John McIntosh

The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study.

OBJECTIVES To examine changes over time in the hospital staffs perceptions of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of care and services that they provide. METHODS A random sample of hospital employees (n = 900) of a large Ontario teaching hospital participated in a longitudinal study which involved surveys at 3 measurement periods over a 2-year period. The questionnaire used in this study included scales reflecting work environment, emotional distress, personal resources, spillover from work to home and vice versa, and perceptions regarding patient care and the hospital as an employer. RESULTS Significant increases in depression, anxiety, emotional exhaustion, and job insecurity were seen among employees, particularly during the first year of the change process. By the end of the second year, employees reported deterioration in team work, increased unclarity of role, and increased use of distraction to cope. Job demands increased throughout the period whereas little change occurred in the employees job influence or decision latitude. Overall, the work environment was negatively affected. Although patient care was unaffected in the first year, a significant decline in perceptions of patient care, attention to quality improvement, and overall quality of care were later seen. CONCLUSIONS This study raises questions about whether hospital re-engineering and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was increase in emotional distress among staff and a deterioration in their relationship with their employer.

The aetiology of sport injuries. A review of methodologies.

SummaryAlthough participation in many sporting activities has increased dramatically in recent years, the study of injuries sustained during training or participation is still in its infancy.The most commonly used strategy is to describe the characteristics of a suitable case-series. This approach is relatively easy to implement, can be used to estimate the total morbidity load in a population, and can identify the relative frequency of various types of injury. However, the case series method cannot validly identify risk factors for injury or athletes at high risk; similarly, it cannot be used to estimate the absolute level of risk associated with sports participation. Finally, the population from which the injuries arose is often difficult to identify, and the series may not be representative of all injuries occuring in that population, and this may produce quite misleading results.In contrast, a variety of epidemiological designs may be employed to address questions of aetiology and to identify high risk groups of athletes. With careful attention to the underlying population denominators, one may estimate the relative or absolute risk of injury for athletes with given risk characteristics, defined by type and intensity of their participation in sports or by their individual physiology. This is achieved by inclusion of suitable control subjects in the epidemiological sample; these controls may be uninjured athletes or random samples of the general population. The comparison of injured and uninjured groups permits valid inferences to be drawn concerning risk factors, avoiding the many potential biases which affect inferences drawn from injured athletes only.

Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study.

This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.

Predictors of Job Stress and Satisfaction among Hospital Workers during Re-Engineering: Differences by Extent of Supervisory Responsibilities

After two years of rapid organizational change within a large teaching hospital, 83 percent of workers remained employed there. Among these “survivors,” job satisfaction decreased and job stress increased regardless of whether they were employed in a supervisory position. This article examines the predictors of job satisfaction and job stress for managers, for people who indicated that they supervised others but were not managers, and for workers. There are areas of commonality in predictors across these groups, as well as some differences by level of supervisory responsibility. Examining and modifying job characteristics associated with high stress could result in healthier hospital work environments.

Determinants of job stress and job satisfaction among supervisory and non-supervisory employees in a large Canadian teaching hospital.

This article explores the extent to which hospital workers at a large teaching hospital at different managerial/supervisory levels (designated and non-designated supervisors, and non-supervisory staff), experienced job stress and job satisfaction prior to the re-engineering of hospital services. For all groups, increased levels of job demands were associated with higher levels of stress. Lower levels of decision latitude were associated with increased job stress for designated supervisors. Increasing levels of decision latitude were associated with both job stress and satisfaction for the other two groups. Co-worker support and teamwork contributed to increased job satisfaction for all groups.

Job Loss among Hospital Workers: Antecedents and Consequences

This article looks at hospital workers in a large Canadian teaching hospital that was surveyed from 1995 to 1997. It compares the perceptions of the working environment and the coping mechanisms of employees who lost their jobs with those of the workers who remained with the hospital. Those who left perceived themselves to be significantly more emotionally exhausted than those who remained. In 1997, employees still with the hospital reported greater anxiety and emotional exhaustion than the workers who had left. The conclusion reached is that as the public sector attempts to become more efficient, the human cost of downsizing should be considered.