), Understanding doctors Performance (pp. 38-48). Oxford: Radcliffe Publishing.
Hakannen et al., 2006
Hakannen, J.J., Bakker, A.B., & Schaufeli, W.B. (2006). Burnout and work engagement among teachers. Journal of School Psychology, 43 , 495-513. doi:10.1016/j. jsp.2005.11.001.
Hayes, 2012
Hayes, A.F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling (White paper). Retrieved from h t t p://www.afhayes.com/public/process2012.pdf.
Institute of Medicine, 1999
Institute of Medicine (1999). To err is human: Building a safe health system . Washington, DC: National Academy Press.
Isen et al., 1987
Isen, A.M., Daubman, K.A., & Nowicki, G.P. (1987). Positive affect facilitates creative problem solving. Journal of Personality and Social Psychology, 52 , 1122-1131. doi: 10.1037/0022-3514.52.6.1122.
Isikhan et al., 2004
Isikhan, V., Gomez, T., & Danis, M.Z. (2004). Job stress and coping strategies in health care professionals working with cancer patients. European Journal of Oncology Nursing, 8 , 234-244. doi: 10.1016/j.ejon.2003.11.004.
Kazmi et al., 2008
Kazmi, R., Amjad, S., & Khan, D. (2008). Occupational stress and its effect on job performance. A case study of medical house officers of district Abbottabad. Journal of Ayuberdic Medicine College Abbottabad , 20, 135-139.
Krokos et al., 2009
Krokos, K.J., Baker, D.P., Alonso, Al., & Day, R. (2009). Assessing team processes in complex environments: challenges in transitioning research to practice. In E. Salas (Ed.), Team effectiveness in complex organizations: cross-disciplinary perspectives and approach (pp. 383-408) Routledge: New York.
Linzer et al., 2000
Linzer, M., Konrad, T.R., Douglas, J., McMurray, J.E., Pathman, D.E., Williams, E.S., … Rhodes, E. (2000). Managed care, time pressure, and physician job satisfaction: results from the physician work life study. Journal of General Internal Medicine, 15 , 441-450. doi: 10.1046/j.1525-1497.2000.05239.x.
McGowan et al., 2011
McGowan, Y., Humphries, N., Morgan, K., Conry, M., Montgomery, A., Panagopoulou, E., & McGee, H (2011). Defining quality of care in hospitals: A ten year systematic review of literature 2000-2010 (Chapter IV). In K. Vedhara, E. Panagopoulou, & A. Montgomery (Coords.). Deliverable D3.1 Systematic review: Improving quality and safety in the hospital: The link between organizational culture, burnout and quality of care – ORCAB. Retrieved from http://orcab.web.auth.gr/orcab/.
McIntyre and Salas, 1995
McIntyre, R.M., & Salas, E. (1995). Measuring and managing for team performance: Emerging principles from complex environments. In R. A. Guzzo & E. Salas (Eds.), Team effectiveness and decision making in organizations (pp. 9-45). San Francisco: Jossey-Bass.
Porter et al., 2003
Porter, C.O. L. H., Hollenbeck, J.R., Ilgen, D.R., Ellis, A.P. J., West, B.J., & Moon, H.K. (2003). Towards understanding backing up behaviors in work teams: The role of personality and the legitimacy of need for backing up others. Journal of Applied Psychology, 88, 391-403.
Preacher and Hayes, 2008
Preacher, K.J., & Hayes, A.F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891. doi: 10.3758/BRM.40.3.879.
Richter and Hacker, 1998
Richter, P., & Hacker, W. (1998). Workload and strain: Stress, fatigue, and burnout in working life. Heidelberg, Germany: Asagner.
Rousseau et al., 2006
Rousseau, V., Aubé, C., & Savoie, A. (2006). Teamwork behaviors: A review and an integration of frameworks. Small Group Research, 37, 540-570. doi: 10.1177/1046496406293125.
Salas et al., 2008
Salas, E., Cooke, N.J., & Rosen, M.A. (2008). On teams, teamwork, and team performance: Discoveries and developments. Human Factors, 50, 540-547. doi: 10.1518/001872008X288457.
