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The added complexity
 

The added complexity

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The added complexity of resources, employee well-being, and the quality of care

The added complexity of resources, employee well-being, and the quality of care
Tuula Oksanen , MD, PhD, Adjunct Professor
7th NOVO symposium 26 Nov, 2013 Helsinki Finland

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    The added complexity The added complexity Presentation Transcript

    • The added complexity of resources, employee well-being, and the quality of care Tuula Oksanen , MD, PhD, Adjunct Professor 7th NOVO symposium 26 Nov, 2013 Helsinki Finland. © Finnish Institute of Occupational Health – www.ttl.fi
    • Sustainable Health Care Innovative health care organizations © Finnish Institute of Occupational Health – www.ttl.fi
    • Outline • Psychosocial work environment and employee health: - The role of occupation and context • The added complexity - Resources - The quality of care © Finnish Institute of Occupational Health – www.ttl.fi
    • Psychosocial work environment Employee health and well-being © Finnish Institute of Occupational Health – www.ttl.fi
    • The Finnish Public Sector Study 10-Town study – PI Professor Jussi Vahtera Hospital personnel study - PI Professor Mika Kivimäki includes employees from 10 towns 6 hospital districts 20% of the public sector employees in Finland Pohjois-Pohjanmaan shp Oulu Vaasan shp Virrat Nokia Naantali Raisio Turku Tampere Valkeakoski Vantaa Espoo VarsinaisSuomen shp Pirkanmaan shp Kanta-Hämeen shp HUS (Jorvi, Hyks) © Finnish Institute of Occupational Health – www.ttl.fi
    • Data collection phases Survey 2000 Survey 2008 Survey 2012 -10Town (N=32 299, 67%) -Hospitals (N=16 299, 67%) -10Town (N=32 322, 65%) -Hospitals (N=15 879, 69%) -10Town (N=38 727, 70%) Hospitals (N=14 053, 72%) -10Town -(N=39 194, 69%) -Hospitals (N=13 861, 71%) Total 48 598 -97 Survey 2004 Total 48 201 Total 52 780 Total 53 055 -98 -99 -00 -01 -02 -03 -04 -05 -06 -07 -08 -09 -10 -11 -12 -13 -14 -15 Respond/ Response survey rate % DOCTORS Teachers Special teachers Social workers NURSES Practical NURSES CLEANERS 1 804 4 541 562 684 7 946 3 623 2 637 56 69 72 83 76 68 63 © Finnish Institute of Occupational Health – www.ttl.fi
    • The role of the occupational position © Finnish Institute of Occupational Health – www.ttl.fi
    • High job demands, low control % 100 2000 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Effort reward imbalance % 100 2000 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Organizational injustice % 100 2000 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Work load exceeds own tolerance % 100 2000 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Retirement intentions ( >55 year old) % 100 2000 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Workplace social capital (mean) 2000 2004 2008 2012 5,0 4,5 4,0 3,5 3,0 2,5 2,0 1,5 1,0 2 © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Experience of violence at work: physical assaults by throwing items % 100 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Experience of physical violence at work: kicking % 100 2004 2008 2012 80 60 40 20 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Experience of violence at work: being threatened with a weapon % 3 2004 2008 2012 2 1 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Physical inactivity % 2000 2004 2008 2012 50 40 30 20 10 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Smoking % 2000 2004 2008 2012 50 40 30 20 10 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Obesity (BMI >30), % 2000 2004 2008 2012 50 40 30 20 10 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Excess use of alcohol (>18 doses a week) % 2000 2004 2008 2012 50 40 30 20 10 0 © Finnish Institute of Occupational Health – www.ttl.fi
    • Sickness absence 2000-2011 (mean annual days by occupation) 35 30 Cleaners Laitosapul 25 Lähihoitaja nurses Practical Sairhoitaja Nurses 20 ALL Kaikki 15 Sos.työntekijä Social workers Special teachers Erityisopettaja 10 Lääkäri Doctors 5 Opettaja Teachers 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 © Finnish Institute of Occupational Health – www.ttl.fi
    • The causes of sickness absence (% of annual sickness absence days) Others Injuries Musculoskeletal Cardiovascular Mental © Finnish Institute of Occupational Health – www.ttl.fi
    • Job Strain Model by Karasek and Theorell Job demands - skill discretion - decision authority -participation in decision making LOW Job control HIGH LOW HIGH low strain active passive high strain Job strain Karasek 1979; Karasek & Theorell 1990 Source: Karasek & Theorell 1990 © Finnish Institute of Occupational Health – www.ttl.fi
    • Job control LOW STRAIN ACTIVE Psychologist Manager Teacher Special educ. teacher Physician Other teacher Physiotherapist Kindergarten teacher Techn. expert Other expert Librarian Social worker Social adviser Tech specialist Private childminder childminder Culture worker Construction worker Fireman Real estate manager Registered nurse Practical nurse Home help Cooker Gardenist Office worker Job demands Dept secretary Orderly Cleaner Driver PASSIVE Dental assistant Finnish Public Sector Study 2012 Kitchen maid HIGH STRAIN © Finnish Institute of Occupational Health – www.ttl.fi
