Hannamaria Kuusio

Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators

BACKGROUND The present study examined whether there are differences in job-related attitudes and well-being among physicians working in private sector and public sector. In addition, we examined whether psychosocial factors (organizational justice and job control) could mediate these possible differences in different sectors. METHODS Cross-sectional survey data from the Finnish Health Professional Study was used. A random sample of Finnish physicians included 1522 women and 1047 men aged 25-65 years. Outcome variables were job satisfaction, organizational commitment, psychological distress, work ability and sleeping problems. Job control and organizational justice were measured using established questionnaires. Series of regression analyses were performed and the mediational effects were tested following the procedures outlined by Baron and Kenny. RESULTS Physicians working in private sector had higher levels of job satisfaction and organizational commitment and lower levels of psychological distress and sleeping problems when compared with physicians working in public sector. Private physicians also had higher levels of organizational justice, which acted as a mediator behind more positive attitudes and better well-being in private sector. Private physicians had higher levels of job control but it did not act as a mediator. CONCLUSIONS Private physicians feel better than public physicians and this is partly due to higher organizational justice in private sector. Public health care organizations should invest effort to increase the fairness in their organizations and management and pay more attention in improving the well-being of their employees, which could possibly increase the attractiveness of public sector as a career option.

The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: A questionnaire study

BACKGROUND Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. OBJECTIVE The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. DESIGN Cross-sectional questionnaire study. PARTICIPANTS AND SETTING 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). METHODS The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. RESULTS Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. CONCLUSION The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important.

Developing a short measure of organizational justice: a multisample health professionals study

Objectives: To develop and test the validity of a short version of the original questionnaire measuring organizational justice. Methods: The study samples comprised working physicians (N = 2792) and registered nurses (n = 2137) from the Finnish Health Professionals study. Structural equation modelling was applied to test structural validity, using the justice scales. Furthermore, criterion validity was explored with well-being (sleeping problems) and health indicators (psychological distress/self-rated health). Results: The short version of the organizational justice questionnaire (eight items) provides satisfactory psychometric properties (internal consistency, a good model fit of the data). All scales were associated with an increased risk of sleeping problems and psychological distress, indicating satisfactory criterion validity. Conclusion: This short version of the organizational justice questionnaire provides a useful tool for epidemiological studies focused on health-adverse effects of work environment.

Organizational commitment among general practitioners: a cross-sectional study of the role of psychosocial factors.

Abstract Objective. To examine whether general practitioners (GP) working in primary health care have lower organizational commitment compared with physicians working in other health sectors. The authors also tested whether psychosocial factors (job demands, job control, and colleague consultation) explain these differences in commitment between GPs and other physicians. Design. Cross-sectional postal questionnaire. Setting and participants. A postal questionnaire was sent to a random sample of physicians (n = 5000) drawn from the Finnish Association database in 2006. A total of 2841 physicians (response rate 57%) returned the questionnaire, of which 2657 (545 GPs and 2090 other physicians) fulfilled all the participant criteria. Main outcome measures. Organizational commitment was measured with two different indicators: intention to change jobs and low affective commitment. Results. GPs were less committed to their organizations than other physicians. Work-related psychosocial factors (high job demands, low job control, and poor colleague consultation) were all significant risk factors for low organizational commitment. Conclusions. The evidence collected suggests that policies that reduce psychological demands, such as job demands and low control, may contribute to better organizational commitment and, thus, alleviate the shortages of physicians in primary care. Furthermore, giving GPs a stronger say in decisions concerning their work and providing them with more variety in work tasks may even improve the quality of primary care. The strategies for workplace development should focus on redesigning jobs and identifying GPs at higher risk, such as those with especially high job strain.

Differences in Well-being between GPs, Medical Specialists, and Private Physicians: The Role of Psychosocial Factors

OBJECTIVE To examine the well-being differences among physicians working in different health care sectors and to test whether psychosocial stressors account for these differences. The well-being indicators used were psychological distress, self-rated health, and work ability. DATA SOURCES/STUDY SETTING A total of 2,841 randomly selected Finnish physicians (response rate 57 percent) returned the postal questionnaire, of which 2,047 (1,241 women) fulfilled all the participant criteria. STUDY DESIGN This is a cross-sectional questionnaire study. PRINCIPAL FINDINGS General practitioners and medical specialists experienced lower well-being than private physicians and this difference was partly explained by differences in psychosocial stressors. CONCLUSIONS General practitioners and medical specialists report more problems in well-being than private physicians. It is of particular importance to be aware of the sector-specific difficulties in work environments.

