Sustainable employability of long-term care staff in self-managing teams: A qualitative study.

AIM: To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable. DESIGN: Qualitative study with semi-structured interviews. METHODS: In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti. RESULTS: LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence. CONCLUSION: In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs. IMPLICATIONS: It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs. IMPACT: A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector. REPORTING METHOD: The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used. PATIENT OR PUBLIC CONTRIBUTION: Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Socioeconomic differences in working life expectancy: a scoping review.

BACKGROUND: In the last decade, interest in working life expectancy (WLE) and socioeconomic differences in WLE has grown considerably. However, a comprehensive overview of the socioeconomic differences in WLE is lacking. The aim of this review is to systematically map the research literature to improve the insight on differences in WLE and healthy WLE (HWLE) by education, occupational class and income while using different ways of measuring and estimating WLE and to define future research needs. METHODS: A systematic search was carried out in Web of Science, PubMed and EMBASE and complemented by relevant publications derived through screening of reference lists of the identified publications and expert knowledge. Reports on differences in WLE or HWLE by education, occupational class or income, published until November 2022, were included. Information on socioeconomic differences in WLE and HWLE was synthesized in absolute and relative terms. RESULTS: A total of 26 reports from 21 studies on educational and occupational class differences in WLE or HWLE were included. No reports on income differences were found. On average, WLE in persons with low education is 30% (men) and 27% (women) shorter than in those with high education. The corresponding numbers for occupational class difference were 21% (men) and 27% (women). Low-educated persons were expected to lose more working years due to unemployment and disability retirement than high-educated persons. CONCLUSIONS: The identified socioeconomic inequalities are highly relevant for policy makers and pose serious challenges for equitable pension policies. Many policy interventions aimed at increasing the length of working life follow a one-size-fits-all approach which does not take these inequalities into account. More research is needed on socioeconomic differences in HWLE and potential influences of income on working life duration.

Clinical Work-Integrating Care in Current Practice: A Scoping Review.

PURPOSE: Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. METHODS: A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. RESULTS: In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. CONCLUSION: Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.

Patients' Experiences, Needs, and Expectations of Cooperation Between Medical Specialists and Occupational Health Physicians: A Qualitative Study.

OBJECTIVE: Cooperation between clinical and occupational health care practitioners is a key aspect of clinical work-integrating care. This study aimed to gain insight into patients' experiences, needs, and expectations regarding cooperation between medical specialists and occupational health physicians. METHODS: A thematic qualitative study was conducted involving a total of 33 participants in eight online focus groups. RESULTS: Participants indicated practitioners are currently working in an isolated manner. However, participants desired for partnership between specialists and occupational health physicians to address work-related concerns and showed a need for explanation of the consequences of their diagnosis, so this can be translated into their ability to work. CONCLUSIONS: Currently, cooperation between clinical and occupational health care is lacking. Yet, some participants experienced that these disciplines could complement each other by working together to support patients in work participation.

Return-to-work rates and predictors of absence duration after COVID-19 over the course of the pandemic.

OBJECTIVES: The aim of this study was to evaluate employee return-to-work (RTW) rates and examine predictors of absence duration after COVID-19. RTW rates were referenced against RTW rates after absence due to flu-like symptoms and assessed over the course of the pandemic. METHODS: Routinely collected data from a nationally operating Dutch occupational health service was used. The data were retrieved from employees who reported sick due to COVID-19 (N=30 396) or flu-like symptoms (N=15 862). Data consisted of responses to a triage survey combined with longitudinal register-based information on sickness absence. RTW rates after COVID-19 were evaluated through Kaplan-Meier estimates and compared to RTW rates for flu-like symptoms, and between three periods with different dominant virus variants. Predictors for absence duration were examined through Cox proportional hazards models. RESULTS: RTW after COVID-19 was found to be notably later than after flu-like symptoms (median RTW=10 versus 6 days, respectively). On average, 5.5% of employees who contracted COVID-19 were absent for over 12 weeks. Time-to-RTW shortened as different virus variants became dominant over time. The main predictors contributing to later RTW were older age, female sex, belonging to a risk group, and the symptoms shortness of breath and fatigue. CONCLUSIONS: Estimates of the RTW rate after COVID-19 and identification of predictors may aid healthcare professionals in gaining insight into variations in the disease course and rehabilitation process. The present findings can help employers and policy-makers grasp the impact of COVID-19 on the workplace.

