Department of Social Medicine and Department of Family Medicine, University of North Carolina at Chapel Hill.
Department of Family Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
J Healthc Manag. 2022 May 1;67(3):192-205. doi: 10.1097/JHM-D-21-00208.
Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians' mental health, burnout, and intention to leave patient care.
We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger's Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales.
The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p < .001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = -2.06, p < .001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years.
Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.
感知到的组织支持（POS）可能会促进医护人员的心理健康，但在 COVID-19 大流行期间促进 POS 的组织因素尚不清楚。本研究的目的是确定医疗保健组织可以实施的与 COVID-19 相关的行动和政策，以促进 POS，并评估 POS 对医生心理健康、倦怠和离开患者护理意愿的影响。
我们于 2020 年 9 月至 10 月间，使用美国内科医师学院的在线内科医生小组进行了一项全国性的横断面调查。采用 Eisenberger 的感知组织支持量表中的 4 项量表来衡量 POS，这些量表经过了适应 COVID-19 的调整。采用简短的筛查量表来衡量心理健康结果和倦怠程度。
在一个包含所有行动和政策以及潜在混杂因素的多元线性回归模型中，有 3 项医疗保健组织行动和政策与更高的 POS 水平独立相关：有机会讨论与 COVID-19 相关的伦理问题（β（回归系数）= 0.74，p =.001）、充分获得个人防护设备（β= 1.00，p =.005）和领导倾听医护人员对 COVID-19 的关注（β= 3.58，p <.001）。对提出 COVID-19 安全问题或拒绝参与大流行部署的员工进行制裁，与 POS 较低有关（β= -2.06，p <.001）。在多变量逻辑回归模型中，POS 较高与筛查出广泛性焦虑、抑郁、创伤后应激障碍、倦怠和 5 年内离开患者护理的几率大约减半相关。
我们的结果表明，医疗保健组织可以通过保障充足的个人防护设备、确保领导关注 COVID-19 相关问题，以及为讨论照顾 COVID-19 患者相关的伦理问题提供机会，在 COVID-19 大流行期间提高医生的 POS。其他政策和行动，如快速 COVID-19 检测，可能是为了工作人员和患者的安全而实施的，但在本研究的多变量模型中与 POS 相关的政策和行动可能对 POS 产生最大的积极影响。警告或制裁拒绝大流行部署或对员工和患者安全发表意见的员工，与 POS 较低有关，应避免这种情况。我们还发现，POS 程度较高与不良结果的发生率较低有关。因此，通过实施与 POS 正相关的有形支持政策，并避免惩罚性政策，医疗保健组织可能能够降低医生的不良心理健康结果和离职率。
