Stress, satisfaction, and quality : studies of organizational and individual well-being in health

The aim of this thesis is to indicate key organizational attributes in the health care work environment that can have an impact on both personnel well-being and the quality of care they provide. In order to achieve this aim, four steps were carried out: identifying important individual and organizational attributes, testing the validity and reliability of the measurement instrument and process, testing a mediational model using structural equation modeling, and investigating the effects of a quality improvement initiative on personnel and patients. This thesis is based on data from three studies. Study one was a cross-sectional study of the psychosocial work environment and well-being of all psychiatrists and psychiatric nurses employed by the County of Stockholm n=1,554), as well as a random sample of the same personnel categories in the West Midlands, England (n=785). The second study was a nonresponse follow-up by telephone of a random sample of the personnel of the Psychiatric division of the Southern Stockholm health district (n=71). The third study was a controlled, prospective study of the effects of a quality improvement initiative on personnel satisfaction and well-being (n=302, time 1; n=201, time 2), as well as patient-rated quality of care (n=528, time 1; n=539, time 2). Both organizational and individual factors play an important role in the health care work environment. In particular, goal quality, relations with one's manager, efficiency, personal development, autonomy and work climate are important factors for determining personnel's sense of professional fulfillment In turn, professional fulfillment, or job satisfaction, plays an important role in mediating the relationship between organizational and individual well-being. That is, it seems that personnel's perception of their work environment does not have a direct effect on their own health. Rather, job satisfaction transforms these perceptions into elements of perceived health. The validities and reliabilities of the items in the scales used in this thesis were tested using confirmatory factor analysis. The analyses indicated that the scales needed more work, although the validities of the individual items were acceptable. Furthermore, two of the scales were not found to be unidimensional, one of which was the Rosenberg Self-esteem Scale. The analysis of non-response did not reveal any evidence for selection bias, despite an original response rate of 52%. Finally, the controlled, prospective study did not find evidence that a quality improvement initiative improved the work environment, job satisfaction or individual wellbeing for health care workers, or on patient-rated quality of care in the department where the initiative was carried out. However, there was a significant, positive relationship between personnel's perception of their work environment and patients' ratings of the quality of care they received. This thesis is important because it identifies key organizational attributes in the health care work environment that can impact on personnel job satisfaction and well-being, and on the quality of care they provide. The results also have implications for the working life of employees in other knowledge and service-based professions