The slow de-implementation of non-evidence-based treatments in low back pain hospital care-Trends in treatments using Dutch hospital register data from 1991 to 2018.

BACKGROUND: Low back pain (LBP) is the leading cause of disability worldwide and has an excessive societal burden. Accumulating evidence has shown that some medical approaches such as imaging in absence of clear indications, medication and some invasive treatments may contribute to the problem rather than alleviating it. OBJECTIVES: To determine the extent of de-implementation of non-evidence-based hospital treatments for LBP care in the Netherlands in the last three decades. METHODS: Using a register-based population-level observational study with Dutch hospital data, providing a nearly complete coverage of hospital admissions in the Netherlands in 1991-2018, we assessed five frequently applied non-evidence-based hospital treatments for LBP. Time trends in treatment use (absolute and per 100,000 inhabitants) were plotted and analysed using Poisson regression. RESULTS: The use of bed rest for non-specific LBP and hernia nuclei pulposi, and discectomy for spinal stenosis decreased 91%, 81% and 86% since the availability of evidence/guidelines, respectively. De-implementation, beyond 84%, was reached after 18 and 17 years for bed rest for non-specific LBP and discectomy respectively, while it was not reached after 28 years for bed rest for hernia nuclei pulposi. For spinal fusion and invasive pain treatment, there was an initial increase followed by a reduction. Overall, these treatments reduced by 85% and 75%, respectively. CONCLUSIONS: In the Netherlands, de-implementation of five non-recommended hospital LBP treatments, if at all, took several decades. Although de-implementation was substantial, slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to many patients in Dutch hospitals. SIGNIFICANCE: Medically intensive approaches to low-back pain care contribute to the high societal burden of this disease. There have been calls to avoid such care. Using Dutch hospital data, we showed that de-implementation of five non-recommended hospital low-back pain treatments, if at all, took several decades (i.e. ≥17 years) after availability of evidence and guidelines. Slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to hospital patients; better ways for de-implementation of non-evidence-based care are needed.

Cancer survivors and adverse work outcomes: associated factors and supportive interventions.

INTRODUCTION: The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed. SOURCES OF DATA: A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted. AREAS OF AGREEMENT: A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions. AREAS OF CONTROVERSY: The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is. GROWING POINTS: Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed. AREAS TIMELY FOR DEVELOPING RESEARCH: Recent developments are tailored and timely interventions.

Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review.

Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.

[The implementation of non-effective care - how and why]. / Niet-effectieve zorg niet langer toepassen.

Increasing pressure on the healthcare system makes it essential that we use limited resources efficiently. In addition to implementation of (cost-)effective care, de-implementation, the abolishment of ineffective care, is important. In two recent Dutch examples, on de-implementation of back pain care and tonsillectomies/adenotomies, it appears that de-implementation can take up to decades. Based on the literature, we describe facilitators and barriers for de-implementation: personal factors of the practitioner (e.g. knowledge), socio-political (e.g. insured care) factors, factors related to the innovation (e.g. guidelines) and organizational (e.g. healthcare procurement) factors. De-implementation can be accelerated by focusing on these factors; e.g. through further adjustment of compensation systems and improvement of (applicability of) guidelines in combination with (de)implementation activities (such as training and campaigns).

Current practices, needs, and expectations of discussing work with a medical specialist from a patient's perspective: a qualitative study.

