Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336 Munich, Germany.
BMC Health Serv Res. 2013 Oct 9;13:401. doi: 10.1186/1472-6963-13-401.
Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care.
A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews.
Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work.
This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care.
医生，尤其是医院里的医生，工作环境恶劣。医生的社会心理工作环境与他们提供的工作质量之间存在密切联系。我们的研究旨在探讨参与式工作设计干预是否对改善工作条件和提高患者护理质量有效。
在两个外科和两个内科进行了前瞻性、对照干预研究。参与者包括 57 名医院医生和 1581 名住院患者。干预措施是一种基于连续小组会议的结构化、参与式干预。医生积极分析有问题的工作条件，制定解决方案并启动实施。医生的工作条件和患者感知的护理质量是结果标准。这些变量通过标准化问卷进行评估。通过访谈收集有关实施情况的其他数据。
在十个月的时间里，确定了几个与工作相关的问题，对其进行了分类，并实施了十个解决方案。与对照组医生相比，干预组医生在干预部门报告的冲突需求明显减少，与患者家属的合作质量也有所提高。此外，同事支持的增强可以归因于干预。关于患者对护理质量的报告，参与组医生的患者对医生护理组织的评价有所提高。对五名参与医生的访谈证实了获得的结果的合理性，提供了有关实施情况和解决方案可持续性的信息，并强调了重新设计干预措施以改善医院医生工作的相关过程因素。
本研究表明，参与式工作设计对医院医生是一种很有前途的干预措施，可以改善工作条件并促进患者护理质量。
