Christoph Kowalski

Burnout in nurses – the relationship between social capital in hospitals and emotional exhaustion

AIMS The aim of this study is to examine the relationship between a hospitals social capital, individual decision latitude, workload and emotional exhaustion in nurses, controlling for age, sex, years of professional experience and job tenure. BACKGROUND In western countries between 15-45% of nurses working in hospitals suffer from burnout, characterised by emotional exhaustion, depersonalisation and decreased personal performance. The prevention of burnout constitutes a great challenge to those responsible for the health care system, not least because burnout may cause increasing turnover rates in nurses and lead to medical mistakes. DESIGN Survey. METHOD A questionnaire was mailed to 1325 nurses working at four hospitals in east and west Germany in 2002. Nine hundred and fifty nine nurses responded (response rate: 72.4%). RESULTS Logistic regression identified three significant predictors of emotional exhaustion in nurses: workload (OR: 4.523, CI: 3.230-6.333) was positively associated with emotional exhaustion. Decision latitude (OR: 0.376, CI: 0.254-0.557) and social capital in the hospitals (OR: 0.549, CI: 0.403-0.746) were negatively associated with emotional exhaustion. Emotional exhaustion was not affected by age, sex, years of professional experience and job tenure. Nagelkerkes Pseudo R(2) was 0.225. CONCLUSIONS The findings underline the importance of social capital and organisational development in hospital management. RELEVANCE TO CLINICAL PRACTICE Efforts to create a good working atmosphere with readiness to provide mutual support and the pursuit of joint values in a hospital, the reduction of workload and increased decision latitude may prevent the development of emotional exhaustion in nurses.

The Relationship between Social Capital in Hospitals and Physician Job Satisfaction

BackgroundJob satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals.MethodsThe results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables.ResultsThe first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors.ConclusionThis analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.

Associations between emotional exhaustion, social capital, workload, and latitude in decision-making among professionals working with people with disabilities.

BACKGROUND Many people working in human services in Western countries suffer from burnout, characterized by emotional exhaustion, depersonalization, and decreased personal performance. Prevention of emotional exhaustion (the first phase of burnout) constitutes a great challenge because emotional exhaustion may cause increasing turnover rates in staff and lead to a lesser quality of care. Prevention of emotional exhaustion requires knowledge of its predictors. The aim of this study was to investigate the associations between emotional exhaustion, social capital, workload, and latitude in decision-making among German professionals working in the care of persons with intellectual and physical disabilities. MATERIALS AND METHODS The study was based on a survey in a sheltered workshop and 5 homes for disabled persons with 175 professionals. Burnout was measured with the German version of the Maslach Burnout Inventory-General Survey (MBI-GS). A multivariate logistic regression analysis was computed. RESULTS Logistic regression identified the following three significant predictors of emotional exhaustion in the sample: workload (OR, 4.192; CI, 2.136-8.227), latitude in decision-making (OR, 0.306; CI, 0.115-0.811), and male gender (OR, 4.123; CI, 1.796-9.462). Nagelkerkes Pseudo-R(2) was 0.344. CONCLUSIONS The results of this study demonstrate that specific factors in work organization are associated with emotional exhaustion. Taking into account sociodemographic changes and the upcoming challenges for human services professionals, the results underline the importance of considering aspects of organization at the workplace to prevent burnout. Specific circumstances of male employees must be considered.

Quality of care in breast cancer centers: Results of benchmarking by the German Cancer Society and German Society for Breast Diseases

A total of 218 breast cancer centers, with 274 operating sites, have been certified since 2003 in accordance with the criteria set out by the German Cancer Society (Deutsche Krebsgesellschaft) and the German Society for Breast Diseases (Deutsche Gesellschaft für Senologie). Most of these centers are located in Germany, but centers in Austria, Switzerland, and Italy have also been certified. This paper presents the results for quality indicators (QIs) from 2009 to 2012, based on data from 195,342 primary breast cancer patients, in order to illustrate the development and progress of these centers. Descriptive results on interdisciplinary collaboration (6 QIs), guideline adherence (15 QIs), and specialist expertise (7 QIs) are reported over time. Fulfillment of the certification requirements was high and remained relatively stable over time, with the extent of variation between sites declining. Sites that do not reach the target values are asked to comment on the discrepancies, and their comments, as well as the QI results, are used by centers and auditors during an on-site auditing process and to constantly revise the QIs set out by the guideline and the certification commission.

Exploring the association between social capital and depressive symptoms: results of a survey in German information and communication technology companies.

Objective: This study examines the association between social capital at work and depressive symptoms in employees. Methods: Data for this cross-sectional study were collected through an online survey with the full population of employees from six companies in the German information and communication technology sector (response rate: 58.4%). A multivariate logistic regression analysis was performed. Results: Results of data from a total of 328 employees suggest that, after controlling for sociodemographic factors, health awareness, and job strain, lower levels of perceived social capital at work are associated with the experience of depressive symptoms (OR = 0.76; 95% CI: 0.64–0.90). Conclusions: Our findings suggest that characteristics of high social capital at work, such as an established environment of trust and a sense of common values and convictions, could be an essential resource for preventing depressive disorders.