Job demands and job strain as risk factors for employee wellbeing in elderly care: an instrumental-variables analysis

BACKGROUND The association between psychosocial work environment and employee wellbeing has repeatedly been shown. However, as environmental evaluations have typically been self-reported, the observed associations may be attributable to reporting bias. METHODS Applying instrumental-variable regression, we used staffing level (the ratio of staff to residents) as an unconfounded instrument for self-reported job demands and job strain to predict various indicators of wellbeing (perceived stress, psychological distress and sleeping problems) among 1525 registered nurses, practical nurses and nursing assistants working in elderly care wards. RESULTS In ordinary regression, higher self-reported job demands and job strain were associated with increased risk of perceived stress, psychological distress and sleeping problems. The effect estimates for the associations of these psychosocial factors with perceived stress and psychological distress were greater, but less precisely estimated, in an instrumental-variables analysis which took into account only the variation in self-reported job demands and job strain that was explained by staffing level. No association between psychosocial factors and sleeping problems was observed with the instrumental-variable analysis. CONCLUSIONS These results support a causal interpretation of high self-reported job demands and job strain being risk factors for employee wellbeing.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care

BACKGROUND Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. METHODS A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. RESULTS Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. CONCLUSIONS Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention.

Psychosocial stress factors and intention to leave job: differences between foreign-born and Finnish-born general practitioners

Aims: Physicians’ high dropout rate is a significant problem in primary care in many countries. One solution to this issue is to recruit internationally mobile physicians. This study explores the role of psychosocial factors in explaining intention to leave among GPs including potential differences between foreign-born and Finnish GPs. Methods: A cross-sectional questionnaire was sent to randomly-selected Finnish physicians (n = 7000) and all foreign-born physicians (n = 1297) living in Finland in the year 2010. The questionnaire was returned by 4333 physicians, of whom 832 were GPs. Of those 176 were foreign-born GPs. Results: Intention to leave was more common among foreign-born GPs (59%) than among Finnish GPs (52%). High job demands were associated with higher intention to leave from primary care both in foreign-born (OR 1.90) and Finnish GPs (OR 2.20). This association remained among foreign-born GPs after adjusted the model for the country of origin or the reason for migration (OR 1.80, 1.82). Lack of job control, patient-related stress, and stresses related to teamwork were associated with higher intention to leave only among Finnish GPs (ORs 0.45, 1.75 and 1.99). Conclusions: There may be cultural differences in the psychosocial factors that enhance or prevent job involvement among physicians. Thus, novel thinking is needed in organizational development of GP work in order to better understand foreign-born physicians’ specific needs in a target country. This study also suggests that lightening workload could help to attract more GPs, both foreign-born and Finnish, to primary care.

Is HIV testing normal or special? Opinions of health professionals in four European countries in 2008

The special norms in testing for HIV infection are not typical of testing or screening for other diseases. In four European countries, we studied health professionals’ views on HIV testing This study is based on cross-sectional surveys of two groups of health professionals: presidents of selected health professional societies and head physicians and nurses of selected hospital clinics in Belgium, Estonia, Finland, and Portugal in 2008. A common structured semi-anonymous questionnaire was used in the four countries. The number of societies responding varied from five to 10 and for hospital clinics from six to 18; the response rates were from 32% to 100% and 41% to 100%, respectively. Opinions on whether HIV testing is like any other test and on the value of specific approaches in HIV testing varied both within and between countries. Some professionals thought that HIV testing is different from the testing of other infectious diseases; others thought that such an exceptional approach may be a disservice to people and to the health system. Many professionals thought that HIV testing should not be thought of only from the point of view of the individual to be tested, but also from that of other people (potential patients). Obligatory testing was considered appropriate in certain circumstances. Generally, more HIV testing in health care was called for. Normalization of HIV testing, i.e., considering it like any other diagnostic test, is unlikely to meet much opposition from health professionals. Larger surveys are needed to confirm the results.

The Prevalence of Potentially Traumatic Pre-Migration Experiences: A Population- Based Study of Russian, Somali and Kurdish Origin Migrants in Finland

Background: On-going mass conflicts and the resulting flow of displaced persons have increased interest in potentially traumatic experiences (PTEs) of migrants. However, studies on the topic using population-based samples are still scarce. Aims: The present study aims 1) to assess the prevalence of specific PTEs in Finlands migrant population and 2) to determine whether socio-demographic and migration-related factors are associated with PTEs. Methods: Data from the Finnish Migrant Health and Wellbeing Study (Maamu), a cross-sectional interview and health examination survey, was used. The sample comprised Russian; Somali and Kurdish migrants aged 18-64. PTEs, with eight specified traumatic event items common among those exposed to war and conflict, were measured using interview questions. Results: The prevalence of having at least one PTE was 21% among Russian, 58% among Somalian and 77% among Kurdish origin migrants, higher in Kurdish men than women and lower in Somali men than women. The most typical forms of PTEs among Kurds and Somalis were war and witnessing a violent death or injury. The most severe events (e.g. torture) were more common and the highest cumulative number of PTEs was among Kurds. Migrating as a refugee or asylum seeker was not associated with higher prevalence of PTEs. Conclusions: Results indicated an alarmingly high overall PTE prevalence among Kurdish and Somali migrants in Finland, especially among Kurds. Results suggest that effort to identify PTEs and interventions should be targeted not only at those migrating with a refugee of asylum seeker status but all migrants from conflict areas.