PURPOSE: Attention to paid work in clinical health care-clinical work-integrating care (CWIC)-might be beneficial for patients of working age. However, the perceptions and expectations of patients about CWIC are unknown. The aim of this study was to develop an understanding of current practices, needs, and expectations among patients for discussing work with a medical specialist. MATERIALS AND METHODS: A qualitative study was undertaken involving patients with diverse medical conditions (n = 33). Eight online synchronous focus groups were held. A thematic analysis was then performed. RESULTS: Three themes emerged from the data: (1) the process of becoming a patient while wanting to work again, (2) different needs for different patients, (3) patients' expectations of CWIC. We identified three different overarching categories of work-concerns: (a) the impact of work on disease, (b) the impact of disease or treatment on work ability, and (c) concerns when work ability remained decreased. For each category of concerns, patients expected medical specialists to perform differing roles. CONCLUSIONS: Patients indicated that they need support for work-related concerns from their medical specialists and/or other professionals. Currently, not all work concerns received the requested attention, leaving a portion of the patients with unmet needs regarding CWIC.

Patients have a wide range of questions regarding work and health, which they want to discuss with their medical specialistIn current clinical practice, not all work concerns get the requested attention, leaving some patients with unmet needsCooperation with different health care professionals, including rehabilitation occupational health care, might aid in supporting patients with their work-related questions.

Development of the core of an ICF-based instrument for the assessment of work capacity and guidance in return to work of employees on sick leave: a multidisciplinary modified Delphi study.

BACKGROUND: Several occupational health disciplines are involved in return to work guidance, implying that good interdisciplinary collaboration is important. A shared conceptual framework and a common language for the assessment of work capacity and guidance in return to work is expected to be at the benefit of appropriate and sustainable employability of sick employees. The International Classification of Functioning, Disability and Health (ICF) can be considered a shared conceptual framework and is also promising in terms of a common language. The purpose of the current study is to reach multidisciplinary consensus among occupational health professionals on the content of an ICF-based instrument for the assessment of work capacity and guidance in return to work. METHODS: To obtain multidisciplinary consensus we conducted a modified Delphi study among twelve occupational health experts, including four occupational physicians, four insurance physicians and four labour experts. The study included two e-mail rounds and two virtual meetings. In the consecutive rounds the experts assessed ICF items as well as a list of non-ICF-based work-related environmental factors on their relevance for the assessment of the work capacity and guidance in return to work together with their interpretability. RESULTS: The four consecutive Delphi rounds resulted in 20 items that are minimally needed for the assessment of the work capacity and return to work possibilities of employees on sick leave. The final list included six items on personal functioning, seven items on social functioning and seven items on physical functioning. CONCLUSIONS: This set of items forms the core of an ICF-based instrument, which is expected to facilitate interdisciplinary and intradisciplinary communication because of the use of a shared conceptual framework. As such, it should be of help in the guidance in return to work of employees on sick leave and contribute to appropriate and sustainable employability.

A conceptual framework addressing the complex labour market dynamics of the work-to-retirement process.

The way in which retirement is conceptualized and measured is likely to influence the research findings. The previous literature has addressed a wide range of elements related to the complex work-to-retirement process, such as early, late and partial retirement, statutory retirement, work disability and unemployment paths to retirement, or different types of bridge employment. However, conceptual clarity in terms of connections between the different elements is called for. We introduce a conceptual framework of the work-to-retirement process to guide its future measurement. Together with information on the statutory retirement age, the main elements of the framework are based on employment and pension receipt, acknowledging that these may overlap. The framework is flexible to the user, providing the possibility to add various specifications-e.g. of types of employment, types of pension receipt, unemployment, and being outside the labour force-depending on the study context and aims. The framework highlights the complexity of the work-to-retirement process, bringing forth its multifaceted, multiphased and multidirectional features. Accounting for such complexity in later-life labour market dynamics helps to elaborate what is actually addressed when investigating "retirement". Our conceptual framework can be utilized to enhance well-defined, precise and comparable measurement of the work-to-retirement process in studies.

Employment trends at older ages: policy impact or secular change?