Salas et al., 2009
Salas, E., Rosen, M.A., Burke, C.S., & Goodwin, G.F. (2009). The wisdom of collectives in organizations: An of the teamwork competencies. In E. Salas, G.F. Goodwin, & C. S. Burke (Eds.), Team Effectiveness in Complex Organizations. Cross- Disciplinary Perspectives and Approaches (pp. 39-79). New York: Psychology Press.
Salas et al., 2005
Salas, E., Sims, D.E., & Burke, C.S. (2005). Is There A Big Five In Teamwork? Small Group Research, 36, 555-599. doi: 10.1177/1046496405277134.
Seligman and Csikszentmihalyi, 2000
Seligman, M., & Csikszentmihalyi, M. (2000). Positive psychology: An Introduction. American Psychologist, 55, 5-14. doi: 10.1037/0003-066X.55.1.5.
Shanafelt et al., 2002
Shanafelt, T., Bradley, K., Wipf, J., & Back, A. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine, 136, 358-367.
Silva et al., 2013
Silva, A.S., Costa, P.L., Costa, R., Tavares, S.M., Leite, E.S., & Passos, A.M. (2013). Meanings of quality of care: Perspectives of Portuguese health professionals and patients. British Journal of Health Psychology, 18, 858-873. doi: 10.1111/bjhp.12031.
Sofaer and Firminger, 2005
Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. Annual Review of Public Health, 26, 513-559. doi: 10.1146/annurev. publhealth.25.050503.153958.
Soler et al., 2008
Soler, J.K., Yaman, H., Esteva, M., Dobbs, F., Asenova, R.S., Katic¿, M., … Ungan, M. (2008). Burnout in European family doctors: the EGPRN study. Family Practice, 25, 245-265. doi:10.1093/fampra/cmn03.
Sweetman and Luthans, 2010
Sweetman, D., & Luthans, F. (2010). The power of positive psychology: psychological capital and work engagemen”, in A. B. Bakker & M. P. Leiter (Eds.), Work Engagement: A handbook of Essential Theory and Practice (pp. 54-68). Hove, UK: Psychology Press.
Teng et al., 2012
Teng, C., Li, I.-C., Chu, T.-L., Chang, H.-T., & Liu, T.-W. (2012). How can supervisors improve employees’ intention to help colleagues? Perspectives from social exchange and appraisal-coping theories. Journal of Service Research, 15, 332-342. doi: 10.1177/1094670511435538.
Thompson, 2007
Thompson, E.R. (2007). Development and Validation of an Internationally Reliable Short-Form of the Positive and Negative Affect Schedule (PANAS). Journal of Cross- Cultural Psychology, 38, 227-242.
Toral-Villanueva et al., 2009
Toral-Villanueva, R., Aguilar-Madrid, G., & Juárez-Pérez. C. A. (2009). Burnout and patient care in junior doctors in Mexico City. Occupational Medicine, 59, 8-13. doi: 10.1093/occmed/kqn122.
Watson et al., 1988
Watson, D., Clark, L.A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.
Weinberg and Creed, 2000
Weinberg, A., & Creed, F. (2000). Stress and psychiatric disorder in healthcare professionals and hospital staff. Lancet, 355, 533-537. doi: 10.1016/S0140-6736(99)07366-3.
West et al., 2006
West, C.P., Huschka, M.M., Novotny, P.J., Sloan, J.A., Kolars, J.C., Habermann, T.M., & Shanafelt, T.D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. The Journal of the American Medical Association, 296, 1071-1078. doi:10.1001/jama.2011.1274.
Winstanley and Whittington, 2004
Winstanley, S., & Whittington, R. (2004). Aggression towards health care staff in a UK general hospital: variation among professions and departments. Journal of Clinical Nursing, 13, 3-10. doi: 10.1111/j.1365-2702.2004.00807.x.
Xanthopoulou et al., 2007
Xanthopoulou, D., Bakker, A.B., Demerouti, E., & Schaufeli, W.B. (2007). The role of personal resources in the Job Demands-Resources Model. International Journal of Stress Management, 14, 121-141. doi:10.1037/1072-5245.14.2.121.
Copyright © 2024. Colegio Oficial de la Psicología de Madrid