Erin Y. Tjam

Organization specific predictors of job satisfaction: findings from a Canadian multi-site quality of work life cross-sectional survey

BackgroundOrganizational features can affect how staff view their quality of work life. Determining staff perceptions about quality of work life is an important consideration for employers interested in improving employee job satisfaction. The purpose of this study was to identify organization specific predictors of job satisfaction within a health care system that consisted of six independent health care organizations.Methods5,486 full, part and causal time (non-physician) staff on active payroll within six organizations (2 community hospitals, 1 community hospital/long-term care facility, 1 long-term care facility, 1 tertiary care/community health centre, and 1 visiting nursing agency) located in five communities in Central West Ontario, Canada were asked to complete a 65-item quality of work life survey. The self-administered questionnaires collected staff perceptions of: co-worker and supervisor support; teamwork and communication; job demands and decision authority; organization characteristics; patient/resident care; compensation and benefits; staff training and development; and impressions of the organization. Socio-demographic data were also collected.ResultsDepending on the organization, between 15 and 30 (of the 40 potential predictor) variables were found to be statistically associated with job satisfaction (univariate analyses). Logistic regression analyses identified the best predictors of job satisfaction and these are presented for each of the six organizations and for all organizations combined.ConclusionsThe findings indicate that job satisfaction is a multidimensional construct and although there appear to be some commonalities across organizations, some predictors of job satisfaction appear to be organization and context specific.

Extrinsic and intrinsic determinants of quality of work life

The objective of this research was to test whether extrinsic, intrinsic or “prior” traits best predict satisfaction with quality of work life (QWL) in health care. Extrinsic traits are salaries and other tangible benefits; intrinsic traits include skill levels, autonomy and challenge. Prior traits are those of the individuals involved, such as their gender or employment status. A survey of employees was conducted in seven different health‐care settings located in the south central region of Ontario, Canada. A total of 65 questions were gathered into scales measuring such factors as co‐worker support, supervisor support and teamwork and communication. These were factor‐analyzed into intrinsic and extrinsic variables, and regressed against a satisfaction scale, with socio‐demographic variables included. Based on the results, the following conclusions can be drawn: objectively identifiable traits of an organization – pay, benefits and supervisor style – play the major role in determining QWL satisfaction. Decision‐makers with an interest in improving QWL in a health‐care institution can focus on these traits and pay correspondingly less attention to enhancing staff autonomy or discretion.

Reliability of standardized assessment for adults who are deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences.

Clinical, Demographic and Functional Characteristics Associated with Pharmacotherapy for Heart Failure in Older Home Care Clients

AbstractBackground: Use of combination pharmacotherapy, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and β-adrenoceptor antagonists (β-blockers) in the management of heart failure (HF) can reduce mortality, prevent functional decline and reduce health service use. However, these first-line therapies are underused in older populations. This article describes the use and predictors of use of first-line HF therapies in a population-based cohort of older home care clients in Ontario, Canada. Objectives: To examine the use and correlates of first-line pharmacotherapy in older home care clients with HF. Methods: This was a retrospective, cross-sectional study of Resident Assessment Instrument — Home Care (RAI-HC) data in individuals aged ≥65 years receiving home care services in the province of Ontario, Canada. Data collected were from all 14 health regions in Ontario. Home care clients with HF were identified from among those aged ≥65 years whose first RAI-HC assessment occurred between January 2004 and December 2007 (n = 176 866). Potential correlates of pharmacotherapy for HF were identified from the RAI-HC and examined using multivariable logistic regression. Results: HF prevalence was 12.4%. Among clients with HF, 28.6% received no first-line pharmacotherapy; this proportion declined by 6% over the 4 years studied. Only 28.0% were receiving recommended combination therapy. First-line pharmacotherapy use was dependent on hypertension and diabetes mellitus status. Use of pharmacotherapy was less likely among older clients and those with functional impairment, airway disease or behavioural symptoms. Conclusions: Approximately 29% of older home care clients with HF received no first-line HF pharmacotherapy, while another 28% received optimal first-line HF pharmacotherapy. In addition to the expected clinical correlates, the increased likelihood of non-use associated with clients’ demographic and functional characteristics raises concerns about quality of care. A better understanding of how these factors affect prescribing practices, particularly for combination therapy, would help to optimize HF disease management. For clinicians, this work also serves as a potential reminder to follow guideline recommendations for HF management in older, vulnerable adults.

Physiological Outcomes of an Internet Disease Management Program vs. In-person Counselling:A Randomized, Controlled Trial

ABSTRACT OBJECTIVE To compare physiological outcomes and satisfaction for followup care between an interactive diabetes internet program and Diabetes Education Centres. METHOD A randomized, controlled trial with outcomes of glycosylated hemoglobin (A1C), fasting blood glucose, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, lowdensity lipoprotein cholesterol and patient satisfaction. Enrollment was staggered, with individuals assessed at baseline, 3, 6 and 12 months. RESULTS Fifty-seven participants completed the study (20 control, 37 internet). Physiological outcomes were not statistically different between the 2 groups. However, within-group comparisons demonstrated a significant improvement in the internet groups A1C, TG and satisfaction levels from baseline to 3 and 6 months (p<0.0452, p<0.0428 and p<0.0138, respectively). CONCLUSION Although the trial was limited in sample size, it yielded significant findings for diabetes management, within group. Further research in using the internet program in other applications for diabetes management is needed.

Prevalence and predictors of antibiotic use in community-based elderly in Ontario, Canada.

Little is known about antibiotic use in the elderly receiving home care. We found that 6,873 (5.4%) of 126,339 home care patients in Ontario received antibiotic treatment; 26% of the antibiotics administered were fluoroquinolones. Antibiotic treatment was most frequent in patients less than 65 years of age and among those with a poorer health status.

Salient and Critical Issues from a Canadian Healthcare Quality-of-Work-Life Survey

The objective of this study was to examine open-ended responses by healthcare staff to a quality-of-work-life survey. The results of the study indicated that staff in six healthcare organizations (n=1,819, response rate 30 percent) completed a 65-item QWL survey. Applying Q methodology to open-ended responses, we developed an overall rating of salient and critical issues. The most salient topics were those pertaining to what staff liked best and least about their workplace. The most critical issues included benefits, compensation, staff orientation and job demands.