Observed increases in retirement age are generally attributed to policies to extend working lives (PEW). In a quasi-experimental design, we examine to what extent increases in employment of older workers can be attributed to secular changes in individual characteristics as opposed to PEW. We compare two countries: one with clear PEW (the Netherlands) and one without PEW (Norway). Data come from the Dutch Longitudinal Aging Study Amsterdam and the NORwegian Longitudinal study on Aging and Generations. From each study, two same-age (55-64 years) samples are selected, one recruited in 2002-03, and one recruited after five (Norway) and ten years (Netherlands). In pooled regression analysis, paid work is the outcome variable, and time of measurement, the main independent variable. Individual characteristics include age, sex, educational level, self-perceived health, functional limitations, sense of mastery, and work status of partner. Employment rose in both countries, faster in the Netherlands than in Norway. Of the rise in employment, individual characteristics explained less in the Netherlands than in Norway. Accounting for these, the interaction country*time was significant, indicating an extra rise in employment of 5.2 and 7.5% points for Dutch men and women, net of individual characteristics and unobserved factors that are assumed to be similar in both countries. The extra rise in the Netherlands represents 57% of the total rise for both sexes. Thus, secular change in individual characteristics explains part of the rise in employment in both countries. In the Netherlands, other factors such as PEW may additionally explain the rise in employment. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00664-0.

Implementing Nonoperative Treatment Strategy for Simple Pediatric Appendicitis: A Qualitative Study.

INTRODUCTION: A nonoperative treatment strategy (NOT) with antibiotics for children with simple appendicitis could reduce anesthesia and surgery-related complications. As the implementation of a new treatment in routine clinical practice may take years, this study aims to identify barriers and facilitators for implementation of NOT for children with simple appendicitis. MATERIALS AND METHODS: To identify barriers and facilitators for its implementation, we conducted 14 semistructured interviews and a focus group with health insurance/hospital policymakers, surgical clinicians, and young people-together with their parents-who have been treated surgically or with antibiotics. Transcripts were open coded and categorized as per the framework for healthcare innovations by Fleuren et al. RESULTS: We identified four main themes: (1) Appendicitis is a well-known disease. Children, parents, and clinicians regard appendectomy as routine and safe, making them reluctant toward other treatment options. (2) Clinicians regard uptake of NOT in the national appendicitis guideline necessary for its implementation. (3) For identification of patients best suited for NOT more experience and scientific evidence is needed. (4) Appendectomy and NOT have different risk and benefits making the treatment choice depended on individual patient preferences. CONCLUSIONS: By addressing how NOT and operative treatment are regarded by patients and surgeons could have a substantial impact on the implementation of NOT for children with simple appendicitis. Furthermore, the individual preferences of patients need to be taken into account when choosing between operative and NOT. In other words, offering NOT in a shared decision-making model seems the first appropriate step in its implementation.

The differentiated roles of health in the transition from work to retirement - conceptual and methodological challenges and avenues for future research.

OBJECTIVES: The aim of this discussion paper is to (i) identify the differentiated roles of health in the work-retirement transition, and, with respect to these, (ii) highlight topics related to conceptual and methodological problems and challenges in research, and (iii) present avenues for future research. METHODS: This discussion paper summarizes an OMEGA-NET working group discussion ongoing from November 2018 to September 2021 with face-to-face and online meetings as well as a written online discourse. RESULTS: 'Health' and 'retirement' are ambiguous concepts. With respect to both, in retirement research, the choice of concept and indicator influences the findings. In addition, the impact of health on retirement is not necessarily a direct one, but can be influenced by further factors such as the ability, motivation and opportunity to work. The strong overall association of poor health with retiring early (path 1) bears the risk of masking distinct and deviating mechanisms in subgroups. In fact, there is evidence that also good health may lead to early retirement (path 2), while both poor health (path 3) and good health (path 4) may also make people retire later. CONCLUSIONS: An increased awareness of the differentiated roles that health may have in the work-retirement transition as outlined in this discussion paper may support research to address questions relevant for policy and practice and increase the impact of research. Recommendations for occupational health and social research are given.

Loss of Paid Employment up to 4 Years after Colorectal Cancer Diagnosis-A Nationwide Register-Based Study with a Population-Based Reference Group.

Cancer survivors consider work as a key aspect of cancer survivorship while previous research indicated that cancer survivors have a higher risk of unemployment. The objectives were to assess: (1) whether colorectal cancer survivors less often have paid employment at diagnosis compared to a population-based reference group, (2) whether colorectal cancer survivors with paid work have a higher risk of loss of employment up to 4 years after diagnosis compared to a population-based reference group and (3) which colorectal cancer survivors are at highest risk of loss of paid employment. In a nationwide register-based study, persons diagnosed with colorectal cancer (N = 12,007) as registered in the Netherlands Cancer Registry, were compared on loss of paid employment with a sex and age-matched population-based reference group (N = 48,028) from Statistics Netherlands. Cox regression analyses were conducted. Colorectal cancer survivors had a higher risk of loss of paid employment (HR 1.56 [1.42, 1.71]). Within the group of colorectal cancer survivors, risk of loss of paid employment was lower for older survivors (>60 vs. 45-55) (HR 0.64 [0.51, 0.81]) and higher for those with a more advanced cancer stage (IV vs. I) (HR 1.89 [1.33, 2.70]) and those receiving radiotherapy (HR 1.37 [1.15, 1.63]). Colorectal cancer survivors at high risk of loss of paid employment may benefit from work support interventions as part of cancer survivorship.

Occupational Exposures Associated with Life Expectancy without and with Disability.

Policies to extend working lives often do not take into account potentially important health inequalities arising from differences in occupational exposures. Little is known about which occupational exposures are associated with these inequalities. This study aims to examine differences in life expectancy without and with disability by occupational exposures. Longitudinal data (1992-2016) on disability and physical and psychosocial work demands and resources of 2513 (former) workers aged ≥55 years participating in the Longitudinal Aging Study Amsterdam were used. Gender specific life expectancies without and with disability by occupational exposures were calculated using multistate survival models. Women aged 55 years with high physical work demands had a lower life expectancy without disability than those with low exposure (1.02-1.57 years), whereas there was no difference for men. Men and women with high psychosocial work demands and resources had a longer life expectancy without disability than those with low exposure (1.19-2.14 years). Life expectancy with disability did not significantly differ across occupational exposures. Workers with higher psychosocial demands and resources and lower physical demands can expect to live more disability-free years. Information on occupational exposure helps to identify workers at risk for lower life expectancy, especially without disability, who may need specific support regarding their work environment.

Proposal to extend the PROMIS® item bank v2.0 'Ability to Participate in Social Roles and Activities': item generation and content validity.

PURPOSE: Previous research indicated that the Patient-Reported Outcomes Measurement Information System (PROMIS®) item bank v2.0 'Ability to Participate in Social Roles and Activities' may miss subdomains of social participation. The purpose of this study was to generate items for these missing subdomains and to evaluate their content validity. METHODS: A three-step approach was followed: (1) Item generation for 16 International Classification of Functioning Disability and Health subdomains currently not covered by the item bank; (2) Evaluation of content validity of generated items through expert review (n = 20) and think-aloud interviews with a purposeful sample of people with and without (chronic) health conditions (n = 10), to assess item comprehensibility, relevance, and comprehensiveness; and 3) Item revision based on the results of step 2, in a consensus procedure. RESULTS: First, 48 items were generated. Second, overall, content experts indicated that the generated items were relevant. Furthermore, based on experts' responses, items were simplified and 'participation in social media' was identified as an important additional subdomain of social participation. Additionally, 'participating in various social roles simultaneously' was identified as a missing item. Based on the responses of the interviewed adults items were simplified. Third, in total 17 items, covering 17 subdomains, were proposed to be added to the original item bank. DISCUSSION: The relevance, comprehensibility and comprehensiveness of the 17 proposed items were supported. Whether the proposed extension of the item bank leads to better psychometric properties of the item bank should be tested in a large-scale field study.