The relationship between social capital in hospitals and emotional exhaustion in clinicians: a study in four German hospitals.

Background: About 30% of doctors working in inpatient and outpatient departments suffer from burnout, characterized, for example, by emotional exhaustion. The prevention of burnout constitutes a great challenge for those responsible for the healthcare system. Aims: Research into the relationship between social capital in hospitals and the occurrence of emotional exhaustion in clinicians is still at an early stage. The aim of the current study is to examine the effects of social capital in the workplace on the emotional exhaustion of clinicians. Method: A questionnaire was posted to 2,644 employees working in four German hospitals, and 1,645 responded. Responses from the 277 clinicians (61%) are analyzed here. The questionnaire looked at symptoms of emotional exhaustion and levels of organizational social capital. Results: Logistic regression identified two significant predictors of emotional exhaustion in clinicians: low self-efficacy and subjectively perceived lower levels of social capital in the hospitals where they worked. The model accounted for 26 % of Nagelkerke’s R2. Conclusion: Efforts to create a good working atmosphere, with the readiness to provide mutual support and the pursuit of joint values and objectives within a hospital, may reduce the development of, or even prevent, emotional exhaustion in clinicians.

The health literate health care organization 10 item questionnaire (HLHO-10): development and validation

BackgroundWhile research on individual health literacy is steadily increasing, less attention has been paid to the context of care that may help to increase the patient’s ability to navigate health care or to compensate for their limited health literacy. In 2012, Brach et al. introduced the concept of health literate health care organizations (HLHOs) to describe the organizational context of care. This paper presents our effort in developing and validating an HLHO instrument.MethodTen items were developed to represent the ten attributes of HLHO (HLHO-10) based on a literature review, an expert workshop, a focus group discussion, and qualitative interviews. The instrument was applied in a key informant survey in 51 German hospitals as part of a larger study on patient information and training needs (PIAT-study). Item properties were analyzed and a confirmatory factor analysis (CFA) was conducted to test the instrument’s unidimensionality. To investigate the instrument’s predictive validity, a multilevel analysis was performed that used the HLHO-10 score to predict the adequacy of information provided to 1,224 newly-diagnosed breast cancer patients treated at the sample hospitals.ResultsCronbach’s α of the resulting scale was 0.89. CFA verified the one-factor structure after allowing for the correlation for four pairs of error terms. In the multilevel model, HLHO-10 significantly predicted the adequacy of information as perceived by patients.ConclusionThe instrument has satisfactory reliability and validity. It provides a useful tool to assess the degree to which health care organizations help patients to navigate, understand, and use information and services. Further validation should include participant observation in health care organizations and a sample that is not limited to breast cancer care.

Changes Over Time in the Utilization of Disease-Related Internet Information in Newly Diagnosed Breast Cancer Patients 2007 to 2013

Background As the number of people with Internet access rises, so does the use of the Internet as a potentially valuable source for health information. Insight into patient use of this information and its correlates over time may reveal changes in the digital divide based on patient age and education. Existing research has focused on patient characteristics that predict Internet information use and research on treatment context is rare. Objective This study aims to (1) present data on the proportion of newly diagnosed breast cancer patients treated in German breast centers from 2007 to 2013 who used the Internet for information on their disease, (2) look into correlations between Internet utilization and sociodemographic characteristics and if these change over time, and (3) determine if use of Internet information varies with the hospitals in which the patients were initially treated. Methods Data about utilization of the Internet for breast cancer–specific health information was obtained in a postal survey of breast cancer patients that is conducted annually in Germany with a steady response rate of 87% of consenting patients. Data from the survey were combined with data obtained by hospital personnel (eg, cancer stage and type of surgery). Data from 27,491 patients from 7 consecutive annual surveys were analyzed for this paper using multilevel regression modeling to account for clustering of patients in specific hospitals. Results Breast cancer patients seeking disease-specific information on the Internet increased significantly from 26.96% (853/3164) in 2007 to 37.21% (1485/3991) in 2013. Similar patterns of demographic correlates were found for all 7 cohorts. Older patients (≥70 years) and patients with <10 years of formal education were less likely to use the Internet for information on topics related to their disease. Internet use was significantly higher among privately insured patients and patients living with a partner. Higher cancer stage and a foreign native language were associated with decreased use in the overall model. Type of surgery was not found to be associated with Internet use in the multivariable models. Intraclass correlation coefficients were small (0.00-0.03) suggesting only a small contribution of the hospital to the patients’ decision to use Internet information. There was no clear indication of a decreased digital divide based on age and education. Conclusions Use of the Internet for health information is on the rise among breast cancer patients. The strong age- and education-related differences raise the question of how relevant information can be adequately provided to all patients, especially to those with limited education, older age, and living without a partner.

Reporting Program for Cancer Care Quality Indicators

The authors outline a reporting program in use by an increasing number of certified cancer centers in Germany to report quality-of-care indicators.

Frequency of psycho‐oncologic and social service counseling in cancer centers relative to center site and hospital characteristics: Findings from 879 center sites in Germany, Austria, Switzerland, and Italy

There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Societys cancer center certification system include the routine provision of psycho‐oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers.