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Alf Trojan, Stefan NickelUniversity Hospital HamburgCentre of Psychosocial MedicineInstitute for Medical Sociology

12th International ConferenceInvesting in health for the futurePositioning health promotion in health care provision & supporting effective implementation

May 26-28, 2004, Moscow

Staff health surveys as a prerequisite for monitoring healthy hospitals

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Staff surveys: identifying workloads with regard to health promotion in hospitals and staff health

Patient surveys: 'boom' in quality management (in spite of methodological and practical problems)

Combined surveys: rarely used so far Aim: increasing the effectivity and efficiency

of quality assessment in hospitals, particularly improvements in patient - and staff-orientation

Background & objectives

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Methods

Research-Setting: internal and surgical departments of two hospitals (A and B)

General surveys among both the medical and nursing staff and the patients (>18 years old, at least 1 night stay)

Staff: all personnel of the departments studied (79 doctors : 55% response rate; 175 nursing staff : 56% response rate)

Patients: representative sample by postal survey 1-2 weeks after discharge (1,235 patients : 35% response rate)

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Scope of the questionnaires

dimensions in staff‘s and patients‘ view of quality

patient carepatient care

admission board & lodging medical care nursing care coodination of care information aftercare patient training

plus: health gains (only by patients) overall satisfaction

dimensions in staff‘s view of quality

working conditionsworking conditions working tasks opportunities for success teamwork & conflict management physical working loads structural working loads quality culture

staff healthstaff health general health complaints feelings of exhaustion ('burnout')

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Example of Type of Question

"Over and over again, there are conflicts between the heavy demands on patient care and my other duties of work."

(0) don't agree(1) agree less(2) agree partly(3) agree fairly(4) agree totally

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Results presented here

Health problems of staff

Doctors' view of working conditions (overview)

Focus: quality culture

Focus: staff- and patient-orientation

Additional results from 2 other studies

Challenges

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General health complaints(means by Zerssen‘s B-L; best = 0, worst = 3)

The differences between the groups for each hospital are highly significant: p<0.001 in hospitals A und B (t-test for independent samples).

0.37

0.67

0.46

0.73

0,00 0,59

doctors

nurses

hospital A

hospital B

standard measure (1976)

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Ranking of health complaints

Complaints of medical and nursing staff are very similar:

First and foremost, the staff complain about pain from physical strains (back, neck, shoulder).

Second, a complex of psychomental complaints follows (exessive need of sleep, brooding, irritability, uneasiness, fatigue).

Finally, symptoms of the digestive system dominate the more rare complaints.

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Quality of working conditions: doctor`s view(means of the 6 quality scales,

converted into a 100-point-scale; 100 = best quality)

doctors

64,9

61,7

69,8

58,2

46,2

51,9

53,4

52,9

50,4

43,3

30,4

34,2

0 25 50 75 100

working tasks

opportunities for success

teamwork & conflict management

physical work loads

structural work loads

quality culture

hospital A

hospital B

Quality culture

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Specific items of quality culture(frequency of the two positive ratings in %)

doctors

39,5

46,2

17,9

43,6

10,5

64,1

29,7

47,4

66,7

10,0

16,2

8,1

42,5

2,5

20,5

10,3

15,8

35,0

0% 25% 50% 75% 100%

preparation for new technique or task

identifying with the managing model

daily importance of the managing model

knowing about the quality manager

importance of staff orientation

importance of patient orientation

opportunities for QM training

opportunities for QM participation

motivation for QM participation

hospital A

hospital B

importance of staff orientation

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Main problems of working conditions

The most notable workloads (doctors and nurses) (frequency of the two positive ratings < 10%) :

little attention paid to staff orientation (hospital A und B) working overtime (A und B) no breaks (B) few qualified personnel (B) conflicts between patient care and other duties (B)

Additional working loads of nursing staff:

insufficient opportunities for further professional training(B) frequent interruptions of work (A) physical obstacles by lifting and loading (A) inadequate pay (A)

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Conclusions of this survey

1. There are considerable health problems of hospital staff.

2. Surveys can differentiate between hospitals.

3. Surveys can give specific information for improvements.

4. Consideration of staff and patient orientation is rated very low.

5. There is a conflict between patient care and other duties.

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Additional Study 1:Impact of new doctor's working hours (new shift system) on patient-orientation and staff health

Impact on

researchedunits

Patient communication and patient care

Doctors' health

negative positive no effect negative positive no effect

hospital I (n=13 =26%)

36% 36% 27% 36% 45% 18%

hospital II (n=31 =42%)

28% 64% 10% 33% 43% 23%

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Additional Study 2: 824 (56%) doctors in hospitals Do you have enough time apart from the purely medical

services to give personal care to your patients?

partly39%

yes9%

no51%

no answer1%

Source: Medical Chamber Thüringen, 2002

Survey amongst doctors in hospitals

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Challenges for health promoting hospitals

to monitor not only patient- but also staff- orientation

to improve the "quality culture" to strengthen health promotion policies for

doctors and nurses to strike a balance between the interests of the

two most important target groups in the hospital:

patients and staff!

Thank you!