    • IPD-Work Consortium POLS, NWCS (n=69 373) BELSTRESS (n=14 226) FPSS,HeSSup, Still Working (n=72 847) SLOSH, WOLF (n=29 246) IPAW, COPSOQ, DWECS(n=9209) Whitehall II (n=10 308) Gazel (n=11 237) © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • (n=2358/ 197,000) Kivimaki of al. IPD-Work. Lancet 2012 © Finnish Instituteet Occupational Health – www.ttl.fi
    • Kivimaki et al. IPD-Work. Lancet 2012 © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • The role of the context © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Resources Employee health and well-being Patient health and well-being © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Overcrowding in hospital wards 1 • In hospitals, overcrowding and excess staff workload has been widely recognised as a serious problem for both patients and staff. • Overcrowding has been associated with increased hospital infections and patient mortality (Cunningham et al. Br J Nurs 2006; Tarnow-Mordi et al. Lancet 2000; Sprivulis et al. Med J Aust 2006) as well as staff burnout and job dissatisfaction (Aiken et al. JAMA 2002) • Overcrowding can be indicated as excess bed occupancy. © Finnish Institute of Occupational Health – www.ttl.fi
    • Overcrowding in hospital wards 2 • Participating hospitals routinely collect monthly figures on bed occupancy for each ward according to a standard procedure. • Bed occupancy %= Sum of in-patient days • Beds available • Beds available: number of beds x the number of days the ward is in use The day of admission but not the day of discharge for each person is included in the numerator. The rate above which a hospital ward is considered overcrowded is usually defined as > 85%. • • © Finnish Institute of Occupational Health – www.ttl.fi
    • Overcrowding in hospital wards 3 • Timing of exposure changes continuously over time. • A fixed time window would lead to inaccurate exposure estimate loss of power (a short time lag between exposure and treatment seeking likely) • Solution: Monthly excess bed occupancy rates treated as time-dependent exposures that may change in value over the period of observation © Finnish Institute of Occupational Health – www.ttl.fi
    • Measurement of overcrowding Excess occupancy: Antidepressant treatment 0 = no 1 = yes •bed occupancy <85% coded as 0% •bed occupancy >85% coded as XX%-85% Monthly bed occupancy 80 75 103 80 85 75 115 79 75 120 89 103 0 0 18 0 0 0 30 0 0 35 4 18 Excess occupancy 18/6=3 0 (18+30)/6=8 0 (18+30)/6=8 0 30/6=5 0 0 (30+35)/6=11 (30+35+4)/6=12 0 (30+35+4+18)/6=15 © Finnish Institute of Occupational Health 1 – www.ttl.fi
    • Overcrowding and antidepressant treatment among staff (n=7340) Virtanen, Kivimäki, Oksanen et al. AmHealth – www.ttl.fi © Finnish Institute of Occupational J Psychiatry 2008
    • Overcrowding and new onset sickness absence due to depression among staff 1.95 (1.18-3.24) Adjusted risk 2 (HR) 1,8 1,6 1.44 (0.90-2.30) 1,4 1,2 1.00 1 0.99 (0.65-1.50) 0,8 0,6 0,4 Ylikuormitus Overcrowding ei <=5% >5<=10% >10%* -> no association with other causes Virtanen, Batty, Pentti, Finnish Institute of OccupationalClin Psychiatry, 2010 Vahtera, Oksanen et al. J Health – www.ttl.fi ©
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Overcrowding in psychiatric wards and physical assaults on staff Adjusted risk (OR) 3.04 (1.51-6.13) 3,5 2.76 (1.32-5.77) 3 2,5 2.03 (0.90-4.54) 2 1,5 1.00 1 0,5 ei Ylikuormitus Overcrowding <=5% >5<=10% >10%* -> no association on ward property Virtanen, Vahtera, Batty… Oksanen et al. of Occupational Health – www.ttl.fi © Finnish Institute Brit J Psychiatry, 2011
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Resources Employee health and well-being Patient health and well-being © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Psychosocial work environment in Primary Care Health Centers and Glycemic control (HbA1c<6.0) in Type2 Diabetes patients Adjusted risk (COR) 2 1,8 1,6 1.53 (0.93-2.53) 1. 54 (1.08-2.18) Päätöksenteonjustice Procedural oikeudenmukaisuus 1,4 1,2 1 0,8 0,6 0,4 Kohtelun oikeudenmukaisuus Relational justice 0.86 (0.60-1.23) 0.70 (0.47-1.05) Ponnistelu-palkkio-epäsuhta Effort-reward imbalance 0.50 (0.23-1.11) Innovatiivisuus Support for innovation Tehtävään suuntautuminen Task orientation 0,2 Virtanen, Oksanen, Kawachi et al. Med Care, 2012 © Finnish Institute of Occupational Health – www.ttl.fi
    • Patients with infectious diseases, overcrowding and sickness absence among staff • Overcrowding increased the risk of sick leave 1.7 fold • We found an interaction with patients with infectious diseases 3 No overcrowding Overcrowding 2.39 (1.09-5.26) 2.5 2 1.5 1 1.00 0.89 (0.53-1.73) 1.00 0.5 0 Low prevalence of ID High prevalence of ID Low prevalence of ID High prevalence of ID © Finnish Institute of Occupational Health – www.ttl.fi Virtanen, Terho, Oksanen et al. Arch Int Med 2011
    • Conclusions • Psychosocial work environment is not universally associated with employee health; differences by occupation occur. • Overcrowding seems to increase morbidity among staff, especially mental ill-health, and experienced violence in psychiatric wards. • Overcrowding is related to higher prevalence of infectious diseases among patients. • High prevalence of patients’ infectious diseases seems to increase health problems among staff in overcrowded wards. • Leadership might be important in the quality of care of people with type2 diabetes. © Finnish Institute of Occupational Health – www.ttl.fi
    • © Finnish Institute of Occupational Health – www.ttl.fi
    • Thank You for your attention! © Finnish Institute of Occupational Health – www.ttl.fi