Hospital Medical and Nursing Managers’ Perspectives on Health-Related Work Design Interventions. A Qualitative Study

Abstract

Background: Research indicates that the active support of managers is essential for the sustainable implementation of health-related work design interventions in organizations. However, little is known about managers' perceptions of such health promotion measures. Objective: Our study aims to provide information that help to foster managers active support of health-related work design interventions in hospitals. Based on Ajzen's Theory of Planned Behavior (TPB) we explore the attitudes, perceived organizational norms, and perceived behavioral control of managers in the hospital regarding such interventions. Methods: Semi-structured interviews with 37 managers (chief physicians, senior physicians, and senior nurses) were carried out in one German hospital. A software aided qualitative content analysis was applied. Results: We observed that the majority of managers are aware of the importance of health-related work design. We found a high variation in the perception of organizational norms related to mental health promotion of employees. Behavioral control for supporting interventions is perceived more on an individual (e.g., appraisal interviews, professional development or support) and team level (e.g., fair work schedule, regular team meetings), less on an organizational level. Conclusion: To enable and to motivate hospital medical and nursing managers to support health-related work design, hospitals need to establish clear organizational norms that the health promotion of their employees is an important organizational goal. Moreover, managers need to get more work-design competencies and decision latitude to get more control. Important arguments for the top hospital management could be that health-related work design is highly effective for economic success, for treatment quality, and that the middle management already has a positive attitude toward the implementation of measures that help promote the mental health of their staff.

How Do Hospital Medical and Nursing Managers Perceive Work-Related Strain on Their Employees?

“…This view is corroborated by a recently published study [ 28 ] that showed that managers perceive decision latitude more at the individual and team level (e.g., through appraisal interviews, designing a fair work plan) and less at the organizational level. Various system-related reasons are cited by managers for not being able to create better working conditions by their own efforts through health-promoting work organization.…”

“…Various system-related reasons are cited by managers for not being able to create better working conditions by their own efforts through health-promoting work organization. In particular, for economic reasons in some cases, they feel externally determined by the top hospital management or the nursing service management and restricted in their work autonomy [ 28 ]. Since a health-related work design is very effective for economic success and for the quality of treatment, Genrich et al [ 28 ] suggest that clear organizational norms and goals should be established in hospitals and that the health promotion of employees is an important organizational goal [ 48 , 49 ].…”

“…We used interviews that emerged from a semi-standardized approach to the following research questions, that served to answer further questions [ 28 , 29 ]: ‘What do you think are the most important work stressors for your employees?’, ‘Which working conditions do you consider supportive and motivating for your employees?’, ‘To what extent do you see a connection between the stressors you have just mentioned and the mental health of your employees?’, ‘How do you describe your own role as a supervisor in relation to the mental health of your employees at work? ’, ‘How important is the mental health of employees in your hospital?’, ‘What opinions do your colleagues have on the subject?’, ‘What changes do you think can be implemented to relieve the strain on your employees in their day-to-day work?’, and ‘Do you personally see opportunities for yourself to maintain the ‘mental’ health of your employees at work and to reduce the stress you mentioned?’.…”

Hospital Medical and Nursing Managers’ Perspective on the Mental Stressors of Employees

“…It therefore seems more relevant to look at the PSC than at the level of social support alone. In addition, a recent study suggested that medical and nursing managers in hospitals themselves need to get more work-design competencies and decision latitude to get more control and to be able to sufficiently counteract stress factors [ 59 ]. We therefore propose for future research to investigate how the PSC influences the perception of the managers.…”

„Also Stress ist jeden Tag“ – Ursachen und Bewältigung von arbeitsbedingten Fehlbelastungen im Krankenhaus aus Sicht der Beschäftigten. Eine qualitative Studie

“…Die Befragten beschrieben Maßnahmen der Selbstfürsorge wie gesunde Ernährung, Sport, Entspannungstechniken und ausreichend Schlaf sowie Rückzugsmöglichkeiten am Arbeitsplatz, emotionale Unterstützung durch den Austausch mit Kolleginnen, familiäre Beziehungen und spirituelle Kraftquellen als wesentlich [11]. Eine qualitative Studie zur Perspektive von Führungskräften auf die Reduzierung von Arbeitsbelastungen im Krankenhaus zeigte, dass diese vorwiegend auf der individuellen-und teambezogenen Ebene gesehen werden, beispielsweise in Form von Mitarbeitergesprächen und sozialer Unterstützung [12].…”