Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany.
Institute of General Practice and Interprofessional Care, University Hospital of Tübingen, Osianderstr, Tübingen, Germany.
PLoS One. 2019 Jan 4;14(1):e0209487. doi: 10.1371/journal.pone.0209487. eCollection 2019.
Workload and demands on hospital staff have been growing over recent years. To ensure patient and occupational safety, hospitals increasingly survey staff about perceived working conditions and safety culture. At the same time, routine data are used to manage resources and performance. This study aims to understand the relation between survey-derived measures of how staff perceive their work-related stress and strain and patient safety on the one hand, and routine data measures of workload and quality of care (patient safety) on the other.
We administered a written questionnaire to all physicians and nurses in the inpatient units at a German university hospital. The questionnaire was an amalgam of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Copenhagen Burnout Inventory (CBI) scale to assess patient-related burnout of and portions of the Hospital Survey on Patient Safety Culture (HSPSC). Indicators from administrative data used to assess workload and patient-related work-strain were: amount of overtime worked, work intensity recording of nurses, cost weight, occupancy rate and DRG-related length of stay. Quality of care was assessed using readmission rates and disease-related length of stay. Univariate associations were tested with Pearson correlations.
Response rate were 37% (224) for physicians and 39% (351) for nurses. Physicians' overtime correlated strongly with perceived quantitative demands (.706, 95% CI: 0.634 to 0.766), emotional demands (.765; 95% CI: 0.705 to 0.814), and perceived role conflicts (.655, 95% CI: 0.573 to 0.724). Nurses' work-intensity measures were associated with decreasing physician job satisfaction and with less favorable perceptions of the appropriateness of staffing (-.527, 95% CI:-0.856 to 0.107). Both professional groups showed medium to strong associations between the morbidity measure (cost weight) and role conflicts; between occupancy rates and role clarity (-.482, 95% CI: -0.782 to -0.02) and predictability of work (-.62, 95% CI: -0.848 to -0.199); and between length of stay and internal team functioning (-.555, 95% CI: -0.818 to -0.101). Higher readmission rates were associated with lower perceived patient safety (-.476, 95% CI: -0.779 to 0.006), inadequate staffing (-.702, 95% CI: -0.884 to -0.334), and worse team functioning (-.520, 95% CI: -0.801 to -0.052). Shorter disease-related length of stay was associated with better teamwork within units (-.555, 95% CI: -0.818 to -0.101) and a lower risk of physician burnout (-.588, 95% CI: -0.846 to -0.108).
Perceptions of hospital personnel regarding sub-optimal workplace safety and teamwork issues correlated with worse patient outcome measures. Furthermore, objective measures of overtime work as well as objective measures of workload correlated clearly with subjective work-related stress and strain. This suggests that objective workload measures (such as overtime worked) could be used to indirectly monitor job-related psychosocial strain on employees and, thus, improve not only staff wellbeing but also patient outcomes. On the other hand, listening to their personnel could help hospitals to improve patient (and employee) safety.
近年来，医院工作人员的工作量和需求不断增加。为了确保患者和职业安全，医院越来越多地调查员工对工作条件和安全文化的看法。与此同时，常规数据也被用于管理资源和绩效。本研究旨在了解员工对工作相关压力和紧张感的感知与患者安全之间的关系，一方面是调查结果，另一方面是常规数据，包括工作量和护理质量（患者安全）。
我们向德国一家大学医院的住院部所有医生和护士发放了一份书面问卷。该问卷是哥本哈根心理社会问卷（COPSOQ）、评估患者相关倦怠的哥本哈根倦怠量表（CBI）以及部分医院患者安全文化调查（HSPSC）的混合体。用于评估工作量和与患者相关工作压力的行政数据指标包括：加班时间、护士工作强度记录、成本权重、入住率和与 DRG 相关的住院时间。护理质量使用再入院率和疾病相关住院时间进行评估。使用 Pearson 相关系数测试了单变量关联。
医生的回复率为 37%（224 人），护士的回复率为 39%（351 人）。医生的加班时间与感知的定量需求（.706，95%CI：0.634 至 0.766）、情绪需求（.765；95%CI：0.705 至 0.814）和感知角色冲突（.655，95%CI：0.573 至 0.724）密切相关。护士的工作强度测量值与医生工作满意度降低和对人员配备适当性的看法变差有关（-.527，95%CI：-0.856 至 0.107）。两个专业群体在发病率（成本权重）与角色冲突之间表现出中等至强的关联；入住率与角色清晰度（-.482，95%CI：-0.782 至 -0.02）和工作可预测性（-.62，95%CI：-0.848 至 -0.199）；以及住院时间与内部团队功能（-.555，95%CI：-0.818 至 -0.101）之间存在关联。较高的再入院率与较低的患者安全感知（-.476，95%CI：-0.779 至 0.006）、人员配备不足（-.702，95%CI：-0.884 至 -0.334）和团队功能更差（-.520，95%CI：-0.801 至 -0.052）相关。疾病相关住院时间较短与单位内更好的团队合作（-.555，95%CI：-0.818 至 -0.101）和医生倦怠风险降低（-.588，95%CI：-0.846 至 -0.108）相关。
医院工作人员对工作场所安全和团队合作问题的看法与较差的患者预后指标相关。此外，加班工作的客观测量值以及工作量的客观测量值与主观工作相关压力和紧张感明显相关。这表明，客观的工作量测量值（例如加班时间）可用于间接监测员工的工作相关心理压力，从而不仅可以提高员工的工作幸福感，还可以提高患者的治疗效果。另一方面，倾听他们的员工可以帮助医院提高患者（和员工）的安全。
