Managers perception of hospital employees' effort-reward imbalance.

OBJECTIVE: Hospitals are frequently associated with poor working conditions that can lead to work stress and increase the risk for reduced employee well-being. Managers can shape and improve working conditions and thereby, the health of their teams. Thus, as a prerequisite, managers need to be aware of their employees' stress levels. This study had two objectives: At first, it aimed to test the criterion validity of the Effort-Reward Imbalance (ERI) questionnaire measuring psychosocial workload in hospital employees. Secondly, mean scales of the ERI questionnaire filled in by employees were compared with mean scales of an adapted ERI questionnaire, in which managers assessed working conditions of their employees. METHODS: Managers (n = 141) from three hospitals located in Germany assessed working conditions of their employees with an adapted external, other-oriented questionnaire. Employees (n = 197) of the mentioned hospitals completed the short version of the ERI questionnaire to assess their working conditions. Confirmatory factor analyses (CFA) were applied to test factorial validity, using the ERI scales for the two study groups. Criterion validity was assessed with multiple linear regression analysis of associations between ERI scales and well-being among employees. RESULTS: The questionnaires demonstrated acceptable psychometric properties in terms of internal consistency of scales, although some indices of model fit resulting from CFA were of borderline significance. Concerning the first objective, effort, reward, and the ratio of effort-reward imbalance were significantly associated with well-being of employees. With regard to the second objective, first tentative findings showed that managers' ratings of their employees' effort at work was quite accurate, whereas their reward was overestimated. CONCLUSIONS: With its documented criterion validity the ERI questionnaire can be used as a screening tool of workload among hospital employees. Moreover, in the context of work-related health promotion, managers' perceptions of their employees' workload deserve increased attention as first findings point to some discrepancies between their perceptions and those provided by employees.

From approachables on the sidelines to dedicated sensitives: developing a leadership typology among healthcare leaders utilizing grounded theory.

PURPOSE: Based on a resulting typing model, this paper focuses on four types of leaders (Approachables on the sidelines, Distanced overseers, Realistic succeeders and Dedicated sensitives), who differ in the analytical core category of "development of awareness." DESIGN/METHODOLOGY/APPROACH: Internal team coaching is intended to strengthen leaders in the health care system. The Team Leader Coaching Programme (TLCP) was implemented as an internal coaching instrument at rehabilitation centers using a train-the-trainer format. Twenty-one team leaders were surveyed on their experience of the coaching process they implemented in their teams. The interviews were analyzed using the grounded theory method (GTM) as theoretically discussed by representatives of second-generation GTM (Charmaz, 2014). FINDINGS: Use of the TLCP proved to be an intervention for initiating and enhancing an awareness development process regarding team leaders' reflections on their own position and leadership role, regardless of their profession. This process was found to be a prerequisite for implementing the learned content. The typing model is discussed given current contextual conditions in the rehabilitation system and their connectivity in practice for integrating coaching elements into daily management. ORIGINALITY/VALUE: This article presents a typology of healthcare leaders. Thanks to the reconstructive approach using grounded theory methodology, this article presents an in-depth analysis of the implementation process of a coaching program. The findings are both connectable to applied leadership research and useable for further development of training and interventions to strengthen team leaders in clinical settings.

The effects of a dilemma management training program on mental health: a prospective study with mid-level executives in hospitals.

PURPOSE: Mid-level executives are confronted with many dilemma situations, in which they are forced to decide between conflicting options, none of them leading to the desired result. If they fail to cope with them constructively, their individual risk for mental strains increases (Gerlmaier and Latniak, 2013). Initial findings focusing on executives in industry (Bossmann, 2020) show that fostering effective dilemma management in executives is a preventive factor against stress-related diseases. Yet, there is little empirical research that evaluates the contribution of dilemma management training on leadership's mental health prevention in hospitals. This study aims to examine whether such a training program, adapted to current working conditions in German hospitals, promotes mid-level executives' mental health. DESIGN/METHODOLOGY/APPROACH: A 10-month training program was administered to N = 69 senior physicians, senior nurses and senior service and administrative staff in four hospitals. To evaluate training effects on perceived stress reactivity, on cognitive and emotional irritation over time as well as the effects of the training dose on these results, participants' self-reported measures were collected at four points in time: before (t0), during (t1), immediately after (t2) and three months after the intervention (t3). FINDINGS: Overall, participants showed less cognitive irritation and perceived stress reactivity over time. However, their emotional irritation did not change significantly. The dose of training participation did not moderate these results. ORIGINALITY/VALUE: This paper contributes to the prevention of stress-related diseases and the promotion of sensemaking in mid-level executives' dilemma management routine in the face of increasingly aggravating working conditions due to financial restrictions in the German health-care system. Findings of this study are explained in greater depth using previously reported qualitative data from the same research project.

