What is already known on this subject? Psychosocial stress at work among health professionals is often present and well studied, but relations between job stress and quality of care were rarely examined. Job demands-resources model by Demerouti, Bakker, Nachreiner and Schaufeli (2001), for assessment of job stress includes job demands (working environment, work overload, time pressures, recipient contact, shift work) and job resources (feedback, rewards, job control, participation, job security, supervisor support) was applied in different studies. There is scientific evidence that burned-out physicians have shown depersonalization from their patients, they have withdrawn from patients, demonstrated sub-optimal care, and sometimes burnout has been related to serious mistakes and patient death. Different research has shown that some workplace factors contributed to the development of work-related stress and burnout among HPs whereas others contributed protectively. What does this study add? Similar and overlapping workplace factors in hospital setting produce stress in health professionals and influence quality of care. Impact of specific socioeconomic environment in Macedonia as a country in transition and EU candidate country on job stress among health professionals and quality of care. Development of criteria and recommendations for the job stress prevention and improvement of the organizational culture and climate in hospital settings.

BACKGROUND:Few studies have examined teamwork as mediator and moderator of work demands-burnout and job engagement-job satisfaction relationships in healthcare workers (HCWs) in South-East Europe.AIM:To assess mediation and moderation effect of teamwork on the relationship between independent (work demands or job engagement) and dependent (burnout or job satisfaction) variables.METHODS:Work demands, burnout, job engagement, and job satisfaction were measured with Hospital Experience Scale, Maslach Burnout Inventory, Utrecht Work Engagement Scale, and Job Satisfaction Survey, respectively. Hospital Survey on Patient Safety Culture was used for assessment of teamwork. In order to examine role of teamwork as a mediating variable we fit series of regression models for burnout and job satisfaction. We also fit regression models predicting outcome (burnout or job satisfaction) from predictor (work demands or job engagement) and moderator (teamwork) variable.RESULTS:Teamwork was partial mediator of work demands-burnout relationship and full mediator of job engagement-job satisfaction relationship. We found that only job engagement-job satisfaction relationship was moderated by teamwork.CONCLUSIONS:Occupational health services should target detection of burnout in HCWs and implementation of organizational interventions in hospitals, taking into account findings that teamwork predicted reduced burnout and higher job satisfaction.

BACKGROUND:Burnout results from a prolonged response to chronic emotional and interpersonal workplace stressors. The focus of research has been widened to job engagement.AIM:Purpose of the study was to examine associations between burnout, job engagement, work demands, and organisational culture (OC) and to demonstrate differences between physicians and nurses working in general hospital in Skopje, Republic of Macedonia.MATERIAL AND METHODS:Maslach Burnout Inventory and Utrecht Work Engagement Scale were used for assessment of burnout and job engagement. Work demands and OC were measured with Hospital Experience Scale and Competing Values Framework, respectively.RESULTS:Higher scores of dedication, hierarchy OC, and organizational work demands were found in physicians. Nurses demonstrated higher scores of clan OC. Burnout negatively correlated with clan and market OC in physicians and nurses. Job engagement positively correlated with clan and market OC in nurses. Different work demands were related to different dimensions of burnout and/or job engagement. Our findings support job demands-resources (JD-R) model (Demerouti and Bakker).CONCLUSIONS:Data obtained can be used in implementation of specific organizational interventions in the hospital setting. Providing adequate JD-R interaction can lead to prevention of burnout in health professionals (HPs) and contribute positively to better job engagement in HPs and higher quality of patient care.

A B S T R A C THealth 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. 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 positividadR E S U M E N 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 *Correspondence concerning this article should be addressed to Patrícia L. Costa. Office 2W8 (Building I). Av.ª das Forças Armadas. 1649-026 Lisbon,

BACKGROUND:Burnout syndrome develops in health professionals (HPs) as a result of exposure to chronic emotional and interpersonal workplace stressors. Research demonstrates the links between burnout, work demands, and job satisfaction in hospital HPs.AIMS:To examine the associations between burnout, work demands and job satisfaction, and to demonstrate the mediation effect of emotional exhaustion on the relationship between work demands and job satisfaction in surgery clinic HPs.METHODS:Maslach Burnout Inventory was used for assessment of burnout. Work demands and job satisfaction were measured with Hospital Experience Scale and Job Satisfaction Survey, respectively. In order to examine the role of emotional exhaustion, depersonalization, and work demands, controlling for age, hospital tenure, and unit tenure, a hierarchical multiple regression models were tested for each job satisfaction factor.RESULTS:Job satisfaction was negatively predicted by emotional exhaustion. Certain types of work demands negatively predicted different factors of job satisfaction. Emotional exhaustion was a significant partial mediator of the relationship between work demands and job satisfaction.CONCLUSIONS:Adequate management of work demands, particularly excessive workload, time pressure, and lack of staff can lead to prevention of burnout and reduced job satisfaction in surgery clinic HPs, and contribute to better quality of patient care.