A longitudinal investigation of structural empowerment profiles among healthcare employees.

PURPOSE: Research on structural empowerment has typically adopted a variable-centered perspective, which is not ideal to study the combined effects of structural empowerment components. This person-centered investigation aims to enhance our knowledge about the configurations, or profiles, of healthcare employees' perceptions of the structural empowerment dimensions present in their workplace (opportunity, information, support, and resources). Furthermore, this study considers the replicability and stability of these profiles over a period of 2 years, and their outcomes (perceived quality of care, and positive and negative affect). DESIGN: Participants completed the same self-reported questionnaires twice, 2 years apart. METHODS: A sample of 633 healthcare employees (including a majority of nurses and nursing assistants) participated. Latent transition analyses were performed. RESULTS: Five profiles were identified: Low Empowerment, High Information, Normative, Moderately High Empowerment, and High Empowerment. Membership into the Normative and Moderately High Empowerment profiles demonstrated a high level of stability over time (79.1% to 83.2%). Membership in the other profiles was either moderately stable (43.5% for the High Empowerment profile) or relatively unstable (19.7% to 20.4% for the Low Empowerment and High Information profiles) over time. More desirable outcomes (i.e., higher positive affect and quality of care, and lower negative affect) were observed in the High Empowerment profile. CONCLUSIONS: These results highlight the benefits of high structural empowerment, in line with prior studies suggesting that structural empowerment can act as a strong organizational resource capable of enhancing the functioning of healthcare professionals. These findings additionally demonstrate that profiles characterized by the highest or lowest levels of structural empowerment were less stable over time than those characterized by more moderate levels. CLINICAL RELEVANCE: From an intervention perspective, organizations and managers should pay special attention to employees perceiving low levels of structural empowerment, as they experience the worst outcomes. In addition, they should try to maintain high levels of structural empowerment within the High Empowerment profile, as this profile is associated with the most desirable consequences. Such attention should be fruitful, considering the instability of the High Empowerment and Low Empowerment profiles over time. REGISTRATION: NCT04010773 on ClinicalTrials.gov (4 July, 2019).

Impact of empowering leadership on emotional exhaustion: A controlled interventional study in a large French university hospital complex.

AIM: The aim of this study is to assess the effect of a systemic intervention on the evolution of empowering leadership and emotional exhaustion in a university hospital sub-centre compared to a control sub-centre, both being part of a large French university hospital complex. BACKGROUND: Empowering leadership is a promising strategy for developing hospital team engagement and performance. However, the bureaucratic functioning of large hospitals, characterized by a managerial culture of control and a stratified organization, can be a barrier to empowering leadership. METHODS: The intervention included empowering leadership training, direct field experimentation of empowering leadership and coaching, involving all the sub-centre hierarchical levels for 12 months. Data were collected before and after the intervention. A total of 441 and 310 participants were, respectively, included in the intervention and control sub-centres. RESULTS: Empowering leadership was decreased, and emotional exhaustion was increased in the control sub-centre, while the scores remained stable in the intervention sub-centre. The increased emotional exhaustion in the control sub-centre could partially be explained by the change in empowering leadership. CONCLUSION: In a context of decreased empowering leadership and increased emotional exhaustion, the intervention had a protective effect. Implications for the design of future interventions were discussed. IMPLICATIONS FOR NURSING MANAGEMENT: This study unequivocally showed the benefit of transforming hospital management towards empowering leadership, to prevent increased emotional exhaustion. REGISTRATION NUMBER: This study is registered on ClinicalTrials.gov on 4 July 2019 (NCT04010773).

Psychosocial and Organizational Processes and Determinants of Health Care Workers' (HCW) Health at Work in French Public EHPAD (Assisted Living Residences): A Qualitative Approach Using Grounded Theory.

In a context marked by negative health indicators that make structural aspects more salient, this paper aimed at understanding and explaining the processes and determinants at work that positively and negatively interfere with the professionals' health in the French public nursing home environment. To this purpose, the qualitative approach by grounded theory was chosen. In total, 90 semi-structured interviews were recorded and 43 were transcribed; in addition, 10 observations of 46 participations in meetings and working groups were carried out in four public service and hospital establishments. Our results indicate that the role of health workers, its definition, and its execution are fundamental to the understanding of their health at work. Two protective and constructive processes are involved in the maintenance and development of the professionals' health in this work, with considerable confrontations with death and suffering: individual and collective control of emotional and cognitive commitment, and the development of resources for formation, information, and cooperation. Nonetheless, they are jeopardized when a lasting imbalance is generated between the work's demands and the available resources. This leads to a loss spiral in organizational, inter-individual, and individual resources that makes it difficult to sustain work.

Exploring Perceptions of the Work Environment among Psychiatric Nursing Staff in France: A Qualitative Study Using Hierarchical Clustering Methods.

Most studies on workers' health are based on non-specific models of occupational stress, thereby limiting the understanding and research on efficient interventions. This qualitative approach aimed to explore the structure of resources and constraints in the working environment of nurses in a deliberately open approach. Semi-structured interviews were conducted with 37 nurses working in closed and open inpatient psychiatric wards in a French university hospital. The data were statistically analyzed using a hierarchical clustering method. Our model highlighted a systemic structure, describing the interactions, including patients, nurses, doctors, and managers in a specific material, communicational, and organizational environment. The results show a discursive structure organized around dimensions pertaining to "environment", "patients", "medical-care group", and "the individual". Our model showed interest in an interdisciplinary approach that encompasses occupational medicine and social psychology.

Impact at two years of an intervention on empowerment among medical care teams: study protocol of a randomised controlled trial in a large French university hospital.

BACKGROUND: Empowerment of hospital workers is known as a key factor of organizational performance and occupational health. Nevertheless, empowering workers remains a real challenge. As in many traditional organizations, hospitals follow a bureaucratic model defined by a managerial culture of control and a stratified organization, which at once weaken professionals' mastery of their work and hinder their commitment and performance. Based on the existing literature this protocol describes a new managerial and organizational transformation program as well as the study design of its effect on worker empowerment in a large French public hospital. The project is funded by the French Ministry of Health for a total of 498,180 €. METHODS: This study is a randomized controlled trial conducted in a French university hospital complex (CHU). The CHU comprises 12 sub-centers (SC) with about 20 care units and 1000 employees each. Randomization is performed at SC level. The intervention lasts 12 months and combines accompaniment of healthcare teams, frontline managers and SC directors to empower first-line professionals in the experimental SC. Quantitative outcome measurements are collected over 2 years during mandatory check-ups in the occupational medicine department. The primary outcomes are structural and psychological empowerment, motivational processes, managerial practices, working conditions, health and performance. Mixed linear modeling is the primary data analysis strategy. DISCUSSION: The protocol was approved by the CHU health ethics committee. The results of the analysis of the intervention effects will be reported in a series of scientific articles. The results will contribute to reflection on prevention and management policies, and to the development of Workplace Quality-of-Life. If the intervention is a success, the system will warrant replication in other SCs and in other health facilities. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov on July 4, 2019 (NCT04010773).