["Stress Occurs Every Day" - Reasons for Work-Related Burden in Hospitals and Coping of Staff. A Qualitative Study]. / "Also Stress ist jeden Tag" ­ Ursachen und Bewältigung von arbeitsbedingten Fehlbelastungen im Krankenhaus aus Sicht der Beschäftigten. Eine qualitative Studie.

OBJECTIVE: Workplace exposures are considered to be high in hospital staff. Workplace interventions might be an appropriate way to reduce workplace exposures. Therefore, views of hospital staff on reasons and implications of workplace exposures were assessed and consequences for workplace interventions were considered. METHODS: Six focus groups and seven semi-structured interviews were conducted with 34 members of hospital staff in total. Qualitative Content Analysis was performed. RESULTS: Stress occurs due to a lack of personnel, high workload, missing common-rooms for breaks and lunch, missing communication, a lack of clarity in work processes, team conflicts and a lack of appreciation. Social support, work breaks, reduction of working hours, physical activity and empowerment were mentioned as factors leading to stress reduction. CONCLUSION: Possible stress reduction by means of problem-related coping and emotional coping depending on hospital structure and culture.

The team leader coaching programme (TLCP) - a programme to implement team coaching in rehabilitation clinics - a feasibility study.

PURPOSE: Team coaching is a promising way to advance a shift from the classical leader to a coach who leads his/her interprofessional colleagues. It is acknowledged as an effective instrument to reinforce leaders' roles but is rarely used in the health-care sector. This paper aims to present the team leader coaching programme (TLCP), designed to strengthen team leaders by implementing coaching tools into their work routine. DESIGN/METHODOLOGY/APPROACH: The TLCP was designed based on the evaluated intervention on patient-centred team development, an expert workshop and a literature search. It addresses leadership styles, self-reflection, role clarity, attitude, moderation techniques and coaching tools with a focus on systemic questions. It was implemented as a train-the-trainer concept, in two training groups including 27 participants from 12 clinics ("multi-clinic" group) and another in-house training group ("single-clinic" group) including 15 participants from one clinic. FINDINGS: There were differences in the evaluation of the training between the group that received an inhouse training ("single-clinic" group) and the group that received a workshop in a group of professions from different clinics ("multi-clinic" group) with a tendency for a more positive evaluation by the "multi-clinic" group. ORIGINALITY/VALUE: The TLCP is a promising programme to potentially improve teamwork in rehabilitation clinics, as it provides team leaders with coaching tools they can use in their work routine without being dependent on external coaches. It is characterized by a reflective stance, which seems to be highly necessary to optimally fulfil the role of a team leader.

Cluster-randomised trial evaluating a complex intervention to improve mental health and well-being of employees working in hospital - a protocol for the SEEGEN trial.

BACKGROUND: Health care employees in Germany and worldwide are exposed to a variety of stressors. However, most of the hospitals in Germany lack a systematic workplace health management. Thus, this study aims at the evaluation of the effects of a behavioural as well as organisational (´complex´) intervention on the mental health and well-being of hospital staff. METHODS: Mental health in the hospital workplace (SEElische GEsundheit am Arbeitsplatz KrankeNhaus - SEEGEN) is an unblinded, multi-centred cluster-randomised open trial with two groups (intervention group (IG) and waitlist control group (CG)). Study participants in the intervention clusters will receive the complex intervention; study participants in the waitlist control clusters will receive the complex intervention after the last follow-up measurement. The intervention consists of five behavioural and organisational intervention modules that are specifically tailored to hospital employees at different hierarchical and functional levels. Hospital staff may select one specific module according to their position and specific needs or interests. Towards the end of the intervention roundtable discussions with representatives from all professional groups will be held to facilitate organisational change. Primary outcome is the change in emotional and cognitive strain in the working environment, from baseline (T0) to 6 month-follow up (T1), between IG and CG. In addition, employees who do not participate in the modules are included in the trial by answering shorter questionnaires (cluster participants). Furthermore, using mixed methods, a process evaluation will identify uptake of the intervention, and mediators and moderators of the effect. DISCUSSION: There seems to be growing psychological strain on people working in the health care sector worldwide. This study will examine whether investing directly in the hospital staff and their interpersonal relationship may lead to measurable benefits in subjective well-being at the workplace and improved economic performance indicators of the hospital. In case of a positive outcome, health promotion strategies looking at behavioural as well as organisational components within the hospital may gain additional importance, especially in regard of the growing financial pressure within the health sector. TRIAL REGISTRATION DRKS: The SEEGEN study is registered at the German Clinical Trial Register (DRKS) under the DRKS-ID DRKS00017249. Registered 08 October 2019, URL. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017249.