Participatory redesign of work organisation in hospital nursing: A study of the implementation process

Stab, Nicole; Hacker, Winfried

doi:10.1111/jonm.12545

Cited by 10 publications

(11 citation statements)

References 38 publications

(60 reference statements)

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“…Each of the following meetings focused on the development of measures for one of the identified work problems. In these guided health circles, participants collectively analyzed and discussed potential solutions for work problems and defined an action plan with concrete measures, persons responsible, and deadlines [19]. Two meetings were designated to evaluate implementation status of measures and to discuss potential adjustments.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, participative interventions apply systematic analyses as well as collaborative improvement of work conditions [15–17]. Thus ‘front-line’ providers, such as ED physicians and nurses, are best suited to identify and solve problems in their work environment [18, 19]. Although preliminary evidence suggests that organizational-level interventions can be effective in eliciting positive changes in work systems and provider well-being, thorough evaluations concerning intervention effects on quality of care outcomes are scarce [20].…”

Section: Introductionmentioning

confidence: 99%

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

2019

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2019

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“…For example, the perception of cooperation in an interdisciplinary team is due to the quality of interdisciplinary case conferences and execution of common tasks, such as ward rounds, or other interdisciplinary meetings. Therefore, observed work characteristics determined with anchored scales may facilitate the process of work redesign better because of their more specific structural orientation (Stab & Hacker, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…interventions by small-group workshops of concerned nurses using this tool may be useful to improve work organization (Stab & Hacker, 2018).…”

Section: Con Clus Ionmentioning

confidence: 99%

“…burnout, hospital organization and administration, nursing, observation, stress, psychological Based on these results in somatic health care, interventions that improve work organization in wards have received increasing interest. Especially, participative assessment and redesign of nurses' work organization by small-group activities of involved nurses, assisted by the hospital management, have been successful (Bourbonnais et al, 2006;Stab & Hacker, 2018). Therefore, the questions are whether the organizational characteristics of somatic wards are relevant for psychiatric wards and, if so, whether psychiatric wards differ in these characteristics.…”

Section: Introductionmentioning

confidence: 99%

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A pilot study on the possibility of human‐centred participative redesign of work organization at psychiatric wards

Stab

Hacker

2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Rationalization and an increasing shortage of nurses in psychiatric care require the improvement of working conditions. Work organization of hospital wards determines nurses’ well‐being on the job. In somatic care, observation‐based assessments and participative improvements of work organization in the wards by involved nurses can reduce workload. What the paper adds to existing knowledge? In psychiatric nursing, observation‐based assessment as well as nurses’ self‐reports may identify characteristics of ward organization that determine nurses’ well‐being. This study suggests a system of characteristics of work organization at psychiatric wards that may guide participative analyses and improvement measures. This may contribute to the research on prevention of conflicts and aggressive behaviour in psychiatric wards. What are the implications for practice? Participative analysis and, if necessary, participative redesign of work organization at psychiatric wards may reduce nurses’ perceived work load. An approach to address the above is suggested for psychiatric nursing, which, in another version, is proven effective in somatic care. Abstract IntroductionThe study was based on an approach for participative improvement of work organization at somatic hospital wards related to characteristics that determine nurses’ health. It differed from research seeking to adjust the environment to prevent aggressive behaviour at psychiatric wards. The focus was on the ergonomic principles of the whole work system and its impact on the nurses’ health. Aim/QuestionWe analysed the prerequisites for a transfer of this approach to psychiatric nursing. MethodThis study employed a cross‐sectional design examining 11 wards of a hospital for psychiatry and neurology; 109 nurses participated. We used a multi‐method design with observation‐based assessments and nurses’ self‐reports of ward organization. ResultsTwo clusters with wards of different work organization were identified. One cluster consisted of better‐organized wards. The other included wards with a worse organization. We found substantial convergence between the observation‐based assessments and nurses’ self‐reports. DiscussionThis study results indicated that observation‐based assessments were an acceptable alternative to nurses’ self‐reports, enabling the evaluation of ward organization in a feasible and reliable way. Implications for practiceThis study showed an approach with a specific view on the structural quality of psychiatric wards; this may support work improvement processes in a more systematic way.

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Verhältnis- und verhaltenspräventives Gestalten dialogisch-interaktiver Erwerbsarbeit

2020

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ZusammenfassungDer Beitrag skizziert die Anforderungsbesonderheiten von dialogisch-interaktiver Erwerbsarbeit, d. h. von klientenverändernden, klientenbeeinflussenden und klientenbezogenen Arbeitstätigkeiten. Möglichkeiten zum verhältnis- und verhaltenspräventiven Gestalten von Interaktionsarbeit im Dienstleistungsbereich werden skizziert. Hierzu werden Beispiele aus der Kranken- und Seniorenpflege, der Bildung sowie dem Einzel- und Großhandel referiert. Die dargestellten Beispiele zeigen Möglichkeiten der Verhältnisprävention (Primat der Verhältnisgestaltung) bei dialogisch-interaktiver Dienstleistungsarbeit. Die Bedeutung der Integration der Befähigung zu präventiver Arbeitsgestaltung in die berufliche Aus- und Weiterbildung wird betont.Praktische Relevanz Arbeitsgestaltung mit dem Ziel der Verhütung von Gefährdungen ist auch in Humandienstleistungstätigkeiten unerlässlich. Für die hohe Zahl der Beschäftigten, die betreuende, ausbildende, pflegerische, therapeutische oder beratende/verkaufende Tätigkeiten ausüben, ist eine präventive Gestaltung der Arbeit erforderlich, um Fehlbeanspruchungen zu vermeiden. Die Arbeit kann sowohl verhältnis-(bedingungs-) als auch verhaltensbezogen präventiv gestaltet werden, wobei der Verhältnisprävention der Vorrang zu geben ist. Der Beitrag führt Beispiele aus der verhältnis- und verhaltensbezogenen Prävention an und benennt dafür nutzbare Verfahren und Vorgehensweisen.

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Participatory redesign of work organisation in hospital nursing: A study of the implementation process

Abstract: Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process.

Cited by 10 publications

References 38 publications

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

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

A pilot study on the possibility of human‐centred participative redesign of work organization at psychiatric wards

Verhältnis- und verhaltenspräventives Gestalten dialogisch-interaktiver Erwerbsarbeit

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