Employee Working Conditions and Healthcare System Performance: the Veterans Health Administration Experience

Abstract

Organizational climate, policies, and resultant working conditions in health care institutions appear to be strong drivers of system performance. Interventions directed toward improving care quality and safety should address these factors.

Disparities in Health Behaviors and Chronic Conditions in Health Care Providers in the Veterans Health Administration

“…1,2 Briefly, these techniques involved advertisement to all employees in VHA by e-mail messages and bulletin boards. Employees received e-mails and e-mail reminders with a link to the survey instrument, and local coordinators supported administration.…”

“…The wellness survey was designed with the following three goals in mind: (1) To establish baseline rates of health behaviors and prevalence of chronic health conditions in the VHA employee population, (2) to support the need for and guide program development for a national health promotion program rollout, and (3) to support evaluation of employee health promotion program effectiveness over time at a national, regional, and facility level.…”

Nurse Working Conditions and Nursing Unit Costs

“…Such working conditions are those in which nurses have autonomy, participate in decision-making, and communicate and coordinate with other health care professionals who are involved in providing patient care (Mark et al, 2007, Warren et al, 2007; Ulrich et al, 2007). Recent studies indicate that working conditions are related to improvements in patient safety, including the detection of medication errors (Seki & Yamazaki, 2006), and reductions in infections (Stone et al, 2007), mortality (Havens & Aiken, 1999) and decubitus ulcers (Stone et al, 2007).…”

Do associations between employee self-reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modelling

“…In addition, because of the recognized strong relationships between employee satisfaction, patient safety and quality of care (Warren et al, 2007), VHA implemented a Network Director Performance measure based on employee satisfaction beginning in 2004, thus increasing attention to AES results. This increased emphasis was accompanied by greater system attention to facility needs and feedback to facilities, with increased employee awareness that AES results materially affect working conditions.…”

“…The VHA has expended substantial efforts to improve quality and safety of patient care over the last decade, with considerable success (Jha et al, 2003;Greenfield and Kaplan, 2004;Asch et al, 2004). Healthcare research from the VHA experience also demonstrates the connection between hospital organizational climate, employee satisfaction and quality and safety of care delivered to patients (Warren et al, 2007;Stone et al, 2005).…”