Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review

Introduction: Healthcare systems increasingly move toward “value-based healthcare” (VBHC), aiming to further improve quality and performance of care as well as the sustainable use of resources. Evidence about healthcare professionals' contributions to VBHC, experienced job demands and resources as well as employee well-being in VBHC is scattered. This systematic review synthesizes this evidence by exploring how VBHC relates to the healthcare professional, and vice versa.Method: Seven databases were systematically searched for relevant studies. The search yielded 3,782 records, of which 45 were eligible for inclusion based on a two-step screening process using exclusion criteria performed by two authors independently. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Based on inductive thematic analysis, the Job Demands-Resources (JD-R) model was modified. Subsequently, this modified model was applied deductively for a second round of thematic analysis.Results: Ten behaviors of healthcare professionals to enhance value in care were identified. These behaviors and associated changes in professionals' work content and work environment impacted the experienced job demands and resources and, in turn, employee well-being and job strain. This review revealed 16 constructs as job demand and/or job resource. Examples of these include role strain, workload and meaning in work. Four constructs related to employee well-being, including engagement and job satisfaction, and five constructs related to job strain, including exhaustion and concerns, were identified. A distinction was made between job demands and resources that were a pure characteristic of VBHC, and job demands and resources that resulted from environmental factors such as how care organizations shaped VBHC.Conclusion and Discussion: This review shows that professionals experience substantial job demands and resources resulting from the move toward VBHC and their active role therein. Several job demands are triggered by an unsupportive organizational environment. Hence, increased organizational support may contribute to mitigating or avoiding adverse psychosocial factors and enhance positive psychosocial factors in a VBHC context. Further research to estimate the effects of VBHC on healthcare professionals is warranted.

Exploring the mediation role of employees’ well-being in the relationship between psychosocial factors and musculoskeletal pain during the covid-19 pandemic

BACKGROUND: The COVID-19 pandemic has increased some psychosocial risks which may aggravate the development of musculoskeletal disorders (MSDs) and reduced psychological well-being, two leading global occupational health problems. OBJECTIVE: This study aims to investigate whether an employee’s psychological well-being mediates the relationship between the psychosocial factors (job strain, work-life balance, and job security) and the prevalence of musculoskeletal pain in the Indonesian general working population during the pandemic. METHODS: A cross-sectional study design was employed using an online questionnaire. A total of 406 from 465 respondents were included in the final analysis. RESULTS: It was found that 73.9% of respondents suffered from upper body part pain, 25.15% from low back pain, and 39.7% reported pain in the lower limb. Process Macro Model 4 analysis showed the significant role of well-being as a mediator in the association between work-life balance and the odds of experiencing the upper body and low back pains. However, neither the direct nor mediating effect on the relationship between job strain or job security and any musculoskeletal pains were observed. These findings suggest that specific psychosocial factors may be more relevant to be investigated in the particular context. CONCLUSION: The use of a mediation model was able to link work-life balance to musculoskeletal complaints through well-being states in the context of the pandemic. Organizations need to mitigate poor well-being triggered by psychosocial stressors which could affect physical complaints to maintain employee’s health and productivity.

Why do men extend their employment beyond pensionable age more often than women? a cohort study

Men extend their employment beyond pensionable age more often than women, but the factors that contribute to this sex difference are unknown. This study aimed to examine sex differences in extending employment and the contribution of sociodemographic, work- and health-related factors to these differences. Participants of this prospective cohort study were 4,263 public sector employees from Finland who reached their individual pensionable date between 2014 and 2019 and responded to a survey on work- and non-work-related issues before that date. Extended employment was defined as continuing working for over six months beyond the individual pensionable date. We used mediation analysis to examine the contribution of explanatory factors to the association between sex and extended employment. Of the participants, 29% extended employment beyond the pensionable date. Men had a 1.29-fold (95% confidence interval 1.11–1.49) higher probability of extending employment compared with women. Men had a higher prevalence of factors that increase the likelihood of extended employment than women (such as spouse working full-time, no part-time retirement, low job strain, high work time control, and lack of pain) and this mediated the association of sex with extended employment by up to 83%. In conclusion, men were more likely to extend their employment beyond pensionable age than women. This difference was largely explained by men being more likely to have a full-time working spouse, low job strain, high work time control, no pain, and not being on part-time retirement.

Changes in Job Quality as People Work Beyond Pensionable Age in Sweden

This paper uses data from the biennial Swedish Longitudinal Occupational Survey of Health to examine changes in job quality among older workers, controlling for work intensity and employment characteristics. Job quality outcomes included job satisfaction and physical (dangerous, strenuous or unpleasant work) and psychosocial (job strain, effort-reward imbalance, work time control) working conditions. First difference estimation was used to analyze within-individual changes in job quality, as well as changes in hours, employment characteristics (shifting to a non-permanent contract, the private sector and self-employment) and health. Individuals who worked beyond pensionable age experienced statistically significant improvements in job quality, with larger improvements among those who reduced working hours and shifted from permanent to non-permanent contracts, from the public into the private sector, and from wage-and-salary to self-employment. We conclude that work beyond pensionable age is a distinctive period characterized by employment that becomes more flexible and rewarding and less stressful.

Indonesian Health Workers during COVID-19 Pandemic

Burnout in health workers causes physical and emotional fatigue; it is a condition of a long-term affective state and is an outcome of cumulative and chronic exposure to stress, particularly work stress. Burnout was especially evident in hospitals with limited availability of medical staff. Mental burdens are higher because they face more patients infected by the coronavirus, followed by the trauma of witnessing deaths among patients. These conditions may weaken the immune system, increasing vulnerability to COVID-19 and higher risk of severe symptoms that can cause death. When talking out of context of the pandemic, burnout can also be associated with various other diseases, including IBS.4 Burnout was associated with a 2.41-fold elevated prevalence of IBS after adjusting for potential confounding variables, including job strain.

Working Hard and Pushing through: A Thematic Analysis of Humanitarian Migrants’ Experiences in the Australian Workforce

Employment can play an important role for humanitarian migrants in their successful integration into a new country. For humanitarian migrants to Australia, there are no skill or language restrictions imposed on resettlement. Despite the benefits, humanitarian migrants often find themselves in low-status jobs and precarious working conditions. The present study examines perceptions of job quality and exposure to workforce psychosocial risk factors such as job strain, bullying, and discrimination. We conducted semi-structured in-depth interviews with 30 humanitarian migrants from South Sudan, Afghanistan, and Iraq. Thematic analysis of transcripts identified three overarching themes: Uncertainty and Insecurity, Working Hard and Pushing Through, and Positive Attitudes and Actions. Overall, our findings show that despite high levels of education and long-term residency in Australia, many of the participants struggled to find a safe and secure place in the workforce. While some spoke about their work in positive terms, their comments should not be taken as confirmation of a positive work environment. Humanitarian migrants face an uphill battle against oppressive working conditions and underemployment.

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

Introduction On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. Method In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. Results The prevalence of aggressive behaviour on psychiatric wards varied (8–76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. Conclusion Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.