Effects of work conditions on provider mental well-being and quality of care: a mixed-methods intervention study in the emergency department

Abstract

BackgroundEmergency departments (EDs) are highly dynamic and stressful care environments that affect provider and patient outcomes. Yet, effective interventions are missing. This study evaluated prospective effects of a multi-professional organizational-level intervention on changes in ED providers’ work conditions and well-being (primary outcomes) and patient-perceived quality of ED care (secondary outcome).MethodsA before and after study including an interrupted time-series (ITS) design over 1 year was established in the multidisciplinary ED of a tertiary referral hospital in Southern Germany. Our mixed-methods approach included standardized provider surveys, expert work observations, patient surveys, and register data. Stakeholder interviews were conducted for qualitative process evaluation. ITS data was available for 20 days pre- and post-intervention (Dec15/Jan16; Dec16/Jan17). The intervention comprised ten multi-professional meetings in which ED physicians and nurses developed solutions to work stressors in a systematic moderated process. Most solutions were consecutively implemented. Changes in study outcomes were assessed with paired t-tests and segmented regression analyses controlling for daily ED workload.ResultsOne hundred forty-nine surveys were returned at baseline and follow-up (response at baseline: 76 out of 170; follow-up: 73 out of 157). Forty-one ED providers participated in both waves. One hundred sixty expert work observations comprising 240 observation hours were conducted with 156 subsequent work stress reports. One thousand four hundred eighteen ED patients were surveyed. Considering primary outcomes, respondents reported more job control and less overtime hours at follow-up. Social support, job satisfaction, and depersonalization deteriorated while respondents’ turnover intentions and inter-professional interruptions increased. Considering the secondary outcome, patient reports indicated improvements in ED organization and waiting times. Interviews revealed facilitators (e.g., comprehensive approach, employee participation) and barriers (e.g., understaffing, organizational constraints) for intervention implementation.ConclusionsTo the best of our knowledge, this is the first study to report prospective effects of an ED work system intervention on provider well-being and patient-perceived quality of ED care. We found inconsistent results with partial improvements in work conditions and patient perceptions of care. However, aspects of provider mental well-being deteriorated. Given the lack of organizational-level intervention research in EDs, our findings provide valuable insights into the feasibility and effects of participatory interventions in this highly dynamic hospital setting.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0218-x) contains supplementary material, which is available to authorized users.

A longitudinal assessment of occupational stress in Emergency Department Nursing Staff

“…Similarly, another study identified considerable variation in changes of perceptions of work stressors over time in Belgian ED nurses, and also determined a positive relationship between rewards and worker engagement, as well as social harassment and emotional exhaustion (Adriaenssens et al, ). A more recent publication has examined the impact of ten multi‐professional meetings in which staff at one German ED developed co‐produced solutions to mitigate work stress through a moderated process (Schneider et al, ). Workers reported higher work autonomy and less overtime 12‐month post‐intervention but in contrast to the findings of this study, a decline in job satisfaction.…”

“…Previous research has identified that ED nursing and medical staff experience similar stressors and has outlined the importance of workplace interventions to support both professions (Smith & Dasan, ). Our main aim was to assess the effect of departmental interventions over a number of years as relatively few studies have previously done so (Adriaenssens et al, ; Schneider et al, ). Although we wished to include ED doctors in our sample, we were mindful that doctors rotate through the department every 4–6 months.…”

“…Although a variety of occupational stressors and associated psychosocial outcomes have been analysed, few studies have assessed these using the full range of theoretical frameworks described earlier. Furthermore, to our knowledge, there is only one published longitudinal study examining interventions in the ED on provider wellbeing (Schneider, Wehler, & Weigl, ). The aim of this study was to assess perceptions of organisational stress and job satisfaction amongst ED nurses over a three‐year period and the impact of interventions to mitigate stress.…”

Systematic review of interventions to improve nurses’ work environments

“…The nurses' positive perception of their job was measured in seven studies (N = 7, 50%). Participatory approach (Aitken et al, 2011;Hall et al, 2008;Schneider, Wehler, & Weigl, 2019;Van Bogaert et al, 2017) and educational strategy (Jeon et al, 2018) failed to improve nurses' satisfaction with their job. However, accreditation process was able to improve job satisfaction (p = 0.008) (Aiken et al, 2008) based on a single-item Likert scale question.…”

Effects of environmental distractors on nurse emergency triage accuracy: a pilot study protocol

“…The theoretical framework chosen for the study is an adapted version of the Systems Engineering Initiative for Patient Safety (SEIPS) model (45). It is a framework frequently used in human factors analysis and patient safety research to gain insight on performance in different healthcare settings, including emergency departments (46)(47)(48). The model comprises three dimensions: work system, processes, and outcomes.…”