Does Context Count? The Association Between Quality of Care and Job Characteristics in Residential Aged Care and Hospital Settings: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Within residential aged care settings, reduced quality of care (QoC), abuse, and neglect have been global phenomena which require urgent intervention. As the reported rate of these problems is much higher in aged care compared to hospital settings, we investigated whether differing job design characteristics between the 2 settings might explain the difference. RESEARCH DESIGN AND METHODS: We used a meta-analysis to compare differences in the relationships between high job demands, low job resources, and job strain with QoC and counterproductive work behaviors (CWBs) across aged care and hospital settings. RESULTS: Data were extracted from 42 studies (n = 55 effects). QoC was negatively correlated with high job demands (ρ¯ = -0.22, 95% confidence interval [CI]: -0.29, -0.15, k = 7), low job resources (ρ¯ = -0.40, 95% CI: -0.47, -0.32, k = 15), and job strain (ρ¯ = -0.32, 95% CI: -0.38, -0.25, k = 22), CWBs had a positive relationship with job demands (ρ¯ = 0.35, 95% CI: 0.10, 0.59, k = 3) and job strain (ρ¯ = 0.34, 95% CI: 0.13, 0.56, k = 6). The association between poor QoC and low job resources was stronger in aged care (r = -0.46, 95% CI: -0.55, -0.36, k = 8) than in hospital settings (r = -0.30, 95% CI: -0.41, -0.18, k = 7). DISCUSSION AND IMPLICATIONS: Our findings suggest that relationships between low job resources and poor QoC are exacerbated in residential aged care contexts. To improve care outcomes, stakeholders should improve job resources such as skill discretion, supervisory supports, and increased training and staffing levels in residential aged care.

Clinical and ethical challenges for emergency departments during communicable disease outbreaks: Can lessons from Ebola Virus Disease be applied to the COVID-19 pandemic?

EDs fulfil a frontline function during public health emergencies (PHEs) and will play a pivotal role during the COVID-19 pandemic. This perspective article draws on qualitative data from a longitudinal, ethnographic study of an Australian tertiary ED to illustrate the clinical and ethical challenges faced by EDs during PHEs. Interview data collected during the 2014 Ebola Virus Disease PHE of International Concern suggest that ED clinicians have a strong sense of professional responsibility, but this can be compromised by increased visibility of risk and sub-optimal engagement from hospital managers and public health authorities. The study exposes the tension between a healthcare worker's right to protection and a duty to provide treatment. Given the narrow window of opportunity to prepare for a surge of COVID-19 presentations, there is an immediate need to reflect and learn from previous experiences. To maintain the confidence of ED clinicians, and minimise the risk of moral injury, hospital and public health authorities must urgently develop processes to support ethical healthcare delivery and ensure adequate resourcing of EDs.